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HomeMy WebLinkAbout0071 SAND POINT - Health 71 SAND POINT OSTERVILLE ' A= 073-014 t Commonwealth of Massachusetts 0-7-3- DI q �n _ (p Title 5 Official Inspection Form I, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 ,1 71 Sand Point Property Address Jeffrey and Alyson Lindsey Owner Owner's Name / information is �/ - required for every OSterv111e MA 02655 10/02/2020 ' page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information /,* IAI1/(0 on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road Company Address Teaticket Ma. 02536 Cityrrown State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority r 4. ❑ Fails /02/2020 Inspector's Sign a ure 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 r Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ...........c� !% 71 Sand Point Property Address Jeffrey and Alyson Lindsey Owner Owner's Name information is required for every Osterville MA 02655 10/02/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: This five bedroom home has an H-20 1500 gallon septic tank with a D-Box feeding 3 leaching lines apx 89'x 6'. At the time of the inspection no visible failure criteria was found. The septic tank has 2 steel covers at grade. 2) 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts a Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 71 Sand Point Property Address Jeffrey and Alyson Lindsey Owner Owner's Name information is required for every Osterville MA 02655 10/02/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. 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: t5insp.doc-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �ii Subsurface Sewage Disposal System Form -Not for Voluntary Assessments h 71 Sand Point V Property Address Jeffrey and Alyson Lindsey Owner Owner's Name information is required for every Osterville MA 02655 10/02/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts ,(,g Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments t.— 71 Sand Point Property Address Jeffrey and Alyson Lindsey Owner Owner's Name information is required for every Osterville MA 02655 10/02/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts lg. Title 5 Official Inspection Form III Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 71 Sand Point u- Property Address Jeffrey and Alyson Lindsey Owner Owner's Name information is required for every Osterville MA 02655 10/02/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: 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? ® El 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form lip Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V � 71 Sand Point Property Address Jeffrey and Alyson Lindsey Owner Owner's Name information is required for every Osterville MA 02655 10/02/2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 GPD-plus Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: 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 town water 9 ( Y 9 (gp ))� Detail: In 2019-273,000 gallons were used and in 2018-186,000 gallons were used. Sump pump? ❑ Yes ® No Last date of occupancy: seasonal use t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 71 Sand Point Property Address Jeffrey and Alyson Lindsey Owner Owner's Name information is required for every Osterville MA 02655 10/02/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day d Y(gP ) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes- ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes E No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts �n ,9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u � 71 Sand Point Property Address Jeffrey and Alyson Lindsey Owner Owner's Name information is required for every Osterville MA 02655 10/02/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known) and source of information: New leaching 2013 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 12"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 L i Commonwealth of Massachusetts Title 5 Official Inspection Form I, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Vic„ !% 71 Sand Point Property Address Jeffrey and Alyson Lindsey Owner Owner's Name information is. required for every Osteryllle MA 02655 10/02/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. 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: H-20 1500 gallon Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle 34" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 I Commonwealth of Massachusetts �� Title 5 Official Inspection Form 15 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 71 Sand Point u Property Address Jeffrey and Alyson Lindsey Owner Owner's Name information is required for every Osterville MA 02655 10/02/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 71 Sand Point Property Address Jeffrey and Alyson Lindsey Owner Owner's Name information is required for every Osterville MA 02655 10/02/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Oil r 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 the time of the inspection the liquid level was at working level and there were no visible signs of leakage or solids carryover. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form pia Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 71 Sand Point V Property Address Jeffrey and Alyson Lindsey Owner Owner's Name information is required for every Osterville MA 02655 10/02/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: apx 89'x 6' 3 lines ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system .;P Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form �1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 71 Sand Point Property Address Jeffrey and Alyson Lindsey Owner Owner's Name information is required for every Osterville MA 02655 10/02/2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding,.damp soil, condition of vegetation, etc.): At the time of the inspection no visible failure criteria was found. 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i � t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 I cam, Commonwealth of Massachusetts ,tip Title 5 Official Inspection Form _ b Subsurface Sewage Disposal System Form Not for Voluntary Assessments 71 Sand Point Property Address Jeffrey and Alyson Lindsey Owner Owner's Name information is required for every Osterville MA 02655 10/02/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 c� Commonwealth of Massachusetts �- Title 5 Official Inspection Form tiI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 71 Sand Point Property Address Jeffrey and Alyson Lindsey Owner Owner's Name information is required for every Osterville MA 02655 10/02/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 r . r t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 pr� sessing As Cards https://townofbamstable.us/Departments/Assessing/Property_Valu... TOWN OF B ARNSTABL LOCATION,N 1 / SEWAGE#,7Q o-e�Q 3 _ VILLAGE l ryrr SSESSOR'S MAP&PARCEL 73- 0/y &PHONE N0: Ida Ca ,5/N' 'Sd9 SEPTIC TANK CAPACITY /SOS 6Wfib a . LEACHING FACILITY:(type) aS Gtptluu t (sue) )(f' `�?fie, NO.OF BEDROOMS S OWNER �ac� Ulr1�}5� Te— Sr}lT1T�,>Ic I?o4f T�l+��T PERMIT DATE: 6_a CF'(3 COMPLIANCE DATE:OGT. a63 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISBED BY C F�7 A 3 � A y si�r7 PT 13` A- a25 -4- 33 1 of 1 W30/2020,5:51 PM Commonwealth of Massachusetts �- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I c !% 71 Sand Point Property Address Jeffrey and Alyson Lindsey Owner Owner's Name information is required for every Osterville MA 02655 10/02/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ' ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 8 plus feet 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: Date i ® 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: I augered a hole at a lower elevation and shot it with a transit. i Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 I , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments V � 71 Sand Point Property Address Jeffrey and Alyson Lindsey Owner Owner's Name information is required for every Osterville MA 02655 10/02/2020 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist) completed _ ._. A ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 { r I SENDER: • •N COMPLETE THIS SECTIONON DELIVERY Iii eomptete:ifem5'1 2,•and 3.Alsa complete _ A.'Signature 1 item 4 if Restricted Delivery is desired. X Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Rec ived by P' Name) C at f Delivery ■ Attach this card to the back of the mailpiece, �_ or on the front if space permits. D. Is delivery address different from item 1? N Yes 1. Article Addressed to:i.. If YES,enter delivery address below: ❑No i Matthev�. Mitchhell, state of 59"SandcOoinr, 0SteNlll 02655 MAw= 3. Service Type U') ❑Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise 'L- ❑Insured Mail ❑C.O.D. t:" ¢ 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number; 1111 7,012; 1010 IOIOO(q l 28f43 2058 I (Transfer from service label) PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 l I UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit.No.G-10 I j • Sender:, Please print your name, address, and ZIP+4 in this box • I I i j Town of Barnstable I j Public Health Division I 200 Main Streety I Hyannis, MA 02601 I I I I I . _.."._. .. !'llhild'l'I Jill'1'"'lillll Ill,Jill t'Iljilr Ill Jill Ill, Ildi i :W Town of Barnst bye, P# �o1E Departmentof Regulaf)6 Services - i ,A,�M r Public Health-Division Date 200 Main Street,Hyannis MA 02601 rFt)MA't� f Date Scheduled_ Time Fee Soil Suitability Assessment for Sewage Disposal Performed By: Witnessed By: LOCATION& GENERAL-INFORMATION: . Location Address " Owner's Name 71 C 0/0 <l M 4)1_!9e_l O tSTL2 ff�lZT /l� Address o21 t,51^C*,Q 4A'E8hr1/ rI� t3 Assessor's Map/Parcel: 3 Engineer's Name ,r1s{l�j /� NEW CONSTRUCTION REPAIR Telephone# R,4s 4.3rcj5'ey,2ssa Inc i .[L C!s}r . �• .,��5'08' 4Yza ,z Land Use e-sid en-K cA I Slopes(%) S- 3 0'/c Surface Stones Distances from: Open Water Body c�fl+ ft Possible Wet Area ft Drinking Water Well N ft Drainage Way N ft Property line D ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands f'n proximity to holes) Uxn N r 0 Parent material(geologic) O v4-S� r ool . (g g ) � a(ir. Depth to Bedrock Depth to Groundwater. Standing Water in Hole:: N I Ft i Weeping from Pit.Face Estimated Seasonal High Groundwater ; DETERMINATION FOR SEASONAL HIGH WATER..TABLE Method Used: Depth Observed standing in obs.hole. In, Depth to soil mottles: In. Depth to weeping from side of obs,hole: ' -` -' in,-"aroundwdtt r AdJustment ft. Index Well# Reading Date: Index Well level..., AdJ.thctbr AdJ.Groundwater Level PERCOLATI0MUST_ Dula-33f), l3,t.xl".��. Observation Hole# Tim,at h;' 3 a`- Depth of Pere time at 6 377 Start Pre-soak Time @ d� C 0 <: Titne:(9"61,) _ SY.O' End Pre-soak Do Rate Min./InchL)L h'1an Site Suitability Assessment: Site Passed Site Failed # Addition aP Testing Needed,(Y/N) o 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:\SEPTICU'ERCFORM.DOC ` ' DEEP.OBSERVATION&HOLE LOG Hole::# — Depth from Soil Horizon Soil Texture Sdil Color Soil Surface(in.) '(US`D`A ai ... . (Munsell) Mottling (Stiiucture;Stones;boulders. onsistency %GraveD DEEP OBSERVATION HOLELOG ` ° Hole# �- Depth'from Soil Horizon SoitTexture Soil Color Soil O[her Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.' onsis cn % ra t DEEP OBSERVATION HOLE LOG Hole# Depth from Soil horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistcnry.%Gravel) DEEP OBSERVATION HOLE LOG :Hole# Depth from Soil.''Ho,izon Soil Texture Soil Color i Soil Other Surface(in.) (USDA) (Munsell)'; ' Mottling (Structure,Stones'.Boulders. Consistency, Flood Insurance Rate Map. a,y d Above 500 year.flood boun ,No Yes r 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 pervi us 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 o (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysts was performed by me consistene with . the required training,expertise and.experience,,described•in;510 CMR 15.017., , SignatureC a j ti. 212�� Date Q:WF-P nCWERCFORM.DOC » " 4 , TOWN OF BARNSTABLE LOCATION SEWAGE# 0013 -QQ3 VILLAGE OSt—e y/r/e ASSESSOR'S MAP&PARCEL 73 ~ O/y INSTALLER'S NAME&PHONE NO. Jam` �Q,C.G /5/c�� yo28-coZQ SEPTIC TANK CAPACITY S06 6'A. M�y LEACHING FACILITY:(type)ASS GeDtluw plc (size) i NO.OF BEDROOMS Jr OWNER 1G�// y �c h�+2_" Ish�Ilcr —JtG � ll`-t d`VST PERMIT DATE: q- 1,3 COMPLIANCE DATE: OC-r Va03 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY l L4 H r ' cr P 'a U't t 9 _tz W1 'Q W W u • , I' I WO 1 1h T F BARNS: L r �/ LOCATION f C�!it � � SEWAGE # VII.LAiiE �f�a-'c r� r 1 le ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. COL Y a cA S A 1t 0-3 SEPTIC TANK CAPACITY 'LEACHING FACILITY: (t3 e) '.5�6 O L �'�a2ALW(size) � NO. OF BEDROOMS BUILDER OR OWNER ' PERMIT DATE: 9 94C COMPLIANCE DATE: Separation Distance Between the: I, . Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by r1 r^r ti' V r� 1s l"t 13 1 4 TO F BARNST L y LOCATION Ott SEWAGE # P -VIIt�AGE ASSESSOR'S MAP & LOT rINSTALLER'S NAME&PHONE NO. -/0 SEPTIC TANK CAPACITY O �v LEACHING FACILITY:(type) ®D l ei Gv 3 � NO.OF BEDROOMS ` BUILDER OR OWNER c� PERMTTDATE: �"r/ COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by fi � .M d Q No. r` f7"" `J / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _. Yes PUBLIC HEALTH DIVISION - TOWN'OF BARNSTABLE., MASSACHUSETTS ZIppYication for &.5pozar *pgtem Construction Permit Application for a Permit to Construct(X)Repair( )Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. -7/ Owner's Name,Address and Tg1.No. t/ar�,r� c 7X eitc T Assessor'sMap/Parcel �K jlBCTEc `� � 3 � �z s/ o tif7 Q i Fie aoe Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.�TGg 9 724V 44, A A �/ns ra 3r-Vr� "O,caLb o i-' sob-5'a6 s.,� x d.Ars,ar� «/G LLc �saaq TTOOac4 orb Type of Building: Dwelling No.of Bedrooms S Lot Size= /rpo sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow SS® gallons per day. Calculated daily flow 93 gallons. Plan Date y1-3a 13 Number of sheets / Revision Date Title 4<010OS4 SeW.46, acsPos�tc SysTEryr �! S.�a[A PD/�clTc OSTE,2y/cc�� .�q Size of Septic Tank /,roo Type of S.A.S. ae�o re_oc.> sA r zed Description of Soil p e,o��0-7 Nature of Repairs or Alterations(Answer when applicable) 45 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss d by this oard of a Sig Date C,G' t` 0!3 Application Approved b Date &1Jqh Application Disapproved for the following reasons Permit No. Oqo Date Issued P-q )43 slp 'Q''cy ' ✓ , �� CJ� f J Fee � © .TNo. �-- { THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: f Yes PUBLIC HEALTH DIVISION- TO,OFr¢BARNSTABLE., MASSACHUSETTS M Zipprfcation for Mi4poktl pgtem Cott!6truction 3permit Application for a Permit,to'Construct(X)Repair( )Upgrade( )Abandon Complete System ❑Individual Components Location Address or Lot No. 3/ -s/1 vA POD l!T Owner's Name,Address and Tel.No. (i�ytS7�R NARkTor2S E� t'� f. L/A/ds� 7/1'e Assessor's Ma p/Pazcel �3 s cT�y�Ti Jc 2e 4f r T�etc5 Installer's Name,Address,and Tel.No. ' Designer's..NName,Address and Tel.No. rDg "9 ?Z r C. i ,u A/q A p/eV rn, /?E 4rC. hoLC(-,I ( a IC 5Uu' 1aF! �eSR� drC-/V `C-ie./.tiG Type of Building: Dwelling No.of Bedrooms S Lot Size si s'oo sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow SS O gallons per day. Calculated daily flow gallons. 3 v / e Plan Date '1� 3 Number of sheets / Revision Date Title P<CFI�SEd SCa!/7GE &,rpc7sac SysTEisa ,a� S/�MIi pL4/•v1-� osT�,�diccE-, .a(�! Size of Septic Tank /j 47' Type of S.A.S. Description of Soil Sc logo.Te-e 7 ---Nature of Repairs or Alterations(Answer when applicable) S F c' 0 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 th` system in operation until a Certifi- cate of Compliance has been issued by,,�this�Boar d of -aa h. \\ Signed ! �( �F X✓U Date �i. /C /i, Application Approved by� __ Date Application Disapproved for the following reasons •y Permit No. 7) Date Issued - - /' THE,'COM ONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( Repaired ( ) Upgraded( ) ' Abandoned( )by ` 10, at 77/ has been constructed in accordance with the provisions of Title 5 and the for 6isposal System Construction Permit No. _ dated Installer ��"c e W-t C',Cc.I i 1 e- Designer �I C� 1'� `1 d - C S FM C;,t c,, The issuance of this permit s a t b ,nstrued as a guarantee that the p te`n will fu/nct•on 0/6esiW DateIns ector -----------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 'Wi5po5ar *pgtem Construction permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at �/ SRC/�3 Do7MT DytrT :C' /✓�-0 c3a� s - and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special condition 9. Provided: Construction must be completed within three years of the date" f this pe t. Date:_ = Approved b -�✓ �_��� r i am Lmm'rmnalm NVId 21001d l� 7�ro^[tir7�T c Q9011load mm SNO-Fume 1S211d03SOd02ld YY VV.. LLJJ LL�7 LL'�1 as �a m 0 � II 11 II 1 9 I i 1 b I r- 1 I 1 L_ i I J 1 I O 1 I 1 I O I I _ I I ---ter----- - I i 1 mom I I 1 I I I 11 I / 1 1 1 1 1 1 II 1 �`---_--__------------- I I I I 1 II 1 uu I I I I I II 1 I 1 I 1 I I II 1 1 I I I I I II I 1 I I 1 I I II I I 1 I 1 I I 11 1 1 I I I 1 1 I 11 I 1 1 1 I 1 I II 1 I 1 I I 1 I I I I I I 1 1 1 I I i 1 I 1 I I 1 1 I I 1 1 1 1 I 1 I 9 1 1 1 1 I I I I I I I I I I I 1 I I I I I 1 1 II I II 1 II PDF created with pdtFactory trial version www.softwarelabs.com C¢D a.o.n 9 va 4a+fin ai W �fdrJ 'oQl'[omisollq�+Y n a "Q tro�oe mF..m= NYId N001d w ON003S 03SOd021d Cy IAI0 S32� ma mood miss sxo-assess 1 x II 11 a d 1 I I 1 F_ a I I i 1 I 1 1 I 1 R E I I / I / I♦♦ I I i 1 I ♦ 1 i 1 i I i PDF created with pdfFactory trial version www.softwarelabs.com BARNS TABLE LAND COURT REGISTRY DEED RESTRICTION Whereas,Jeffrey R.Lindsey,Trustee of Salten Tide Realty Trust,under Declaration of Trust dated March 4,2013 and recorded as Document No. 1,216,052, of 135 Carriage Road, 2112 Oyster Harbors, Osterviile, MA 02655, is the owners of Lot 52 on Land Court Plan 15354- 66 and Lot 277 on Land Court Plan 15354-141,(hereinafter,the."Lots"); and Whereas, Jeffrey R.Lindsey,Trustee of Salten Tide Realty Trust, as aforesaid, as the , owner of the Lots have agreed with the Town of Barnstable'Board of Health to a restriction as to the number of bedrooms which can be included in any home built on the Lots as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000, State Environmental Code,Title V,Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; and Whereas,the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code,Title V,Minimum Requirements for the Subsurface Disposal of' _Sanitary Sewage, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the Lot be put on recorded with the Barnstable County Registry.of Deeds and/or the Barnstable Registry District of the Land Court, as applicable, by recording this document. Now,therefore,Jeffrey R. Lindsey,Trustee of Salten Tide Realty Trust, as aforesaid, do hereby place and impose the following restriction upon the Lot in accordance with his agreement with the Town of Barnstable Board.of Health,which said restriction shall run with the land and be binding upon all successors in title: The dwell'ng constructed upon the Lot shall contain no more than five(5)bedrooms d6less and until i ,is connected to the municipal sewer or the a Board of Health of the Town of Byarnstable permi otherwise. , rs=t two 1`0effreY R. Lin • ?, certify that I am the sole trustee of Salten'Tide Realty Trust,and I have been at%horned by all t beneficiaries to sign,,seal and to execute this Deed Restriction relative to the , rp- M l estate descri in this deed for the consideration stated herein. We also certify that said Trust is in full orce and effect and has not been altered,Amended,rescinded or revoked in any manner other than amendments recorded in the Barnstable County Registry of Deeds prior to the date of this certificate. Property Address: 71 Sand Point Road,Barnstable(Osterville); MA 02655 For title,see deed recorded with Barnstable Land Registration Division as Document No. 1,216,053. I Executed as a'sealed instrument this 4ane.day of J h 2013: Jeff?e : Lindsey COMMONWEALTH OF MASSACHUSETTS Barnstable,ss. 1* On this day of June,201%before me,the undersigned notary public, personally appeared T�� A. 7 ,�,A e, , (/,, personally known to me to be the,person whose name is signed on the preceding or-attached document, and acknowledged to me that he signed it voluntarily for its stated purpose, Notary Public My Commission Expires: (BARK H.. BOUDREAU >y,� NQTAPY PUBLIC a % Commonwealth ct P!assachuselts My C0MMi88I0n Expires May 2. 2014 u i r i CC �4 aa-wt laal wr arc tmd a1 ' •¢GO�n wasp'l as Aw.ww�tl ®]ldrJ ama vnoa mrte>< LIN3W3 YY�as�R� MH BaOd GM 5N0-.LAMSNIlSIX3 o W 1 Y 8 HO 2� 3e 6{ 1 , S(4( I qk I i B 1 � 1 i z m i I t ® r i s � i i r j IL-Al PDF created with pdf Factory trial version www.softvrarelabs.com 'oIIl'N+�7�a774�Y amm trrm®tm i ., NIO�S��I SMU aeOtI 3tuod uttls 8No-bw8e3s aoo-dtsaia oNusixa I El 1 I. i El �d o° ° I i i ----------- -�t------- PDF created with pdfFactory trial version www.softwarelabs.com aoe-lu pool�•. aar-al toll a (� • asom�a iv�>*rom am WrJ eu �•vroe>m� 'aQ!'tomlaali4a+V am ANM ans u NVId 21001d 1 X. Y��LJSI�Q 008 Mod tl0mZKO—E3N8A9S ON003SONIISIX3 �I $ W Id Li aawlwry a i 1 I I I I m I I I m 1 1 I I r-- I ll � 11 _L I . � I — 1 1 I 1 r-- yl 11 I 1 I I 1 1 1' 1 I I 1 � I I3 I 1 p i 1 I I L__ I I y I I I 1 I 1 _ 1 I I ❑ 1 1 1 1 1 p I 1 1 PDF created with pdfFactory trial version www.softwarelabs.com Town of Barnstable Barnstable Board of Health + ■ARNgrAULF- ` MAn $ 200 Main Street, Hyannis MA 02601 FD MAI°i`� 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi May 28, 2013 Ms. Arlene Wilson A.M. Wilson Associates 20 Rascally Rabbit Road Marstons Mills, MA 02648 RE 71 SandzPolnt Road, Osterville Dear Ms. Wilson, You are granted conditional variances on behalf of your client, Salten Tide Realty Trust (Jeffrey Lindsay, Trustee), to construct an onsite sewage disposal system incorporating a . GEO-Flow Pipe Leaching System at .71 Sand Point Road, Osterville. The variances granted are as follows: 310 CMR 15.211: To install the soil absorption system 15 feet away from the top of a coastal bank, in lieu of the minimum 50 feet separation distance required per the State Environmental Code, Title 5. Section 360-1 of the Town of Barnstable Code: To install the septic tank 35 feet away from a coastal bank, in lieu of the minimum 100 feet separation distance required per the Town of Barnstable Code. Section 360-1 of the Town of Barnstable Code: To install a distribution box 33 feet away from a coastal bank, in lieu of the minimum 100 feet separation distance required per the Town of Barnstable Code. Section 360-1 of the.Town of Barnstable Code: To install a soil absorption system 96 feet away from a wetland, in lieu of the minimum 100 feet separation distance required per the Town of Barnstable Code. 310 CMR 15.405 (a) & (b): To install the soil absorption system nine feet away from a slab foundation (garage), in lieu of the minimum 10 feet separation distance required. Q:\WPFILES\WilsonSaltenTideRealtyVariances2013.doc s These variances are granted with the following conditions: (1) No more than five (5) bedrooms are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to. five bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. (3) Every GEO-Flow Pipe Leaching System installed in Massachusetts must be inspected annually by an operator certified by ADS/Hancor to perform this inspection. Operators inspecting a GEO-Flow-Pipe Leaching System must complete the required DEP approved form in its entirety. Operators must also complete a copy of the DEP Approved Inspection and 0&M Form for Title 5 I/A Treatment and Disposal Systems. Copies of both of these completed forms must be mailed to MA DEP at the following address: Department of Environmental Protection, Title 5 I/A Program, One Winter Street, Boston, MA 02108. (4) The septic system shall be installed in strict. accordance with the i engineered plans dated April 30, 2013. (5) The designing registered sanitarian shall supervise.the construction:of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the . engineered plans dated April30, 2013. These variances are granted because the. ,proposed plan appears to meet the maximum feasible design standards contained within the State Environmental Code, Title 5 and local Health Regulations. The designing engineer designed the septic system to be located in an area to attempt to maximize setbacks to wetlands. Sincer ly yours, I / • � v Wayne M Iler, M.D. Chairma J QAWPFILESM I son SaltenTideRealtyVariances2013.doc � ' t ?, t'- :^ii,.:,r.t _ h - _ _ - _ y�,r= J r r i A`, '° at rt-. 1 `•r ,e ;1't '• ..`.�_ 1Q - r. _ -i: '-''., ',r ,:°' ','.'�'`•,� `i+t H .... k .r<T'''f , -:,;-# .j'sa ""�, .`�v"'''w".. •p 1 :,�, ,.� '� � �:' ,, -. 4 .}.'r,a ..,"r. :a..r. r= -t.,u, - .. r." ,'!h •5 r ` .. 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April 25, 2013 Dr. Wayne Miller, Chairman Barnstable Board of Health 200 Main Street ' Hyannis, MA 02601 Re: Request for Local Upgrade Variances 71 Sand Point, Oyster Harbors (Our File 2.1770.0) ' Dear Dr. Miller; Attached please find a request for Local Upgrade Variances filed on behalf of our client Salten Tide Realty Trust. The Trust has recently purchased the residentially developed property at 71 Sand Point, Oyster Harbors. They intend to undertake interior renovations to the dwelling and add a small addition. The dwelling is currently serviced by a septic system which passed inspection, and two single cesspools which did not. The dwelling is sited on a ridge with Coastal Banks ' located on each side of the dwelling. The 50' setback lines actually cross each other in the area of the dwelling. Consequently, there is nowhere on the lot where a replacement septic system can be constructed without Variances. ' The AssessingDepartment p tment shows the dwelling to contain 6 bedrooms. The Inspection Report cited 5 bedrooms. The proposed renovations will result in 5 bedrooms. Thus, there will be no increase in flow and we believe that a Local Upgrade Approval is appropriate. ' Because the house has a basement with block walls in the main section of the dwelling, we have chosen to hold the required foundation setbacks for the SAS ' 1 20 Rascally Rabbit Road Unit 3 508 420-9792 ' Marstons Mills,MA 02648 FAX 508 420-9795 especially considering that the design maintains ±96' to the nearest vegetated wetland, even though the setback to the Bank Top is as close as 15'. i Yours, ' A. M. WILSON ASSOCIATES, INC.. ' Arlene M. Wilson, PWS Principal Environmental Planner Attachments cc: Jeff Lindsey, Tr Howard Woollard t ' I 2 o Commonwealth of Massachusetts Executive Office of Energy &Environmental Affairs Department of Environmental Protection One Winter Street Boston, MA 02108.617-292-5500 1 DEVAL L PATRICK RICHARD K.SULLIVAN JR. Governor Secretary TIMOTHY P,MURRAY KENNETH L,KIMMELL Lieutenant Governor Commissioner GENERAL USE CERTIFICATION Pursuant to Title 5, 310 CMR 15.00 Name and Address of Applicant: Advanced Drainage Systems, Inc. 4640 Trueman Blvd Hilliard, OH 43026 Trade name of technology and models: GEO-flow®Pipe Leaching System (hereinafter called the "System"). The "GEO-flow®Pipe Leaching System Design, Installation and Operating Manual" including schematic drawings of typical Systems, an inspection checklist, and a System Installation Form are part of this Approval. Transmittal Number: W080364 Date of Issuance: Revised March 19, 2013 Authority for Issuance Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000, the Department of Environmental, Protection hereby issues this Approval for General Use to: Advanced Drainage Systems, Inc., 4640 Trueman Blvd, Hilliard, OH 43026 (hereinafter"the Company"), certifying the System described herein for General Use in the Commonwealth of Massachusetts. The sale, design, installation, and use of the System are conditioned on compliance by the Company, the Designer,the Installer and the System Owner with the terms.and conditions set forth below. Any noncompliance with the terms or-conditions of this Approval constitutes a violation of 310 CMR 15.000. March 19, 2013 David Ferris, Director Date Wastewater Management Program Bureau of Resource Protection This information is available in alternate format.Call Michelle Waters-Ekanem,Diversity Director,at 617-292-5761.TDD#1-866-639-7622 or 1-617-574-6868 MassDEP Website:www.mass.gov/dep r Printed on Recycled Paper I Revised General Use Certification Page 2 of 3 GEO-flow Pipe Leaching System Revised:3/19/2013 Technology Description The System is a subsurface unit that replaces a soil absorption system (SAS) designed in accordance with 310 CMR 15.000. The System consists of a 10-inch inside diameter corrugated high-density polyethylene pipe perforated with eight 7/16th inch diameter holes equally distributed around its circumference at each corrugation and manufactured in 10 foot lengths. The exterior of the pipe is wrapped in two layers of material, a 20 oz/yd2 geo-grid polypropylene grid inner layer and an outer layer wrapping of 4 ounce/yd2 polyethylene non-woven geotextile fabric. The System also includes a minimum six inches of sand (concrete sand-ASTM C-33) surrounding the exterior of the GEO-flow pipe. Conditions of Approval The term "System" refers to the Alternative Soil Absorption System in combination with the other components of an on-site treatment and disposal system that may be required to serve a facility in accordance with 310 CMR 15.000. The term "Approval"refers to the technology-specific Special Conditions,the Standard Conditions for General Use Certification of Alternative Soil Absorption Systems,the General Conditions of 310 CMR 15.287, and any Attachments. For Alternative Soil Absorption Systems that have been issued General Use Certification for the installation of Systems to serve facilities where the site meets the requirements for new construction,the Department authorizes reductions in the effective leaching area(310 CMR 15.242), subject to the Standard Conditions that apply to all Alternative Soil Absorption Systems with General Use Certification and subject to the Special Conditions below applicable to this Technology. Special Conditions 1. The System is an approved Patented Sand Filter System for use as an Alternative Soil Absorption System. In addition to the.Special Conditions contained in this Approval, the System shall comply with all Standard Conditions for Alternative Soil Absorption Systems, except where stated otherwise in these Special Conditions. 2. The System is approved for facilities where a conventional system with a reserve area exists or can be built on-site in full compliance with the new construction requirements of 310 CMR 15.000 and has been approved by the local approving authority. 3. This Certification shall not be used for the installation of a System to upgrade or replace an existing failed or nonconforming system, unless the facility meets the siting requirements for new construction, including a reserve area. 4. The separation distance to the estimated seasonal high groundwater elevation shall be measured from the bottom of the System sand below the GEO-flow®Pipe Leaching System. 1 / Revised General Use Certification Page 3 of 3 GEO-flow Pipe Leaching System Revised:3/19/2013 5. The System shall only be installed in bed or field configuration, as described in 310 CMR 15.252. The System shall not be installed in trench configuration and no sidewall area shall be considered in the total effective leaching area provided. The effective leaching area shall be the bottom area only (length times width) of the sand bed. 6. Systems shall be installed with differential venting for aeration and inspection access at end of each run of pipe, section or serial bed and whenever the System is installed under impervious surfaces. 7. Serial distribution laterals shall be limited to no more than 500 gpd with each lateral a maximum of 100 feet, and must be laid level. Multi-level systems shall not be allowed. 8. System component material specifications for the pipe,plastic components, fabric and sand shall comply with the specifications identified in the initial I/A technology approval. Prior approval from the Department for any change from these specifications shall be requested in writing. 5. Any changes to the approved plans must receive prior Local Approving Authority (LAA) approval. Before a Certificate of Compliance can be issued by the LAA the System Designer must include any changes to the approved plan into the as-built plans. f w 71 Sand Point Page 1 of 1 Desmarais, Donald From: Linda Pinto [linda@csn-eng.com] Sent: Friday, May 03, 2013 9:51 AM To: Desmarais, Donald Subject: RE: 71 Sand Point okay, thanks. I will get that to you. From: Desmarais, Donald [mailto:Donald.Desmarais@town.barnstable.ma.us] Sent: Friday, May 03, 2013 9:41 AM To: linda@csn-eng.com Subject: 71 Sand Point Linda, while reviewing the septic plan for 71 Sand Point I have come across some potential issues. First, the general use certification says under"Special Conditions"#3 that a reserve area must be shown. On #6 it is stated that inspection access must be at the end of each run of pipe. The letter states that the sand surrounding the pipes must be ASTM C-33 (concrete sand)which is mentioned in note#26. 1 don't believe that this is stressed enough. Under the system design calcs I would like some documentation concerning the allowable reduction of 60%. The table which I suppose shows how much pipe to use needs to be provided for our review. That's all I have for now. Donald Desmarais RS v Health Inspector Town of Barnstable 508-862-4740 5/6/2013 i t�. ;n TRANS.NO.: CITY/TOWN: OerYt I(Z . APPLICANT: ADDRESS: DESIGN FLOW: 5 SO gpd REVIEWED BY: DATE: N/A OK NO Legal boundaries denoted[310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan[310 CMR 15.220(4)(u)] Locus Provided 310 CMR 15.2204(t) Plan proper scale?(1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown[310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]-if not, a variance is required [310 CMR 15.412(4) Location of impervious surfaces (driveways,parking areas etc.) [310 CMR 15.220(4)(d)] , Location all buildings existing and proposed 310 CMR :, CDP 15.220(4)(c)] < Location and dimensions of system components and reserve / wCD areas. [310 CMR 15.220(4)(e)] System Calculations 310 CMR 15.220(4)(f)] daily flow septic tank capacity(required andprovided) r soil absorption system(required andprovided) c m whether system designed for garbage grindei North arrow 310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and(i)] Location and date of percolation tests(performed at proper elevation?) 310 CMR 15.220(4)(i)] Percolation test results match loading rate? 310 CMR 15.242 Certification statement by Soil Evaluator[310 CMR 15.220(4)0)] ` Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] Address Sheet 1 of 7 I N/A OK NO Location of every water supply,public and private, [310 CMR 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR. 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR 15.220 4 m) (if water line cross see 310 CMR 15.211 1)[1 Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer 310 CMR 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate(two in each of the primary and reserve / unless trenches as permitted in 310 CMR 15.102(2) or as f approved for an upgrade under LUA at 310 CMR 15.405 1) k Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? 310 CMR 15.103(3)] Benchmark within 50-75'of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR 15.000] System components not>36" deep (unless Local Upgrade Approval or LUA requested) 310 CMR 15.405 1 b) Address 5a1-'G� Sheet 2 of 7 N/A OK NO E,r..�' � _ r� n� Ei s r, rfl � � x�ti. ��3 "."hEEC 9 Wiz•.t, w,ss RlS, ...4knu . '5' e�re&Karet = i4. Size OK? 310 CMR 15.223(1 Inlet tee located ten inches below flow line 310 CMR 15.227(6)] Outlet tee 14" or 14" + 5"per foot for increase ft depth[310 CMR / 15.227(6)] V Outlet tee with gas baffle or approved filter 310 CMR 15.227(4 Note regarding installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees(no less than liquid depth) 310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater j (except as described 310 CMR 15.227(5))or permitted for VJ upgrades under LUA[310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20"'or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<I 000gpd, two fors stems>1000 gpd 310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation 310 CMR 15.211 1) Buoyancy calculation Required/Done [310 CMR 15.221(8)] H-20 Where appropriate? 1310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] MuAbCaim aara�atetaTa ks � �� t ,.„,. �',,,,,,,., ,< t ..,:. E,•,,,, k E E•.„n,.p, ,...;E i,Ex14,E� .�. ,b _v. Required when other than single-family dwelling or flow>1000 d [310 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment 100% daily flow 310 CMR 15.224(2) and 3)] "U pipe through or over baffle, outlet of each compartment with gas baffle or approved filter[310 CMR 15.224(4)] I i Address Sr Ana Sheet 3 of 7 N/A OK NO Located at least ten feet from any water line? [310 CMR / 15.222(2)] J Disposal piping at least 18" below water line (when water and sewer cross, see 310 CMR 15.211(1)[1]) Cleanouts required/provided? 310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2) c Siphonproblem/ leachfield below pump chamber) Endca s or vent manifoldspecified? Size and orientation of discharge holes specified?(not.smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" 310 CMR 15.232(2)(b)] Minimum sum 6" 310 CMR15.232 3 e ] Watertight cover if<2000gpd);waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] m. c Capacity(emergency storage above working--design flow)? [310 CMR 231(2)] Proper setbacks 310 CMR 15.211 same as septic tanks Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible(not too deep with piping, / disconnects accessible) V Alarm floats- alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag / mode. [310 CMR 15.231(6) and(8)] V Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed?Provided? [310 CMR 15.221(8)] Address Sheet 4 of 7 N/A OK NO S(QI����► , ,, RP'1� C3,l�SS, CE��, ,. .�G � �;w�:;� .,,,�,� . , ... ,« Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)] Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] E „ Chambers and Gal. in trench configuration supplied with inlet every 20 ft. 310 CMR 15.253(6)] Each structure with one inspection manhole(if>2000 gpd must be to grade) [310 CMR 15.253(2)] Aggregate P minimum- 4'maximum. 310 CMR 15.253 1 b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a In bed configuration, inlet every 40 s . ft. [310 CMR 15.253(6)] Width 2' minimum 3'maximum[310 CMR 15.251 1)(b 100 feet-maximum length 310 CMR 15.251(1)(a) Minimum separation 2x effective depth or width whichever greater(3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours 310 CMR 15.251(2)] Breakout OK? 310 CMR 15.211 1 [4] and Guidance Document W `1�7 um size f : minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximura separation between lines 6' 310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" maximum. 310 CMR 15.252(2)(g)] Separation between beds 10'minimum. 310 CMR 15.252(2)(0] Bottom area used in calculations only [310 CMR 15.252(2)(i)] Address Sheet 5 of 7 N/A OK NO Pressure Dosed System ? Provided pump and piping calculations as required 310 CMR 15.220(4)(r) Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and VA Remedial Use Approvals] If used in gravelless system-make sure jet is directed as not to scour soil interface [Guidance Document] ✓ Inspections once per year(systems< 2000 gpd) or quarterly (>2000 d) good to note on plan[310 CMR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255 3)? Impervious barrier and/or retaining wall? [Guidance Document] Impervious barrier installation must be supervised by designer 310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer 310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for 1� perpetual maintenance agreement? " Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? V Has a2plicant submitted a co of a maintenance Are the variances listed on the plan? [310 CMR 15.220 (4) RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 CMR 15.414 Address �� �o) Sheet 6 of 7 i N/A OK NO 11Fa�U' 4sIZ.S� � L� pGa 3=ram.. E �.-, � €.., �' d�k,.4tG„�ba»„•d..�w�sbwt.o�aE. EI�C.a=„ ,€aka, ORM Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] Pumping to septic tank? 310 CMR 15.229 Shared System [310 CMR 15.290] l l i Address SGcNd poi I Sheet 7 of 7 Town of Barnstable P 4t 3 2<��a oar — Department of Regulatory Services Public Health Division Date 200 Main Street,Hyannis MA 02601 • lfb MA't a . Date Scheduled Time �� Fee Pd. /L" Soil Suitability Assessment for Sewage Disposal Performed By: Witnessed By: = ' LOCATION& GENERAL.INFORMATION Location Address y Owner's Name OytsT2 �2Tc .2�5 �/o R m r9i9s0�1! lss�' l Address 6�'_o k61rrC9e_� .f'A�B��LPAIi � Assessor's Map/Parcel: ;TV /��{ Engineer's Name ,LlAt�fz �-I-VZ9 NEW CONSTRUCTION REPAIR Telephone# -6 Or �'O, p 2Ll o A.M OrGSe y A :sscd A,st `«SctJ.(L oG'li�Tc�iS, Olrj••��-p S' ZO ��z. Land Use 6Zes end a I G Slopes(96) Surface Stones No Distances from: Open Water Body o O+ ft Possible Wet Area ft Drinking Water Well ft Drainage Way I w 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) zz -S V) Q L,( p Q I M N r , a J m Parent material(geologic) P ICA(ir u4csAA Depth to Bedrock 100 Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: ___--____In, Depth to sell mottles. itt. Depth 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 We 3/1-01 TIme.YY Observation Hole# Time at 9" 3.5�, _ Depth of Perc J Time at 6" ' Start Pre-soak Time @ d� 00 Time(9"4") 5^0 End Pre-soak S`•D 0 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:\SEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Sdil Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. onsistency.96'Gravel) (9 - W K _�_L h �. 3z—13 c� C, Q 1, , DEEP OBSERVATION HOLE LOG Hole# �- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% 0 - S - �'1 S!, 1 o IV 312, CI A301Ad I9 BIZ S►q DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ConsistencX. O 1 t t c nM1 ' DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other t;+ Surface in.(' ) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Flood Insurance Rate Map: Above 500 year flood boundary No— Yes L Within 500 year boundary No V' Yes Within 100 year flood boundary NoZ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi us material exist in all areas observed throughout ilte area proposed for the soil absorption system? . . If not,what is the depth of naturally occurring pervious material? Certification I certify that on ,D\( 09L- (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 tra' ing,expertise and experience described in 310 CMR 15.017. Signature Date Q:4SEPT➢CkPERCFORM.DOC ' Op tNE tp� DATE: LI 1-2 1 FEE: IABNgrABLL ' MASS v 1639.� REC. BY Town of Barnstable SCHED. DATE.5 I I � ) Board of Health ' 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. ' FAX: 508-790-6304 Junichi Sawayanagi Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION Property Address: 71 Sand Point,Osterville Assessor's Map and Parcel Number: 73/14 Size of Lot: f 1.37 Acres Wetlands Within 300 Ft. Yes X Business Name: No Subdivision Name: APPLICANT'S NAME: Salten Tide Realty Trust Phone Did the owner of the property authorize you to represent him or her? Yes X No PROPERTY OWNER'S NAME CONTACT PERSON Name: Salten Tide Realty Trust Name: Arlene M. Wilson ' Jeffrey R. Lindsey, Trustee A. M. Wilson Associates,Inc. Address: 155 Carriage Road/P 0 Box 2112 Address: 20 Rascally Rabbit Rd., Unit 3 Oyster Harbors, MA 02655 Marstons.Mills, MA 02648 Phone: Phone: 508-420-9792 Email: amwilsonassoc@amwilsonaliates.co VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(Maytlach if More`' Space Needed) t 11 = 310 CMR 15.211 SAS f 15' from Top of Coastal Bank Septic Tank±35' from Top of Cods y Bank r Ch 360-1 SAS ±15' from Top of Bank D Box f33'from Top of Bank Septic tank±35' from Top of Bank SAS t96' from wetland. ':t=t NATURE OF WORK: House Addition r House Renovation.r Repair of Failed Septic System ' Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. _ Four(4)copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) = Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) _ Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals(same owner/lessee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman ' NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. _ r+ , a ?REMITTANCE ADVICE A M'WILSON ASSQCIATES,tI�lC 20 RASCALLY RABBItTp D C.t , �J�� 53.7054 2113 _., '.��7"'GgLT MARSTONS M US"'! 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Y .r } y� �. n .it 3 t .Z \-'d °S:. II'02L9P, >11: 211370S4SI: 30L44440LII' ----- ---------._._ . ... _.. 1 List of Attachments Salten Tide Realty Trust Septic Variances A - Locus Map B - Assessor's Card ' C '- Town Aerial D - Deed E - Plans tF - Floor Plans/Existing and Proposed G - Assessor's Map H - Abutters List I - Abutters Notice A.."K WILSOWASSOCIATES, IN.C. From USGS Topographic 20 Rascally'Rabbit Road Unit 3 Marstons Mills, MA 02648 Quadrangle for Cotuit 508-420-9792 FAX 508:420-9795 EXH A o :`/i 50 \\ Q "' '' \ /•o , Q o .50© Ors •Q 9 �. ,I 2 O�� � ®`g, ��,� � u o 0 0 o c• p �, ( , S" �'\ lam- J © � 2�O � O ��\�\ •� �� •�• ` F J�E/G %. ', )I ll ;r r .t��/r..r � x ,.4 j \¢'i/ 0 0 •Q• �a°; tr ' Cran BO Hi I Ai n �• °1 �h1\ o\\\D� o oIsab I a f „` w (� - l ♦W 1 V1 1 \ \\� • //..r`� *�4hr , � Jµ...' 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' F ,��� • 10 .: 7� i s v:. ♦ ► �e�. ��n 0 Q I\N 1° r�r Cn`tj( \)0 ` BIU k , \- �Y�, _ c s ; �I4•ll I � 15°� 1♦ : \ t .I;S Ipt\ry _ (e Tl�a� )� � old q,,,. � tr �B{ �" d' !I ii " "J✓✓� -�s;2 b�t,l F�s ?#y y F`{dlt _ t • I _ I ♦ 1 O F.� xbtl IV r ` i• , ni S A is "*. \ taimpso sr, d ec 0 Oea t> 4 4 / 2. 2�b 0►'S < r. / z 2 , - <t t a r3 f'`k ` ..�.��__,, x i Oyster e i' �z t 6 a, 4 ,t1;._ {r"'C . ,.,� I r y / v-N5 \ \v�'�t�� t?..:l i, y: ..--. °.,a'1 fi .4fi.: 1..�:� r,t•,.,•,`,-� ,c,-�: _. i�5�7:_.5 Y ,�,-:+ fr'TI �•? ,n„r.. YA ..t i. ' �r:s:_. \ \\r t 341 s F•`r'9nls� � � 1 � ,� \ 5�i,;c�s�^e� ya �/r�sr`R . i x�>,� t � c !- S 4 •a`r -.�1'fA '�=�'t U�S.L' to 4�f j..t. s'.P Ci.�.\. t✓♦ t i ' �"�•✓_. - .ram •.— _ _— - � + fMOOUCT 2g7.1(Single Sheets(205.1(Paddedl ' Owner Information - Map/Block/Lot: 073 /014/- Use Code: 1010 EXH B Owner Map/Block/Lot 0 GIS MAPS 73 / 014/ ' MITCHELL, MATTHEW J ESTATE Property Address Owner Name as of OF 111113 39 SAND POINT 71 SAND POINT OSTERVILLE, MA. 02655 Co-Owner Name Village: Osterville Town Sewer At Address: No GIS Zoning Value: RF-1 ' Assessed Values 2013 - Map/Block/Lot: 073 /014[- Use Code: 1010 2013 Appraised Value 2013 Assessed Value Past Comparisons ' $ 252,000 $ 252,OOq Year Total Assessed Building Value Value Extra Features: $ 42,800 $ 42,800 2012 - $ 5,501,200 Outbuildings: $ 8,200 $ 8,200 2011 - $ 5,504,200 Land Value: $ 4,769,400 $ 4,769,400 2010 - $ 6,060,300 2009 $ 6,455,300 2013 Totals $ 5,072,400 $ 59072,400 2008 - $ 4,931,500 2007 - $ 5,025,800 ' Tax Information 2013 - Map/Block/Lot: 073 /014/- Use Code: 1010 ' Taxes C.O.M.M. FD Tax $ 7,507.15 (Residential) ' Community Preservation Act $ 1,333.03- Tax Town Tax(Residential) $ 44,434.22 Fiscal Year 2013 TAX RATES HERE ' 53,274.40 • Sales History- Map/Block/Lot: 073/014/- Use Code: 1010 History: Owner: Sale Date Book/Page: Sale Price: 1 MITCHELL, MATTHEW J ESTATE OF 12/29/2011 #D1181272 $0 MITCHELL, MATTHEW J 5/6/1998 #D725515 $0 MITCHELL, MATTHEW J 11/5/1990 #D783824 $0 ' MITCHELL, MATTHEW J & HELEN G 12/29/1967 C43304 $0 MITCHELL, MATTHEW J & HELEN A 6/7/1961 C26891 $0 • Photos 073/ 014/- Use Code: 1010 4 W • Sketches-Map/Block/Lot: 073 /014/- Use Code: 1010 Y a s As Built Cards:Click card#to view: card#1 • Constructions Details -Map/Block/Lot: 073/014/- Use Code: 1010 ' Building Details Land ' Building value $ 252,000 Bedrooms 6 Bedrooms USE CODE 1010 Replacement Cost $315,023 Bathrooms 4 Full + 1H Lot Size (Acres) 1.37 ' Model Residential Total Rooms 10 Rooms Appraised Value $ 4,769,400 Style Cape Cod Heat Fuel Oil Assessed Value $ 4,769,400 Grade Average Plus Heat Type Hot Water Year Built 1951 AC Type None Effective depreciation 20 Interior Floors Hardwood ' Stories 1 1/2 Stories Interior Walls Plastered Living Area sq/ft 3,562 Exterior Walls Wood Shingle Gross Area sq/ft 6,722 Roof Structure Gable/Hip Roof Cover Asph/F GIs/Crop • Outbuildings & Extra Features - Map/Block/Lot: 073 / 014/- Use Code: 1010 ' Code Description Units/SQ ft Appraised Value . Assessed Value PAT1 Patio- Average 288 $ 1,400 $ 1,400 FOP Open Porch-roof- 40 $ 2,100 $ 2,100 ceiling BRR Bsmt Rec Rm- 416 $ 2,500 $ 2,500 Average FPL2 Fireplace 1.5 stories 1 $ 3,700 $ 3,700 FPO Ext FP Opening 1 $ 1,200 $ 1,200 SPL2 Pool Vinyl 512 $ 3,400 $ 3,400 DKPL Pond Dock-Light 1 $ 3,400 $ 3,400 BMT Basement- 1064 $ 19,600 $ 19,600 Unfinished GAR Attached Garage 575 $ 13,700 $ 13,700 • Sketch Legend rProperty Sketch Legend 132N Bam-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only ' BAS First Floor, Living Area FTS Third Story Living Area(Finished) SOL Solarium BMT Basement Area(Unfinished) FUS Second Story Living Area(Finished) TQS Three Quarters Story(Finished) BRN Barn GAR Garage UAT Attic Area(Unfinished) ' CAN Canopy GAZ Gazebo UHS Half Story(Unfinished) CLP Loading Platform GRIM Greenhouse UST Utility Area(Unfinished) FAT Attic Area(Finished) GXT Garage Extension Front UTQ Three Quarters Story(Unfinished) FCP Carport KEN Kennel UUA Unfinished Utility Attic FEP Enclosed Porch MZ1 Mezzanine, Unfinished UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) PRG Pergola WDK Wood Deck FOP Open or Screened in Porch PTO Patio Assessing As-Built Cards Page l of 1 `I T F BARNSMSEWAGE#-9:s LOCATIO �� ! F 1 VM AGE <_%tNr:� E 1I f' ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. y���� SEPTIC TANK CAPACITY dO O LEACHING FACILITY: (type 11 an size) ' NO.OF BEDROOMS 5 BUILDER OR OWNER PERMI TDATE: COMPLIANCE DATE: 2 G Separation Distance Between"the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by b 1 f ' http://www.town.bamstable.ma.US/Assessing/HMdisplay.asp?mappar=073014&seq... 1/8/2013 Vr�;. .r1� � '�-i 3 �•�T4+< i= x �'� f t r t}'Y 4€fT St • _ _ •` ' s 41`(x tS, + r� •y 7 ark' J 0 1�'`��lc fly' {^� rrt fe4y;1�` r •A, ���;`� - ,� x� r« �, r'S`FS > '•�fi` FF �M .s �9" .. + „". fx�" r'S• � i�- - � �r:3L..-�• �..�'i�?�f.^ "" tr•r j ��r�,+f; N,' ,e k' a�+��d a,�•."A# yp+ '+v :r7rfra. 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'r t�c a`a�{^s' �� ,,,.�,,,.x.f.�X�,. 4 1 '���' >9 i� 'tor - 4t �k.� + .t.• # i' :l�k}.a e r ,•e, 'G� t�' } -'y�,. ,` ��,``•�•AA ��'�"�; "w , ' ',.., la. •".'T.,;,} il? 'Y. •7•+ ,a, y>�,t Sr lt' µi.`rR 3 !M,^.. ,t '* p { .t 'i' .,:+ .j r ^ 9 ,:.,r+ ('I.♦h �` '�'' `t ;` i! ge�'.t r'�a, , 7 '� ;�;':..�,of ,,',s�"-t yy•�'` 'r��•r..� "�4 }".aI {i+ Ei+ aI h tx""'� � �.:(r• e.. �.t „�*�d- r r�� ISf 'rift T-1' j ("^► r 'A } t: :�'•w<„: � ;��.� >�':7" 4 tr ,:'-;,+r..., .t=.?s�,.x..?,'«. •��F^ �# +Y�! tr�� ^'r"'r s�i'�; •.! �?. ���± }� ,'a.J_:,• _ r.d�;4 &\ ,�pr'-'Cii_ °t},9����" • 014 Selected Parcel -`. Owner:MITCHELL,MATTHEW J ESTATE Total Assessed Value: • 1• rr - POINTAcreage,1.37 acres Abutters Location:71 SAND EXH D ' — —2013 2324 Doc=1 s 216.053 03 []8 Ct f-w a 199803 BARNSTABLE LAND, COURT- REGISTRY 1 1 . FIDUCIARY DEED 1 Grant H. Gra Y and Helen Mitchell Burleson, as Executors under the Will of Matthew J. Mitchell, duly appointed in Barnstable County Probate and Family Court Docket No. . 13A11P1387EA-(the "Grantor), by the power conferred by Article Seventh of said Will and every other power, and not individually, tA 1 'O for consideration of THREE MILLION FIVE HUNDRED FIFTY THOUSAND AND 140/100.($3,550,000.00)DOLLARS paid, grant to.Jeffir*ey R. Lindsey, Trustee of Salten Tide Realty Trust, under declaration of trust 1 dated March , 2013 and recorded herewith (the "Grantee"), having a mailing address of 135 .Carriage Road, 2112 Oyster Harbors, Osterville, Massachusetts 02655, 1 the land with the buildings thereon, located in Barnstable (Osterville), Barnstable County, Massachusetts, now known and numbered 71 Sand Point, described as follows: a LOT 52 LAND COURT PLAN 15354-66 1 a LOT 277 .. LAND COURT PLAN 15354-141 H Said land.is conveyed subject to and with the benefit of any rights, easements, stipulations, restrictions and reservations of record, insofar as any or all of the same are now in force and 1 applicable, including but not limited to any and all public rights legally existing in and over the �. same below mean high water mark. Said land is further conveyed subject to all real estate taxes assessed for the current fiscal year, but not yet due and payable, which the Grantee, by iacceptance hereof, hereby assumes and agrees to pay.' For Grantor's title to Lot 52, see Certificate of Title No. 26891..:For Grantor's title to Lot 277, see Certificate of.Title No. 197934. See also Barnstable County Probate and Family Court i , Docket No. BA11P1387EA; Death Certificate of Helen A. Mitchell filed as Document No. 783824 Statement of No Divorce filed as Document No. 783825; and Death Certificate of Matthew J. Mitchell filed as Document No. 1181272. ' [SIGNATURES,ON FOLLOWING PAGE] III hAi 83 C0 MASSACHUSETTS T STA E EXCISE TAX BARNSTABLE LAND COURT REGISTRY ' Date: 03-08-2013 9.02:24R� Ct1Y: 1122 DaC:: 1216053 Fee: $121l4l.00 Cons: $3r550V000.00 BARNSTABLE COUNTY EXCISE TAX BARNSTABLE LAND COURT REGISTRY ' Date! 03-08-2013 8 02:24am Ct1V .1122 DocT: 1216053 Fee: $9,585.00 Cons: $&550r000.00 Witness our,hands and seals this day of March, 2011 Grant H. Gray, Executor aeathresaid and ' not individually Helen.Mitchell Burleson, Executrix as aforesaid.and not individually COMMONWEALTH OF MASSACHUSETTS County: Su-9.1k , ss. On this day of March,2013, before me,.the undersigned notary public, personally appeared Grant.H. Gray, Executor as aforesaid, personally known to me or-proved ' to me through satisfactory evidence of identification-, which was ' G.�..c� , to be the.person whose name is signed on the preceding or attac ed d ument an acd knowledged to me that he signed it voluntarily for its stated purpose. GRMORY R.BRADFORD Moad Public CcmmcrwNea bcs y commission expires: ' My Commission Expires August.M,2019 / COMMONWEALTH OF MASSACHUSETTS County: f-JGfn��t�,��� , ss. t On this day of March, 20.13, before me, the undersigned notary public, personally appeared Helen Mitchell,Burleson, Executrix as aforesaid, personally known'to me or proved to me through satisfactory evidence of identification, which was to be the person whose name is signed on the preceding or ttac�hed—document, and acknowledged to me that she signed it voluntarily for its stated purpose. j Notary Public ' My commission expires: t REGISTRY OF DEEDS SARNSTABLE EXI i F- • 7dA baf'IomWolWa+Y otl®>o�K°°ru � mm raooa am NVId I' ± X aVOH IMOd WS aKo-LIMIM 1N3W3SVe SNIISIX3 ud I 1 s 4 t 1 t ❑ p s IN I % \ 1 i - I a I } i . 4 I I I I ' I I I a I I a I i I i i 1 f I PDF created with pdfFactory trial version www.softwarelabs.com 1 . r mrst fsW w mn�t(W« - rom'rymteati4a+y amu i NT�j ^ �7�j NV'ld I i O✓S aN Qypy j�j[pd��gqp- NOMA Isau EJMISIX3 1 I I I I I I I I I I I I I I 1 I I I 1 I I I 1 i I 1 II i II II it ii II li it O000 ,NO , =U till Q II II 11 3 II II I, I, I, I � • I III'' I I PDF created with pdtFactory trial version v ww.sottwarelal s,com nab 'rym�ovlryary T�T NV-Id 21001d Y D L L Q am mod am smo-6dmm ON003S ONIlSM i, $ W � � I Ltd 1 ' I 1 1 m 1 I i I 1 i t 1 I _ T 1 1 I 1 r-- b 1 1 f I 1 1 i 1 1 1 i 'T 1 1 I I g ' 1 � M I I I I d I I � 1 I 1 1 I . 1 1 ❑ d 1 i I 1 I i 1 a 1 � 1 1 im PDF created with pdfFactory trial version www.softwarelabs.com i I �wt dwl w �m fowl M C®h�vn'/YO t4 qA n1 f✓00/dR1 roa/'N+�1�w174a+Y i auan®l m vrellnloe NVId LI l 1 T— am m ilme mles u 00 d - T�T r7�T WO �Itl a Y�L �1SLZQ c ��Mod am BHO-ESN9d96 1S2i1J03SOd02ld 9 8 Q 1! t o o E9 11 11 II e 1 1 I 1 1 1 r- 1 1 i r------i 1 I I - I I a I I 0 1 I _ 1 I 1 1 I I I 11 1 _-- i i i i 1 i 111i i --- • 1 1 I 1 I I II 1 ♦•♦ 1 I ` I n I u 1 I 1 t 1 I 1 1 I 1 1 1 1 1 1 Ij ♦♦♦♦ 1-------- 11 I �I ♦♦ I L---------- it ♦I E II 1 1j I 11 1 PDF created with pdtFactory trial version www.softwarelabs.com m-rump.,m�lr o` ap N o Yioe,m��� NV'IdilOOlj 89 ^ y�O�S�1T c um LIIOd mm Ico_au�ess ON003S 03SOd01ld W 1 i a t o d� 11 II II II II u u e p d I I aP 6 1 I I I i I I ` 1 I I 8P � ice--------- , I ' I ------------- i I � ' I � I ` i I I I I --i i I PDF created with pdfFactory trial version www softwarelabs.com Town of Barnstable Geographic Information System April 25,2013 079092' #70 @ 073015001 073015002 014 #88— #71 i0_73.:.•3 02 : #74:-;::.. Z 073016 C - 08 2 - _ o 0 001 73014 ftOr73011"4003, pOO73013 #100 073014002 021 073018 #38 073018002 0 66 #18 DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:073 Parcel:014 Board of Health l ®Selected Parcel M boundary determination or regulatory interpretation. Enlargements beyond a scale of Abutter List Type-Direct abutters(no set distance)and the properties located 1"=100'may not meet established map accuracy standards. The parcel lines on This map '� �:3-" E are only graphic representations of Assessor's tax parcels. They are not true property across the street. Abutters boundaries and do not represent accurate relationships to physical features on the map rr+ such as building locations. Buffer ';,�" ►+^+ y` r AbutterReport Page 1 of 1 Board of Health Abutter List for Map & Parcel(s): '073014' EXH H Direct abutters(no set distance)and the properties located across the street. Total Count: 5 Close �=Wm M- 1 r °$x h�.. �asa r�., at t' �F� # a, J i,a., x., 4p, - ' MITCH ELL=:., f a i:dP*"'� v"'grALTE.N -.d ^'%, ' z � ,s a if f :¢ �m W k Apr i ati v `3 a� 2 50 �- S'� �f '': m '-'%s�` 135 ` ! s'� � '" t v. x MATTHEW /oLI'DSE ,,TIQE, r�U 05TERVILLCC h 'J4. z�rVe'� dE / !; , ¢ 4-/e.-s�`�€ '^d,fi ,': 073:014 . , .,< , . s g&, CARRIAGE r �r � r y #D11E812,7'2 r - � ;REALTY w Af0,2b55 s gar , g ESTITkEJEFFRE,Y R T � x ,P 4�," fa` � �,"'�tr��.K�er'�,�"v A t �' 4 F1 t�' �d, .� `�„ � � S �, a� � ? °e# RD= D `k � i v ��� ,.�"`7 K s:z� ,;zr�,�t+'r? � RUSTr, �., � f �9 �� �s L �a.�w ..,M. ', ................ - PALU M BO, WEST 073014001 KEITH R & 65 LENOX NEWTON, C196965 JENNIFER STREET B MA 02465 era sexr<;,;aam'^fl'"a<`�✓.s 07P,��3f 0'E,`{,�",�E9�'.b7d A `©�w;�, �0'w r,,G P rEC��;,RG Q.d�; f ,Df �w t��f.� c a c�. ,Ea zr _.._:.}Ya'Ew EPA" � nm Q4 A5 M FA ` �BS�T�,+ Y P zmvo , ' FISH, CHRISJEN—B 65 BOSTON, 073023 JOHN F TR REALTY TRUST STLERTON MA 02119 C172587 aas�=as .*�rt:aFr,. ;:ra ,ar.:.;x 7 e✓ ufr4 .X {a ay,r:r, ,�s!x�r�r l rr nu Fd .n,:g.;�"rx-xz: u�x .le, y1'1%i* r•: -h .,d z c/` t '�.,vn4# !fif 5'�',..gv s Y st`j c j� >Ji v''. S �k r'�� 'rs "'t s ,rj IN SE.s 2� ""g...;v LY+ �,.gE,� �: s,'`' d ki °fit �`�,it o'sti','a,�,a.,�`�ra ^ `, i. �rax -..l ..,�5�' b .F r, .„ W.: .tu¢a3`,. �.cT'aY w32tK i'v4 .r I 'kd+' x, `t'_ -( .i�fi a kar°'S* .Y �kat ,6 CALLAH N CON ; NENTAL �, 1�.0 ARLES ; e �� wt � f aA,.!a <t ,F, , >,. .�F,:, #r " .; ���o- �'�i, r"(;,.,.�'� � .r 073032P r tBRIANE W,INGATEF,S. .n v � RIV�ERPL— g � w 1c dC� 9 9907/3 _ +w /�-'.� ^r*.,.;^x r ki3Y��" �' .. :� �'r,E� `� rSr E E t ,5 sz 1a�, _.t6"�FI,E a ;-„' ,� J:> v x r:3"'.�",,r u :, » S� tw,. e �..w�g'�'R°z' `m ,,,r L s,: 4'0 L2. s ;'j3t R ,253'k TR COMPANY 63 ,^ r ace 5 rk vzy s P > a Ya ' � ?.�ax�`f� INC KEIYDRICK Px as f t#'-15 ;s This list by itself does NOT constitute a certified list of abutters and is provided only as an aid to the determination of abutters.If a certified list of abutters is required,contact the Assessing Division to have this list certified.The owner and address data on this list is from the Town of Barnstable Assessor's database as of 4/25/2013. 4 , F , ' http://6'6'.203.95.236/arcims/appgeoapp/AbutterReport.aspx?type=BOH 4/25/2013 SEPTIC SYSTEM VARIANCE ABUTTER NOTIFICATION LETTER DATE: 4/26/13 RE: Upcoming Barnstable Board of Health Public Hearing To Whom It May Concern, As an immediate abutter of a proposed project,please be advised that a Septic System Variance ' Request has been filed with the Barnstable Board of Health APPLICANT: Salten Tide Realty Trust PROJECT ADDRESS OR LOCATION: 71 Sand Point Oyster Harbors, MA ASSESSOR'S MAP&PARCEL: Ma 73 p Parcel 14 ' PROJECT DESCRIPTION: Replace existing septic system and 2 cesspool systems with new septic system on street side of house ' VARIANCE REQUESTED: Local Upgrade Variance to site 'Q p� SAS as close as 15 , ' tank as close as 35' & D box as close as 33' from Top of Coastal Bank, and SAS as close as 96' to BVW. APPLICANT'S AGENT: A. M. Wilson Associates, Inc. 20 Rascally Rabbit Rd., Unit 3 Marstons Mills, MA 02648 PUBLIC HEARING: Town Hall,Hyannis ' Conference Room—2°d floor Date: 5/14/13 ' Time: After 3:00 P.M. ' *Please call Board of Health office for exact time. NOTE: Plans and application describing the proposed activity are on file with the Board of Health (508 862-4644) i Town of Barnstable Regulatory Services Thomas F.Geiler,Director ' MASS. = Public Health Division 619. Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: O CC-t G3 Sewage Permit# cW/3-d a3 Assessor's Map/Parcel 3 O I Lt Installer&Designer Certification Form r sr.. ` Designer: �;,5)-1 E(16i1r1LC.r r'h�'► �_ Eller: �J(''��e. R.��1,uc5G� Address: pb '13 o/- Zo 1 Address: 8 02 ?y A4 t 6re.Ws�/ , yvlp� 0`2.J,3i Cis�er ,4, c ace �� On 6 a�/-/3 �i1-rc /`7 l�`1 was issued a permit to install'a (date) (installer) septic system at 1 SaNj�i VQt n� , 0 S e based on a design drawn by (address) CN-A Qnht ne,e-t�n!!� dated 413011-3 (designer) I certify that the septic system referenced above was installed substantially according to the design; which may include minor approved chanocs such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to,follow. Stripout(if required)was inspected and the soils were found satisfactory. (ks taller's Signature) A^i V(Designer' Signature) (Affik esiN e s St��,,]Mere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLLk—6TCE WILL_NQT !4E 15!T D UNTII.�LRQT�'!'�S �L' _AN'�1D AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formAdesipercertification form.doc Doc® 1 s 2 23 r 4 47 06-12-2b13 10=`5 BARNSTABLE LAND COURT REGISTRY DEED RESTRICTION Whereas, Jeffrey R. Lindsey, Trustee of Salten Tide Realty Trust, under Declaration of Trust dated March 4, 2013 and recorded as Document No. 1,216,052, of 135 Carriage Road, 2112 Oyster Harbors, Osterville, MA 02655, is the owners of Lot 52 on Land Court Plan 15354- 66 and Lot 277 on Land Court Plan 15354-141., (hereinafter, the "Lots").; and Whereas, Jeffrey R. Lindsey;Trustee of Salten Tide Realty Trust, as aforesaid, as the owner of the Lots have agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on the Lots as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; and Whereas, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the Lot be put on recorded with the Barnstable County Registry of Deeds and/or the Barnstable Registry District of the Land Court, as applicable, by recording this document. Now, therefore, Jeffrey R. Lindsey, Trustee of Salten Tide Realty Trust, as aforesaid, do hereby place and impose the following restriction upon the Lot in accordance with his agreement with the Town of Barnstable Board of Health, which said restriction shall run wit land an" be binding upon all successors in title: c�r The dwelling constructed upon the Lot shall contain no more than five (5) iedrooms , unless and until it is connected to the municipal sewer or the Board of Health of the own of Barnstable A permits otherwise. CA) I, Jeffrey R. Lindsey, certify that I am the sole trustee of Salten Tide Realty Trust, a d I have$ben ., authorized by all the beneficiaries to sign, seal and to execute this Deed Restriction.relative to the real estate described in this deed.for the consideration stated herein. We also certify that said Trust is in full force and effect and has not been altered,amended,rescinded or revoked in any manner other than amendments recorded in the Barnstable County Registry of Deeds prior to the date of this certificate. Property Address: 71 Sand Point Road, Barnstable (Osterville), MA 02655 .For title, see deed recorded with Barnstable Land Registration Division as Document No. 1,216,053. Executed as a sealed instrument this Mime day of J �% 'i-, 2013. Jeff ey . Lindsey COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. On this day of June, 2013�before me, the undersigned notary public, personally appeared T r_ Ly �1; ,3�at°i e�, ; C 4-, personally known to me to be the person whose name is signed on the preceding or ttached document, and acknowledged to me that he signed it voluntarily for its stated purpose. Notary Public My Commission Expires: MARi{;H:..:B.OUDREAU NQTfi= t' PUBLIC Comm R: . ssachusetts MV Commis ron Expires c:> May 2, 2014 r Town of Barnstable Barnstable �OpSHE tp� y�P Regulatory Services Department j e"ac j MASS. - Public Health Division i639• �� 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director. FAX: 508-790-6304 'Thomas A.McKean,CHO CERTIFIED MAIL # 7012 1010 0000 2843 2058 February 27, 2013 ` Matthew J. Mitchell Estate of 39 Sand Point Osterville,MA 02655 I RE: 71 Sand Point,Osterville ORDER TO COMPLY WITH STATE ENVIRONMENTAL.CODE, TITLE 5 The septic system located at 71 Sand Point, Osterville, MA,was last inspected on 2/07/2013, by Frank Nunes 111, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails"under the guidelines of the 1995 71TLE 5 (310 CMR`15.00) due to the following: • Single cesspools automatically fail in the Town of Barnstable. Both cesspools in the rear of house need to be replaced. You are ordered to repair or replace the septic system within two (2) years from the date you receive this notification. Failure to repair/replace the septic system with the deadline period,will result in future enforcement ac on. PER O `OF THE BOARD OF HEALTH a T ean, R.S. CHO Agent of the Board of Health -` • Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\71 Sand Point Ost Feb 2013.docQ:\SEPTIC\Letters Septic Inspection Failures or Future Eval\71 Sand Point Ost Feb 2013.doc Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=4486 1HE AM y,?� �+y/ x " � � W 1Gl;Ci' CfCETILi"L +.CcVMfi° ' a � Logged In As: Parcel Detail Wednesday, February 27 2013 Parcel Lookup ParcelInfo 4 Parcel ID 0 37 014 Developer LOTS 52&277 TI Lot I Location 71 SAND POINT Pri Frontage 12 11 41 Sec Road, I Sec Frontage[ Village OSTERVILLE I Fire District C-O-MM � I Town sewer exists at this address FN Road Index 1682 _ (, Asbuilt Septic Scan: Interactive' 073014_1 Map .... i Owner Info_ Owner IMITCHELL, MATTHEW J ESTATE OF Co-Owner^ Streetl 139 SAND POINT ,I Street2 city OSTERVILLE ( State jMA' Zip,r02655 Country Land Info m , Acres 11.37 Use[Single Fam MDL-01 I zoning RF-1 Nghbd IWF14 Topography Above Street Road Paved Utilities Septic,Public Water _ I Location Waterfront,Excel View Construction Info Building 1 of 1 Year Roo _ _ ____ _ Ext f Wood Sh Built 1951 Struct Gable/Hip wall ingle Living 13562 RoofAs h/F Gls/Cm AC None �w, Area I Cover p Type[None _.. 0 style Cape Cod Int Plastered �. • J Bed 6 Bedrooms Wail�, Rooms Int Bath 6MT 4 w Model Residential FloorHardW00d Rooms 4 F ull+ 1H r Grade Avera a Plus Heat Hot Water Total 0 Rooms _.. _ 9 Type. J Rooms1 Stories 1 1/2 Stones Heat?Oil Found- Stories 610Ck Fuel l ation Gross 722. —_I Area Permit History_._._,, http:Hissgl2/intranet/propdata/ParcelDetail.aspx?ID=4486 2/27/2013 f ` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 71 Sand Point C �� Sys—�e w► Property Address Mitchell Owner's Name Bemsteble al e fV1 116 MA 02655 2/7/13 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. A. General Information 1. Inspector: Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown . State Zip Code 508.272.6433 Telephone 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 16.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 2/7/13 InspecteA 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. . ` v I l 3 71 Sand Point Cesspool Inspection•03/08 Title 5 Olfiaal Inspection F surface Sewage Disposal System•Page t of 15 Commonwealth of Massachusetts Title 5 Official Inspection - Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 71 Sand Point Property Address Mitchell Owner's Name Barnstable MA 02655 217/13 Cityfrown 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: There are 2 single cesspools at this propert which"Fail'due to regulation 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 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. ND Explain: Na ❑ 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 71 Sand Point Cesspool Inspection-03/08 rdle 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 15 f ' Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 71 Sand Point Property Address Mitchell Owner's Name Barnstable -" MA 02655 2/7/13 City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: n/a ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: n/a 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 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. 71 Sand Point Cesspool Inspection•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 71 Sand Point Property Address ` Mitchell Owner's Name Barnstable MA 02655 217/13 CitylTown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health(cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria 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: n/a 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 ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: Ly ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. a ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 71 Sand Point Cesspool Inspection•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .' 71 Sand Point Property Address Mitchell Owner's Name Barnstable MA 02655 2/7/13 City/Town State Zip.Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No ❑ ® 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. 71 Sand Point Cesspool Inspection•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection . Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 71 Sand Point, ' Property Address . Mitchell Owner's Name Barnstable MA 02655 2/7/13 City/Town State _r "-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 a ® this inspection? Were as built plans of the system obtained and examined?(If they were not `u ® 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: ❑ . r Z _ 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)] 71 Sand Point Cesspool InspecKion•03/08 • Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M '< 71 Sand Point Property Address Mitchell Owner's Name Barnstable MA 02655 2/7/13 Citylrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): n/a Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: seasonal Date Commercial/Industrial Flow Conditions: Type of Establishment: n/a 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: Last date of occupancy/use: Date Other(describe): n/a 71 Sand Point Cesspool Inspection•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 71 Sand Point Property Address Mitchell Owner's Name Barnstable MA 02655 2/7/13 Cityfrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: No pump history given 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/Altemative 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): 2 single cesspools Approximate age of all components, date installed (if known)and source of information: 1951 per age of the home Were sewage odors detected when arriving at the site? ❑ Yes ® No 71 Sand Point Cesspool Inspection•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 F Commonwealth of Massachusetts V Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 71 Sand Point Property Address Mitchell Owner's Name Barnstable MA 02655 2/7/13 . Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 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: Sludge depth: Distance from topof sludge to bottom of outlet tee or baffle 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 How were dimensions determined? 71 Sand Point Cesspool Inspection•03/08 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection `Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 71 Sand Point Property Address Mitchell Owner's Name Barnstable MA 02655 2M13 Citylrown State Zip Code Date of Inspection D. System Information (cons.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): system"Fails" Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete. ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): n/a 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): n/a Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): n/a 71 Sand Point Cesspool Inspection•03/08 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 10 of 15 I &\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 71 Sand Point Property Address Mitchell Owner's Name Barnstable MA 02655 2/7/13 City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cunt.) 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.): n/a *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 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 out of box, etc.): No D-Box Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 71 Sand Point Cesspool Inspection•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 o115 Commonwealth of Massachusetts w. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments b 71 Sand Point Property Address Mitchell Owner's Name Barnstable MA 02655 2/7/13 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): nla Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 71 Sand Point Cesspool Inspection•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 a, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 71 Sand Point Property Address Mitchell Owner's Name Barnstable MA 02655 2/7/13 City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration 2 seperate 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 El Yes 0 No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Cesspool"A"is 4' below grade w/riser to 2' it is dry at this time. Cesspool"B"is about 7'below grade probing gives no indication of a raised cover. It was video inspected and has approximately 1"of- effluent in it at this time 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.): n/a L71oint Cesspool Inspection-03/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts Title 5. Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r� 71 Sand Point Property Address Mitchell Owner's Name. Barnstable MA 02655 2/7/13 Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 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. - i y ' 2-Q 3 v Lt lj f 71 Sand Point Cesspool Inspection•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 r - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 71 Sand Point Property Address Mitchell Owners Name Barnstable MA 02655 2/7/13 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: 12' 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: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: topo mapping You must describe how you established the high ground water,elevation: , see above 71 Sand Point Cesspool Inspeclion•03/08 Title 5 Official Inspection Fond:Subsurface Sewage Disposal System-Page 15 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage DisposalSystem Form -Not for Voluntary Assessments M 71 Sand Point "1 yOVti �S f ZWI Property Address Mitchell Owner's Name f -ftrRst b �'f�I'V� 1 MA 02655 2/7/13 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. A. General Information 1. Inspector: I V Frank Nunes III _ Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State Zip Code 508.272.6433 Telephone 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 2/7/13 Inspe 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. 3 71 Sand Point-03/08 Title 5 Official Inspection form: ubs ce Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 71 Sand Point Property Address Mitchell Owner's Name Barnstable, MA 02655 2/7/13 Cityfrown 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: Pumping suggested every 3 yrs to prolong the life of the system 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 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. ND Explain: n/a ❑ 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 71 Sand Point•03108 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 71 Sand Point Property Address Mitchell Owner's Name ;Barnstable MA 02655 2/7/13 Cityfrown State Zip Code . Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: n/a ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: n/a 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 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. 71 Sand Point•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 71 Sand Point Property Address Mitchell Owner's Name Barnstable MA 02655 2/7/13 Citylrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: '*This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria 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: n/a 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 ❑ ® 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 El ® tributary to a surface water supply. 71 Sand Point-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M . ' 71 Sand Point - Property Address Mitchell Owners Name Barnstable MA 02655 2/7/13 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No ❑ ® 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 god to 15,000 god. 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 f ❑ ❑ 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. 71 Sand Point•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 71 Sand Point a Property Address Mitchell Owners Name Barnstable MA 02655 2/7/13 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? El ® 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)] } 71 Sand Point•03108 t Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection, Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 71 Sand Point Property Address Mitchell Owner's Name Barnstable MA 02655 2/7/13 City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms(actual): n/a DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Seasonal Date Commercial/industrial Flow Conditions: Type of Establishment: n/a 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: Last date of occupancy/use: Date Other(describe): n/a 71 Sand Point-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 71 Sand Point Property Address Mitchell Owners Name Barnstable MA 02655 2/7/13 Citylrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: No pump history given 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): Approximate age of all components, date installed (if known)and source of information: 11/20/97 per BOH record Were sewage odors detected when arriving at the site? El 0 No 71 Sand Point•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts o- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments w 71 Sand Point Property Address Mitchell Owner's Name Barnstable MA 02655 2/7/13 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 12"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain). Distance from private water supply well or suction line: feet feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): 611 Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) H-20, steel cover to grade If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1500g Sludge depth: trace Distance from top of sludge to bottom of outlet tee or baffle '12" Scum thickness trace >2'1 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle >2" How were dimensions determined? measured 71 Sand Point-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 71 Sand Point Property Address Mitchell Owners Name Barnstable MA 02655 2/7/13 Citylrown 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.): Pumping suggested every 3 yrs to prolong the life of the system Grease Trap(locate on site plan): Depth below grade: feet Material of construction: { ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): n/a 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): n/a Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): n/a 71 Sand Point•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 71 Sand Point Property Address Mitchell Owner's Name Barnstable MA 02655 2/7/13 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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.): n/a Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan):. Depth of liquid level-above outlet invert level w/the bottom of the pipes Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 71 Sand Point•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 71 Sand Point Property Address Mitchell Owner's Name Barnstable MA 02655 2/7/13 City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 3 per as built ❑ ,- 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.): Top of chamber is 28" below grade, steel cover to grade, chamber is dry at this time,no indication of backup or high effluent 71 Sand Point•03/08 4 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 r Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 71 Sand Point Property Address Mitchell Owner's Name Barnstable MA 02655 217/13 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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 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.): n/a 71 Sand Point•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 71 Sand Point ' Property Address Mitchell Owner's Name Barnstable MA 02655 2/7/13 Cityrrown State -,Zip Code Date of Inspection D. System Information (cont.) 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. k �39. ' . . 3Z� � 71 Sand Point•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 71 Sand Point Property Address Mitchell Owner's Name Barnstable MA 02655 2/7/1 3 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: 12 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: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: topo mapping You must describe how you established the high ground water elevation: see above I , f 71 Sand Point•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 _ I COMMONWEALTH OF MASSACHUSETTS EXECUTIVE:OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION :TITLE 5 . . OFFICIAL INSPECTION FORM-NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM Cie n,�m� PART AI CERTIFICATION Property Address: —39 Sandpoint Osterville,MA 02655 Owner's Name: Matthew Mitchell, estate of Owner's Address: . Date of Inspection: April 30 2012 Name of Inspector:(Please Print) James M.Ford Company Name: James M.Ford" Mailing Address: �. P.O:Box 49 Ostervlile.MA 02655-0049 Telephone Number: (508)8624400 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 ama DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:. ✓ Passes ` Conditionally Passes eds Further Evaluation by the Local Approving Authority Fa is Inspectors Signature: Date: May 9 2012 The system inspector shall sub a copy of 's 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 how the system will perform,in the future under the same or different, conditions of use. . ' Title 5 Inspection Form 6/15/2000: page 1 20 �l Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) d , Property Address: 39 Sand Point w Osterville.MA , Owner: Matthew Mitchell estate of Date of Inspection: Apri130,2012 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please. explain: The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with 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: p 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 n obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of.Health); a _ broken pipe(s)are replaced obstruction is removed ND explain: 2 : Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 39 Sand Point Osterville,MA Owner: Matthew Mitchell estate of Date of Inspection: April 30, 2012 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment." 1. System will pass unless Board of Health determines in accordance with 31.0 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'Bosi•d 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.. A copy of the analysis must be attached to this form. 3. Other: ' t 3 Page 4 of 11 �3 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 39 Sand Point Osterville,MA Owner: Matthew Mitchell estate of Date of Inspection: April 30, 2012; D. System Failure Criteria applicable to all systems: You must indicate either"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. ✓ 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.,y ✓ 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 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.] No (Yes/No)The system fails. .I have determined that one or more of the above failure criteria exist as described in 310 CUR 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 System: To be considered a large system the system must serve a,facility with a design flow of 10,000 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: 39 Sand Point Osterville,MA Owner: Matthew Mitchell estate of Date of Inspection: April 30, 2012 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: 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; 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C: SYSTEM INFORMATION Property Address: 39 Sand Point Osterville,MA Owner: Matthew Mitchell estate of Date of Inspection: April 30, 2012 FLOW CONDITIONS . 't RESIDENTIAL . Number of bedrooms(design): 5 - Number of bedrooms(actual): N/a DESIGN flow based on 310 CMR.15.203 (for example: 110 gpd x#of bedrooms): 550 Number of current residents:' 0 Does residence have a garbage grinder(yes or no): N/a Is laundry on a separate sewage system(yes or no): N/a [if yes separate inspection required] Laundry system inspected(yes or no): no Seasonal use(yes or no): no Water meter readings,if available(last 2 years usage(gpd)): - Unavailable Sump Pump(yes or no):, No Last date of occupancy: Unknown COMMERCIALANDUSTRIAL , Type of establishment: Design flow(based on 310 CMR 15.203): Vd Basis of design flow(seats/persons/sq/ft 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: Unavailable Was system pumped as part of the inspection(yes or 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 a 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): Approximate age of all components,date installed(if known)and source of information: Date.ofinstallation 11120197_12er as-built card' Were sewage odors detected when arriving at the site(yes or no): No 6 ° .Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 39 Sand Point Osterville,MA Owner: Matthew Mitchell estate of Date of Inspection: April 30,2012 BUILDING SEWER(locate on site plan) ,Depth below grade: Materials of construction: _cast iron 40 PVC other(explain): Distance from private.water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc:): SEPTIC TANK: ✓ (locate on site plan) Depth below grade:. 12" 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: 1500 gal.H-20 Sludge depth: 2" ff- Distance from top of sludge to bottom of outlet tee or baffle: 30 Scum thickness:. . I" 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:: 10" How were dimensions determined: . Measuring 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.). The tees were present The liquid level was even with the outlet invert. There did not appear to be any signs of leakage. Steel cover was to grade. GREASE TRAP:_ None (locate 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 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property.Address: 39 Sand Point Osterville,AM Owner: Matthew Mitchell estate of Date of Inspection: . April 30, 2012 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete _metal fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/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: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of' leakage into or'out of box,etc.): PUMP CHAMBER: None (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 r y ` Pagc 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 39 Sand Point Osterville.MA Owner: Matthew Mitchell estate of Date of Inspection: April 30, 2012 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:. ✓ leaching chambers,number: 3-500 gal. chambers with 3'stone per as built 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.): The chambers were dry and clean There did not appear to be any suns of failure.A steel cover was to Qrade. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: , Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note.condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 R • Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION.(continued) Property Address: 39 Sand Point 1 Osterville,MA Owner: Matthew Mitchell estate of Date of Inspection: April 30,2012 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. CO GAM�� n AClu LWA�/ I a� 3a� z 5 , k 10 I I t� Page 1'l of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 39 Sand Point Osterville,AM Owner: Matthew Mitchell estate of Date of Inspection: April 30 2012 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 14+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: Topographic and water contours mans Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: , You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps the maps were showing approximately 14+%to ground water at this site. This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees,either expressed,written or impliec4 relating to the septic system,the inspection,this report and/or any components of the septic system which have not been located and inspected 11 � "7 No. �• Fr�s ..�.�.:o .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiutt for Diu.puial Workii Tunitrurtiun Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (t, man Individual Sewage Disposal f System at: 4 -3q-...SaYUA.....pQiz t-- -------------------------- - . . ! e Location_-_,lddress I( or Lot No. "y!£' ....... ..t 4 .�.�.. ---------------------- ••----------.........----....------------------.......... Owner Address a (act l.........................Le caw, 5-------------------------------- ----------c. ....................................................o .... Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms--------------- --------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons----------------------.----- Showers ( ) — Cafeteria ( ) a Other fixtures --------------------------------- - W Design Flow............................................gallons per person per day. Total daily flow..-.........-..-..---------------- ---.---..gallons. WSeptic Tank[Liquid capacity............gallons Length---_---_----. Width.............._ Diameter---------------- Depth................ x Disposal TrenclT No. .................... Width-------------------- Total Length.........---.-..---- Total leaching area....................sq. ft. Seepage Pit Nod............-_---- Diameter.......:............ Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-.--...................................................................... Date........................................ Test Pit No. l................minutes per inch Depth of Test Pit............-------- Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.--.............---. Depth to ground water........................ 0 --•-•------•-----------------------••---•--•----••••-•-••--•---•----•--------•---•-•-.........------......................................................... 0 Description of Soil......................................................................................................................... .............................................. W V --........-•...........................................•-•-----••-••---•-•--••--••....-•--•---------........---..................-•-•---•------..........----•-----•-•••••..........------......-------- W --------------- -----------------------------------------------•---..........------------------------...------•---------...-•------••-••-----------------------------•---•-••------•-----------.....--•- U Nature of Repairs or Alterations—Answer when applicable---------L4p...c.r ---.....---FA_.t).e...... ................. •-••-------•••------------•-•----------•-----•----------•--•-----------••--------•------------••-•-•-----•-••------------------•-----------•--....••--•--•------.......--••----•••-•-•-................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ......VY�� G -. .4,C ------------------------------ -- 13— Application.Approved B lr, -- Application Disapproved for the following reasons: .... ='............................ .................................... ....................... ............... .................. ....................................:--------------....................................................... --- ---................................ Permit No. Issued ....................... _?........ r- - `�Dace h� ,.. FizR THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Dbnp i al Wnrkii Towitrnr#inn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( L,,ran Individual Sewage Disposal System at: 1 Sa T r v, l { Loca6onaA,ddress 0 1 t or Lot No. .._••--•---•......'r t�p "----•-s)-•'..... --- ------------------------•-----•--•--••......--•--•----.....-•-•-----..............--•----........_ Owner Address U ................................ .......... Je................................................... Installer Address _ UType of Building 7 Size Lot............................Sq. feet Dwelling— No. of Bedrooms____________________________________________Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type T e of Building No. of persons............................ Showers GL YP g ---------------------------- P ( ) — Cafeteria ( ) a'' Other fixtures ---------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacity-__.__-__-_gallons Length................ Width---------------- Diameter................ Depth................ x Disposal Trench—No_ ____________________ Width.___.._.......____.. Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No---------_........... Diameter-------------------- Depth below inlet.................... Total leaching area.................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by__________________________________________________________________________ Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water_..-_.-.--._-_--_-__-.-. fX Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P+ •-•••--------------------------•---•----••--•-•-••----•••--•---•••-•--•••-•-•••••••-•--•------•••-----•--••••-••••.._.......-•-•---••----•......._:......... 0 Description of Soil...........................................................................................................................................-............................ x U --•...............•....-------•••---•••-------------•-------•-------------------•--------.-..----•----•--------•-------------------••-•--------------•-••-••--------------....__._...---___.....••-•---- w UNature of Repairs or Alterations—Answer when applicable._______.t<t.0. -[:-C--__._E'..___.__._J...t._ _�. .... ................. --------•----------------------•---• .........................................................:....................................................... ............................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ........tiftG2'/� � -� Application.Approved By --------- U -^ -� ------------------------------- ------------- ............ ,._. ....'t,�_. '..- l�� Date Application Disapproved for the following reasons: ..... . ................................... . --............ . . .................... ------------------- ------------------------------------------------------ µ-------------------------------_...._------._------._------.._...------.._.._..__-µDate....... .......__........._......... ....... Date J,.." Permit No. ---------?..4+. ��..1.....�''�............ Issued ------------------ -.I ? "'?. '' — THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (9ertifira#e of TomyltUnce THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by .....L).Ck l.....P_..... ---------------------------------------------- Inualler ------------------- --------------------------------------------------- has been installed in accordance with the provisions of TITLE5_of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..7-_-7-7-r- .1-3............ dated ._. .. _"�r:.�.::...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. f l �----------------------- In ..._..V..........DATE -............. ..,..-... - - .... ..... ------------------------------- --------------------- ------------------ —� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE -5 Disposal Morkii Tnnitru#ion "rrntit Permission is hereby granted........... -Uck--!t.e T.....L. .t..5................... ---------------------------------------- to Construct ( ) or Repair (v)-an Individual Sewage Disposal System - Street i ltr application for Disposal Works Construction Permit No. __ Dated_______: __..........7 :...�� -� �. 013oard of Health EN.INC..PUBLISHERS • T �F BpRNSTA4L •� Yl 3 _ ;I:QGATION g Ot� SEWAGE # ASSESSOR'S MAP & LOT - MLAGE p'1N;STALLER'S NAME&PHONE 140. Gt//,(5'ty/ ..SEPTIC TANK CAPACITY LEACHIIVG FACILITY:.(type) O 4e� 'NO:OF BEDROOMS BUILDER OR OWNER q ;PRMTT'DATE: a/ COMPLIANCE DATE: Separation Distance Between the: fir` ?Ma�ttrinum•Adjusted Groundwater Table and Bottom of Leaching Facility Feet. . Private Water Supply Well and Leaching Facility ( any liIf wells exist 'on site.or within 200•feet of'leaching facility) Feet' :`Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by :Sr Ap I 1 N0 TOP Of FOUNDATION 24"diameter concrete covers EL=14.1± rased to within 6'of hm5h grade Inspection Port and cap with magnetic ROOF VENT �Y marking tape to within 3'of grade LOW VENT { t (or as noted) � � H 2%SLOPE(MIN.) Pt fL=13.4(mm) fL=13.5tI 0' MIN. 0 1' 34' / SEPTIC TANK m D-BOX s VENT THROUGH D-BOX BACK TO 12 /+ /l 50 ADS PIPE ' OFFSET ADAPTER " { 11.25 /1.00 10.83 �, .. xA '% ti SEPTIC TANK TO UTILIZE ROOF VENT ,h i fwstmg OtA N 6.;•. 6.95 Baffle 1 �J t, ✓� ..r - , BOTTOM EXTERIOR OF ADS I I Marsh � �3 '�► � � • PIPE TO BE SE7 LEVEL AT 7.0'+ r' ' - I '� � � E ar ; ;1� �*• 'f, � r Y`• �- DIFFERENTIAL VENTING DETAIL ;4 �� � ` �� �� ��� • fLEVARON 9.60 ' G �+ I a 4 16, --� -- 4 Longest Run �, � I � � �, NOT TO SCALE V a � 9 EL 2.l+Bottom of Test Hole ' j �,� °a TIt)75 0� r + •• • Q . PROPOSED 1500 GALLON DB-6 � r r � � � $ • ONE BED WITH 250 LF OF P/PE � � '' � �pt Co�l3 q N (H-20 RATED) (H-20 Rated) r I G O m o ti 4.0' I' Pt „ I I ✓, . ♦ d0 5EPTIC TANK D-BOX GEOfL OW.5A5 04 i I FINAL GRADE �0�► � .. � a ,1 ,,,�. FLOW PROFILE ,L ' �'��i���i I .S' 1 .5' %x NOT TO SCALE / li i /' SITE LOCUS, O NOTES: NUMBER OF ADS LINES PER BED:3 NOT TO SCALE 4"0 PERFORATED INSPECTION PORT TO BOTTOM OF / ,l `� / �`,' / ,' -- , �; i��; �S� Ln CENTER TO CENTER SPACING: 1.5' SYSTEM SAND AND THREADED CAP WITHIN 3"OF FINAL GRADE.WRAP PIPE WITH PERMEABLE GEOTEXTiLE __ ___._ _._---- - - 0k\1 / l I 1� / ri' ,' �� 1 - ',' '" ��'\ Top Of Coastal Bank - / /i i i / FABRIC TO ELIMINATE SAND INFILTRATION. __ __ ;-- - - - -- - __ / I / , , ��' _ ,- ���/,'�--By TOO Defirntion I .0' 0.5' ASSESSORS REF • 0.5' ADS GEOFLOWPIPE OUTSIDE BOTTOM OF ADS GEOFLOW PIPE TO AL / i' / / ,'� �i,' ,'�%' '' ���� ���• ', i��� BE LAID LEVEL AT ELEVATION 47.10 Map 73, Parcel 014 -T..•..� OVERLAY DISTRICT. � / � %;� r CRO55-SECTION OF GEOFLOW BED Marsh i 1 ' �� AP - Aquifer Protection District NOT TO SCALE CO SYSTEM SAND /� / i lr _1 /i i j _ , e ,,� FLOOD ZONE: a + -YNATURALLY OCCURRING iPERVIOUS MATERIAL = Zones A13(el=12),t INSPECTION PORT Community Panel No. NOT TO SCALE � Existing Drive ` _ -- -- - - - - --- - ,►IIL J 1992 _______. l 1 I � �/ `� ,, in this Area to i � � July 2, 018 D J AIL JIL be Abandoned ,►il� �II� ,'� ,'� j / j � � �.�� g � � ZONE. RF-1 I I i i CONSTRUCTION NOTES - - wood Pier , , o Area (min) 87, (RPOD) -- , - See SE3-1872 � , , , i I ,J _�� � � co Q'" ` 20 J 'n. 1 ____ Frontage (min) 20 1 .)ALL WORK SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE, TITLE 5 (3 10 CMR /��'/ ,'/ // Width (min) 125' 15.000): STANDARD REQUIREMENTS FOR THE SITING, CONSTRUCTION, INSPECTION, UPGRADE, �' / 1 ' ,' ,' l f' o i i I Setbacks: --' l t"00 S Fron t 30' D-Box AND EXPANSION OF ON-SITE SEWAGE TREATMENT AND DISPOSAL SYSTEMS AND FOR THE ,' / D:' r � � P1°0 S'6% \ I � OFFSET ADAPTSR TRANSPORT AND DISPOSAL OF 5EPTAGE, AND THE LOCAL BOARD OF HEALTH REGULATIONS. / I� / ' / G SO Side 15 / 2.) ANY SEPTIC SYSTEM COMPONENT INSTALLED IN A LOCATION WHERE THERE 15 POTENTIAL / ' 1 /l q� J NOT TO SCALE Rear 15' FOR VEHICLES OR HEAVY EQUIPMENT TO PA55 OVER IT SHALL BE DESIGNED TO WITHSTAND AN ,/ H-20 LOADING. IF UNDER AN IMPERVIOUS SURFACE, SYSTEM SHALL BE VENTED TO THE Parcel Area ' / ' i' i/ tk d ATMOSPHERE. / ,/ -- r k / / �s �rO' / �� 81,500±SF 1.87±AC / i ''►'w � '�-� � i �� OFFSET ADAPTER(TYP.) AIL 3.)TO MINIMIZE UNEVEN SETTLING, SEPTIC TANKS SHALL BE INSTALLED ON A STABLE To Mean Low Water MECHANICALLY-COMPACTED BASE ON SIX INCHES OF CRUSHED STONE. i i x /' Ratio to`be 7 l -� Removed 4J COVERS OVER THE INLET AND OUTLET TEES OF THE SEPTIC TANK,THE DISTRIBUTION BOX, / '/ .7 / ,' , ,' , , oot AND THE 501L ABSORPTION SYSTEM SHALL BE RAISED TO WITHIN G"OF FINAL GRADE. LEACHING AL /,� � , Cewp � j I FIELDS,TRENCHES, AND OTHER 501L ABSORPTION SYSTEMS WITHOUT ACCE55 MANHOLES cA0 4 /� i' ' ' ,' "1 Q`�ti�� J) p�A° roxrmate Location, of SHALL HAVE AT LEAST ONE(I) INSPECTION PORT CONSISTING OF PERFORATED 4" PVC PIPE i fxi5tin 5e tic Com onent5 to PLACED VERTICALLY TO THE BOTTOM OF THE SOIL ABSORPTION SYSTEM WITH A CAP, TIED WITH Q O I , i, i , �� g e P Lot 52 < .� �. (�� k, /„ be Removed(See Note#22) MAGNETIC MARKING TAPE, ACCESSIBLE TO WITHIN 3"OF FINAL GRADE. _ O co / % , J-J _ d 0.5' :' 0� Ia ,- ° :I (SEWN SEAM) Cesspools �c rEhs �dE 0.5' w to / 4o o q^ W �I' 5.) PIPING SHALL CONSIST OF 4"SCHEDULE 40 PVC OR EQUIVALENT. PIPE SHALL BE LAID ON A �} > 7 1 '`4' / Q (to b. m � m Ohs �aiss� o cD � 1 �Ilc r i ;, �bar►doned-See w Ora x/ b MINIMUM CONTINUOUS GRADE OF NOT LESS THAN 2% FROM THE BUILDING TO THE SEPTIC o ti (, Note 1 ���� ..� ��< 2� GEO GRID TANK, AND NOT LESS THAN I%OTHERWISE. tfl0 11 ` / �) o tv} o �� AL `L ON N 4 1� Lawn c ` s G.) DISTRIBUTION LINES FOR THE SOIL ABSORPTION SYSTEM SHALL BE 4" DIAMETIER SCHEDULE 1 5�u ,'y�t ' / ,r �4 ♦ m�o��" °i ° '�, GEO-TEXTILE FABRIC 40 PVC (OR EQUIVALENT) LAID AT 0.005 FT/FT. UNLE55 OTHERWISE NOTED. LINES SHALL BE �� ++,���i CAPPED AT END OR AS NOTED. 1 zoo / , n Cesspool Pilaou ,�� � n �\, Dries �. AI I (el.I I) li rl I CROSS SECTION 12„ 7.) LINES FROM THE DISTRIBUTION BOX TO BE LEVEL FOR THE FIRST TWO (2) FEET BEFORE �IIL / 1 on y PITCHING TO THE SOIL ABSORPTION SYSTEM. DISTRIBUTION BOX SHALL BE WATER TESTED TO , '/ / 1 1 e• i + Z e l r (NOT TO SCALE) ASSURE EVEN DISTRIBUTION. / 1� ' Putting Slab Lawn 1 /` ��� , • 7. J '� 5.)GROUT TO BE USED AT ALL POINTS WHERE PIPES ENTER OR LEAVE ALL CONCRETE ,' i Foundation - STRUCTURES IN ORDER TO PROVIDE A WATERTIGHT SEAL. ,� �� ` (to be A n; Removed) ,' *'' CORRUGATED 9.) HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS OF THE SEWAGE J� ' taw" 2a a '' ' +� PLASTIC PIPE v i chip 1P- , pr DISPOSAL FIELD DURING THE COURSE OF CONSTRUCTION OF THE SYSTEM. /V� - 0 10. IN ACCORDANCE WITH 3 10 CMR 15.22 I ALL SYSTEM COMPONENTS SHALL BE MARKED INSTALLER TO VERIFY THE LOCATION OF ALL / I AD5 GEOFLOW LEACHING SYSTEM WITH MAGNETIC MARKING TAPE. UNDERGROUND AND OVERHEAD UTILITIES __ _ __ .\ ,_ l l 'o o , - O �� `� ` �', - /' i i 11 ` / I 1 .)THERE ARE NO KNOWN WELLS WITHIN 100'OF THE PROPOSED SOIL ABSORPTION SYSTEM. PRIOR TO THE START OF ANY EXCAVATION NOT TO SCALE ACTIVITIES AND RELOCATE AS NECESSARY Lowe 12.) FROM THE DATE OF THE INSTALLATION OF THE SOIL ABSORPTION SYSTEM UNTIL RECEIPT OF (SEE NOTE #1 5) \`.,�� 1 R9. �� i' ° '/J A5TM C-33 SAND THE CERTIFICATE OF COMPLIANCE, THE PERIMETER SHALL BE STAKED AND FLAGGED TO PREVENT (SEE NOTE#2G) USE OF THE AREA THAT MAY CAUSE DAMAGE TO THE SYSTEM. `5�9�, gyp• ,1 11 Ora , �� / Lawn 13.) THE DESIGNER WILL NOT BE RESPONSIBLE FOR THE SYSTEM AS DESIGNED UNLE55 15. CONSTRUCTED AS SHOWN ON PLAN. ANY CHANGES SHALL BE APPROVED IN WRITING BY THE _ - /i f ADS GEOFLOW PIP Y TEM DE51GN CALCULATIONS - E C� C� _ _ DESIGNER. .J ..J - __ �� i i 1 / i �r'� i eh h\\I I 11Wt `� / / N OF 14.)THE BOARD OF HEALTH REQUIRES INSPECTION OF ALL CONSTRUCTION BY AN AGENT OF THE P 1 l l 11 I t r Pit / ` �� BOARD OF HEALTH AND THE DESIGNER. THE DESIGNER SHALL CERTIFY IN WRITING THAT THE SEWAGE DESIGN FLOW REQUIRED: 5 BEDROOM DWELLING @ I I 0 GPD/BEDROOM = 550 GPD ,� l l l / I ' r I i , 1 / SEWAGE DISPOSAL SYSTEM WAS INSTALLED IN ACCORDANCE WITH THE TERMS OF THE PERMIT ``" ���, it ,i j �� rr ( i 1 i / LINDA J. AND THE APPROVED PLANS. 48 HOURS ADVANCE NOTICE IS REQUESTED. TASK 1 : SEWAGE DE51GN FLOW PROVIDED: ONE(1) GEOFLOW BED WITH 250'OF PIPING IN 3 ROWS %9 1 1 �' 1 r 'moo INSPECTION PORTS SS, . PINTO of o 6�� / (UNDER REMEDIAL USE APPROVAL) �� d � r 1 , 1 i y�o � � r ; Ila 15.) LOCATION OF UTILITIES IS APPROXIMATE AND CONTRACTOR SHALL BE RESPONSIBLE FOR S G 6 DETERMINING THE LOCATION OF ALL UNDERGROUND AND OVERHEAD UTILITIES PRIOR TO 550 GPD/0.74 = 743.2 S.F. X O.G (GEOFLOW ALLOWABLE 40% REDUCTION - UNDER SPECIAL \\ r N •4 ' COMMENCEMENT OF ANY WORK. THIS INCLUDES, BUT 15 NOT LIMITED TO, REQUESTS TO CONDITIONS#3 AS SHOWN IN TABLE Ill PART B) = 44G.0 S.F. I \ 0 S¢r / Edge Of F 10 to T DIG5AFE, ANY PRIVATE UTILITY COMPANIES, AND THE LOCAL WATER DEPARTMENT. \I Oc Phragmit/es ' �07 ' 1 ' $TONAL 6N rt=� 5 BEDROOMS-CLASS ISOIL-2 MIN/INCH (FROM TABLE I) = 250 FT OF PIPING REQUIRED t I� (Approx Wetland Edge) I G.) CONTRACTOR SHALL VERIFY THAT ALL WASTELINES ARE CONNECTED BY WATER TESTING � 1 /a ,S \ 'i 990 �¢�; WITHIN THE DWELLING PRIOR TO INSTALLATION OF ANY SEPTIC COMPONENTS. I BED PROVIDED 85.5'x G' = 5 1 3 S.F. > 44G S.F. REQUIRED �+ S,i 6' N / , / G' VENT MANIFOLD 89 FT OF PIPING X 3 ROWS = 2G7 FT > 250 FT REQUIRED ' �N9yw \\ i i ( �, �,o� ` ,' Lot 94 PLAN VIEW (TYP.) 17.)CONTRACTOR SHALL VERIFY EXISTING INVERT ELEVATIONS PRIOR TO INSTALLATION OF ANY 31 O� ^�S SEPTIC SYSTEM COMPONENTS. w O p 6d \ , , @ of i i TASK 2: SAND BED TO HAVE NO SLOPE co , o _ SCALE: I" = 10' s I �Clli/91rip'o� i ��N II rD c 8.) INSTRUMENT SURVEY CONDUCTED FOR PROPOSED WORK ONLY. 51TE PLAN SHALL NOT BE TASK 3: MINIMUM CENTER TO CENTER PIPE SPACING = 1 .5 FT(1 .5 FT PROVIDED) 9 , \ I i I , o 1 q 01 Gravel USED FOR STAKING, OR ANY OTHER PURPOSES. �' s0 ^�° ' of i I 1 I Ddw SEPTIC TANK CAPACITY REQUIRED: 550 GPD X 200% = 1 100 GALLON REQUIRED11 , *� o\�0 1 LEGEND. y y 19.)THIS PLAN DOES NOT CERTIFY, GUARANTEE OR WARRANTY COMPLIANCE WITH DEEDED OR SEPTIC TANK CAPACITY PROVIDED: 1500 GALLON SEPTIC TANK -�-� \ o I i i I \ o I Serve Work b ZONING BYLAWS, SPECIFICALLY, BUT NOT LIMITED TO, 51DELINE SETBACKS AND BUILDING HEIGHT m 1 I ` CapeSu ry RESTRICTIONS. OWNER IS RESPONSIBLE FOR OBTAININGINo SUCH A DETERMINATION FROM THE A GARBAGE DISPOSAL IS NOT PERMITTED WITH THIS DESIGN FLOW - '� �' �i i i I 1 `- Lot 93 ` APPROPRIATE AUTHORITY. 7j �o� \ II II O \\ d 7 / EXISTING SPOT GRADE Cedar Tree 7 Parker Road o \ 1 , �Fol / 24x5 PROPOSED SPOT GRADE Ostervllle MA 02655 20.) IF SOILS DIFFER FROM TH05E SHOWN IN THE SOILS LOGS, DESIGN ENGINEER 15 TO C� C� ��j - - ` I - - EXISTING CONTOUR INSPECT THE SOILS PRIOR TO PROCEEDING WITH INSTALLATION. TEST HOLE LOGS ' t 11 II ` �$/ •/_ _- \ I W ,b 24- PROPOSED CONTOUR (508)420-3994/420-3995fax 2 1 .) EXISTING SEPTIC COMPONENTS TO BE LOCATED, PUMPED DRY, FILLED WITH CLEAN SAND VARIANCES REQUESTED _ t1 it I I + o / W WATER SERVICE LINE Holly Tree AND ABANDONED IN PLACE. AREA TO BE COMPACTED TO MINIMIZE SETTLING. + Local Upgrade Approva(s. 31 0 CMR 15.403 1 ' I 1 p �V Q O l oHw- OVERHEAD WIRES Test Hole#I (EL=13.0_) �� I 1 } �' � � . �` O %j c GAS SERVICE LINE 22.) EXISTING SEPTIC COMPONENTS TO BE REMOVED. ANY CONTAMINATED SOIL SHALL BE Variances: 3 10 CMR 1 5.2 1 1 Minimum Setback Distances: I I 1 Depth Layer Soil Class Soil Color Comments ---___ , , �� \ ���� W REMOVED FOR A DISTANCE OF FIVE(5) FEET LATERALLY FROM THE SOIL ABSORPTION SYSTEM _ -� \ p �� EDGE OF CLEARING REVISION 05l04/13: Added Inspection Access, documentation AND REPLACED WITH CLEAN SAND. AREA TO BE COMPACTED TO MINIMIZE SETTLING. 1 .) Soil Absorption System not 50'from NW Coastal Bank: -I i it \ \� \� ���\�- _ I ---�-�- FENCE �{ Deciduous Tree 0"-18" Ap Fine-Medium Sandy Loam �OYR 3/2 _ 18"-32" B Medium Loamy Sand I OYR 4/G 40' Held I O' Variance Requested ___ I ; 1� �� TEST HOLE LOCATION Prepared for: 24.) FOR PRODUCT INFORMATION OR THE NEAREST DEALER CONTACT ADS AT: 32"-1 30" Cl Fine-Medium Sand I OYR 5/4 Perc @ 45" `� \ ��� t p�� CAPE COD WINWATER 2.) Sod Absorption System not 50'from SE Coastal Bank: I �� �� �\ \� O ST SEPTIC TANK Woollard Builders LLC 174 AIRPORT ROAD 15' Held 35'Variance Requested I \ \ �� --�_ o ' HYANNIS, MA 02G01 I \ \ , _ \ `,� \ �`\ \ DB DISTRIBUTION BOX I � � � � o\\ Coniferous Tree 71 Sand Point, Osterville, MA (508)SG2-01 GG I \ \ ,\ o SAS SOIL ABSORPTION SYSTEM Test Hole#2 Variances: Town of Barnstable Regulations: `� `� `� \ Proposed Sewage D15p05al System 25.) DESIGN ENGINEER AND INSTALLER SHALL BE TRAINED AND CERTIFIED BY ADS. (EL= 13.2±) \ -�•�-�, Depth Layer Sod Class Sod Color Comments 3J Septic Tank not 00'from NW Coastal Bank: �� �"� �� �� �� ��` 7 1 Sand Point, O5terville, MA 2G.) MINIMUM OF G OF MEDIUM TO COARSE SAND WITH LESS THAN 2%PASSING A# 200 p y 59' Held 4 I' Variance Requested v: to \ 51EVE REQUIRED AROUND CIRCUMFERENCE OF ADS PIPES. (SEE DE51GN AND INSTALLATION 0"-1 5" Ap Fine-Medium Sandy Loam I OYR 3/2 I CERTIFY THAT I AM CURRENTLY APPROVED BY THE tea+. ' �� `� �� Prepared by: MANUAL FOR COMPLETE SAND AND FILL SPECIFICATIONS) THE SAND SURROUNDING THE ADS 4.) Septic Tank not 100'from 5E Coastal Bank: DEPARTMENT OF ENVIRONMENTAL PROTECTION PURSUANT TO �\ a 15 -24" B Medium Loamy Sand I OYR 4/G 43' Held 57" Variance Re uested 310 CMR 1 5.01 7 TO CONDUCT 501L EVALUATIONS AND THAT 0' ° 20 Rascally Rabbit Road PIPE SHALL MEET ASTM C-33. q \ \ \ \ SITE PLAN Marstons Mills,MA 24"-130' C I Fine-Medium Sand I OYR 5/4 THE SOIL ANALY515 HAS BEEN PERFORMED BY ME CON515TENT y ��rr \� \� +'� \� \� `\ \ Zone q/) 02648 4SN 27.) WATER/5EWER CROSSING: 4" PVC WASTELINE SHALL BE SLEEVED IN A SECTION OF G"PVC 5.) Soil Absorption System not 100'from NW Coastal Bank: WITH THE REQUIRED TRAINING, EXPERTISE, AND EXPERIENCE (e� PIPE CENTERED OVER THE WATER LINE TO MAXIMIZE DISTANCE TO JOINTS. WATER LINE SHALL BE 40' Held GO' Variance Requested DESCRIBED IN 3 10 CMR 1 5.01 7. 1 FURTHER CERTIFY THAT THE �� �� C \/� �,��� SLEEVED IN A SECTION OF PVC PIPE WHEN WITHIN TEN (1 0) FT OF ANY SEPTIC COMPONENT OR RESULTS OF MY SOIL EVALUATION AS INDICATED ON THE �^ SCALE: I" = 20' ���►,, Lr l'It�ll1E'G'Yl a WASTELINE. DATE OF TESTING: 03/25/1 3 G.) Sod Absorption System not 100'from 5E Coastal Bank: ATTACHED SOIL EVALUATION FORM, ARE ACCURATE AND IN \ �'I -'-'- 501L EVALUATOR: LINDA J. PINTO, P.E., C5N ENGINEERING 1 5' Held 85'Variance Requested ACCORDANCE WITH 3 10 CMR 15.100 THROUGH 1 5.107 BOARD OF HEALTH AGENT: DON DESMARAIS, BARNSTABLE HEALTH DEPARTMENT O 2O 4O 6O INSPECTION NOTE: � � � "- - PERCOLATION RATE: LE55 THAN 2 MIN/INCH IN "C" LAYER 7.) Soil Absorption System not 100'from Edge of Wetland: o. - P.O.Box2030 Phone:(508)299-3250 PRIOR TO FINAL INSPECTION BY THE ENGINEER, SYSTEM 97' Held 3' Variance Requested a T� �- i (� SCALE 1 "=20' A. M. Wilson Associates Inc. Teaticket,MA 02536 Fax:(508)548-5478 NEEDS TO BE COMPLETE INCLUDING BUILDUP FOR COVERS. NO GROUNDWATER ENCOUNTERED Linda J. Pinto, Certified Soil Evaluator C:\CSN\AW-Sand Point\AW-Sand Point-SDS Plan.dwg 508 420 9792/ FAX 420 9795 Date: 04/30/13 1 Scale: As Shown I By: UP Check: MTA I Project No. C5N0324 TOP Of FOUNDATION 24"diameter concrete covers EL=14.1± raised to within C'of firn5h grade Inspection Port and cap with magnetic ROOF VENT (ora5 noted) I LOW VENTAl B4a I)Ila marking tape to within 3 of grade �; e Q(") j =ti U Q W �9 2%5LOPE(MIN.) I EL=13.4(min) EL=/3.5+ FL=12.5+-/3.7± 1 10' MIN. "z o *� �k is r, �. .. u •>' o II 12.5_ I SEPTIC TANK 1 D-BOX 7 ) l2 /+ 11.50 A05 PIPE VENT THROUGH D-BOX BACK TO OFFSET ADAPTER l 1.25 //.00 O lO.B3 A AN SEPTIC TANK TO UTILIZE ROOF VENT • ' �u>yIPC .� 7 y �,,, ,.. Ex�stmg _ � � N /0.27 .. .,. I I Z Ga5 Baffle �.� N • - -rt d64 •• Jk BOTTOM ENTER/OR OFADS � Marsh N PIPE TO BE 5ETLfV5LAT �.O'} �- - o DIFFERENTIAL VENTING DETAIL �. 7P. a 1 l.a. •. 4 Longe�tRun ELEVAT/ON9.60 I�IL y� �� NOT TO SCALE tt �� f a •. � R ` r o• ---� �- EL=2./+Bottom of Test Hole I �.� _ Tirtls r i. .• o PROPOSED /500 GALLON DO `�' x. e • ` (r1-20 RATED) (iH-20 Rated) ONE BEO WITH 250 LF OF PIPE I Pt / 1 m G.0' Handy U di .. '7 4. f "land 6fof�ow 5�s0*41 I i i 4.0' f1 Pt •„+ d0 :'��' �>�~:� '` .. r '` 5EPTIC TANK o-25oX , 1 r , FINAL GRADE l FLOW PROFILE os ; / I ' v / �� �, � 1 .5' 1 .5' NOT TO SCALE / /l \ SAND o SITE LO C U 5 O NOTES: NUMBER OF ADS LINES PER BED:3 NOT TO SCALE 4"0 PERFORATED INSPECTION PORT TO BOTTOM OF ` / / \ / 1 / /' ",'i'i CENTER TO CENTER SPACING: 1.5' SYSTEM SAND AND THREADED CAP WITHIN 3"OF FINAL O GRADE.WRAP PIPE WITH PERMEABLE GEOTEXTILE \ \ � / ,, i' ,, �� �� � '_ -- - -� ---' '�' Cv\ Top Of Coastal Bank FABRIC TO ELIMINATE SAND INFILTRATION. / , / ,' �' ,' \`� ���_ �` ' ���/ By TOB Definition 0.5' I .0' 0.5' ' ASSESSORS REF. : \ �� ADS GEOFLOW PIPE OUTSIDE BOTTOM OF ADS GEOFLOW PIPE TO / / i',' ,' i' `� - y BE LAID LEVEL AT ELEVATION 47.10 Map 73, Parcel 014 '� OVERLAY DISTRICT: e•T t r CR055-SECTION OF GEOFLOW BED AP - Aquifer Protection District .� I NOT TO SCALE j� AL SYSTEM SANO� / , - v / _ FLOOD ZONE: NATURALLY OCCURRING PERVIOUS MATERIAL'; \ / ,� / ' t i I i ' 4 = Zones A13(el=12), to of ma s ike A 11(el.=11), B & C INSPECTION PORT _ - - - - - I Community Panel No. \ / �� , � � /i'' � \� \\t \\�� �...� 40,J Existing Drive NOT TO SCALE / / i \ #2 July 2, 1992 018 D m this Area to / /, be Abandoned ,� / // J� / \ AL ,� , �a ZONE: RF-1 CONSTRUCTION NOTES wood Pier r: o4�o ;, ( 87,120 ( ) See SE3-1572 Area min. 87120 RPOD Frontage (min) 20 1 .)ALL WORK SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE,TITLE 5 (3 10 CMR l/lam' �, //' /' '' \ Width (min) 125' 1 5.000): STANDARD REQUIREMENTS FOR THE SITING, CONSTRUCTION, INSPECTION, UPGRADE, Setbacks: c. �/ AND EXPAN510N OF ON-SITE SEWAGE TREATMENT AND DISPOSAL SYSTEMS AND FOR THE / j r / / � os��,,,� ' , � OFFSET ADAPTER Slde t15�' D BOX �' l i // , �` -✓ pto!'tM� bra TRANSPORT AND DISPOSAL OF SEPTAGE, AND THE LOCAL BOARD OF HEALTH REGULATIONS. / / , / / O, - 2.) ANY SEPTIC SYSTEM COMPONENT INSTALLED IN A LOCATION WHERE THERE 15 POTENTIAL AL '' / Rear 15' �� NOT TO SCALE FOR VEHICLES OR HEAVY EQUIPMENT TO PASS OVER IT SHALL BE DESIGNED TO WITHSTAND AN AL H-20 LOADING. IF UNDER AN IMPERVIOUS SURFACE, SYSTEM SHALL BE VENTED TO THE Partiel Area ATMOSPHERE. / �i / s G. �, AL 81,5001SF 1.87±AC OFFSET ADAPTER(TYP.) 3.)TO MINIMIZE UNEVEN SETTLING, SEPTIC TANKS SHALL BE INSTALLED ON A STABLE To Mean Low Water MECHANICALLY-COMPACTED BASE ON 51X INCHES OF CRUSHED STONE. ,� \ Existing / Patio to be / r� 4.) COVERS OVER THE INLET AND OUTLET TEES OF THE SEPTIC TANK, THE DISTRIBUTION BOX, Removed .� AND THE SOIL ABSORPTION SYSTEM SHALL BE RAISED TO WITHIN G"OF FINAL GRADE. LEACHING '�' FIELDS, TRENCHES, AND OTHER 501L ABSORPTION SYSTEMS WITHOUT ACCE55 MANHOLES N 04 / �J /'� tMd� N �� / A roximate Location of SHALL HAVE AT LEAST ONE (1) INSPECTION PORT CONSISTING OF PERFORATED 4" PVC PIPE Lp %� (� ? ' 1 �* -� pG ,J ��., ♦ \ i .Existing Septic Components to PLACED VERTICALLY TO THE BOTTOM OF THE 501L ABSORPTION SYSTEM WITH A CAP,TIED WITH 4 ON / y/ < J i I ,l 1t y {� . P �, be Removed(See Note#22) Lot 52 MAGNETIC MARKING TAPE, ACCESSIBLE TO WITHIN 3"OF FINAL GRADE. _ - o�E 0.5' J A o ' 0� .� (SEWN SEAM) Qaw\ Cesspools �c c / O' Ehs��a\. 0.5' 5J PIPING SHALL CONSIST OF 4" SCHEDULE 40 PVC OR EQUIVALENT. PIPE SHALL BE LAID ON A v� �� N' ( '-"} (to be MINIMUM AND NOOTILESOSUTHANAIDE Of%OTHEORWISES THAN 2% FROM THE BUILDING TO THE SEPTIC ° *� (, Nots 1 0. o ����. L - Mi l /S WE� 2� GEO GRID o AL S ( Abandoned-Sse p � a }. AL `r PI) F o do s, � � � � �,' - Lown a a o 0 � . , _ G.) DISTRIBUTION LINES FOR THE SOIL ABSORPTION SYSTEM SHALL BE 4" DIAMETER SCHEDULE ✓ O S� u a' e °i I I / GEO-TEXTILE FABRIC 40 PVC (OR EQUIVALENT) LAID AT 0.005 FT/FT. UNLESS OTHERWISE NOTED. LINES SHALL BE r CAPPED AT END OR AS NOTED. 111 A PO '� co a Paved 1 � cp - DrPoe A I I (el• % , rt 1 I CROSS SECTION 12rr 7.) LINES FROM THE DISTRIBUTION BOX TO BE LEVEL FOR THE FIRST TWO (2) FEET BEFORE A � �) � s• ; �,, /�. Zone � , ✓ (NOT TO SCALE PITCHING TO THE 501L ABSORPTION SYSTEM. DISTRIBUTION BOX SHALL BE WATER TESTED TO > J rf ?' 10 AL ) ASSURE EVEN DISTRIBUTION. l Slab 8.) GROUT TO BE USED AT ALL POINTS WHERE PIPES ENTER OR LEAVE ALL CONCRETE .'' ��0°n Foundation ' • t " °\ STRUCTURES IN ORDER TO PROVIDE A WATERTIGHT SEAL. (to be lQ� ,� / i 1 AL f Removed) � �.; � r � CORRUGATED i, Lawn -00 y ,' O �` PLASTIC PIPE 9.) HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS OF THE SEWAGE 7a 7P- a / or DISPOSAL FIELD DURING THE COURSE OF CONSTRUCTION OF THE SYSTEM. 10.) IN ACCORDANCE WITH 3 10 CMR 15.22 I, ALL SYSTEM COMPONENTS SHALL BE MARKED INSTALLER TO VERIFY THE LOCATION OF ALL � � \ \� `� � � i � � p � � ADS G EO FLOW LEACHING SYSTEM WITH MAGNETIC MARKING TAPE. UNDERGROUND AND OVERHEAD UTILITIES , . \ ��\��\ r���-- ,_i // °� o ♦ti�o� O PRIOR TO THE START OF ANY EXCAVATION ��' ` NOT TO SCALE I 1 .)THERE ARE NO KNOWN WELLS WITHIN 100'OF THE PROPOSED SOIL ABSORPTION SYSTEM. � � i' / l / i �- � ACTIVITIES AND RELOCATE AS NECESSARY �� ,' l � ' ! i � � F �� vi Lawn / �c e rA / 12.) FROM THE DATE OF THE INSTALLATION OF THE 501L ABSORPTION SYSTEM UNTIL RECEIPT Of (SEE NOTE #1 5) �' , / l I �. i ASTM C-33 SAND THE CERTIFICATE OF COMPLIANCE, THE PERIMETER SHALL BE STAKED AND FLAGGED TO PREVENT �9a+ t l ,l , 1^ -, �, r' /� >>' ,. a. �aA, / (SEE NOTE#2G) USE OF THE AREA THAT MAY CAUSE DAMAGE TO THE SYSTEM. s9� �O• l ,l �e // i' iO� wp / Lawn 13.) THE DESIGNER WILL NOT BE RESPONSIBLE FOR THE SYSTEM AS DESIGNED UNLESS ��� / I / / CONSTRUCTED AS SHOWN ON PLAN. ANY CHANGES SHALL BE APPROVED IN WRITING BY THE ,l l l ,l r i/ i' \ �� / ADS GEOFLOW PIPE SYSTEM DE51GN CALCULATIONS , , DESIGNER. 14.)THE BOARD OF HEALTH REQUIRES INSPECTION OF ALL CONSTRUCTION BY AN AGENT OF THE `h P ,l i C 1 1 �1 j Well ASH OFq�s BOARD OF HEALTH AND THE DESIGNER. THE DESIGNER SHALL CERTIFY IN WRITING THAT THE SEWAGE DESIGN FLOW REQUIRED: 5 BEDROOM DWELLING @ I 10 GPD/BEDROOM = 550 GPD .t1 S. SEWAGE DISPOSAL SYSTEM WAS INSTALLED IN ACCORDANCE WITH THE TERMS OF THE PERMIT `� �� � ' / � L1ND 1cs AND THE APPROVED PLANS. 48 HOURS ADVANCE NOTICE IS REQUESTED, TASK 1 : SEWAGE DESIGN FLOW PROVIDED: ONE(1) GEOFLOW BED WITH 250' OF PIPING IN 3 ROWS %��� �' cos PINJ. INSPECTION PORTS (UNDER REMEDIAL USE APPROVAL) `9�s dG y�°i` v6i�Sp, CrO 15.) LOCATION OF UTILITIES 15 APPROXIMATE AND CONTRACTOR SHALL BE RESPONSIBLE FOR DETERMINING THE LOCATION OF ALL UNDERGROUND AND OVERHEAD UTILITIES PRIOR TO 550 GPD/0.74 = 743.2 S.F. X O.G (GEOFLOW ALLOWABLE 40% REDUCTION - UNDER SPECIAL I COMMENCEMENT OF ANY WORK. THIS INCLUDES, BUT IS NOT LIMITED TO, REQUESTS TO CONDITIONS#3 AS SHOWN IN TABLE III PART B) = 44G.0 S.F. \ Q Edge Of l o,� G �Q I O DIG5AFE, ANY PRIVATE UTILITY COMPANIES, AND THE LOCAL WATER DEPARTMENT. \ OC ^i�, �� / t ' t / Phragmltles Fs �STE a� _ 5 BEDROOMS-CLASS ISOIL-2 MIN/INCH (FROM TABLE I) = 250 FT OF PIPING REQUIRED \ �we ��o '' i t (Approx Wetland Edge) s/pkAL EpG� 1 G.)CONTRACTOR SHALL VERIFY THAT ALL WA5TELINE5 ARE CONNECTED BY WATER TESTING ' G�%O, rs \\ WITHIN THE DWELLING PRIOR TO INSTALLATION OF ANY SEPTIC COMPONENTS. I BED PROVIDED 85.5'x G' = 5 13 S.F. > 44G S.F. REQUIRED o ' �i� \ 6"O CoO, / 1 , I 6 VENT MANIFOLD W -� 89 FT OF PIPING X 3 ROWS = 2G7 FT > 250 FT REQUIRED N s�ON 9,Q�Ldq \ J / ` i I i I �,o ` Lot 94 PLAN VIEW (TYP.) 17.)CONTRACTOR SHALL VERIFY EXISTING INVERT ELEVATIONS PRIOR TO INSTALLATION OF ANY �► i SEPTIC SYSTEM COMPONENTS. TASK 2: SAND BED TO HAVE NO SLOPE �„ c'o OCd of j c, ' /% �� s m I �i I i \ SCALE: I " = 10' .. I 15.) INSTRUMENT SURVEY CONDUCTED FOR PROPOSED WORK ONLY. SITE PLAN SHALL NOT BE TASK 3: MINIMUM CENTER TO CENTER PIPE SPACING = 1 .5 FT(I .5 FT PROVIDED) ` 1 Cti T990,O� / \ ��� _ N1 1GroveI USED FOR STAKING, OR ANY OTHER PURPOSES. �' 1 ^�° \\ o I �' I i 1e ` SEPTIC TANK CAPACITY REQUIRED: 550 GPD X 200% = 1 100 GALLON REQUIRED ' -J �' \ U_ Ni i 1 / 1 19.)THIS PLAN DOES NOT CERTIFY, GUARANTEE OR WARRANTY COMPLIANCE WITH DEEDED OR SEPTIC TANK CAPACITY PROVIDED: 1 500 GALLON SEPTIC TANK -� \ o N jorA , LEGEND. Survey Work by: ZONING BYLAWS, SPECIFICALLY, BUT NOT LIMITED TO, SIDELINE SETBACKS AND BUILDING HEIGHT m \ r `, RESTRICTIONS. OWNER 15 RESPONSIBLE FOR OBTAINING SUCH A DETERMINATION FROM THE A GARBAGE DISPOSAL IS NOT PERMITTED WITH TH15 DESIGN FLOW \ t- ° I I V apes u r V > O O jr \ = I I tl �- 8 � N Cedar Tree 7 Parker Road APPROPRIATE AUTHORITY. Lot 93 % 24 5 EXISTING SPOT GRADE 20.) IF SOILS DIFFER FROM TH05E SHOWN IN THE SOILS LOGS, DESIGN ENGINEER 15 TO C� •2j �_� ! t t I ,�Fo / PROPOSED SPOT GRADE 05terville MA 02G55 INSPECT THE SOILS PRIOR TO PROCEEDING WITH INSTALLATION. TEST HOLE LOGS , tt ti moo/ / EXISTING CONTOUR VARIANCES REQUE5TED �' ` tt I W t ,b 24- PROPOSED CONTOUR (508)420-3994/420-3995fax 21.) EXISTING SEPTIC COMPONENTS TO BE LOCATED, PUMPED DRY, FILLED WITH CLEAN SAND - --__ l t t + W WATER SERVICE LINE holly Tree AND ABANDONED IN PLACE. AREA TO BE COMPACTED TO MINIMIZE SETTLING. Test Hole#I (EL= 13.0t) Local Upgrade Approvals: 3 10 CMR 15.403 `�t II it it OHW- OVERHEAD WIRES 22.) EXISTING SEPTIC COMPONENTS TO BE REMOVED. ANY CONTAMINATED 501E SHALL BE Variances: 310 CMR 15.21 1 Minimum Setback Distances: \ tl it tt t ` �� \�'`---- ;N G GAS SERVICE LINE Depth Layer Soil Class Soil Color Comments REMOVED FOR A DISTANCE OF FIVE(5) FEET LATERALLY FROM THE 501L ABSORPTION SYSTEM i t p I EDGE OF CLEARING REV1510N 05/04/1 3: Added Inspection Access, documentation AND REPLACED WITH CLEAN SAND. AREA TO BE COMPACTED TO MINIMIZE SETTLING. 1 .) Soil Absorption System not 50' from NW Coastal Bank: i t 0'-18" Ap fine-Medium Sandy Loam I OYR 3/2 � � ------ ""'""""'� FENCE �{ Deciduous Tree 18"-32" B Medium Loamy Sand I OYR 4/G 40' Held 0' Variance Requested ' t\ �\ � t ��� Z n' 24.) FOR PRODUCT INFORMATION OR THE NEAREST DEALER CONTACT ADS AT: 32"-1 30" CI Fine-Medium Sand I OYR 5/4 Perc @ 45" ` p TEST HOLE LOCATION Prepared for: CAPE COD WINWATER 2.) Soil Absorption System not 50'from 5E Coastal Bank: \�\ \�� \�� `-`3 �� \� �� \ `----- \gip 5T SEPTIC TANK 174 AIRPORT ROAD 1 5' Held 35' Variance Requested ` �� DB DISTRIBUTION BOX HYANNIS, MA 02G01 \ \ \ '•, \ \ \ \ \\ o WOollard Builders, LLC (508)8G2-01 GG ` o� Coniferous Tree 7 I Sand Point, 05terville, MA sAs SOIL ABSORPTION SYSTEM Variances: Town of Barnstable Regulations: \ \ \ \ \\ \ V 25.) DESIGN ENGINEER AND INSTALLER SHALL BE TRAINED AND CERTIFIED BY ADS. Test Hole#2 (EL= 1 3.2±) Proposed Sewage Disposal System 3.) Septic Tank not 100'from NW Coastal Bank: S� �r �� �� •7 1 Sand Point, 05terville, MA 2G.) MINIMUM OF G"OF MEDIUM TO COARSE SAND WITH LESS THAN 2% PASSING A# 200 Depth Layer Soil Class Soil Color Comments 59' Held 4 1' Variance Requested v'a 'eat. �\ `, \ SIEVE REQUIRED AROUND CIRCUMFERENCE OF ADS PIPES. (SEE DE51GN AND INSTALLATION 1 CERTIFY THAT I AM CURRENTLY APPROVED BY THE 6+. Prepared by: 0"-15" Ap Fine-Medium Sandy Loam I OYR 3/2 p � � � � � 3 MANUAL FOR COMPLETE SAND AND FILL SPECIFICATIONS) THE SAND SURROUNDING THE ADS 4.) Septic Tank not 100'from SE Coastal Bank: DEPARTMENT OF ENVIRONMENTAL PROTECTION PURSUANT TO O \ r 15'-24" B Medium Loam Sand I OYR 4/G15.017 0 20 RascallyRabbit Road PIPE SHALL MEET A5TM C-33. y 43' Held 57"Variance Requested 3 10 CMR TO CONDUCT 501L EVALUATIONS AND THAT \ 24"-130" C I Fine-Medium Sand I OYR 5/4 THE SOIL ANALYSIS HAS BEEN PERFORMED BY ME CONSISTENT � � � � � done Marstons Mills,MA 5.) Soil Absor tion S stem not 100'from NW Coastal Bank: WITH THE REQUIRED TRAINING, EXPERTISE, AND EXPERIENCE A// SITE PLAN 02648 �e71Y , 27.) WATEWSEWER CROSSING: 4" PVC WASTELINE SHALL BE SLEEVED IN A SECTION OF G" PVC P Y �% PIPE CENTERED OVER THE WATER LINE TO MAXIMIZE DISTANCE TO JOINTS. WATER LINE SHALL BE 40' Held GO' Variance Requested DESCRIBED IN 3 10 CMR 1 5.0 1 7. 1 FURTHER CERTIFY THAT THE �� \ �� C \�� M SLEEVED IN A SECTION OF PVC PIPE WHEN WITHIN TEN (1 0) FT OF ANY SEPTIC COMPONENT OR RESULTS OF MY 501L EVALUATION AS INDICATED ON THE �� SCALE: 1 " = 20' /�►�� ' WASTELINE. DATE OF TESTING: 03/25/1 3 G.) Soil Absorption System not 100'from SE Coastal Bank: ATTACHED SOIL EVALUATION FORM, ARE ACCURATE AND IN hi � � Engineering SOIL EVALUATOR: LINDA J. PINTO, P.E., C5N ENGINEERING 15' Held (55'Variance Requested ACCORDANCE WITH 3 10 CMR 15.100 THROUGH 15.107 \� BOARD OF HEALTH AGENT: DON DE5M,\ INSPECTION NOTE: RAI5, BARNSTABLE HEALTH DEPARTMENT 0 20 40 60 PERCOLATION RATE: LE55 THAN 2 MIN/INCH IN "C" LAYER 7.) Soil Absorption System not 100'from Edge of Wetland: \ t P.O.Box2030 Phone:(508)299-3250 97 Held 3'Variance Requested ° A. M. Wilson Associates Inc. Teaticket,M1I02536 Fax:(508)548-5478 PRIOR TO FINAL INSPECTION BY THE ENGINEER, SYSTEM NO GROUNDWATER ENCOUNTERED ( SCALE I =2O NEEDS TO BE COMPLETE INCLUDING BUILDUP FOR COVERS. Linda I Pinto, Certified Soil Evaluator C:\C5N\AW-5and POlnt\AW-Sand Point-5D5 Plan.dwg 508 420 9792/FAX 420 9795 Date: 04/30/1 3 1 Scale: As Shown I BY: LJP Check: MTA I Project No. C5N0324