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0890 SEA VIEW AVENUE - Health
890 Seaview Aveo'ej ` Osterville A= 090-002-001 1 No. c -- Fee 45 / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: i/ PUBLIC HEALTH DIVISION - TOWN OF PARNSTABLE, MASSACHUSETTS Yes 2ppliLation for Misposal 6petem Construction Permit Application for a Permit to Construct V Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 8 CID Secw`,2.tk) &1194 Owners Name,Address,and Tel.No. . ' 'T hOuv)a S 4 knne Assessor's Map/Parcel ��© �a ©6 „ 1�r I 1 Z _PjOC4c5 K,A s i>n -jA o c?3 Installer's Name,Address,and Tel.No.R.'S. 6Qv kCkC_*G Desi ner's Name,Address,and Tel.No. �oY�S UG+it3Yl S 2 K i 1S uaaL /woe u9;c�� �1G n gam, .+�, J-v,c .!2SS q Crz,n 6"tk,r , MA- 02-563 021S3 l 570-9-2.1303 I)rpe of Building: Dwelling No.of Bedrooms Lot Size g 06l2S sq.ft. Garbage Grinder( ) Other Type of Building S%-.!2,91P TCtm, H No.of Persons Showers( ) Cafeteria( ) Other Fixtures J l Design Flow(min.required) gpd Design flow provided �o `y gpd Plan Date Number of sheets Revision Date Title 1 \ Size of Septic Tank a +, Type of S.A.S. —1500( Description of Soil �;)kf—c Nature of Repairs or Alterations(Answer when applicable) Asti 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 Environm Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued a l l /'K ' No. U ^� gf r y Fee !t /O THE COMMONWEALTH OF ASSACHUSETTS Entered in computer: Y L/ PUBLIC HEALTH DIVISION - TOWNV < 4_. RNSTABLE,, MASSACHUSETTS Yes r i � , 0[pplitatlon' for 33I0"posal �pstem tonstrULtion Permit Application for a Permit to Construct( Repair( ) Upgrade( )� Abandon(r ) ❑Complete System ❑Individual Components Location Address or Lot No. 9 CID cS�c2c 0•,.0 o ►k,�h Owner's Name,Address,and Tel.No._, t'�,- c_ t✓n-,e Assessor's Ma /Parcel p ��� CYJa Oa J . � �� t`{G= .,Ct�`:it.ttl �1' , d� `•, .> > �i�' �Z��? Installer's Name,Address,and Tel.No. 0 5, 6e v��CtC quc� Designer's Name,Address,and Tel.No. �cn 4vc�c hcm i 2 K i�I�Sh2 �( e t/ 0 Z ^ 6'3 f U s 9 �W 2-'7 Z -rl Type of Building: Dwelling No.of Bedrooms ,,; n. k Lot Size y S (r((n S sq.ft. Garbage Grinder( ) 4 Other Type of Building �_,Wl lr 76- 1.);✓'�� No.of Persons Showers( ) Cafeteria( ) Other Fixtures v 1 Design Flow(min.required) gpd Design flow provided �Q � gpd Plan Date Number'of sheets Revision Date r Title Size of Septic Tank c?_000 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: f n Agreement: F The undersigned agrees to ensure the const�ruction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Envi�ronme Code and not to place the system in operation until a Certifi ate of Compliance has been issued by this Board of Health Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. �J '� 3 Date Issued oZ ------ ---------------------------------------------------------- --------------------------------------------------------- THE COMMONWEALTH OF•MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed((, Repaired( ) Upgraded( ) Abandoned( )by ✓ (A.f ` 1 at t7 Se nr;&W �,VP (ui i(,o, -"iri 01-6S,� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Now/5 -G 3 adated 1 3 h 5 Installer Designer #bedrooms -77 Approved design flow gpd The issuance oft is permit shall not be construed as a guarantee that the system willPnctin designed. Date pp �� i Inspector U�- No. 'I — 3�- Fee S THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct Repair( ) Upgrade( ) Abandon( ) System located at cj t� � ,;2,,� jP. ":_ - I Ci + j A %) ,-(9 S and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must a comp eted within three years of the date of this pe it. Date Approved by TOWN OF BARNSTABLE LOCATIO V M ASEWAGE# 'VILLAGE ASSESSOR'S MAP&PARCE D� INSTALLER'S NAME.&PHONE NO \Dueiw�r, SEPTIC T`AN�K CAPACITY 2®®� � o LEACHING FACILITY:(type) X t® (size) NO.OF BEDROOMS OWNER l PERMIT DATE: 2_—Ii COMPLIANCE DATE: 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 2- t I �_ gq° AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATTO �Caw SEWAGE# 2 VILLAG ASSESSOR'S MAP&PARCE 0� INSTALLER'S NAME&PHONE NO • V ��pp��-83 ,y�lq SEP'1'1Ij�V�y C'CANK APACITY Z o 0O LEACHING FACILITY:(type) X (size), - NO,OF BEDROOMS OWNER lI A PERMIT DATE: - 15 COMPLIANCE DATE: 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 Of any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY u. 3 5— U I " o 2 1 I y http://issgl2/intranet/Propdata/prebuilt.aspx?mappar=090002001&seq=2 7/6/2018 f 04/22/2015 03AG 5082730387 <`- #3871 P. 001/001 T. "down of Barnstable Regulatory Services Thomas F.Geiler,Director ��•��� •MA Public Health Division NS. °rso'r 10. Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office; 508.862-4644 Fax: 508-790-6304 Date: Sewage Permit# V '�)- Assessor's Map/Parcel oaf .qa Installer&Desianer Certification Form Designer- -SC• EnKtreectn T-Oc:. Installer: g � — Address: 285H ccanher 14iq,hwa./ Address- Fes{ UJOC. hcm fi 0253B`. ` � On s. was issued a permit to install a (date) (install ) septic system at Sea- V f e w f ku emu based on a design drawn by (address) sc En�tt�ee.;t � rriG, dated 'Yaiulx!� 9+ 2015 (designer) F I certify that the septic system referenced above was installed substantially according to' the design, which may include minor approved-changes such as lateral relocation of the distribution box and/or septic tank. Stripout '(if required) was inspected and the soils were found satisfactory. r 1 certify that the s ptic system referenced above was installed with major changes (i,e. greater than 10' t ral relocation of the SAS or�any vertical relaca#ion of any component of the septic s.ste ) but in accordance with State.&Local Regulations. Plan revision or certified as-0it y designer.to Follow. Stripout(if required) was inspected and the soils.'�' were led sa sfactory. 3 'CH4NN� le 's Signature) oi ?!t ,..L esigner's ign (A li p Here) PLEASE RETURN TO HARNSTA13LE PUBLIC If<H DIVISION.. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION, THANK YOU: gAatiice fonpsldesignermniticotion foml,dvc '. <,; N`? r `f.;< � / - - .,,,•.fir•.- �<. .li:.�3 / x20.4 pww ON SOUP PENCE,POOL CODE. / 1�'1 x I C X 2L,i X20.5 4 STEPS ON W/GRAD[ '�+ �� x 3• . - NEW 4'HIGH CHESTNUT HILL PICKET, ,,,,off+••" 'fin To BE POOL COD[ 42 / .' ��5g►�',,.!' xi 9�8 r _ SO P X1 x 21_ / 2 : 1' y, 0.+ 6. 3 VA Y$"PA i''" !_ A2 i d 21.5X 21 ( ae ,zz. iACTOR 2" ` I'i O •a '�' :�, I' 1.46 .GRAD[ ��•�� i' 22.7 •', ARBOR. TICcz FFE 23. _ I` ,v?vj,r 21 C 1 DOWN., i��'o U ,,e ,.• % ��:t U {' :`.yam" •''^ ';. /;1.:: �!hi:idG s°;,*0_2. X118. I ./ <.�Q h 21 , qq X22.13 ..%' f•n' t �. .. END 6'H SOLID - '•!.<.° - -••v�e'4tEq� - .' UNIVERSAL w. 4 7' to NEW,;.•HIGH CHESTNUT ° .. X Zl.:_ �' j 4O PO� LL f t4 < 'rE• 67D 90 �S/ 2:.9 • SEPTIC F q N X21.6a FL, e/ ICI''� EXISTING SOLID @�~_f FENCe-SAVE EX,LAWN X l.i 8 POOL EQUIP ��,, F Ji OAK EX. LAWN J ce e' OAK F(. She cVIFBRIOX21.g LK-5A E �r EW 6,W R _ t. DR:V• f SPINDLE TOOPP A ARBOR W/ . x21.9 DEL GATE BY WALPOIP EX.GRAVEL DRIVE •• ./ '/ -� REPLACE CC - ••LJ W H WHITE WOOD FENCE WITM E �E I 4'HIGH.50LID NATURAL CEDAR 1.0 MA•N. { ?X�lrl •;J J UNIVERSAL BOARD FENCE , y :.UL•> ..f- _ _,>,Ai r,,J•ON V p' ON LIFEGUARD P05T BASE Y "OAK DRFr.0 WrV K.. IN NATURAL COLOR !y-- 21,3 LGT POST- "�. REPLACE ___R/I. i :c:1.0 Ti?:•eOGe. < PLACE EX LIGHT ::•.:: :,c t::: x 20.5 CREA7>:;5'WED.`•OPPN::eG P05T5 W/NEW X 21.0 r 1 HAMILTON.P05T5 , /. 4'OAK HOLD F115 CC1 GRAVEL DRIV •a' r EDGE, o CiF.A7E;S.WIDE l 20.8 01-AFTCR oB:: 4"PINE.:: WENHAM 12'CUi.UMN ENTRA NC B(P _ `< ,'•+4'.:6"� .y c WENHAM CAP.Ill' /IJSTALIEp I '�'�::::• -' ®EACH DRIVE ENTRA\CE EX.GRAVEL DRIVEOH 0 OF OH �� OH � - ._.. OH�` O O w= / OH w- OH uL- Town of Barnstable P# \� Department of Regulatory Services1k1w / BAMSTABLE ? Public Health Division Date .t6 e� „1, 200 Main Street;Hyan is MA 02601 Date Scheduled ime . 0 Fee Pd. / Wd V IT 4 A aifi7 Soil Suitability Assessment for e e Di �' e ' Performed By: N t LVi a e t Owl Cn r0 I C T'T C SC Witnessed By: LOCATION& GENERAL INFORMATION Location Address ��9D A Owner's Name� - _ Address �pG GL-!(1.D r..,:.v T. ��� Weston/M4, 0,949 Assessor's Map/Parcel: Mq,P 090 Engineer's Name �n y=� VTF—n I nP��6 / NEW CONSTRUCTION VI REPAIR Telephone# ,a Land Use Sq 15te EG.�tly d_ Lv Slopes(%) 2 -� Surface Stones Distances from: Open Water Body It Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line 7 i O ft Other ft • L SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests;locate wetlands in proximity to holes) S ee a-4a6vr d .elas/1 • kwastr► Parent material(geologic) ou Depth to Bedrock `' - • Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face i Estimated Seasonal High Groundwater 7 13 i1 b,t s DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: WeC O VSZs VetAt" 7 t 3 Depth Observed standing in obs.hole:„ in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# — Reading Date: Index Well level Adj.factor Adj.Groundwater Level= PERCOLATION TEST Date:al2=ll 1 y Time :LQ a;n Observation Hole# 3 Time at 9" Depth of Pere -(00 y L -(00 Time at 6" Start Pre-soak Time @ /0.'6 3 am 10:25 a.vi Time(9"-6") End Pre-soak /0%ly am /0:33 �•» Rate Min./Inch 2 2 T—•I Site Suitability Assessment: Site Passed N Site Failed: _ Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back---------:r-q e. ***If percolation test is to be conducted within 100'of wetland,you must first notify the" Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM:DOC 01 a DEEP OBSERVATION HOLE LOG Hole#' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. p Consistent %Gravel (P h� ,.,, - 6- /8 A/C L S IDYr3/3 Ifi-YL Pa `ypYr 516 - w2- 138 C. M 5 DEEP OBSERVATION HOLE LOG . Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) ^(USDA)_, , _ (Munsell) _ .-Mottling (Structure,Stonz,Boulders. Consistent %Gravel k DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel DEEP OBSERVATION HOLE LOGHole: # Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel Flood Insurance Rate Map: Above 500 year fl&od boundary No_ Yes `;.Y k 3 Within 500 year boundary No' V Yes o r Within 100 year flood boundary,No Yes +4 w Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Ie-5 If not,what is the depth of naturally occurring pervious material? Certification I certify that on lb'1-7'9? (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the:required training,expertise an perience described in 310 CMR 15.017. Signature �''— Date 1- 6 -1-5 Q:\SEPTIC\PERCFORM.DOC Commonwealth of Massachusetts Title 5. Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 890 Sea View Property Address Sea View Realty Trust Owner Owner's Name information is 2r V 1 I I required for Cott 6 MA 01907 April 2% 2013 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information ` When filling out forms o the computter,use 1. Inspector: -. only the tab key to move your Linda Pinto cursor-do not Name of Inspector use the return key. CSN Engineering Company Name P.O. Box 2030 Company Address Teaticket MA 02536 Cityrrown State Zip Code 508 299-3250 4432 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR•15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority , o May 1, 2013 tNv Inspector's Signature Date I The system inspector shall submit a copy of this inspection report to the Appro ng Authcy(131�4rd of Health or DEP)within 30 days of completing this inspection. If the system is shared s sterner has a design flow of 10,000 god or greater, the inspector and the system owner shall sulit this report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of.inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. ' • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 890 Sea View Property Address Sea View Realty Trust Owner Owner's Name information is Swampscott MA 01907 A rll 29 2013 required for P P every page. Citylrown State Zip.Code Date of inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any-failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements..If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exMtration 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): I r ' r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-.Not for Voluntary Assessments ,M 890 Sea View Property Address Sea View Realty Trust Owner Owner's Name,' information is Swampscott MA 01907 Aril 29 2013 required for P P every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cunt.): Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system-required pumping more than 4.times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require'further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect-public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or,privy is within 50 feet of a bordering vegetated wetland or a salt marsh Commonwealth of Massachusetts . Title 5 Official Inspection Form p , Subsurface.Sewage Disposal System Form-Not for Voluntary Assessments M 890 Sea View Property Address Sea View Realty Trust Owner Owner's Name information is Swampscott MA 01907 April 29 2013 required for P P every page.' Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) 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. El 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 l coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must. be attached to this form: 3. Other: D) System Failure Criteria Applicable to All Systems: r You must indicate"Yes"or"No to each of the following for all inspections: c 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 El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day.flow Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 890 Sea View Property Address Sea View Realty Trust Owner Owner's Name information is Swampscott MA 01907 29 2013 required for pApril, every page. City town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within?1100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. l ❑ ® 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 11 of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, I 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. J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System form-Not for Voluntary Assessments M 890 Sea View Property Address Sea View Realty Trust Owner Owner's Name information is Swampscott MA 01907 April 29, 2013 required'for P P every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of - this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic,tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria,related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms(actual): 4 440 DESIGN flow based on 310 CMR 15.203.(for example: 110 gpd x#of bedrooms): i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M s 890 Sea View Property Address r Sea View Realty Trust Owner Owners Name information is Swampscott MA 01907 required for P April 29, 2013 every page. Citylrown State Zip Code Date of Inspection M'System Information Description: 1,500 Gal concrete septic tank, D-box, two 1,000 gallon leaching pits Number of current residents: 2 Does,residence have a garbage grinder? ❑ Yes 0 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)): Detail: 2012 - 137,000G 2011 - 139,000G Sump pump? ❑ Yes ®' No Last date of occupancy: PresentDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? o ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5.system? ❑ Yes ❑ No Water meter readings, if available: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 890 Sea View Property Address Sea View Realty Trust Owner Owner's Name information is Swampscott 29 MA 01907 A nl required for P P � , 2013 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Town Was system pumped as part of the inspection? ❑ Yes ® No if yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑' Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 890 Sea View Property Address Sea View Realty Trust Owner .Owner's Name information is Swampscott MA 01907 April 29 required for P P � , 2013 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: System installed 1993, designed by Baxter& Nye, Inc. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): " Depth below grade: 20 feet Material of construction: ❑ cast iron ®40 PVC• ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments(on condition of joints, venting, evidence,of leakage, etc.): (Tight) (Yes) (None) Septic Tank(locate on site plan): 6„ Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) 1,500 Gal Septic Tank, cover is 3"below grade,top of tank is 30"below grade If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ® No I Dimensions: 1500 gallon , . ' 2„ Sludge depth: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Foam-Not for Voluntary Assessments 890 Sea View Property Address Sea View Realty Trust Owner Owner's Name information is Swampscott MA 01907 Aril 29, 2013 required for P P every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 2' Distance from top of scum to top of outlet tee or baffle 61' Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): w The structural integrity of the tank appears sound. The tank has,PVC pipes with PVC tees on the inlet and outlet ends. The liquid.level is at the level of the outlet invert and there was no sign of backup or leakage in any of the tanks. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness MDistance 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 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M s 890 Sea View Property Address r Sea View Realty Trust Owner Owner's Name information is Swampscott MA 01907 A nl 29 2013 required for, p R every page: Cityrrown State Zip Code Date of Inspection D. System Information (cost.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm,in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): f Attach copy of current pumping contract(required). Is copy-'attached? ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 890 Sea View Property Address J Sea View Realty Trust Owner Owner's Name. information is Swampscott MA 01907 April 29 2013 required for P P every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): 0,. 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.): The D-box appears to be in good condition with no sign of solids carryover, and 2 outlets. The top of the D-box is 24" below ground:. There is-no sign of backup or leakage. 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.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 890 Sea View Property Address Sea View Realty Trust Owner Owner's Name information is Swampscott - MA 61907 April 29, 2013 required for P P every page. Cityfrown State Zip Code Date of Inspection j D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation; etc.): There are two 1,000 gal chambers.There is no sign of hydraulic failure in the area of the SAS. The top of the chambers is 14" deep. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 890 Sea View Property Address Sea View Realty Trust Owner Owner's Name information is Swampscott, MA 01907 Aril 29 2013 required for P P , every page. City/Town State Zip Code Date of Inspection D. System Information- (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids "Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' 890 Sea View Property Add Sea View R al Trust Owner Owner's Name information is Swampscott MA 01907 A nl 23 2013 required for P , every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage disposal System: Provide a view of the sewage disposal system, including ties to at least'two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately A- $ Ucs! 3 z -6 'P-50" K, F �Sg o 3 z fwkr— S101001- - r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 890 Sea View Property Address Sea View Realty Trust Owner Owner's Name information is Swampscott MA 01907 April 29, 2013 required for P P every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope J ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >5' below bottom of SASfeet 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: August 1993 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: You must describe how you established the high ground,water elevation: Design Plans by Baxter& Nye Inc. 8/1/93 show ground at site at elevation 21, Bottom of SAS is. Elev. 10.0, Approx. Ground Water EL 4.0, Seperation between high groundwater and bottom of ' system is> 5' Before filing this Inspection Report, please see Report Completeness Checklist on next page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage(Disposal System Form-Not for-Voluntary Assessments 890 Sea View Property Address Sea View Realty Trust Owner Owner's Name information is. Swampscott MA 01907 A nl 29, 2013 required for P P every page. Cityrrown State Zip Code Date of Inspection, E. Report Completeness Checklist 0 Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information-Estimated depth to high groundwater ® Sketch of Sewage.Disposal System either drawn on page 15 or attached in separate file t tw DATE:_7/27/99__-- PROPERTY ADDRESS:_ 890. Seaview_Ave Osterville ,Mass . ------------------------ ------------------------ On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 1-1500 gallon septic tank. 2 . 1—Distribution box . 3 . 2-1000 gallon precast leaching pits . Based on my Inspection, I certify the following conditions: 4 . This is a title five septic system. ( 78 Code ) 5 . The septic system is in proper working order " at the present time . SIGNATURE: Name:_ _ Macomber Jr1______ Company: Jose_ph_P.— Macomber_& Son , Inc . ------- - ; Address:_ Box 66 -------------------- �, A U !T lggg Centerville , Ma . 02632-0066 3 � �U��fPTAB�f Phone: 508_775_3338______- A I ,6 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachflel ds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 • 1VjCOMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVMONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292.5500 TRUDY COX Sacreta ARGEO PAUL CELLUCC! DAvID B. STRLF Governor Corr ss:c� SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECnON FORM PART A CERTIFICATION PropertyAd&,":890 Seaview Ave NwTwofOwna< Al Laub Osterville ,Mass . Addre"ofOwrw: Data of Inspection: Noma of Inspector:(Piaase Print) Joseph P. Macomber Jr. I am a DEP approved syrtam lrupector pursuant to Section 15,340 of Tale 6 (310 CMR 15.000) corrspanyNarne: Joseph P Macomber & son, Inc. I.taa7usg Addrass: 2 6 3 2—0 0 6 6 Tdephorss Number: �i..CLR—_., 7 F—3.:�3-8 CERTIFICATION STATEMENT I certify that 1 have personally Inspected the sewage disposal system at this address and that the Information reported below is true, accurate and complete as of the time of lmspection. The Inspection was performed based cn my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: asses Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails 7 �/ lnspectW's Signature: � Date: r The System Inspecto all submit a copy of this Inspection report to the Approving Authority (Board of Health or DEP)whhin thirty (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 ownet Mall submit the report to the appropriate regional office of the Department oKnvironmental Protection. The original should os sent to-MR system owner and copies sent to the buyer, If applicable, and the approving authority. NOTES AND COMMENTS 9 revised 9/2/98 Pe¢rlorii �, Pnnlsd on Recycled Papa! f} SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) PropertyAddrass: 890 Seaview Ave Osterville ,Mass . Owner: Al Laub Data of Inspection: 7/2 7/9 9 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: 1 have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 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. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all Instances. If "not determined". explain why not. The septic tank is metal, unless the owner or operator has provided the system Inspector with a copy of a Certificate of Compliance (attached)Indicating that the tank was Installed within twenty (20) years prior to the date of the inspection: or the septic tank, whether or not metal,Is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure Is Imminent, The system will pass Inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed In the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass Inspection if(with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box Is levelled or replaced - The system required pumphig-more than-four•times•a•yeardue to broken or obstructed pipe(s). The Tmem wiif-jess-- Inspection If(with approval of the Board of Hae)th): - broken pipe(s) are replaced obstruction Is removed 6 I revised 9/2/98 Page 2ofII CA SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Ad rass: 890 Seaview Ave Ostefville ,Mass . owe: Al Laub Date of Inspection: 7/2 7/9 9 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the 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.PRQTECT THE PUBLIC HEALTH.AND SAFETY AND THE EN%OBOkMENT: &$ Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE ENVIRONMENT: 1� 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a AV private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the press ce of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid).- 3) OTHER i ICI 9 revised 9/2/98 Page 3ofIt ;./ SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTiON FORM PART A CERTIFICATION (corrtinuad) P,c,9.nYAddraaa:890 Seaview Ave Osterville ,Mass . Owner; Al Laub Data of Inspection: 7/2 7/9 9 D. SYSTEM FAILS: You must Indicate either 'Yes' or 'No' to each of the following: sL I have determined that one or Mora of the following failure conditions exist as described in 310 CMR 15.303. The basis tot this determination Is Identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No/ ,••�[ Backup oFtawage lrtto IaciNtY-or-vratem componertt•duarto m overloaded orcbgged•SAS-or-cesspod. 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•distrlbptioo box above outlet Invert due to an overloaded or clogged SAS or cesspool. Liquid depth'in Ca,&4v"sapsel Is less than 6' below Invert or available volume Is lass than 112 day flow. Required pumping more than 4 times In the last year NOT due to clogged or obstructed pipe($). Number of times pumpedQ. Any portion of the Soil Absorption System, cesspool or privy Is below the high groundwater elevation. Any portion of a cesspool or privy Is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is-within a Zone 1 of a public well. Any portion of a cesspool or privy is within 60 feet of a private water supply well. Any portion of a cesspool or privy is less-than 100 feet but greater than 60 feet from a private water supply well will) no acceptable water quality analysis. It the well has been analyzed to be acceptable, anach copy of well water analysis lot coliform bacteria, volatile otganiccompounds, ammonia nitrogen-and nitrate nitrogen. - E. LARGE SYSTEM FAILS: 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes /No _ at// the system Is within 400 lest of a surface drinking water supply _ IO the system•Irwitk;n 200 teat ol-&-t#;Lutery-(o a wrlaoe dnnkirsg water supply -- the system is located In a nitrogen sensitive area (Interim Wellhead.Protection Area IWPA) or a mapped Zone II of a puohc water supply well) The owner or operator of any such system shall upgrade the system In accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further infor,inadon. revised 9/2/98 Peee4ofII ! i li SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Prop"Address$90 Seaview Ave Osterville ,Mass . Owner: Al Laub Date of Inspection: 7/2 7/9 9 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No, •� Pumping information was provided by the owner, occupant, or Board of Health. None of the systemsornpownts hawhean pwwgwd4or-stJeast t+woawe"s andAhe•system hasAmmaasceiaiwgwasaw low rates during that period. Large volumes of water have not been introduced Into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. All system components,rcluding the Soil Absorption System,f-have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System orr the site has been determined based on: Existing information. For example, Plan at B.O.H. � _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) 115.302(3)(b)I _ The facility ownar.(and. paats.lf diflarmg frarn a"er).warapravidad.wlth Infnrmaiioann* o prpar mniatanaaC 0f SubSurface Disposal Systems. II 6 VII I revised 9/2/98 Pagesorii t G SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 890 Seaview Ave Osterville ,Mass . Owner: Al Laub Date of Inspection: 7/2 7/9 9 FLOW CONDITIONS RESIDENTIAL: Design flow: jib g.p.d./bedro m.' Number of bedrooms}� i ): Number of bedrooms(actual):_ Total DESIGN flow 7 . r Number of current residents: Garbage grinder(yes or no):ZD Laundry(separate system) ( es or®:_;: If yes, separats Impaction,required Laundry system Inspected a r no) Seasonal use(yes or no): may+ r ' t7 �1 Water meter readings,If av ilable(last two year's usage(gpd): )'7y — l� Sump Pump(yes or no):J312., Last date of occupancy: '6 zyk7 y9 COMMERCIAL/INDUSTRIAL: Type of establishment: ! Design flow: AM npd.( Based n 15.203) Basis of design flow Grease trap present:(yes or no)Nfi Industrial Waste Holding Tank present:(yes or no)A,0 Non-sanitary waste discharged to the Title system: (yes or no) " Water meter readings,if avalla le: Last date of occupancy: Ad OTHER:(Describe) Last date of occupancy: 29 GENERAL INFORMATION PUMPING RE ORDS and source of information: ve System pumped as part of inspection: (yes or no)_ If yes, volume pumped: _gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy low Shared system(yes or no) (if yes, attach previous Inspection records,if any) jqw I/A Technology eti.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other �� APPROXIMATE AGE of all components, date Installediif Icnown)•and source of•iwformation: 00, Sewage odors detected when arriving at the site: (yes or no) �l r revised 9/2/98 Page 6or11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (coerdnuod) Pope Addr.": 890 Seaview Ave Osterville ,Mass . oWTW; Al Laub Dou of moo^: 7/27/99 BUtLDWo SEWER: (Locate on site plan) l� Depth below grads: M►terls) of construcdon:_cast Iron Y—/40 PVC_other(explain) Distance hom_Drivsto waist supply wall or suctlon line Dlamater_V, _ Commsnts: (condition of Joints, ventlng, evidence of leakage,-etc.) Joints a . S&TIC TANK: (locate on site plan) Depth below gfads: � Matsrlal of constructlon: concretaAHmstal4 FlbsrplasaA0Polysthylens //other(explaln) AA It tank Is Emote!,Ust ape • 1s.ago.conrumed by CortJflcato of Compllancs� (Yes/No) r) t r si A•/ �t ��� Dimenons: Z Sludge depth-: - Distance from top of ludgo to bottom of outlet too ortratfie: /lr/&-V- Scum thickness: el Distance from top of scum to top of outist toe or baffle: Tr Distance from bottom of scum to bono of outlet too or bstflo:, E ei How dimensions wets daurminod: Commsnts: Irecommend►tlon for pumpin , condition of Inlst and outlet less o(•batfles, depth of liquid love!In,oladon to outlet invert, svuctura::ntegr_ evidence of leakage, etc.) ""MP tank annually - (, RrhARr dilg osal Pref3enl: Inlet & outlet tees are in p"Q@ .T.!qu4d depth fit the autlet t, CREAS E TRAP: (locate on site plan) Depth below gr►do:—AM Material of consuuctlon concrst.meta) AFibsrplassjiAPolyethylen othsrlaxplain) Dimensions: Scum thickness: Olsuncs from top of scum to top of outlet too or baffler Distance from bottom of +4um to bottom of outlet too or battle: Dale of last pumping: Comments: Irscommsndatlon for pumping, condition of Inlst and outlet tees or baffles, depth of liquid level In rolation to outlet invert. structural int.gn ovidencs of leakage, etc.) tease r. le revised 9/2/98 Page 7ofII I I = `F f� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PrWeMAddresa: 890 Seaview Ave Osterville ,Mass . Owner: Al Laub Day of kupection: 7/2 7/9 9 TIGHT OR HOLDING TANK(Tank must be pumped prior to, or at time of, Inspection) (locate on sit# plan) Depth below grader Materiel of consuucUonA/AconcretvvAmetaLi!gFiberglass4�QPolyethylene,4V8pther(explain) WA Dimensions: Capacity: gallons Design flow: gallons/day Alarm present �9d Alarm lava): Alarm In working order: Yes 4 No, Date of previous pumping: Comments: (condition of Inlet tee, condition of alarm and float switches, etc.) Tight- or holdTng tankq ,arp nnt present . DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet Invert:_ Comments: 1 ote•it level and distribution is equal, eviden" of solids carryover, evidence of leakage Into or out of box, etc.) — — �istribution box has two laterals No Pvidf-nrp of enlidz _ carry over No Pvi rlpnrp of 1 ankago into e;^ eut e4 the bem . PUMP CHAMBER:V'�/�P� (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.) _ umy chamber is not prPgPnt revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTU,4,,INSPECTION FORM PART C SYSTEM INFORMATION (conrtirwed) PT%-MAdd1-: 890 Seaview Ave Osterville ,Mass . Owner: Al Laub Dau of Irtspec.-oon. 7/2 7/9 9 p�/�'�,lNl? �p�s PTb�e SOIL ABSORPTION SYSTEM(SAS):JID4 / uon not required,location may be approximated by non-Intrusive methods! (locate on site plan,If possible; excava If not located, explain: Type: leaching pits, number:_ leaching chambers,number: leaching galleries, number: leeching trenches,number, length: leaching fields,number, dim gr Ions: overflow cesspool,number: Alternative system: e -`�+'� Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp toil, condition of vegetation,.etc. Lo si ns o or- p"4ing . Scr-ttg re r CESSPOOLS: (locals on site plan) Number and configuration: Oepth•top of liquid to Inlet Invert: Depth of solids layer. Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater. inflow (cesspool must be pumped as part of Inspection) ess {I Comments: (note condition of soil, signs of hydraulic lailura,.level of ponding,condition of vegetation, etc.( ass o PRIVY: (locate 0�-t- pl.n) Dimensions: Materjals of con str c qn: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, revel of ponding, condition of vegetation;etc.) Friv i P i revised 9/2/98 Paec 9 of 11 I f SUBSURFACE SEWAGE DISPOSAL SY5�WSPECTION FORM PART C SYSTEM INFORMATION (corttirti+od) PropemAd&—: 890. Sea,v1ew Ave Osterville ,Mass . D'"""' Al Laub D"'of h+pecvon:7/2 7/9 9 SKETCH OF SEWAGE DISPOSAL SYSTEA: Include des to at Fast two permanent reference landmarks or benchmark& locate all wells within 100' (Locate where public water supply comes Into house) g� 191AJ Ave, revised 9/2/98 Page 10of 11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (cor►dnued) Prop"Addreu: 890 Seaview Ave Osterville ,Mass . Owrw: Al Laub Date of inspection: 7/2 7/9 9 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Cellar Shallow wells l Estimated Depth to Groundwater Feet Please Indicate all the methods used to determine High Groundwater Elevation: _Obtained from Design Plans on record l�Observed.Site (Abutting propert observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health _Checked FEMA Maps Checked pumping records Checked local excavators, Installers _Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Used water contours Map . Gahrety & Miller Model 12/16/94 e revised 9/2/98 Page ttof11 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I A , m / �(�C�"- LI DATA f TOWN OF BARNSTABLE LOL. T10N 4`!� � � SEWAGE # a VT' LAGE ASSESSOR'S MAP& LOT INSTALLER'S NAME.&PHONE NO. SEPTIC TANK CAPACITY / 74 `I P LEACHING FACILITY: (ty ) ��� l (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: 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 e ' t within 300 feetof leachi fa ty, Feet Furnished �i%% *; _r. t 1 • � s g� a Ave, '" ( r TOWN OF BARNSTABLE LOCATION �•-d 'q �ui eV SEWAGE # 93 '1101 VILLAGE DS �G�v►��Q ASSESSOR'S MAR& LOT ,Q 2/ INSTALLER'S NAME & PHONE NO. 771 " 10`l 0 SEPTIC TANK CAPACITY C ,5-d o q a DLO A S LEACHING FACILITY:(type) ' I.Q���+ Q�T 5 (size)1000 95 6�44 NO. OF BEDROOMS 1" _PRIVATE WELL OR PUBLIC WATE BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �J �- �� ��' �(� V ya _ � Ct MAP 90 'P� Zy,r THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH --------...- ........--...OF..... Niel'57-A5.Giz..................................... ,� lirtt#iurc for Diipuual Vorkg Tomuurtiuu Vamit -01 Application is hereby made for a Permit to Construct tel or Repair ( ) an Individual Sewage Disposal System at ve Liz Lon-Address e/ or t No. ner ddress Installer Address Q Type of Building Size Lot......_r5__k f44_Q..Sq. feet Dwelling—No. of BedroA ,____..._...._.. Expansion Attic ( ) Garbage Grinder�Gf� _ No. of ersons_______________-__-_______ Showers — CafeteriapPL4Other—Type of BuildiII __. ___. p ( ) ( ) A4 Other fixtures ... W Design Flow..................... ..____.._._____gallons per person per day. Total daily flow------------------------------------------------��-__..._..gallons. W Septic Tank—Liquid capacityl .gallons Length................ Width---------------. Diameter---------------- Depth................ x Disposal Trench—No.--_-----_---.___-- Width................... Total Length............I...... Total leaching area....................sq. ft. Seepage Pit No.___----Z_-______ Diameter........`� ....... Depth below inlet...... ®......... Total leaching area......-'J---�Isq. ft. Z Other Distribution box ( Dosing tank ( ) Percolation Test Results Performed by___�;AX^rMrL.AA G...1AC......................... Date.....LLIiA./ZZ........... Test Pit No. 1.....—Z..—..minutes per inch Depth of Test Pit........J.-Z_ Depth to ground water-----------------------. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' •---------------------------------------------------------------------------------------------------......................................................... 0 Description of Soil........................................... ..._ ............... .........:........................................... V W -------------------------------------------------------------------------------------------------------------------------------------------------- ..................................................... U Nature of Repairs or Alterations—Answer when applicable................................................................................................ •-------•----------------------------------•----------------------------------------------------------------------------------------------------------------------------------------..._...._•••---•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned f rther agrees not to place the system in operation until a Certificate of Co rice has en iss by the boar alth. (y Signed -.. Q-.... Dale Application Approved ..... ............. .......... .... Application Disapproved for the following reasons- ----------------------------------- ..................................................................................................................................................................................................------- ...........................------------ Permit No. l" . .. ............... Issued '' ." 1' Dare ` ------------------ Dace No................_....... F:ms.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............10W. A ............OF.... � T"Ek. L _... ApplirFation for Digpnaal 10arkii Tonotrurtinn Prrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ... ��- Y�.���,/. dE. ���� � ��� •----------------------------.....7" .:`. Location-Address or Lot No. ^---•................_.....------......................--------------___........................ ------------ ---............................._.. ...--.--------•----. -------- Owner Address W Installer Address Type of Building Size Lot..__..... -- Sq. feet IJ Dwelling—No. of Bedrooms..........................................:Expansion Attic ( ) Garbage Grinder ( V' Other—Type of Building No. of persons............................. Showers — Cafeteria dOther fixture, --------------------------------•-------•------•-••----••---------------------------------------•---•----•-•-•----•------------••-••............_... W Design Flow...•.................�`.:......�.....__gallons per person per day. Total daily flow--- &&Q........ WSeptic Tank—Liquid capacity`.-�.. .gallons Length................ Width__............._ Diameter__.-____-____- Depth................ x Disposal Trench—No..................... Width.................... Total Length............ Total leaching area....................sq. ft. Seepage Pit No----------L------- Diameter........4.!;�...... Depth below inlet............... Total leaching area......5 _ sq. ft. z Other Distribution box ( I- Dosing tank ( ) Percolation Test Results Performed b _i'D). _+__ .. l •r........................ Date.....L M..&1.Aw............ Test Pit No. 1.....:�.<--'.minutes per inch Depth of Test Pit--------- Depth to ground water...----___.-----=---- G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 •------•---------------------•----------•---•---•--•----•--••--.....-------••---••--........................--•------'•-•-••----••-------.......-•----...... 0 Description of Soil.........................................................................................................................------••-•-----•-•--•--•---•--•-••------------- .............. U Nature of Repairs or Alterations—Answer when applicable................................................................................................ -•--------------------------•-------------------------------------------------------•-•--•-•------------•-------------------------------------------------------------------------------..........--•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 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 issuedaby the board offhealth. Signed ........................................ Date Application Approved ='''- =s � "'.rt.�i r an, ' r , - --------------------------------------------------..-......--...-.....---.-...---I.....------._........_....... ------------....Dare....r Application Disapproved for the following reasons- --------------------------------------- ------- ------- ------------------ -----------....-- i J-------- ---- ---- -- -- ---------.......,......--------------..................------........-...................................... ........................................ Permit No. ......... fIssued Date '.. .......... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -------------- 0b(A-------------- OF -------R. `i.rk.3t•=7_ 7........... ......................... Trr#ifiratr of %L'Umplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ......................................................................... ........--------.................-- -- . ---- ----------.................----...------------..------------------------------------------...... Installer at ------------ --------- --- -------------------------- -----------------------------.--- ------....-----------------...... ---- ------ -- --------L....................................................... has been installed in accordance with the provisions of TITLE-5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. j 1. :-..,.�............ dated --_rC-: �.......' pp P r .. .--- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 'I DATE------------------------ .:-.: .. '.�� .. ----------------- Inspector _ .: -0---------------------------_.................................. THE COMMONWEALTH OF MASSACHUSETTS --�-� BOARD OFHEALTH No.L - . I t FEE..I.......... . �i��r�a��a1 , nrk� �nn�#ruan rruti� Permission hereby granted........... . •-•-•-•-----------•------------------------••••---•-•..............--- to Co.... tC� ) or Repair . ) an Individual�Sea�,age��Disposal =yst at No.... 1_.. - .._. ....X '=6'Lt.!�..._.. ------ Street as shown on the application for Disposal Works Construction Permit No.�_V`...... Dated.... ._ _.�..._f�_✓_.. ----------------••--•-----------------------------------------------•-•----------•-••---•.......__.......-. Board of Health DATE......................... ....................................................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS `'f ®►rtJESl6�J 77ATA1rT l 01= 2 : `J.1l aZ FAIL`( 4 13&,rl wl ., . :Wrrlq G►A�F3Al,E GIZIIJDEI� AILS( FLOW 4XIIo �-:O%=Ua6?b ...:.: .. . 5El7rl C TANIL U4E ►Soo (nAL Ti.w- 1 _D1'$FMAL FtT U51 2- Icoo GAc. �2��g S �'���� o� �aAt l� t�E►L nF 51DEW4IL AReA 1655E EA44 I t aT S V I F.c) UE _...Voi7om A = I S sF- Ek.44 �STr✓6ZViL.t..E MA. , TM7-\L-te5l6W lot 6 6fp, TorAL VA Ly rLOy/ : 660 6-PD.,oV_ PE2Ce)/_ATI oN ATE OF JL d PETER <;'' I' OUTERM SULLIVAN40 ` No M33 � N' ,� Y,�� .. •�, ���. 'mom��w�°;� ,Eq� 8` i-g3 TF .Z3 L� l8 2 C=G=21 --- -1 wL/ I12 i Svs6oa 1. 4 i 3oA, 2 IrJ✓ �N✓ GQL iuJ rur B.cx l L t& s SEprlc. 6AL IG 2 Ib.d TAR ( Le` S t '.. . WI �...._ , /4,. /Z AL 6mpooFJn' 5 5Er Mo2E .S4uD'" WAF,FI<�; . �il•IA►J A- FT'TEED SHALL_ f¢.. �_►�S. STONE te- HZO EL►1 _MA a,2 ; s Z D Cl.. 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C -- - - I CIA Ln '-NE'W.Z.DpPERT•t06F SECOND_ FL '—OVER AOW WINDOW i , n.: x rrTi 7JEY:IuORMERS FIRST F.1-MR.TBATHROOM _ p „ .I 7{ITCHEN/Bft-AKFhS'T$-h_RJiGG - - _ -WKITE-CEMIR R$R EXlR/i.O`2R'tSCr FCl7'. _ .. RTN'ELE� W Ld - F W DORM ER_.WFIITECEDAP.RERL-XTRA IgRED CEDAR PER ON/'3OLSLT_OVE - . FECTI FH .: .- t- '�LEDhFt AREATI-IER. Ll R IS V� C T w VENT/REDCEDAR WEAVCDUP5 -- — -- - — — J_ ILIN SECOND FLCE G - - — _= MFF — — _ --- b6i�ERSI;�1H1T1= XTPh CD hR RCRE ' TSC CVUPCMP.D t3, ..SECOKD FL � = 1ilII I - 1 - - -- FI-RST FL i � Q — NOTE ENTRARCE R]RCH GUTTERS _ IE1�C6PPERR66S= K413T 1 S1 DE S 4=5DFF7CEcuTreRRE -URNtNTb - RDOW,WINDOW pOF I '^ B AROUM DEN GUTTERS _-._ =-KEGSCEDAi� 18"*r)/CEDARFSWTHEFt I J 1� —__30 LT-./-RIDGCvT47/COPPERRJ�J�ING „f N OUTR-ELE VAT.I ON =-510,E WALL _'r QN_T-CL.&F'vOAR'J:,hlhTCif L�CI571AU` 51DE5 ZKK WRITE CEW-KXTR4 P.tR- - REMOVE A+L ,c=-PLAGC n-1OF4. I u — , a I ' i " • ; d . i y 17aM I I-X Room LLJ ! I aIt, j k Taal o �- h ti _.. � /.,c7":IVE'-�'ASStVLT R � i '. :. - • .cam ,. .. `. '... ,' < -MASTER BE1iIROOM- .' a. EY15TING _ sLo s ET. ,# ' \ - f _ ]Z537- NEW- µ�I N.a. NDR i _ ,LIVING ROOM BREAKFAST �, t tvTM1 _ .: . 4_-. . I I 1 j3 - -..-.. '• >., _ REtDdai'E ', : '(I 'a .. �.J,,I[GLE CrILING: ,-�T'C.I TCk EN• Man J R00 h 3iTiTL :c L W f{OHLER VINInGE o . I I — hl 3759 - F 72+a92x24 Ui �'.- -- - — — LL is u MER.000IrETR- - �i - - - - 2 N - I — Y1 13"`Fl HALE' - I_.I.nEF RO-3'1314z.4'i13/4 w O ExM roc, �L- - - - =�� [1 Li O � - ER Reuss 3'lz _ - - DOTr0M4Li b:oFF'F.E •a , .-- Ia, ,w NEW �iec ,. :•.F_M ` - _` � — - _ - �, GAi3AG - p i -- .. I. F e n� _ q .. -4 . 4 .EMBT NG T- .. "BEDROOM�2Y .' - .FOV'ER DIN'VNG'ROOC1 f >( 4DEN _ -_ � EXISTING I ----- --------__ _ -;.F'(ITS.ELI:INC. e ------------- M FRON T ENTR--NCE P0ZC-li o h L S7b1QE VGN+.cER' ------ " .L- - „ O 7 b" ^�. 3�i0 NOTES, L)(ISTING WALLS - NEW WALLS WINDOWS F£L'LA450 SC RI ES �. OF _PERMANENT GRILLS BETWEEN GLASS II • - I II I - Ii II II ,. y , I I i IT 1IDORIIER#, I T&TCH EXISTING EXISTING NGElISTING.DORMER-_ DtiRMCR' ]DORMER W 741 r 3 0.. .• _ I I I� 3p97 CSfN - 'RIDGE - �) _ a°b•.. I ' I OR 6ELM-L -.1 - _IQ30 SN-30. -_gd m - - •. y' _FSO:30r3''O(R)R.L LIN _STORAGE CL - TV/.GAFFE R001 ' W PEAROOM. 3 3RLd>`cEIL[NG — J W J Gx}STING Y RECESS 3%�'d9 Wxl8H z tIUNG m _KEW I FLAT pOT LLJW_LOM �'O . . (N 7- =NEW-._- I, _3tp•- I—J .y Lj EK19TI9G O 1T �7 _ m � W — — — — cy -FDLDIRG:ST,mF5—.. al-RYAlIX yy—. > YINi �XISTi(IG Al IGARAGE'DLYR5 AH WINDOW A60V L FA I 3-N 1 1 --aEW NEW R RO 1 W4x3'5S/4 zz 7iNbLECEIIING= I I � `� I , —._ 3 I8EDK60M#s._ FSEDR00W _I g ---- I►: --------- I - I =--g� �-- - yz•:, ,. - —" =' ( I _ - �Gl+RAGE'DCC�RS , I zl��-----------_ I -. � UINDOW AAWE � I L--1 I 374.1---- - ---- - — -- -- i I R:D:3:la/9x3`-5_fP i i R03'-1s/4x3=53/9 I'I n •� � W .I 3 ;2�7_Vl" 7%4 Llt77!J/lj.' 2_,V/V 3toW 1774' 2=7%4' .4.Y4` -- 9�... - C O i .-ZG'-0:7NEVJ-DORMER YYG` 1 I ' L W - ;zq o-NEI. PORCFF. , - 3757 }'7 - - K 0.3'1314x*930f I _.. 'EX lSTTN.G`WALCS �11N DOES-'P0-LA 450'SERIES A30Fg 9 PERMANENT GRILLS WrWEEN.GIJaSS I. t: Y x } a-IO OVERIAY ....ow AORM ER/-aria. v .� -; . :' .. ._.. ".-�` .: 1"_ il. ��I/, ` � - •: 1 � R.03r0,•30 l` - m .: i . r, I - • « , h , z u r[Ell 1 y , Li : -'NOTES > .- f C j i - q : RAFIELIPS',- ..--.:.. �.�_. R C _ r51MP90N 140..3 J6O.0 r` I O.0 R 8C .3, -2F.1a 16 O.C.R98C' _ „.- I -h- •i. ! - .. - !.ter' - .. P� I � \ it ��' �o .r. .. .• - - a _ �4',000LB s a 60CR14 Gx 61nIIRE' _ll0"15/8+�1?.••. .. , �i/z _ANCHOC L+olTS , S'1'O VEN✓_'6'R z"IOIGrocexlsrlNG — 4.11 MUSE .FTNISN FLIX7RH E ' " I1� ZtN MATCH RG „•, �.. .L_•----- -...------- — — - — EFOUNIDATION - .� _ ------------------- I � ,. � �_Czl71:L..Stidfs�l"TK OWL _ a _ - BCEND_REINF.pRLE I , O _ ---_ - .__ T _. - Ip•- -H- OUSE C NS"FOU ATI O N pp I -R12 Y I 2q'Li r" ONT l�i5AR5 # ' J=OaT 1 -gkLL 3 tl HORIZON E-0e5 - ( SECTION V-B SCAL FOUNb&TIONL FRONT PORCH� SECTION C-C --SCALE 1/2=I'-0_ -`SV�LC 0V°1'O KQ7ES _"EXISTING... Ja4oc4 : T.O.F. EL.= 22.8'+ FINISH GRADE OVER D-BOX= 18.0'± FINISH GRADE OVER CHAMBERS= 18,0' - 18.3' GENERAL NOTES PROVIDE EXTENSION RISER SLOPE @ 2% MIN. OVER SYSTEM 3/4"TO NE T DOUBLE WASHED REMOVABLE WATER-TIGHT COVER OVER STONE TO CROWN OF PIPE 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION WITH COVER OVER INLET& FINISH GRADE OVER TANK EL.= RISER TO WITHIN 6"OF FINISHED GRADE OUTLET TO WITHIN 6"OF F.G. 4"SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS BOX TO METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL fFINISHED GRADE 18.0' - 19.8' MIN SLOPE 1% 2"OF 1/8"TO 1/2"DOUBLE WASHED @FOUNDATION = 21 .7'± 5"DIA. OUTLET(S) F.G. (SEE NOTE#22) STONE OR GEOTEXTILE FILTER FABRIC CODE AND ANY APPLICABLE LOCAL RULES. - - 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE 20"MIN.ACCESS _ __. _ _ . _ PLACE RISERS ON ALL COVER(3 TYP.) 36"MIAX. ^ TOP OF SAS= 15,33' DESIGN ENGINEER. 9"MIN. CHAMBERS WITH 3. 4 SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL PROP. SCH.40 36"MAX. , 9 MIN. " PVC SEWER PROP. SCH.40 14.50 36"MAX. BREAKOUT EL= 15.00' INLET PIPES TO 6"OF SYSTEM UNLESS OTHERWISE NOTED. FINISHED GRADE MIN. 6=�^ 2" DROP MIN. PVC SEWER _ �+ 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN " L 21 _SLOPES 1% 3" DROP MAX. 3 9 MIN.SLOPE@ 1% PROVIDE WATERTIGHT o ELEVATION = 15.00' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS L=19± 13" 4" PVC IN FROM JOINTS (TYP.) o � A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF * '-I 14" SEPTIC TANK 4" PVC OUT TO 0 0 0 O 0 0 0 0 0 0 O kc) THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 17.5 _ 15.75 LEACHING FACILITY `�TOp o o 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. ^ Op o 0 16.00 15.17' M N. L6- 15.00' 2� o o o p pp 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 48" OUTLET TEE op o0 7 LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK 6"CRUSHED STONE °° o o oo FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS GAS BAFFLE OVER MECHANICALLY po 0 0 o NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH 26.7'OFFSET TO FND COMPACTED BASE I AND DESIGN ENGINEER. 5 8.5' TYP OUTLET DISTRIBUTION BOX 4 0 (TYP) 4. 4.0 4.83' 4.0 8. ELEVATIONS BASED ON APPROXIMATE MEAN SEA LEVEL DATUM. BENCHMARK#1 6" CRUSHED STONE TO BE INSTALLED ON A LEVEL STABLE 59.0' (TYP.) ELEVATION OF 17.14' ESTABLISHED ON TOP OF WATER GATE AS SHOWN ON PLAN. OVER MECHANICALLY 1 COMPACTED BASE BASE. FIRST TWO FEET OF OUTLET , GROUND WATER ELEV.- < 5.50 PROPOSED 2,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 12.50 12.83' 9. ELEVATIONS BASED ON APPROXIMATE MEAN SEA LEVEL DATUM. BENCHMARK#2 LENGTH 12'-2' WIDTH 6'-8" DEPTH 5'-8" (Dimensions per Wiggin CROSS SECTION VIEW 500 GALLON CHAMBERS 5'MIN. CHAMBER END VIEW ELEVATION OF 20.00' ESTABLISHED ON TOP OF NAIL IN 24" PINE TREE AS SHOWN ON PLAN. "CONT IONPzRTOAFYWORK & SEPTIC TANK PROFILE Precast Corp., Pocasset,MA) DISTRIBUTION BOX DETAIL TYPICAL CHAMBER PROFILE CHAMBER DETAILS 10 TROUGHDIGSAFEAT LCTOR SHALL EFY ALL UTILITY LOCATIONS AST ST72HOURS PRIOR OCOMONCNGWORKONSITEAT R TO CONSTRUCTION ELEVATION PRIOR TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES _- TO THE DESIGN ENGINEER. PLAN NOTES: TEST PIT DATATEST PIT DATA 11. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. PERC NO. 86 PERC NO. 14586 f n b 12. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING • INSPECTOR: Donna Miorandi, RS INSPECTOR: Donna Miorandi, RS REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED LEACHING FACILITY TO ENSURE EVALUATOR: Michael Pimentel EIT CSE EVALUATOR: Michael Pi n CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILSi . me tel, EIT, CSE APPROPRIATE AUTHORITY. ' +► C.S.E. APPROVAL DATE: Oct. 1999 C.S.E.APPROVAL DATE: Oct. 1999 ARE NOT CONSISTENT WITH TEST PIT DATA. IF 13. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS DATE: December 11, 2014 DATE: December 11, 2014 LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE 3.) ENTIRE PROPERTY IS LOCATED OUTSIDE THE LIMITS OF A DEP APPROVED ZONE 2 AND THE ESTUARINE WATERSHEDS. "`-� THEY SHALL WITHSTAND H-20 LOADING. TEST PIT#: 1 TEST PIT#: 2 P� l �•, + �,.+ ELEV TOP= 18.00' ELEV TOP= 18.00' 14. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. �O +' ``ai► C " 15. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE � � ELEV WATER= <6.50 ELEV WATER= <6.50 !} 2� , - - MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. HYD �, PERC RATE <2 min./inch PERC RATE - REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, A1�PN l���N�O / IIIIIIIIIIII1 N �,'�,� ,.r .� *yt FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). V`� po/ -f-� r i �" ' �11 11 DEPTH OF PERC = 42"-60" DEPTH OF PERC = 16. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN 60 T r �-I' co ''�/� . r' + If i� TEXTURAL CLASS: 1 TEXTURAL CLASS: 1 SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. EXISTING LEACHING PIT TO Benchmark#2 6 %$ \�1 z � ► F - _,�i� i 0 �1"!� Nail in 24 Tree c 17. PROPOSED PROJECT IS LOCATED WITHIN: BE PUMPED & REMOVED 8„ Elev. =20.00' / ;: It : ..e . �, { �../'� -. _.__ -- Approx. M.S.L. ,�,% \ X �j SE ; ('`+', r°v 0" 18.00' 0" 18.00' ASSESSOR'S MAP 90 BLOCK 2 LOT 1 PROPOSED 2,000 / �O j r. X "" .' ` • LOCUS / Fill Fill OWNER OF RECORD: THOMAS B. &JEANNE M. KING Benchmark#1 GALLON SEPTIC TANK � ,/ 18" i { a ,._- Water Gate \ " * • • + " '" " 17.50' ^ ' -�' ---- / x .� 6 6 17.50 PROP. DISTRIBUTION BOX Elev. = 17.14' { Approx. M.S.L. - `,�56• ao IRRIG. BOX ` AE y AE Y ADDRESS: 42 BUCKSKIN DRIVE Loam Sand Loam Sand 24 �A' , x 10Yr 3/3 10Yr 3/3 WESTON, MA 02493 PROPOSED 6 - 500 GALLON LEACHING / R 3 LAWN CHAMBERS WITH AGGREGATE _ ✓'. �� / / Light 18" 16.50' 18" 16.50' FEMA FLOOD ZONE X __ { Loamy Sand g Loamy Sand COMMUNITY PANEL# 25001CO757J EDGE OF PAVEMENT _ _ _ _.� r� . :. � ,� '" - - B 18. DEED REFERENCE: L.C.C.# 186071 � 10Yr 5/6 10Yr 5/6 116.50' ^ 12" 1 ,�� It i OECk - 42" 14.50' 42^ 14.50' 19. PLAN REFERENCE: L.C. PLAI+12664=122 THE - S89 52 05 E 2 z Pe60 - - tf - =- 20. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. / r E (TYP) / 6" 13.00' Ors 0{ ~x 21. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY U X FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY „ - - - _ 12 ' /G W X FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. TP 1�- � ry� i� Q-0: � l � C Medium Sand C Medium Sand -- - ; 18x0" G - EXIST. 1,500 GAL. SEPTIC { X 2.5Y 6/6 2.5Y 6/6 22. A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A PROPOSED INSPECTION PORT TP 4 12' 1 ( - TANK TO BE ABANDONED { DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A 17x0'~ 18 0' p ` \ (i.e. PUMPED, BOTTOM (- LOCUS PLAN REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. �., OPENED / RUPTURED& ,' ��� \ x 18" CLUSTER 6" O { \' �S` ' FILLED w/CLEAN SAND) �` _ �� ! o SCALE: 1" = 1000' ^ ^ TP 3 I N " 138 6.50 138 6.50 18x0' �$ O gx ! x 21.1 PER 310 CMR 15.354 - O { 12 k, boo No Standing,Weeping or Mottling Observed No Standing, Weeping or Mottling Observed #890 O " F� LAWN { w -_. -- _ -- ---- -- - -- -- - - - _. -- ------------_--. ---- -_ - �- o 1\85;--., w o EXISTING X1 m TEST PIT DATA TEST PIT DATA LEGEND p LP 4-BEDROOM � { � DESIGN DATA / 14586 PERC NO. 14586 \ DWELLING -x PERC NO. X 18.2R�� / / , \c, �Sq TOF = 22.8'± PROP. COVERED X NUMBER OF BEDROOMS (EXISTING) 4 INSPECTOR: Donna Miorandi, RS INSPECTOR: Donna Miorandi, RS 50x0 EXISTING SPOT GRADE i 18" FRONT ENTRANCE jrX NUMBER OF BEDROOMS DESIGN 7 INS 50 Est / 3 ��X X ( ) EVALUATOR: Michael Pimentel EIT CSE EVALUATOR: Michael Pimentel, EIT, CSE -- EXISTING CONTOUR 6„ / \ I PORCH / ` TX\ �� { DESIGN FLOW 110 GAUDAY/BEDROOM ' ' 18" 6' / / / !r ,�.� LAWN 6•3' 1 1 �. C.S.E. APPROVAL DATE: Oct. 1999 C.S.E. APPROVAL DATE: Oct. 1999 50 PROPOSED CONTOUR o / N X { TOTAL DESIGN FLOW GAUDAY Q 3 G LAWN x 770 December 11 2014 December 11, 2014 C4MAP 90 ` / 10" \ �� co 290 q' S�GF ry� ° _ 1,540 DATE: 3 DATE: 4 50 PROPOSED SPOT GRADE ;�, h �Sq (jq 9 ry x DESIGN FLOW x 200 /° - GAUDAY TEST PIT#: TEST PIT#: BLOCK 2 6" 18" 3 L•�223 /� X USE PROPOSED 2 000 GALLON SEPTIC TANK = _ E/_I /C EXISTING UTILITIES LOT 1 \ �.__`, { ELEV TOP 18.00 ELEV TOP 17.00 51,450±S.F. - EXIST. LEACHING PIT TO BE PUMPED, `\18 �� f X GAS - - EXISTING GAS LINE id FILLED w/ CLEAN SAND & ABANDONED "_� / ELEV WATER= <6.50 ELEV WATER= < 5.50 N78^2 N 18" 6„ 0 GR \� X PERC RATE _ <2 min./inch PERC RATE= W W EXISTING WATER LINE 349.041 18" /�/ gVEt OR/V� \� x _ DEPTH OF PERC= 42"-60" DEPTH OF PERC= � TEST PIT LOCATION 12" o' ' � 3� � X INSTALL 6 500 GAL. CHAMBERS w/ AGGREGATE _ i2 " a? { TEXTURAL CLASS: 1 TEXTURAL CLASS: 1 �� SIDEWALL CAPACITY O O O PROPOSED 2,000 GALLON SEPTIC TANK 12„ ! / , 3 4,. x (LENGTH + WIDTH) (2 SIDES) (2 HIGH) (0.74 GPD/S.F.) = GAUDAY _ _ -- -� _ X (59.0'+ 12.83')(2 ) (2' ) (0.74 GPD/S.F.) = 212.6 GAUDAY O 00 EXISTING 1,500 GALLON SEPTIC TANK v`r { 0 18.00 0 17.00 _� 12" -' 12 _ 24" { Fill Fill PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE BOTTOM CAPACITY 6^ 17.50' 6" 16.50' { LENGTH x WIDTH 0.74 GPD/S.F. = GAUDAY AE Y AE y ❑ PROPOSED DISTRIBUTION BOX w FLAGPOLE x � ) ( ) ( ) ) L 10Yr 3/3 d L 10Yr 3/3 d HYD 78^22,54 1 { 59.0'x 12.83' 0.74 GPD/S.F. = 560.2 GAUDAY SEA VIE -_ 9515, X 18" 16.50' 1g^ 15.50' PROPOSED 500 GALLON LEACHING CHAMBER '¢0"w/'OeZAYoU) - p X , TOTALS: g Loamy Sand g Loamy Sand 1 1-29-15 MCP JLC Added proposed covered front entrance porch TJ GE OF PAVE��- \ TOTAL NUMBER OF CHAMBERS 6 10Yr 5/6 10Yr 5/6 REV. DATE BY APP'D. DESCRIPTION SWING-TIES PLAN SCALE: 1'=20' _ - MENT _ _ _�_ / TOTAL LEACHING AREA 772.8 SQ.FT. 42" 14.50' 42" 13.50' � � PROPOSED SEPTIC SYSTEM PLAN TOTAL LEACHING CAPACITY 1,044.3 GAL./DAY PREPARED FOR: �� Perk `�� 2) HC-1 (3 31 JOHN SILVIA & SILVA CHURC I_L JR. I 26 7, No. 8UC6 i ZONING DISTRICT: RF-1 Medium Sand Medium Sand LOCATED AT #890 SWING-TIES C 2.5Y6/6 C 2.5Y6/6 890 SEA VIEW AVENUE 90' O g69 REQUIRED PROPOSED EXISTING 4-BEDROOM DESCRIPTION HC1 HC2 OSTERVILLE, MA 02655 O 4 FRONT SETBACK= 30' MIN. 51.8' O ) SIDE SETBACK= 15' MIN. 86.3' DWELLING --- -- _ (6� O O TOF = 22.8'± REAR SETBACK= 15' MIN. 77.0' SEPTIC COVER IN (1) 33.7' 40.5' 138" 6.50' 138" 5.50' SCALE: 1 INCH = 20 FT. DATE: JANUARY 9, 2015 80 • % HC-2 BUILDING HEIGHT= 30' MAX.* <30' SEPTIC COVER OUT 2 41.6' 48.8' No Standing, Weeping or MottlingObserved No Standing, Weeping or MottlingObserved �1d �1 ` � o io 20 ao ao FEET PREPARED BY: *Or 2 1/2 stories,whichever is lesser. - -- -�-- ., CORNER OF STONE(3) 47.3 48.6 ~= JOHN L. (5 ��� / / CORNER OF STONE 4 46.5' 38.5' RESERVED FOR BOARD OF HEALTH USE o C L i � CO O CHURCIIILLJR JC ENGINEERING, INC. N 418p7 2854 CRANBERRY HIGHWAY CORNER OF STONE (5) 105.4' 89.9' �i c�S R�° EAST WAREHAM, MA 02538 SITE PLAN CORNER OF STONE (6) 105.8' 94.7' I - 508.273.0377 SCALE: 1"=20' Drawn By: MCP C Designed By:MCP 4 Checked By:JLC 1 JOB No.2953