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0007 VAN GOGH DRIVE - Health
7 Van Gogh Drive, Osterville IL k - c pp 'I i I TOWN OF BARNSTABLE LQCA7. N 7 SEWAGE # 2b0 OS3 VILLAGE Q"ro yi d B �� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO._SJ_S--124-97M ,oZe o4 Q{ l3Qo�oro 3 SEPTIC TANK CAPACITY ��3t��/�� /SO® Gil �ti� OX/V LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: 2 ,!q-0 COMPLIANCE DATE: .2 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 lea hing facility) Feet y Furnished b .c�� `� —� --_.,..�.._._..x.. ' ,� 6�c�c a � ' TOWN OF BARNSTABLE LOCATION V �1oGt� �r' SEWAGE# � n5� VILLAGE O�T-et,�ti�1e ASSESSOR'S MAP&PARCEL INSTA NAME&PHONE NO�cs=TT-i LtL ® GYvU`) SEPTIC TANK CAPACITY l000 LEACHING FACILITI':(type) (size) NO.OF BEDROOMS OWNER LkJJ6l`S f c-f1,S4 PERMIT DATE: C I DATE:,7, j r- i f A08 Separation Distance Between the: x 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 Van Gogh Drive Water Service i 22 22 25 31 TOWN OF BARNSTABLE LOCAnGN AN SEWAGE # O� b VILLAGE Vo-(V I ``�'-- ASSESSOR'S MAP &"LOT /V5 '078 INSTALLER'S NAME&PHONE NO. _r—«-_ SEPTIC TANK CAPACITY �,000 (ot1A� 0`_ N-1 ������� pp LEACHING FACILITY: (type) ly� (size) NO. OF,BEDROOMS BUILDER OR OWNER PERMITDATE: i4 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 c gad gin) 12 Or Fee �V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: f. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes pplicattou for ;h5pogal 6pftem Con0tructtou Vermctt Application for a Permit to Construct O Repair O Upgrade O Abandon O Complete System �iv-dual Components Location Address or Lot No.1 1/,v qq f ® y Owner's Name,Address;and Tel.No.� psr,5r 17- O f y Qu�w%e Assessor's Map/Parcel R!= Installer's Name,Address and Tel No. �^� "77`5^ J Designer's Name,Address and Tel.No. .c dl�lhtrs?'011J Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) j006 /! .S': G r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. )0 t'_0-5—3 Date Issued o .. "'} .. ., , ._-..+ �ir11'y"4-ire.—^i.-L.+-`..�•.�Y.w"! �''C.IY''•1>�'��`"�"� i Y-.Fy�✓:,M�='i.lX�''Ytid.-':�+•�/^r:.• 4h.thT"ia'"..lk.�..'..+�,�!""�`r- . No. —tL Fee U THE COMMONWEALTH OF MASSACHUSETTS', Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 21ppYication for �Oioozar 6p!gtem Con0truction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑.Complete System li�] n�dual Components Location Address or Lot No.17 Owner's Name,Address;and Tel.No. Assessor's Map/Parcel +78' /_� Installer's Name,Address and Tel No. d�" 28V-775 S Designer's Name,Address and Tel.No. Type of Building: Dwelling R No.of Bedrooms (/v Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of;Persons Showers( ) Cafeteria( *) Other Fixtures t Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) � _XQlt gam:p/kt r�= lzyr4 / 5 aeg 6,4/ ,cd ' � ih Lr C-1417,w i Date last inspected: K Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate,of Compliance has been issued by this Board of Health. Signed i Date Application Approved by _ Date Application Disapproved by:V Date for the following reasons z - Permit No. _?r)Q 0.5- Date Issued ————————————————————————————— ————— ———THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by �p3Gp�i�� S,0rrUS at 7 = / has been constructed in accordance with the provisions of T tle 5 and the for Disposal System Construction Permit No. dated Installer '1'ool (�� �xl/^HOS Designer r #bedrooms A IIA _ r?D h tQ 4,c n 4 y �C4 Approved design flow i f gpd The issuance of this permit shall not 'ey construed as guarantee that the system will Etion as deli ed. n Date /�'/ J �'� Inspector f.- r, r/ ti ✓ No. V Q Ic —o Fee Ao THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS &5po!6al 6p5tem Construction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at Db�t-F ' 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 conditions. Provided: Cor�stro ction must be completed within three years of the date of th's- ermi . Date _ It� Approved b 1A PP Y n/ �, • 1. v - k, 4 .._ h . r Sk Town of Barnstable Barnstable ,y�P OF SHE T��O�ti z Regulatory Services Department ®-AmedcaC y t nat..TAunr., . MASS.9. Public Health Division - ArFD MAC a' 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO February 6, 2008 Ann Quinlin Premier Asset Services 167 Lovell's Lane Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 7 Van Gogh Drive, Osterville MA was inspected on January 22, 2008, by Patrick O'Connell, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system CONDITIONALLY PASSES under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Septic tank is leaking and in need of replacement. Liquid level was found to be at 50%. You are ordered to repair or replace the septic system within Sixty (60) days from the date of this notification. Failure to repair/replace the septic system within the'deadline period will result in future enforcement action. PER ORDER OF THE OARD OF HEALTH - omas Mciean, R.S., CHO Agent of the Board of Health Y CEaT►c«a- mA%L di -loo6 a�so oco� wsv �•$99 QASEPTIC\Letters Septic Inspection Failures\7 Van Gogh Drive.doc 'Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 7 Van Gogh Drive, Osterville MA 02655 Property Address VAN 0C' I �� Premire Asset Services C/O Ann Quinlin Owner Owner's Name information is required for 167 Lovell's Lane, Marstons Mills MA 02648 January 22; 2008 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the vv computer,use 1. Inspector: . only the tab key to move your Patrick,,M O'Connell cursor-do not Name of Inspector use the return . key. Septic Inspection Services Co. Company',Name 189 Cammett Road Company Address Marstons Mills MA 02648 renen City(rown State Zip Code 508-428-1779 Telephone Number License Number B. Certification certify that l 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 Saiction 16A40 c Title 5(310 CMR 15.000). The system: w ❑ Passes ® Conditionally Passes ❑ Fails' c.n w ❑ Needs Further Evaluation by the Local Approving Authority _ v January 22, 2008 �- Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 08-14 Wells Fargo.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 7 Van Gogh Drive, Osterville MA 02655 Property Address Premire Asset Services C/O Ann Quinlin Owner Owner's Name information is required for 167 Lovell's Lane, Marstons Mills MA 02648 January 22, 2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ 1 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: Septic tank is leaking and needs to be replaced. Liquid level was found at 50%. ❑ 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 08-14 Wells Fargo.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 ' Commonwealth of Massachusetts Title 5 official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 7 Van Gogh Drive, Osterville MA 02655 Property Address Premire Asset Services C/O Ann Quinlin Owner Owner's Name information is 167 Lovell's Lane, Marstons Mills MA 02648 January 22 2008 required for ry every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: 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. 08-14 Wells Fargo.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Van Gogh Drive, Osterville MA 02655 Property Address Premire Asset Services C/O Ann Quinlin Owner Owner's Name information is 167 Lovell's Lane, Marstons Mills MA 02648 January 22, 2008 required for ry every page. Cityrrown 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: 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 tributary to a surface water supply. 08-14 Wells Fargo.doc-08/06 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 7 Van Gogh Drive, Osterville MA 02655 Property Address Premire Asset Services C/O Ann Quinlin Owner Owner's Name information is required for 167 Lovell's Lane, Marstons Mills MA 02648 January 22, 2008 every page. Cityfrown 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. 08-14 Wells Fargo.doc•08/06 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 ° 7 Van Gogh Drive, Osterville MA 02655 Property Address Premire Asset Services C/O Ann Quinlin Owner Owner's Name information is 167 Lovell's Lane, Marstons Mills MA 02648 January 22, 2008 required for y 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)] 08-14 Wells Fargo.doc•08/06 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 M 7 Van Gogh Drive, Osterville MA 02655 Property Address Premire Asset Services C/O Ann Quinlin Owner Owner's Name information is 167 LoveH's Lane, Marstons Mills MA 02648 January 22, 2008 required for ry every page. Cityfrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 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 ears usage d 158 gpd gal. _ 9 ( Y 9 (gpd)): 158 gpd. Sump pump? ❑ Yes ® No Last date of occupancy: One year prior toinspection. 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? ❑ 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): 08-14 Wells Fargo.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Van Gogh Drive, Osterville MA 02655 Property Address Premire Asset Services C/O Ann Quinlin Owner Owner's Name information is 167 Lovell's Lane, Marstons Mills MA 02648 January 22, 2008 required for ry every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: None 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Compliance date for leaching system: 2/7/06 Were sewage odors detected when arriving at the site? ❑ Yes ® No 08-14 Wells Fargo.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 i - Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Van Gogh Drive, Osterville MA 02655 Property Address Premire Asset Services C/O Ann Quinlin Owner Owner's Name information is ry 167 Lovell's Lane, Marstons Mills MA 02648 January 22 2008 required for , every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 2'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: 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: 8.5' long x 5.2' long- 1000 gal. Sludge depth: Distance from top of 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? OB-14 Wells Fargo.doc-08/06 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 7 Van Gogh Drive, Osterville MA 02655 Property Address Premire Asset Services C/O Ann Quinlin Owner Owner's Name information is 167 Lovell's Lane, Marstons Mills MA 02648 January 22, 2008 required for ry every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level was foound at 50% capacity, tank is leaking and needs to be replaced. 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.): 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): 08-14 Wells Fargo.doc•08fO6 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 7 Van Gogh Drive, Osterville MA 02655 Property Address Premire Asset Services C/O Ann Quinlin Owner Owner's Name information is required for 167 Lovell s Lane, Marstons Mills MA 02648 January 22, 2008 every page. 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.): *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 0 11 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No solids or high stains present. Liquid level at bottom of single outlet pipe. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 08-14 Wells Fargo.doc-08/06 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 ,. 7 Van Gogh Drive, Osterville MA 02655 Property Address Premire Asset Services C/O Ann Quinlin Owner Owner's Name information is 167 Lovell's Lane, Marstons Mills MA 02648 January 22, 2008 required for ry every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: Type: ❑ leaching pits number: ® leaching chambers number: 5 Infiltrators ❑ 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.): Infiltrators have no standing water or evidence of saturation. 08.14 Wells Fargo.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 ' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w ,.•'' 7 Van Gogh Drive, Osterville MA 02655 Property Address Premire Asset Services C/O Ann Quinlin Owner Owner's Name information is required for 167 Lovell's Lane Marstons Mills MA 02648 January 22, 2008 every page. 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.): 08-14 Wells Fargo.doc•08106 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 7 Van Gogh Drive, Osterville MA 02655 Property Address Premire Asset Services C/O Ann Quinlin Owner Owner's Name information is required for 167 Lovell's Lane, Marstons Mills MA 02648 January 22, 2008 every page. City/Town 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. Van Gogh Drive Water Service \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ ♦ \ \ Y \ \ \ 22 22 25 31 ................................. ................................. ................................. Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Van Gogh Drive, Osterville MA 02655 Property Address Premire Asset Services C/O Ann Quinlin Owner Owner's Name information is required for 167 Lovell's Lane, Marstons'Mills MA 02648 January 22, 2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to ground water: 20feet 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: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water at el. 20 and topo map shows property at el. 50 08-14 Wells Fargo.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 I Town of Barnstable OF 1HE tp� Regulatory Services BARySTAB Thomas F. Geiler,Director y$ 1M^ss p,Eo ,�A Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Faz: 508-790-6304 This septic system inspection report°was completed by a private,inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division receiv PY ed the original/co of this report; this Division does not warranty the functionality of the septic system.in the future nor does this Division agree with any technical observation s and interpretations contained within this report. 4 In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed-within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. T No. � �d Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: :.PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,'MASSACHUSETTS Yes Rpplication for �Digo!6af �&Velem con.5truction i3Ermit Application for a Permit to Construct( ) Repair( ) Upgrade( andon( ) ❑Complete System ZJndividual Components Location Address or Lot No. 7 VAN G O J� � t Owner's Name,Address,and Tel.No. OSi E2Vi�`�Assessor's Map/Parcel Icyekvkl� S -2 Insta 's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. A.,�,-7i- , Pv 34414`� Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) -3 _ gpd Design flow provided 33 T gpd Plan Date � � Number of sheets Revision Date Title iz� _ Size of Septic Tank le-1 I &t o�— \b 0 0 Type of S.A.S. Description of Soil 1 <-j2—S Nature of Repairs or Alterations(Answer when applicable) NA- Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued b�this h. Sig ed Date `(y� Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. (p `"0 © Date Issued i5- ' Nod , Fee THE.COMMONWEALTH OF MASSACHUSETTS Entered in computer: T PUBLIC HEALTH 01la FSiON - TOWN OF BARNSTABLMASSACHUSETTS Yes Rpprication for aigpogal 4§p5tem Congtruction Permit Application for a Permit to Construct O Repair O Upgrade(Abandon Q Complete System individual Components Location Address or Lot No.-7 VAN G o utl ner's ame,Address,and Tel.No. p Assessor's Map/Parcel /�(s o7� e�Y - Ins 's ame,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: __ Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures. /7 Design Flow(min.required) 3�v gpd Design flow provided ( � T V gpd Plan Date (—'�1'6 +. Number of sheets Revision Date Title ^✓C C f Size of Septic Tank SI'k \boo Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site,sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by_tLa Boar nn Sig,ed Date /,�td--0� Application Approved by Date C / (O } Application Disapproved by: Date for the following reasons Permit No. & --0 O Date Issued e` —————————————————————————————————————------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY t the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded Abandoned( )by / D e ? t at U, �f► ��7��J.I has been constructed in accordance v ` Co -OYO with the pro ' ' s`of Title 5eand the for Disposal System Construction Permit No. dated caZ / Installer UCXj Designer #bedrooms Approved design flow _ 3,30 gpd The issuance of this perm't shall not be construed as a guarantee that the systems(,w'fufic i n as esigned. Date e /�1� Inspector\ 7 -------------------------------------------- No. ( C)%© I Fee 0 O THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Di!5poga[ *pgtem Congtruction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade (L,,)'Abandon ( ) System located at c 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 conditions... Provided: Construct on niust be completed within three years of thedate of this e. it. Date C: , Appro ed-by t 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems. Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, (f4, Y hereby certify that the engineered plan signed by me dated 1 concerning the property located at meets. all of the. following criteria: • This failed system is connected to a residential dwelling only. There.are.no.commercial or business uses.associated with the.dwelling. • The.soil is classified as.CLASS I and the percolation rate is less than or equal to 5-minutes per inch. The applicant may use historical data to conclude this fact or.may conduct deep test holes and percolation tests.at the site without a health agent present. • There is no.increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the. Frimptor method when applicable) Please complete the following: A) Top of Ground Surface Elevation(using GIS information) . SC B) G.W.Elevation, +adjustment for high G.W. . l Z. DIFFERENCE BETWEEN A.and B H , e SIGNED : DATE: G . NOTICE Based upon the above information-,a repair permit will be issued for bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. gASeptic\percexemp.doc 0 Town of Barnstable FtHE Regulatory Services Thomas F. Geiler, Director (+ iAEIVSfABLE, 9� M�& 1�� Public Health Division AIED�A°yA 9. Thomas McKean, Director 200 Main Street,Hyannis,MA 0260i Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form y . Date: Designer: Shay Environmental Services, Inc. Installer: ���, �c5 �c Address: P.O. Box 627 Address: East Falmouth, MA 02536 + �c .vti M;?(zN-. On Z-Ar-U-0 �-,s C was issued a permit to install a (date) (Installer) septic system at \ aGS G n 5 based on a design drawn by ' (addr ) c Shay Environmental Services, Inc._ dated (designer) - I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. 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. OF 4fAS_c, CARMEN �N nstaller s na e ig )' o E. SHAY - No. 1181 sTE�`�`o (U�(Y'QJh SAN I TARS P� ( esigner's Signature) (Affix De'§i7IMMStamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. , Q: Health/Septic/Designer Certification Form Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of _` Nov 2 s Environmental Protection William F.Weld Trudy Coxen Go�wr a , Y Argeo Paul CelluccF tDav@d B. hs u.Gwemor '`� commli.fons►' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART A Q\v el - 7 Van ogh CERTIFICATION Oster ille Lillian Kronber Property Address: Address of Owner. g Date of Inspection: / r (If different) Name of Inspector. W.E. Robinson SR Company Name,Address and Telephone Number. ( 5 0 8 ) 7 7 5—8 7 7 6 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA 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 inspection. The inspection was performed based on 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 Inspector's Signature: �'l%3 f` Date:,O/' �--9 The System Inspector shall submit a copy of this inspection report to the Approving Authority within 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 owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C,or D: A) jSYSTTEEM PASSES: " I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yea, no,or notdetermined(Y, N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) _ The septic tank is metal, 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 Fonforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Tekphone(617)292-S600 Printed on Recycled Paper 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 7 VanGogh Rd Osterville Owner. Lillian. Kronberg Date of Inspection: B]SYSTEM CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(*) 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 pumping more than four times a year due to broken or obstructed pipe(s). The system will pa*a inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C) THER 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. SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and:is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or,more from a private water supply well,unless a well water analysis 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 few than 5 ppm. S) OTHER (revised 11/03/95) 2 L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) Property Address: 7 VanGogh Rd Osterville Owner. Lillian Kronberg Date of Inspection: /© DI SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due town 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 1/2 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 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 I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El GE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: 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 and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater.treatment program requiremental of 14 CMR 5.00 and 6.00. Please consult the local regional office of the Department for fiuther information.., (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 7 VanGogh Rd Osterville Owner. Lillian Kronberg- Date of Inspection: Check if the following have been done: lumping information was requested of the owner,occupant,and Board of Health. _Lyon of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. f✓As built plans have been obtained and examined. Note if they are not available with N/A. 2/The facility or dwelling was inspected for signs of sewage back-up. e system does not receive non-sanitary or industrial waste flow "e site was inspected for signs of breakout. t/All system components,excluding the Soil Absorption System, have been located on the site. r�he 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. size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub. Surface Disposal System. III (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 7 VanGogh Rd. Osterville Owner. Lillian Kronberg`� Date of Inspection: FLOW CONDITIONS RESIDENTIAL Design flow: � �allona Number of bedrooms: ooms:,'T Number of current residents: Garbage grinder(yes or no): A- Laundry connected to system or no):_�'4=3 Seasonal use(yes or no): fi 1994 53, 000 gals . Water meter readings, if available: /b , UUU g a s gals 1st 6 months) Lest date of occupancy:_ COMMERCLhL1INDUSTRL4L: Type of establishment: Design flow:_gaIIons/day Gresse 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: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pudped as part of inspection: (yea or no)_ If yes,volume pumped: gallons Reason for pumping: TYPE O"YSTEM 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) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source of information: Sewage odors detected when arriving at the site: (yes or no) /!s (revised 11/03/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 VanGogh Rd Osterville Owner. Lillian Kronberg Date of Inspection: /0 SEPTIC TANK (locate on site plan) Depth below grader / _ Material of constriction:_concrete_metal_FRP--other(explain) t < < Dimensions: rk Sludge depth: 3 a y Distance from top of sludge to bottom of outlet tee or baffle: y b Scum thickness:_ i Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffler Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) %e ,,..1 C G o a cl o,.. G E TRAP:_ (locate o site plan) Depth belo grade: Material of nstriction:_concrete_metal_FRP_other(ezplain) Dimensions: Scum esa: Distance m top of scum to top of outlet tee or baffle: Distance m bottom of scum to bottom of outlet tee or baffle: Comm ts: (reco ndation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) ProperVAddresw 7 VanGogh Rd Osterville Owner. Lillian Kronberg Date of Inspection: TIGHT OR HOLDING TANK:_, (locate site plan) Depth grade: Material construction:_concrete_metal_FRP_other(explam) - Dimensio Capacity gallons Design fl w: gallons/day Alarm 1 1: Commen (conditio of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: L.� Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP HAMBER:_ (locate site plan) Pumps working order:(yes or no) Co nts: ( ndition of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 VanGogh Rd Ostreville Owner. Lillian Kronberg Date of Inspection: / SOIL ABSORPTION SYSTEM (SAS):_v ' (locate on site plan, if possible;excavation not.required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits,number: leaching chambers,number:_ leaching galleries, number: leaching trenches,number,length: leaching fields,number, dimensions: overflow cesspool, number: Comments: (note condition of$o',signs of hydraulic failure, level of ponding,conditioppt vegetation etc.) l 6 a O 4e l L r CE, POOLS•_ (loca on site plan) Number d configuration: Depth-top of liquid to inlet invert: Depth of lids layer- Depth of layer: Domensio of cesspool: Mate ' of construction: n of groundwater: inflow(cesspool must be pumped as part of inspection) Commen I: (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.) P (locate n site plan) Mate ' of construction: Dimensions. Depth of lids Commea :(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) LIM (revised 11/03/95) g i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 VanGogh Rd Osterville- . Owner. Lillian Kronberg Date of Inspection: , Q -AS- S SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' y E DE FM TO GROUNDWATER Depth to groundwater:/:2-A- feet method of determination or approximation: (revised 11/03/95) 9 h No.......�. .��.5 FEs.........�................ THE COMMONWEALTH OF MASSACHUSETTS ,k 0 BOARD OF HEALTH „/) jq ��?� ............... OF.............................--._........--...--.----•---.-----..........------........... !� ( pli iration for Eli-4posal orki �1RBt 1�L titn.� Prllttf Application is hereby made for a Permit to Construct A or Repair ( ) an Individual Sewage Disposal System at: k Cc,/ �`` -7 ��� .y a . ....... .................. ® .-• 5�� .... ........... .•-........... ----• Location•Add, •• -� � I,ot No. w -ti--� /� ..�C Owner �} ..................................Address .. a ...................•----•••---••----........---.........:.._.... ✓k•`........P . -.. �t 'XrS..�..r:..._...........^ Installer Address dType of Building Size Lot....... ...Sq. feet U Dwelling—No. of Bedrooms................3......................Expansion Attic Garbage Grinder kt-0 aOther—Type cf Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) PLO Other .fixtures ................................. . W Design Flow........................ --------gallons per person per day. Total daily flow...........777.3...Q..............gallons. WSeptic Tank—Liquid capacity.-f.Ac1.ftallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—Ko. ................(... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet....... ........... Total leaching area.............. .sq. ft. Z Other Distribution box ( ) Dosing tank ( �- �--. Percolation. Test Results Performed by...................1%�Y............... .... ...... Date.......... ..... .... Test Pit No. 1_- __.er5minutes per inch Depth of Test Pit.._._.__./. ... Depth to ground water......//y�.... ....... Li Test Pit No. 2.... nlinutes per inch Depth of Test Pit..._.....(..�epth to ground water........................ Z (�__�_....... ODescription of Soil................................................................... Z....----••--V . x ----•-•••-•--------------------•-•-•-•--.....---••--•••----•---------. •-• ----...-•--(-1/....-- --- ••••-•-••-------------------•-••--•-•-••...•----------------------•---------------------- Z� A.................. ...... U Nature of Repairs or Alterations—Answer when appli e. .. ................... ...��..._...� '...... -----•-••-----•-------------••........_...-•--•••••-----••-•--------•-•--•-•---•••--........--.---------.....---••••••-----••-----••---•••..._....-----•-------•----•----•--•---•-•--•-••-------....---. Agreement: The undersigned Agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of�ITL L 5 of the State Sanitary Code— The undersigned further a rees not to place the system in operation until a Certificate of Compliance has been issued e board of ealth. Signed.................... - ------------- -= ---------- ----------------------- Application Approved BY --.....:.. '' �.....................••-• --...1` �" , ��-J---....Date Application Disapproved for the following reasons:--•....-•-----••---.....---•--••----.......-•----------------------------------•----------:............-------- ----------------------- ------------------------------------••-------..----.------------•--------------------•------•---------•----•-•-•-------------------••-----•---------------•-•------ Date PermitNo......................................................... Issued....................................................... Date t No....... a. .' FEs............._............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................................OF.........................................--------------........ ......................... Allpfirtt#ion for DioVnottf Workii Tono#rnr#inn rrmi# Application is hereby made for a Permit to Construct (A) or-Repair ( ) an Individual Sewage Disposal System at: � � ��� � � ...................................... .. ,,�� ............_.--.•. �........ �....-.. ..... .• 1 ...............Location OC........... e ..: / � h o a ,vj� No. .�a Owner �wA/ ,( ........................Address Installer Address d Type of Building Size Lot....... ...Sq. feet U �. Dwelling—No. of Bedrooms................. ........................Expansion Attic /o Garbae Grinder `4 Other—Type of Building No. of persons............................ Showers f�•I g ---------------•----------•• P ( ) Cafeteria ( ) a' Other fixtures ................................. . W Design Flow.......................�........gallons per person per day. Total daily flow__-_.-_-.---7- .............gallons. WSeptic Tank—Liquid capacity_I.O.ttallons Length................ Width................ Diameter..._............ Depth................ x Disposal Trench—No.................:... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.-__-_----_---_._-- Diameter.................... Depth below inlet....... .......... Total leaching area..... _sq. ft. z Other Distribution box ( ) Dosing tank a Percolation Test Results Performed by------- _... ..__ .._... .. Date......... �r.�r � Test Pit No. 1__ .c Cminutes per inch Depth of Test it..... Depth to ground water....... //j_ Gz, Test Pit No. 2.._.,�,��►tuinutes per inch Depth of Test Pit..............:.....Depth to ground water.....f_/.`._........... .... •------------------------------ 0 Description of Soil...................................................................�•---...I--• • ,r �- <1 .•�+ V -----_.--•� �X- • --------�+.q ;... W .�- I f ---------------- U Nature of Repairs or Alterations—Answer when applical5le............................................................... ............................... --------------•-------------•--•--•-••-••••••....••-•--•••-•-----•---••••--••-•••-------....--------•-•-----------••----•••-•••--••-••----•-----•--=........................................................... Agreement: The undersigned agrees to install the aforedescribed. Individual Sewage.Disposal.System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certilicate of Compliance has been issued b e board ofealth. Signed................... �� .... s Dt Application Approved BY..............•-••-- 1_..... /r ...._..............----- ---../(�, 2' .......... Date Application Disapproved for the following reasons-................................................................................................................ - .........-•-••-•••-••--••••-•-•-•....••••-•---•------•••-•-••--•-•-••-----•----•----....-•-•-•---•------•.....----•---------•--•..........--•-•------•-••••--•-••-•---_--•-•-------•--•-•--_----•...••. Date PermitNo......................................................... Issued-............................................. . Date ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... (Irr#if irtt#r of TnngAittnrr THIS IS TO CERTIFY, Ttat4he Individual Sewage Disposal System ucted )"' or Repaired ( ) bY.................................................. Inf :-..:.---• fir fi ........................................................... Installer �J ��� at.•............................................................. , (3 `' �TI' ' =---�-------•-• -•f�• �......fC�'o v- has been installed in accordance with the provisions of TIT F ` ohe State Sanitary Code as described in the P Y application for Disposal Works Construction Permit No....... Q _.____.__. dated_...-______.............. `.__................ THE ISSUANCE,OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® A GUARANTEE THAT THE SYSTEM WILL U TION SATISFACTORY. DATE........... 2 l Z ✓_........ Inspector.....----- --------•--.....:............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.................................... No..�•f.....l9s FEE.....kA............ Uiopoottf Works Tnno#r Uan r # Permission is hereby granted..................•- � �.!`�*'i�t. --•)...----V .. -----•---••--------------.......------.......--•--••---•----- to Construct ( ,r<or Repair ( ) an Individual Sewage Dispo al System . -•---- --J- at No. � Zt 4--- Street as shown on the li ion for Disposal �t j s Construction Permit No....................• Dated---------------....._..................... s Health - - DATE..f`.. ... ............ ........ -••---••-•--•...... FORM 1255 A. M. SULKIN, I " '4. r b ZDID C 5-3 lc>RAuu S o i4 rL +'+n (/ .5 ,o, �• I�. 40° m O 1 A /hen mar• N� �� T -r ' Lp G 7-4- t kA 1 0?4hu-4C,E �gSEirjEnJT ^ ` . . IA rv✓c 7��07` w ,JE E<IS rEnI� '-Rorn,�rr/,Q, AC(eS5 7URo tT�28 >�4yi3aA� Li/ - CS7,4TE H�GHwAY /ELp ui T 9cv 3 ORSE I Z/ S r ,p No.10951�p Q L. T y LEGEND EXISTING SPOT ELEVATION Ox� CERTIFIED P LOT PLAN EXISTING CONTOUR —_— ® --- �T`�N°FM�S`�+ FINISHED SPOT ELEVATION z�' °tic Pictsso r�cs�CE � � �1--c ?� - ROBERT s a S rc r2V/�c FINISHED CONTOUR 0 -- 1 BR - a ELDRED H I N APPROVED 80/1R0 OF (HEALTH �A A 5 1 A ' 1 8, A) A J J, 1y p`'1�10 OAT E AGENT s su SCALE l DATE, 8-E l 8-3 LOREDGE ENG/NEER/IVP CQ wepC L I It NTH I CERTIFY THAT THE PROPOSED EGISTERE REGISTEREb ' , JO® No., BUILDING SHOWN ON THIS PLAN CIVIL LAND �� � CONFORMS TO THE ZONING -LAWS ENGINEER DR.BY :--�-AAM OF BARNSTABLE , MASS. 712 MAIN S TR E ET CH. BY HYA NN I S, MASS. SHEET.! OF D TE REG.r LAND SURVEYOR t ?��10TF - //r E/TNLRJ. TAN 'C OR 140 _E.4C.HING P/T ARE MORE T/,1�1:`! /2"9ELOX4 PT. J" s-VALL E CCc�� ar _ GOMC/it�TLtii 4'P'YG' O/PB BE ®aOuGNT TD G.gAOE. �.►,v AVIAO' A/TCl/ HEAVY CAST /R'ON G -.)yE� �•pE.�i �r f /Fl.V �R/VEiVAY -3= .'Sc.. t� ? '�• .wIN. COa'C2�tT_ 141 �~ � AQ'. � - - - - `. -r ..:�--c��_ 2`•L AYE.? dp • dOlC e o e • . • • s • • • • •• RYA S Ye4> 57U C - � � - ; - e.o • • • a pCpTp • •r •` ; • • 3yA31rE0 STJ,9/: +� IJ�/�f' '�.���II�"/a��_ 78 Sv. / o e• f a 1 e e e o • • • 9, ••' PRECAST SE,ffAWaZ' IAIYZR7 ANY`AIMADA4 4 z%� 6 jP7:a/�4"_ _r r fT O/sAl►� C 7-JLIL A770/V �► .SEA iz- S lTER TAQ2 t✓A/O ff ' r iii!►'i DIPIEN-TIOM AAM ,c a.4cAr o15A05A4 tW/r iyo ntE - SOl� LOB At f" TOTii1 t E.TY//►3RTE® FLONI. 3 3 v 69.4E/A4Y SOIL TtaST 0l, SOIL.7VS7-,lZ �SlJMBE.?C1F LP�CXfX!i 0/T. �+LrLEY, SO Z / SIDE L�ACNI/V6 aBse p/7` Mr. 1 ELAY,_— JOA7-Ec OF".p0/L TEST 7/ /�k 3 joTTO/+t 1CM/NC3 PLsJ�PtT 7k—SO'. .fT. o v AESVLTS h/1TN8SSE0 dD'' i 7T/►L LcT4CNI/1/G A.qE/t 26 V .tQ FT. ?`a�s vrG ''F'4COLAT/O/v R,gT/s / ?ESE.4VEL�CNIIV6AR46 -zb 6 S4. FT_ � �,��` �.. � �.tCOL�+T-iaNROTE,�2 z,r; <} ;''-`1tw.//.vC/,► K OF A4gss �`a�' C` C-) ROBERi. v ,AS T'" �,.\ S / L 0 T91't V� r; -7 r BRUCE�'r ! G- fELDRc °J + No.10951 O I o A� IS S? ,Q CO / �F�`�OWAL E��\� EL. 3 8,7 EL Or?EDGF cNGJNFf 'G `U / . ® NO G�OLJNJ ivYATCe4 f 712 �'!^I�`/ ST. • h�Y.4N.v/S. NA11. NCOUNTE.�EO CL/EN Q GRO llNO 1tiA TE.4 AT T JOe .,1/O,• S"c 2_,%'b SN E�=0f a' LOCATIONoT VAe.1 Ge>001 i 40 /� (JZgNO. VILLAGE QS7EQVlL L. DATE 07 If- SS APPLICANT Jt3QJ >� Dc-�rPJu� T Co Q.P. FEE +� 1g► — t ADDRESS G.EAITE fwt LL'E TELEPHONE NO. '17 1-3 61{, (Non-refundable ENGINEER LL.CR.�DG►� ,d�,I► 9 NA}„w__._., TELEPHONE NO. '1] 1 - j DiTE SCHEDULED'. JVL`( Z.fP Applicants signature • . • • • • • • •s e'• • • • •.• • O o 00 00 • 00 lO0 owe 0•06• 00.•O0• OL•O • 0O0O0000000 •.0 • • O •O• 000 }„0Ak0 •O•+.00.• SOIL LOG: SUB-DIVISION NAME -CIS emkl figlgg 0- OSTS&L.Le •..DATE o7 • 'L!a TIME 9 30 EXPANSION AREA: YES ✓ NO J tj Lt Q. . ELL.19 ENGINEER 7 �..... .w _ �.. . TOWN WATER✓ PRIVATE 'WELL J04 W J A Gd P. I BOARD OF HEALTH J.I M- Ia,S t SCE, L L. EXCAVATOR SKETCH: (Street .name,etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetland$ in proximity to test holes) • p►�A-S-w_%= PL. CW'� NOTES: Q s1.so At IS 3 Q=25.o0 � A=otll8 LOT 44.8 20 M15THOL Iry c5i Q=25.ao 80 A = .G�t �.g PERCOLATION RATE: < AAIt j / i cjGv-! TEST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: l:ofrA.i 2 2 3 3 4 10 - S "aD S/kwlb 4 5 5 ..6 6 CSC Si� 7 7 P J T c v iT)A 8 Fj tisa 8 9 5,_1�L SPr�D 9 10 10 11 . 12 12 13 l v pTe-(L_ 13 14 14 15 15 / 16 16 ' SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS LEACHING TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE. REA$ONS: WJA • r NOTE: ENGINEERING PLANS MUST SHOW NUMBER. ASSIGNED ON PERC TES PPLICATION ORIGINAL: COMPLETED IN RETURNED TO BOARD OF }IALTH � COPy! RETAINED BY APPLICANT . *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. 0WMW,442Y I I ti 10 min. from SECTION A A �r-`--'2 d Existing Foundation house to septic tank ALL OWLET PIPES FROI THE. I, v►.«.w y SHAL BE TOP OF FOUNDATION = ELEV. 100.00 (Assumed) septic tank covers must o-BOX cover must be PROFILE VIEW OF ADDITION TO LEACHING SYSTEM SET�70NFORBOAT LEAST 2 FT. � tr within 6 in. of finished a v within 6 in. of finished grade grade H Grade over Septk Tank-96.00 Grade over D-Box- 96.00 over SAS-96.OD ;--�..:4 e �� _eZ 3" of 1/8' - 1/2" Washed Peast 3-5.OUTLET . 2 3/4" to 1 1/2 ' Washed Crushed Stone - icllodtouTs S 0.02 3 HOLE H-10 4•PVC(CAPPED)INSPECTION PORT TO BE { 55• OUILET 1r NET f tir l 9v'`nPs' ST. BOX 3' Maximum Grover INSTALLED AND To BE U'*M S'OF GRADE e• ,' ( f 11 EgSL_PrE '� 1r EXIIn 1,000ST.GAL s�0.01 ar rap of system-oa, •ss�s �� _....s TV"fw�IL M O Greot.r rRalt EXIST. FOUNDATIDN W a SEPTIC TANK g 2W S. 0.a1•per toot 155• 0 I _. SEEM= coNOREfE , , •11: In 0 10"Effective�� PLAN SECTION CROSS-SECTION °h o i m o' 0 0.83' (10 inches) S Units 2 625' 30' /�A`` %2 0 SYSTEM PROFILE 6 in.of 3/4--1 1/2- -4 1 3 3' _ to 31.2s 3 HOLE 'H-10 DISTRIBUTION BOX c compacted stone o • rn t ✓ �'; ;�" 1� ` Not to Scale - c 'o • • O= 37.25' NOT TO SCALE P==XtP n ono > 5 c '0 3.5' 3.5' Effective Length '�xsHAe=ew key a ata�fmrtm n 3' o SOIL ABSORPTION SYSTEM (SAS) 6 in.of 3/4*-1 1/2' a 10' m GENERAL NOTES compacted stone < Effective vidat INIFILTATROR HIGH CAPACITY (H-20 LOADING)/ GEORGE O'BRIEN NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE m 1. Contractor is responsible for Digsofe notification, Verification of Utilities z (OR EQUIVALENT)• Not to Scale and protection of all underground utilities and pipes. pi w Bottom of Test Hole 1 Elev-86.50 p Groundwater observed - NONE OBSERVED NOTE: OVERALL HEIGHT OF INFILTRATOR IS 18' /EFFECTIVE HEIGHT IS 10" 2. The septic tank and distribution box shall be set level on 6" of 3/4"-1 1/2" stone. 3. Backfill should be clean sand or gravel with no stones over 3" in size. PERCOLATION TEST P 4. This system is subject to inspection during installation IC'A by Carmen E. Shay - Environmental Services, Inc. S� 5. The contractor shall install this system in accordance Date of Percolation Test: JANUARY 12, 2006 -� with Title V of the Massachusetts state code, the approved plan Test Performed By. 6. If, during installation the contractor encounters any CARMEN E. SHAY, R.S., C.S.E. RAG �.� C and Local Regulations. Results Witnessed . '40 FOOT WAIVER (BARNSTABLE B.O.H.) HT OF WAY EXCAVATOR: Shay Env. Svcs. ) Drainage Easement soil conditions or site conditions that are different Percolation Rate: Less Than 2 MPI ® 30" `- from those shown on the soil log or in our design `'- installation must halt & immediate notification be Test Hole Test Hole - _ made to Carmen E. Shay - Environmental Services, Inc. No. 1 No. 2 ---___� 7. No vehicle or heavy machinery shall drive over the DEPTH SOILS ELEV. DEPTH SOILS ELEv. = septic system unless noted as H-20 septic components. 0 98.00 0 97.50 ��` 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. Loamy Sand Loamy Sand 53.56, ��� 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. 10 YR 3/2 10 YR 3/2 / ��\ 10. All solid piping, tees & fittings shall be 4" diameter Ae 97.25 0'-9, A. 96.75 �S \\ Schedule 40 NSF PVC pipes with water tight joints. Sandy Sandy J �� •gyp, 11. Municipal Water is Connected to ALL OF The Residence and Abutting Properties Within 150 Feet. aam Loam � LOT #47 r t'j. PROJECT BENCH MARK Pro P 10 YR 5/6 10 YR 5/6 J 9"- 30' Bw 95.50 9"- 3a" Be 95.00 1 f5,007 Square Feet t/- --_-- •Gs6'' �� TOP OF FOUNDATION THE PROPERTY LINES ARE APPROXIMATE AND t ELEV. = 100.00 (Assumed) COMPILED FROM THE SURVEY PLAN GENERATED BY Med-Fine Med - Fine' � -- Sand sand �� ELDRIDGE ENGINEERING OF HYANNIS, MA 2.5 Y 7/4 2.5 Y 7/4 ENTITLED CERTIFIED PLOT PLAN OF LOT47 VAN GOGH DRIVE,OSTERVILLE, MA" 30-- 1321 \� , �� DATEDAUGUST 30, 1983 and, LCC PLAN 34625-A C, 30"- 132 C, 1 -- �\ AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN G3` IT SHOULD BE USED FOR NO PURPOSE OTHER THAN _� tt She •�tp, THE SEPTIC SYSTEM INSTALLATION. EXISTING LEACH PIT TO BE PUMPED OUT AND REMOVED j r A j TO INSTALL NEW SEPTIC SYSTEM i EXISTING t A NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE 3 BEDROOM �Q� 10 I � FROM THE EXISTING LEACH PIT TO BE DISPOSED / HOUSE �`�G � •o I � OF AS PER BOARD OF HEALTH SPECIFICATIONS. / EXIST_.1 ppqq��-GAL _ THERE ARE NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY SEPTIC TiKNK Depth to Perc: 30" to 48" Pere Rate= 2 MPI Groundwater Not Observed �' EXIST. O ASSESSORS MAP 145 PARCEL 078 ' \� ` No Observed ESHWT i ��> `� DRIVEWAY LEGEND ADJUSTED H2O Elev. = None 0 f1 2-1e" IMAM. ACCESS MANHOLES Zo `� for Shed \�� � \�► = O 104X1 DENOTES PROPOSED g / D-Box 37.25► SPOT GRADE / / o DENOTES EXISTING } �.�..:_�.-._:.�-�.� / �. •- .•;;�F... . . -r, x 104.46 SPOT GRADE , -...ti• _ !} J PROPERTY LINE INLET /.-- Gx1~ J �`` h i=-` r L/ PL ET p` J Failed I 96P PROPOSED CONTOUR r THE ACCESS GBOX A FOR THE SEPTIC TANK, ® LEACH PIT j EXISTING CONTOUR DISTRIBUTION Box AND LEACHINGBELOW COMPONENT FINISHED / -97 '�;._:..;.z;-?:?�•�:^:*=-,--'-.-�' SET DEEPER THAN 6 B+aHFs BEu1w FtNisED � -- --- :: GRADE SHALL BE RAISED r0 tRTHM 6. OF TEST HOLE j12 \ TEST HOLE #1 I STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE' J ELEV.= 97.50 ELEV.=✓98.00 2 .4' I PLAN VIEW INSTALL TUF-TITe GAS BAFnxs OR EQU&S ; IN ® DEEP TEST HOLE & �-3-24"REMOVABLE COVERS-� PERCOLATION TEST LOCATION -` -_ �1 •---• 6 FOOT STOCKADE FENCE 3' min. clearance - •t3• NET / INLET 6•min. r min. Not to outlet a. \ _- Lgald �vai OUTUT s -r ,o•e* 'V-7' Drainage em 6�, u P LOT PLAN €as e st " 4•-0•ink,. �� eft 36,,- J ca goers. [- Uquid depth ........ ---- - - OF PROPOSED SEPTIC SYSTEM UPGRADE 80.46 - ------ --- V O -•,�.L•y� At'•.L. Sao :�.. ,�. � � •:, j / PREPARED FOR CROSS SECTION END-SECTION g FJ MR. D 0 0 0 LAS S BEARS E AT TYPICAL 1000 GALLON SEPTIC TANK #7 VAN GOGH DRIVE NOT TO SCALE ------------ ' Design Calculations ----------------------------------- '��/ OSTERVI LLE, MA �aZK F s Number of Bedrooms: 3 Equivalent to 330 Gal./Day (330 Gal./Day Min. per Title V) PR ARED BY: Garbage Grinder: No Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) O �� 8 A -A HEW E. Sff Y Septic Tank : - 2 x 330 Gal./bay = 660 USE EXIST. 1,000 GAL. Septic Tank. A Ca NVIRONMENTAL SERVICES, INC. SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch 5 Bottom Area: 0.74 gal/sq. ft. x 37Z5 sq. ft. = 275.65 gallons 0 20 40 50 i 'Q a �O P.O. BOX 627 ft Sidewall Area: 0.74 gal./sq. . x 78.72 sq. ft. = 58.25 gallons JSTE EAST FALMOUTH MA 02536 Providing: = 333.90 gallons I I I1 SgNI TARAPN TEL/FAX : 508-539-7966 Use: (5) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, TO BE USED WITH 3.5' OF;WASHED STONE ON THE SIDES, AND 3.5' OF WASHED STONE SCALE: 1"=20' DRAWN BY: CES DATE: JANUARY 31, 2006 ON THE ENDS. NO STONE UNDER. SCALE: 1 =20 PROJECT#SD859 FILENAME: SD859PP.DWG SHEET 1 OF 1