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HomeMy WebLinkAbout0306 WEST BAY ROAD - Health 306 WEST BAY ROAD, OSTERVILLE - A= 116 014. a _ i Jan 09 2019 23:05 HP Fax page 1 commonwealth of Massachusetts 11F Title 5 Official Inspection Form X Subsurface Sewage Disposal System Form - Not for Voluntar y Assessments' 306 West Bay Road - Property Address r� Mark Curley Trust -r Owner Owner's Namea information is ,5 required for every Osterville MA 02655 12-20-18 - * page. City/Town State Zip Code Date of Inspection U1 Inspection results must be submitted on this form. Inspection forms may not be altered In any way. Please see completeness checklist at the end of the form. Important:When \�ptstuuntuAir fill out forms A. Inspector Information on the computer. Z c use only the tab James D.Sears :' JAM ES % key to move your Name of Inspector SEAR S cursor-do not : use the return Ca ewide Enterprises CO* key. Company Name ' ,,RTIF� 153 Commercial Street ''�4,4F g'IN'SP�L;`�p��` "11 Company Address truturu Mash pee MA 02649 Chy/Town State Zip Code �^ 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 , (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection, and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: I. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 1'La•a. d-� 1-4-19 J0i pector'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 has a design How of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform In the future under the same or different conditions of use. t5insp.doc-rev-7/28/2018 Title 5 Official Inspection Form:Subsurface Sewa a Di 9 sposel System•Page 1 of 18 I Jan 09 2019 23:05 HP Fax page 2 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 306 West Bay Road Property Address ' Mark Curley Trust Owner Owner's Name information is required for every Osterville . MA 02655 12-20-18 page. City/Town. State Zip Code Date of Inspection C. Inspection Summary Inspection Summary; Complete 1, 2, 3,or 5 and all of 4 and 6. 1) System Passes: ; ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist,Any failure criteria not evaluated are indicated below. Comments: Note: Septic Tank is 1500 Gal.. The system is a 1500 Gal Tank D Box and three chamber's 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or'not determined"(Y,N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y. ❑ N ❑ ND (Explain below): t5lnsp.doc•rev.7/28/2018 Title 8 Offwjai Inspection Form:Subsurface Sewage Disposal posel System•Page 2 U 18 f Jan 09 2019 23:05 HP Fax page 3 commonwealth of Massachusetts - � Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 306 West Bay Road Property Address Mark Curley Trust Owner Owners Name information is required for every Osterville MA 02655 12-20-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumpslalarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ NO (Explain below): ❑. obstruction is removed ❑ Y ❑ N ❑ NO (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO(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 ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5lnsp.doc-rev.71282018 TIUe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 d 18 Jan 09 2019 23:05 HP Fax page 4 'y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v�r 306 West Bay Road Property Address Mark Curley Trust Owner Owner's Name information is required wired for every Osterville MA 02655 12-20-18 page. Cityrrown state Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well'". Method used to determine distance: *'This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: s You must Indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.T126/E018 Title 5 C16cial Ins pecliort Form:Subsurface Sewage Disposal System.Page 4 of t8 Jan 09 2019 23:05 HP Fax page 5 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form .Not for Voluntary Assessments y 306 West Bay Road Property Address Mark Curley Trust Owner Owner's Name information is Osterville MA 02655 12-20-18 required for every II page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in isl is less than 6".below invert or available volume is less than 1/z dayflow CAia¢ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000 gpd 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15,303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5inap.cloc•rev.7126/2019 Title 5 Official In epeceon Fo;rr:Subsurface Sewage Disposal SyaDarn•Page 6 o11B Jan 09 2019 23:05 HP Fax page 6 Commonwealth of Massachusetts ,ig Title 5 Official Inspection Form '- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 306 West Bay Road Property Address Mark Curley Trust ` Owner Owners Name Mcrmation is Ostervill required for everye MA 02555 12-20-18 page. CitylTown Slate Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered'yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been Introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened,and the interior,of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® 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)] Mnsp.doc•rev.7/2812016 TRIa 5 Offidal InspeWion form,Subsurface Sewage Disposal Systern•Page 6 of 15 Jan 09 2019 23:05 HP Fax page 7 Commonwealth of Massachusetts V° Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �� 306 West Bay Road Property Address Mark Curley Trust Owner Owners Name information is Osterviile required for every MA 02655 12-20-18 page. CitylTcwn State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms (actual): 1 Apt. 3 House. DESIGN flow based on 310 CMR 15.203.(for example; 110 gpd x#of bedrooms): 440 Description: 1500 Gal.Tank D Box and three chamber's. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No' Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): 2016-112,000Gal Detail: 2017-166,000Gal Sump pump? ❑ Yes.® No Last date of occupancy: NA Date t5insp.doc•rev.7MI2018 Title 6 Official Inspecdon Form:Subsurface sewage Disposal system•Page 7 or 18 Jan 09 2019 23:06 HP Fax page 8 Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments " 306 West Bay Road Property Address Mark Curley Trust Owner Owner's Name information is required for every Osterville MA 02655 12-20-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Comm erciaUlndustrial Flow Conditions; Type of Establishment: Design flow(based on 310 CMR 15.203): canons per day 19Pd1 Basis of design flow(seats/personslsq.1., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: NA Was system pumped as part of the inspection? ® Yes ❑ No If yes,volume pumped: 1500 Gal. gallons How was quantity pumped determined? Gage on pump truck. Reason for pumping: Maint Pump I f f t5irtsp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page a of 18 Jan 09 2019 23:06 HP Fax page 9 Commonwealth of Massachusetts Title 5 Official Inspection Form 4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 306 West Bay Road Property Address Mark Curley Trust Owner Owner's Name information is required for every Osterville MA 02655 12-20-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tigh1 tank.Attach a copy of the.DEP approval. ❑ Other(describe): Approximate age of all components, date installed(if known)and source of information: Tank NA-Leaching 2006 Permit#2006-•191 Were sewage odors detected when arriving at the site? ❑ Yes.® No 5. Building Sewer(locate on site plan): Depth below grade: 34" 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.): Pipeing is 4" PVC SCH -40. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface sewage Disposal system-Page 9 of 18 Jan 09 2019 23:06 HP Fax page 10 Commonwealth of Massachusetts ,P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 306 West Bay Road Property Address Mark Curley Trust Owner Owners Name info mation is required for every Osterville MA 02655 12-20-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): " Depth below grade: 2'teat Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal. Precast Sludge depth: 2„ 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 12" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Asbuilt-Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Tank at working level. Tank at 2' below grade w/inlet cover at 10"and outlet cover at 16", Three inlet tee's and outlet Baffle. No sign of leakage or over loading, t5insp.doc-rev.T/IMI8 Title 5 6tfidal Inspection Form:Subsurface Sewage❑Ispesat System•Page 10 of 18 Jan 09 2019 23:06 HP Fax page 11 Commonwealth of Massachusetts- . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 306 West Bay Road Property Address Mark Curley Trust Owner Owners Name information IS required for every OStervllle MA 02655 12-20-18 page. City/Town State Zip Cade Date of Inspection D. System Information (cons.) 7. Grease Trap(locate on site plan), Depth below grade: feet Material of construction: ❑concrete ❑metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom.of scum to bottom of outlet tee or baffle " Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): ' Depth below grade: Material of construction: ❑ concrete ❑metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5nsp.doc•rev.712 M18 Title 5 Offk al Inspection Form:Subsurface Sewage Disposal system-Page 71 oT to I Jan 09 2019 23:06 HP Fax • page 12 V Commonwealth of Massachusetts ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments C 306 West Bay Road Property Address Mark Curley Trust Owner Owners Name information is required for every Ostervllle MA 02655 12-20-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: pate Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 20"x20"-2'-4" Below grade. D Box is clean and solid. No sign of over loading or solid carry over. 15insp.doc•rev.7/26MI8 Title 6 Mcial Inspection Form:Subsirlace Savage Disposal System•Page 12 of 18 Jan 09 2019 23:06 HP Fax page 13 Commonwealth of Massachusetts Title 5 Official Inspection Form ` Subsurface a e SewageDisposal System Form Not for Voluntary AS sessments P Y Y 306 West Bay Road L Property Address Mark Curley Trust Owner Owner's Name information is required for every Osterville MA 02655 12-20-18 page. City/Town State Zip Code Date of Inspection D. System Information (cons.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms In working order ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): i *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan,excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number. ® leaching chambers number:' 3 ❑ leaching galleries number: ❑ leaching trenches number,length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Typetname of technology: tSinsodoc rev.712812018 Tltle 5 Official Insp ection Form:Subsurface Sewage Disposal System•Pega 13 of 13 Jan 09 2019 23:07 HP Fax page 14 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 306 West Bay Road Property Address Mark Curley Trust Owner Owner's Name information is required for every Osterville MA 02655 12-20-18 page, Citylrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS)(cost.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.): Leaching is three 500 Gal. Dry well chamber's. Chamber's are 33"below grade w/cover at 7". Chamber's are clean and dry like new. 12. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions Hof 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.): t5lnsp.doc•rev.7/26/2018 Tide 5 0fri W in spection Form:Subsurface Sewage Disposal system•Page 14 of 18 Jan 09 2019 23:07 HP Fax page 15 Commonwealth of Massachusetts y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 306 West Bay Road Property Address Mark Curley Trust Owner Owner's Name information is required for every Osterville MA `02655 12-20-18 page. City/Town State Zip Code Date of Inspection D. System Information (cant,) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic'failure, level of ponding, condition of vegetation, etc.): t5lnsp.doo•rev.V2612016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 or 1s Jan 09 2019 23:07 HP Fax page 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 306 West Bay Road Property Address Mark Curley Trust Owner Owner's Name information is Osterville MA 02655 12-20-18 required for every page, City/Town State Zip Code Date of Inspection- D. System Information (cons.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks, Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 15insp.doc rev.7126/2016 Title 5 Official lnapecifdn Form:Subsurface Sewage Disposal System Pepe 16 of 16 Jan 09 2019 23:07 HP Fax page 17 • AsBuilt Page 1 of 2 i V w LA Iir D A►lu*4 J i nn l.t7 j Qn LOCATION SEWAGE# DO VILLAGEP V r ASSESSOR'S MAP A LOT �o Q t -INSTALLER'S NAME&PHONE IVO. C SEPTIC TANK CAPACrry Q j LEACHING FACIUM(type)MNO (size) NO.OF BEDROOMS BU[LDER OR OWNER PERbVDATE: COMPLIANCE DATE: S Separation Distance Between the: Meximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply-Well and Leaching Facility (If-any wells exit on site or within 200 feet'of leaching facibry) Feet Edge of Weiland and Leaching Facility(If any.wetlands exist within 300 feet of leaching facility) feet Furnished by r - Z P-1 014 -- --� A 36rB ............................. http i/!issgl2/intranet/propdata/prebuilt.aspx?mappar=l 16014&seq=l 12/14/2018 Jan 09 2019 23:07 HP Fax page 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 306 West Bay Road Property Address Mark Curley Trust Owner Owner's Name information is Osterville required for everyMA 02655 12-20-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells O 10, Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked,date of design plan reviewed: 4-20-06 Date ❑ Observed site(abutting propertylobservation hole within 150 feet of SAS) ❑ Checkedr with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: M You must describe how you established the high_ground water elevation: T.H.on Design plan 4-20-06 10'no G.W,. Bottom of chamber's at 5'below grade. Bottom of chamber's at 5'above T.H. Depth; n . Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5lnsp.doc-rev,7/26/2018 Ttle 5Official Inspection Form:Subsurface Sewage 01sposal Syslem•Page 17of 1s f Jan 09 2019 23:07 HP Fax page 19 'y Commonwealth of Massachusetts., uir-,ov-f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 306 West Bay Road Property Address Mark Curley Trust Owner Owners Name Informadon is OStervllle required for every MA 02655 12-20-18 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B.Certification: Signed&Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1,2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed ® D, System Information: For 8:Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included S e R c m /Q nN Q U.w 15insp.doc•rev.W26/2018 Title 6 Offidal Inspection Form;Subsurface Sewage Disposal System•Page 1B of 1B COMMONWEALTH OF MASS ACHUSETTS a ExEcUTI\CE OFFICE:OF ENVIRONMENTAL f AFFAIRS " I DEPARTMENT OF ENVIRONMENTAL P ROTECTION f TITLE 5 OFFICIAL INSPECTION FORM:'- NOT FOR VOLUNTARY,ASSESSMENTS f SUBSURFACE SEWAGE DISPOSAL SYSTEM:FORM } PART A 1: + CERTIFICATION I 1 Property.Address: 306 West Bay Road ` f Ostetville.MA 02655 Owner's Name: Michael Marchese " t Owner's Address:. f b Date of Inspection: May 4: 2012 i Name of Inspector .(Please Print) JanmesM Ford ti Company Name: Jariiea M."Ford Mailing Address P.O.'Box 49 Oaten ville,MA 02655-0049 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal;system at:this address and.that the information reported . t` below is true,accurate and complete as,of the time of the inspection: fihe inspection.was performed"based on my training and experience in the proper function and maintenance of on site sewage disposal`systems. 'I.arn a DEP approved system inspector pursuant to Section 15:340 of Title 5(310 CMR:15,000). The system:; i ✓ Passes !; Conditionally.Passes : Nee&Further Evaluation by the Local.Approvmg Authority Fai s Inspector's Signature:" Date ' " Mav 21."2012 The"system inspector shall sub it copy of this inspection report to the.Approving.Authority::(Board of Health or I DEP)within 30 days of complet this"inspection: If the system.is a shared.system'or has a design flow.of 10000 gpd or greater,the inspector and the systern"o.wner shall submit-the report to the, appropriate regional office of the p . buyer,DEP.'The original should be sent to theaystem owner and co ies sent to the bu er if applicable,and.the approving authority. P Notes and Comments t This report only describes conditions at the time of inspection and under the conditions of use.at that time. This inspection does not address how'the system will.perform in the future under the same or.different conditions of use. Title 5 Inspection Foim 6/15/2000 page I Page 2 of 11 e OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM>INSPECTION FORM PART A y - CERTIFICATION (continued) Property Address: 306 West Bau Road — Osterville M�1 1 Owner: Michael Marchhese Date of Inspection: Mav,4 2012 c Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section 1; A. . System Passes: ry ✓ : I have not found any information which indicates that anyof the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.:Any failure criteria not evaluated are indicated below. p Comments: a t 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. k 3 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(whethet metal or not) is structurally. unsound,exhibits substantial infiltration or exfiltrahon 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;. 4 {; 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 t f distribution box is leveled or replaced ND explain: s H i The system required pumpingmore than4 times a year due to broken,or obstructed pipes) .The system Will pass inspection if(with approval of the Board of Health): broken pipe .(s)are replaced f obstruction is removed ND explain: p . 2 l; Page 3 of 'I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY°ASSESSIVIENTS SUBSURFACE SEWAGE'DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) . Property'Address: 306 rest Bav Road Osterville MA. Owner: Michael Marchhese Date of Inspection: _ May 4, 2012 C 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 s is failing to protect public health,safety or the environment. system 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the f 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 borderin vegetated wetla nd gor a sa lt It marsh- 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. pP Y• The system has a septic tank and SAS and the SAS is withina Zone 1 of a public water supply. The system has aseptic tank and SAS and the SAS is within 50 feet of a private water supply well. p - The system has a septic.tank and SAS and the SAS is less than 100 feet but 50 feet or more from a z private water supply well**. Method used to determine distance **This system passes if the well water analysis,performed at'a DEP.certified laboratory, for coliforin` bacteria and volatile organic compounds indicates that,the well is:free from pollution from that facility and the.presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy.of the analysis must be attached to this form. • E 3., Other: 4 _ - y Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIQN FORM PART A 'CERTIFICATION (continued) ' i Property Address: 306 West Bay Road d Ostei-ville MA Owner: Michael Marchhese Date of Inspection: May 4, 2012 D. System Failure Criteria,applicable to all systems: r 'You must indicate either"yes"or,"no"to.each of the following for all inspections: @ Yes No ✓ Backup ofsewage into facilityor system componentdue 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 1.00 feet of a surface water supply o water supply. r tributary to.a surface ✓ 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 4 supply well with no acceptable water quality analysis. [This system passes if the well water analysis, ' performed at a DEP certified laboratory,for coliform,bacteria and volatile organic compoun ds indicates that.the:well is free from.pollution from that facility and the presence of ammonia j nitrogen and nitrate nitrogen is equal to or, less than 5 ppm,.provided that no other failure criteria are triggered. A copy of,the analysis must be attached to:this form.], . No (Yes/No)The system fails. I have determined that one or more.of,the above failure criteria existas E 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 System: . To be considered a large system the system must serve a facility with a.design flow of 10;000 gpd to 15,000 t . gpd.. ' You must indicate either"yes"or"no'.'to each of the.following:' - (The following criteria apply to large systems in addition-:toahe criteria above). Yes. No _ the system is.within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area IWPA)or 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 systein has failed..The owner or operator of any large system considered a significant threat under.Section E or failed under Section D shall upgrade the system-in accordance with 310 CMR 15.304: The system owner should contact the appropriate regional office of the Department. ` 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 306 West Bav Road Osterville.MA COwner: Michael Marchhese Date of Inspection: May 4:2012 Check if the following have been done: You-must indicate"yes"or"no"as to each of the following: Yes No $ . ✓ Pumping information.was provided by the owner,occupant;or.Board of Health ✓ Were any of the system components pumped out m the previous two weeks.? k f ✓ Has.the system received normal flows in the previous two week period? k _✓ 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 mere not available note as N/A): z ✓ Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of breakout,? 1 # ✓ _ Were all system components;excluding the SAS,located on site? Were the septic tank manholes uncovered,opened,and the interior of the tank mspec,ted for the condition r of the baffles or tees,material of construction,dimensions,depth of.liquid,depth of sludge and depth of scum?, Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage'.disposal systems The size and location of the Soil Absorption System(SAS).on the site has been determined,based on: Yes No t n ✓ _ Existing information.`For.example,a plan at.the Board.of Health. u ✓ Determined in the field(if any'of the failure criteria related'to.Part C is at issue approximation of distance ` is unacceptable) [310 CMR 15.302(3)(b)]. • i r 5' r ' r Page 6 of 11 . OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION;FORM PART-C SYSTEM INFORMATION Property Address: 306 West Bav Road I Osterville.MA (. Owner Michael Marchhese Date of Inspection: May 4. 2012 FLOW .CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example:'110 gpd x#of bedrooms): 440 ' Number of current residents: 0 Does residence have a garbage grinder(yes or no). lU/a Is laundry on a separate sewage system(yes or no): N/a ,[if yes separate,inspection required] Laundry system inspected(yes or no): ` no Seasonal use(yes or no): no. " Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL Type of establishment: ,. Design flow(based on 310 CMR 15.203): gpd` } Basis of design flow(seats/persons/sq/ft etc.): 9 Grease trap present(yes or no): ' Industrial waste holding tank present(yes or no) t Non-sanitary waste discharged to the Title 5 system i; �' g Y (Yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL :INFORMATION Pumping Records Source of information: Unavailable' 1 Was system pumped as part of the mspection,(yes or no): If es volume-pumped:Y p p gallons--How was quantity pumped determined? :. Reason for.pumping TYPE OF.'SYSTEM } ✓ Septic tank,distribution box,soil absorption system 3 Single cesspool T 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: . Date of installation 51512006 per as-built card Were sewage odors detected when arriving at the site(yes,or no): No i i 6 h., r Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE'SE,'WAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION (continued) 1 Property Address: 306 West Bay Road Osterville,MA F, Owner: Michael Marchhese i Date of Inspection: . May 4. 2012 BUILDING SEWER(locate on site plan) � Depth' p below grade: ' Materials of construction: cast iron _40;PVC , other(explain): f Distance from private water supply well or suction hne:` i Comments(on condition of joints,:venting,evidence_of leakage,etc.): F SEPTIC TANK: ✓ (locate on site plait) Depth below grade 12`" Material of construction: ✓° concrete metal fiberglass "_polyethylene _other(explain) 7. t If tank is.metal list age: Is age confirmed by a Certificate of Compliance(yr no): (attach a copy of certificate) . Dimensions: 1000.gal. Sludge depth: 2 Distance from top of sludge to bottom-of outlet tee or baffle: 3011 Scum thickness: 1" Distance from top of scum.to top of outlet tee or baffle: 6" �i Distance.from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measwinz stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity;liquid levels as related to outlet invert,evidence of leakage;,etc.). The tees were resent. The lig d level was even with the outlet invert There did not avpear to be aizv signs of lealcage 1 GREASE TRAP: None (locate on site plan).: Y Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene'_other. (explain): Dimensions: r; Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition;structural integrity,liquid levels as-related to outlet invert;evidence of leakage,etc.): 7 p E I` Page 8 of l l OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE:DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 306 West Bav Road Osteiville MA Owner: Michael Marchhese Date of Inspection: _. May 4, 2012 j ti TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: i Material of construction: _concrete._metal fiberglass ,_polyethylene ., other(explain) l - Dimensions: Capacity: gallons Design Flow-gallons/day. Alarm present(yes or no): k Alarm level: Alarm in working order:(yes or no): i 'Date of last pumping: r Comments(condition of alarm and float switches,etc.):. r DISTRIBUTION BOX: ✓ (if present must be opened),(locate on site plan)( . p ) Depth of liquid level above outlet invert: Even: Comments(note if box is level and distribution to outlets equal,any.evidence of solids carryover,any'evidence of, leakage into or out of box,etc.): t' PUMP CHAMBER: None (locate on site plan) C 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.). I , i Page 9 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY.ASSESS MENTS SUBSURFACE`SEWAGE DISPOSAL SYSTEM INSPECTION`FORM tl PART C i SYSTEM INFORMATION (continued) Property Address: 306 Jest Bau Road Osterville MA }. Owner: Michael Marehhese Date of Inspection: May 4. 2012 " SOIL ABSORPTION SYSTEM(SAS) ✓ (locate on site plan,excavation not"required ) ##; If SAS not located explain why: 1 Type. leaching pits,number: leaching chambers,number: 3-500 zal:chambers-20'x 28' per as built r leaching galleries; number: leaching trenches, number, length: leaching fields; number,;dimensions: overflow cesspool, number: € Innovative/alternative system � Type/name of technology: k Comments (note condition of soil;.signs of hydraulic failure, level of ponding, damp soil, condition of vegetation; ,etc.): i - 77te chambers ivere dry and clean..77tere did not a 'ear to be an signs o ailure:A centenf cover.tivas to grade. 1 , CESSPOOLS: None (cesspool must be pumped as part of inspection) (locate on site plan' F Number and configuration: r Depth,-top of liquid to inlet invert: is - n Depth of solids layer: Depth of scum layer: Dimensions of cesspool: is , Materials of construction` ! Indication of:groundwater inflow(yes.orno) Comments (note condition of soil;signs of hydraulic failure,level of ponding,condition of vegetation,etc.): t PRIVY: None (locate on site plan) - Materials of construction: Dimensions: r Depth of solids: Comments(note condition of soil;signs of hydraulic failure,level of ponding,condition of vegetation,.etc.): Page 10 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) f Property Address: 306 West Bap Road Osterville MA } Owner: Michael Mgrchh'ese 'r Date of Inspection: May 4, 2012 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or f' benchmarks. Locate all wells within 100 feet; Locate where public water supply enters the building. 6 r r; y A r a 1 90 40 P fi , 10 • Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 4` SYSTEM INFORMATION.(continued) J Property Address: 306 West Bav Road Osier-Wlle;MA Owner: Michael Marchhese Date of Inspection: Mav 4. 2012 SITE EXAM Slope Surface water , Check cellar Shallow wells Estimated depth to ground water 12412 feet 4 Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked, data of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: '_TovoQr'aphic and water contoiiis inZaps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established'the high ground water elevation:' Usin-a Barnstable.topo-araphic and water contours maps the'nsapa were showing approximately 12 +/ to Qr out d water at this site.. t This report has been prepay ed only for the septic systenvarnd components described herein. This septic system has been" ti lnspected.and passed as of the date of ittspectiom This report is riot a warra' ty or guarain'tee that the system will fiirnction properly in the future. There have been trio warranties or guarantees, either.expressed;..written or implied, relatingto the septic system,the iris ection,this're or.•t and/o•an corm orients o the se p tics stun which have not P y p p. y p f p J' been,located and inspected: t , � la I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments `10 1 306 West Bay Road �M • Property Address Barry Crawford 1 Q Owner Owner's Name information is Osteryille Ma. 02655 2/19/2008 required for , every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC Company Name �t rab P.O.Box 763 Company Address Centerville Ma. 02632 etam City/Town State Zip Code (508)428-4028 S14454 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: a 0 Passes ❑ Conditionally Passes ❑ Fails' P ' U1 ❑ Needs Further Evaluation by the Local Approving Authority c - o: 2/19/2008 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 DER 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. 306 West Bay Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 306 West Bay Road Property Address Barry Crawford Owner Owner's Name information is required for Osterville Ma. 02655 2/19/2008 i 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: The septic system is in proper working order at the present time. 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: ❑ 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 U8 West Bay Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 306 West Bay Road Property Address Barry Crawford Owner Owner's Name information is Osterville Ma. 02655 2/19/2008 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 1 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. . 306 West Bay Rd.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 306 West Bay Road Property Address Barry Crawford Owner Owner's Name information is required for Osterville Ma. 02655 2/19/2008 every page. City/Town 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 El ® 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 Y2 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. 306 West Bay Rd.-12/07. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 306 West Bay Road Property Address Barry Crawford Owner Owner's Name information is required for Osterville Ma. 02655 2/19/2008 I every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for.fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition.to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ 0 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. 306 West Bay Rd.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 306 West Bay Road Property Address Barry Crawford Owner Owner's Name information is required for Osterville Ma. 02655 2/19/2008 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes"or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? E ❑ 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)] 306 West Bay Rd.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 306 West Bay Road Property Address Barry Crawford Owner Owner's Name information is required for Osterville Ma. 02655 2/19/2008 I every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 2 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 2006:86,000 g ( y g (gpd)): 2007:80,000 Sump pump? ❑ Yes ® No Last date of occupancy: 2/19/2008 Date 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): 306 West Bay Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,cG 306 West Bay Road Property Address Barry Crawford Owner Owner's Name information is required for Osterville Ma. 02655 2/19/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: New Leaching Chambers installed 2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No 306 West Bay Rd.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c 306 West Bay Road Property Address Barry Crawford Owner Owner's Name information is required for Osterville Ma. 02655 2/19/2008 . every page. City/Town 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: 1 + fee et Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): 2 Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 8'6"x4'1 0"x57' 1„ Sludge depth: Distance from top.of sludge to bottom of outlet tee or baffle 30 Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 8„ Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Measured 306 West Bay Rd.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 J Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 306 West Bay Road Property Address Barry Crawford Owner Owner's Name information is required for Osterville Ma. 02655 2/19/2008 every page. City/Town State Zip Code Date of Inspection D. System Information cont. Y (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.): Pump septic tank every 2 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structurally sound. 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): 306 West Bay Rd.•12/07 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 306 West Bay Road Property Address Barry Crawford Owner Owner's Name information is required for Osterville Ma. 02655 2/19/2008 ' every page. City/Town 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 No 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.): Box is Ievel.Box has two outlet laterals with equal distribution.No evidence of solids carryover.No signs of leakage into or out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 306 West Bay Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ,M 306 West Bay Road Property Address Barry Crawford Owner Owner's Name information is required fog �Osterville Ma. 02655 2/19/2008 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: 3-500 gallon . ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy dry soil.No signs of hydraulic failure.Chambers had 2" of water at time of inspection. I 306 West Bay Rd.•12/07 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 306 West Bay Road Property Address Barry Crawford Owner Owner's Name information is required for Ostefville Ma. 02655 2/19/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 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.): 306 West Bay Rd. 12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 -Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer. Custom Map Abutters Map Size Zoom out J ,fl I In xr Rr t I } r I '.'i. rFl.� WN f i ,a y I�f .hffk `'f�6 •�My.±'dJ e of 3tr. ;i2 ica J''�5a y.ii y I S 3 O J V�'c. t T� #4Yi�g�.•F��� 'I ' 0 2.0 Feet / i II Set Scale 1" = 20 I .Aerial.Photos f:nn—inhf 9005-9M7 T-A-of Ro'rnOnhIn KAA All rinh}e roconn http://www.town.bamstable.ma.us/arcims/apt)geoapp/map.asi)x?i)roi)ertyID=l 16014&map... 2/19/2008 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 306 West Bay Road Property Address Barry Crawford Owner Owner's Name information is required for Osterville Ma. 02655 2/19/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of leaching 5' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: As-Built Card ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high`ground water elevation: USED:Gaherty& Miller model 12/16/94 ground water elevations.USED:USGS observation well data.USED:Technical Bulletin 92-000-01 plate#2 annual ranges of ground water elevations. 306 West Bay Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Town of Barnstable Op IKE r Regulatory Services BARNSTABLE, ; Thomas F. Geiler, Director AlED �p Public Health .Division Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 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'received the original/copy 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. 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. TOWN OF BARNSTABLE E C LOCATION � :: SEWAGE # ®O 1 VII.L AGE P Ile, ASSESSOR'S MAP & LOT I ®� r � INSTALLER'S NAME&PHONE NO. ��f.Cy ,!1 ���/�! � SEPTIC TANK CAPACITY 0 LEACHING FACILITY: (type) (size) Y (�— NO. OF BEDROOMS BUILDER OR OWNER tP PERMIT DATE: COMPLIANCE DATE: CJ 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 F� I , A- 57B9 . 3Y j n-� No �_ / / Fee no r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - T PUBLIC HEALTH DIVISION OWN OF BARNSTABLE, MASSACHUSETTS es Rpplication for �hgpo!6oY *V.tem UCow5truction Permit Application for a Permit to Construct O Repair X Upgrade( ) Abandon O ® Complete System ❑Individual Components Location Address or Lot No.301. W. 13 A4 RvA.D Owner's Name,Address,and Tel.No. OSTi:R%/tLLC=,� MASS IBARR CRAwPoR0 Sob � 13s+►Y RD. Assessor's Map/Parcel //G O l y 0s,r&1ZV .LG MJss Installer's Name,Address,and Tel.No. �l !y`� Designer's Name,Address and Tel.No.SOIr-426—33'4 y l.Yi/41-/4177 O � SULLIVAN rNtt.Iw669-INy trve- 6 L O//U.© V T44 - 'osr av X 6 ' M ass Type of Building: I Agova Gprroew t Dwelling No.of Bedrooms 3 MAili HSE Lot Size 22,G 6/ sq.ft. Garbage Grinder (A Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 4 4 0 gpd Design flow provided L4(V( gpd Plan Date APR%t- 21 1 7L.,000 Number of sheets I Revision Date Title SITE PLOM - 5EPTIG SY57-E/N 12EPAOL Size of Septic Tank EJ(1 ST. 1 000 GAL. Type of S.A.S. 12'X 31; LBA0 iget C11.40S R Description of Soil 0-ISI rtL.L 16'"- 45" 01.,YELIS14 SRW L.OAM`/ SAN(>- IB-•1O�qlz 46"'-12.8" LT. -ArL1514 . STZW-' t-i0D. SAND-C- Z•sY Gfy Nature of Repairs or Alterations(Answer when applicable) EX 1 57. SYSTEM 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. Signe d� ; Date Application Approved by ICI Date A,1a Application Disapproved by: Date for the following reasons Permit No. [)G lP �'1 ( Date Issued No x, l 1. F j w a Feenoo x _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. '''f v :1L. y PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIppfication for bigonl *pztem Con!'Aruction Vermit e Application for a Permit to Construct O Repair 0<) Upgrade( ) Abandon O ®Complete System ❑Individual Components ix c ' uv f3/�y 12vA D Location Address or Lot No.3 O� �� Owner's Name,Address,and Tel.No. C)S-"I✓RV1L-6# I\/1A55 IBAny VZAwF&3AY P-D•RD 3aG vCi. ( Assessor's Map/parcel // G/ OS-T 2✓I LLC- Installer's Name,Address,and Tel.No. �%Jl rjy/� Designer's Name,Address and Tel.No.Sofr-L4 20- 33 4�/ (.fi/zL/ J/ �/ll1�T, ' ; C� Sut_LIvAr4 NCI IVEC- Zin�y.IrVC 7F4r2-iC-L=rZ MD. Type of Building: I A50VZ- Dwelling No.of Bedrooms 3 M A k 1� H S E Lot Size 2 2, G 5/ — sq.ft. Garbage Grinder (N C) . Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 4 LI U gpd Design flow provided H to I gpd Plan Date A P>R t L. '2..1 2.006 Number of sheets I Revision Date Title SiTG Pl-AaN - SFf--rTIG S yS74F14 12CIP>AIR- { Size of Septic Tank a 15 T. 1000 GrAL. Type of S.A.S. I Z'X 3(a L,e ACW i rvo C/IAMBL 12 Description of Soil 0-16 (=i L,L- 15= Li 5'" L?IG, '71 E L i S H l3 R N LOAM`/ SA N O ►oYR y/-/- a NS -128" Lf `/ff6.5N . C3R.M. MLSD. 5Aty0 -C- 2-5-Y 6,4y Nature of Repairs or Alterations(Answer when applicable) F-)(1 5 T. S`/5 Tl=M FA 1 L.(:-0 , Date,last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. �- (,-nlA� Date Signed_ �� ,� "`j Application Approved by Date Application Disapproved by: +, Isis Date for the following reasons 1 Permit No. A �-�! Date Issued — —————————————————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTI that the On-site Sewage Disposal System Constructed ( ) Repaired (x) Upgraded ( ) Abandoned( )by ,� . at o G W. C3 Awl fZ o ()57EI2 //I� / ,43 S has been constructed in accordance ` with the provisions of Title 5 and "the for DisposalSystem Construction Permit No. '2-C)(-) ro 191� dated V Z Installer Designer SULL►i/f/V G/7/Gl/'1lF_C2ING ( NG #bedrooms L4 Approved design flow 4 (; I gpd The issuance of this permit shall not/fie co trued as a guarantee that the system will functi`on-ad`E�st ned. Date t�/ Inspector `�y ,�!_ r� --•-. --------------------------- ------------------ No.200 62-/C ) Fee W THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 'i5pool,*pgtem ConsAruction 30ermit Permission is hereby granted to Construct ( ) Repair ()( ) Upgrade ( ) Abandon ( ) System located at 3 0 C. W, R A.�,/ RoA D Q S T[::R I/1 L L 6 1"4 S 5 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' n 7ust be completed within three years of the dat th S—rkit. 5 ,� Date � Approved by._ � 1� - ' - To vvn of Barnstable fr` a Regulatory Services Thomas F. Geiler,Director \9� MASS Public Health Division Thomas McKean.Director 200 Main Street,Hyannis,PYU.02601 Of-ice: 508-862-4644 Fax: 508-790-6304 Installer& DesiF_ner Certification Form Date: ^ 0 Designer: ��111ynv� C-n�:,� 4���.��r �- Installer: Address: 7.0 Address: L tCe �.11P , Y �t7 On 7 as issued a permit to install a (date (installer) • 1 septic system at 5�Cc We.�,k Ex%v -R 0 -e"Ae based on a design drawn by (address) En;,:, dated Ir:l Zi, ZL� Vic; (de igner) I certify that the septic system re-Irenced above was installed substantially accordm' z 4 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 is accordance wi*th State& Local R egWations. Plan revision or certified as-built by designer to follow. (Installer's Signature) SUUMN CML (Designer's ignature) (Afnx Designer's Stamp Here) PLEASE RETURN TO B4R-NSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLLANCE NVILL NOT BE ISSUED UNTIL BOTH THIS FORM A-N-D A,5- BUILT CARD ARE RECErVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Healt6.'Septic/Desiper Cer-.Zcadon Form Town of Barnstable a7 S of Tl r`�o Department of Regulatory Services i 6AANBTAn[.11 i X'llul>ic Z atlh Division uate MAM. )� 1659. �e$ 200 Main Simi,Ilyannis MA 02601 Date Scheduled Time—�=— hceI'd. Ov Soil Suitability Assessment fog° Senyag �Duiswstd Performed ny: Sv��� �,(l�i Sl�L Witnessed Ay: rLOCATION Sc GENERAL INFORMATION Location Ad dress 3�(Q \� Owner's Namcr V AeZ - _0 v C)S tZ 2�!t 1 Lv I Address ? � �IJ E5�1�,4y Qg Assessor's Map/Parcel: i (�, dl igincer's Name. S����v Kl r�1� k►►C�`N C.. s ` NEW CONSTRUCTION REPAIR �_ Telephone! 15CC�_. 47k-,-S-oz� ,Lend Use _12Q�;&(XVC4,\ Slopes % c jqn '� .• � ( ) ,©'•�fa Surface Shines Distances from: Opcii Water Body o�+ 0 0 Possible We[Arc,300 — Il Urhrkhrg Mier Well 00 Il t Ju k ll Drainage Way JC�(7 It 1'ropcity Line 1'0 n Ulhcr SICCTCII:(Street none,dimensluns of Ivt,exact locations or(csl hoies&pere(esls,locn(e iveilands in proximity to holes) I -, 11 WEST fly tK('nD Parent nralcrlal(geologic)C'�d �s� Dcplh to Dediuck 300 , MIA to Groundwater. Standing Water in Itole: IZ8 Wccping fron 11il face Nooci- Cslimntcd Scnsunnl l ligli Gruandwntcr Z@ ( E L Z 3 3 I D E'I'EIMINAUONI'ORSEASONAL1IIGIMA'I'ER'I'AI3LE Method Used: Noe__ 140X19)4L -it, QCecw s? Depth Observed slanding in obs.hole:• in. Delrlh to soil munlcs: In. Depth to weeping fium side of obs.hole: in. Gioundwalcr Adjustment a. index Well N Reading Dale:. Indcx Wcil level Adj.faclur Adj.Giuundwnicr.Level I ]RCGLAT-1ON TEESI` gate tMao •111ne 10— Observation Jule N Z Time nl 9" T 1vCpIlI of PCIC 5y Time at 6", Slml Pre-sunk Tinic© ZS �r 1l w Time(9"-6") • i�1 0 End Pre-souk Rnle Min./hrch Site Suilabilily Assessment: Site Passed f Site Failed: Additiunal Testing Needed(YIN) orighenl: I'ublic tlenlilr Division Observation Hole Data'fo Be Complcicd on hack----------- ""If percolation test is (0 be conducted lvilhin IUU' of ivetland,you iirltsl first notify (lie Baritstable Cunservaliun Division at least one(I) ivicell priur to beginning. Qa u:nLTn/wrmltlCFORn-t TT ii I ) T ROLE LOG _ r f - A`iIJIJ�r UBI✓��.�\VI�r�,JIUN JI�UJV�J AJU`7 �.,1.tJ)t rI Depth ftunt ";oil Ilutirun oil fesliftc .Soil Culur ;;oil - Vlb+t Zitur .,i,(ill,) (USDA) (Munsoll) hlvltilnu (;;hneUnr,,,`;h nac, I ,iildiis. O-16 h i_t_ 4(v 120_ _ c-- DEED' OBSERVNHON HOLE-LOG Hole It _Z — Depth fium Soil lluriron -Suil'rcxluic Still Color Soil - Other Soifnce(in.) (USDA) (Munscll) Mottling (SUuclwc,:ilvnc?,Dould is. _— �_1S t s i t Mtn ys--IZ� �- � yn DEEP OBSERVATION HOLE LOG 1101c I/ Ucpth from Soil Ilorizvn Soil Textuir, Sul[Color •'ivil _ 011tcrF` Sutliice(in.) (USDA) (Munscll) htulUhig (;ihucluic,Stunts,110o(lns. t i ll>�i..ILl!'OBSERVATION 1>(OL>�.,LOG Z.lolt, ll _ Depth fium Soil I lot iwn S0il'l*cxltnc Suil Color soil ---011icr Smfncc(In.) (USDA) (Munscll) Muitling (liouloic,Sloncs,0mildcis. Flood Insurance Rate Map: Above 5U0 ycnr flood buondaty No (/ Ycs — Within 500 ycnr buundniy No— Yes Within iOU ycnr flood butmilmy No_ Ycs D nth of Naturnily Occurring 1'crviulls Malcrilll Does at least fuur feet ofnaturnily occurring pervious nintelill caisl ill all ara►s ubsclvc,l thruui;huut Ill!- at en ill uposcd for the soil absorption-yMcm7 �( _ 1f nol,what is(lie depth of naturally occurring pervious;nlatcri117— (-;ct li[icltt(un 1 certify thnl on QL_(dnle)I linve passed file soil evulunlur c milinaliun npprovod by file J)cparinicut of L'nvirouuicntnl 11rutectivti nod(lint ilia above nunlysis wns petrurmcd fry ilia consistent Nvith Ih��rciiuircd Iraiuing,cxpcttisc and cxlicricuco described in 310 Cfv1R 1.5.01'l. Sii;nnlurc llalc z OCQ t1a IIiAI�I711W1'/l'IiItCfURA1 `TOWN OF BARNSTABLE LOCATION 30 cOcist IJ`�t/ �. SEWAGE €€ a FVILLAGE ��"�i° �,;�Lp . ASSESSOR'S MAP & LOT�//�^ INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY — LEACHING FACILITY:(type) J G `ocqi 04US S es e) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER �c��!�-�/ yz Z2 iv p moo{ DATE PERMIT ISSUED: .,>fY DATE COMPLIANCE ISSUED: ��`/ ` VARIANCE GRANTED: Yes No i .. --- � �� � � � �. �GoC, = �-� 5� ° ��� � � . r� � 3 � � ,� � .,[D F>a......_0.0........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Dbip ial Workii Tontitrurttnn Errant Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: • ---- ,���.�.....( s7 ._._� ............................ ------------------------------- ---- c tion-nd cs o t o. t ow ncr STtaV) '� Ad ress - . Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.-_-_. -------------------Expansion Attic ( ) Garbage Grinder ( ) pi Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------- - -------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow..._..........._....._..............._......gallons. 9 Septic Tank—Liquid capacity............gallons Length________________ Width................ Diameter---------------- Depth................ 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ ,.1 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (X. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ------------------------------------------------------------------------------------------------------------------------------------------------------------- 0 Description of Soil----------------------------------------------------------------------------------------------------------------------------------------------------------------------- x 44 --------------------------------------------------------------------------------------------------------------------------------------------------------------- w x ------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------........-------- 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—T ndersigned further agrees not to place the system in operation until a Certificate of Complian 's ed the boar of health. p�L Signed ......... �. Date Application Approved By ----------.. �........ .. ------------------------ ----5.7 �/...'...T 2,� Date Application Disapproved for the following reasons: ............................................ .......................................................................................... .. .................. . .... ..................................................................................... . .........................................- -- ........................................ Date PermitNo. --------,�..' .^.. .�............. Issued ........................................................ a........ Dare No..... .. - r 3 FEB .V_..__......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliralian for Di ipaiial World, Cnomitrur#ion Urnnit Application is hereby made for.a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: ........36.6..... I............................. ....----------•--------- ------------------------------....._.... n e,ltion-Addyf-ss or Lot No. Oa ncr r ' _....._.Add ress 5----------------------------------------------- �Tf 2 V E Installer Address UType of Building Size Lot............................Sq. feet Dwelling— No. of Beclrooms-__- V-------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building -------------- .____- No. of ersons.._.._......_........__.___. Showers — a YP g •------- P ( ) Cafeteria ( ) dOther fixtures I....................................................................................................................................................... W Design Flow...........................:....._-___----gallons per person per day. Total daily flow............................................gallons. xSeptic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter_.-�..- Depth................ Disposal Trench o. .................... ........_........__. Total Length.................... Total lea Dih—N Width area....................sq. ft. 3 Seepage Pit No--------.-_-_..... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) /1- Percolation Test Results Performed by........................................................................... Date........... ............................ 14 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ L� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----------------------------------•------••--..........-----------••-•---•-==.............................................................................. D Description of Soil.................................. x 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—T e-undersigned further agrees not to place the system in operation until a Certificate of Compliance has e/ed by the boardtof health. JS�.... �........_�... ..///�1' _. �� .7.... Signed ....Z Application Approved BY ` .... .-.-Dafte.�..'... `..�? Application Disapproved for the following reasons: ............................... ............................................................................................ ...................................................................................................................................................................................................... ........................................ Permit No. ......... --------- Issued .........................................................77e...... .. '.. Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE , 01-JErtifirate of V����rtT-omplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ........( ./ . - ...... ......... ........ . .........�«............. ...... ................................................................................................ at ............J.U. ...._...G FsT.:.. r�. --..�.�-----------.----------------.1.2..V. t .. ................. ........ .. ........................... has been installed in accordance witK the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. -----...57I.-"._...�....... dated .. _ ...... .......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE , 'SYSTEM WILL FUNCTION ATISF�TORY. DATE .. .....� .. ._. Inspector "..... �. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Permission is hereby granted.......l_A kLTi�_t.z_... .----•--------------------------------------------------- to Construct ( ) or Re a•r ) a Individua Sewage Disposal System I Street as shown on the application for Disposal Works Construction Permit No._`%:72 �_ Dated....... )`~..............�....�(..... .................................. f -----------------.-----------------•.................. L � o�of Health DATE.................�=•�---•---;�1.----�--- -----------•-----------------•-- B FORM 36508 HOBBS R WARREN,INC..PUBLISHERS y n t -00 CO- WAw YOIL&d t l�u2,� tiJ f i Yyy ,I ' I l l _ -�'�!'-;;t ..�~� ��'?�`�^! `F'`��, �>�✓i� J, �-'�- ( I t.,,�,F!,#-?''-a:�.✓ i,' 4�:°r.��iy.�"r".;3 4„��.......� •1 _h 1�.� ���t ( t f f�. .�:�, L;;�t' <�,c..r?�r ��. � �I,.(�-..- ==' f /J/�i J1 f /r� -!','�J�i'�--�,'/)v/,�q�'� �l'1, _-._._—.____. � � .- r j>16i 4✓..• 1 (�E✓ / � j. U G� d� %/��/l'v°(,.�1.�-.. IC`� . .:. {Ya - _ • _.—_ Ll�} lcjrl �' _ra�•� V.sf/ �y � (,,6 � I N � N I -- �I� N L- 141q I3 31 � u v It 0 0 tl m _ 1 irhRY J� _ CD h 0 .. s I : � t00 f 5 i i I I i N I: o � f ....._ .. •Yl�I SIG ..- l,l./I�G �----� �"r�_ .:. _. � I Y,x♦�Ih�i. _•PAC-�,� 11 C - - ,,O„ Co. P` •P,Aw:`:u .. .. c i drys�sl�"1 �1S. �O�•:/ 'v y 1' -..•- land �, �'Jp d•\. NOTES :t gay z FG.13.4 Nent •'' •j FG. 12.8 _J. Water Supply For This Lot is Municipal Water. • ° �`'+�. 4 II ,If "o.4 2.Location.of Utilities Shown on This Plan Are Approx. Y;'��,� c. �° r- ••` IL L- —_-L �`I At Least 72 Hours Prior to Any Excavation.For This `' „ ry i:••., - �� —� Project The.Contractor Shall Make The Re uired ••Exist. 1000 q q ` J �„OCiUTop El. 10.73 Notification to DI G SAFE-1-888-344-7233.GollonSeptic 3:The Contractor is Re uired to Secure A ro fiafeII 10:23 q pp. p Tank IIBot.El. •7.73 Permits From Town Agencies For Construction :•cam Defined byThis.Plan. Bedding as 5 4 Install Risers as Required to Within 6"of Finished ��� dltil • it '•�� Insiall Tees8,Gas Baffle 9 Bot.ofT.H.-28, El.2.73 Gradef3SholIbeH-•20Loading. + if Required.See Note No.B. Per Title 5 xls r erA Ground Water I W�onlG(i)t3R 5.All Structures Buried Three Feet(3)or More or Subject to Vehicular tobe H-20 Loading. I ���� Neck DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM I NottoScale 6.Septic System to be Installed in Accordance With �- 310 CMR 15.00 Latest Revision And The Town at �,,/..! S/a as Barnstable Board of Health Regulations. �, fi;;• ° pRsea 7All Piping to be Sch.40 PVC: '' - °° b a �`✓ 8.Depth of Inlet Tee Below Flow Line, I O"Min, f O,ca Depth of Outlet Tee Below Flow Line•14'Min. With Gas Baffle. tro26 LOCUS PLAN Scale, 1 2000' Assessors Map 116 Finished Grade DESIGN DATA / Parcel 014 Single Family-4Bedroom J o Compacted Fill No Garbage Grinder pd Filter Fabric Daily Flow: 110 x 4 =440 g \ c 0 \3 .r.`,clsT. SPOT F-LIaV. C'TIJP.) M Septic lank 440 gpd x 200% 880gpd s / Gar" `atal.LIvA tj vLNcri r4err_ kti\i r,inc - SNt_I:I.PA14K1Nc. 4 21 C(o 0 "Use Existing 1000 Gallon Septic Tank. s 1 H / / o _ 2',1/8'-1/2 LEACHING AREA �x/ �rioly -^1 o Leaching Pea Stone 4 M + 440 gpd/0.74°595 s.f:Required p d N Chamber +�+-+'+�'•� 3/4 -11/2 Sidewalk 2 x 96=192 s.f. O F 2 N �+ oos+r, Double Washed Bottom Area:12 x 36 =432 s.f. _u Q I 4-10 Stone 624 s.f.Total Provided. 0 ►- 12.-0Is LEACHING CHAMBER DESIGN (H—20) Ali Pipes to be Schedule 40 PVC.Use 3 \ 7 \ Is -500 Gallon Leaching Chambers in a �� ? I CROSS SECTION OF CHAMBER Washed Stone Field as Shown. r� 10 MIr\I, Not to Scale 043 M2 L PROP.t_eA Cµ.ARwP. PROP -:`Ok DI MEN WONS iEMFD-C3C1X D A1l- Kk \ \Z01 I C. VENT EL aV, 13.4 C lrt.-2 ELEV• 13.4 ` \ 3 F o I z F\>✓L 1=I,L 1 i.\ L ?j 1 1 \ a �� 1d'-- - op,cr\c VF- LOWISH 0t20WN bARK.Y�t_L'Ow►SH BROWN c \2ra0 Y yL L LOAM SAND \OYR -i/lo $ LOAMY SAND IOYR+i/(o �a \ , •+ L tGHT YELtOWISH BROWN C I.IGIITYF_"0WISH QT�OWN N NLELO\UM SAND 2.5Y 6/4 . M601uM SAND 2,5-/ U1 J N-\0 GR0UI,40WATGR clyCOltt3CQn GROUNDWATER (ED \zs, PIRG.No. 1{�2�'S •. .:,_ _ _r_.-___�_,.-___.�_r-._--- _�.--_ ,.._- .-- LI? / �+ y OEP-rt4. 54++ Jr0o LGSS THAN 2.MIN./INCH QY� SULl.1VAi+I ENG1 6Ej21NG \Nc: w \2 \� eal \Zf' `SCAL I_VAL.UA'TOR' 5.ONI.\ O'OA,Vc S Z W VT NCSS+• Di'5TANTON,T•o:e.,5.o•w . . ,, _ SOT P.RE i L;q� •Q' ���„ �'..4. �. . r• IDI 22. to 61 S,t=•» M � �` \ \ - " e f a-fox r a Q B,qy LEACHING CHAMBER DETAIL PLAN VIEW .1po Not to Scale Scale I$I--201 OF SITE PLAN SEPTIC SYSTEM REPAIR BARRY CRAWFORD 306 WEST BAY ROAD OSTERVILLE , MASS. SCALE: AS SHOWN DATE: APRI L 21 ,2006 SULLIVAN ENGINEERING INC. OSTERVILLE , MASS. i Wan H e at ` St Marys (l � st o r /�I� �{ Island (kJ� r PO_nd — - �°• va3 �� belle01 li P• , _ •w bcr_ Z 2 s7p�# -DESIGN DATA ,it r� •. . , �= ;t'., ,:; �' .i 0 EXISTING 3-BEDROOM DWELLING N F I ` � • � ;�o `; ;"' '`' 'ADDITIONAL BEDROOM OVER PROPOSED GARAGE RICH / Q AR EG cr /- ,' NO GARBAGE GRINDER ET B. AN' /F �•: 1. � p:�-✓- ;,, and xo, o' °o `• '•.;'l� ` FULLER ',DAILY FLOW: 4 110 = 440 GPD x' VIRGIN `L `l SEPTIC TANK: 440 GPD x 150% 660 GPD !4 M "� 0 arker k p6 0 Nec ` � I S W -°-_ - USE 1000-GALLON SEPTIC TANK CB/NO DH FND. /r x gaff-� , W CJ / 4.00 D' ° ' wwG<,o ryJ - LEACH FIELD: USE FIVE 4' x 8' FLOW DIFFUSORS X 121. ♦�x� WITH 2-FEET OF STONE - H-20 LOADING 271' 25 / (� PARCEL AREA: 0 F- �NES'r BAY yx'`o 19,179 SF t I- !„' :. �� \. P • �i SIDEWALL AREA: 72 SF LLI { co ce/DH FND. CAPACITY: 72 x 2.5 = 180 GPD PROPOSED 28.0' �� O 1 12 € #` LOCATION MAP BOTTOM AREA: 288 SF Q - - --- ADDITION \ Q PROPOSED DRIVEWAY J 1: 25,000 CAPACITY: 288 x 1.0 = 288 GPD W EXISTING RELOCATE \\� 2--CAR o \\ ��� z ' TOTAL DESIGN: 468 GPD SHED 11 N GARAGE N �� 4 \ WALL � FROST ,e Q xk I- s DESIGN PERC RATE. LESS THAN 2 MINUTES PER INCH 4.0 Of \ ' 00 \ s 0, 22—INCH MAPLE TREE <00 \< f\\ _ NF\ ;L J \ SITE PLAN Ld bo o S.T. a. I-- W AT , �\ --- N I N PERC TEST00 --I bl < �� Z 0 1 16.o 20.0• , P 8190 #306 WEST BAY ROAD \ 12.3' • LL —.J N \ �I EXISTING SEP / cn b m ryx� z PUMP TIC SYSTEM; x OSTER VI LLE, MASS. DRY, FILL 35.5' CLEAN WI TOM: w 10.0' 24' AND ABq pONND iIUM , HSE #306 D.B. 48.2' FOR I FIRST FLOOR n FIVE 4' x 8' FLOW DIFFUSORS WITH 2' STONE 2' 1 20' 2' { \ EL = 14.4' o H-20 LOADING ' i BARRY CRAWFORD 0 94, I ; I P�2.3.H N 22Q30' Tb �I 39.61RESERVE AREA SCALE: 1 " = 20' MARCH 18, 1994 i k \� REVISED: MAY 4, 1994 REVISED: MAY 17, 1994 , FIVE 4' x 8' "FLOW•DIFFUSORS \ \� - - OC E L A T - I H-20 LOADING o RE o I "� EXIS c�TING BUILDING �\ { >� BAXTER & NYE, INC. l N 00 \ �\ REGISTERED LAND SURVEYORS 2-FEET 3/4" TO 1 1/2" WASHED STONE o q <c { CIVILENGINEERS C i \ \ ; OSTERVILLE, MASS. id C\4 I - 79, FOFpq-��vq �� 8-FOOT WIDE �0 (9 TOE, 41 "tMFro� \ PAVED DRIVE }' \�� FLOOD ZONE LINE SCALED FROM COMMUNITY < 0 \ \_ PANEL No. 250001 0016 D - REV: 07-02-92 r POUT `� - FACILITY ���\ ' D'ETAI L LEACH A NOT TO SCALE EXISTING WETLAND AREA AT BARNSTABLE s �A29 ASSESSORS MAP 116 PARCEL 116 DELINEATED TBM @ BRB FOUND EAST, _ _ BY KATIE BARNICLE, FUGRO-McCLELLAND- EL = 11.42 NGVD & NYE,O NC.702417-914LD- OCATION FLAG #A 2 BA ER P-8190 r 6F - FOUNDATION EL - 14' t MARCH 15, 1994 f,, ���` ass 'p BAXTER & NYE, INC. o 1 FINISH GRADE = 12 f Pc TER INV. 11.2 � �JCs 0 o SUt' 'PIN � ss 4" DIAMETER SCH 40 PVC - TYPICAL 1, LOAM Y a .� Lis INV. 1i.7' 2' SANDY SUBSOIL �No. 29/33 y�No.29874 rlslt INV. 11. 4 5 (v �S^ � � NOTES: INV. 10.7 s/ �� INV. 10.95' BOTTOM 9.45 OiVAL� . INV. 10.45' o MEDIUM SAND /� W��$�d• �5�18 �q� i TOPO/LOCATION DATE: 02-16-94 DISTRIBUTION FIVE,4 x 8 FLOW DIFFUSORSJ C� I 1000-GALLON BOX WITH 2 STONE - H-20 LOADING w J ELEVATIONS REFER TO NGVD SEPTIC TANK - WATER @ 8.75 EL = 4.45 O 10' EL = 3.2' 4�j FIRM COMMUNITY PANEL No. 250001 0016 D GRAPHIC SCALE REVISED 07-02-92 LOCUS WITHIN zo o 10 zo ♦o eo FLOOD ZONES A13 (EL 11) AND B DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM ASSESSOR MAP 116 PARCEL 14 m ( IN FEET } CURRENT ZONE: RC NOT TO SCALE 1 inch = 20 it. FRONT SETBACK: 20' SIDE AND REAR SETBACKS: 10' 94009 (PPP01.DWG)