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HomeMy WebLinkAbout0070 WEST STREET - Health ZO West Street PF Ostervil le A== 139-072 f 1= I i i i Commonwealth of Massachusetts u W Title 5 Official Inspection Form M Subsurface Sewage Disposal System Form -Not for Voluntary Assessments :t 70 West Street Assessor's Map: 139 Parcel: 72 J�! Property Address Kenneth R. Reeves, Tr. j..A Owner Owner's Name �_• information is Osterville MA 02655 March 19, 2018 required for every page. City/Town State Zip Code Date of Inspection °v 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 A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not David D. Coughanowr use the return Name of Inspector key. Eco-Tech Rapid Response r� Company Name 155 George Ryder Road South Company Address Chatham MA 02633-1621 City/Town State Zip Code 508 364-0894 1328 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ZNOFgg4,9. ❑ Conditionally Passes ❑ Fails DAVID . 9 ❑ Needs F r E40atlon ' he Local Approving Authority ' COUGH 0 R N No: 32 ° March 19, 2018 Inspector's Signat FM tNgp� Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 ,Co��rUs r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 70 West Street Assessor's Map: 139 Parcel: 72 Property Address Kenneth R. Reeves, Tr. Owner Owner's Name information is required for every Osterville MA 02655 March 19, 2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) -System Passes;,:, ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Inspector's Notes==> The septic system described herein is deemed to pass this Real Estate Transfer Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4- 5, or specified by local regulations. The scope of this inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. Removal of garbage grinder is recommended B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic fank,(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltrationf'or tank fallure,is imminent. System will pass inspection if the existing tank is replaced with a complyingIseptic tank as approved by the Board of 1� ,,�.,, :1•. Health. N% *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 _'Y.0 years old,is`available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 1 x Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 70 West Street Assessor's Map: 139 Parcel: 72 Property Address Kenneth R. Reeves, Tr. Owner Owner's Name information is Osterville MA 02655 March 19 2018 required for every page. CityrTown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): The system required pumping more than 4 times a year due to broken or obstructedpipe(s). The ❑ Y q P P 9 Y system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain.below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 70 West Street Assessor's Map: 139 Parcel: 72 Property Address Kenneth R. Reeves, Tr. Owner Owner's Name information is required for every Osterville MA 02655 March 19, 2018 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 70 West Street Assessor's Map: 139 Parcel: 72 Property Address Kenneth R. Reeves, Tr. Owner Owner's Name information is required for every Osterville MA 02655 March 19, 2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or,privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the.Board of Health to determine what will be necessary to correct the failure., E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 West Street Assessor's Map: 139 Parcel: 72 Property Address Kenneth R. Reeves, Tr. Owner Owner's Name information is required for every Osterville MA 02655 March 19, 2018 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the.following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 6 Number of bedrooms (actual): 6 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 gpd t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 70 West Street Assessor's Map: 139 Parcel: 72 Property Address Kenneth R. Reeves, Tr. Owner Owner's Name information is required for every Osterville MA 02655 March 19, 2018 page. City/Town State Zip Code Date of Inspection D. System Information. Description: A system designed for 6 bedrooms was approved in 2012. Number of current residents: 0 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d 1149 gpd 9 ( Y 9 (gpd)): Detail: 2017: 606,000 gallons 2016: 233,000 gallons Irrigation system in use. Sump pump? ❑ Yes ❑ No Last date of occupancy: Not determined 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: t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'c^M 70 West Street Assessor's Map: 139 Parcel: 72 Property Address Kenneth R. Reeves, Tr. Owner Owner's Name information is required for every Osterville MA 02655 March 19, 2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: owner's agent Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 70 West Street Assessor's Map: 139 Parcel: 72 Property Address Kenneth R. Reeves, Tr. Owner Owner's Name information is required for every Osterville MA 02655 March 19, 2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Age: 4+ years. Certificate of Compliance for a new system was issued 4/16/2013 (Permit#2012-255 at Health Department). Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2feet 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.): No evidence of leakage or backup into dwelling. Septic Tank(locate on site plan): Depth below grade: 2 feet. Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10.5' x 5' x 6-1500 gallon Sludge depth: 6 inches t5ins.doc•rev.6116 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 70 West Street Assessor's Map: 139 Parcel: 72 Property Address Kenneth R. Reeves, Tr. Owner Owner's Name information is Osteryille MA 02655 March 19 2018 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28 inches Scum thickness 2 inches Distance from top of scum to top of outlet tee or baffle 9 inches Distance from bottom of scum to bottom of outlet tee or baffle 13 inches How were dimensions determined? design plan Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping not required at this time. Maintenance pumping is recommended within 2 years and every 2-4 years thereafter with year round occupation. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. Removal of garbage grinder is recommended. 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 t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 l Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 West Street Assessor's Map: 139 Parcel: 72 Property Address Kenneth R. Reeves, Tr. Owner Owner's Name information is Osterville MA 02655 March 19, 2018 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: • gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System,Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 'cnM 70 West Street Assessor's Map: 139 Parcel: 72 Property Address Kenneth R. Reeves, Tr. Owner Owner's Name information is required for every Osterville MA 02655 March 19 2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert at outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No adverse conditions observed. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 70 West Street Assessor's Map: 139 Parcel: 72 Property Address Kenneth R. Reeves, Tr. Owner Owner's Name information is required for every Osterville MA 02655 March 19, 2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 1 ❑ 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.): No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. Leaching gallery was uncovered and found to be dry. No effluent contact staining was observed at cover interface or into riser. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4.170 West Street Assessor's Map: 139 Parcel: 72 Property Address Kenneth R. Reeves, Tr. Owner Owner's Name information is Osterville MA 02655 March 19 2018 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 West Street Assessor's Map: 139 Parcel: 72 Property Address Kenneth R. Reeves, Tr. Owner Owner's Name information is Osterville MA 02655 March 19, 2018 required for every !, page. Cityl-T-own -State—Zip-Code--Date-of-Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately SEPTIC IMF® AT EC®-TECH. S P; 508 364-0894 THIS SKETCH IS L Oo C A T§O S BEST VIEWED IN COLOR FORMAT -OF SEPTIC COMPONENTS DISTANCES IN DECIMAL FEET NOT TO A B C SCALE 1 45 34.5 --- In1 2 51.5 37 - p^�U 3 --- 37 21.5 WATER LINE — -_ EXiS TWO unuU �B -- -C LEACHING GALLERY A 30 1 0 10 0 I 0 DISTRIBUTION BOX 1�2 1500 GALLON SEPTIC TANK t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 West Street Assessor's Map: 139 Parcel: 72 Property Address Kenneth R. Reeves, Tr. Owner Owner's Name information is required for every Osterville MA 02655 March 19, 2018 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10.5+ 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: 8/9/2012 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Approved design plan on file with the Board of Health shows bottom of system to be 5.2 feet above the bottom of a witnessed test pit in which no water or groundwater mottling was encountered. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 70 West Street Assessor's Map: 139 Parcel: 72 Property Address Kenneth R. Reeves, Tr. Owner Owner's Name information is required for every Osterville MA 02655 March 19 2018 page. City/Town -- —State Zip-Code— - -Date-of-Inspection— -- E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file GEOHYDROLOGICAL PROFILE — NOT TO SCALE MOMi,1 ., *., Z L Z G W PRECAST 8 DRYWELL BOTTOM OF Q. LEACHING PER DESIGN PLAN LEACH/NO IS ABOVE HIGH GROUNDWATEA N NO GROUNDWATER MOTTLING SEEN t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Town of BarnstableR x BAMiloMA s «' ,Regulatory Services Thomas F.Geiler,Director � Public Health.Division T Thomas MCKean,;Director" f 200 Maio Street,Hyannis,MA`02601 . 3: Office: 508-862-4b44 ' Fax+508 790-6304, Installer& Designer Certification Form ' r _ Date: �� /3 , Sewage Permit# ��Z"2 s Assessor's Map�Parcel .�3 9 a Z --..Designer- Ice` 4 � i�e n Installer ��1�C� La��Sc�7S Address: 7 �a r�ej, �� ., Address: s ecr�ie h On y,/Z �'oce / sr�,o,�_ was issued a permit to install a (date). (installer) ` septic system at 70 �%�s�" �� based on a design`drawn by *. � k=. . (address) � r z�. t ell (designer) I certify that the septic.'system referenced above was installed substantially_„ according to the desiM:..which may include minor approved changes such as lateral relocation of the,distribution box and/or septic tank. I certify that the septic,system referenced above was installed with major,changes (i.e:greater than 10' lateral relocation of the SAS or any vertical relocation,of any component of the septic system)but in accordance with State&Local M Regulations. Plan r 'sion oT certified as-built by designer to follow. ' H�F MgssOc a (Installer s Signature) �o�' ia� GJ t' ' _ - , U ,.�.�,, fro• .y _ a .y FSS��M. 3 (Des er'.s Signature) (Affix.Designers Stamp Here) ' .k _ ---"PLC+`A$E-It1rT�N-TaHB�R1�AB�E-RD$I,IC- 'Ai XH nD SIGN CERTIFICATE OF COMPLIANCE VII:L NOT BE ISSUED UNTIL:BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED"BY'I'HB BARNSTABLE PUBLIC HEALTH DIVISION.THANK YOU °,. Q alth/Sept dNSigner Certificatton"Form 3-26-04.doc t. TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGE ASSESSOR'S MAP.&PARCEL 13 - o 7z INSTALLER'S NAME&PHONE NO. 1nnL4 CL.` SEPTIC TANK CAPACITY LEACHING FACILITY:(type) �5ZV (size) )0 577 Y Z_ NO.OF BEDROOMS Co OWNERI PERMIT DATE: %�1�1�-l2i COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on` site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY NF7 L " -97 S3' 13 3Z h3 - 3b, y�, r No. t, - Fee I O d5 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppficatiou for -Disposal *pstrm Construction 30ermit Application for a Permit to Construct(.,<Repair( ) Upgrade( ) Abandon( ) . omplete System ❑Individual Components Location Address or Lot No.70 l Owner's Name,Address,and Tel.No. 1Z�2veS Assessor's Map/Parcel 077— Z43Ce\ ckrlo�\Dr. 15u..4"'. ��,i� FL 3�1 35 Installer's Name,Address,and Tel.No. DGesyi, er's Name,Address,and Tel.No. p �J 774, ` SL+\\\�6 M Type of wilding: —ron�e,l,�.,- 31.0 ?(o va 0 Dwelling No.of Bedrooms Lot Size Z( a?j j sq.ft. Garbage Grinder#Ud) Other Type of Building No.of Persons ' Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) k(4® gpd Design flow provided gpd Plan Date ACu��Zfi1Z Number of sheets Revision Date Title �\� Q� Tr r � Size of Septic Tank too kot,� Type of S.A.S. S—Soo Cb��r~.�er"j i 12•fo`X50-6 Description of Soil�fC I?�,3�Cj �-(m�` l7(.E\�el" a -�� Q(f�.4_ t0i '�_ u ki tcgy►1 E La I 5 GK 10- y` MkTh Lacrn Sw_ Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: igned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in The und�rs accordance with the.provisions of Title 5 of the Environmental Code and Ao-place the system in operation until a Certificate of Compliance has been issued by this Board f al A ed Date Application Approved by Date Application Disapproved by. Date for the following reasons Permit No. Date Issued ---------------------- -------------------------- - _- - - - - - - " NO. +d, .'`,,�,.,,,,,d,,. ':;i iG _' ._V. ,Fh4i. _ Fee THE COMMONWEALT14 F MASSACHUSETTS Entered in computer: RUBLI HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS, C. Iitation,.for Disposal 6pstem Construction Permit i Application for a Permit to Construct(-< Repair( ) Upgrade( ) Abandon( ) �fComplete System [:1 Individual Components Location'Address or Lot No.70 V)C Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel 1-39 -07Z Lt¢3Ce\ Cl�"ktp'.,7r. Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Typeof`Building: On`� �,��5.c�3cj - 3toa(7/o3 b Dwelling No.uof Bedrooms Lot Size Z�,,71� sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �Q�Q 0 gpd Design flow provided �Q gpd Plan Date'N-i,4 ,Z�I Z.. Number of sheets Revision Date Title .51\r— Qkr TruQo,�)ecI �r�UCW�Qh S Size of �0co;Septic Tank. Type of S.A.S. S-Soo �4 t�1�rhb"er S ^ �2�IO�A 50 F Description of Soil rL I':�,3C G 04c" C L!7 er tUyR?j�( �..._ tKrq C L A- Z•5 41 metes Nature of Repairs or Alterations(Answer when applicable) 4 Date last inspected: Agreement: y. 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 a d.noi to place the system in operation until a Certificate of Compliance has been issued by this Board f alt i ed Z, _ Date - Application Approved by f^ p, /v �1 /' Date � Application Disapproved by 0 Date for the following reasons Permit No. Date Issued .-----=---------------- ----`-- ----------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (tPrtifirate,of (Compliance THIS IS TO CE TIF ,Tatthe,0 - 'te wage Dis osal system Construc ed( Repaired ) U ed Z Abandoned( )by !v/ L C//� (f/1 at 70 (,-�4 S�- ��+N_qhas been const �cted inoaccrg with the provisions of Title 5 and the for Disposal System Construction Permit No Sd r Installer ((-- Designer #bedrooms �P Approved design flow 2 gpd The issuance of this permit,shall not be construed as a guarantee that the system will ctio /as 6signed. Date Inspector VbV_ i ------------I--------- _- • - ------ -- - -- - -- _ No. rV101rIL, K� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE, MASSACHUSETTS Disposal 6pstem Construction permit Permission is hereby granted to Construct Re air( ) Upgrade( ) Abandon( ) System located at 7 ��� and as described inthe above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction mustbe co m ete tthin three years of the date of this permit. Date Approved by J . No. �7 7 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in co<mputer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rpplicatiou for Mie;poar �&pgtem Cou.5tructiou permit Application for a Permit to Construct"( ) Repair(,- Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. ,o v� -J/• S� Owner's Name,Address,and Tel.No. GY ��wC3 Assessor's Map/.Parcel bS �� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. NA C. jYC-,C'G-%/�%e yak—ssaS S 0- Si-Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil r—, �• Nature of Repairs or Alterations(Answer when applicable) %?C/- i9CG c� t. Sc'O wtr P if/t N�Crl � 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 Date Application Approve'dj2y Date Application Disapproved by: Date for the following reasons Permit No. Date Issued No. / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes pplicatiou for Migponf 6p.5tem (fow5truction Permit Application for a Permit to Construct( ) Repair(Wil"Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. 1 -�'� '�(� li✓� Owner's Name,Address,and Tel.No. " Assessor'sM.ap/Pareel lay- Installer's Name,Addr ss,and Tel.No. Designer's Name,Address and Tel.No. �r� Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers.(:,,...) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 2&54��_2_ r�fICC" c 0 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore'described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. i $igne Date Application Approve Date Application Disapproved by: Date for the following reasons Permit No. Date Issued _ — ` THE COMMONWEALTH OF MASSACHUSETTS ARNSTABLE, MASSACHUSETTS certificate of Compliance THIS IS TO CERTIFY,thato e On-site Sewage Disposal System Constructed ( ) Repaired ( " ) Upgraded ( ) Abandoned( )by -S���c/`!t�_r-nf at /U A-JtJ% S? Q�/ il�i has been constructed in accordance with the provisions of Title5 and t� c:for Disposal System Construction Permit No. ? dated Installer,.Dr u ec / z G�� /'J�� Designer #bedrooms Approved design flow and The issuance of this permit shall "not be Jconstrued as a guarantee that the system wil l funcion a,designed. Date l Inspector�ti .r �-`- - -E�� -uarie3esr,ira���s��r.�wo�w..Ses�� No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Mgoal *pgtem Cow5tructiou Permit �1 Permission is hereby granted to Construct (_ ) Repair (� Upgrade ( ) Abandon ( ) System located at �0_ S�CI C.r 7C 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 con'd'i'tions. Provided: Constructio must e completed within three years of the date of th's ermit. i���Date Approv d`bX t ' 4 a ------------------------------------ a Fe n�ia ma 1O1tl ; eaa� ,a.o i s+� __ _______ ______ ______ _______ ___ _ 1 N ' ZQ J 000 O -- i ----- Ir FIRST FLOOR PLAN SECOND FLOOR PLAN to p a � , yv $ � Q A A 'IPPIPFW fT Imp 9111 1 <w �1111111 1 IIIUIII, -��- 1�=r�I MEMO A - v �■•, �--.. #'�!'wlU������11/11111p111'���� - ��. ©� ,�rw Y ICI , � ; RIM■��=='-- 'ILA '-11 Town of Barnstable r Department of Regulatory Services H Public Health Division Hate: 7_ 9— 200 Main Street,Hyannis MA 02601 / Date.Scheduled 1 Time Fee Pd.. "Soil Suitability Assessment for a Disposal _ �—y,` _ Performed By: VG¢,,�:..L l�q/h C ��7k.L SIC eWitnessed Ey.. +. .P 51 LOCATICIN$i GENERAL INFORMATION Location Address _ _ Owner's Name C h h `��eV es, 7D lvesf Sfree - vr/1 Address..'% V.i'/�i'n it IP�e Ve.S �l 0sr Assessor's Map/Parcel �� • I'L�� n �C En vise;s Name SCJ1 VLLI� - 9 g '3� NEW CONSTRUCTION REPAIR Land Use 1 . Slopes(%) D -3�o_ Surface Stones ��"�qhc Distances from Open Water Body ft Possible Wet Area MA: ft :Drinking Water Well �� 8 Drainage Way It Property Line (O ft Other': /� ft SKETCH:(Street name,dimensions of lot;bxaet locations of test holes&pera tests,locate wetlands in proximity to holes) 0so�z 3 70 2v- IL Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face U Estimated Seasonal if gli Groundwater 1 ow pF �p.¢ws kE�C Grzo�v . PsP C Z.o ANION EO `. ASONAI HI H WATER;TABLE Method sed: Depth Observed standing m obs.hole in. Depth to soil mottles in. zt Depth to weeping from side of obs.hole: in, Grbundwater Adjustment ft. L Index Well# Reading Date. index Well level' Adj.f ictor Adj.Groundwater Level i PtCOI,ATION TEST.. iDate0�l2/i\Tlme Observation Time at 9 Hole# • i1 A2 Depth of Pere , i a �— Time at 6" t Start Pre-soak Time'® t�',41 Time(9"6) : End Pre aoak I`:3 S cj ' , 98i)_ iMA NG Rate Mkt/Inch'- 7 I Site Smtability Assessment Site Passed Site Failed Additional Testing Needed E i.. bbservattOn Hole Data`To Be Completed on Back Original.rPublic Health Division { ***If percolation testis to be conducted within,100 of wetland,you must firstnotify the Barnstable Conservation Division at least one(1)Week prior to.beginning. Q:4SEYnC�PERCFORM:DOC' DEEP OBSERVATION HOLE I,OG. Hole#_;� Depth from Son Horizon, Textwe:. "Soil Color Soil Other ` Surface(in.) (iJSDA) (Munsen) Mottling (Structuue,Stones,Boulders. , Consistency<%Gravel) © ��y rccov--tLRpm G LCA,5 Ncam(?[-S �Avv� l.La�,;,,.. tort e3/i �zl 42- \IZ C 'M g i5''Ptcv Z,a Q. (Q0 \VJ 4-( (2 ,DEEP ODSERVA�f'ION'HOI:E Li (rt Hble# Depth from Soil Honor So*f Texture Soil Color Sod Other Surface(m.) (i�SDA) . . (Munsell) Mottling (Structure,Stones,Boulders. I Consistency %Gravel) b 7.7. {' ws �( Bonn 1� i2'3 l � e - 1 1 Z.S 2 2: L5 6 lie 14a / 2 , . DEEP OBSERVATION'HOL E LQ Hole#?� Depth from $oil Horrzdn Soil Texture Soil Color Soil Oilier Surface(in,) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency:"/o Gravel) to A„r. y R�a Le> M �PrfV i7 Z 5�►2(s� a DEED OBSERVATION BOLE LOG i Hole# Depth from Soil Horizon_,_ Soil Texture Soil Color. Soil Other Surface(in.) (USDA) (Mansell) Mottling (structure,Stones,Boulders. /rr Consistency-%Gravel) y i Z 3l 1 �p to 2 t2fv C LAA �a �? ? 5 6 �� Flood Insurance Rate Maa, I Above SOtl year flood boundary, No Yes withi�500 eat botindary No I Yes f , Within lo0 year flood boundary.No , . Yes De th of.Naturall-"Occurcaa! Pe s Material 1-Does at least four feet 0 initttlfally:occ g pe 'o; material exls in all areas observed throughout the area proposedi for the sotl,abqjo ,ion sys o ? �5 ! If not,what is'the depth of n OP'. g.p rvious material? I ; Certification j I certify that on Q 2 �= �. .(date); have p serf the soil eval�lator examination approved by the Depar�ent of Environmental P.cotectlo atid th t the above analy?ts was performed by me consistent with the required expertise exp 'ence scn$ed ui 310 C. 15.017 Signature ate2,ZO �. c Q:\SEPnc\PERCFORKDOC TOWN OF BARNSTABLE LOCA TION 7D Gl ;csT SEWAGE VILLAGE 0S 7S a c11/14e- ASSESSOR'S MAP & LOT -0 INSTALLER'S NAME &.PHONE NO. AOZ4 H Co.v^5- SEPTIC TANK CAPACITY lab 0 &,1 LEACHING FACILITY:(tVpe)/�i��C/�S% � (size) to of &-f NO. OF BEDROOMS :,2 PRIVATE WELL OR PUBLIC WATER Bt,EMD; It-O WNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No- 7 - Gv�s7 �7 a-0 9s i _ r ' l . -- f qq N4/1 :--�111--.. Fina..,,.dam_-®_. P R O V E D THE COMMONWEALTH OF MASSACHUSETTS Barnstabl. 'rvationCommission BOAR® OF HEALTH TOWN OF BARNSTABLE Signed Applira# A for Dispati al Workri Tomitrnrtinn ami# Application is hereby made for a Permit to Construct ( ) or Repair (Z:!�-ra�nndividual Sewage Disposal Systems at: -• -...- - = �5 ....................................................... ...........5%�...... ........................................... Loca -- tion Ads or Lot No. �:�..--=`�•-----..Zg.�..v�..---•--•---••----------------------------- ..........-------------....-------•---..... ----•--------•----------------............._._ • Owner Address -....••••-------•----•--....----- --•-•-...---•..............•---......•-•...--•-.._..... -- ----------------.._.........-•---••----------------------•---•--------_.. Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms..... ...............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of ersons____________________________ Showers � YP g ---------------•------------ P ( ) — Cafeteria ( ) Otherfixtures _----•-•--------------------------------------------------------------------------------------------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic 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........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit____________________ Depth to ground water......................... (i Test Pit No. 2................minutes per inch Depth of.Test Pit...:................ Depth to ground water........................ a -----------------------------------------------------------•---•-----------.._.......__...----------........................................................ 0 Description of Soil............................................................................... --------------------------------------------•--••---------------------------------_----- x c, W ....................... Nature of Repairs or Alteratiorus—Answer when applicable__ !?�s T�.� ______ _____________________________________ ---------------------------�®.®O-S�--------�----�(I.-----�•�-••l o.'---� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compl' ce has been:issued �t boar of It i Sign --- ---- /te-----�- / / G3 � Application Approved B Date Application Disapproved for the following reasonr- ------------------------------------- --..-...----.....------- -----.....................................-------- -------------------------------------- .........................----- - Date PermitNo. .......... -------------------------- Issued ------ -- --- ---- --..--...--...--..--...--- -- ---------- Date r 'No.,�1 == ��--• ... +^ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABL' E Applirattiou for UhgVoaat1. Works C om4rurtiodrumi# Application is hereby made for a Permit to Construct ( ) or Repair (G an Individual Sewage Disposal System at: 7D �J�Si �i � '� r✓ �� .... _ .... ............ •..................................... ... .�..__ _c ---.... ---- ^> L�t_ .•--------•--------------......---•-••---- L ott �� �✓ �\ C .......... -- ................................ ......... ........._..._...._ Owner Address Installer Address._...-----•-•----------------•-------..... QType of Building ,{{ Size Lot............................Sq. feet Dwelling No. of Bedrooms...... .................................Ex Expansion Attic a g— p ( ) Garbage Grinder aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------------------------•-----------......----------------------------------------------............--------......-----....... W Design Flow............................................gallons per person per day. Total daily flow__...........................................gallons. WSeptic Tank—Liquid capacity�� gallons Length................ Width................ Diameter................ Depth................ x .Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.-;Z..............sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ~' Percolation Test Results Performed by______________________ ' Date._______..__..____..___....._.__.___...- a --•••-••. ---..... Test Pit No. I................minutes per inch Depth of Test Pit---------�!_....... Depth to ground water........................ G;, Test Pit No. 2................minutes per inch Depth of Test Pit........ __..`______. Depth to ground water......................... t� --------------------- -•------- --------------- -- •------------------------ Descriptionof Soil................................................................................................................................................................. 1 U -----------------•-------- --------------------------------------------- ------••-----------------------------•----•-------•--•---------------------- •------------- .--------------- W Q OO < o v --- -• 1....... = ..................... U Nature of Repair/s or Alterations—Answer wher�pplicabl... v s_T y �� 7 T� / j - --------------------------------------------------••--------------:---- --------------•-•---•••••--••-----------•••--•--------•----------------••--•••----......----------•----•....-----•---------••••------------•-•-••-------•-----•---•---•----------•-----........._•----- Agreement: ` The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli fce has b ,en issue by`t e'boa d,o.ealth, 1 Sfgn�....... ....................................Date Applicatiori Approved YBy .. --- ------- ....... ^�^--�- - /. Application Disapproved for the following reasons: ................ ........ ........................................ ....................................�-------------------- ....--- `.... . ........... ......................----- -- ------...---...----- -- ---- --------- .---------------------------------------- ---------.............................. qq•. Date Permit No. -----------//` ��� Issued ...........................................Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Gertif rate of CLlompliance C� THIS IS TO CER ' or Repaired FY That the Individual Sewage Disposal System constructed C by.......................................................----------------------------- ------------------------------------------------------------------------------------------- -- ......................................................... nn t�all+er_ at ................. ... G--- ------------ - --- --- --..... .... -- . ---------........------------------------........------.....------.....--.....------... has been installed in accordance with the provisions of TITLE 5 o�T�e tec, nvironmental Code as described in the application for Disposal Works Construction Permit No. ..........7......... .............70... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ` DATE ....... .. ....... Ins ector -(r, P . ------------------------------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 9� 39� TOWN OF BARNSTABLE No.... FEE..............•......... i rya 1 r v ��str ivit rrmit Permissionis hereby granted`---------------------- -------------------------------------------------------------------------------------------------••-•--.-- / to Construct ( ) or Repair ��dividual Sewage Disposal Syste�_. atNo. --- ------•--..... ..................... ----- -- Street as shown on the application for Disposal Works Construction Permit N^�.: .___._ Dated.......................................... y ............................ ---.------------------. ----------------•---------•--...-•-•---•---- DATE. / ............................................. l/ Board of Health FORM 36508 HOBBS&WARREN.INC..PUBLISHERS -t «•_ -..:sue-.. _ _ _ 1 FEMA Zone Line SEPTIC NOTES OVERLAYD iS TRI C T: As Shown On FIRM _ 1.Location of Utilities Shown on This Plan Are Approx.At Least 72 Hours Prior to Any Excavation For This Project the Contractor Shall Make Panel 250001 00016 D •` 1, AP - Aquifer Protection District the Required Notification to Dig sate(1-8s&344-7233). c" • ZONE rev July 2, 1992 Lot 14 2.The Contractor is Required to Secure Appropriate Permits From Town �- � ' .:-.- - • As Shown on Plan Entitled» _ Agencies For Construction Defined by This Plan. Revised Groundwater Protection 37 E � .. 3.Wherever Sewer Lines Must Cross Water Supply Lines Both Lines Shall RF-1 OverlayDistricts" - Aril, 1993 Lot 15 IP M65.09 Cg�H... Be Constructed of Class 150 Pressure Pipe and Shall be water Tested to Area (min.) 43,560 SF P any E gurfin 259e i Frid_f . _ 25.p0' �I Fnd Aasurewatertightneas In General,water Lineashaubt Conshuctalin N p / Coordination With COMM water,and Shall be in Accordance Fro n toge (min) 20' Pb 3068 9 ce/DH f width (min) 125' FLOOD ZONE. ` �t9 4.AMinhimin 8CMR1'0fCove&310CMR for All a Lot 16 StocR?�e° s.All Structures oBuried Three Feet ae ar Subject ts. Setbac s • Zone P & C Lot 17 '' to Vehicular Traffic to be H-20 Loading.It is the Engineer's Front 30 Community Panel No. .' �p3"f: 1s.1 Recommendation that H-20 Always beUsed. Side 15' 6.lostall watertigbt Risers and Covers to Within 6"of Finished Grade Rear 15' #2500 D 1 0016 D off_o N 65 p0 4' / Over Septic Tank hllet and Outlet,D-Box,and One Leeching Chamber . Ju I y 2,- 992 f TON G (1e / }ate 0 7.Septic System to be Installed in Accordance With 310 CMR 15.00 dt 10 j, a 248 CMR 1 A-7.00 Latest Revision and the Town of Bamstable Board ofHeatthRegnlation.4. 8.All Piping to be Sch.40 PVC. of • o f , y t ' n ; 9.D-Box Shall Have a Minimum Inside Dimension of 12",and a Minimum • �# Ir i Fnd N p N'r• Sump of 6". ' r 1 '1'arc Ar a N o tance__ '`/� / 26,79 �Np� w 3 10 Oudet4Shall bye N Less than the Liqui the dD Inleptic Tank t eb�Shall Extend t ,3.•., ROpOSEO r / / x N / O t,t a Minimum of to-Below the Flow Line.outlet Tees Shall Extend 14" _..:D / / M >1 J o' Below the Flow Line,and Shall be Equiped With a Gas Baflte. j LOCATION MAP i r\ , zo-- ! _ F.F. le. 2 / 1"=2,000f' , ( ..... _ L0 , // .-r.-- • / / ISnNG SEPTI X E 0 R E M ,� Fe. E . ASSESSORS RE ,, , � �. � TO PERC TEST. 13,369 PERFORNWIFr:PETERSULLMAN,PB-SULLIVANEKOINEPRING Mop 139, Parcels 072 1 ^� op SOH.EVALUATORN0.2376 �/ 0.5 WITNESSED BY:DONALD DESMARAIS,Rs..TOWN OF BARNSTABLE 5 ' \ 1K L W 70 / OPOSED A'S' w AuwsTlz2o11 i \ 1 Sty //1", . I TEST HOLE-1 162 TEST HOLE-2 EL I62 2�c r4i , w/ Dlwellin pOSED / :::.: :.OIa�Yffit:.::::::. :::.: :.::•::.viA�x:......::::::. PRO !_ pR0 DE O OSE oarivor..... :::.i niioaaiosniiiieevss:::t:: POO FIR ::::::ri i+r�eis.:::::::.: s7 :::::iei ; si:. :.: M 1 i. CLEAN / V T .Alxtr�ltmtxt:.: ::: ::.,.1 WW ct WWis�;► .......... --_: n , sm•19.Y stone Patio �, pROpDp X D �' Lot 5 _.'.'.*itD:�a�l6m-.*::::•:::•::•::is ::. izaA:t:;:::::;::; 15.5 1.� Lot 6 TBM E1-14.4 NGVD IJGttdlitS A111EtD:'r:?{ :::'r:1s J7XddMt�9%►EDD::tf'{:'r:::i: To of MAG NAIL .::... ': :........ P ce rr ::�• ::•:t�:::.: ::��t•�osvti:;�:�: �'� _ '147 47 CI LAYER ZJY✓ ( � Shower Lawn ' ' / PROPOSANK `¢ / Fnd LI HTOLM �LOw ImNrotIVEYEILOW WE TEST Stied % ✓ SEPOO Lot 7 ' / / FINESAND 4 FRIESAND COUIDNOTMAINTAIN25GAL COUIDNOTMAWIAW25GAL. �1 0 o� 4 PFRCRATE<2)MNAN(LTAR-a74)12.7 PERCRATB<2tAMM(LTAR-o.74)17 V c of \ Lawn _ .2 i j / TRFl3T D \ N LIGHT YID2AWISHBROW14 LIGHT YELLOWISH BROWN Lot 8 fir^ / 126- I�.SAl'ID 5.7 126- MED.SAND ,7 I `Q IV b \ �,,. j NO R UNDWAIER ENCOUNTERED R DW TER ENCOUNTERED � Stone P CIo 1 ice► �5 �, f,7 o 'r - 4 R .. -~- y:,ot'0l�' S: a // TEST HOLB-3 PL IZ TEST HOLE 4 I>�Is 1 0 ' 5 . . Vo Wve ay> J / :.r' iviees :::}::. O of :' Prate / i / .:r:A•L.LY�Ltt.SR3t1..... . rr:ATxYaRaoz.......:..::. �j Stone Drive i A" r Wi e / ..... cif:usiieiburr:r::::':;: :c:::v�iYrisiixi;fix�i:......... 7... :: It:::;::::::: Q- ::.BAtmiY'.fbilYi'::::•::'::':.:•: 7 .1 lot onstructed) rELAYBRraNRs/3:. ::::::. O _ J / / :Jf +llSt*9Aft6:'::ii'r:i'r'ia 6 'iX�tAAdN'' 4 PROPOSED econ r xoatc�ts>rri::::::.::: tttssvii::::::::: ~ DRIVEIWAY :' / ..... .......... o ............. . ct j , u w C1 IAY®t25Y S!6 Ci IAYPA 23Y S/6 .... ./ (iHl'OLIVE Yffi].OW I26HTOLIVB YD / st LW FINESAND I SAND O / �• C2 LAYER 23Y 6N C2 uYER 23Y till - / ..,1 �' eeNe FRevoc 7fe TN 1 LIGH YELL01 L4HBROWN 9 I � slLLOWISH AO s 1y/ _ I ` � -. ..-•^l s'� - Kenneth R R T Reeves NOGROUNDWA7ER HiOgMIER® NOOROUNDWAIM EN000MFRFD Virgini6935/1p4 SITE PASSED , � 6 y f �p1 I Vent-Find Locotatran to De NIF It Trust Determined I onspTkne a1 u sta Pootion eo DESIGN DATA os to be os hreomspreuous as Posalble paimifY Rea Y T Reeves reeves Tr Single Family Vfrgintd Virgins T m780 see Note 6(typ.) GPD Ctf 18 F.G. EL. MOO F.0 EL 17.50 F.G EL 165 oGarbs Grinder t Se k N/� Total Daily Flow-660 GPD E CdP� Trust Row tEqulllzen Kathleen E CaPo Tr Fln�Grad\ EL 15. As Required use a 1500 Gal Septic Taolc teen f"�°�To Conrmm Pr1� 1500 G°sO" LEACHING AREA Kath ctf 192170 •Mkki' Compacted FRI To Any Work Hic T 1sp EL 13-50 Flier Sepik to 5 H-20 Md/or (see Nots 5) H-� I 660 GPD/0.74(LTAR)=891 SF Required Sidewall=2(lT-10"+50'-6")2'-253 SF 1 - 'A•- '�• LeOC�"9 Bottom Area= IT-l0"x 50'-6")=648 SF jf10F/lj9�s Pea Stuns oTboeBe�fnetdf���f lriam6er ya qc 3/4"- t 1 Total Provided-901 SF O� LEACHING Doable ed Beddkr% rsT �o. `� CHAMBER Stone Inspection Port LEACHING CHAMBER DESIGN &BoHels . _ N � .....-....._.....;..... ...r ���LLL.���LL��� os Per III/s 5 :: ;:K alCAfg� %b.�s... Cf L 4'- fo' ' - co All Pipes to be Schedule 40. Use y o8 - 12'- lo• No Groundwater 5-500 Gal.Leaching Chambers in a EL 2.5 OFF F�/sTER`` �`Q CROSS SECTION OF CHAMiBER DEVELOPED PROFILE OF SYSTEM Per Test Hds 4 12�_l0"x so'_6"Washed Stone Field as Shown. `ss/0NAI ENS' NOT TO SCALE Approve Groundwater NOT TO SCALE Per T.O.B. Groundwater Maps TITLE: PREPARED BY.• PREPARED FOR: NOTES: j Site Plan Ca eSurlv Proposed Improvements Sullivan Engineering, Ins. p Kenneth R Reeves TR 1.) The property line information shown was � PO Box 659 7 Porker Road compiled from available record information. m At Osterville, MA 02655 Osterville MA 02655 C/+O Virginia T Reeves -+ 70 ,/'/ea7t Street (508)428-3344 (508)428-9617 fox (508) 420-3994 (508) 420-39951fox 26361 Clarkson Drive 2.) The topographic information was obtained �/�/ capesurvtapecod.npt Bonita Springs, FL 34135 from an on the ground survey performed on 091JUNII 1 p Barnstable, (Osterville)Massachusetts j Draft: J00 Field. WHK/MLL 20 0 10 20 40 80 3.) The datum used is NGVD '29, a fixed mean �l IDATE: SCALE.' rr ► Review: PS Comp.: WHK/RLH sea level datum. August 9, 2012 1 =20 Pro ect: 31018 Project: C515 'I l