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0148 WIANNO AVENUE - Health
148 Wianno Avenue 'Osterville -- - -,�, � �. �,�. _:4� � ° �'v2-' .'F-• —.-•yam.-.-.-�-�` ray - �r�'-'�Ma-YZ',L�.y. I a ' P q P a , m • a . ° u m a � a . t TOWN OF BARNSTABLE /LOCATION �' (,J �t WD , Q0_ SEWAGE# VI):LAGE ASSESSOR'S MAP&PARCEL I o O INSTALLER'S NAME&PHONE NO. 3 SEPTIC TANK CAPACITY Ajg� .i LEACHING FACILITY: (type) (size) 3JC i� NO. OF BEDROOMS OWNER f Tcr'fZfGE PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: r Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility -4—4, 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) NFeet FURNISHED BY �L�igq C�'IS/�►��i�r 1 � � _ 1. w ' � �0 � v� _ cs a I �` � { � , � ; � . . � + _ � _, _ � � :'� X:. .. _ � � � -dam s s --C, � oQ ,I �. _ ��. ' I TOWN O/F�B�ARNSTABLE ^LOCATION��� W Ca►�V�C� (dV Q- S=V@E VILLAGE `Wt)t���Q ASSESSOR'S MAP&PARCEL I 'S NAME&PHONE NO. R SEPTIC TANK CAPACITY 10 9-4 LEACHING FACILITY:(type) ' (size) /GUO NO.OF BEDROOMS OWNER PERMIT DATE: C ATE f '1I 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 34 Front of House 1 37 17 \ \ 4 4 4 4 4 \ 4 4 4 4 4 \ f ! ? f f ? -- 4...:4 f f ? / ?1? f / f J ,• 4 4 4 \ 4 4 4 4 4 \ 4 4 4 4 \ 4 4 k I v a a � �^ r 3c30 Z woa — c N N � m °c a v C 7 J w �o N ' ' Massachusetts Department of Environmental Protection Bureau of Resource Protection Well Completion Reports k it Well Driller LO Please specify work performed: Address at well location: a rew Well Street Number: Street Name: fm 148 WIANNO AVE X Pleases specify well e: Building Lot#: Assessor's Ma #: 0 P fY type: 9 P Irrigation 140r Assessor's Lot#: ZIP Code: O Number Of Wells: 002 02655 Cityrrown: Well Location BARNSTABLE In public right-of-way: GPS f'Yes t"No North: West: 41.62582 70.38074 Subdivision/Property/Description: Mailing Address: click here if same as well location address Property Owner: Street Number: Street Name: DENNIS BERKEY 148 WIANNOAVE Citylrown: State: Engineering Firm: BARNSTABLE MASSACHUSETTS ZIP Code: 02655 Board of health permit obtained: Yes Not Required Permit Number: Date Issued: '� W2018 019 07/17/2018 Massachusetts Department of Environmental Protection _ Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) Well Driller - General Well Form DRILLING METHOD Overburden Bedrock uger Choose Bedrock— WELL LOG OVERBURDEN LITHOLOGY From ft To Code Color Comment Drop in drill Extra fast or slow Loss or addition O O stem drill rate of fluid Fine To Coarse S���� Brown '! �Fast(�Slow YES NO �� Loss Addition 20 40 Fine To Coarse S; Brown "- r I f`Fast r Slow Fr YES NO Loss Addition 40 45 Fine To Coarse S, Brown ► r ("YES NO Fast f'Slow ® Loss Addition 45 50 Medium Sand Brown f"Fast r Slow YES !� �� Loss Addition _.----------- _,_._.w__� ��. ______........._ _......_. __......._........___.........._.........._.._.........................._....... ___....- _..........____ _ __ 50 55 (Fine To Coarse S Brown r Fast(�Slow r r YES NO �� Loss Addition ............................. WELL LOG BEDROCK LITHOLOGY _ Drop in Extra fast or Loss or Visible Rust Extra From(ft) To(ft) Code Comment addition of Large drill stem slow drill rate fluid Staining Chips P F— 0 Choose Codes r �E: YES NO Fast Slow Loss Addition -- -- ---- ADDITIONAL WELL INFORMATION Developed Disinfected —(-'Yes r No Total Well Depth 55 Depth to Bedrock Surface Seal Type (No�ne''" racture Enhancement I r Yes f:No CASING M Is Casing above ground? From To Type Thickness ~^ Diameter Driveshoe f 0-���1 52�mm Polyvinyl Chloride �� Schedule 40����) �4 —_� �Yes SCREEN r No Screen .___---------- ______ __.___.._._..._._..._.__.._....._._......_ ......_...................._.____.... _. From To Type Slot Size Diameter 52 55 I Stainless Steel Well Point 0.012 1=4 WATER-BEARING ZONES -DRY WELL From To Yield(gpm) 35_....._...._..__ 55_ ._ 12 ______ PERMANENT PUMP(IF AVAILABLE) Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) Pump Description Wire Variable Speed Horsepower Submersible / Pump Intake Depth(ft) 50 Nominal Pump Capacity(gpm) 15 ANNULAR SEAL/FILTER PACK From To Material 1 Weight Material 2 Weight Water Batches Method Of (gal) (count) Placement Choose Material �� Choose Material �J —Choose One' WELL TEST DATA Date Method Yield(gpm) Time Pumped Pumping Level(ft time To Recover K Recovery(ft (HH:MM) BGS) (HH:MM) BGS) 7/24 p I201 B Constant Rate Pump 12 1:30 37 0:01. 35 WATER LEVEL Date_______ Measured Static Depth BGS(ft) Flowing Rate(gpm) • 7/27/2018� � 12 COMMENTS WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete and accurate to the best of my knowledge. Supervising Driller DESMOND THOMAS E Monitoring[M] Signature III, DrillerDESMOND III Registration# 764 THOMAS,E DESMOND WELL Firm DRILLING INC. Rig Permit# 0551 Date Job Complete 8/1/2018 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. I ' r CERTIFICATE OF ANALYSIS ?' Barnstable County Health Laboratory (M-MA009) ��o�usw Recipient: Sally Desmond Order No.: 6181.08586 Desmond Well Drilling Report Date_d; 07/25/2018 P O Box 2783 Submitter ` Well Driller Orleans, MA 02553 Description, 2 DAY RUSH-.148 Wianno Ave. .-................ ......._.......................--- - ---_.. _......- Laboratory ID#: 18108586-01 Matrix: Water-irrigation well Sample#: Sampled;_ 07/24/2018, 14:45 By: DWD Collection Address: 148 Wianno Ave Ostervilie MA Received; 07/24/2018 15:50 By PalmerP Sample Location: Turn Around: 48.Hr Rush Routine M ITEM RESULT UNITS RL 'MGL. METHOD# ANALYST TESTED . .TIME Nitrate as Nitrogen. 4.0 mg/L 0.10 % EPA 300.0 LAP 07/25/2018 13:33 Iron ND mg/L. 0.10. 0:3; SM 3111B LAP 07/25/2018 13:33 Manganese. 0:058 mg/L 0.025 0.050 SM 3111B CL 07/25/2018 13-56 pH 5,7 PH AT 25C NA 6.578.6 SM 4500-H-B DCB. 07/25/2018 10:21 mg/L 2,5 20 SM 3111B LAP 07/25/2018 13:33 Sodium r220 Total Coliform Absent P/A 0` 0+ SM KO RG 07/24/2018 17:15 Conductance 11600 umohs/cm 2.0 SM:25108 DCR. 07/25/2018 10:21 Soditan level is aboLe the maxium contaminant level.Those on a lowsodium diet.may wish to consult a physician. Attached please find the laboratory certified parameter list. 4 Approved By , ' _ (Lab .Director) 7 ND None Detected RL = Reporting Limit MCL.=:Maximum.Contaminant Level 3195 Main Street, PO. Box 427, Barnstable, MA 02630 Ph: 508-375.6605 Page:. 1 of 1 Nd/)"5 Fee BOARD OF HEALTH TOWN OF BARNSTABLE 01ppYication ff or Yell Con.9truction Permit Application is hereby made for a permit to Construct(✓, Alter( ), or Repair( ) an individual well at: Location-Address Assessors Map and Parcel AMAer(�. B zr 4-0" I�l _�00100 Civ9, 4A o a eP S-,c;- Owner Address 5mand '9c5>e C)rlOQ k S MA aZ(053 Installer-Driller Address Type.of Building Dwelling Other-Type of Building No. of Persons Type of Well �� L Capacity /r� Purpose of Well_ RA-1 G A---( 7 61q Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of alth Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Ce 'fica Compliance ha een issued by the Board of Health. Signed 7 IG 14 .Date Application Approved By�� �� to Application Disapproved for the following reasons: Date Permit Nd✓�-��� ® � Issued Date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of (Compliance THIS IS TO CERTIFY,that the individual well Constructed 4,f, Altered( ), or Repaired( ) by ]DAE-=, 0 nej "Ll- 7rl jtIn� InG. Installer at I Uv�o-nn 0 e- (%-�-ry l I U.- (54`05; has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.0 Z#)l Dated� - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector I d 2:JW1 l/` - Fee 00 BOARD OF HEALTH TOWN OF BARNSTABLE ZIppYtcatton _for Yell Conotructton Permit A lication is hereby made for permit to Construct Alter O Repair( pp y p (1/� or Re air an individual well at: HS Wainn I�UP. ( S- r'v_,i( _ nAA !'�u/ci5�,looa Location-Address Assessors Map and Parcel (q'K UJAOM GV`P_ OMM 11(..e_ AAA oacp S17 Owner Address L _-cwori� We t ( D► i 1l tg_�tic. . `�� T3vx �JR� Cyr lec�►-is N1A D2(v53 Installer-Driller Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well (p V L Capacity l_5 t cs risA Purpose of Well L RC1 G AL )L( Agreement: The undersigned agrees to.install the afore described individual well in accordance with the provisions of the ` Town of Barnstable Board of -ea th Private Well Protection Regulation-The undersigned further agrees not to place the _ well in operation until a Ce 'fificalte Compliance has^been issued by three Board of Health. Signed �f-I � ^[L 7//6 �� Date Application Approved By � / � : w.. Date Application Disapproved for the following reasons: Date Permit Nod/ ) [ ; Issued z ; 1C r • Date v --------------- -vmeme e 4 m Q------------- --------------------- .----e _--_------< . -----— �Ier:�d M. �' •"1 e- BOARD OF HEALTH .TOWN -OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed� Altered( ), or Repaired`( ) by .�. nr�(j "P 1 'l r ill � I riG. Installer at y Ik)l Ct,nn n Nl-e— M 6 6-3(015; has been installed in accordance with the provisions of the Town of Barnstable ,,��Bo,,,,ard of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.b Q, Dated '1 THE.ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date re' inspector i BOARD OF HEALTH TOWN OF *"BOAR*NSTABLE Yell Con.5tructton Permit No.WZO[© ` at Fee 2 Permission is hereby granted to T)PS111 C yld �} S U -DrO h"n ) c' Installer j to Construct(l), Alter( ), or Repair( an individual well at: Street as shown on the application for a Well Construction Permit No0�t 0 �ated 7 1 �10,)l 9 Date/ Approved By f - Lawn Lawn v Z� Paved Drive �l O I i Lawn h c Lawn' / 42.25 *T, /. 2� / 4N-2 4�.5 Lot 7 / Proposed D—Box & SAS 26,972 ±SF #148 w 2 Sty l w/f Dwelling Lawn �! Lawnjq L)lf Lawn I Existing Septic iGnk W to be Reused: Invert_ s to be confirmed prior to on y work. lJ Existing Leach Pit to be Removed and l Grovel Drive filled. Any Unsuitable Material to be removed @!ldvglq#iNth clean granular fill / / / that meets 310 CUR 15.254 2 d) * / Lawn Strip Out \ \. J Flag l Pole g ' 204.90 � � i -- — --" - Side Walk Side Walk Utility Manna ' Pole Avenue H a�O a2[ss M e I No. 0 Fee I THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION — TOWN OF BARNSTABLE, MASSACHUSETTS Yes AppUration for disposal bpstent Construction j3ermit Application for a Permit to Construct{Repair( ) Upgrade(_� Abandon( ) ❑Complete System Nr Individual Components Location Address or Lot No. /`l�� � N"® 'e Owner's Name,Address,and Tel.No. lt 13-ark 2Y Assessor's Map/Parcel /YO a S g 01�- 2— Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel No. �G!L:i�tio'1 CAWS-.t; 5��`7`71—A 3y?q S-u 'vc,h eh� :hee�rn� f�hf�l�.nf��s,c Type of Building: Dwelling No.of Bedrooms / Lot Size Z �72 sq.ft. Garbage Grinder( ) Other Type of Building Res.WeO-�14 l No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) !��Q gpd Design flow provided L ss. gpd Plan Date ®//: 3 4;'26/(o Number of sheets / Revision Date Title 'Sl� P 9h ?01 c S Size of Septic Tank F_Xi 64, ( f 6a116n Type of S.A.S. '3 Sop C-Alldl, (f 9-44 S t-- �/of-e Description of Soil 'T H—J- O—Go d r� F�11 fc0—(o `� f e f� La r fa YR Vz. �r/ Gfa ,'s4 Qrowi SIf qj ( * `t- 82 0314 rr Joek 6/9 t'e --.S4 S 02- .13 1 cC4 el- toYR ' ec PIJAJ w ,S Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the EnvironmentaLCode_ " not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health,r'A j Signed �'9� Date /A� Application Approved by -Date Application Disapproved by Date for the following reasons Permit No. ((��'� l Date Issued No: � Fee 1 00 �— :O Entered in computer: THE COMMONWEALTR'` F�:IIQpSSACHUSETTSYes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rpplication for`Misposal *pstrm' Construction permit l � 1 Application for a Permit to Construct Repair( )+ Upgrade(�) Abandon( ) [:]Complete System IndividualS�ComponentsS Location Address or Lot No. ,f`f '��'"''��'�' Owner's Name,Address,and Tel.No. Assessor's Map/Parcel / G 05.6-ors 2- Installer's NameoAddress,and Tel No. 7-7(- � t Designer's Name,Address,and Tel.No. PQ/c,--j A A C4t4,ST- �3 F`1 ,��f�h� t Cv if rrsi. <,c ` , N D 0,5 1 M/ X rM,M i lti1 Type of Building: f Dwelling No.of Bedrooms Lot Size 7Z sq.ft. Garbage Grinder( ) Other Type of Building OeS, e- No.of Persons 1. Showers( ) Cafeteria( ) Other Fixtures Design�.Flow(min.required) � gpd Design flow provided 415_5,I gpd 'ram Plan Date'/"Cat! 3 41,2 0/ io Number of sheets / Revision Date Title s,-41. �9h 'r-w c f 9 Size of Septic Tank •Yt S54,�, < is oc, 6;;///0 Type of S.A.S. _SciG t',a f/c+, C49A err Description of Soil " 1 I f� +'�j 60-6 7 �� A_r G 4v-e/' /o " 5/Z (tee/ 7b /� Crr,/,t54 aro"".1 6 - fi2" C 69-er IuPi? 5i/6- f` (�•;slr �3!'o+.�s7 e%2 - 13 2 C el- ,to K4 - '�lv yerz fve i't S., Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: ; The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the EnvironmentaI-C ?not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health., Signed Date Application Approved by e^ Date- 12--f-(/e&? - _ Application Disapproved by Date for the following reasons - I Permit No. aC-) (n.• �-( �� Date Issued - ----- ---------------------- - --- ------------------- ---------- ----- --- - ---------------- ---------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Qtertifi>cat>e of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( le Repaired( ) Upgraded( ) Abandoned( )by fie!/-�w 0 C_tj 14 b J AW 0n iV RJ at /4 �✓GI h n U ��is i'h 1,e - - - - has been constructed in accordance- J with the provisions of Title 5 and the for Disposal System Construction Permit No. ( r. (dated r{ I'! Installer Designer Scri l"do 11 r,,r"'A�-e r,'h #bedrooms C/ 13 r Approved design flow '/ 51, + Z gpd The issuance of thisf permit shall not be construed as a guarantee that the system will ctioni s designedl J� Date j Inspector -------------------------------------------------------------------------------------------------------------------------------------------- No.v�C�((C L_(�J Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal *pstent Construction Permit Permission is hereby granted to Construct( Repair( ) Upgrade( ) Abandon( ) 'i ystem ocat,ed at /�� fi �;� a ov A V e ,and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date t �' �' Approved by / •�-�/,/ �( �� , 1 - 0 Town of Barnstable Regulatory Services Richard V. Scali, Interim Director • ■AMSTABI�, + Public Health Division En " Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form a Date: Selvage Permit# � y2.1 Assessor's Map\Parcel A�DL58 'aoa Designer: .Su( V q k Installer:, Address: 7 parlt", Address: <<<�- On 1-L '�'j�,r was issued a permit to install a "(date) (installer) septic system at Yllisp dt, based on a design drawn by (a dres dated ;f lu 3a 7_0 t � designer) certify that the septic system referenced above was installed substantially according to the_design,which-may-include_minoLappro-ved changes_such_aslateraLrelocation-oLthe distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the I\A approval letters(if applicable) 'I C. (Installer's Signature) L4 us 4 V (Desi er's Signature) (Affix Desiki er=s Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc Town of Barnstable P# SINE Department of Regulatory Services Public Health Division Date M ,4 1 o639.& 200 Main Street,Hyannis MA 02601 Akb Date Scheduled `� Time u^ Fee Pd. s os Soil Suitability Assessment for Se ge Dispos l a Performed By: l� �✓ Witnessed By: V' t ✓1t �J -LOCATION&'GE_NERAL.INFORMATION Location Address j� Owner's Name 11 Address�C Assessor's Map/Parcel: Engineer's Name 1 NEW CONSTRUCTION X REPAIR Telephone# 15 0 P � Land Use Q,S.1 Slopes Surface Stones . -o Distances from: Open Water Body f f' ft Possible Wet Area ;Z:v eft Drinking Water Well ft Drainage Way ` ft Property Line ft Other ft SKETCH:.(9treet name,dimensions of lot,exact locations of testholes&perc tests,locate wetlands in proximity to holes) J y r6 W"NNV4 Parent material(geologic) S Depth to Bedrock 7 �0 Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face ✓°` Estimated Seasonal High Groundwater DETERNIINATION-FOR.SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. 7 Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level / S78 PERCOLATIONTEST Date (T' :Time. d Observation Hole# Time at 9" Depth of Perc 4 _Z b Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak Rate Min./Inch 4 �y Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/l) Original: Public Health Division Observation Hole Data To Be Completed on Back------------ ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC i. DEEP OBSERVATION HOLE LOG , Hole# / Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel 0- 0 C A (6hs4rL t1(o*, Oiler 7,' ff--, 82-lam c A s� DEEP OBSERVATION HOLE LOG Aoie#` °2. Depth`from } �' Soil Horizon=, Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,.Stones,Boulders. Consistent ° Gravel Q— 570 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.° Gravel O—e ell, Ale 'W—K&At lan? '5/Z cotle 30- r3Z 3 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel t V& �a V � I0yt? �2 3 ZOO~ J6 s !o 3 Flood Insurance Rate May: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? e If not,what is the depth of naturally occurring pervious material? Certification I certify that on 7 l� 20 /7(date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required trainin ,expertise and ex hence described in 310 CR 15.017. P P M SignatureZ Date 02-5XA. Q:\SEPTIC\PERCFORM.DOC I F Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Wianno Ave Property Address Manning Owner Owner's Name - information is Osterville MA 02655 November 15, 2011 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. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: j - l/�. • p Y only the tab key to move your Patrick M. v Conne cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name r16 189 Cammett Road Company Address Marstons Mills MA 02648 City/Town State Zip Code 508-428-1779 _S1 12855 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address;arid that they —I information reported below is true, accurate and complete as of the time of the inspection. The inspectioIn was performed based on my training and experience in the proper function and maintenance of on site'. sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The.system: ® Passes ❑ Conditionally Passes ❑' Fails � = ❑ Needs Further F-valuation by the Local Approving Authority (\7- i NA( ' " 1 November 15, 2011 Job# 11-204 In ector' nature _T— Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 I 1 Commonwealth of Massachusetts u Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Wianno Ave Property Address Manning Owner Owner's Name information is required for Osterville MA 02655 November 15, 2011 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: ® 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: Tank was not in need of pumping at time of inspection. Leaching pit showed no signs of surcharge or saturation. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a corr:plying 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): l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 r Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Wianno Ave Property Address Manning Owner Owner's Name information is required for Osterville MA 02655 November 15, 2011 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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 obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•1 MO Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Foam Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Wianno Ave Property Address Manning Owner Owner's Name information is required for Osterville MA 02655 November 15, 2011 every 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 aseptic,u^k and SAS and-the SAS w withlitI a Zone .i 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.septi.c 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_day flow t5ins•11/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 4 of 17 '1 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Wianno Ave Property Address Manning _ Owner Owner's Name information is required for Osterville MA 02655 November 15, 2011 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No El ® 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. }l! rQrtion, of cesspool 'r't vy iS"d✓Itl n i00 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 2000gpd7 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-11/10 Title 5 official Inspection Form Subsurface Sewage Disposal System-Page 5 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Wianno Ave Property Address Manning Owner Owner's Name information is required for Osterville MA 02655 November 15, 2011 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for.signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•11110 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 6 of 17 I Commonwealth of Massachusetts t Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 148 Wianno Ave Property Address Manning Owner Owner's Name information is required for Osteryille MA 02655 November 15, 2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ® Yes ❑ No Water meter readings, if available last 2 ears usage d N/A Irrigation g ( y g (gp )) system. Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons perday(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: 15ins-11/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Wianno Ave Property Address Manning Owner Owner's Name information is required for Osterville MA 02655 November 15, 2011 - every page. Cityrrown 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: Unknown Was system pumped as part of the inspection? ❑ Yes ® No I 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): 15ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w� 148 Wianno Ave Property Address Manning _ Owner Owner's Name information is required for Osterville MA 02655 November 15, 2011 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Compliance date: 10/20/88 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer.(,.16catez on site plan): 2 Depth below grade: feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 14"feet Material of construction: Z concrete 0 metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8.5' long x 5.2'wide- 1000 gal. Sludge depth: 3 15ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Wianno Ave Property Address Manning Owner Owner's Name information is required for Osterville MA 02655 November 15, 2011 every page. Cityfrown 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 27" 2" Scum thickness Distance from ton,of scum to top of outlet iee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 12 How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level was found at bottom of outlet invert and tees were intact. Recommend pumping tank every three years. 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 !Sins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Wianno Ave Property Address Manning Owner Owner's Name information is required for Osterville MA 02655 November 15, 2011 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cost.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Wianno Ave Property Address Manning Owner Owner's Name information is required for Osterville MA 02655 November 15, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 11 Comments (note if box is level and distribution Ato outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No solids or high stains present.Liquid level was at bottom of si6glc outlet pipe. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No I Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Wianno Ave Property Address Manning Owner Owner's Name information is required for Osterville MA 02655 November 15, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: One 6x6 pit. ❑ leaching chambers number: ❑ leaching-galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching pit had one foot of standing water at time of inspection with a faint stain line at 50% capacity. 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•11/10 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 148 Wianno Ave Property Address Manning _ Owner Owner's Name information is required for Osterville MA 02655 November 15, 2011 _ every page. Citylrown 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.): I t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Wianno Ave Property Address Manning Owner —� — - ------....._.._.. Owner's Name information is Osterville MA 02655 November 15, 2011 required for _._.._..._.__.._.._..._....__...,.._.-.. ,,._. .... _.,...._...._.. ----------__..----- every page. City/Town 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 34 Front of House 16 \ \ \ 37 17 _ f\ ! Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Wianno Ave Property Address Manning Owner Owner's Name information is required for Osterville MA 02655 November 15, 2011 every page. Cityfrown 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: 20+feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked,,date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers - (attach documentation) ® Accessed USGS database-explain: USGS topo map and town GIS You'rnust describe h6!'w you established the high ground water elevation'. Town groundwater contour map shows water-below el. 5 and topo map shows property above el. 30. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11110 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 16 of 17 , Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 148 Wianno Ave Property Address Manning Owner Owner's Name information is required for Osterville MA 02655 November 15, 2011 � every page. Cityrrown 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 l5ins-11/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 117 of 17 A/uilt Page 1 of 1 �a 7 L O-G Al ION�� /iLiiur �v� SEWAGE ;PERMIT 'TI'Q. VILLAGE INSTALLER'S NAME i ADDRESS S U1LDER OR OWNER TO4el 8 .5w� .e� � y T DATE PERMIT ISSUED DATE COMPLIANCE 1tSUED N http://issgl2/intranet/propdata/prebuilt.aspx?mappar=140058002&seq=1 11/21/2011 pPs,r o f 1 ` 0 - 5"R ' , w No...... ...ZS 7 Fps 5. ..^- THE COMMONWEALTH OF MASSACHUSETTS �,J� \ BOAR® OF HEALTH Appliration for Disposal .lVorks Towitrurtiun Vantit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal Syst at: ...�iAl..l.A:L,X.la-�•.o...k.Q.....0.5 -----------=�)T:.7 x..... .... ------------------------------------------ Location-Address + or Lot No. ---•---•-----••-------_.....--^-----------•-----•---•^-----••-•...........................•.... ....................:.............................................................................. n� caner Address Installer Address UType of Building 22 Size Lot...Z.Gr _97Z....Sq. feet �- Dwelling-No. of Bedrooms..... .................:.................Expansion Attic s1e) Garbage Grinder (1U Other-Type of Building ............. .. No. of ersons__............... __.____ Showers - - a g --------•._-- P ---• ( ) Cafeteria ( ) Otherfutures =•----•-----------------------------•-----.---------•---•---------------......----......--•-••---...---- W Design Flow......•��-.-5............................gallons per person per day. Total daily flow.._...53-C)........ ............gallons. WSeptic Tank-Liquid capacity.10M.gallons LengthV�...... Width_'A.._l�?... Diameter__._ ._..... Depth_._-.A..11 Disposal Trench-No.......:..:......... Width..............._.... Total Length.._................_ Total leaching area....._._.._..___...sq. ft. x . Seepage Pit No........I._......... Diameter.......6........ Depth below inlet............... Total leaching area. .sq. ft. Z Other Distribution box ye Dosing tank (Q10 `\ ~' Percolation Test Results Performed ...._._ ...k!oea..... Date... l !�►_ '?�19�_6 Test Pit No. L.AZ-----minutes per inch Depth of Test Pit.....1Z-......... Depth to ground water.._A�sa_�__ tGot:r�t�21r0 w Test Pit No. 2.......::..:....minutes per, inch Depth of Test Pit.................... Depth to ground water.....___............___. O Description of Soil...0!;' ...1- '1 s! _ :_. t�. _4-..__: -�`�______ �� 1J a,_' 2 ( U .� ------6.A.. 1- _T .......�`-�.!4�IP ............................................................................................... UNature 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 Sanitary Code-The undersigned further agrees not to place the system in operation until a Certificate of O,*plianas bee ss°ed by the oard of health. d. •----- ---•.............•••••. Date ApplicationApproved BY.....-.......................... --------- ---•----- ..•••. -------- .... ....... Date Application Disapproved for the following reasons-- ------------------•••-•••----•---------•----•------•---•••--......----------•-' -•------....-•----•-------------------•-------------...---------•----•--••-----------••------•-•-----------------••-- Date PermitNo.......pp-9. ...................................... issued....................................................... Date ......................... Fs$ .......... THE COMMONWEALTH OF MASSACHUSETTS `, — BOARD OF HEALTH / J �..C" ..�...............OF..... !BIZ"S l Appliration for Disposal Works Tonstrnrtion Prrmit Application is hereby made for a Permit to Construct ('X) or Repair ( ) an Individual Sewage Disposal Systap at: .. -• - _. A ................. ........................... .............................................. Location-Address or Lot No. ......................-----•---------------................._.._...•... ..__...._.......... Address .......... � . ................................•--••. •.... Installer Address U Type of Building � � Size Lot___ ;-G77Z...Sq. f�t ., Dwelling—No. of Bedrooms....._ ......................................Expansion Attic (IQIP Garbage Grinder ( Xj Other—T e of Buildill a YP g ---------------•---•-------- No. of persons............................ Showers ( ) — Cafeteria ( ) dOther tures -------•---••••----------------••-•••-----•-••-•••-•------------------------------------ �� W Design Flow........� __________________________gallons per person per day. Total daily flow___.._..7______.__________. ______._.__.gallons. W �eptic Tank—Liquid ca.pacity_.k gallons Length_8"�:'. Width_!__-` '_ Diameter__.""....... Depth.__�_'�l.�� x Disposal Trench—No_____________________ Width.................... Total Length................... Total leaching area __________________sq. ft. Seepage Pit No---------'�:__.__.�. Diameter._._.._........ Deptl} below inlet......_��._......... Total leaching area.__`4-' -`sq. ft. Z Other Distribution box ( _ Dosinn- ank _ '-' Percolation Test Results Performed b ._T?U=��u P� � `�� Date__. �+.__`-Ii)e-G Test Pit No. I._.:4_�___.minutes per inch Depth of Test Pit______}_3._______ Depth to ground water--------- _.. !-�Sc� 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W �------------------------------------- ---•------- O Description of Soil 0A '!vr ,- - = .- ± 1�- l: t�:' "►�+ " {Z t r� 4�J F -T e 4 U ._____________________________________________________________________________ ___._._.._._._.3._____.__.._______________.__________..._____._________._..._..._..______......___..________...___ 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 TIT12 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliancehas beenissued by the bard of health. 11.67 Signed. - Application Approved BY......................... ....J ..tZ, as 4 - Date Application Disapproved for the following reasons--- ------------------------•-----------------•------------------------------•-•-- ............... .....--•---------•------------------------------•--------------------------------.......------------•----•.._.._........•--•-•---•--------••--•--•---•--------•---••---------•------•---••--•-•-_----- Qp- Date Permit No._.....D_�...._�_f-..,--__......-•-••••----•--• Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... %rdifiratr of Tomplianrr THIS IS TO E ' That^t by he �,dividual Sewage Disposal System constructed ( ) or Repaired ( ) '-------------------- Installer has been installed in accordance with the provisions of TIT 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...... f' ..... 5�> ______.___. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.DATE..................I............................................................ Insp.tor--••-•-...----••).]D ............................................... THE COMMONWEALTH OF MASSACHUSETTS F 615_ BOARD OF HEALTH .............OF................_._..__._._..........._..._......... .._..__......._... ......_.. No.. FEE.. . -•......... Disposal Works Tonotrnrtion frrmit �" r �,Permission is hereby granted.............. __�_f��i�.::_S!�'��___•_•��••••••._•-•• to Construct (X) or Repair ( ) an Individual Sewage Disposal S stem at No...............................4,01...........-.7....W.;-'j4V-1V-6.....A-ti ------- C2S1n.,t1Aj_f--a-------------------•---------------------•--•-•--...... Street as shown on the application for Disposal Works Construction Permit No._5b.'_ S_)__ Dated........... _2.6 ......... ...................................... .................. B a of FIealth DATE. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS h IMG-LC VAMIL -- - , ,N `CTAIZ6 DCtZ...' 3 f 1. :330' USC' IQO SAL A O w,_ - /� �--- �- 1S.06CAL. 1 P 1"r E t 000 { „yin. 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Use l000. . ice' .3 s. D IS Po!SAL P iT QSE t 000 6-AL ' _ } 51 OEWAU` ^RCA y 15o S, R C)C 'i 3'75' C3: P. O. s bars 9g. Zy�� 6oTT'o r-I A?- A So 6..F. . i �,a Se 76 TA PcSiGQ 4Z-5 o- P. D95�j —rb-rAL- DA%Ly FLoQ = 330. CG P,O: 97-7._ p.a a, ,< 3 M� i'F-V,e-O Al E. oQ RAT rJ, oQ LASS � S r°'�'' ' A. No.2;b43 %+ No. 29733 `> 'Q� •7 m �.3 "� i ,p Q f �4,n �c�STEa4 � SS 4)' Slut ti` F11P t i _----__ j4V.. Z3, 77 /v10 D d O to D) s .. A/y '`' � f• /coo BoX /w✓. /,w �.�//� ;, GAL /•YJ/ _ •�,• Yo CEgC.N �x/cLiT� w I r14 I v- LA�� ��. W�S Hj`D ' * �2 �� G'E.GTIFiE.F� PG GT F'L:?.t/ sr AJ f.,b RC PROM Lr NO SCALE �! f�E,�Eov G•Or+lP�Y.S W/T// Ale. • 10OVIO "T!�/1G� ,2E41J/,�'EkIENj.S o� Tiy� ,C�E6isr�,ec'�,t.4No.SlieY� . ToxWiv Avv /.S 4 7 - G fir)O` T//Ct P�iv /.S iS/o7-6AX pAv,4,v/iY,ST,tz- - --l�iNEiS/T.Sv,2!/Ey�tiv0 Tf/E aGFS�� .5•;�l�f/X/fj/E.e�'4N..S�4UG1���r ,c5 USEp NO. CATION i � nv» S-P /1P1 a • :LLAGE r �' DATE D2c-,190 'PLICANT k FEE _ )DRESS TELEPHONE NO. (Non-refunds le !G INEE R - ,of TELEPHONE NO. `,TE. SCHEDULED 2' q�s ,, (Applicant' s signature . . . 0,6 O • • • • . • . • • . • • . • • . • . . • • • . O . . . . . ... . • . • . •-. . . • . . . . • • . . . . . • • • . • . .•. • • • • • . . . • . • , 3SESSOR'S MAP & LOT NO. SOIL -LOG - .. \\ , B-DIVISION NAME DATE Z-2�,� 1`jS G, TIME :PANSION AREA: YES NO ,4r ENGINEER '?� IWN WATER__X,_PRIVATE WELL ��' � �,( BOARD OF HEALTE • JG1Mj='1Z�,5 EXCAVATOR :ETCH: .(Street name, etc. ,dimensions of lot, exact location of test holes and .1.'percolation tests, locate wetlands in proximity to test holes ) NOTES T vJ l o -Ex. 2`me-Y r esMw�a f N •• `� ' 1 6D A9- • ' :RCOLATION RATE :_ Z-Zt 'l k"S :ST HOLE NO: ki- - ELEVATION: TEST HOLE NO: ELEVATION: 1 Lo/ :nti , `ate-s�cL l uc $5u • 2 � 2f--� - -. 5 5 6 � C- 6 ' 8 8 9 o 9 10 10 11 11 12 12 13 r2 13 14 �� "`� '12 14 15 15 16 16 J.ITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELDDLEACHING PITS LEACHING TRENCHES VSUITABLE FOR SUBSURFACE SEWAGE. REASONS : • ATE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PER C TEST APPLICATION RIGINAL: COMPLETED_IN ENTIRETY BY P . E . AND RETURNED TO BOARD OF HEALTH OPY: RETAINED* BY APPLICANT IT 1.ALL EXTERIOR WALLS SHALL II 1 BE 2X6 @ 16"O.C.UNLESS OTHERWISE NOTED. " T 2.ALL INTERIOR WALLS SHALL BE 2X4 @ 16-O.C.UNLESS OTHERWISE NOTED. 3.CONTRACTOR SHALL VERIFY ALL WINDOW ROUGH OPENINGS PRIOR TO ORDERING WINDOWS. 4.CONTRACTOR SHALL VERIFY r---------------' ALL DIMENSIONS PRIOR TO _ I CONSTRUCTION. CONTRACTOR e I ASSUMES RESPONSIBILITY FOR I ANY MISSING OR INCORRECT DIMENSIONS NOT BROUGHT TO THE ATTENTION OF THE DES, GNER. I I GENERAL NOTES I —---------------- EXISTING 1 GARAGE r------------------- EXISTING NO. REVISION DATE DECK r6 I COPYRIGHT NORTHSIDE HEREBY EXPRESSLY RESERVES ITS COMMON LAW COPYRIGHT.THESES I PLANS ARE NOT TO BE REPRODUCED CHANGED OR COPIED IN ANY FORM OR MANNER WHATSOEVER WITHOUT FIRST I OBTAINING THE EXPRESS WRITTEN PERMISSION AND CONSENT OF NORTHSIDE DESIGN ASSOCIATES. BUILDER: EXISTING LAUNDRY O EXISTING LAV. —————— DESIGNER: I. NORTHSIDE I I I I I I DESIGN I I I I I -- ASSOCIATES -- DISTINCTIVE RESIDENTIAL&COMMERCIAL DESIGN .REF 141 MAIN STREET'YARMOUTHPORT'MA 02675 I (606)362-2210 (506)362-9802 EXISTING I - - _ NORTHSIDEDESIGN.COM \ LIVING ROOM ___p nPRhsiAel@aum ast e[ STRUCTURAL ENGINEER: DW ' EXISTING TAYLOR I I I ' ---- BREAKFAST DESIGN LLC 10 EXISTING I EXISTING - M.BATH MASTER BEDROOM EXISTING STAMP: KITCHEN [(DF — — I ( ——————— WALL OVEN PROJECT: _ EXISTING BERKEY ------ RESIDENCE 148 WIANNO AVE. OSTERVILLE,MA. EXISTING EXISTING STUDY DINING ROOM TITLE FIRST FLOOR EXISTING PLAN FOYER .� SCALE:1/8"=V-0" 0 1 2 4 6 L PROJECT#: SHEET EXlSnNG PORCH 16-17 rl DATE: OF 9/23/16 4 M� 1.ALL EXTERIOR WALLS SHALL BE 2X8 @18"O.C.UNLESS OTHERWISE NOTED. 2.ALL INTERIOR WALLS SHALL w�7 BE 2X4 @ 18"O.C.UNLESS OTHERWISE NOTED. 3.CONTRACTOR SHALL VERIFY ALL WINDOW ROUGH OPENINGS TO PRIOR TO ORDERING DERING WINDOWS. 4.CONTRACTOR SHALL VERIFY ALL DIMENSIONS PRIOR TO CONSTRUCTION.CONTRACTOR ASSUMES RESPONSIBILITY FOR ' ANY MISSING OR INCORRECT DIMENSIONS NOT BROUGHT TO THE ATTENTION OF THE EXISTING DESIGNER. BEDROOM#4 GENERAL NOTES NO. REVISION DATE COPYRIGHT NORTHSIDE HEREBY EXPRESSLY RESERVES ITS COMMON LAWCOPYRIGHT,THESES PIANS ARE NOT TO BE REPRODUCED • _ CHANGED OR COPIED IN ANY FORM OR -- _ MANNER WHATSOEVER WITHOLR FIRST ' OBTAINING THE EXPRESS WRITTEN \ I PERMISSION AND CONSENT OF NORTHSIDE DESIGN ASSOCIg1ES. EXISTING BATH BUILDER: e DESIGNER: NORTHSIDE DESIGN ASSOCIATES DISNNCTIVE RESIDENTIAL&COMMERCIAL DESIGN 141 MAIN STREET'YARMOUTHPORT•MA 02675 EXISTING BATH (50R)36 NO- ( 2-98W NORTHSIDEOESIGN.COM.COM orthsidel@co EXISTING ��„�� STRUCTURAL ENGINEER: BEDROOM#2 ----- TAYLOR DESIGN LLC STAMP: EXISTING BATH EXISTING BEDROOM#3 h 5 RESIDENCE PROJECT: - EXISTING BERKEY 148 WIANNO AVE. OSTERVILLE,MA. TITLE: SECOND FLOOR PLAN SCALE:1/8"=1'-0" 0 1 2 4 8 PROJECT#: SHEET 16-17 A.2 DATE: OF 9/23/16 4 N/F Linda Dill (HIT)" ZONE. ° RC f Area (min.) 87,120 SF (RPOD) +Frdntoe (min) 20' Width (min) 100' o � w 1 Setbacks: • , Lawn Front 20' r`` j } f Lawn Side 10' ,` • �,.` _V 7777!17777 ti �� Rear 10' ��� • �" OVERLAY DISTRICT: x "� �.� •�. f Paved Drive l / 8 p Y o , AP - Aquifer Protection District Lawn SEPTIC NOTES lot � .�3 • .14 , m - Lawn 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 / the Required Notification to Di Safe 1-888-344-7233 and contact SILL ; g ( ) Location Map: 42.25 � � � Sullivan Engineering&Consulting Inc.(508-428 3344). p 2. The Contractor is Required to Secure Appropriate Permits From Town 1"=2,000±' Lot 7 Agencies For Construction Defined by This Plan. Propos3. Wherever Sewer Lines Must Cross Water Supply Lines Both Lines Shall l d Q 0-Bo &eSAS y 26,972 .f'SF 14$ o � Be Constructed of Class 150 Pressure Pipe and Shall be Water Tested to ASSESSORS REF.: # W- ---_' / M a Asaune Watertightness. In Cenral,Water Lines Shall be Constructed in Mqp"140 Parcels 058-002 2 Sty / / /� ;, Coordination With COMM Water,and Shalh be in Accordance w/f Dwelling 1 / � � v> With 248 CAR 1.00-7.00&310 CAR 15.00. ----------------------- `o l Lawn � r^ 4.A Minimum of9"of Cover is Required for All Components. r---------------I r t n` 5.All Structures Buried Three Feet or More or Subject I Strip Out ( I W to Vehicular TrafiSc to be H-20 Loading.It is the Engineer's I I� 33.5 Lawn / ! Lawn '� Recommendation that H-20 Always be Used. I O TM a 6.Install Watertight Risers and Covers to Within 6"ofFinished Grade 1 IExisting septt'c"'rank / m Over Septic Tank Inlet and Outlet,D-Box,and One Leaching Chamber. / to be Reuconfirmed sed: Inver to be i > 7.Septic System to be Installed in Accordance With 310 CCARI5.00& ts / O obi I O 1 ( prior to any work. ( O 248 CAM 1.00-7.00 Latest Revision and the Town ofBanistable 1 12.8 1 !/ t� Board of Health Regulations. I 1 \` 8.All Piping to be Sch.40 PVC. 1 Existing Leach Pit to be Removed and / `3 „� i 9.D-Box Shall Have a Minimum Inside Dimension of 12" and a Minimum j Gravel Drive filled. Any Unsuitable Material to be J , I removed *gv#lq#i*th clean granular fill Sump o1`6". 1 1 that meets 310 CMR i5.254 2 d) r 1 r aa utility 10.The Separation Distance Between the Septic Tank Inlets and I C Pole Outlets Shall be No Less than the Liquid Depth.Net Tees Shall Extend I SAS FIELD 5 0 NOT TO SCALE strip out \Lawn a Minimum of 10"Below the Flow Line.Outlet Tees Shall Extend 14" I 1 \. Below the Flow Line,and Shall beEquiped With a Gas Baffle. L------- ------------------ -----J , Flog / I Pole i> j 204.90 sB DESIGN DATA Center / Side Walk Single Family \,// Side Walk -- -T 4 Bedroom 44 PERC TEST: 1 S 197 utility - @ 0 GPD , No Garbage Grinder PERFORMED BY:CHARLES ROWLAND PE- SULLIVAN ENGINEERING Wiar�no � Pale Avenue ... „ Finish(;rode g j = =' Filter atal AaiEla�r440 GP SOIL EVALUATOR NO. 13586 9-Max. ��_` � ._ '' 11 Usea1 ;00GalS cTank, Compacted Fill WITNESSED BY:DAVID STANTON,R.S.--TOWN OF BARNSTABLE Fabric o LEACHING AREA OCTOBER 24,2016 < - And/Or _ 118 / - 112 Pea Sonnee 440 GPD/0.74(LTAR)=594.6 SF Required Slf TE PASSED Stone 3/4-- l 1/z- Sidewall'=2(12.83'+33.5)2'=185.3 SF. ' LEACHING Double Washed CHAMBER Stone Bottom Area=(12.83'x 33.59=429.8 SF Total Provided=615.1 SF(455.2 GPD) TEST HOLE- 1 TEST HOLE-2 4 - 1D- EL.39.2 EL.39.2 r 12 lo- LEACHING CHAMBER DESIGN CROSS SECTION OF CHAMBER All Pipes to be Schedule 40. Use „ ::.:.:.•:.:......... . FI.... :.:.::.:. . . .. .... .............................. 60 .. 34.4 34.2 58 3-500 Gal.Leaching Chambers in a AE LAYER I.QYR 3/2 AE LAYER IOYR 3/2 NOT TO SCALE 12.83'x 33.5'Double Washed Stone Field as Shown. VERYDARI ,GRAYISH:BROWN .. VERYDAiZK.GRAYISII:BRQWI�T.. 69" ..........'. ..SANDY.L�TAM............ . 33.5 68" •.•.SANDY 16.... 33.5 See Note 6 (typ) B LAYER 10YR 518 B LAYER 10YR 518 FG. EL. 39.5 F.G. EL. 39.00± YELLOWISHBROWN YELLOWISHBROWN 82" LOAMY SAND ' 32.3 81 it LOAMY SAND 32.5 C LAYER 10YR 713 C LAYER 10YR 713 Flow Equilizers VERYPALEBROWN VERYPALEBROWN As Required 132" MEDIUMSAND NO GROUNDWATER ENCOUNTERED 28.2 132" NO GROUNDWATER ENCOUNTERED28.2 Ex sting Septic Tank ✓ EL. 36.84 Too EL. 36.00 100E Gallon 35.46 D-Box EL. 35.30 f TEST HOLE - 3 EL.37 6 TEST HOLE -_ 4 EL. 7.6 3 Leaching :::: 1.0'YIt.312 .. A/f9l;AYBR'10i+it 3' To Be Installed On Chamber VERY.DARK GRr1YISHBItOWN... ...-VERYDARK GRA-YISHBR.OWW...- .,,:, stable ompacted Base Bot. EL. 33.00 6„ tS f y Bedding,"T"s If Encountered Remove Bc Replace B LAYER 10YR 5/8 B LAYER OYR 37.1 8" 36.9 S9 Inspection Port, ill. iJnsultabfe 5cr11s..Withln;.5 of ;:.. YELLOWISHBRORW YELLOWISHBROWN ARlFS & Ba ffel s Th:e Outer F'erlrn e ter :a f Th e System :-d LOAMY SAND 32" LOAMY SAND 34.9 !AN as Per Title 5 Ftll :fo crmeef Speclfication5 co 26„ PERC TEST C LAYER 10YR 713 ii� .310CM_R 1 254( )(ii) 25 GALLONS GONE,IN4 MIN 10 SEC VERYPALEBROWN g:j'�� EL. 26.6 ✓ 30 PERC RATE,2 MIN/IN(LTAR�.74) 351 132" MEDIUM SAND p 26.6 No Groundwater CLATFk-10YR7/3 NO GROUNDWATER ENCOUNTERED ` DEVELOPED PR Per OFILE OF S YSTEM Test gale 3 VERYPALEBROWN 132" MEDIUM SAND 26.6 NO GROUNDWATER ENCOUNTERED NOT TO SCALE TI TLE. Site Plan PREPARED BY.- PREPARED FOR: NOTES: Proposed Improvements Engineering & Cah terine S. Berkey Tr 1.) The property line information shown was I compiled from available record information.. � Atconsuiting, tac. ivanCatherine S. Berkey Family Trust 2.) The topographic information was obtained 148 Wianno Avenue from on on the ground survey performed on148 WlannO AvenueOstervill e MA 02655 or between Oct. 28, 2016 and Nov. 18, 2016. (508)428.3344 • P.O. Box 659 • 7 Parker Road, Osterville, MA 02655 3.) The datum used is based on TOB GIS .J Barnstable (osterville) Mass. secl@sulilvanengin.com • www.sullivenengin.com Datum o Draft: CTR Field: CTR/WHK 20 0 10 20 40 80 �•l DATE: SCALE:November 30, 2016 1�� - 20+ Review: CTR Comp.: CTR - Project: 360031 Project Berkey