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Home My WebLink About0375 OST.-W.BARN. RD - Health L :W�1424j1.w4Tarst . - - - - - O10 � i i 1 J TOWN OF BARNSTABLE LOCATION 375 ooze-eyi/!e aj, &Qal. SEWAGE#Z01 -Z 7 2 VILLAGE /`Z t-JASSESSOR'S MAP&PARCEL 121 1 �� INSTALLER'S NAME&PHONE NO.dAg 12i A/A( et6nM p q� SEPTIC TANK CAPACITY LEACHING FACILITY.(type(Z p o�,_a► oJ,..,,�,�< (size) I 'NO.OF BEDROOMS 3 f OWNER PERMIT DATE: COMPLIANCE DATE: 1 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 t\ 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 ,N.s 1�� ° � � �, � ... �17 '�- 3 ,� . , �� 'y ��.a � � .p� ,At 1Y, _ Cr�1[�c�1� � No. ' THE COMMONW ALTH OF. MASSACHUSETTS FEE loot , r BOARD �OF HEALTH APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair ( pgrade Abandon ( ) - [:]Complete System Ofndividual Components LA on 10 ,Ownery Map/Parce # Address ��`�. �1 e nstaller y s�—� \ CJ►f"'e"E er's_ NartLe ,�' ` Address t.^ e ?" p/p j7,1� Telephone# Telephone# Type of Building: i4mb/�"`t J` Lot Size d q.feet Dwelling—No.of Bedrooms Garbage Grinder Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(mi .req fired)' � gpd Calculated design flow-$ pd Design flow provide gpd Plan: Date Number of sheets Revision Date Title Description of Soil(s) 12L Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation X TO DESCRIPTION OF REPAIRS OR AL ERATIO The unders' ned agrees to install the above describe 1 dividual Sewage Disposal System in accordance with the provisions of TITLE 5 and fu er agrees no to plat el system i' operaiio until a Certificate of Compliance has been issued y the Board of Health. Signed Date Inspections FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 R� No. � ( ^� � THE COMMONWEALTH OF MASSACHUSETTS FEE '00i se0 *-Z 4 BOARD OF HEALTH OF APPLICATION FOR DISPOSA SYSTEM CONSTRUCTION ERMIT Application for a Permit to Construct ( ) Repair ( pgrade Abandon ( ) - ❑Complete System Individual Components Zer 'r 4 Map//Parce # G� Address `Installer's Address Telephone# Telephone# 9/ 'j I-Ve Type of Building: vro-U)AA1.11 Lot Size d �q.feet Dwelling—No.of Bedrooms 25 Garbage Grinder Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures ' Design Flow(mil.rea fired)- ! gpd Calculated design flow. pd Design flow provide gpd Plan: Date QJ Number of sheets Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soiltvaluator Date of Evaluation -7(7P� ;i4�-- IDESCRIPTION F REPAIRS OR ALTERATIONSI (i The unders' ned agrees to install the above describe I dividual Sewag`i Disposal System in accordance with the provisions of TITLE 5 and fu er agrees no plat system i ope until a Certificate of Compliance has been issued by the Board of Health. Signed Date Inspections /. FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 ,A -\NO. 7 027 E COMMONWE LTH OF MASSACHUSETTS FEE 1,4!�/ BOARD OF HEALTH [ ! CI' IFICATE OF COMPLIANCE Description of Work: TlQividual Component(s) ❑Complete System The undersigned hereby certify,that the�Sewage Disposal System;Constructed( ),Repaired( ,Upgraded(�bandoned( ) at 31 C �� / I M has peen installed in accordance��e pro isions of 31 CM 15,E (Title 5) and the approved design Ian /as-built plans relating to application No. -Z dated `� Approved Design Flow (gpd) - Installers Designer: Inspec or ate The,issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 PD THE COMMONWEALTH OF MASSACHUSETTS NO. FEE1-?" --�� V� BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereb r nted to Construct ( ) Rep 'r ( pgrade ( A don ( ) an individual sewage dispasal system at as described in the application for Disposal System Construction Permit No. dated Provided: Co structiio/n shall be completed within three years of the date of this e ' All local co r i ' ns must et. Date _ r`'r Board of Health - ` S FORM 2 - DSCP DEP APPROVED FORM 5/96 i FORM! 1255 (REV 5/96) H&W HOBBS&WARREN TM PUBLISHERS- BOSTON j i Town of Barnstable .�'"E' tio Regulatory Services Richard V.Scali,Interim Director BARMABM 9 NAMPublic Health Division Thomas McKean,Director i+ 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form- Date: .� Sewage Permit# 2 C, Assessor's Map\Parcel Designer: }�'Jf9 Installer. 6, CAM Address: Address: i r� On Cam"`K KAA____)was issued a permit to install a at ) (installer) septic system at 0 �ed on a design drawn by A (`address) p� ✓� TOP 'V ` `�i dated ISP11 ( esigner) ZTcertify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. 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 construes *iliance with the terms of the IAA approval lette (if applicable) `py�tI OFR4gs�`.,\t i u9 1T. Qa� DAVIO �y 8 G . � MASON y staller' ignature) No.lasso '- -4 TARS-9 (Design s Signature (Affix Designers 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 r Town of Barnstable P# ( � f Department of Regulatory Services . F Public Health Division Date (� MASK. 2639. 200 Main Street,Hyannis MA 02601 perry Date Scheduled �� Time Z Fee Pd. I * 1 -n X Soil Suitability Asse sment for S: age Disposal y C) Performed By: IO 13. M� Witnessed B LOCATION & GENERAL INFORMATION _ _ 3 Location Address �Ojwner's Name -15 �L-,{�� D✓�"�vl �,�/ Address �Lll�i•�`"' Assessor'sMap/Parcel: 12 I io 'm/M Engineer's Name )wc t'•l� NEW CONSTRUCTION ( REPAIR Y Telephone150bV�# ;�ZtTT Land Use Slopes(%) T Surface Stones 4 Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) V_ 21 Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION 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. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date Time tio Observan .�� _ Hole# 0 �� Time at 9" —24 r. } _ DEEP_OBSERVATI_ON HOLE•LOG _ Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other�� Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders., Consistent %Gravel 147 ~Z ___ DEEP-OBSERVATION HOLE LOG _ Hole# epth fr _ Dom v�Soil Horizon. Soil Texture' Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) 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) III _ i 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) i Flood Insurance Rate Mai): Above 500 year flood boun dary No Yes Within 500 year boundary No s Within 100 year flood boundary No= Yes Depth of Naturally Occurring Pervious Material . . . s Complete items 1,2,and 3. - Signature �Agent ■ Print your name and address on the reverse X so that we can return the card to you. AddresseeI A Attach this card to the back of the mailpiece,.. \ B. Rec ived by(Printed N . e). C, o ;of elivery Por on the front if space permits, �q r, IQ/��S 1. Article Addressed to: D. Is delivery address different from item 1? ❑ es If YES,enter delivery address below: ❑No awa 3 Service Type __ _ A Priority IN�I FJcpn sc� II I�III6I IDII ICI I II I I II I I IIIII I I I II I I I III I III t O.Adu'Signature Restricted Delivery p R V erect Mail Restricted 7 Aetirla N��mhat?ransfer from_sermee_/abe/l Mal9590 9402 1934 6123 0978 07 c M Restricted Deh i shancoollect on Delivery el eat ri rration- ac Iry o _ +:. ail ,,; ❑Signature Confirmation .7 1i 5 �1 .3 0. 01 t4 9 9 0 6 3 V i t 1 ail Restricted Delivery Restricted oeuvery i N ti, PS Form 3811,July 2015 PSN 7530-02-000.0053 Domestic Return Fleceipt USPS TRACKING# z. First-Class Mail { Postage&Fees Paid USPS { Permit No.G-10 { I 9590 9402 19 '1;];i23 0978 07 United States •Sender:Please print your name,address,and ZIP+4®in this box* j { Postal Service Town of Barnstable Health. iyision , e . 200 Main Street { l Hyannis,MA 02601 I 6tlf1"" HIP tii a ei i�1 m C3 0 ,.. Er Certified Mail Fee � $ �I� M, Extra Services&Fees(check box,add fee as appropriate) 4C ❑Return Receipt(hardcopy) $ 1 ❑Return Receipt(electronic) $ Z+Postmark t' ❑Certified Mail Restricted Delivery $ + re o J6 P 7 � ❑Adult Signature Required $ � ZO1 []Adult Signature Restricted Delivery$ O Postage m $ r-I Total Postage and Fees \s P s C3 Sent To �2t.. iX!! O Str f /(g]—_!�/-N., r(PO q .{.o lV Iti CS to Z W V r r r r r rrr•r• Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mall label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the; •A record of delivery(Including the recipient's retail associate. signature)that is retained by the Postal Service' Restricted delivery service,whichprovides � for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders: Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of gge(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age. International mail. and provides delivery to the addressee specified •Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance.coverage automatically included with accepted as legal proof of mailing,it should bear a7 certain Priority Mail items. USPS postmark If you would like a postmark on rn •For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail Item at a Post Office-for r , the following services: postmarking.If you don't need a postmark on this Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this label,affix"ittothe mailpiece,apply F You can request a hardcopy return recelpt or'on appropriate postage,dd-deposit the mailpiece. electronic version.For a hardcopy return receipt, (complete PS Form 3811;DomesUc Return vb� ) " t > Receipt;attach PS Form 3811 to your mailpiece;, IMPORTANT:Save this receipt for your records. / ::��. Ps Form 3800,April 2015(Reverse)PSN 7530.02.000.9047 t�r Town of Barnstable mst Regulatory Services Department ffl'ca�j IAFtNSFABM MASS. Public Health Division fD a 200 Main Street Hyannis MA 02601 2607 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4990 6371 July 11, 2017 LAURINAITIS, ANDREW 375 OST-W BARN RD OSTERVILLE, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 375 Osterville West Barnstable Road,Marstons Mills, MA was inspected on 06/15/2017 by Michael DiBuono, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching pit or cesspool with high liquid level, <12" below inlet (per Town Code 360-9.1). You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S.., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\375 Osterville West Barnstable Rd Marstons Mills.doc ~ "» Town of Barnstable URNSr"t+►�, , Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA-02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO'REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15,000) _ 'An"x'marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑Discharge or ponding of effluent to the surface of the ground . ❑Pumping more than 4 times during the last year not due to clogged or obstructed pipe ❑Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TKO )YEAR EADLINE CRITERIA p Single Cesspool- ❑Any"conditionally passed systems" (broken cover,relocation of a pipe,'relocation of a driveway due to H-10 components, etc) Leaching pit or cesspool with high liquid level, <12"below inlet (per Town Code 360-9.1) ❑Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:ISEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts ��` ��-0/0 P. Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessmentsm c�M 375 Osterville west Barnstable Rd Property Address k� Andy Laurinaitisw;l Owner Owner's Name information is Osteryille µn Ma 02655• 6/15/17 ' 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:When filling out forms A. General Information �.-- on the comprter, use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono use the returr key. Name of Inspector DiBuono Sewer and Drain Q Company Name - 8 Johns path Company Address rennn S Yarmouth MA 02664 City/Town State Zip Code 508-364-9587 S113522 - Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR.15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the-Local Approving Authority 6/15/17 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Y— --91 VS Commonwealth of Massachusetts ' W Title 5 Official Inspection Farr Subsurface Sewage Disposal System Form - Not for Voluntary Assessments -375 Osterville west Barnstable Rd Property Address Andy Laurinaitis Owner Owners Name information is required for every Osterville Ma 02655 6/15/17 page. City/Town State Zip Code Date of Inspection B. Cectificati®n (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Bo ard of Health will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y. ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 375 Osterville west Barnstable Rd Property Address Andy Laurinaitis Owner Owner's Name information is required for everyOsterville Ma 02655 6/15/17 page. CityTrown 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 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): 1 l 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 CMIR 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 375 Osterville west Barnstable Rd Property Address Andy Laurinaitis Owner Owners Name information is required for every Osterville Ma '02655 6/15/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public water Supplier, if an determines that the system is functioning in a manner that protects the public health, safety and environment: R ❑-The system has aseptic tank and soil absolrpti6rf 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 supply well. a private water ❑ 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 forma 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 4 ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool E ® Static liquid level in the distribution box above outlet invert due town overloaded or clogged SAS or cesspool ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/day flow t5ins•3/13 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 .' 375 Osterville west Barnstable Rd Property Address Andy Laurinaitis Owner Owner's Name information is required for every Osterville Ma 02655 6/15/17 page. Cityrrown 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: ❑ .0 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 ofa 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. i 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 OfficialInspeetion Form Subsurface Sewage Disposal System Form - Not for,Voluntary Assessments c�M 375 Osterville west Barnstable Rd Property Address .Andy Laurinaitis Owner Owners Name information is required for every Osterville Ma 02655 6/15/17 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® . ❑ Was the site inspected for signs of break out? ® ❑ 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 CM 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 . Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 375 Osterville west Barnstable Rd Property Address Andy Laurinaitis Owner Owners Name information is required for every Osterville Ma 02655 6/15/17 page. CityfTown State Zip Code Date of Inspection - D. System Information Description: Level of liquid in leach pit does not meet the required 12" seperateion by law pertaining to 310 CMR 15.303 Septic tank is in good working condition Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 228 GPD Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 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•3/13 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 K5 Osterville west'Barnstable Rd ' LAM - Property Address Andy Laurinaitis Owner Owners Name information is .required for every Ostervllle; Ma 02655 6/15/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cost.) Last date of occupancy/use: Date Other(describe below): General Information T Pumping Records: Source of information: 2014 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 systerr (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alte.rnative.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 l/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 f p Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 375 Osterville west Barnstable Rd Property Address Andy Laurinaitis Owner Owner's Name information is required for every Osterville Ma 02655 6/15/17 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: 27 Years Were sewage odors detected when arriving at the site? ❑ Yes 0 No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of-leakage, etc.): System is vented at the roof line Septic Tank(locate on site plan): 1.5 Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1,000 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate), ❑ Yes ❑ No Dimensions: Sludge depth: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form,- Not for Voluntary Assessments 375 Osterville west Barnstable Rd Property Address Andy Laurinaitis - Owner information is Owners Name required for every Osterville Ma 02655 6/15/17 page. City/Town State Zip Code Date of Inspection D. System Information, (cons.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness Distance from top of scum to:op of outlet tee or baffle 42" Distance from bottom of scum to bottom of outlet tee or baffle Sludge stick How were dimensions determined? Tape Measure -- Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank is structurally sound and not leaking Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El 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•3/13 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Fora Subsurface Sewage Disposal System Form Not for Voluntary Assessments f (°� r 375 Osterville west Barnstable Rd M Property Address Andy Laurinaitis Owner Owner's Name information is required for every Osterville Ma 02655 6/15/17 page. Cityrrown 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System,Form - Not for Voluntary Assessments --375 Osterville west Barnstable Rd Property Address Andy Laurinaitis Owner Owners Name information is required for every Osterville Ma 02655 6/15/17 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 Rotted and decayed 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.): 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of N6assachusetts W Title 5 Official Inspection Foram Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 375 Osterville west Barnstable Rd Property Address Andy Laurinaitis Owner Owner's Name information is Osterville Ma 02655 6/15/17 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ 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.): Level of liquid in leach pit does not meet the required 12" seperateion by law pertaining to 310 CMR 15.303 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-3/13 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 375 Osterville west Barnstable Rd Property Address Andy Laurinaitis Owner Owners Name information is Osterville required for every Ma 02655 6/15/17 page. CityiTown 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-3/13 Title 5 Official Inspection Fo rm:orm:Subsurface Sewage Disposal System g p y tem•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 375 Osterville west Barnstable Rd Property Address Andy Laurinaitis Owner Owner's Name information is required for every Osterville Ma 02655 6/15/17 page.e. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100.feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 OffidalInspectionrm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 375 Osterville west Barnstable Rd Property Address Andy Laurinaitis Owner information is Owner s Name required for every Ostervill.e Ma 02655 6/15/17 page. City/Town State . Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: TBD 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: You roust describe how you established the high ground water elevation: Before filing this Inspection.Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 l k BARNSTABLE Location: 375 Osterville West Barn Road Osterville F :. Septic .1000 Gallon. Septc Tank Owner Andy Laurinaitis - I PUMPING HISTORY 10/4/11 1000 Gals - — '-- -__- - 1 g9kgk - Al -- to cF } m e 3° 1 Doc) Cl ci l Ion Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a t 375 Osterville west Barnstable Rd Property Address Andy Laurinaitis Owner Owner's Name information is required for every Osterville Ma 02655 6/15/17 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 K I t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 ccam�`` r No....u.j..... Fxs... .............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ........... .......0F.............514?N S r t4V/5 L(................................ ApplirFation for Dispati al Works Tonstrurtion "prrani# Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: ................__...................................................... .•............... _........•--•••-•-•-•-•-•••......---•------• ...............-•••------- -L= d .o Address � or t No. .j W �` � � /�-S s�6�•� ner� /�� Address Installer AddressPO y Type of Building Size Lot-_.....j...................Sq. fie" Dwelling—No. of Bedrooms.......................................Expansion Attic (IV) Garbage Grinder PL4Other—Type of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures .----••......•-•--•-•••••......- W Design Flow...............6.�.....................gallons per person per day. Total daily flow...........3.�_ o....................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter--...--......... Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter......--.--......... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ) �� Ai *... �� Percolation Test Resul s Performed by...........................................�_ -.--•---.-..... Date...._ ._...___.._..:.... aTest Pit No. 1........--------minutes per inch Depth of Test Pit.-.--...__.......... Depth to ground water-----.-..�..-.--- --- fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit...-----....--...... Depth to ground water-----.------------------ ----------- 0 Description of S oil........�4�!`!5�--- •-��- S F�y�----...-----•-•--------•----•-----------------•------•----•-------•---...------•- ---------------------------------------------------------------------------------•-----------------••-•-•--•-•----••••- V •-••--•--•••-••-•--•------•--------•-•--••••••--•••••-••••••....................•-•••••••-•--•--•••••.........-•--•-••-•-•-•-•-••••••••--••--•---••••••••----•--•----•••••....--•-•--•-•••......-•--•-•. W -•••---------------------------------------•---•-•-----••--•-------•-•-•-•-•-•--•-•-••---•••---•-•------••••••••-----•---------•----•-•-••••-••-•----•-••--••••••-•••••••-•--•••••••...----•-•--•••••--- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... --------•-•-----------------•-------------------•---------•------------•-----------._.......-•-•-•--•-•-•-•--•-•-•----------•----------•--••••••••------•------••-••-•-•••......••-••-•............-•-- Agreement: The undersigned agrees to install the aforedescribed I ividual Sewage Disposal System in accordance with the provisions of'TT .% p 5 of the State Sanitary Code Th nderigned further agrees not to place the system in operation until a Certificate of Compliance has b e is u by., board of alth. e Signed v be Application Approved BY �`' ► ------.�� -/ ate Application Disapproved for the following reasons:.............................................................................................................. ---------- •--------- ------•------•-------------- --------------•-----.--•---------- ------- ------•----------- p Date PermitNo.... ---- ........................ Issued-----------------------................................ Date No................._....... Fmc............................... THE COMMONWEALTH OF .MASSACHUSETTS BOARD OF HEALTH ........ . ............................ OF.............�?? ApplirFafiou for Eliopos al Works Tilmitrurtioat Vrrutit Application is hereby Trade for a Permit to Construct ) or Repair ( } an Individual Sewage Disposal System at: t,v r�. IV ,� r -» t ........ .....__---------........ ----- --------•---•- '-------"'.-:_....... ------•---......---...------------•--....... •--------.....-- //�� Location-Address or Lot No. .........C�.�.)......5_1..�!r'"�.......... �.Z`�..d .............................. �__._..._..._... ----- ----- ,�r Owner Address Installer_ .,' ,'' Address M ,,N x Type of Building L 1{ Size Lot____________________________Sq. feet �-, Dwelling—No. of Bedrooms..........................................Expansion Attic (fie') Garbage Grinder ( ) PL4Other—T e of Building....,., No. of persons............................ Showers — Cafeteria QOther fixtures -------------------------------------------- -------------------------------------------------------------•-------------...--------- W Design Flow______________- .. ............................gallons per person per day. Total daily flow........... .....................gallons. 04 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area-._________:--______sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosin tank W Percolation Test Results Performed b ........_"............:................... ..----------------------- Date----- ...... -____:__..______..__._.. a Test Pit No. 1________________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.--_-______-____---___- a ----- O Description of Soil-------�C='-`-'--��------- ��- v-�----•--....�_��r�------------------------------------------------•------------•-••------------•--•-- x -------------------------------------------------------------------------------------- U -------------------------------------------------•-•----•------•--•--------------------------------------•----------------------------••---------------------------•----------•-------------•-•--•----- W UNature of Repairs or Alterations—Answer when applicable--------------------------------_.............................................................. --- - ------- ---------------------------------- Agreement: The undersigned agrees to install the aforedescribed I ividual Sewage Disposal System in accordance with 'TILE^ the provisions of'TILE i of the State Sanitary Code ""I Thy ndersigned further agrees not to place the system in operation until a Certificate of Compliance has btee4 issu�d by tl�e board,of 2`ealth. s 1 t1 t 0't O P P � Signed........... :... ........... ------- ....... - r� Date Application Approved By----------� -1�t_ �-.� ----....•��'- - --�-..� ..._ -------------•-•------------•----^- ate Application Disapproved for the following reasons----------------------------------------•----•---------••------------------------•--------------•--------_------ ...---•-------------------------•-------......._...-----------------.........-----------.....-----------•-----------------------------------------------------------------------------------------_.._.. Date C,— PermitNo.--.$-�---`----- ------------------------- Issued....................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH rz..v ..................`'............. .....OF...... ::'....... ................................................................. �rrfif iratr of TuutpliFaure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed t , ) or Repaired ( ) Installer ----------�---------------------.............................. 5/----------...---•--••--------------------------------- has been installed in accordance with the provisions of T I T I E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No....... `l:_.�} ........... dated_............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...........................................•-------....-----•-------------...... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..... •'fly':�!'� a I ..................................... o F. ,0 A-AJ S _ No.... i 7 Disposal jVorho Toato#ratrtiou rrrufit Permission is hereby granted_..- ..`___.__`........ 't: ..f: 1a`�.,... "¢'�` --• to Construct )r-or Repair ( ) an Individual Sewage Disposal System ------•------ ............................................ Street as shown on the application for Disposal Vorks Construction Permit No,��:_,?-_5-,1_oar____of ealth Dated.......................................... d -----------------------------•--------- 9 DATE.................. -1.go-------•-----•-••--•-•-•---- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS OW OF BARNSTABLE LOCATION &-Jeovg5l-Able LSEWAGE # 5'S"1 ` VILLAGE ASSESSOR'S MAP & LOT o -/ oO;o I� INSTALLER'S NAME & PHONE NO. T SEPTIC TANK CAPACITY /000 6'A 6 LEACHING FACILITY:(type) Pf eC-► 5-f 19 -f (Size) /DOG QNO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATE ;BUILDER OR OWNER C�2 t:!�IJ CO-",O DATE PERMIT ISSUED: " /O — � DATE COUPLIANCE ISSUED: -'.. VARIANCE GRANTED: Yes No 45r"� 5 r01 \AJ( EArnSIAbla_ i c t � _ f ASSESSORS MAP : TEST HOLE , LOGS PARCEL: __. _ i ` �L 1) The installation shall c,ornl�y with Title V and Town of � Board o> �VTU, �� FLOOD ZONE: of Ann, O� SOIL EVALUATOR: i�� W 1lealth Regulations. ----- — — location its and septic WITNESS : 2) The installer shall verify the t n of utilities, sewer rove a pis REFERENCE: 1 DATE: --av Z�" t _ components prior to installation and setting base elevations. Y PERCOLAT ION ATE: .:e— 1 , t 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first t� 1 two feet out of the d-box to the leaching shall be level. v✓ lZ `� — — — -- TH- I TH-2 4) This plan is not to be utilized for property line determination nor any other purpose other than the proposed system installation. 5) All septic components must meet Title V specifications. " / 0- I !�' � t 6) Parking shall not be constructed over H 10 septic components. 7) The property is bounded by property corners and property lines. 8) The property owner shall review design considerations to approve of total LOCATION MAP '7 �ar design flow and number of bedrooms'to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed /l C ►�� approval of the design flow by the owner. l�� 1 ` 4ti.1 0 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per 'I ,1'\ Title V specs. L. C 25575 10)System components to be 10 feet from water line. Sewer lines crossing the Arlo C NQ,, WO o water line shall be sleeved with 4 inch SC1I 40 PVC with ends grouted if applicable. The proposed SAS is being installed below the water service c{„ line. The line is to be sleeved as aforementioned and maintained in place. SEPT ,I C SYSTEM DESIGN 11) If a garbage grinder exists it is to be removed and is the responsibility of the 4p, owner to ensure such. o FLOW ESTIMATE 12)The installer is to take caution in excavation around the gas line if such ZA exists. o BEDROOMS AT I I0 GAL/DAY/BEDROOM - �GAL/DAY 13)The installer shalt Verify the location, quantity and elevation of the sewer r' lines exiting the dwellingprior to the installation. 00 14 This plan is representative only that a system can fit on a property meeting �+ SEPTIC TANK ) P P Y Y P P Y g e Title V requirements. w GAL/DAY x 2 DAYS - (OW GAL i �°' USE XOGALLON SEPTIC TANK6fYJ�5CIW6E ?, so l C ABSoRP*rf0"Y6TEW TO,r �b 07 /}' Lj-fDW El kLDl 'l7 -40L4C, LV4DVL O� � nAvm � SIDE _ { c -� � .-�. , � , 2�• 3 � �- Z5 -t- I Z,Qj?j ( I � o B. C:4 ,I , o BOTTOM AREA: Z5 �Z► k �3— MASONR, 7 5 I No.1066 \ �b 0 .�� '�r� (`✓� Vr ` SIN/TAR1�k' / o / SEPTIC SYSTEM SECTION "' " 125. b� ` � q OSTER VILLE — > b WEST BARNSTABLE ROAD W b, I11� 10�� F I I� � ��✓ ' bF�,3 57 (50' WIDE)) ,% .-._ � �0g 0 -„ e GAL SEPTIC TANK v _ Kt `/ SITE AND SEWAGE PLAN 2q L0CAT1ON : V:.,Tm U-& , I ��rMVI Zo---- PREPARED FOR OVA OlHA G � o M 0 SCALE: I �� O O DAV I D B . MASON DATE: W IZ o1 , DBC ENVIRONMENIfAL DESIGNS Z z DATE HEALTH AGENT EAST SANDWICH . MA 3 ( 508 ) 833- 2177 ZI 0 G cl r n 0 N OTE, S: MARSTONs miLLS. 0 1. ALL WORKMANSHIP ,AND,�MATERIALS -SHALL:CONFORM D.E.O"t 20' WNILM OR AS INDICATO ON PLAN - TITLE 5 ;_THE,'TOWN OF-,.", BARNSTABLE - :RULES AND REGULATIONS fORJHE tSUBSURFACE DISPOSAL� OF,� SEWAGE; tocus 10, ANDTHE REQUIREMENTS OF 'THIS PLAN, -ALL COVERS TO SANITARY.UNITS SHALL 13E BROUGHT TO' ROUI E 28 ROUTE 28 BLUENOSE T.O. FOUNDAI BACKFU m7H WITHIN .1 2'*,� OF,�FINISHED, GRADE.ONJ WN. MEAN $AND 3., ALL MASONRY, UNITS USED :TO BRING COVERS -10"'GOADE LANE VASORNRY SHALL BE MORTARED IN PLACE.N CAPABLE PI IV UK AIAO PVC PIM OF WITHSTANDING H ' '1610AIDING -UNLESS. THEY ARE UNDER OR TCH PER k ALL COMPONE I TS OF THE, SANITARY SYSTEM SHALL BE /41 PER FT. PITCH 1/8*,. —20 LOADING '.WITHIN 10 FT., OF.DRIVES OR PARKING AREAS. H r tAm OF UNE I -e I . I � I I 0 now SHALL' BE .USED UNDER OR WTHIN' 10 FT. OF .lbRIVES '"R WASHM PTONE PARKING. ' L'T A' �:,F_3 4 I I W/2;D ,I :, �: 0 1 " I .uo" < I./A LL'vm :�, �I ' I I , , F 55 EFFLUENT'PIPINIG FROM DISTRIBUTIOW'BOX SHALL _NTER LEACH IT,DISTRIOU11ON -ONLY. N Y LOCATION MAP i8ox 0 - THROUGH SIDEWALL, OR TOP EXTENSION' WILL'NOt BE ALLOWED VIA-DtTtRMINAllON ,HA v NO 8 EEN' MADE�AS TO COMPLIANCE .WITH DEED ks GALLON SEM TANK ESTRICTIONS 'OR ZONING REGULATIONS. OWNER/APPLICANT SHALL . S :OBTAIN SUCH DEERMINATION ' FROM' THE APPROPRIATE AUTHORITY."SEWAiQE-DISPOSAL-SYSTEM '-PROF]Lt- 0 HORIZONTAL AND BOTTOM ClFlEST 'HOLE 8. VERTICAL', CONTROL, ,SEE LEVY, ELDREDGE NOT M SCAM WAGNER FIELD 'NOTEB OK OR USGS PROBABLE HIGH WATER' LEVEL, o'CURRENT -,,ZONING I NTERPRETATION: I ATIOKS :1MIN. .FRONT SETBACK FE T NUMBER .OF BEDROOMS aAl MIN. SIDE SETBACK , FEET 'GARBAGE DISPOSAL UNIT 10TAL ESTIMATED FLOW V� MIN. REAR "FEET SETBACK . BR.) GAL. " ( 110 GAL/BR../DAYX /�AY-REQUIRED �SEPTIC 'TAN -=GAL.K tAPACITY /000 GAL�ACTUAL SIZE OF SEPTIC TANK-LEACHING' AREA REQUIREMENTS i��'SIDEWALL AREA L15 GAL.-/S.F.� BOTTOM AREA i.b GAL/S.F.�..PERCOLATION "SOIL'',TEST LEACHING CAPACITY (BOTTOM +,,SIDEWAL L) GAL St 41T 7 /2�'(!,0)OFSo 2#( IZ12)(4 )(2.5) , GAL R S/kTC svzzt V,+q E' ERVE LEACHING CAPACITY WITNESSED BY PERCOLAT10N ATE IN-/INCH SAME-M Ile, -HOL 2 l OBSERVATION 'OBSERVATION'' �HOLE ELEV,=LEV,..... '00 0.00-0. BREAKOUT -CALCULAIION- ttEGEND tITING .SPOT ,E T!ON' OOYO LEVA r-pl A —00----- -4 EXISTING' CONTOUR 00.0 FINAL SPOT ELEVATION R AT ELEV,WATE SOIL TEST PIT ,LOCATION WATER AT ELEV Ll W W TOWN WATER ISEPTIC TANK L DJUSTMENT BOX ,WATER , LEVE /V PRIMARY LEACHING PIT tRESERVE LEACHING PIT WATER LEVEL TEST DATE c 'INDEX WELL, INITIAL ISSUE WATER LEVEL RANGE ZONE DEPTH TO .WATER LEVEL, OR INDEX WELL 7 NO. DATE DESCRIPTION BY FOR 'THIS MONTH SITE LEVEL 'ADJUSTMENT- PILAN , DESIGN,WATER DEPTH TO ,HIGH WATER 41F y AIS rA IN BLE � MASSACHUSETTS FOR 0 t 44 -OPMENTL Co,. iNc.GREENBRIER L DEVEL u - 1472 BOARD :017, HEAL A APPROVED. TH v A JOB NO SCALE 401,05 I10 WAGNER ASSOCIATES 'INC.0 N A 11L AC"T, -PUNM un S=ORS PLAN LEVY, ELDREDGE ICENTERV= MA 02632,,889 VEST : MAIN 'STREEr ttItI