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0050 OVERLEA ROAD - Health
50 Overlea Road + ►= Hyannis P , 287 153 1 J Commonwealth of Massachusetts Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 OVERLEA RD Property Address ONIELL Owner O-w�n�r's Name, information is required for Q Oil S MA every page. City/Town Date of 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 A. General Information forms on the '51 1 computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return p key. DOUGLAS A BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA CltylTown State 02632 Zip Code 508-420-4534 S14297 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: --t -, • 4 � �3 „� 7t ® Passes ❑ Conditionally Passes ❑ Fails a,f ❑ Needs Further Evaluation by the Local Approving Authority r t 2/2/10 — •t Insp dtt s Signature Date 1 W M 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•09/08 ... ., . Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 V 0 I D Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 OVERLEA RD Property Address ONIELL Owner Owner's Name information is HYANNISPORT required for MA 2/2/10 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be. replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. 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•09r08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Forrrt Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 OVERLEA RD Properly Address t ONIELL Owner Owner's Name information is required for HYANNISPORT MA every page. City/rown 2/2/10 State Zip Code Date of Inspection B. Certification (cunt.) B) System Conditionally Passes(cunt.): ❑ 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(1xb)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•09I08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17 f Commonwealth of MaSsBchuSetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 OVERLEA RD Property Address ONIELL Owner Owner's Name information is HYANNiSPORT required for MA 2/2/10 every page. Cftyfrown State Zip Code Date of Inspection B. Certification (dont.) 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within . 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private.water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well" . Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory,for 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 dogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or dogged SAS or,cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than Y2 day flow 1.5ins•osros Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 F N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 OVERLEA RD Property Address ONIELL Owner Owner's Name information is HYANNISPORT MA required for 2/2/10 every 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: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system falls. 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 CM 15.304.The system owner should contact the appropriate regional office of the Department. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 OVERLEA RD Property Address ONIELL Owner Owner's Name information is HYANNISPORT required for MA 2/2/10 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ 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 R Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sew age Disposal System Form Not for Volunta ry Assessments 50 OVERLEA RD Property Address ONIELL Owner Owner's Name information is required for HYANNISPORT MA 2/2/10 every page. Cftyrrown State Zip Code Date of InsP ection D. System Information Description: ACCORDING TO AS BUILT CARD SYSTEM CONSISTS OF A 1000 GALLON SEPTIC TANK, D- BOX,AND 2 1000 GALLON LEACH PITS Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system?[if yes separate inspection required], ❑ Yes ❑ No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): 08-379/09-406 ' 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: l5ins 09n18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Com monwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 OVERLEA RD Property Address ONIELL Owner Owner's Name information is required for HYANNISPORT MA every page. Cltyrrown 2/2/10 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: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): 15in5•osM Title 5 Official Inspection.Forth:Subsurface Sewage Disposal System•Page 8 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 OVERLEA RD Property Address ONIELL Owner Owner's Name information is required for HYANNISPORT MA 2/2/10 every page. Cityrrown Date of State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known) and source of information: UNKNOWN 1 Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): 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: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene y ❑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: 1000 GALLON Sludge depth: VARYING LIGHT, RECENT PUMPING t5ins•09ros 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 50 OVERLEA RD Property Address ONIELL Owner Owner's Name information is required for HYANNISPORT MA 2/10 every page. Qty/Town Date of State Zip Cade ate of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge,to bottom of outlet tee or baffle Scum thickness TRACE Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments(on Pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): . TANK WAS CLEAN AT THIS TIME IT WAS RECENTLY PUMPED BY SCOTT FRANK 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °w 50 OVERLEA RD Property Address ONIELL Owner Owner's Name information is HYANNISPORT required for MA 2/2/10 every page. irty/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene El 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•0908 Title 5 Ofricial Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �Y 50 OVERLEA RD Property Address ONIELL Owner Owner's Name information is required for HYANNISPORT MA 10 every page. City/Town 2/ of 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 On 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.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: DEPTH OF PITS ONE APPEARS TO BE UNDER DRIVEWAY t5ins•09/08 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 50 OVERLEA RD Property Address ONIELL Owner Owner's Name information is HYANNISPORT required for MA 2/2/10 every page. CltylTown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ 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.): 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•09IMB Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 OVERLEA RD Property Address ONIELL Owner Owner's Name information is HYANNISPORT required for MA 2/2/10 every page. Cltyrrown 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-09/08 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 50 OVERLEA RD Property Address ONIELL Owner Owner's Name information is required for HYANNISPORT MA 2/2/10 every page. i;r_rown Date te of State Zip Code D 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 't 50 OVERLEA RD Property Address ONIELL Owner Owner's Name information is required for HYANNISPORT MA every page. City/Town State Zip Code Date Date of of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 10 FT++ 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 must describe how you established the high ground water elevation: LOT IS ON A HILL Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disp osal posalSystem•Page 16 of 17 Commonwealth of Massachusetts Sum Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 OVERLEA RD Property Address ONIELL Owner Owner's Name information is required for HYANNISPORT MA 2/2/10 every page. City/Town bate of 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 t5ins-09M . Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 17 of 17 New Page 1 Page 1 of 1 fr w ' TOWN . STABLE C)aC� i.QiR 1�ION SEWAGE# VU.LAGE ASSESSOR'S MAP& Lose INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Ob LEACHIIYt3 FACII.TTY: (type �-- S_____. �.�� (size). (C NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of LeachingF Facility eat 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 i ;t A<c�- OTC[ • wn� podl cq v 44 D Aft+Q C Q AC 0 qJ http://www.town.bamstable.ma.us/assessing/2010/HMdisplay.asp?map'par=287153&seq=1 2/3/2010 COMMONWEALTH OF MASSACHUSETTS 2.3� EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS . DEPARTMENT OF ENVIRONMENTAL PRO MAP' RIrCEIVE PARCEL • `3 AUG2 _OT42004 TOWN O B NSTABLE. TITLE 5 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: SO nvPrlPa Rd H*annisport Owner's-Name: Rra-d. Blank Owner's Address: Date of Inspection: t B Name orinspector:(please print) wi 1 1 i am E_ •Robinson Sr; Company Name: William E. Robinson Septic Service Mailing Address: P 0 Box 1089 Centerville, MA Telephone Number: (5081 775-8776 " CERTIFICATION STATEMENT i certify that 1 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 SSee ion 15.340 of Title 5(310 CMR 15.000). The system: � Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails { Inspector's Signature: i�A) „ t Date: 't 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. Notes and Comments •`••This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 Y OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 50 Overl ea Rd Hs annisport Owner. Brad Blank Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Sy s( Passes: ve not found any information which indicates that an of the failure criteria described in 31 Y OCMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. tern Conditionally Passes: ne or more system components as described in the"Conditional Pass'section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer Cr s,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,a diibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tai k is replaced with a complying septic tank as approved by the Board of Health. •A metal s-ptic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating i hat the tank is less than 20 years old is available. ND expla' O servation of sewage backup or break out or high static water level in the distribution box due to-broken or obstruct pipes)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approva of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND expla The ystem required pumping more than 4 times a year due.to broken or obsutxted pipe(s).The system will pass inspect n if(with approval of the Board.of Health): broken pipe(s)are replaced obstruction is rcmovod ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) ' Property.Address: - 50 Overlea Rd H�anniShort ' Owner: Date of Inspection: . C. Further Evaluation is Required by the Board of Health: onditions exist which require further evaluation by the Board of Health in order to determine if the system is failin to protect public health,safety or the environment. 1. S stem will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the sy tem is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the System h functioning in a manner that protects the public health,safety and environment: _ rhe system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surf a water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply,well The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a pr vate water supply well'' Method used to determine distance ' This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform acteria and volatile organic compounds indicates that the well is Gee from pollution from that facility and e presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria arc triggered.A copy of the analysis must be attached to this forma 3 Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM—.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 50 Overlea Rd Hyannisport Owner: Brad Blank Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate').res"or"no"to each of the following for all inspections: Yes o _ 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 ar cesspool Liquid depth in cesspool is less than 6"below invert or.available volume is less than day flow equired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number f times pumped y portion of the SAS,cesspool or privy is below high ground water elevation. y portion of cesspool or privy is within 100.feet of a surface water supply or tributary to a surface •ater supply. y portion of.a cesspool or privy is within a Zone 1 of a.public well. _ y portion of a cesspool or privy is within 50 feet of a private water supply well. y portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private xaier s 1 well with no acceptable water quality analysis. This system asses if the well water analysis, PPY P q tY Y 1 Y P Y p rformed at a DEP certified laboratory.,for coliform bacteria and volatile organic compounds it dicates that the well is free.from pollution from that facility and (lie presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria a e triggered.A copy of the analysis must be attached to(his form.] (Yes o)The system fails.I have determined that one or more of the above failure criteria exist as escribed in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of ealth to determine what will be necessary to correct the failure. E. Large ystems: To be con idered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gPd• You mus indicate either"yes"or"no"to each of the following: (The foll wing criteria apply to large systems in addition to the criteria above) yes the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a swface drinking water supply Y �Y — the system is located in a nitrogen sensitive area(Interim We Protection Area—IWPA).or a mapped Zone I of a public water supply well If y u 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 vw er or operator of arty large system considered a signi cant threat under Section E or failed tinder Section D shall upgrade the system in accordance wi':h 310 CMR 15.304.The system owner should contact the appropriate regional off-ice of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 50- Overlea Rd H�zanni s=nrf Owner:- Rr;;.d Blank Date of Inspection: Check if the following have been done.You must indicate`yes"or"no"as to each of the following: Yes No / c/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 V. /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? 3 W i _ ere 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: Yes ... /no �/Existing information.For example,a plan at the Board of Health. y _ Determined in the field(if any of the failure criteria-related to Part C is at issue approximation of distance.. is unacceptable)13 10 CZAR 15.302(3)(b)j t 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 50 Overlea Rd Hyannisport Owner: Brad Alan� Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):.. Number of bedrooms(actual) DESIGN flow based on 310 ClA 15.203 for example: 110 d x# bedrooms : 6 Number of current residents: Does residence have a garbage i der(yes or no): !ti v Is laundry on a separate sewage system(yes or no):,I d jif yes separate inspection required) Laundry system inspected(yes or no):.�Q Seasonal use:(yes or no): �•5 � c) Water meter readings,if available last 2 ears usage d ): -y©� �- ` Qs g � ( Y g (gP ) � Sump pump(yes or no): n- 0 ��Cp 2-.T;z -17 C e' � Last date of occupancy: .F-C o l COMMERCIAL IND STRIAL Type of establishment• Design flow(based o 310 CIv1R 15.203): �pd Basis of design flo (seats/persons/sgft,etc.): Grease trap presen (yes or no):_ Industrial waste lding tank present(yes or no):^ Non-sanitary w e discharged to the Title 5 system(yes or no):_ Water meter -e ings,if available: Last date of u ancy/use: P OTHER( acribe : GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part the inspection(yes or no): If yes,volume pumped:_gallons•-How was quantity pumped determined? Reason for pumping: TYP' F SYSTEMptic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval _Other(describe): Approximate age of all components date-installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no) — [J 6 Page 7 of OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 Overlea Rd _ Hyannis ort Owner: Brad Blank Date of lnspecllon: BUILDING SEWEJ(loca site plan) Depth below grade: Materials of construt iron 40 PVC—other(explain): Distance from privaly well or suction line:Comments(on conds,venting,evidence of leakage,etc.): SEPTIC TANK:/(locate on site plan) D . Depth below grade: Material of construction:_concrete metal_fiberglass—polyethylene other(explain) — If tank is metal list age: Is age confirmed-by a Certificate of Compliance(yes or no):_(attach a copy of certificate) ► r Dimensions: Sludge depth: , r Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle:. Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions detcmiined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP:—(locate on site Ian) Depth below grade:_ j Material of construction:_co rete metal fiberglass_polyethylene—other (explain): — -- Dimensions: Scum thickness: Distance from top of scum o top of outlet tee or baffle: Distance from bottom of cum to bottom-of outlet tee or baffle: Date of last pumping: Comments(on pumpi g reconunendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet' ert,evidence of leakage,etc.): Page 8 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 Overlea Rd P Y Hyannispor Owner: Brad Blank Date of inspection: G (3 � P 7f" TIGHT or HOLDING TANK: (tank must be at time of ins ection locate on site plan) pumped P )( P ) Depth below grade: Material of construction: c crete metal fiberglass Polyethylene other(explain): P F� Dimensions: Capacity. allons Design Flow: gallons/day Alarm present(yes or no : Alarm level: larm in working order(yes or no): Date of last pumping: Comments(conditio of alarm and float switches,etc.): y DISTRIBUTION BOX: tf resent u ( p must be o ened locate on site Ian P )( plan) Depth of liquid v p q level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: Bate on site plan) Pumps in working order( s or no): Alarms in working order yes or no): Comments(note eonditi n of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 Ov rl a ga TjYanni G=nrt- Owner: Rrad R1 and Date of Inspection: 6 SOIL ABSORPTION SYSTEM(SAS):—Lz�focate on site plan,ezcavation'not required) If SAS not located explain why: Typ r . leaching pits,number: al, 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.): .� Z, 4- je 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 in ow(yes or no): Comments(note condition f 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 conditi of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 1 l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 Overlea Rd Hyannisport Owner: Brad Blank Date of Inspection: > —O dam/ SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. a 1 1 i L r 10 Pagel 1 of i l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: S 0 Over l ea Rd _H=Ann i spnrt Owner. d Blank Date:of Inspection: - 1 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water�feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Che eked with local Board of Health-explain: C ecked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: J ,. 11 Commonwealth of Massachusetts Executive'Office of Environmental Affairs Dept. of,Environmental Protection One winter Street,Boston,Ma. 02108. John Grad D.E.P. Title V Septic Inspector P.O. Box 2119 Teaticket, MA 02536 WILLIAM F.WELD r (508)564-6813 Governor ARGEO PAUL CELLUCCI Lt.Governor " SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 50 OVERLEA RD. HYANNISPORT MAP 287 PAR 153 LOT 7 Address of Owner: Date of Inspection: 12/5198 (if different) Name of Inspector: JOHN GRACI RICK AGNEW C/O FIRST PROPERTYMANAGEMENT 932 MAIN ST.SUITE F OSTERVILLI I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name,Address and Telephone Number: . CERTIFICATION STATEMENT certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: x Passes This Inspection Is based on criteria defined In TRIe V Conditional) Passes code 310 CMR 16303.My findings are of how the system is Y performing at the time of the Inspection.My Inspection does Needs Fu her Evaluation By the Local.ApprovingAuthority not imply any warranty or guarantee of the longevity ofthe ' F8115 septic system and any of Its components useful life. c Inspector's Signature: ( Date: 1215198 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. C„ y INSPECTION SUMMARY: Check A, B, C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure'criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: i One or more system components need to be replaced or repaired: The system,upon completion of the replacement or repair,passes inspection.' Indicate yes, no, or not determined(Y, N,or NDj. Describe basis of determination in all instances. If: "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of CoMpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal, is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04127)97) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 'PART A, CERTIFICATION.(continued) Property Address: 50 OVERLEA RD. HYANNISPORT MAP 297 PAR 153 LOT 7 Owner: RICK AGNEW CIO FIRST PROPERTYMANAGEMENT 932 MAIN ST.SUITE F OSTERVILLE MA.02655 Date of Inspection:1215199 _ Sewage backup or.breakout.or. hiah.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box..fhe system will pass inspection if (with approval of the Board of Health). Describe observations: , - broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s), The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed 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 the public health,safety and the environment, 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE OUBLIC.HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. , 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM 15 FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT`. The system has a septic tank and soil absorption system and is within 100 feet to a� surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tankand soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine'distance (approximation not valid) 3)Other D] SYSTEM FAILS: .You must Indicate either"Yes"or"No"as to each of the following: 1'have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The,Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No , Backup of sewage in facility or system component due to an overloaded or clogged SAS or — cesspool. Digcherge or ponding of effluent to the gurface of the ground or`iurface wider§duo to an overloade-d or cloggH, — . cesspool. . , SAS is in hydraulic failure. (revised 04R7197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 50 OVERLEA RD. HYANNISPORT MAP 297 PAR 153 LOT 7 Owner: RICK AGNEW CIO FIRST PROPERTYMANAGEMENT 932 MAIN ST.SUITE F OSTERVILLE MA.02655 Date of Inspection:1215198 D]SYSTEM FAILS(continued) a Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or.cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 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. If the well.has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS:' You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of.10,000 gpd or greater(Large System)and the system is asignificant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into.full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the'local regional office of the Department for further information. (revised 04)271971 c { "SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: .50 OVERLEA RD..HYANNISPORT MAP 297 PAR 153 LOT 7 Owner: RICK AGNEW CIO FIRST PROPERTYMANAGEMENT 932 MAIN ST:SUITE F OSTERVILLE MA.02655 Date of Inspection:1215198 Check if the following have been done:YOu must indicate either"Yes"or"No"as to each of theJollowing: _c_ — Pumping information was requested ofthe owner, occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and.the and the system has been receiving normal flow rates during that period. Large volumes'of water have not been Introduced into the system recently or as part of this inspection. ., x As built plans have been obtained and examined. Note if they are not available with N/A. x — The facility or dwelling was inspected for signs,of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. -x— — The site was inspected for signs of breakout. x All system components,excluding.the Soil Absorption System,have been located on the site. x The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions, depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, if different from owner)were provided,with information,on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any.failure criteria related to Part C is at issue,approximation of distance is — — unacceptable)]15.302(3)(b)] (revised 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM:INFORMATION.' Property Address: 50 OVERLEA RD. HYANNISPORT MAP 287 PAR 153 LOT 7 Owner: RICK AGNEW CIO FIRST PROPERTYMANAGEMENT 932 MAIN ST.SUITE F OSTERVILLE MA.02655 Date of Inspection:1215198 FLOW CONDITIONS RESIDENTIAL: Design flow: 440 9•P•d./bedroom for S.A.S. Number of bedrooms: < Number of current residents: n Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): Yes Water meter readings,if available:(last two(2)year usage(gpd): nla ... Sump Pump(yes or no): No Last date of occupancy: n1a COMMERCIAL/INDUSTRIAL: Type of establishment: n1a Design flow:0 gallons/day Grease trap present:(yes or no)_to Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) Nc Water meter readings, if available: nra Last date of occupancy: n(a OTHER:(Describe) nla Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source ofinformation: - rda System pumped as part of inspection:(yes or no)Nc If yes,volume pumped:0 gallons Reason for pumping: Na TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records, if.any) I/A Technology etc.Copy of up to date contract? Other: :. APPROXIMATE AGE of-all components,date Installed(If known)and source Information: tag@ PERMIT I @®In Sewage odors detected when arriving at the.site: (yes or no) No• (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 OVERLEARD. HYANNISPORT MAP 287 PAR 153 LOT 7 Owner: RICK AGNEW CIO FIRST PROPERTYMANAGEMENT 932 MAIN ST.SUITE F OSTERVILLE MA.02655 Data of Inspection:1215199 SEPTIC TANK:X (locate on site plan) Depth below grade: 4' Material of construction:x concreate_metal_FRP_Polyethylene—other(explain) If tank is metal, list age nia . Is age confirmed by Certificate of Compliance Nc (Yes/No) Dimensions: Le'e^He•7^w4'10^ Sludge depth:3„ Distance from top of sludge to bottom of outlet tee or baffle:31" Scum thickness: Distance from top of scum to top of outlet tee or baffle:2' Distance form bottom of scum to bottom of outlet tee or baffle:0 How dimensions were determined: MEASURED Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING SYSTEM EVERY TWO YEARS. GREASE TRAP: (locate on site plan) t Depth below grade: rda Material of construction: _concrete_metal_FRP_Polyethylene_other(explain) Dimensions: rda Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle: Na Date of last pumpingnra Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) rda i BUILDING SEWER: (Locate on site plan) Depth below grade: 4'6" " Material of construction:_cast iron x 40 PVC_other(explain) Distance from private water supply well or suction Iine:rOWN Diameter: nia_ Qmments: (conditions of joints,venting,evidence of leakage,etc.) (revised 04127)971 a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART,.0 SYSTEM INFORMATION (continued) Property Address: 50 OVERLEA RD. HYANNISPORT MAP 287 PAR 153 LOT 7 Owner: RICK AGNEW CIO FIRST PROPERTYMANAGEMENT 932 MAIN ST.SUITE F OSTERVILLE MA 02655 Date of Inspection:1215198 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rva Material of construction:_concrete_metal_FRP_Polyethylene_other(explain) Dimensions: We Capacity: nla gallons Design flow: magallons/day Alarm level:_nra Alarm in working order?=YeS_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) rJa . DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert: n1a Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.) DID NOT EXPOSE PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no)No Alarms in working order(yes or no)_ves Comments: A; ' (note condition of pump chamber,condition of pumps and appurtenances,etc.) rVa {revised 04R7197) a SUBSURFACE SEWAGE DISPOSAL SYSTEM,INSPECTION FORM PART.0 SYSTEM INFORMATION (continued) Property Address: 5O OVERLEA RD. HYANNISPORT MAP 287 PAR 153 LOT 7 Owner: RICK AGNEW CIO FIRST PROPERTYMANAGEMENT 032 MAIN ST.SUITE F OSTERVILLE MA.02655 Date of Inspection:1215199 SOIL ABSORPTION SYSTEM(SAS):X (locate on site plan,if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: rda Type: leaching pits,number: 2-1006 GALLON LEACH PIT ' 6 leaching chambers,number:Na leaching galleries,number: n1a leaching trenches, number,length: rda leaching fields, number,dimensions:rda ,, overflow cesspool,number;n1a Alternate system:-rda Name of Technology:_n1a Comments: (note condition of soil, signs of hydraulic failure;level of ponding;condition of vegetation, etc.) THE LEACH PITS ARE FUNCTIONING PROPERLY.ONE PIT WAS EMPTY,THE OTHER PR IS UNDER THE ASPHAULT AND WAS NOT EXPOSED. . CESSPOOLS: (locate on site plan) Number and configuration: We Depth-top of liquid to inlet invert: rda Depth of solids layer: Depth of scum layer: rda Dimensions of cesspool: rda Materials of construction: rda Indication of groundwater: rda inflow(cesspool must be pumped.as part of inspection) rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) n1a ` PRIVY: (locate on site plan) Materials-of construction: rva Dimensions: rve 1 Depth of solids: Na Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation,'etc.) rda - (revised 0412797) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C , SYSTEM.INFORMATION(continued) 50 OVERLEA RD. HYANNISPORT.MAP 287 PAR 153 LOT 7 RICK AGNEW CIO FIRST PROPERTYMANAGEMENT 932 MAIN ST.SUITE F OSTERVILLE MA.02055 1215198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks T locate all wells within 100'(Locate where public water supply comes into house) peek , F p� g rac o e A4 13 6 Ali it � A P 3c �0 .31 �R a3 �34 Page 9 4f 10 (revised 04)27197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) . ^, SOOVERLEARD. HYANNISPORT MAP 287 PAR 153 LOT 7 RICK AGNEW CIO FIRST PROPERTYMANAGEMENT.032 MAIN 137.SUITE F OSTERVILLE MA.02555 1215198 - Depth of groundwater 12. Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property,observation hole, basement sump'etc.) I , Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS MAPS AND CHARTS (rwlsed04127197) 1�q• 10 e[`30 TOWN C&apqNSTABLE i SEWAGE # ��GE- Cat�'��S C1��ASSESSOR'S MAP & 1.09L� 3 0 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ®b LEACHING FACMrrY: (ty Q�k S (size) CCU NO.OF BEDROOMS BUILDER OR OWNER �— PERMUDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility, Feet Private Water Supply Well and Leaching Facility,(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands st within 300 feet of leaching facility) Feet Furnished by �Qcl r Yc� y 04 ^'U r l a. . -7v TOWN OF BARNSTABLE � LC ATIOIV VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME& PHONE NO. SEPTIC TANK CAPACITY /mav LEACHING FACILITY:(typeP ecr C t e.,*+ (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER &l. BUILDER OR OWNER �r9i/� /71�Y/�.✓ DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �� � `MM N ? wjK � �, � � � c � /� .rl o _ V _.� , r� -. e,.� �' u -� f' No.... FEz...,7 ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF . HEALTH Appliration for Uiopooal i9orkii TonstrudWit tirrmit Application is hereby made for a Permit to Construct ( :) or Repair ( ) an Individual Sewage Disposal System at .......L�.r__._..7.....41/_ErL.I_EA p._...._................... ..•••••-•-----•-•- • - ....... ..... -................... Location•-Address or Lot No ................ :K._._ or? !►•!.. ... --------------•--._...._. `�`�..M}l!!y.S T.....w:.` A QW !. ►:1a...»....».»..... ... .. �. �! (r Owner Address /!� .E::d....._6=S![_- :.........................::................ .............:.._.....-------•-•--..._........-•----........._.._.......--•- --................ Installer Address -} Type of Building Size Lot__.r�-_lzl._ _......Sq. feet Dwelling—No. of Bedrooms__......................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures .................................................. ........... ...... ......... . WW Design Flow...........5 _________________________gallons per person per day. Total daily flow........ _____...:"_..gallons. WSeptic Tank—Liquid capacity_1560._gallons Length....1.1.........Width;....R....... Diameter...•..........__ Depth. 1..O�F x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.....................sq. ft. 3 Seepage Pit No....j... -._.'L.... Diameter...... Depth below inlet............... Total leaching area.`J19.-.. -.sq/t.6/D Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by...:5: =V 9....N A9!J ...... �'.:..:............... Date...Jr.-Jr.......7.........._..... ,aa Test Pit No. 1.... z.....minutes per-inch Depth of Test Pit....1_t4.1�_._._. Depth to ground water... ........ Lj. Test Pit No. 2................minutes per inch Depth of Test Pit..../`.f.4........ Depth to ground water... ....... x # ---------- :............ ........... ............. O Description of Soil..... ........�J_ . y:��:-TOP.. . ... .........Z`...�...�� C�MPAGT•.�I N£ 'MEb $/l,�.it'........••---- .. ._..--•------•--....-•-----••.........................................•-•••---=-_... 11 W -� . .....Z4......T4.P 5�� Zt. ..1-�`...... S h4f7 ------••...............................•----•----....................... 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 LITLZ 5 of the State Sanitary Code-The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board /of health. Signed... G!' .....( ? .. ..................................... .......................... Date Application Approved BY { ••- ..�t.u,��.......�.................................. ......... .F. 16... Date Application Disapproved for the following reasons:...........................................................•-----•--•---....................................»» ----•-•------•--•----•--•---•......................•---•------•-•--------••••--•-•--••••---.......__..............................-•-..............--_..._._..._...........---................---...... �• Date Permit No.....--- •'1.�'-• ••---_____•••••...__._. Issued................... ............. ... ................ _................. Date No...... R � Fas.... .. ............ _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........TowtY ............OF......��.A. .51 G L ' Amiliratiun for Disposal Verks Tonstrur#iun Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .......L,o r.:.1' 7.....QV6 A ��:................. ...... l�r � , .Location-Address Lot No » ...................... .......MA 2K. •_fly r?-:;arm. ---- ------------ --.». Owner •--•------- - •--•--•-•-•--••-•-•-•-• --•---......Address ........... .......................... W ��C....... C�i�+.^ Installer Address ••1•- Type of Building Size Lot............................�01S feet U Dwelling No. of Bedrooms.._.......:!............... .....Ex Expansion Attic '-' g— --------- p ( ) Garbage Grinder ( ) `14 Other—T aYPe of Buildin g .......................:.... No. of persons............................ Showers ( ) — Cafeteria ( ) QOther fixtures .................................. .............................--- Design Flow...........55.........................gallons per person per day. Total daily flow........14 4t)-............. . ....._gallons. Septic Tank—Liquid capacity.5 ..gallons Length....U........ Width:..:6....... Diameter:...:...._.._... Depth_4'.5'.ETF Disposal Trench—No..................... Width................... Total Length.................... Total leaching area...... ft. 3 Seepage Pit No.......: ...�... Diameter.......le)......... Depth below inlet...... �........ Total leaching area.`-� (: .sq.tft. �f Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by..5�l u ....f^�I VS�� E L;.,: Date..:-:'5-97 Test Pit No. 1....�.....minutes per inch Depth of Test Pit....i`� --....-- Depth to ground water...&Q?�'E........ f� Test Pit No. 2..... ...minutes per inch Depth of Test Pit......4�.i..... Depth to ground water...Na.N:. --------------- = ...----.... -----------.....---......................................................... O Description of Soil..,.......r?.- 2u '1"oP ' SUS Ztl 1 G4. CgMpACT �#�£ ��?Eb Ind 0 x ,.• . ........ ............. s-----•-••---.... ..,.............. W (� -.. ¢.. ...5 yr 4'' _1 �__4_ Ell 5AN ____.. __ Nature of Repairs or Alterations—Answer when applicable ................................................................. PP 1 •--------------------•-------------..............--------------------------........-•--•---•-----•-•-..........------------.....------------------•--......------.....-•------••-•-•-•.................. Agreement: The tmdersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of•,I' Is . .5.of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Si � i , gned . -------------------------..................................... ................................ Date Application Approved BY......-. .�......................... - ......- 47 - I K ................_...... . _..... ................. Date Application Disapproved for the following reasons---------------------------..................................................................................... ..................................................•------..................---................. ...............----•----.......------•----........-----...-•------............................... ` Date PermitNo......_.... /2...................».... Issued........................:............................... Date ------------- THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF HEALTH e..i�.0 . ............OF.........../ .9.; �Q�� �" ... ............................................................... Tntif irate of Tomplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by....................... ............••---.................--•------•..................•...._ ............------------..... -- ..........-..•--..................................... n (1 Installer has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...... ............. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. ..........: ` ............................. Inspector----- . -..'`=�= -...---------.............-•------------......••....... •-—-' . h.,a. ......tau..-.nnw .....�v�—ti�...�.. .• ....e.�Aw Y .._ M ..n .w..� ..�b� r._ �✓�w Y..'n.�..R+-......'n n. .i • me � n«.. e-..—rw�..+...- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH % � ............OF.......... <P: . :�: pr No... ...v Flax............ Disposal 180rho Tunstnutiun Permit Permission is hereby granted..........— to Construct ( ) or Repair ( ) an.Individual Sewage Disposal System at No.......... Z. ' rj Street as shown on the application for Disposal Works Construction Permit No.l ^UAL.. Dated.......................................... » Board of health DATE--------------------- 1=a..-..f �ek5 ._.......... r RLE & SE CTION - SEWAGE 1 p0� R_9?.So' v —SEPTIC TANK— �J1 —"D"BOX— ZZ� —LEACH Z �I TS : L1f 4!` M� AT BOUND 5? _ •' �`?�` ��� \ TOP QFq i N u�V. `1 J5'. U�✓G5 i y�Q �J: .IMSL1• -2-OF11,TO kt" WASMEO STONE 2 MACH PITS Ia',1�v.n{� so x -74 50.0 OUT IN• OUT 45 { IN• ,� o � ' `�.�. �,tee" g1 , ; EPTIC TANK .T5ELEV. ELEV. ELEV. G QQr� ELEV. •-1_-I br 1 r J a ELEV. -ELEV. . - L1T Y 14OTli VMFY GLFAW :�' .Ofa~�-It�s�' r "M>=b'5A14P Tb Etter. *4SHEO STONE r j � TO coN sTrrvcttW ; — TEST HOLE LOGZn ' ; - r • 3 s a: a.• k1 o yj, —r - �-,T�tl£ NE � f ES O T S 8 7 r $fORODM HOUSE TEST ON ELtV.53aJ ELEV. 5 .,3 NO . „ . ..!DISPOSER r"OISPt)SEA Aluli3C�_=' a=:• R �� t d- MIN/�N. a ATE __ PERC R ' .r ,, GA wYALL , t .. , " 24 s1:. Z4 _ YsZ. W RATE.'�'�- _ .. SEPTIC'TANK SE C o REO D SEPTIC TANK Si2E IM LEACH;=FACiL1TY - . . . :SrDE�=wAu: t1 . ,,_ •� = 14 i.� # Z•3 BOTTOM i D.:1 /D. CQ , T F f. f T +y I - 77 it nL : WAT.f/t fNGOUNTEREO . 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DATE: as N+'■ DRAWN H■n of a■4�N FORM OR MANNER EERR"ATSDEVER FLOYD RESIDENCE A.O R/17/10 K t!I"ww DISTINCM RESIDENTk s COMMERCIAL DESIGN WITHOUT FIRST OBTAINING THE oWAR ao/a HVmart 50 OVERLFA ROAD ut VAN STREET•r,Ut4outHPORr•Lb Ozese EXPRESS WRITTEN PERMISSION (9•IECKED OR t■vtri AND�v+nWN RLuxwto Wi / LMB)362-980 DESIGN. SENT OF NORTHSIDE oao®°tr�H tTnucn■k 1IYANNISPOR7 MA. c�>��-�+� �Q rr--rr - --- -------- -------------- ------- ---"-U ... ___y� O n I 1 \ s� r r �� \ N \ \ ;\ a I I \ 73 '�k�'Ne � r o \ ",3�. �krbr DD u '�7t n r e� yiI 4 \\ <oA! A��a� �zr�}�� v,,. f srl�airo a.y r 5�} I i iOZ F� ., AP- +1"'� y#e OA ' / Fey{ o +/ ``/ WPv i x'���s/�'rtr � -�'�'7`.7''+•'F i'�*�`tEy*�� �y�}M is I Y s a. 4J3`p.i 4irr?I /i MMMj td r+J In ra� Q. a 1 �agaxk � Iz��� a k ® r Y v m I+ u k•1� '�� J� J 1 h :r n a Z It; `, , 'C '"i"F - p ' I p ----------------- s J a All AND LOCAL SUEDND CODES VArtr . Pd : 1 8'�1'-0• nr M CwNAc DOE 10 ANDoDAm rAaANts enl - COPYRIGHT DATE REVISIONS °mwgcnm '�'"°"ra LOWER LEVEL PLAN NORTHSIDE NCRTHSIDE HEREBY EXPResr DEG 73 0 1 $ a a s�N94D01 a RTHS01ID>all NDNIM9�E DE9011 - DESIGN -�air THEE COMMON NANS ARE ANY O�1 ASSOCIATES DRAWN SHEET N0. DATE AN H m NOT TO BE REPRODUCED o oraol ADrrsaN CHANCED OR COPIED A ANY FLOYD' RESIDENCE Path OR MANNER WHATSOEVER 8/17/10 *�=�)A1� WITHOUT RRS'T OBTAINING THE A.1 ADAD11N71�N0/CN 50 OVERLEA ROAD 1D a c�uuE�c� EXPRESS WRITTEN PERMISSION a NcvepT AND Afi11WAC NE.VmEp .t4i WAIN STREET•rARMOu1HPOlrt•NM DYDr6 AND CONSENT Of NORTH510E CHECKED ONSWOVIDTS#ISWACNNAL HYANNISPORT, MA, (M)34D-n10 cT08>362-OM DESIGN. a mv le�_r _ - - I i I 4-2' 0 PRONT' - - � PROPOSED _ 11 gU II u z A ^ (D y® Z < s g ig 4 all D a e 8 a F �Q J z p- A O O Mx 4 , 8 q gg Ig r9 , A -r. yr r. u ATL AND UX;At m COUS cC0[a rury b�OALE: l 8' 1'-0' nr rA V MAx ou TO aor aAw rue�eus aaN COPYRIGHT DALE REVISIONS +�Oa M OU FIRST FLOOR PLAN NORTHSIDE NORiF140E HER MYDPRE9.V 0 1 E 4 8 M�CC a oaNSI M.,X N �j DESIGN DESIGN RESERVES ITS COMMON LAW NO �" r a� COPTRIGNT.THESES PLANS ARE ON 'ANY Lam aR Maw - T► NOT TO EE REPRODUCED SHEET No. DATE- a kOU,M„ ASSOCIATE. p+ANCED OR COPIED IN ANY DRAWN „ ,AL FLOYD RESIDENCE FORM OR MANNER WHATSOEVER A. 8/17/10 qm raa wcu DISnNCTNE RESIDENTIAL B COMMERCIAL DESIGN "TROUT FIRST OBTAINWG THE oFyAnIV6R""AND/CN MW.'W= 50 OVERLEA ROAD EXPRESS WRITTEN PERMISSION „�,�ANo ASPXOYAt p,yC.. 1 a MAIN STNEET•rnnMoumvom.•MA l-saw AND CONSENT OF NORTHSIDE CHECKED dsO1OONiE MaTaucnpq HYANNISPORT, MA. �0°a>aaa-u�° cme)sm-o� DESIGN. - t a 1 I I I I I I � I I I 'I 1 \ \ I \ I \ I \ 1 , \ \ \ \ \ \ \ \ \ \ \ \ n \ X \ \ 1 \ , Q I n , I �--- r-4'I ' I� ly_gr p II , LI II 1 I I D IL--- I, I rot , , 1 e , i D 1 / / / , / / / 1 / 1 � / 1 1 I Art Mp earx elaxua YAW! - - b'OALE: 1 8'°•1'-0- ur ee m 0o osaR ruaaaARWAw. CIA To s,01 COPYRIGHT DATE REVISIONS so a o 1 z a e m SECOND FLOOR PLAN NORTHSIDE NORTHSIDE HEREBY EXPRESLY DESIGN DOM DESIGN RESERVES"S MON LAW a m to tus COPYRIGHT.THESES PLANS ARE ANY plasm OR 14cllmam NOT pTO BE REPRODUCED SHEET NO. DATEOR N ASSOCIATES �ALI�MANNER 01 ANY YER DRAWN Ara .� FLOYD RESIDENCE FOR B/17/10 PLANS aHa+ Trt"'m1N:+�uca D60NCINE RESDENML @ oDVWERcou DESIGN WITHOUT RTRST OBTAINING THE x,�cc,0a 50 OVERLEA ROAD EXPRESS WRITTEN PERMISSION ,K�AM APPRON�Rmwlmalo 141 MAIN STREET r YAAMOUTNPORT-MA 0297e AND CONSENT OF NORTHSIDE CHECKED aa0IVIOM MaIRMRK HYANNISPORT, MA. (50a)3a2-22+0 (508)3a2-9e02 DESIGN. 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