Loading...
HomeMy WebLinkAbout0030 BARNARD ROAD - Health °30"Bl amard �Zo d 4 A'= 139. 031 a < n e o ° u. ° g < o ° . a i• n ` " ° v a ° Y r o ° ° r I � Ao os Vil,L7C EMOLE WNDOW REMOVE WNDOW .� co� OFFICE BATH NEW ST IR OP Lti -G - - - - 0- uoVE EVSPNG DOOR/ FL— -O - - - - - - O- BEDROOM' SITTING ROOM o:. 4'-2" �t INCREASE OPENING TO 4'2" --- BETWEEN EXISTING ROOMS EXISTING HOUSE NEW CLOSET BEDROOM ........:....:�""� NEW WNDOW ,a - ' -"1SM8aClPR66W- ' NEW WN REMOVE WNDOW NEW WNDOw REMOVE WN00W NEW WNDOW rw. ' ——i' - 1 .,�- 2� 3k I L/ C.,41/1-1 )L.4a I -,f, J-1, rub - To V-1 ot TO /�30 I&d r 5 ��o�,� 12 7.25 TYPICAL ROOF CONSTRUCTION CONT. RIDGE VENT.- ROOF SHINGLES ARCH. .30YR ASPHALT SEE 15 # FELT PAPER F 1/2" COX PLYWOOD FASTENER DETAIL RAFTER VENTS 2X 10 16" O.C. 2" X 10" WOOD RAFTERS @ 16" O.C. METAL HURRICANE CLIPS CONTINUOUS SOFFIT VENT 2"X 10" CEILING JOISTS (PER FRAMING PLAN) 9" KRAFT FACED INSULATION R30 MIN. INSULATION BAY VENTS (INSULATED RAFTERS) 1"X3" STRAPPING 1/2" GYP BLUE BRD/ SKIMCOAT PLASTER 2ND FLOOR co CONT. SOFFIT VENT. 12 12 TYPICAL EXTERIOR WALL CONSTRUCTION ;. CEDAR SHINGLE SIDEWALL w TYVEK OR SIMILAR � — /2 CDX -PtYWD-SHEATHING- 1'-2" — — — — — DO J 2'X 4' WD STUDS LPG 32W 11—7/$.. I SEE SPEC SHEET @ 16" O.C. ..,.,-, �.non „(•. .,, •,. ,.,n,., ......... ....a ......... ...... . ......... ......... ....................... ................ ...................... ...................... ...................... ...................... ...................... .................................... 2 X 0 RAFTr DOR ER ROOF G Jo SI S 2 X 0 CEILI ........ .. ..... 0 16' O.0 ............. .................. ............ ................................. ......................... ....................................... :EXISTING ROOF :FRAME .............. ................... ................................................................................... .................. ......................... .................. ......................... ........ ... .............. . ................................... ......... ..... ................. .................................................... ................... .......... ...................... „• 1: I FINISHED AREA OF BASEMENT I fi f j 37' — — — ——— -- ———— -- -o• ..ates - --- --- --� I-- -------- ———————— - I I , r ——————————<; -------- -- 40, I I --,_r-- I — — - — — _a • ` ———————————————————————— : �//�)A?AA, .; TOWN OF BARNSTABLE ✓ LOCATION -A SU SEWAGE # ZOO pI ' 13Y VILLAGE :C AP_ ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. ceC )t .1 t�"1 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) J X 43 NO.OF BEDROOMS 5 BUILDER OR OWNER PERMIT DATE:��' " 6 7 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 (1f any wetlands exist within 300 feet of leaching facility) aan - Feet Furnished by pAS�`d7e-� ��-A yr- e— I-�C> u�� r - �. . � TOWN OF BARNSTABLE LOCATION b A(nn(d 2 . SEWAGE# VILLAGE 'ruv,k ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY ClLSS(�W LEACHING FACILITY.(type) (OX(, (size) NO.OF BEDROOMS 3 OWNER SV I I VAn PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist Within 300 feet of leaching facility) Feet FURNISHED BY Sn 5 ��yn FOr 4 30 y -Deck- d i L 10*7 No. &DOC FEE - COMMON (%L1 ®I~ MSSCI�USETTS Board of,4ealth, ��I MA. APPLICATION FOR DISPOSAL SYSTEM CON TRUCTI®N PERMIT Application for a Permit to Construct(• Repair( ) Upgrade( ) Abandon( ) - }Complete System ❑Individual Components Location 115, \i.L� Owner's Name Map/Parcel# _ Address Vo 11y7 ft— Lot# Z Telephone# Installer's Name Designer's Name M Address �t� AddressSNO ( Telephone# 5®� _ 4a f_93 0® Telephone# EAST PALM® ,M PE Type of Building Lot Size�4 _;Z,�sq.ft:,. el g-No.of Bedrooms ✓ Garbage grinder( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow(min.required) o gpd Calculated design flow Design flow provided tv0 gpd Plan: Date l n q Number of sheets Revision Date Title Description of Soils) Soil Evaluator Form No. Name of Soil Evaluator 5, Date of Evaluation c) DESCRIPTION OF REPAIRS OR ALTERATIONS Co S'(cv C_A Jy Irz w "��'-(` The undersigned agrees to' the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees o of to a cyst ration until a Certificate of Compliance has been issued by the Board of Health. Signed Date Inspections !! t forT No. , ���"�. }✓"� .err aF 9 � 7wl - FEE " C®MMONWLALTH, OF MASSAWSMS Bocgril f,dealth, t ' ✓��Y r i, MA. T t APPLICATION POP DISPOSAL SYSTEM CONSTRUCTION PERMIT - � Yet. ,,Application for a Permit to Construct(,V ( (Repair Upgrade Abandon(,) -. Complete,System ❑Individual Components af.. �O Location aaez.� .� � : Owner's Name Map/Parcel# Address too %c-f �..�;>��►( `�'rt� Lot# Z - Telephone# Installer's Name Designer's N r• ¢.r ame STEPHE\J.DOI'LE AND ASSOCIATES Address /9 a ,�j /� j Address 42 CANTERBURY LANE Telephone# 5,0,0 e ��g..,9,9 p d) Telephone# 508/540-2534 t Type of Building Lot Size 14�� sq.ft. Dn?g-No.of Bedrooms Garbage grinder( ) Other-Type of Building ti No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow(min.required) f o gpd Calculated design flow + Design flow provided gpd Plan: Date 1.1��c� ,L 1 A , Number of sheets �` Revision Date Title �i ' . F oT> ! \' L�k�t\rl `�'�,a u� l�` /4�-e.�•Y r�R-�.1�._ a�. Description of Soil(s) c,,�� Soil Evaluator Form No. Name of Soil Evaluator S Z>jA t\ .t 'Date of Evaluation 0-7 l!j U. DESCRIPTION OF REPAIRS OR ALTERATIONS 1— The undersigned agrees to install)the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees,t/o`not to place the system-in'operation until a Certificate of Compliance has been issued by the Board of Health. Signed �f %r%� e:-^'-- Date Az 3 Inspections FEE / COMMONWEALTH OF MASSACHUSETTS Board of Health,V.*, BA C. , MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System ' bando�,/'� The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded (&) A' ned ( ) by: A�4 - r Al r-„ at S&2aaA44t) C� -&TIZV'ELr 4r. has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. 4 w dated S7hf71??.,Db0. Approved Design Flow ,: a' (gpd) Installer {{�� Designer: .[ -R�_ v i lnspector: "Date: 1,41 q The issuance of this permit shall'not be construed as a guarantee that the system will function as designed. No. U� )31 FEE COMMONWEALTH OF MASSACHUSETTS Board of Health, ?.)NJZ MA DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrade(l.F)�don( ) an individual sewage disposal system at 1��'1 14�+.V-`o �� � ��t��V 1�•�.I- /�'1� as described in the application for Disposal System Construction Permit No.2 — dated Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date,4/b Z w Board of Health i •• + Town of Barnstable Regulatory Services �P °s Thomas F. Geiler, Director t BMWSTABLE, 9 MASS. Public Health Division Q)p 1639. p�0 rF n� Thomas McKean;Director 2.00 Main Street, Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Sewage Permit# 2.,669- 13Y Assessor's Map\Parcel i =?� Designer: STFPNF.N,t.DOSTF AND ASSO TES Installer: 42 CANTERBURY LANE Address: EAST FALMOUTH,MASSACHUSETTS 026M Address: 62 i�.5 I On p sTeg,6 D—'C AV R-fi ar- was issued a permit to install a (date) (installer) septic system at -30 � `.�� � , based on a design drawn by (address) dated � .� g1fic ( signer)ify that the septic system referenced above was installed substantially according to design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (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. Stripout (if required) was inspected and the soils were found satisfactory. ®®A04A� ® �``��=qe Ch✓r (Installer's Signature) ® r c' P. (Designer's Signature) esigner's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 03-09-06.doc r i.uwn uT narnstaoie P# Department of Regulatory Services . �6 �oFtFX r� Public Health Division ate v r, — P o„ 200 Main Street,Hyannis MA 02601 YA HARNSTABIE, 9 MAM. Qj��0rfo MA1 A10 Date ScheduledX aOTime Fee Pd. Soil Sui ability Assessment for Sewage Disposal Performed By: #, t 0 Witnessed By: ol�� ':_ , ,I!:" ..'w�.!,n',!,�.:I,,I.I,,i1 L'II!I,?,l!i!•;!!aI i!l.°.�i ,I;4� fill, ;a,,a,,;..,,;i,! !I;! !' 111114.1.101. I ,1C j!f;i!!.I'I,;!�,I.�,L•:„:I,A!,• ! Location Address ,3w..,�?_ Owner's Name. +��/'\�v�it Address Assessor's Map/Parcel:hj�/ Engineer' � NEW CONSTRUCTION REPAIR Telephone# y' p " �1 Land Use -�'?„ Slopes(%) Z.y r Surface StonesgIV , Distances from: Open Water Body >��ft Possible Wet Area_>_�ft Drinking Water Well __14]A, ft Drainage Way ft Property Line } t p' ft Other $ SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to.holes) - i - .101 t i -rA (� V _ koo Parent material(geologic) (` 6 = Depth to Bedrock_ '7 3\0 Depth to Groundwater:.Standing Water in Hole: JA Weeping from Pit Face Estimated Seasonal High Groundwater 1 t t�o \t�/a. '�-� O I:...:..:.:...:.:...........:.:!.,a::,!....,....,.,.,;,.!,._,....,.,.:::--�:.._,_..!.....a::;....1i......:!i,::!,.u.:!:.n.,.,.•,.,::n ..aa,.! u..! !.,..!:.: :: .:1, ,.I. :!.. .III!;:;,.•,.•;.:III;,.,I;ay.!:.;.yu.li...,., ...'...; :IL:.!:: ��.1��i ;� Method Used: uCy-y Depth Observed standing in obs.07 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_ .............L..... ..:....:.,:...,,..,....:.......:.......:,... ...,....:..:.."; .............L:,. .....L ..............L M. a,..1.:..:,::..,:..n,...!.: ,� irh: : Observation Hole# Time at 9": Depth of Perc _ Time at 6" Start Pre-soak Time@ kk �00j• 1 O Time•(9"-V) End Pre-soak ($ 1 k-D . . L� .y pdV►.L� �f Rate Min./Inch Site Suitability Assessment: Site Pa ��-`- Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----=---- Q:I1E ALTH[W P/PERCFORM .................... .. .. :.:.::::::::::::::.:::::�.a::::::::,::......1.... ..::::::::::::::::.::::::::::::: Depth from Soil Horizon Soil Tex lure Soil Color Soil (her Surface(in.) (USDA) (M unse ll) Mottling, (Structure,Stones,Boulderes. e 0 -.L�� I Sl. t012+ �' Z ij�ot ti�n�4 •3 D ,`L bEt �t�sr . Z �\ Lva Sr��,�N� �•�' re ti olo soil:•;:•;>: ther:.:: Depth from Soil Horizon. Soil Textur . So C r S Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. J'9 Gravel) lsi Z,jr y isi Sr<iY...... i<i''::.::.,:..,,.::,;:.,.::::;:•:,::..:,:;.,..,:.;.:"'..`..,..�':;': is:: .:; 52 Depth from Soil Horizon Soil Texture . Soil Color Soil lher Surface(in,) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. e nos V. D .(ri 1, � �71i' t°`.t►t(; 3 "(. � l►�� st'{!+<">rlc� La1+�� Depth from Soil Horizon Soil Texture Soil Color Soil her Surface(in.) (USDA) (Munsell) Mottling (Structure.Stones,Boulderes. Consisteng e Gravell �0 li L S 10 12 `% It Mood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No_3/ Yes Within 100 year flood boundary No V Yes Depth of Naturally Occurring.Rervious Material Does at least four feet of naturally occurring pervi us material exist in all areas observed throughout the area proposed for the soil absorption system? f If not,what is the depth of naturally occurring pervious material? Certification I certify that on �3 5 (date)1 have passed the soil evaluator examination approved by the Department of Envir nmental Protection and that the above analysis.was performed by me consistent with the required training, experti a and experience described in 310 CMR 15.017. 0;� ,, -Lp .. tl�*- Si>7nature _.. �� Date COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-"NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 30 Barnard Road Osterville, MA 02655. Owner's Name: Shirley Sullivan Owner's Address: Date of Inspection:.. May 16, 2007 Name of Inspector:,(Please Print)Jaynes M. Ford Company Name: James M. Ford Mailing Address:. P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported 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 properfunction and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340of Title 5(310 CMR 15.000). The system- Passes ; No 'tionally Passes r e ds Further Evaluation by the Local Approving Authority Fa Is ---:3 Inspector's Signature:. Date: May 21. 7-0 7 The system inspector shall sub t a copy of this�nspection report to the Approving Authority(Boar of He or DEP)within 30 days of comple g'this inspection. If the system is a shared.system or has a design ow of 100 rn gpd or greater,the inspector and the system owner shall submit the,report to the appropriate regional ffice of the DEP. The original should be sent to the system owner:and copies sent to the buyer, if applicable,an 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. 6/15/20.00 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 30 Barnard Road Osterville, MA Owner: Shirley Sullivan Date of Inspection: May 16. 2007. 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 Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will.pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance. indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): . broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 30 Barnard Road Osterville. MA Owner: Shirlev.Sullivan Date of Inspection: May 16. 2007 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 CAM 15.3U(1)(b)that the. system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines.that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water.supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. I The system has aseptic 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 1.00 feet but 50 feet or more from 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 and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less.than 5 ppm,provided that no other .failure criteria are triggered. A copy of the analysis must be attached to this form. 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: 30 Barnard Road Osterville, MA Owner: Shirley Sullivan Date of Inspection:. May 16, 2007 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level.in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. ✓ Liquid depth in cesspool is less than 6 below invert or available volume is,less than day flow ✓ 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 groundwater 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 coliform.bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)'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 System: To be considered a large system the system must serve a.facility with a design flow of 10,000 gpd to 15,000 gpd You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) I 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 30 Barnard Road Osterville, MA Owner: Shirley Sullivan Date of Inspection: May 16, 2007 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: Yes No ✓ 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 15.3.02(3)(b)J. 5 Page 6 of 11 - OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 30 Barnard Road .Osterville. MA Owner: Shirley Sullivan Date of Inspection: May 76, 2007 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n1a Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n1a Number of current residents: . 0 Does residence have a garbage grinder(yes or no): n1a Is laundry on a separate sewage system(yes or no):. n1a. [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No . Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd. Basis of design flow(seats/persons/sgft,etc.): ' Grease trap present(yes or no): Industrial waste holding tank present(yes or no) . Non-sanitary waste discharged to the Title 5 system(yes or no); Water meter readings, if available: Last date of occupancy/use: OTHER(describe): - GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons==How was quantity pumped uanti um ed detennined? 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 an Innovative/Alternative.technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components, date installed(if known)and source of information: Date of installation unknown Were sewage odors detected when arriving at the site(yes or no): No 6 . Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 Barnard Road Osterville. MA Owner: Shirley Sullivan Date of Inspection: May 16, 2007 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron 40 PVC other,(explain): Distance from private water supply well or suction line: Cotmnents(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) (Cesspool acting as a septic tank) Depth below grade: 10" Material of construction: concrete _metal _fiberglass _polyethylene ✓ other(explain) Cesspool block If tank is metal list age: Is age confirmed by Certificate of Compliance(yes or no): (attach a copy of certificate Dimensions: S'W x S'T x 7'bottom to Prade Sludge depth: ]off Distance from top of.sludge to.bottom of outlet tee or baffle: -- Scum thickness: 1" 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: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): An outlet tee was present. The cesspool had 2'ofliauid on the bottom. The cover was 10"below grade GREASE TRAP: None locate on site plan) Depth below grade: Material of construction: _concrete metal _fiberglass ._polyethylene _other (explain): Dimensions: . - Scum thickness: . Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition;structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 Barnard Road Osterville, MA Owner: Shirley Sullivan Date of Inspection: May 16, 200 TIGHT or HOLDING TANK: None (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Continents(condition of alarm and float switches,etc.): DISTRIBUTION BOX: None (if present must be opened)(locate on site plan) Depth.of liquid level above outlet invert: Continents (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: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Corn ments(note condition 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: 30 Barnard Road Osterville, AM Owner: Shirley Sullivan Date of Inspection: Me 16, 2007 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS riot located explain why: Y Type leaching pits,number: 1 -6'x 6'(1000 gal.) 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.): The pit was dry and clean. There did not appear to be an signs of failure The bottom to Qrade was 8.5. The cover was 10"below Qrade. CESSPOOLS: . None (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 or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): PRIVY: None _(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.): - 9 Page 10 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART C SYSTEM INFORMATION (continued) Property Address: 30 Barnard Road Osterville, MA Owner: Shirley Sullivan Date of Inspection: Mav 16:2007 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. Q� II Ack 1 l`1' 30 is _ _ a a s - 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 Barnard Road Osterville, MA Owner: Shirley Sullivan . Date of Inspection: May 16, 2007 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25 +/- 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) J Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: I You must describe how you established the high ground water,elevation: Using Barnstable toj2oggraphic and water contours snaps, the maps were showing approximately 25'.+17. Around water at this site. This report has been prepared.only for the septic system and components described herein. This septic system has been inspected andpassed as:of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future..There have been no warranties or guarantees,,either expressed,written or implied, relating to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 41.O Health Complaints /31°-0 3� 12-Jul-05 Time: 3:48:00 AM Date: 7/8/2005 Complaint Number: 18240 Referred To: DAVID STANTON Taken By: SHARON CROCKER Complaint Type: TITLE V SEWAGE Article X Detail: UNSANITARY CONDITIONS Business Name: Number:. 30-40 $treeL �13ARN R9 RDA Village:-OSTERVILLE Assessors Map_Parcel: Complaint Description: CALLER SAID BAD SEWERAGE SMELL. BELIEVES ITS COMING FROM 30-40 BARNARD RD PROPERTY LINE Actions Taken/Results: DS WENT TO SAID AREA. DS DROVE ALL AROUND THE AREA, INCLUDING OTHER STREETS IN THE AREA, AND DID NOT NOTICE ANY SEWAGE ODORS. A HOUSE WAS TAKEN DOWN AT THE END OF THE STREET, BUT IT DID NOT APPEAR THE ODOR WAS COMING FROM THERE (INCASE AN OLD SEPTIC DAMAGED DURING TEAR DOWN.) NO FURTHER ACTION REQUIRED. Investigation Date: 7/11/2005 Investigation Time: 2:45:00 PM 1 G 1 rr DN 56 DN 56 Y- © RO 36 1/2-w%48 1/4-N GE GE2 c® 2 CAR GARAGE - zl 15' n o GE GW J-0%6-B J-D%6-B S, GST GSS _ I � I I I I I I I I � I I BREEZEWAY I I I I - I I i 15 J0'-J B- 3 PATIO N.LC OH706 2W IED 6068 DN O60 R.O.5'-0• S'-0 1/4' .0.6'-0'x 6'-10 1" R.O.2'-6 1/2 %5'-0 1/4' O - ry n _ LMNC AREA ip o I i1 0 NEW ADDITION ITI N II O 12'-4 15/16- ,It Ein O NEW •C- KITCHEN v ❑ C O C REF 6'-4 1/Y 51 \l Q REMOVE ACCESS WELL 4 ED ATM v �. a CD -I BLOC. AND WP S@ >.•'^<�'' •.'"'� C C) s BED Dom ..�1. 1 - _ T11N R tJg EXISTING HOUSE F I , PORCH 14' I } .. .. .. 12 i .:.:::::::::::::::::::::::......:... 12 I _ o .........:::::". 0 ......................................................................................................................................................................................................... 4'-11" i i 1 '-10 1/2" STORAGE AREA N O \ N O' I IIA I 4'-0 1/4" 48X36 SHOWER Ln �� T i �IJ� I I� .............................�I � I lil ......................... ......... . ............ r� �. i ` 14'-7 13/16" • V N I N w008038 H-n\r w (1 • 83MOHS 9MV - o 83MOHS 9£X91, i H1V8 831SVN4 5-4 3/8' N . mI - 22'-5 1/2" u N008038 831SVN1 N I DH3056 2W -1 R.O. 5'-0" X 5'-0 1/4" 5_1 1/8 ' 10'-10" I I - I 21• I � I r D . s-„pia 7151'-7 I I I � 8 zs' i 9 9 la _ 00 00 m _ O p I I N - frl I I I i I � 9 -- 9 t s' o t n 2486 SF TOTAL FOOTPRINT 16.3% Si nsi mer addition/renovation FIRST FLOOR PLAN Indesi gn N-C 30 Barnard Rd. Osterville MA SCALE: 1/8" = 1'-0" May 06, 2009 Ln REF R OVE WtNDO REMOVE WINDOW — — — g G s REMOVE ACCESS WELL EDR OM ATH BLOCK—IN AND WP N ST P ° — — — — — — - - — �— MOVE Ew NO DOOR/ —O — — — — — — BEDR ITTIN R00 I EXISTING HOUSE W CLOSET - B ROO Ew WNDO E W1NDOw REM O vnNDOw WINDOW REMOVE NOOw NEW"!I I NEW DOOR KL 00 PORCH 14 si nsi mer addition/renovation FIRST FLOOR PLAN (EXISTING HOUSE) Indesi gn LLC 30 Barnard Rd. Osterville MA SCALF: 1/8" = 1'-O' May 06, 2009 I I . I I . I I J I , I I BREEZEWAY I I I I I I I I I I I PATIO N.I.0 I I i LIVING AREA I I 00 Ln NEW ADDITION i 12'-4 15/16" N N SHOWER O0 ° oo o 0 NEW KITCHEN o BILCO "C" 00 I d El I a 1) REF - ' R fOYE W1Np0 REMOTE NDOW nva c1 \ Z/r si nsi,mer addition/renovation FIRST FLOOR PLAN (ADDITION) Indesi gn LLC 80 Barnard Rd. Osterville MA SCALE: 1/4" = 1'-0" May 06, 2009 J r � 041--1 DD 0 co w a 2, O� 01 N m O O co m m D _ 12'-0 1/2" Q O(:l) � N D �= mM, m co O m O ou O O i 13'-5 1/8" si nsi mer addition/renovation SECOND FLOOR PLAN J Indesi gn LLC 30 Barnard Rd. Osterville MA SCALE: 1/4"= V-0" May 06, 2009 S YS TE;M R O _1;7'I1L,_' VIA' W 1�T T. ,S. ulh vILLL" TOP OF EXIST. FOUNDATION EL. 31.5' 0 0 FAST N FINISHED GRADE EL. 30.0't gA} � 1/8" TO 1/2" DOUBLE WASHED STONE @ 3" THICK OR GEOTEXTILE FABRIC II 6�' a 6 Charcoal Vent (2) I/PORTS (WITHIN 3" OF FINAL GRADE) REQUIRED SEE PLAN VIEW 20" 20" FINISHED GRADE EL. 30.0't FINISHED GRADE EL. 30.0'f 36" Above Grade LOCH, 0 w Dia. Dia. O M w 6" lllll llllllllllllllllllllllllllll/llllll1113" llllilllll/lllll !llllllllll dill 0 INV EL r" Stone 111 15' HORIZONTAL < Q Q v I--- 8.5' -� ll NO BREAKOUT o00 000 (r, -'uAl"/ o < .' INV EL 10" MIN. 14" MIN. INV EL 7 INV EL :..' e o e o e e e e m e : ''.:• 12.83' o z z °' 27.42 �- INV E INV EL -48" -48"- ;. 'b < Q J o BELOW FLOW LINE GAS 27 17' 26.t 3/4' - 1 1/2" 34' LIQUID LEVEL 48" BAFFLE26.67' DOUBLE WASHED STONE o 24 m j o 48• ,48" U p > rn PROPOSED DISTRIBUTION BOX 42' S8 NANTUCKL7 w PROPOSED CHAMBER TRENCH kr3 SOUND 0 NUMBER OF TRENCHES = ONE PROPOSED 1500 GALLON TANK H2O LOAD BELOW DRIVEWAY NUMBER OF UNITS = FOUR Z UU11UM UlfiL=)! HOLE EL. 19.0 PROPOSED LEACH TRENCH-END VIEW PRECAST REINFORCED CONCRETE DISTRIBUTION BOX w o NO GROUND VVAILR OR INSTALL FOUR 500 GALLON UNITS T "O C zJ' MAP PRECAST REINFORCED CONCRETE 1500 GALLON SEPTIC TANK Minimum wall thickness = 2" REDOXIMORPHIC FEATURES OBSERVED WITH FOUR FEET OF DOUBLE WASHED STONE Tees shall be constructed of Schedule 40 PVC and shall extend a Minimum inside dimension = 12" AT ENDS AND AT SIDES minimum of 6" above the flow line of the septic tank and be on A watertight cover is required the centerline of the septic tank located directly under the Outlet inverts shall be equal to each other and at ASSESSORS MAP 139 PARCEL 31 clean-out manhole. 2" minimum below inlet invert. The inlet pipe elevation shall be no less than 2" nor more than 3" The distribution lines from the distribution box shall all have above the invert elevation of the outlet pipe. equal inverts as determined by flooding the distribution box to ZONING DISTRICT: RF-1 the height of the distribution line invert after all lines have Septic tank shall have a minimum cover of 9". been sealed in place. L UIY OVERLAY DISTRICTS: AP & RPOD Two 20" manholes with readily removable impermeable covers Invert adjustments shall be made by filling with durable and FIVE BEDROOMS = 5 x 110 GPD = 550 GPD REQUIRED FLOW of durable material shall be provided with access ports nondeformable material permanently fastened to the line or NO GARBAGE DISPOSAL ALLOWED The outlet tee shall be equipped with gas baffle. reconstructing the lines until all inverts are of equal elevation. ,> LOCUS ADDRESS: 6' Z� USE: CHAMBER TRENCH 42'L x 12.83'W x 2' EFFECTIVE DEPTH 30 BARNARD ROAD, OSTERVILLE N�52 _i" [42 + 42 + 12.83 + 12.83] X 2.0 = 219 S.F. GENERAL CONSTRUCTION NOTES `N 31 -O 35 42 x 12.83 = 538 S.F. BUILDING SETBACKS: 757 x 0.74 = 560 GPD TOTAL DESIGN FLOW FRONT-30' 1. All the workmanship and materials shall conform to D.E.P Title 5 p\PE E(E 1 s SIDE & REAR-15' and the Town of Barnstable rules and regulations for the subsurface Access NGR 32 disposal of sewage. COUNT F�10• w � SEPTIC TANK SIZE: Z 2. ports over tank tees shall be accessible 80 550 C� 200% - USE 1500 GALLON N P 5 FEMA DATA: s within 6 of finish grade. \� 25, ZONE "C" 3All components of the sanitary system shall be capable of PANEL: 250001 0016 D withstanding H-10 loading unless they are under or within 10 ft o SEO s MAP REVISED: JULY 2, 1992 0 of 10 f drives t of dri drives or parking u be used under or hin unless noted.. H-20 loading shall Plastic equals may be \ \ w PRpP PGON" ESN�ti \ w Q used in lieu of all precast units 32p0��� ` Y 4. The exca va for/contractor shall call dig safe and verify the location `\ �51 P of all site utilities prior to any excavation, and shall be responsible ` �� �' 29 EXISTING FENCE z for all matters relating to electric easements 3' `\ ` o-o 5. Sewer pipes shall be 4" Schedule 40 PVC laid at a min. 0.02 slope. `� SAP 0� �� EXISTING UTILITY POLE � < e> 6. An masonryunits used to bringcovers to grade shall ` ` Lr o be 100%mortared in plae. gS.A.S. RES. �cp ; ' E 3 EXISTING CATCH BASIN 7. Finish grade shall have a minimum slope of 0.02 ft per foot. 31 30 8. Existing system components -if any- shall be abandoned o \ POS�Q\ � PROPOSED CONTOUR per Title 5 requirements. CIA, 9. The excavator/contractor shall be responsible to contact ��� 3� '�in� PpOgPS0*011 � \ 29 Doyle Associates 24 hours prior to any required inspections. 3 Z� O ��v 30' �\ EXISTING CONTOUR 10. All components shall be marked with magnetic tape or �� p .•� comparable means in order to locate them once buried. ��� \ G WATER LINE try 6' o �N 11. 36" max cover over system components. �; �` cP EXISTING CESSPOOL 12. Where water service connection is located closer than ten feet from 6' X�S�\N U�o -' TO BE ABANDONED sewage components, service line shall be set in PVC and pressure tested. 2 Eo P°R tS 13. Septic tanks, grease traps, pump chambers and distribution 31 010, N0 ,11- boxes shall be installed level and true to grade on a level, °ENERP` stable base that has been mechanically compacted If the component vj 56_ is placed in fill, proper compaction is required to ensure stability and to LOT 24 GFt F prevent settling. Native ground with a 6" aggregate base is otherwise adequate. DRIVEWAY PAVED �1 � \ TP3 TP4 15,237f S.F. S�O�FF PROPOSED 1500 0 r, / LIJ � GAL. TANK OF t�j` 0 PROPOSED P��.,`.. DA1r'ID ��y. f B. MASON m' SOIL DATA: TEST DATE: 07-17-08 SOIL EVALUATOR: S. DOYLE �N \/ d2 i• '''` ` �., t 0 ) VENT o ( APPROVED: 03-95 .-••• w J OF`;: 0� WITNESSED BY: DON DESMAIRIS R.S. n * < 110 < P#12285 GRPN\ FN� l`;. y" ,, - TEST PIT 1 ►®�w•�•�.�a O o TEST PIT 2 TEST PIT 3 TEST PIT 4 s► a PERC <2 M/INCH PERC <2 M/INCH PERC <2 M/INCH PERC <2 M/INCH J D• ,. :' ' �y �� E�F�s> L. Ld Q z w w L. 30.0' 01+ EL. 30.0, 011 EL. 30.0' R O" J y .•; STEPHEN p, J U) "A" SL 1OYR 3/2 '>A» SL 1OYR 3/2 »A" SL 1CYR 3/2 "A" SL 10YR 3/2 �G�•"` :r�. �� " o DOYLE Z 0 6" 6" 'B» LS 1OYR 5/6 "B" LS 1OYR 5/6 »B» LS 10YR 5/6 B» LS 1OYR 5/6 `cF ®s w Q N' f _ In 30 (EL. 27.5') 30"(EL. 27.5') 30"(EL. 27.5'} 30"(EL. 27.5') �J� } '• ' :! e®��'f; E�®.' CD PERC ® 60" PERC ® 60" ~'�' � GRAPHIC SCALE �--` 0 LO »C» MED. 2 5Y 6 4 "C" MED. 2.5Y 6/4 »C» MED. 2.5Y 6/4 »C» MED. 2.5Y 6/4 P SOON `� 1 ¢ - N O o00 CD SAND / SAND SAND SAND O 20 0 10 20 40 80 Ln EL. 19.5' » EL. 19.5' » gME�' �1 G5� = L` z 126 126 EL. 19.0' EL. 19.0' ��M � ~ � O NO G/WATER OR NO G/WATER OR 132" 132" Q P ( IN FEET ) F Ww w- < 7- REDOXIMORPHIC FEATURES REDOXIMORPHIC FEATURES NO G/WATER OR NO G/WATER OR 1 inch = 20 ft. w REDOXIMORPHIC FEATURES REDOXIMORPHIC FEATURES