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0069 BAYVIEW CIRCLE - Health
69 Bayview Circle, Osterville J 0 . i _ ..-_ .r r r . - ,�.�••.ti....-,...w-.-��"'--E'•,'•-r. ..-»-„..'w-.r,.,,...�... M... ��. -' .. -`�.�,9... mod. - No. �C1\ 1�N 3 T ; a Fee /_5 0 evv THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: I/ .PUBLIC HEALTH DIVISION = TOWN OF BARNSTABLE, MASSACHUSETTS Yes ���\A\ 3pprication for 30i5po5ar *p6tem Cott,5tructtott Permit Application for a Permit to Construct(A Repair Upgrade Upgrade( ) Abandon( ) El Complete System ❑Individual Components Location Address or Lot`t o. �(!Q V1P� (24 Owner's Name,Address,and Tel.No. zL� OSt� Z t��,�sago c-J-1 , 4sh(&1 w1A y1 -72/ Assessor'sMap/Parcel l(� `` ,. 0it0 Installer's Name,Address,and Tel.No. J® Designer's Name,Address and Tel.No. 101 rl1w--okan3 MCI Type of Building: Dwelling No.of Bedrooms v Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building I No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3� gpd Design flow provided `► O gpd Plan Date `)130 l �' Number of sheets Revision Date Title Size of Septic Tank n Type of S.A.S. Description of Soil :E fi wl. Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Ti"4 5 of t e Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by t is card Health. Signed Date Application Approved by Date N 1 Application Disapproved Y� Da te for the following reasons Permit No.`A( �- �2(ry Date Issued j( '4{1 Z.0 1 3 NOAC/v{ t. I �. x ri: a -+ � ��It' Fee ' /50 �J r Entered in computer : tE THE COMMONWEALTH OF MASSACHUSETTS �, 3I PUBLIC HEALTH DIVISION - TOWN OF BARNSUBLE; MASSACHUSETTS Yes ZIpprication-for �Digpogal 6pgtem Congtruction 3perm it r 6' Application fora Permit to Construct Vj Repair O 'Upgrade O Abandon O ❑'Complete System❑Individual Components P r �r Location Address or Lot o. �' Owner's Name,Address,and Tel.No.4 K J y 2 f�11n���, p jrJ.c�j rf` )Ge e� �G� l ✓jZ.,/ Assessor's Map/Parcel )t./'L Al Installer's Name,Address;and Tel.No. Designer's Name,Address and Tel.No. YL1Ys C' `jc.a(JP.I) / ��a< �Jlh Ll 2 Type of Building: �/�/l� 600 W Dwelling No.of Bedrooms ✓ Lot Size sq..ft. Garbage Grinder ( ) Other Type•of Building L I No.of Persons _ Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) � gpd Design flow provided 3 gpd Plan.,,.Date /Q 1 Q,5�0 t� LS Number of sheets Revision Date Title ' Size of Septic Tank Type of S.A.S. Description of Soil �IV� t UvVA_ r Nature of Repairs or Alterations(Answer when applicable) Date last inspected: , 4 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by tthis Boar %f Health. Signed/ �— Date 4 Application Approved b Date N Application Disapprovemy: Date for the following reasons ' Permit No.4('-�— (4Z6 Date Issued � 7,C)1� M —————————————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE 4FY,that the On-site Sewa e Disposal System Constructed ( ✓) /Repaired ( )/ U�p rtided Abandoned( )by- at/0 Pry yw A2 Gf4 i z 5 jL has been constructed in accordance L� with the pr6isions.of Title 5 and the for Disposal System Construction Permit No.ztil3- y?& dated Installer Designer r #bedrooms -3 Approved design flow 330 gpd The issuance of this permit shall+not be onstrued as a guarantee that the system w u-funetto'7�p g y esigned. Date a�0s7�LJ Inspector (�Z013' 1F No Fe ----------- ---- yA� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS ligpogal *pgtem Congtruction permit Permission is hereby granted to Construct (✓) Repair ( ) Upgrade ( ) Abandon-( ) System located at 6q �—�C, c, �3 i�K✓i[�L . and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply_with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this'permi Date'1 t IY f 7 Approved by � �r= �1� �•----,'� TOWN OF BARNSTABLE LOCATION / /34-y If t Ct f -, SEWAGE# Vli LAGE ,S1cY J ASSESSOR'S MAP&PARCELme s 6 8 Yo o Goo G� INSTALLER'S NAME Bi=PHONE NO. yd ��l-e r1 SEPTIC TANK CAPACITY I S"Ot> - +' LEACHING FACILITY:(type) 6 (size) SO o C 2� 1T0.OF'BEDROOMS s J 4.,�a�, 1''►c� OW: : : R �. l J�re$'..� V� �2 7 � . PERMIT:`' ATE: J- �� •2 ° �� 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 1117 S - C z V Z f - Town of Barnstable P�oF1He Togo Regulatory Services Thomas F. Geller, Director:, + BARNSTABLE MASS. Public Health Division s639. ''Fa►��°i Thomas McKean,Director 200 Main Street,.Hyannis,MA 02601 Office: 508-862-4644 Fax; 508-790-6304 Installer & Designer Certification Form: ate: � 6 Sewage Permit# Zd ;5. t AAssessor's`Map\Parcel 1 y p D �� g � Designer: Installer: Address: Glrt v Address:' za 1 cam • It- 4— `�: On -RAt4 � -i��► a was issued a permit to install a (date) (installer) septic system at based on.a design drawn by (address) 1 l� 14?- F—� dated (designer) 7� I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. 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. Pian revision or certified as-built by designer to follow: OF �ss-�. DAV9D'> y sSi i c ( MASON m • . `..v 9 �o.1�SS� �sy, • s'�NI TAR\4k,R (D si s Signature) (Affix Desi tamp 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. Healfh/Septic/Designer Certification Form 3-26-04.doc f ZI C)LSERVA ION KOLV LOG — Hole#_� Depth from F.,il 1?orizuf. Soil Texture Stii t olur Soil Other .Surface(in.) (USDA) (Mu o.e:l) Mottling (Structure,Stones,Boulders.. . Co ste .:cy %Gravel) it�. _ t' - -- — 3 2 DEEP OBSERVATION HOLE LOG. Hole# Depth from Soil Horizon Soil Texture Soil Color Soi4 tither Surface(in.) - (USDA); (Munsell)., Mottling .(Structure,Stones,Boulders. _ Consistency.°b Gravel) �'�_�„ /� �,,�.vt iTv�. 111•. (L-3w ail.. �6r1. ..4`ll Sa DEEP OBSERVATION HOLE LOG Hole#' 3 - Soil Horizon . Soil Texture. Soil Color Soil Other Pm De pth th from , - Surface n � -. (USDA) (Ntuosell) - Mottling. (Structure,Stones,Boulders. - Consistent '90 Gra DEEP OBSERVATION.HOLE LOG Hole#: Depth from Soil Horizon Soil Texture' Soil Color. Soll Other Mottling (Structure,Stones,Boulders. Surface(in.) (USDA) (Munselq Consistency ra Sttiu� Flood Insurance Rate Map: . Above 500 year flood boundary.,No Yes Within 500 year boundary No Yes Within 100 year flood boundary.No_ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist to all areas observed throughout the ` area proposed for the soil absorption system? If not,what is the depth of naturally occurring rvious material? Certification 0 �� I certify that on (date)I have passed the soil evaluator examination approved by the Department of Enviro mental Protection and that the above analysis was performed bymme consistent with p c described in 3.10 CMR 15. 0 7 the requir in .: x erns an e x Ho e,, p Signature 4" Date Q:\SEpTI(1PERCFORM,DOC, `l'ow� a ;� -nstable P#- -- rr•tr rJhy\ I -• .. - ff�7j` d Deparhveitt of RegWatory Services 7 j �� Futulic TIealth Division Bate-- Rsv �e 200 Main Stree4 Hyannis MA 02601 - f 11 Fee Pd-160 ,')at-.Schedyleri—_E. D-4�-.1- . - i Time Soil-Suitability Assessment for Sewage Dis osal Pertbmid By (� Q. t CSL !C)1 L� Witnessed By. 1 ) 0 61 -- LOCATION&GENERAL INFORMATION Location Address r{ �) Owner s Name U .n A I Address U�le'��1.11(� fv�`C Assessors Map.R�tcel: 1� I Engineer's Nat Y f e'\ ��1 NBW CON5IRU�'fION � REPAIR __ f Telephone# A0-33 / Jj l rni t - S.a/ SurfaceStanes �n Z Land Use !?P.S i ,slopes( ) .• - - Z�V ft Dunkin Water Well 29©ft Distances from: Open Water Body>10 D CC Possible Wet Area g Drainage Way 1 ft Property Line ,� Q ft Other ft SKETCH:(Street name,dimensiods'of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) r.. I Paten[material(geologic) - .I Depth to Bedrock Depth to Groundwater.Standing Water in Hole p) i Weeping from Pit Pace Estimated Seasonal dtlgh Groundwater _ I " TE R TAD LE. � A G W DETERMINATION FOR SEASONAL HI , Method Used:. in: .Depth to salt mottles: Jn Depth dbperved standing in ohs.hole - Depth toiweeping from side of ohs.hole Jn. OmundwnterAdJustment Adj.factor Adj.l9roundwnter Level e - index Well# _. Reading Date: Index Well ibvd PERCOLATION TEST . Date xhne ; Observation 3; I limest9" Hole# L!�t 1 1 Dep[hofpere r '[U ..�p Timeat6 Time(9'-Ch ' Start Pre-soak Time.@ �,,1 : End Pre-soak Rate M Anch Site Suitability Asse smeot Site Passed Site Failed Additional Testing Needed(YIN) original Public Tde'�lth Division Observation Hole Data To Be Completed on Back ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable C4r#seryatien Division at least one(1)week prior to beginning. TRANS. NO. CITY/TOWN: APPLICANT: ADDRESS: Clq DESIGN FLOW: gPd 4 REVIEWED BY: DATE: N/A OK NO 2GENERAL � � Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] _ Locus Provided [310 CMR 15.2204(t)] "_ 2 or fewer for — plans, 1 0 4 for lot proper scale. 1 0 Pla n ro , p p ( p P CM R 4 - components) 310 C O] p Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- i not, a variance is required [310 CMR 15.412(4)]. _ Location of impervious surfaces (driveways,parking areas etc.) [310 CMR 15.220(4)(d)]. Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions.of system components and reserve areas, [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(f)] daily flow septic tank capacity(required and provided)< soil absorption system (required and provided) whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g)] " Existing and'proposed.contours [310 CMR 15.220(4)(g)]' Location and log of deep observation holes (existing grade el: on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and (i)] Location and date of percolation tests(performed at proper elevation?) [310 CMR 15.220(4)(i)] r/ Percolation test results match loading rate? [310 CMR 15.242] Certification statement by Soil Evaluator [310 CMR 15:220(4)0)] ; Observed and Adjusted groundwater (method for adjustment given or indicated) [310 CMR 15.103(3) and 310'.CMR 15.220(4)(n)] Address Sheet 1 of 7 N/A OK NO Location of every water supply, public and private, [310 CMR - t 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case . of private water supply wells Location of all surface waters and wetlands located_up to 100 ft. isted in 310 CMR 1$.211 and any catch basins beyond setbacks .listed ` located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR . 15.220(4)(M)] (if water line cross see 310 CMR 15.21l(1)[1]) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(0)] Stamp of designer 310 CMR 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes (adequate two in each of the primary and reserve q unless trenches as permitted in 310 CMR 15.102(2) or:as approved for an upgrade under LUA.at 310 CMR 15.405(1)(k)] Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] Benchmark within 50-75' of system [310-CMR 15.220(4)(q)] i Materials specifications noted? [various sections of 310 CMR , 15.000] System components not> 36",deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405(1(b)] i Address Sheet 2 of 7 N/A OK NO u.sm Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line[310 CMR 15.227(6)] t Outlet tee 14" or 14" +.5" per-foot for increase ft depth [310 CMR 15.227(6)] a Outlet tee with gas baffle or approved.filter [310 CMR-15.227(4)] Note regarding installation on stable compacted base [310 CMR / 15.228(1)] t/ Separation between inlet and outlet tees (no less than liquid C O]15.227 2 MR s/ depth) [3 10 Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for... upgrades under LUA [31.0 CMR 15.405(1)(k)] - Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box).[310 CMR 15.2228(1) and 310 CMR'15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access to within 6" of grade,:'- one port for systems<1000gpd, two for systems >1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from.building foundation [310 CMR,15211(1)] Buoyancy calculation Required/Dorie [310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15,.226(3)] Setbacks from resources [310 CMR 15.211in WOW ] lYIu tiomp;arment#Tanks _. w� kk.� 5, S W� .. Required when other than single-family dwelling or flow>1000 gpd [310 CMR 15:223(1)(b)] First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15:224(2)and (3)] "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)1 Address Sheet 3 of 7 N/A OK NO $LT�i=LDaINGEWEt�N ® HtERPTPI G u �...� faxes_»�.�,�F., �.7,, ��.. ,..,.. �.;H a, � ,.�A .�w,.,�.. ..,,,�.�r ...�i .�».•:_,. �,xs,�..,�'� ., 4_.�.n ,.,��n��a���,. ,� Located at least ten feet from any water line? [310 CMR 15.222(2)] Disposal piping at least 18" below water line(when water and ; sewer cross;see 310 CMR-1 5.211(1)[I Cleanouts required/provided.? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)]. Slope of sewer line not less than 0.01 (1/8"/ft)-0.02 preferable [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9).and 310'CMR 15.252(2)(c)} Siphon problem/(leachfield below pump chamber) Endcaps or vent manifold specified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310. CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) =DxSxTRXB�U` ®Na ,�• ., ew, . �,�a u, Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep.p, ch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(0] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sump 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] Capacity(emergency storage above workin —desi flow ? 310 CMR 231(2)] Proper setbacks [310 CMR 15.211'(same as septic tanks)] Watertight 20-in minium access manhole at least20" MUST BE. TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, disconnects accessible) Alarm floats - alarm on circuit separate from pumps specified? - Exceeds two units must have two pumps operating in lead-lag , mode. [310 CMR 15.231`(6)and (8)] ` Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed ?Provided? [310 CMR 15.221(8)] Address Sheet'4 of 7 . N/A OK NO OILABSORPZ1OI\t - Calculations correct? 4 feet of naturally occurring material demonstrated? [310-CMR 15.240(l)] Required separation to groundwater? [310 CMR"15.212)] Aggregate specified as double washed [310 CMR-1 5..247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] - Inspection ports specified and Within 3"final grade? [310 CMR 15.240(13)] Breakout requirements met? (No-violation of breakout elevation within 15 ft of SAS.unless barrier) [310.CMR 15.211(1)[4] and Guidance Document] ^ .„^^^ 3Y 6• x x "'. E ' 3�to ror ,i, d4 3.s "�`.r GALLERIES TS �N?�!TBRS3Gl�R ,S 23� � � Mom` Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole(if>2000 gpd must be to grade) [310 CMR 15.253(2)] Aggregate 1'minimum- 4'maximum: [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration; inlet every 40 sq. ft [310 CMR 15.253(6)] - Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] 100 feet - maximum length [310 CMR 15.251(1)(a)] Minimum separation.2x effective depth or width whichever greater,(3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR_15.211(1)[4] and Guidance Document] tw3 t§ 5 a F_ � . minimum 2 distribution lines [310.CMR 15.252(2)(a)] Maximum separation between lines 6' [310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4 [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6"minimum; 12" maximum. [310 CMR 15.252(2)(g)] Separation between beds,10 minimum:.[310 CMR 1'5.252(2)(f)] Bottom area used in calculations only[310-CMR 15.252(2)(i)] Ad dress ss Sheet 5 of 7 N/A OK NO o � fi� Pressure Dosed System,? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] - Pressure dosing.required on all systems >2000gpd or alternative / systems under remedial approval [310 CMR 15254(2) and UA t/ Remedial Use Approvals] If used in gravelless system-make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year(systei s<2000_gpd)or.quarterly (>2000gpd) good to note on plan [310 CMR'15.254(2)(d)]; Construction in fill Did the plan specify that the fill shall meet the specification of.310.CMR.15:255(3)? Impervious barrier and/or retaining wall-? [Guidance Document] 01. Impervious barrier installation must be supervised by designer [310 CMR.15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer [310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] :Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to'edge'of SAS (10 ft..' recommended) [310 CMR 15.255 (2)(e)] :i:raCl s syste►n�[ A� 1pPovl rtt's .,. ., `�.. .. ,. .h � .. � a Check DEP Approval letters for credits and.design conditions If used with.pres sure dosing do not allow pressure discharge to scour soil interface lter SUM44- stem A Alp oval haefi s Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is.the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for „ p g perpetual maintenance agreement? r Any alarms involved on separate circuits Did the applicant submit`an operation and maintenance. manual? Has applicant submitted a copy of a maintenance IBM%ON FA Are the variances listed on the plan? [310 CMR 15.220 RLS Stamp necessary on plan if:a component .is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed - [Refer to 310 CMR 15.4141 Address r `Sheet 6 of 7 N/A OK NO `Nitrogen Sensttcv�eAreas �� � , �� � �., �. ��� ,°_' s.?r�?... � r Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)?.[310 CMR 15.214, 310 CMR 15.215 and. 310 CMR 15.216 - also refer to Policy regarding upgrades of such existingsystems] Y stems ] Is the system.proposed on the same lot as served by private well ? [310 CMR 15:214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15 216(1)] 2cscellaneous �3 s..x - . e'sEoW,: - Pumping to septic tank ? [31 O CMR 15:229] Shared System [310 CMR 15.2901 . Address' Sheet 7 of 7 TOWN OF BARNSTABLE f LOCATION SEWAGE# Z 0 13 C/2- VILLAGE t,�' f[-P ASSESSOR'S MAP&PARCEL ®-&q 1 SQ8 Y066�e INSTALLER'S NAME&`PHONE NO. 2qgxyo 4J- Rv I, SEPTIC TANK CAPACITY I S"Oe LEACHING FACILITY (type) DY)lWC(( (size) So 0 2 MO. OF BEDROOMS OWNER alnr�� f PJZ_ 1- Jtae$ _P V7 02 72. /. PER1b1ITATE: COMPLIANCE DATE: z 8 y Separation Distance Between the: ' Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility(If any wells exist on Feet site or within 200 feet of leaching facility) Edge of Wetland and LeachingFeet Facility(If any wetlands exist within 300 feet of leaching facility Feet FURNISHED BY A ` N 'own of BInstable , -P# 197 Department of Regulatory Services" ' Public Health Division Date S �►xxareet$ "r"se absy s$ t '200 Main Street;Hyannis MA.02601 t fD µyl � y+S` `.,tie e �' a. 1• . t i °` ;�' (� � I �� � :Fee P : Date Scheduled t. Time d _ 1 � � �° Sewa� e Dig osar Foal' su tability Assess�nejt fo g t d e ►.� Performed By: L �'d f e �"� �' ' Witnessed By: 141 i — ' LOCATION & GENERAL INIFORIVIATION Location Address (���' ®��1 '� Owner's NameAA4 . ` IAddress a Assessor's Ma /P tcel:, "( .I �E-Engineer's Nairn s NEW CONSTRU(�LION X REPAIR Telephone# L ° Stones Land Use V 10.c 1✓ �l.p(�/ ti Slopes 4Surface i+f y {. Y r J Distances from: Open Water Body ® ft Possible Wet Area �-0 67'ft Drinking Water Well Drainage Way F'ft Property lane =ft�t Other � �`r R` ft T - SKETCH:(Street name,dimcnstoris'of lot,exact locations of test holes&Pere tests,locate wetlands in proximity to holes) 5. _ t 1 ., Parent material(gedl0gic) Bedrock . ` v`� _ Depth 0 - - Depth to Groundwater- Standing Water to Hole.- Weeping from Ptt Face - oq Estimated seasonal,7-ligh Groundwater �� r O� AL HIGH WATJ�R TA15LE � DETERMINATION FOR SEAS � _ • ,. - _ • Method Used: in. Depth to Sall mgltles: ln. Depth db�served standing in obs.hole - tk- $ . in. clrouadwnter AdJuetment Depth toiweeping from side of obs.hole:' I Adj.factor Adj.droundwaterL.evel.,s , Index Well# Reading Date IndexVell level — PERCOLA.TION TEST R D�>tp n+ xln� Observation 3 Time at 9" -- Hole# C UWj Time at G" Depth of Perc k Titrie(9" Start Pre-soak Time.@ , End Pre-soak Bate MinJlnch sed X Site Failed: Additional Testing Needed(YIN) Site Suitability Assessment: Site Pas ' I ' n Observation Hole Data To Be Completed on Back—`- -- • Original..Public o c 1 1th Division , ***If percolalyion test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)wet=:k prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel Logym 2,Sy 3 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. nn Consistency.%Gra el L A to �a '-i�l N �►�►� � lie 2- 7 . Sa DEEP OBSERVATION HOLE LOG Hole# 3 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel �-to A LAa ao {L3 YAj tl� tl ' v�rid r i. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other t" Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. ra 1 cat'- t0`� ✓h a �b�(��1� � - &VVI/ Flood Insurance Rate May: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist.in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring tl6rvious material? Certification l® C ` I certify that on ` 1 (date)I have passed the soil evaluator examination approved by the Department of Enviro mental Protection and that the above analysis was performed by me consistent with the require tr ' in t14Vpertis4 and,exp ri nee described in 3:10 CMR 15.0 7. Signature j Date Q:\SEPTIC\PERCFORM.DOC TV COMMONWEALTH OF MASSACHUSETTS z EXECUTIVE.OFFICE OF ENVIRONIV ENTAL AFFAIRS DEPARTMENT OF.ENVIRONIWI8,NTAL PROTECTION TITLE 5 . OFFICIAL INSPECTION.FORM-NOT FOR.VOLUNTARY'ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FO1bM PART A CERTIFICATION Property Address: Owner's Name: rc - Owner's Address:ly Date of Inspection: a RECEIVED Name of Inspector: (please print) 1-'i0� q=1 Company.Name - . SEP 21 2001 Mailing Address: -;70 u /-c�Cn�� TOWN OF BARNSTABLE HEALTH DEPT. Telephone Number: D '7 /- r 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.proper function and maintenance of on site sewage disposal systems.I am a DEEP Approved system inspector pursuant to Sectio.h 15.3409f Title 5(310 CMR 15.000). The system: r� Passes. Conditionally Passes . ZIFurher Evaluation by the Local Approving Authority. iZ_ ls Inspector's Signature: ate: ll d l 3 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 I I OFFICIAL INSPECTION.—FORM-N T FOR VOLUNTARY-ASSESSMENTS SUBSURFACE SEWAGE DISPO AL SYSTEM INSPECTION FORM PA ; TA CERTIFICA" ION (continued) Property Address: ' a4e:�_, Owner'Ins. oE- Date of pec(ion: b Inspection Summary. ,Che'ek A,B,C;D oe E/ALWAN S complete all of Section D A. System Passes: 1 have not found any jnformation which.indicates fiat any of the failure criteria described in 310 CMR 15.303 or in 310 GMR 1`5.304 exist.Any failure criteria n it evaluated are:indicated below. Comments; B. System-Conditionally Passes; One-or more system components as described in ti e"Conditional Pass"section.nee.d xo be replaced or repaired.The system,upon completion of the replacemeni or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined(Y,N,ND).in the r'the following statements. If"not determined"please .explain. The.septic tank is metal and over 20 years old*'or. he septic:tank(whether metal or not)is structurally unsound,exliibits substantial:infiltration or exfiltration ortank failure is irriminent.System will pass inspection if the existing tank:is replaced with a complying.septic tank as approved by the Board ofRealth. *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 hig i static water level in the distribution'box due to broken or obstructed%pipe(s)or due to a'broken,settled or uneven di..tribution box. System will pass inspection if(with . approval of Board of Health): broken pipe(s:)are re laced obstruction isyemou d distributiodbox is,.le eled or.replaced NDexplain: The system.required pumping more than times a year due to broken or obstructed pipe(s).The system will pass in if(with approval of the.Board of Health):. broken pipe(s)are rep aced obstruction-is removeA ND explain: . s Page 3 of l'l OFFICIAL INSP..,ECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM;INSPECTION FORM PART A ti CEIRTII+ICATION4cotitinued). Property Address: Owner: Date of Inspection: 2/&/eal 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'eirvironment. I. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b).that the system is not functioning in a manner which.will protect public health,safety anal tite envirotinrent: _ 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 ally)determines that the system is.functioning in a.inanner that.protects tile.public stealth,safety and environinent: _ The.system has a septic tank and soil absorption system(SAS)arid 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 l 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 5.0 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 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 pptn,provided that no other failure.criteria are triggered.A,copy.of the analysis must be attached to this form. 3. Other: - 3 r Page 4 of 11 OFI+ICIAL.INSPECTION FORM NOT FOR,VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAI; SYSTEM INSPECTION FORM PART A 'CERTIFICAT'ION(continued) Property Address: ,ep d Owners Date of Inspection: D. System r'ailure Criteria applicable to all systems: .. You must indicate"yes"or"no"to�each of the-following for all inspections: Yes N9' i/ Backup of.sewage into.fac. I or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the starface of the ground or surface waters'due to=an overloaded or /f clogged SAS or cesspool . 1/ Static liquid level in the distribution box above outlet invert due to"an overloaded or clogged SAS or cesspool _ j 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 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. y Any portion of a cesspool or privy is within a'Zone l of a public well. Any portion of a cesspool or privy is within 50.feet of a private water supply well. 10 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 duality 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 froth pollution from that facility and the.presence of ammonia nitrogen-and nitrate nitrogen sequal to or less than 5 ppm, provided that no other failure criteria are triggered.`A copy:ofthe analysis must`be attached to this formil (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 flie system fails. The"system owner should contact the Board of Health to determine what will be necessary to correefthe failure. t E. Large Systems: To be considered a.large`systeinalie system.must`serve'A facility with a-desigii flow of 10.000 g A 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) 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 1I of a public water supply'well If you have answered"yes"to any questibn 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 I Page 5 of 1:1 OFFICIAL INSPECI'IONN FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE 01SPOSAL S.YSTLM INSPLCTION'FORM PART 13 CR CIMST Property Address: 1 Owner: � Q — Date of h►spection: Check if the following have been done. You must indicate"yes" pr"tio"as to each of the following; Yes No Pumping,information.was provided:by the owner, occupant,.or.Board of I'lealth. Were,any of the system components pumped out in the previous two weeks? t/ 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 ofthis,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?- t!, _ 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 fi-om.owner).provided with information on the proper maintenance of subsurface sewage disposal.systems The.size and location of t>ie Soil Alb-sorption Systea.r(SAS)on the site,has been determined based on: Yes no _ Existing.inforrnation.For example, a plan.at the IIoard of Health: V111,_ Detennined 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(3)(b)J .5 ' Page 6 of 11 O1+I+ICIAL I.NSPrCT.YON,FORM NOT FOR -OLUNTARYASS.ESSMENTS . SUT;SLTRTA.CE SEWAGE"D7SPOSAL SYSTEM INSPTCTION`FORM PART C SY�T* M INI+OTZMATION Property Address: Q Owner Date of Inspection: / FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design) _ Number d bedrooms(actual); DESIGN flow based'on`310:CMR 15.203 (for example: 11:0'gpd x 0 of bedrooms): -Number of current residents:12)ar lA-y - Does'residence.'have.a garbage grinder(yes orno r r Is laundry on a separate seNvageisystem (yes:or no [if yes separate inspection iquired] Laundry system inspected(yes or nq. - Seasonal use: (yes or no): Water ineter readings, if av ble(last 2 years usage(gpd)): Sump pump(yes or no Last date`-of occupancy;. COMMIRCTAI'JINDUSTRIAII,90" Type of establishment:.. Design flow{based on 310 CMR.15.203): gpd ' Iasis of design.flow(§eats%persons/sgft,ete,): . .. Grease trap.present'(yes or no):_ Industrial waste.holding tank present(yes or no):— Non-sanitary waste discharged to the Tittle 5 system(yes or no):'_ Water meter readings, if available:- Last date of occupancy/use:.. OTHER—(describe): GENERAL INFORMAT.TON Pumping Records Source of ffiformation:. Was system.ptimped as partofthe' inspectioV(yes or no 0- Ifyes, volume pumped: gailons--:How was quantity.pumped determined?. 4 - Reason'for.pumping: . TYPE Or 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) _Tigbt tank _Attach a copy:of the DEP.approval _ZOther''(describe): A proximate age of 11 components,date installed(if known)and source of information: a • Were:sewage odors-detected when arriving,at the site(yes-or no) ? Page 7 of 1 I OFFICIAL INSPECTION F010.1—NOT FORYOLUNTARY ASSESSMENTS SUBSURFACE'SEWAGE,DISPOSAL SYSTEM INSPECTION FORM PART C < SYSTEM INFORMATION(continued) Property Address: ,4 Date of Inspection; I BUILDING SEWER(locate on site plane Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain):. Distance from private.water supply well or suction line: Comments(on condition of joints, venting,evidence of leakage -etc.): Af SEPTICTANK:. V(locate on site plan) Depth below grade: Material of construction:, oncrete_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) Dimensions: . = N Co ' N S Sludge depth: 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: /® . I-low were dimensions determined' rs fla- G [h ' Comments (on pumping recommen atid' nlet and outlet tee or baffle condition,structural integrity, liquid levels s related to outlet invert,evidence of leakage,etc.): = J GREASE TRAP locate on'site plan). l' t g`«: _ t r. ,r V 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: Continents(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of.leakage,etc.): ' f Page 8 of 1 l OFFICIAL.LNSPECTION FORM 'NOT FOR VOLUNTARY�ASSESSMENTS SUBSURI+ACE`SEWAGr DISPOSAL SYSTE{M INSPECTION FORM .PART`C '- SYSTEM INI+ORIVIATION(continued) Property Address: i1,c�•c•C " .4 Owner: Date of Inspection: TIGI.TT or HOLDING TANICt-ank 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: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX&M.(if present must be opened)(locate on site plan) Depth of liquid 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 COAMPL locate on'site plan) 'Pumps in working order(yes or no): Alarms in'working order'(yes or no Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): s I Page.9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION.(continues]) Property Address: Owner: Date of Inspection: p SOIL ABSORPTION SYSTEM (SAS):._(locate ou site plan,excavation not required) If SAS not located explain why: Type �ching pits,number: , 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, kit Ji'l 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 or no): Comments(note condition of soil,.sighs of hydrauk failuf_e,•level of pending, condition-of vegetation,etc.): , PRIVY: &&} Jpcate 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.): f 9 Page 1 o of 1 l OFI+ICIAL INSPECTION rORM.= OT FOI2 VOLUNTARY ASSESSMENTS SUBSURFACE SrWAC,T; DISPOSAL SYSTEM INSPECTION FOiN, P � RTC SYSTEM INFORMATION(continued) Property Address: C . e A Owner: Date,of.Inspection SKETCI-I OV,SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system mcludt g ties to at-least two permanent reference landmarks or benchmarks. Locate all wells within 106 feet. Locate w�iere public water sdpply enters the building. i l 10 Page I 1 of I l OFIRCIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION.(continued) . Property Address: A Owner: Date of Inspection: SITE EXAM Slope Surface water Check cellar. Shallow wells Estimated depth to ground vvater A'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) Checked.with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database=explain: You must describe how you estalilished-tlie high.groundwater elevation: II ` r 2. . �r Permit Number: Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: 6 Q1r��� _ � . Lot No. Owner: L q' G!t ,W�' � Address: ����� G/ ®cj M Contractor: �JD�' ��L' �' /`� ; .- �� Address: Gl�'>47,, �✓� �✓�'�1��� +$ ' Notes: STEP 1 Measure depth to water table ll to nearest 1/10 ft. ..................... ... ... .......... .Date 9lX1l month/day/year STEP•2 Using.Water-Level Range Zone.and Index Well Map locate site and determine: OA Appropriate index well....:.................:...:.....................:.. OB Water-level range zone ......................:............................... STEP 3 Using monthly report"Current, Water Resources Conditions" determine current depth to water level for index well ...:.......:...............: 0� month/year STEP 4 Using Table of Water-level Adjustments. for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 2B) determine water-level adjustment .... 3' . STEP 5. Estimate depth to high water by subtracting the wL'!ter ! ` level adjustment (STEP 4) from measured depth to water level at site (STEP 1) 4 Figure 13.--Reproducible computation form. 15 L J i I .. �� � _ _ y- _._s' i t � '� _ _ _ .. � ,. . �. � �\� e® .. - � � � .. - �, .. �i C-n . .. ��) -� .. �— ,. - � � .. ? � 7 �.. F �"e `• � � , C, ^�--� �� �. (�, . ��� ., - r . � �� a / SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of ro ert II Owner ' s name P Y ' Q �l V 16, u Cl2G( � s��/�(i( ( l e Date of Inspection � l c ? _5— / PART A CHECKLIST Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. _ ne of the system components have been pumped for at least two weeps and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the J system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. �CThe facility or dwelling was inspected for signs of sewage back-up. __.Z/The site was inspected for signs of breakout. All system components, excluding the SAS, have been located on the site. � 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. _�e size .and location of the SAS on the site has been determined based or k:xisting information or approximated by non-intrusive methods. facility .owner (and occupants, if different from owner) were pr�uzded with information on the proper maintenance of SSDS. ll d2 RECEN'EO ,t SEP 1 2, 11996 ►anar. rsra�t� w BFA MDER J, ._ 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B /l SYSTEM INFORMATION ) FLAW CONDITIONS If residential 3 number of bedrooms _2,--number of current residents /2�garbage grinder, yes or no laundry connected to system, yes or no seasonal use, yes or no If nonresidential , calculated flow: Water meter readings, if available: Q 3 - �3 i b d 6 94 Last date of occupancy GENERAL INFORMATION Pumping records and source of information: 4/System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping: Type Sf.-system ySeptic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records,�i f�any.) Other (expiarij �7� Approximate age of)'all components. Date installed, if known. Source of information: °i ' 3 Sewage odo�fsd�etectedwhen arriving at the site, yes or no i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK:'Z:�fv (locate on site plan) depth below grade: material of construction: �ncretemetal FRP other(explain) dimensions: l sludge depth '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 ILA distance from bottom of scum to bottom of outleiL. tee or baffle 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 lea recommendations for repairs, etc. ) , c DISTRIBUTION- BOX: (locate on site plan) depth of liquid level above. outlet' invert Comments (note if level and distribution is equal, evidence of solids carryover, evidence of leafage nto or out of box, recommendation for repairs, etc. ) /A 7� PUMP CHAMBER: (locate on sl an) pumps in working order, r no Comments:. (note condition o mp chamber, condition of p s and appurtenances; , recommendat ' for maintenance or repairs,etc ) L 1c i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORK , PART B SYSTEM ,INFORMATION continued SOIL ABSORPTION SYSTEM '(SAS) : y (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type. leaching pits and number leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool , number Comments: (note condition of soil , signs of hydraulic failure, level of ponding, Condit ' n o e�etation, reco endati ns for maintenance or repairs,etc. ) o CESSPOOLS (locate on site plan) : number and configuration depth-top of iquid to inlet invert depth of solid ayer depth of scum lave dimensions of cesspool materials of construction indication of groundwate inflow (cesspool mu a pumped as part of inspect ' ) Comments* (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) PRIVY: (locate on site plan) materials of construction dimensions depth of solids Comments: (note condition soil, signs of hydraulic fail e, level of ponding, condition o egetation, recommendations for mainte nce or repairs,etc. ) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE : =SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' 2 63 DEPTH TO GROUNDWATER depth to groundwater method of determination or appr imation: �- t c� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of dete mination in all instances. If "not determined" , explain why not) VBackup of sewage into facility? Discharge or ponding of ent to the surface of the ground or surface waters? Q Static liquid level in the distribution box above outlet invert? --4= Liquid depth in cesspool <6" below invert or available volume< 1/2 di flow? A) Required pumping 4 times or more in the last year? number of times pumped QG�J Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? IVIs any portion of the SAS, cesspool or privy: below the high groundwater elevation? -� within 50 .feet of a surface water? J within 100 feet of a sur ter supply or tributary to a surface water supply? D within a Zone I of a public well? �, _ within 50 feet of a bordering vegetated wetland or salt marsh / (cesspools and privies only, not the SAS)? 4/within 50 feet of a rivate water supplywell? �— PL A/-/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 ana ' . for coliforn bacteria, volatile organic compounds, ammonia nitrog and nitrate nitrogen. TOWN OF K/�5�'r .� BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D - CERTIFICATION -TYPE OR PRINT CLEARLY- I f' PROPERTY INSPECTED STREET ADDRESS C / _ ASSESSORS MAP, BLOCK AND PARCEL f�� OWNER' s NAME PART D -- CERTIFICATION NAME OF INSPECTOR V 1 a 2 t ram' ��- COMPANY NAME I" `a 2 ( &0 COMPANY ADDRESS 5 5A 4- c. Street Town or City State EIP COMPANY TELEPHONE (.-a FAX ( ) CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system a this address and that the information reported is true , accurate , and complete as of the time of inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on site sewage disposal systems . Check one: ��System PASSED The inspection which' I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED The inspection which I have conducted has found that the system fails t protect the public health and the environment in accordance with Title 5, 310 CMR 15 . 303 , and as specifically noted on PART C• - FAILURE CRITERIA of this ins_ ction form. Inspector Signature Date -2 One copy of this certif cation must be provided to the OWNER, the BUYER (where applicable) and the BOARD OF HEALTH. * If the inspection FAILED, the owner or operator shall upgrade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 310 CMR 15 . 305 . partd.do, TOWN OF BARNSTABLE LOC. �,rC SEWAGE # VILLAGE ASSESSOR'S MAP & LOT 1®0 INSTALLER'S NAME &i'PHONE NO. APO SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) CoAc(.ate J NO. OF BEDROOMS PRIVATE WELL OR R'EBL�IC WA �R" Il-�' BUILDER OR OWNER y if e 4�y0 DATE PERMIT ISSUED:f DATE COMPLIANCE ISSUED; VARIANCE GRANTED: Yes No ', 3es�n:i.J S�F Fa� Py�S Yo' t ±f I/A 'le Ir � 4 Of � a, a �w No, 'G�'. Fas......... ..a .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH APPROVED TOWN O F B A R N ST A B L E 6ernatsplQsonratio� .� �JItPFYtit�l� fi1Xi!i�JIt1F$l [ax��l Tdyflt X t' t • �� /�-9 Dato Application is hereby made for a Permit to Construct ( ) or Repair (-,_�an Individual Sewage Disposal System at: -R-- •!�' --1�.1? ! -•-C�V-CA �---- ...................Q�Z?`�V vb..��•-••--••--....--------.................--- -•- -- /�� Location-Address or Lot No. 1 1�/L�� _ _1 •--_--- _- ,,,, �,,� pp Owner ddr ss PQ Installer Address UType of Building Size Lot............................Sq. feet .., Dwelling—No, of Bedrooms._3--------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------. Showers ( ) — Cafeteria ( ) 04 Other fixtures -------------------------------- Design Flow.......... ................ gallons per person per day. Total dail flow_.33 ........................gallons. 1:4 Septic Tank 4 Liquid capacitv,lDCO g g .---.__-_ Width.... ......... Diameter................ Depth................ Disposal Trench--No. .................... Width Length g g q W . . ___ 'Total Length.................... Total leaching area_......._....____...s ft. x 3 Seepage Pit No..................... Diameter..../..6.)......... Depth below inlet..... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ►.' Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water-----................... a ............................... ..•••-•••-•---••••-•.-••------•--•••---•.................----------------•••........ ......... ........ ........... ............. 0 Description of Soil----------•................•-------------------•-..................-----•--•---------------------------....-------------•-•--......-----------••--•----•.........._..... U .............. --------------------------------- ......-------------------------------------------------------------------------------------------------------- •--------------------- -------------------.. -------------------------------------•----........---------------•-------........------•-----------------------------------------------------------------------------•---....._.....------•----•--...... U 'Nature of Repairs or Alterations—Answer when applicable._._-: 000._S ......0:74)F........... f------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issue o rd of ealth. Signed .............. .. ............ 01 -- --- --�:.J�..�5...` -.. Dare Application Approved By ...... G � ... ...✓.. .......0.... :%� Date Application Disapproved for the following reasons: .................................../...............I...................................................... ............................................................................ .................................................. ........................... .............................. ........................................ Permit No. ...... �: .......... Issued .... ��.=` _ .'-f'� e------ _ Date . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Tora 7linure - THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (C.- '5" by .... ........... .. ...... .....A`G '°..h: .--�� ° 'c _.............. ------ ....._..... .. . .. ............ ...... ............................. at ..................................(,0a.1 ...._....�7...b � f...U..1. G c�-2__. --O.S`1` vu1�4- . ............................................................ has been installed in accordance with the provisions of TITI.E of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ,�._�. �� .��.. .._. dated ..- .. .' ., .,7�.�7 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT jTHE SYSTEM WILL FUNCTION SATISFACTORY. DATE.. !#/ /�./ I I . Inspector .`r�� ....... { .1(j G. `...... ------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 2 TOWN OF BARNSTABLE FEE....... ` . No......................... Rapmal Worb �u #r r#i n rrmi� Permission is hereby granted---------- --- ---------------------•--•------•--....... _. to Construct ( ) or Repair Individual Sewage Disposal System atNo.•---•-------•---------------1�-C------%6N;. .------------ Q-S%ev v 1��`P ..................................... Street / as shown on the application for Disposal Works Construction Permit o��"����ated..../.............. �.'�.�.�e— f / p M Board of Health DATE.... �'---•--..........-- -..... •-• / FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS .. ' L w,J.r.a..,. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE pp. hration for Di�iiaooul 3lorkl3 Tomitrurtt� rrmit Application h-e by made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal em at Syst ,:-' / / Location- Address or Lot No. ..............rn...r................�S_� ----------------------------------- '-AVV-2._----------------------------......----..............-------- O"" Address a ......... ..( u4 A/—') �� e�'���-------•............. .........A.�2,.... �...•-••y -L•----AAJL .............. Installer Address Type of Building Size Lot............................Sq. feet U Dwelling— No. of Bedrooms.-3---------------------------------- ---Expansion Attic ( ) Garbage Grinder ( ) 4 4 j' Other—Type of Building -------------_--_.._.----- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 04- d Other fixtures ------------------------•------•---•----------------------------------------- -------- ------------------------- ................................. w Design -Flow.........`° .'a........................gallons per person per day. Total daily flow....�3_o........................gallons. 1 Septic Tank 4 Liquid capacitylllfD..gallons Length-- F---._--- Width.-:,'_...... Diameter................ Depth................ Disposal Trench--No. .................... Width.................... 'Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------/............. Diameter----/P...`....... Depth below inlet..._....._..... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by ............. Date -------•-•------------------.. Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil.................................................................................................................................. ..................................... w U Nature of Repairs or Alterations—Answer when applicable.----- C? ___Ge.016_.C-_ ------------------ t 0 ....-•--•-------•--------------------------------------...-----------------------------------...........--•--•-- Agreement: E - The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued-by-the board of health. Signed��J ----------------- - -----,--a--...�ate .- ..�.. � Application Approved B Dare Application Disapproved for the following reasons: ......................... --------------------------- -.............. ----------------- ................................................................................................................................................................................................... ........................................ Date Permit No. ......9.��.... �''�,j'- .......... Issued ........; ��. -- ..." . ...... Date ��C ������ '��T�p� , ' , _ ._ ., •. - - . a rC� .. ' y SEWAGE SYSTEM P 'ROFILE VIEW N .T. S . T.O.F. EL. 102.5' PROPOSED FIN GRADE = 101'f cD RISERS. FIN GRADE = 101'f 1/8" TO 1/2" DOUBLE WASHED STONE ® Y.THICK OR GEOTEXTILE FABRIC 20" 20" r , DIA. DIA. (o FIN GRADE = 101'f EL,99.87' 8 MIN DIA. p INV E �- 8.5' -� INSPECTION 98.7' 10" MIN. 14" MIN. INV EL. ON L. 98.0' INV EL: -\ 98.4T .. / -. 98.22' INV EL MIN: 6' INV EL. ° BELOW FL NE OW LINE 97.5T o 0 0 0 0 0 „ :7T SUMP EL: 97.1 T LIQUID LEVEL 48 97 _ GAS BAFFLE. as 6"'STONE a ° a ° SON �'..... ._ ..:: : .. fn •°. EL. 95.1T PROPOSED 1500 GALLON TANK DISTRIBUTION BOX o 48" 3/4". 1 1/2" -__ - 48" - PRECAST REINFORCED CONCRETE DISTRIBUTION <BOX DOUBLE WASHED STONE TEES SHALL BE CONSTRUCTED OF SCHEDULE 40 PVC AND SHALL EXTEND A DISTRIBUTION BOX SHALL HAVE WATERTIGHT'COVER 2rj' ` MINIMUM OF.6'. ABOVE THE FLOW LINE OF THE.SEPTIC TANK AND BE ON MINIMUM WALL THICKNESS 2" F - I PROPOSED CHAMBER TRENCH cD THE CENTERLINE OF THE SEPTIC TANK LOCATED DIRECTLY UNDER THE MINIMUM INSIDE DIMENSION 12" OUTLET INVERTS SHALL BE UAL TO.EACH OTHER AND AT CLEAN OUT MANHOLE. Q THE INLET PIPE ELEVATION SHALL BE NO LESS THAN 2" NOR MORE THAN 3" 2" MINIMUM BELOW INLET INVERT. ABOVE THE INVERT ELEVATION OF THE OUTLET PIPE. THE DISTRIBUTION LINES FROM THE DISTRIBUTION BOX SHALL ALL HAVE l SEPTIC TANK SHALL,HAVE A MINIMUM COVER OF 9' EQUAL INVERTS AS DETERMINED BY ,FLOODING THE DISTRIBUTION BOX TO, THE HEIGHT OF THE DISTRIBUTION LINE„[WERT'AFTER ALL LINES HAVE BOTTOM OF SOIL PIT = EL 88.8' TWO 20" MANHOLES WITH READILY REMOVABLE,IMPERMEABLE COVERS BEEN SEALED IN PLACE. E NO GROUND WATER OR OF DURABLE MATERIAL SHALL BE PROVIDED WITH ACCESS PORTS. INVERT ADJUSTMENTS SHALL BE MADE"BY FILLING WITH DURABLE AND REDOXIMORPHIC FEATURES OBSERVED MIDDLE ACCESS PORT SHALL BE 8" DIA. MINIMUM. ` NONDEFORMABLE MATERIAL PERMANENTLY FASTENED TO THE LINE OR THE-OUTLET TEE SHALL BE EQUIPPED'WITH'GAS BAFFLE.,, RECONSTRUCTING,THE LINES UNTIL ALL INVERTS ARE OF EQUAL ELEVATION. #w SEPTIC TANK' SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL, DISTRIBUTION BOX SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL,", ' STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED`AND ON WHICH STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON.WHICH 6" OF. CRUSHED STONE HAS BEEN PLACED-TO ENSURE STABILITY AND -6" OF CRUSHED STONE,HAS BEEN PLACED TO ENSURE STABILITY AND TO PREVENT SETTLING 83� FIN GRADE 101'f c ro PREVENT SETTLING.-µ >.y DESIGN DATA: 12. i i i i + i SEPTIC TANK CAPATICY: THREE . BEDROOM =- 3 X P 1 10 = 330 GPD REQUIRED FLOW • REQUIRED 330 GALLONS AT ;200% NO GARBAGE DISPOSAL ALLOWED 34 ,"`•a ° `.� 24„ PROVIDED - 1500 GALLONS TO REMAIN $ -USE: CHAMBER TRENCH 25'L X 12.83'W X 2' EFF/DEPTH . 48" • 58" � 48" (25' + 25' + 12.83', +: '12.83) X 2.0 151 S.F. 25' X 12.83 = 32O S.F� NUMBER OF TRENCHES ONE NUMBER OF UNITS TWO GENERAL NOTES: LL 471 X , 0.74 = 348 GPD' TOTAL DESIGN FLOW 1 . ALL. THE WORKMANSHIP AND MATERIALS -SHALL CONFORM TO DEP ? PROPOSED LEACH TRENCH END VIEW TITLE V-AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS ;SOIL DATA: INSTALL TWO 500 GALLON UNITS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. ., TEST DATE: 10-30-2013 wrrH FouR FEET of DOUBLE WASHED STONE ' AT SIDES AND ENDS 2. ACCESS PORTS OVER TANK TEES SHALL BE ACCESSIBLE WITHIN . 6" SOIL EVALUATOR:' 'DARREN MYERS CSE 16.14 OF FINISHED .GRADE ; HEALTH AGENT: DONNA MIORANDI 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE ,CAPABLE OF " WITHSTANDING. H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' OF DRIVES OR PARKING. H-20 LOADING SHALL BE' USED UNDER OR ,WITHIN T.Pf #1 T.P. #2 T.P. #3 PERC <2 M/INCH T.P. #4 10' OF DRIVES OR PARKING, UNLESS' NOTED. C 4. THE EXCAVATOR/CONTRACTOR SHALL CALL "DIG SAFE" AND VERIFY THE LOCATION EL. t'00.8' 0„. � EL. 10 1'-0„ EL.. 101' o„ EL. 101.' 0„ OF SITE UTILITIES PRIOR TO ANY EXCAVATION., AND SHALL BE RESPONSIBLE FOR „ „ „ 10 YR 3/2 „ .: 10 YR 3/2 "A" „ 10 YR 3/2 „ ..' 10 YR. 3/2 ALL MATTERS- RELATING TO ELECTRIC AND/OR GAS .EASEMENTS.: A L5" 8„ ' A LS 8„ A LS" 10„ "A Ls. 10" 5. SEWER .PIPES SHALL BE SCHEDULE ''40 PVC. (4" DIA. UNLESS OTHERWISE NOTED) °j„ „ „< „' 6. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL, BE : B "LS 10 YR 6/6 B LS 10 YR 6/6 B LS 10 YR 6/6 B LS 10' YR 6/6 MORTARED`* IN PLACE AND SECURED TO UNAUTHORIZED ACCESS. 39" (EL 97.5') 0" (EL .97.6'j 32" (EL 98.3') - 32" (EL. 98.3') 7. FINISH GRADE SHALL HAVE A MINIMUM : SLOPE OF 0.02 FT.' PER FOOT. FNE FINE FINE FINE 8. EXISTING SYSTEM COMPONENTS -_ IF ANY - SHALL BE, ABANDONED PER n MEDIUM 2.5 YR 7/3 „ „ MEDIUM " MEDIUM „ „ MEDIUM / TITLE 5 REQUIREMENTS. - 0 SkMD 0 SAND 2.5 ,YR 7/3 - C SAND 2.5 YR 7/3 C -SAND 2.5 YR 7 3 r_ 9. THE EXCAVATOR/CONTRACTOR SHALL BE RESPONSIBLE TO CONTACT YANKEE EL 88.8' 144" EL 89' 144". EL 90.5' 126" EL. 90.5' 126" SURVEY 24 HOURS PRIOR TO ANY REQUIRED . INSPECTIONS. 10. .ALL COMPONENTS .SHALL BE MARKED WITH MAGNETIC TAPE OR _ -NO G\WATER OR NO G\WATER OR NO G\WATER OR NO G\WATER OR COMPARABLE MEANS IN ORDER TO LOCATE- THEM ONCE BURIED. REDOXIMORPHIC FEATURES REDOXIMORPHIC FEATURES REDOXIMORPHIC FEATURES 'REDOXIMORPHIC FEATURES SHEET 2 OF 2 JOB#: 54962 LEGEND PR - ��N�N 100 51 ti CONCRETE BOUND (FND) WATER SERVICE LINE `CB ap BURIED GAS LINE G oho a SFr LOT 7 TELEPHONE POLE EXISTING CONTOUR 100 SPOT ELEVATION X100.9 BAY IEW ^ I TEST PIT Al PERCENTAGE OF LOT COVERAGE LOT AREA 15033f S.F. LOCUS Cg � �\ LOT 6 �jlPROPOSED STRUCTURE 17.8% o �P 15 33±S.F. F 0. ACRES - ��e LOCUS S M A P - PROPOSED \ �', `` PLAN REF: -129-73 SHOWER \/ _— .=_— 101 �5 00. �0- oo �� HOFMgssq DEED REF:,. 14304-116 e — Qa DAVID �y ASSESSORS MAP: 142 089 —— - — — — 4�� / B. ZONING: R C 01 sp ' a — — — — — — — — ti,; MASON m SETBACKS: 20'-10'-10' _ _ _ _ _ _ o NO. y o � FLOOD ZONE: ' C gyp, —_—_-_ —: — _—_— —_ - r. �,®a s�Isre� PANEL NUMBER: 250001 0016 D Q .0� 0 loos POPCHED — — — PR,OPOSED- — \ I DATED: 7/2/1992 �� DWELLING OVERLAY DISTRICTS: RESOURCE PROTECTION 100% �� — _ _ _ _ _ _ _ — r�, � SALT WATER ESTUARY ' RVE , "' � RARE - - - - - - - - o 00 ''s 2 — — — \ ' PLAN C) C OJ r P OPO ECK .SED� — f — — — — \G / G . R a D . . SITE 8c S 7pC 0.9 -- --- - - - ;, LOCATED AT: 69 BAYVIEW CIRCLE µ # �;$ o {,� == OSTERVILLE, MA 1 12 o o x �w o , 0.8 PREPARED FOR: PROPOSED CONCRETE / B A i S I D.E BUILDING CHAMBER. TRENCH - �O \ #1 OCTOBER 30, 2013 PROPOSED D/B O . • sue/ r \ �� : REV: � "gg O PROPOSED 1500 GALLON TAN REV: REV: '�`' YANKEE LAND SURVEY CO, INC. � LOT 5 � � 56 �- 119 ROUTE 149 GRAPHIC SCALE ',o J MARSTONS MILLS, MA 20 0 10 20 40 NOTE: a: TEL: (508)428-0055 FAX: (508)420-5553 ELEVATION DA'TU`M ASSIGNED I yonkeesurvey@comcast.net www.yankeesurvey.net 1 inch = 20 ft. . IF SHEET 1 OF 1 JOB#: 54962 JM IIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIII EEM ICE III®II �'� IIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIII 0 II �� • Il�t�o rl� i �'1 ..;�.. � � IIIIIIIIIIIIIIIIIIIIII ulllllllllllll I � oilIIIII• • • �� � • IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII MEN IIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIII ..... ! I ■■■■��� IIIIIIIIIIIIIIIIII I� IIIIIII 1 1 n� + � r 'ego �e C _ INMat 11 , IC: IC■ THE SLATER a ���- _ IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII ' °' . . CIRCLE _ ----------------------- I Y El � II - j ICI r n. n . rn r D A. _. ------------ Z _. PROJECT: B AYS I D�E B:U I L�DING INC. _� � THE SLATER. .R�5IDENGE Z m 6q BAYVI:EW. CIRCLE OSTERVILLE, MA w 3 BAYBERRY: SQUARE, CENTERVILLE MA 02632 A F 910 ELEVATIONS PHONE: 508-771: 1040: FAX: 508-775-0155 �, r; .. .. .. .. .. .. .. .. .. 31'-pd. .. .. .. .. .. .. . 2t3'-0" _ ... ... w, 101. 5_2 9 .. .. .. .. J Ul .. .. m .. m .. .. .. .. .. - .. ..: ... ��l 44I 30 18° 2 _ D - / 60 7/a° N.. ... ... M. m Uj O 0 1/8°x60 /8°. TW 2441 _ - 3n 1/ - O:' �II:- X z 30 8° 6 7/8° 12' 0 14'_9n, L ° - - - I: 41 _ I Ki a .. :. p" 3'-bn O_ _ :. '.:W b A .._ II .. .. ... .. ... ... ... 4'-a° .. .2'-4° 7'-6" ...I ... O- FWN 60611"PALR .. .. Z . /P Imry N I... . . - N - -- --- --- 0 o. SIN :. � 4 �2)'TW 28510 D D m O X ml O s ..' 1/8"x72 5/ :-n ::: 10'=2.1/16° o m . tl. o. - D '----III 13'-3 9/16n .. .: .. .. .. .. O -U 3 0 ol FWFI 60611 APLR Z ,ry r�rtr A m - _ .. .. e TW 24410 F s - .30 1/8°x60'7/b° I I .. ..J O 16, w.w Z Z . .. ... ... .. .. 17- o .. .. .. 6-2 1/4".c 13.'-9.3/4" - _ Q c, M x A _ STEEL BEAM ABOVE .: w.N' n o s -—-—-— -----— -- z 3 to ui 1 ... c . .. ... _.O — mN p m. t Am ` L \ o. W D = C7 . f r.' _ - w 4_6 a. x -6n .. b._Qn .: 6i_p° 4'_0" - q CJ L .. .. .. -; PROJECT: ➢ � BAYSIDE SUILDINC.,. IltiiC. m THE SLATER. RESIDENCE . . m 6q .BAYVI:EW. CIRCLE OSTERVILI.E, MA 3 BAYBERRY SQUARE, CENTERVILLE MA 02632: W PLAN PHONE: 508-771-1040 FAX: 508-775-015 26�_oa wool 131-01 N D TW.2442-3 s 89.5/8*42 7/8a ..a o .. _ .. _ - — m ... .. .p,.. .w - 3-0 _I� ul _ D , c O - :.. Z Z .. ... : .. .n 1 D Z R -m v 0.. m 13'._2a:: AFFW 605:: 71 3/411x6q 13/16a . rn o � _ Z iD n r � N 70 — T_W 2442 2 8 59'7/8°A2 7/8°. N 3 NLU .. # ... .. .. .. .. .. .. .. - 70 D LU ... . .. .. .. .. .. ... ...J .. 23'-On .. ... .. PROJECT: yi D mz THE S BAYSIDE BUILDIN , INC..LATER. RE5IDENCE _ m 6q eaYviEw ciRc�E os-rRvi��E, Ma 3 BAYBERRY SQUARE, CENTERYILLE, MA 02632 9 j ml w F g PLAN PHONE: 508-771-1040 FAX: 508-775-0155 40'-bp 26'-0°: Ir= r ------------- --- -- ----, - _ I 2Xi0's �, 2x10's I I. 14; 1loo.c. = - Lu I q ; . 7 o -- - I w TxM x 4 fh R I I I o F. 4-p D. N I , l 0 3 mt=X�DCZD0_L1 mA aq z gm.1 . 2X10's N 7. NJ Gi 2:V4#' :!T x:I 6IIIII1 i0'O':s 91 .3No N317'=0° m N OIIIIIIIII - ..�.3Y;. d7 I` \eoU1ZIn ,l @ �A i. ' ZZ s L rt Jrn .� D Xm J ; � �Mr . l . _ V-4°. 4._0.., PROJECT: BAYSIDE BUILDING . . I�Nt1I :'. � i NCLI °Nm .m F THE SLATER RESIDENCE V E OST I ERVILLE, MA 3 BAYBERRY SQUARE, CENTERYILLE, MA 0263 a2 FLAN PHONE: 508-77 1-1040 FAX: 508-775-0155 . - .. ... ... " .. O N .. f P Pa. N D. sT N' A m m _ N-------------- O N .. .. 0 a 9'-4 1/2" 8'-4 I/V L lu c 12'-0" r . MOM — x :15'-8 1/2".::' _ h� N: -- ... 3 W .: <. .. U ^ W ' w e D W a ��1mfn'• < N 'NWul T' Oro C+ 0 . m - _ X X "W' 4.'1/2" 8'-4" jm 7m11 .'X N . .. W :. _ y� .. N O ..� _ 9'-2 1/2n 10 '® 5 j .__ N Z _ _ IV 12" A'. .. F. - - 12'-4 14':: L :; Z.: .. O IO N 9 7 w Q A1A I' :VJ A A 0° ... _ .. .. .. - N rn D r n m _ c _ - o Z � n A5Ns 1�-ttt-t cn Q mm s A QD.z O O � A .NDi to r tton O81L�1��'JI .. :$:rr Fz Dr® 3Z10 O n. _ _.. ... ..N � ... .. ... .. .. A PROJECT. - - m THE SLATER RESIDENCE BAYS I D E BUILDING, INC. z m 6q BAYViEW. CIRCLE OSTERVILL:E, MA - A 3 BAYBERRY SQUARE, CENTERVILLE; MA 02632. T � _ f SECTIONS: . PHONE: 508-77'1 -1040 FAX: 508-775-0155 n. _ ... ... _ _ .. .. DVf- .. n D p 6 LA . - - N p x 3 r11 .. . ,�. ... _... ... ... W ..o O: X , N _ 0 D ,N 03 �1 Z O 0 � _ 14''Ou , � bD z m D _ . 2x1o,5 m _ .. — _ ..7� 2a D <m _ r r 12-6a 10-6° 25_On pp m 12 12 tp A ® X ' Z � y� o � p .. ... 12 12: p :: :. :. .. .. .. 12 d 5 rn 1� Q w ... ... z .. 4'—Ba 13'-2' 19 (3) 9 I/4"LVLs i� N m m. �N 12 n HE i .. r O m 2x10's _ (3) q:1/41:WLs Q 9 m 12 n: I/4" L - . .. ... .. .:.. ... .(3):q VLs _ .. 12� A 10 D 7-1 _ 3 DZ _q 1/4'.' LVL O m — N -ti N _ Z o D _ A .. .. ... .. ,. .. ear _ i 12 12 - 12 12. O A PROJECT: . m.F '. _ THE SLATER. .RESIDENC.E BAYSIDE BUILDING... INC. 6q SAYVIEW. CIRCLE OSTERVILLE, .MA 3 BAYBERRY SQUARE, CENTERVILLE MA 02632 w f 9 STRUCTURAL. PHONE: 508-771'-1040 FAX:-508-775-0155