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HomeMy WebLinkAbout0235 BRIDGE STREET - Health 235 BRIDGE bSTERVILLE, A = 093 040 f i 0 4 � Commonwealth of Massachusetts 0178 -011b-60/ r- .. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessmentsa � tr! `............. 235 Bridge Streeta> u— - Property Address �& Estate of Charles Ford Curran " Owner Owner's Name i'n information is u required for every Osterville ✓ Ma. 026.55 08-08-2019 page. City/Town State Zip Code Date of Inspection r�I Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. , I ' i Important:When A. Inspector Information �/ gyp ! filling out forms on the computer, ! use only the tab Michael T Bisienere key to move your Name of Inspector ! cursor-do not Cape Septic Inspections use the return Company Name i key. 52 Rivers End Road � Compan `Address Teaticket Ma. 02536 City/Town State Zip Code 508-280-3356 S13938 j Telephone Number License Number I B. Certification i I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my I inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: � i 1. ® Passes '?" 2. ❑ Conditionally Passes j I ' 3. ❑ Needs Further Evaluation by the Local Approving Authority i 4. ❑ Fails I � � r jl 08-09-2019 Ins ector's Signature Date i 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 has a design flow of 10,000 gpd ort;greater, the inspector and the system owner shall submit the report to the appropriate regional office''of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ,I Please note: 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. i { t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 ! II � i i 'I ti i Commonwealth of Massachusetts rn ,�.p Title 5 Official Inspection Form I, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i 235 Bridge Street Property Address Estate of Charles Ford Curran Owner Owner's Name information is i required for every Osterville Ma. 02655 08-08-2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary f , Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. i i 1) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: This 4 bedroom home has a H-20 1500 gallon septic tank and a D-Box feeding a 12 x 50 leaching trench. At the time of the inspection there were no visible failure criteria found. i i . II 2) 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. I Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. j 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. I *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. i I ❑ Y ❑ N ❑ ND (Explain below): I' :i i; 4� I.I i I . I i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 I i I Commonwealth of Massachusetts ,�.p Title 5 Official Inspection Form !� I, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 235 Bridge Street I Property Address Estate of Charles Ford Curran Owner Owner's Name I information is Osterville Ma. 02655 08-08-2019 required for every i page. CityTTown State Zip Code Date of Inspection 'I C. Inspection Summary (cont.) I 2) System Conditionally Passes (cont.): h! ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. i i� ❑ 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): I i ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): !I ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): I i I� lj i ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). Thilb system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): it ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): d i i it i 3) Further Evaluation is Required by the Board of Health: j ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if� the system Is falling to protect public health, safety or the environment. a. System will pass unless Board of Health determines on accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: 1 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 r I I Commonwealth of Massachusetts l� Title 5 official Inspection Foam b Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 235 Bridge Street u� Property Address Estate of Charles Ford Curran Owner Owner's Name information is required for every Osterville Ma. 02655 08-08-2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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, l I safety and environment: r i; ❑ 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. I,} ❑ The system has a septic tank and SAS and.the SAS is within a Zone 1 of a public water supply. it ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water s supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen'and nitrate nitrogen is eq'aal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis m6k be attached to this form. i ` I c. Other: ° I ; t � It E jf t li f 4) System Failure Criteria Applicable to All Systems: , s You must indicate "Yes" or"No"to each of the following for all inspections: Yes No I . ❑ ® Backup of sewage into facility or system component due to overloaded or j clogged SAS or cesspool j El ® Discharge or ponding of effluent to the surface of the ground or surface wate;ra due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 t I Y II Commonwealth of Massachusetts I , Title 5 Official Inspection Form 1 (= r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i 235 Bridge Street Property Address Estate of Charles Ford Curran p Owner Owner's Name !I information is Osterville Ma. 02655 08-08-2019 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) E - i 4) System Failure Criteria Applicable to All Systems: (cont.) i� Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool I1 ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or.'I 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 tributary to a surface water supply. I ❑ ® Any portion of a cesspool or privy is within a Zone 1'of a public water supply ' 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 fe§,t from a private water supply well with no acceptable water quality analysis. [Ti is system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence; of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm II� provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. 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. Thea system owner should contact the Board of Health to determine what will be i necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a � E design flow of 10,000 gpd to 15,000 gpd. i For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. I i Yes No 4� ❑ ❑ the system is within 400 feet of a surface drinking water supply ,I ❑ ❑ 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 Protectioin Area—IWPA) or a mapped Zone II of a public water supply well iF t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage bisposal System•Page 5 of 18 , i !i, 1 i I,I Commonwealth of Massachusetts Title 5 Official Inspection Form " H r h Subsurface Sewage Disposal System Form -Not for Voluntary Assessments [� 235 Bridge Street Property Address Estate of Charles Ford Curran Owner Owner's Name information is Osterville Ma. 02655 08-08-2019 required for every page. City/Town State Zip Code Date of Inspection j4 C. Inspection Summary (cont.) � I If you have answered "yes"to any question in Section C.5 the system is considered a significant ' [ threat, or answered "yes"to any question in Section CA above the large system has failed. The :r owner or operator of any large system considered a significant threat under Section C.5 or failed F i under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owneer should contact the appropriate regional office of the Department. Ili 6. You must indicate "yes" or"no"for each of the following for all inspections: I: ,t I i! 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? CIF ® El Has the system received normal flows in the previous two week period? rIi Have large volumes of water been introduced to the system recently or as partjof ❑ ® this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not :,I available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? k ® ❑ Was the site inspected for signs of break out? !II` ® ❑ Were all system components, excluding the SAS, located on site? I ® ❑ 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? 't ® ElWas the facility owner(and occupants if different from owner) provided withI! information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has f been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue) approximation of distance is unacceptable) [310 CMR 15.302(5)] I ,I ki IipIi f(. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 i fir `l r , kl: Commonwealth of Massachusetts F �n I Title 5 Official Inspection Formz Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I 11 i 235 Bridge Street Property Address Estate of Charles Ford Curran Owner Owner's Name j�y information is required for every Osterville Ma. 02655 08-08-2019 page. City/Town State Zip Code Date of Inspection j D. System Information f +j F 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 �l ii DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 444 GPD I I Description: IIf I L 411 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ? El Yes ® '.�o If yes, discharges to Is laundry on a separate sewage system? (Include laundry system inspection jl information in this report.) El Yes ® No Laundrysystem inspected? No y p ❑ Yes ® , Seasonaluse? ® Yes ❑ No Water meter readings, if available last 2 ears usage d I' 9 ( Y 9 (gp ))� Detail j illy 1 i!r 6 I� Sump pump? Nli ❑ Yes ® No I occupied ,WI Last date of occupancy: ! Date !jlr 'I l�l t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 i 'i Commonwealth of Massachusetts ' Title 5 Official Inspection Form h Subsurface Sewage Disposal System Form - Not for Voluntary Assessments j / I ' 235 Bridge Street Property Address lit Estate of Charles Ford Curran y;r Owner Owner's Name t! information is required for every Osterville Ma. 02655 08-08-2019 EMI page. City/Town State Zip Code Date of Inspection t?t D. System Information (cont.) II I Ii . 2. Commercial/Industrial Flow Conditions: �1 Type of Establishment: ' Design flow(based on 310 CMR 15.203): '� t Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? El Yes ❑ No Water treatment unit present? El 'Yes ❑ N�o IF If yes, discharges to: i Industrial waste holding resent?tank ❑ Yes ❑ INNI p .h Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No ,II Water meter readings, if available: ki Last date of occupancy/use: ' Date Other(describe below): �Ir ,i a 3. Pumping Records: ¢i Source of information: Was system pumped as part of the inspection? ❑ Yes ® No fIf f I i If yes, volume pumped: gallons tll M ! I How was quantity pumped determined? �t Reason for pumping: aid s I I t5i 1 nsp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 i !ill. Commonwealth of Massachusetts ,j Title 5 Official Inspection Form Ifrf. 1 Subsurface Sewage Disposal System Form Not for Voluntary Assessments ;f 235 Bridge Street Property Address �� Estate of Charles Ford Curran l�f Owner Owner's Name `If information is Osterville Ma. 02655 08-08-2019 :f required for every i page. City/Town State Zip Code Date of Inspection D. System Information (cont.) f 4. Type of System: I ® Septic tank, distribution box, soil absorption system ' I ❑ Single cesspool j I, ❑ Overflow cesspool 9 r l I�� ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latestI inspection of the I/A system by system operator under contract ;lid ❑ Tight tank. Attach.a copy of the DEP approval. 'IkI k I ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information`. dl� 07-13-1999 ,i �i Were sewage odors detected when arriving at the site? ' El Yes ® No p�. 5. Building Sewer(locate on site plan): E „ �l I Depth below grade: feet I� It Material of construction: I' 'i i ❑ cast iron ®40 PVC ❑ other(explain): l� Distance from private water supply well or suction line: town water p pp y feet III Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 +kl; l ii Commonwealth of Massachusetts �n Title 5 Official Inspection Form ' itll Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 'j! ' I( 235 Bridge Street u Property Address l'f Estate of Charles Ford Curran l!i Owner Owner's Name information is �! required for every Osterville Ma. 02655 08-08-2019 IS page. City/Town State Zip Code Date of Inspection D. System Information (cont.) II IIII�� 6. Septic Tank(locate on site plan): 4 Depth below grade: e6t { €. Material of construction: fi ® concrete ❑ metal ❑ fiberglass ij g ❑ polyethylene El (explain) it I,I 1 I. i II I �1I If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ NO l� Dimensions: Standard H-20 1500 gallon ;l k., ti 4E Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 3211 i Scum thickness 1 '! 411 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 12 sludge�judge How were dimensions determined? ! Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At the time of the inspection the liquid level was at working level and the tees were in place. I recommend the new owner put the tank on a maint. plan with a local septic pumping co. The Barnstable Health Dept. has a list of approved septic pumping co. is tT 64jE �i{y! li ! 4, Ij lif ,s It qq] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page' !10 of 18 !P I',4 'al I �If Commonwealth of Massachusetts q� rn _ Title 5 Official Inspection Form I�; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I I, I11 235 Bridge StreetI� Property Address i Estate of Charles Ford Currant Owner Owner's Name information is required for every Osterville Ma. 02655 08-08-2019 i page. City/Town State Zip Code. Date of Inspection ; D. System Information (cont.) I' p;f gliC 7. Grease Trap (locate on site plan): 9h Depth below grade: il feet Material of construction: ,I ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): i J E ;pl Dimensions: Scum thickness : Distance from top of scum to top of outlet tee or baffle i �I{ Distance from bottom of scum to bottom of outlet tee or baffle ; Date of last pumping: Date I� \ Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integri)y, liquid levels as related to outlet invert, evidence of leakage, etc.): { f ,I I{ 1 ��I 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: ', f I '. Material of construction: . ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain{): Dimensions: 1 �' �C ' Capacity: l�l gallons If Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 4u :it i t Commonwealth of Massachusetts �- Title 5 official Inspection Form 1 �1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 235 Bridge Street 9 I,I Property Address b Estate of Charles Ford Curran Owner Owner's Name yl� information is Osterville Ma. 02655 08-08-2019 required for every page. Cityrrown State Zip Code Date of Inspection iM D. System Information (cunt.) i 8. Tight or Holding Tank (cont.) + Ik Alarm present: ❑ Yes ❑ No Alarm level.' Alarm in working )order' Yes ❑ Nol i f G�k Date of last pumping: Date lei Comments (condition of alarm and float switches, etc.): i aI *Attach copy of current pumping contract(required). Is copy attached? El Yes ❑ NC 9. Distribution Box (if present must be opened) (locate on site plan): ' 011 Depth of liquid level above outlet invert i �! ! i 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.): i At the time of the inspection the liquid level was at working level and there were no visible signs of�E solids carryover or leakage. III t I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 l I �I Commonwealth of Massachusetts =• Title 5 Official Inspection Form j ! J� FiI Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �I 235 Bridge Street ;! u� Property Address l i Estate of Charles Ford Curran ; Owner Owner's Name information is Osterville Ma. 02655 08-08-2019 j required for every 1 page. City/Town State Zip Code Date of Inspection 31i D. System Information (cont.) �! 4 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: LJI Yes ❑ No* i Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.)'. 'lit kl * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan,,excavation not requited): l' N� If SAS not located, explain why: I� i Type: ❑ leaching pits number: li; ❑ leaching chambers number. jk ❑ leaching galleries number: i w one 12 x 50 ® leaching trenches number, length` fli. : i ❑ leaching fields number, dimen ions: h�! i ❑ overflow cesspool number: ❑ innovative/alternative system E t Type/name of technology: k t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 I ti�i III Commonwealth of Massachusetts i f Title 5 Official Inspection Form !I Subsurface Sewage Disposal System Form -Not for Voluntary Assessmentsg �� pl 235 Bridge Street Property Address Estate of Charles Ford Curran14 Owner Owner's Name information is Osterville Ma. 02655 08-08-2019j required for every I page. Cityfrown State Zip Code Date of Inspection III D. System Information (cont.) tlIk i 11. Soil Absorption System (SAS) (cont.) N( I Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of s vegetation, etc.): sl At the time of the inspection there were no visible signs of failure criteria in the leaching. JI. y I �If t l tl`t i 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): II d, NI; Number and configuration y; yll Depth—top of liquid to inlet invert RIB I' Depth of solids layer ,I 'III t 411 Depth of scum layer II II( Dimensions of cesspool 4 Materials of construction Indication of groundwater inflow ❑ Yes ❑ No � ri Comments (note condition of soil, signs of.hydraulic failure, level of ponding, condition of vegetatio', etc.): Ir ICI 3 r� I All �I i jfllt if t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 tlf ; ul Commonwealth of Massachusetts Title 5 Official Inspection Form , !I - Ft; Subsurface Sewage Disposal System Form Not for Voluntary Assessments l 235 Bridge Street Ali u� Property Address �) Estate of Charles Ford Curran Owner Owner's Name information is f! required for every Osterville Ma. 02655 08-08-2019 page. City/Town State Zip Code Date of Inspection i D. System Information (cont.) �E III. 13. Privy(locate on site plan): Materials of construction: ; NIl ill Dimensions Ii Depth of solids hid kli r Comments(note condition of soil, signs of hydraulic failure, level of pondinLg, condition of vegetation, i etc.): "t t �E h1I j IC i II 1 fit y l; I�( lid �Ir : t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 M1�I I h!i i Commonwealth of Massachusetts €•ii �� .• ,t Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments gj! ill, 235 Bridge Street j 1 Property Address p1 Estate of Charles Ford Curran Owner Owner's Name information is k required for every Osterville Ma. 02655 08-08-2019I; page. City/Town State Zip Code Date of Inspection D. System Information (cont.) �i 14. Sketch Of Sewage Disposal System:'. Provide a view of the sewage disposal system, including ties to at least two permanent reference. landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: �f ❑ hand-sketch in the area below® drawing attached separately �11 it I F ail , ail s 51(t i ! li III i 6i 1► 1 i �,rlli t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 TOWN OF BARNSTABLE- LOCATION SEWAGE N -338 VILLAGE OS �/C ASSESSOR'S MAP&LO'>�� INSTALLER'S NAME&PHONE NO.-D��.O/NN RCA,&,7_R 3W 7SSd9 SEPnc TANK CAPACITY /.Soo GO/- /-ao LEACHING FACILITY:(type)-f / 17 (siu) )01'X.56 NO.OF BEDROOMS 3 BUILDER OR OWNER ClH rr(f S Pr•-ftK PERMITDATE: ? IQ 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 feu of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist ; within 300 feet of leaching facility) Feet Furnished by L/ A �� 1Z�n�►rx�eb 3Q' 6�aeas€ 1a v F i i F i i e 0 v 3 Fcc 00 THE COMMMWF-ALTH OF MASSIMMUSETTS PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE.MASSACHUSETTS r r 2pplication for Miopolat&_item t onotrturtion Permit I Appinaaon Wa PCnnu n,C4WWMC1( )Repair t. 1 t_Ctunptae k%.tern t j lndividuat t'oalpinCnla • Ir_Ga+?wa�:��ar.wwl.,a na. a3S Br,af�ye St, ds-i.-,-r.>�e. c, era:,:= , To W, .. - � �A.v.wM i�Lynpuc.l r i3✓rr�¢ a•t eri¢p,�.� /"site,(,r/Q^/ f7}!�Y✓.lif /'yaH CM/e95' 5`W_'Y.:6':.1G,2,L... In_,Wt.+`a\anm:AJi.'naa.:mJ Tel.tin. !a. grrr.\fir.�1,r-v.acil 1'cl.\a. /lTfi,e';)anf!••en IrC r SaJr/,-vC t> ��aly v r',F (� � 7 sat v/a.•rzd i - ( f?.aPo✓✓.%rk. IYJII aJad.y.i'ptaP'4./F'3.°,yH,� Y}pe of flailding: - r Dwelling -No.of 11wronms Lm Sin 'zr�BL ut.ft. G:afvge grinder(MO 1 Chber T"w of Building W,.of Pcrsr ns,,. .._., —Sho.i m>t ) Caletcria t ) Other Fixtures — --,— -- r Design Flow 44b g;di<ar prrday,(73 culatod daily flow_44 galinna. Pion bate tom:1.9 Nurnbciot,beets 1,14- RevisionIMte_,�! rills$+C>r id.a.y k�itCiO JrS `ram_P.^�S�Fyraa�T_?�' SiQ.4�F t= Size or Septic Tank __T)pn of S.AS. t2 X 6 i Ft("sc tt� - 1lestriptlanatsuil cr-2" f7 i,a>6t1;1( cf_� L r,A.%%13]�,C 2 12" A - Lcs+�`(�^a4e.-* J . � ,oy'e.ri� ,a--affit• �- a��o�A•�u •�o-�12r�ia z�r�-fisa.:.�e��.,cn, .�. ��..,�ic�a.b(.�', f . Nature of Repairs orAtten lens(Answer when applicable) { 'n%Dart la.at I petted: . at:Agaeemr Teundersigned aR�r*to enure tirt cursredior and mairtemiore of flue he afore described on-site a dispinal sy slem l in accordance with rho pro0sions of'ritic S of the P.®vin,nrle ode and rot to Place the system_in operation until a Certtfi- talc of Compliance has been imniso by this 11 Sighed Date Application,Approved by Date r Application D' f Disapproved far the i r follow n APP ppreT reCuons g (Fermi N.a Date issued' 'y r THE COMMONWEALTH OF MASSACHUSETTS AV BARK'$TPiBI.E,E:7ASrA4`HtiS@M - CtrtffiWte Of COmPUMEe THIS is TO ,dint the Savage Disposal System Abaodamad )by s .. Camstructod( ) > t )upgraded( } siffi 'G��r t ' Cl �}Cu' �^� � nos oe0ri COIIah9Cted tlt OOldarii�s .. - WldtflKtptOYiS[o080jTid0 attd11leforDisposal Constriction Plimit `�• t,�i,��"d� �� '. a�� Iaelittlta[ r issittgtce aft r be construed as a gft111tatitee that the i onllgtlf G - ---- Inspector r' t a i N 0 I I Commonwealth of Massachusetts + ,iP Title 5 Official Inspection Form �I I} 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 235 Bridge Street Property Address I Estate of Charles Ford Curran Owner Owner's Name information is ill t serve Ma. 02655 08-08-2019 required for every O J,.f page. Cityrrown 1 State Zip Code Date of Inspection ?+` D. System Information (cont.) r 15. Site Exam: P!l ® Check Slope 9!' ® Surface water �E I Ik ® Check cellar I �i %4 ® Shallow wells ' Estimated depth to high ground water: 8 plus feet �� feet s i Please indicate all methods used to determine the high ground water elevation: I ❑ Obtained from system design plans on record q4 I If checked, date of design plan reviewed: Date l ® Observed site (abutting property/observation hole within 150 feet of SAS) pli ❑ Checked with local Board of Health -explain: G C ❑ Checked with local excavators, installers-(attach documentation) t ' ❑ Accessed USGS database-explain: j You must describe how you established the high ground water elevation: Ail 1 augered a hole at a lower elevation and I shot it with a transit to show four plus feet of seperation:!!�! 41 N'!k yi If ihIllj. . S;fis l;} i c llil Before filing this Inspection Report, please see Report Completeness Checklist on next page. l t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 }}3 i • li t Commonwealth of Massachusetts + Title 5 Official Inspection Form7. I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i i 235 Bridge Street Property Address Estate of Charles Ford Curran I Owner Owner's Name information is r.l Osterville Ma. 02655 08-08-2019 i required for every t, page. CitylTown State Zip Code Date of Inspection j E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: it ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked �14 ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriateI 4 (Failure Criteria) and 6 (Checklist) completed ;M ® D. System Information: p t ?i For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached Nt For 15: Explanation of estimated depth to high groundwater included ii I r, r)F i 1 191,3 �! No NZ� ;, I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 i t i TOWN OF BARNSTABLE LOCATION SEWAGE SEWAGE # Tq-_3138 VILLAGE f�S l rr ASSESSOR'S MAP & LO') INSTALLER'S NAME&PHONE SEPTIC TANK CAPACITY A00 #26 " LEACHING FACILITY: (type) l, (size) /01 X'S(9 NO.OF BEDROOMS BUILDER OR OWNER UlfRrr[E.S Cr^C-ftW,v PERMITDATE: -2 l.Q, 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 wt4i A i 60?' 7 "A 3:2 6 ,60 t v a S a 1 i TOWN OF BARNSTABLE r C . LOCATION /a7t ,8lr, y� sy`r�� SEWAGE # VILLAGE 0.11 er/rI``l-e ASSESSOR'S. MAP & LOT INSTALLER'S NAME & PHONE,NO. o`i 7 A. Ae/'D yap�s�5 SEPTIC TANK CAPACITY Q3, S00 z5 LEACHING FACILITY-(type) 47/ f�2,s-,i3 size) NO. OF BEDROOMS PRIVATE WELL OR UBLIC W 'E BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: - VARIANCE GRANTED: Yes No �/ r 0k°�p5r" s 1 1 py�✓e ,� r J i t. / r/olye .57ree 6YKTIHG 2nl o� I'IEjV% P.ppITION IZ GZZINO ' ig ro•v► I Fxr pt.y(N =0 j 16'sTicK y o I ( I � 2XIOKL, I(o OG 14A 0 a of I AP PUZ y;a i Ice, I y-� scnh' gddb 2-13/µv 9'� LN. I 41F Tlk I©►.� Ili- P 2'2Ao N ti �I'fG H Et-I �� ca•u�z�w � . � � M IL IZ L 12 N .=a-^4 VWMLL 2AoYi a 16 O C- d, m to �rf5f rt2 ifcVJf N I �ipvt�ElL 44 F�f 2X61316"O G Q I 2Z-NO 11114 LYL of 1] T VlpU ! I m I 0 0 T %Al AtiIrIG,, er-! I . I i I �uGe � ter► ,L a hTIOU _ rflet2T P;7Looe F'LotJ 10 TOWN OF BAMSTABLE LOCATION SEWAGE # -338 VILLAGE ASSESSOR'S MAP & LO INSTALLER'S NAME&PHONE NO.1.A//ACA1I s/4 e SEPTIC TANK CAPACITY If 00 /Gkyf 141 a d LEACHING FACILITY: (type) (size) NO.OF BEDROOMS 3 BUILDER OR OWNER Ch Ptr`1 t.s PERMITDATE: ')I t C COMPLIANCE DATE: 1 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on 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 F 1 1 L' i 60 ...................._ THE COMMONWEALTH OF MASSACHUSE+ITS, }. �j u pipe I �- BOARD OF HEALTH J 1 .............OF....BZ7.!.rt�," _-_--.-..._.---_--._--.----.__-_---._._. Appliraiion for Disposal Works Toustrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (�n Individual Sewage Disposal Systemat: ..-----. .. -- ............................... ....0................... .............................................................. � 3s L ation-Address or Lot No. 45 ............................... a ....................... wner Address ...................................................... Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.........................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. 'of persons---------------------------- Showers — Cafeteria Q' Other fixtures ..--••-•----•-•-••-•---••------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length________________ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) . Dosing tank ( ) Percolation Test Results Performed by................•-----•-----.........-•----------•--------------•••--..... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_-___-_______-___._-___. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q+' ••••-•-•--•---------•-••......-•--•-....... --•--------•...........................•••-••---------•---------••------•---------•-•--..................-•-- ODescription of Soil........................................................................................................................................................................ -------------- - - ................. 0 Nature of Repairs or Alte —Answer when applicable._-- -_�____ _.�_ �..... .._ ---- : -----•----------------------------------------•-------------•------•------------------------------------ --------------------- Agreement: ............ The unders gned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL% 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' by the board.,pf health. 0, OVI Si ned_�Z / ' � Date Application Approved. By............. �. .....�' -- • ... ...........•-•--- -•----------- Date Application Disapproved for the following reasons:......................................................•---•---------------••-................................. .............................................•--•-•--••-•---•-----------......._.....•---•-•---............ Date PermitNo......................................................... Issued........................................................ Date lvo........8. .:: b o ........................... THE COMMONWEALTH OF MASSACHUSelFhT•S �--- BOAR OF HEALTH L. i .............OF...!?..:.. .-:-....... Appliratiou for Uhupus al Workii Tumitrurfivaa Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: f --•" 1 catiio�n--Address or Lot No. S.S........-. 4 _.:^.'.1:: :=--4.._�:............................. ........................................................•. wner �, Address -• .. ,W1 ,.....�.' .. ...t_ e!C' '`.......................••------•--•-... ..----..:._._.... .¢� ;. .......................................•... Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a 'Other—Type of Building ............................ No. of persons_-_--_--_-__-_-__.__.______- Showers ( ) — Cafeteria ( ) QI Other fixtures -------------------------------- - W Design Flow............................................gallons per person per day. Total daily flow.._........__.___...____._.._._.............gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by........................................................................... Date...................................... aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---------------------------•------....._....-----••----.............-----------••---- ...... -------------------------------------- ... ODescription of Soil........................................................................................................................................................................ x w --•--•--•-•-------------------------------------------------------------------------------------------------------------------------- _. ------------- UNature of Repairs or Alt ions—Answer when applicable�'� _. _, . � � .-,d i� --------------------••-• .----•-. ••-------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1Z 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beef su, by the boar pf health Signed ¢$-.. 44/ - Date Application Approved By........... jam' —.,-A'-.....etf -. ........-•---•-- ........................................ Application Disapproved for the following reasons----------------------------••----•----...--------------------.....----------•--•----------------------••--•-•••- _ ..--------••-•--•---••-----------•-•--------------•-•----•---------------------------------•-•-•----.......---------------------------------........................................................... Date PermitNo........................................••-•--••--•--•-. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS. .-M BOARD. F HEA TH "'-'?�..............OF.. ... . :. F �aer�ifirtt�� of f�u�t�li�a>rtrae TWHIE CERTIFY hatSewage Disposal System constructed ( ) or Repaired 1 by THI T CERTIY hat the, '- Installer_- ....- --• ------------------------------------------- 'ell- at.. ��'y'` �-.......---`---------------------------------------------------•-------•-•------------------•----------------------... has been installed in accordancE.with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..... ........... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFAC ORY. DATE .----•---- Inspector------. 71 -' t ....................................... THE COMMONWEALTH OF MASSACHUSETTS ��...-� BOARD OF HEA TH ?.......OF... . .. ., . ........../,/ ��' ................:............................................ No..e.�^�:n/, :o FEE.. .................. Diupus 1 rki nutrudiuri aerutit Permission is hereby granted...... 4 r ? t; to Constr>ct ) or Repair ( n Individual5ewage Disposal System -_ -- .;;r ------ 'at No...,: am Street as shown on the application for Disposal Works Construction Permit No..�.................... Date4.......................................... ..._......�'y+'••'y�_ y�O. H ____••__.____......._.......___....Boath DATE---- ---------�. ................................... ,CORM 1255 HOBBS &WARREN, INC., PUBLISHERS l i '73. / e f-,,... I Fee _ THE COMMONWEALTH OF MASSACHUSETTS W f.ntered in computer: `' Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpplic tion for DioponY *p$tem Com6truction VCrmit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. fl?35 rgri dff Sf 6,s4crvi%1 e_ Owner's Name,Address and Tel.No. Charles eur,-a(,L Assessor's Map/Parcel In a_r 9 3 I aL r@<..L 5/0./ �s¢e r✓�i1 /rl A CU65S SAS- yae aGe2o2. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. netc.r 5u1/."va1-2 4-".9•ShG 7 P4,rKt r 2 cC Os f tr r,%�� lY119 oa roS.S .33 y Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(kc) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 4AX3 gallons per day. Ca culated daily flow 4 gallons. Plan Date hCOIN L %fit o k Number of sheets k Revision Date k B 9 'D+4 tm 6 z"?i�§ Title _S rTE� ?(-4r,J 1?2Qk66D 1 Tt— I wtPe20JQ,1,Lera.t'�,, lt'- 23 i GeIo&C—:"�' Size of Septic Tank `�© Type of S.A.S. Description of Soil 0-2" D f tyC— Z-aotF A,& %0__ 10-12,17(2 )2`'—28`1 - wl Ep r-A,0Jp L0-44 4A 29`` " 12b C. COAIM6 SPV,.-k Yel��S Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environ enjal Code and not to place the system in operation until a Certifi- cate of Compliance has been iss by this B of Heal �� Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. I crg,-3_D,� Date Issued ..0 /7/99 s_ r Fee ! ntered in computer: v � THE COMMONWEALTH OF MASSACHUSETTS �- _ ��'� P yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 0(ppYication for �Digosml *pgtem Construction 3permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. e7 3,; ,(� ol� St 6S4cr✓.7 e- Owner's Name,Address and Tel.No. Cha rlP4 C U r/a ct Assessor's Map/Parcel /J7 Q GIJ Pig�"&t O s f e r✓,'il{, i7'7 f7• Gd G�S` 3 0cY- rf��'-�?loa1,2, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. lift r 61,011 ian f E�' >v/i r�i 1) /_1 1) --Z✓7C;, 'J aot r,4Vt r' I?f-L 0Si'rr✓,%1e n7,9 Odb•S`s_ Type of Building: Dwelling No.of Bedrooms Lot Size 2A600 sq.ft. Garbage Grinder(t4=p) Other Type of Building No. of Persons Showers( -) Cafeteria( ) Other Fixtures - Design Flow A40 1 gallons per day..Ca culated daily flow 4 Aq F gallons. d Plan Date ea-,L \A , ,97) Number of sheets* 1 Revision Date T/\a 195 6PA tm 3 Title 5 lTL- 37c tavV ?a0AMSD S1 wl?r WCW-ie,_k '5 a-Z_�5-6 e\D6C=19M Size of Septic Tank 15: Type of S.A.S. l Z X•Sn r'S(�2 z Description of Soil O-7" a Lu E tO r-s-;fir es L art=M-I nE _ 2`=IZ" A 6A C x ►A--(Q -- 12`'— ZS`' � W1eD -e- ��� �,� Z8'' Vzb,! C Cok�SE SPV.a ye-1. Nature of Repairs or Alterations(Answer when applicable) f Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of.the'afore.described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environme tal Code and not to place the system in operation until a Certifi- cate of Compliance has been issV by this B d of Healpt Signed Date Application Approved by � / � Date 4� Application Disapproved for the following reasons Permit No. .!bate Issued 7 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On/p�it Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by L' �`. at has been constructed.in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9"1 3 25P dated 99 Installer ',9r lr t /))c rr, Designer The issuance of this rm(t s�/alln be construed as a guarantee that the s to will function asreslgne q� Date ! VI G Inspector �11 Ji JA No. Q ^33� --------------------------Fee /W THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwigpoza[ *pgtem (Construction Vermit Permission is hereby granted to Construct(Repair( U grade )Abandon( ) System located at 2 3 0 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 th's- rmit. Date: �°' �;� Approved • `"� 1I Town of Barnstable P# Department of Health,Safety,and Environmental Services dlV* Public Health Division Date Q 367 Main Street,Hyannis MA 02601 Date Scheduled' b g q9 Time C�o &M Fee Pd. 9/D O -Soil Suitability Assessment fort'Sewage Disposal Performed By: Pe,4cr Su Y varl /0., ' Witnessed ByINFO .1 Location Address Owner's Name a35 /3r 2e S/-ree)- Char/,eS hurrah Osterv�'/Ie Address o't 3S ,Br,ol�c- fit, Osferv� /� Assessor's Map/Parcel: " '7 93 0 a re e-1 1 0-� Engineer's Name Pet¢r Su/) NEW CONSTRUCTION REPAIR Telephone N/1 i✓lcY7 L r7Ji nrPrr'n9 S emu- ra.�- p �a�-3 3� Land Use 1Z L5tt7Eaf.T A t` Slopes(%) L E55 TK*Ic .% Surface Stones k1'b Distances from: Open Water Body 3LO ft Possible Wet Area P-kz-C ft Drinking Water Well {c. -ft Drainage Way 040 ft Property Line 10} ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) (v L � Z0, t Parent material(geologic) OOTWASM Yt pt N Depth to Bedrock 300 + Depth to Groundwater: Standing Water in Hole: g6 Weeping from Pit Face 0 ' Estimated Seasonal High Groundwater D%C-e-q EC) Sits 1.5 ►.of.AyC_p OLI LITTLE: kSL/k"O wVIIActi is gti,1 .................................._.... ......................:,. ....:..:.,.:..:,,:...:..:,...:>;:.,......::;.:::;. <•.:;;:<;;:..:...,.............:.,......::..... ...,......,..::...,: : ::,.::. 16 �>al? E7CE1[ YIA ::Y11�I.t�':t3R. EA ONA .<HIGT.'�? AER:<T ) LE<<::: ><><::< <. .............................................. .. ............. ......................................................:................... :. .:.:- l t -AGt a sue.<.; Method Used: 1�85F1LY,4Tlp,.� �yt'Fitt►U CTS 0 1 "C {7,0 A-t-V. Mfg Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. ..Index Well N_ .Reading Date: Index Well level..___ Adj.factor Adj.Groundwater Level :.;...; . PER+GaLATIUN TEST Daft ,me: .:::.:.::.:::..::...:.:.:....: .. :::......:.:::...::::..::.: ............._::: Observation 25CTA��orJS tt.� LG$5 tme at 9 Hole H " IS PA� Depth of Perc a, Time at 6" Start Pre-soak Time® Time(9"-6") End Pre-soak Rate Min./inch LESS nrloc" Z+MtW 92 t t_A 1 ' Site Suitability Assessment: Site Passed YES Site Failed: K10 Additional Testing Needed(Y/N) N Original: Public Health Division - Observation Hole Data To Be Completed on Back--� Conv: Annlicnnt 4 DEEP,�BSIVATIdI Y,QG».. ..:.::::. Io1e# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % P„n.�e�c,s s toy 2 3 I 1 ►.le, O ��v loyf� s�to n1ti 6ow.� a�.�as v�►Ep. , Ib`l•2 w�cc> Looms 29 - i2o` C loll e 6/S DEEP OBSERVATION HOLE LAG: Hole Depth from Soil Horizon Soil Texture i Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % .. DEEP OESERVA'�'I!) i RULE .......T _`Tole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell)- Mottling (Structure,Stones,Boulderes. % .....::. DEEP OBSERVATION RULE LOG. Hale:;# : : Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure;Stones,Boulderes. • o 4 5 Flood Insurance Rate Man: 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? 92 ?t_t)5 If not,what is the depth of naturally occurring pervious material? Certification I certify that on AfR—%L DS- (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature ��.�[X.�� Date i� p M � y. z x o J ti r w -t aJ � • p, j t W . < < Fl . WIt .. �DINING . _ MOW LPJINDRY ., i ° w a. LU rDEN Lu ` Y WLL o- O .• a _, . . � � a w r. .. - ... !i Z y _ ( � I InLn uj � V cmv w - MAY N9;3015 . + t » E X 1 5 T I N G F I R 5 T FLOOR PLAN y EX-1 G j}}j,,,������V - A-1tAg - r T AL PMT FL,W.PV A6E ]bbl - - t d. I y - r H .q x ----_ ___ Y „ �i A ; BATH , y ILI ----- ------------------------------------------ • e v h • •t it R „ 1 , , e x 1i it if sane' — -A -------- - Ing --- - ' ,r 1, r tts� g s ss - (31 _ f BEDROOM BEDROOM - ... .. I ,, .. Ok LL iu Z ur F Jb CI— Ll ` ' 1 4 E X:I S T I N G E, E G O N D P L O O R F L A N : -� �� .. .e c.a�e: i/a• i.-o. �sam�.eo.roour,�wr roues ewi - � - � �e T A&ISM=P poi W.T%WrA6£ 0 EX-2 , UjI � M. � O 0 ' _ - r o _ ..... ..... .. � 2so• .: � 9',ti �I ((ANCHOR EOL"S SPACED A-� C'! � ..... ..... ... ...:. ... -.... N� FLLL PGRED FOUNDATION a-D• �• �-0•I ��4t; j G C�4;Fsw'i�17 ni .. DROP TOP Or FCOTIN65 TO I4 t i .... ...... . ...... .. !� A-0'SEEN GRADE AT TiIE '' p). pp 3. .. tA' .. ... .. ... .. .. .. ADROP OAR[O HALL- rSU VG: � _ _ . r� v � r3\ %dd 0 I r t ..... ........ ... .. .. .. .. _ .. A,..... .. .:. �. .. ;:.. .. ... .. ::. ..1.. :.w.: I FRAMED KA I i j. _ s a � ---- - ,>e r� , brua I I o TS DROP TO-OF L FOR RS a. I �. P.T 2xb SILL N/5W ANCHOR Q a .... ... I � .... :. :• HATCH F EXISTING- FOGTIW ATMLL—.. .^-'0 1 °ACTS AND:X3'WARS �.FViSD-E068 _ ..... .... KICKS EXISTING-F ICATE LL .. .\. .. "'I� SPACED PER LOGE. . - ..... HEIGHTS A51Kri'LA1EC. ....:$ ...-. .�DRE551NG o ' ..... .... I ...... DRILL IN 05 RE5AR AS' DROP FOOi1N6�AT THIS. .. ...... .. .. • I .. .. .,. -.... i' .... .. ...... ... __ LdLLAR TIE AP.C/E m a� X A O�UIRED aT xr!ni \ POINT 70 ALJJY.^.vATE A - K \ -_ -- .;. FV.L HEI6Hi>G,^n.MA'NTAM O �--.va _ . " TOP OF K41L HE16HT .. - i L O ..... .. .... .. .... p 1 .... .BEAM POCIE,, ....ISEW.� POC'' .. -- } '5�I �i I/2" 22. SI f - ggyy 4 .. -, DRILL IN 15 REEAR ..... .. :.. INTO EXISTING E N W'O •>'� 'p ..... .....FOUNDAtICN A9 ..... I _ .. .... /:1 .. .... } _ - Y y .. ..: REMIREC: II;:!. NDoa t� '.. ''BASEMENT LrtI\� •/ ! _ ' r '' O REMO✓c ALL Ec TER10R"'—'. f L' 3 .... .. .. �„w!!( �. CROP TOP OFN 4.CATIGN. ... - DtW PND RE-SIRrALE. ��. p C .-.I O . •. .. .. .. HALL TO ALLON ACCESS TO .. b .. .. rri'N 6YPSUHI BOARD."- .. MASTER 1 �'T� AAN-2a2a _ .... IN EX$S.Wt ANC TO tPPRY.ANiNS .:.. ..... Q L� ... ..... - .... CREA1E NEN A,',E'_S W0 .. .IN EXK i!NS.WA.L/4P"RX a'.0'. ..... ..: :....: EXI5TIW CRAW-SPACE .. .. .. .. m. d ,1 BA I!iI. y STERdy h... .. ... .:� m .. ..aE.AwINDon - - EEDROOM.Y .. Z: -. ..... .... •—� ,WNC.DLSTW`/ER AT ,?� .' !__._._ ;I' LPPER LEVEL .. .I O ../� PAC-0TSURF_ALE-- — 0 EB +I ...... .. .. ' A.STIY6-LHINOEl' _ I J \ �ril'H IX S"FAPPINS H�— ..... P057 UP FRG.EXI5T!N6 AND CHIMNEY FDOT!b TO \ �! _ \ I .. .. SEAM POL ET--- .. OND.RSID DF N-W STEEL W .. .. BEAM TO SUPPORT .. o.rr�al.� FF�+x ...-. Y .. _ _ LANTILEw_RED END. o EXI5TIN6 D-N. /`-_ - -' UP To { STEEL A,.AEIO�- - ET SRALE:A`$REWRED: .. .. .. — I FIR PLA S" 4 .. LLJ ANPh c sd LOi C SI-AS-- I Tu 3', -: SLOP-D iO OJER- 1, .. in I' O Q ErISTll�iY.15E_ - LIN N. . ! FOJND 71CN YVry.L 4pR HEAPED D TO C .} i .. .. .. -10 V2 V- I, b O _1 3 __ it-6' :E_�._I'� � t•�`- �� � I- z °Z f �F�y Id7 - EDSE CF FLA - ii AM 2a2a -I', / 111�� H N. .. .. .. ... O: .: .: .. - DRILL M c5 ..... .... VAV_iEC C O .. .... .... !� _ >. IVTO EX ISTIN6 � ...,'6' F[ CF !_--_.-- _ .-..__ _ ._...._ _ ri Q. ...�.... FOUNDREMIRATION AS - g O .. .... —DROP TO ACCOATT11!5 -�: rc`I, � ...... ...... .:.. � ( POINT o Lc DATE A .. .... .. .... N T A ONtO - - I FULL POUF MAIMAIN' .. I ... ... I ` TOP OFF N,wA1 N"cIC,R _ .... ... .... ..:.I HATCH FOOTIN>-vfP^iS I . OF EXI5TIN6 FROSTINLL . .. .. (.- NEI6 AS NOILATEP. C4LL IN n5 REBAR, - 1 !t. � dstC FG 5,201] .. .. I i REc'IR-c r1AL_D AT FOOTING I A / ... .. .. ND CONTt-ITOR TO ENSURE 1 I' _RC TWAL L ':... ..FULL Pa REP FaNV ATO I STABILITY CF ENIS M ... I : - .. .'... - ::.' .: .. .. .. .. .. dr6•An PERATGR I �1 I'S .•. ..A5 NIT-T MDERMIN TrE - .--- - . .i .... I FOMATIO'.FP.:STW.^_LS I Y (ANC-OR BOLTS SPALEO AT 3 .G 1.— —_----.— t . EXCAVAT ON ANC COVS"Lt TIOI: � 'Ary 3,^C1' . : ..:n F0U.,N:DATION FLAN' .. S T F L O.O:F—:F L A N .. .. ... _ -�9O ALE, /4 . 1•-C. ... ::�.: Oyu R/^GE STiQ`cLc�,�� a �- 2jh � E X Cb \ �y0 �3 \ wI Q \ Aa \ry Z 2 . X `o \1 J h \ PATIO �IDDiTION p �I G IRXIST. L.EAC14ING ;:) 3T 10 TO Bra�eMOVsp ��++.✓T a .-9 T... A RAC E o TANK N �4j0 Z 50�. PR►MARY 0. Q w�� - - - -- --- -- g 566'S81I0"s ?, - I6I .Oyi c -- a, w PLAN VIEW Scale : I"= 20, , Perc Test P-9412 'Date 4129/99 " SEI P,Sulliwan"_: BoHealth Donna Miorandi Test Hole 1 O Pine Needles&Leaf Matter 10YR311 2"-12". A Loamy.Sand,some roots 1OYRS/6 12"-2& B Med.Sand,few med roots 10YR 6/4 26'-120". C Coarse Sand,single grained 10YR6/5 Water Encountered®96"E1.1.0 . Perc @ 36" Pre Soak 15 Minutes Drop 12"-9" 25 Gallons in less than 15 min. S 25 Gallons In less than 15 min. Class 1 Material _ r - '0 .2 Meryl , pis", J Isai>e e NOTES DESIGN DATA Family L Water Supply ForThis Lot is Munici at Water. With Singl no Garb Garb -4 Bedroom ith age Grinder .ST/QEE,. iw Ltication of Utilities Shown on This n Are Approx. Daily Flow=4 x 110=440 GPD Atteast72HoursPriortoAnyE> vationForThis SepticTonkr440GPDx200%=880GPD Project The ControctorSholl Makd The Required Use 1500 Gallon Septic Tank n°- v �o Notification to Dig Safe(1-800-$22-41344) _ „ •n " LEACHING AREA t I 21'2 o I,E The Contractor is Required to Secure Appropriate _ •` eR oeI . I 440 GPD/0.T4 595 SF Required " Permits From Town Agencies For Construction a•OO o 1 Iti7.36 Defined byThis Plan. ,�• �'° .„fir •�; • X- le Bottom Areas 12�x 56 a 600 S.F � zr • " _ 4 Install Risers as Required to Within12 of 600 S.F.Total Provided !`� I :. x — . LEACHING.BED DESIGN . " ;o , _ o ands rye. , . . 13.All Structures Buried Fovr Feet More or Subject All Pipes to be Schedule 40.PVC Ti.��, ' �Qa to Vehicular Traffic lobe H-20 Loading. Perforated With Capped Ends.Use o -Bti •' .3 i 6� Septic System to be Installedin l�ccordance With 3-4"Distribution Line in Leaching b P Bed in a 12'x 50'Washed Stone .. ° �, 310 CMR 15.00 Latest,Revisioh And The Townof Field as Shown e ' Barnstable Board of Health Regulations. It HIV a Z All Piping to be Sch40 PVC \ �ti LOCUS PLAN \-541- p Scale: I H= 2000' \ � Assessors Map 93 a .� Parcel 40-1 o N `1 Zoning : RC Setbacks Front:20� 9 \ti' - Side: 10' A�pj Np F.G.12.4 i F.G.9.0 Rear: 10 X 2� See Note 4 10. � Inv.7.5 S1500 Lion Bot.El. `0 1 1-1 u 0 ' Septic Tank - 8.0 Beddinq s 6 \z Qa \� ✓, �ti ...,, " Per Title 5 ' \ `I° PROJECT SITE IS LOCATED WITHIN Bottom of Test Hole El.-1.0 I�j \ \ / - EX sT, ,1 ti Ground Water Encountered El.*1.0' FLOOD ZONE Al (EL 11.0) AS SHOWN ON FIRM PANEL 18 of 25 h \ \ PATIO 2.y i PROpbSEt� \Z / �1 COMMUNITY-PANEL NUMBER •y� I2, \ � �ODITION _ �o \ -- ----t ti ,r / 1 DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM 250001 0018D 12 -\.y.o5 Not to Scale i � MAP REVISION DATE:. JULY 2, 1992 L? VzXIST. 1-•EAGNING PITSa M �� 10' TO B6 iZeMOVmO --�� l� t�_-X 1ST I MIN, all GARAGE 2' Finish Grade (J PR©aos 1 � — S6PT1c N o .� ART O-BOX TANK \ \ ---O)mpocted,Fiil 3! Maximum Fabric PRI M ARY 01 CQ a -.. —- - - ------- -- o Pea Stone 56 So'58' 1O"E rh 161 .OLI/ °` \ �i ��°,a o 4"O Perforate 3/4"-I I/2%outile PVC Pipe Washed PLAN VIEW ll , ,, 3-0 3-0 3-0 3-0 Scale : I"= 20' • i CROSS SECTION OF LEACHING BED Not to Scale i i Pere Test P-94 f 2 Date 4/29199 SEI P.Suftan BoHeallh Donna Miorandi 1 Testof 1 0"-2" O Pine Needles&Leaf Matter 10YR3ti 2"-12" A Loamy Sand,some roots 10YR516 12'28" B Med.Sand,few med roots IOYR 610 Directions to Site: Route 28 toward Osterville; Left onto Osterville West Barnstable 28'-120" C Coarse Sand,single grained 10YR615 ! Road; Left onto Main Street; Right onto Parker Road; Right onto West Bay Road; Water Encountered®96"E1.1.0 I Bear left onto Bridge Street; house is on the left #235 (after going over the draw Perc Q 36" Pre Soak 15 Minutes bridge) Drop 12"-9" 25 Gallons in less than 15 min. 9"-6" 25 Gatlons in Im than 15 min. Class f Material SITE PLAN PROPOSED SITE IMPROVEMENTS �jjA OF Q# „ A T *` PETER �� 235 BRIDGE STREET SULLIVAN � ca NO.29733 OSTERVI LLE,MASS " CIVIL FOR Ojs CHARLES CURRAN j �$10i+ �' a SCALE: AS SHOWN DATE: APR. 1411999 SULLIVAN ENGINEERINGINC. 5�18l99 OSTERVILLE,MASS ATTACHMENT A Cl 0 1 (o