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HomeMy WebLinkAbout0435 BRIDGE STREET - Health 435 BRIDGE STr,'MTERVILLE q ll p II p I pp si 1 c Commonwealth of Massachusetts W Title 5 Official*Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 435 Bridge Street Property Address Judith Dow Owner Owner's Name t information is MA 02655 10/31/14 required for every Osterville page. City/Town State Zip Code Date of Inspection r� Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completene`ss'checklist at the end of the form. Important:When A." General Information filling out forms l; on the computer, use only the tab 1. Inspector, . key move to D your cursor-do not James Ford ` use the return key. Name of Inspector I• rab Company Name P.O. Box 49 Company Address A �r Osterville MA 02655 City/Town State Zip Code 508-862-9400 S12482- Telephone Number License Number B. Certification s'a I certify that I have personally',inspected the sewage disposal system at this address and that the information reported below is f. ue, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails El Needs Further v luation by the Local Approving Authority 11/13/14 Inspe s Signature Date r, The s m inspector shall submit a copy of this inspection report to the Approving Authority(Board of Hea or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describ4s conditions at the time of inspection and under the conditions of use at that time.This inspec'kion does not address how the system will perform in the future under the same or different conditions of use. 7. 1 l5ins-3/13 Title 5 Offici I s ction Form:Subsurface Sewage j0iosal System-Page 1 of 17 _ Commonwealth of Massachusetts Title 5 Officia,1,Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 435 Bridge Street Property Address Judith Dow Owner Owner's Name information is required for every Osterville MA 02655 10/31/14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) i Inspection Summary: Cheek.A,B,C,D or E/ always complete all of Section D A) System Passes: i. t` ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or[lin 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. i a Comments: ;I 4 B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, vy.ill;pass. Check the box for"yes' "I,o'; or"not determined" (Y, N, ND)for the following statements. If"not et determined," please explain.. �l The septic tank is metal and'over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank Is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N F ,❑ ND (Explain below): i. Y , G` i ,i ii ii l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 fl i i, r i Commonwealth of Massachusetts Title 5 Offici�',I`Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments h 435 Bridge Street Property Address Judith Dow I' Owner Owner's Name information is MA 02655 10/31/14 required for every Osterville page. City/Town I' State Zip Code Date of Inspection B. Certification (cont.j '; ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): El Observation of sewage'backup or break out or high static water level in the distribution box due to broken or obstructedpipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with.a�pproval'of Board of Health): ❑ broken pipe(s),are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): s ❑ The system required purnping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): Elbroken pipe(sl)iare`replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstructioh,isiremoved ❑.Y ❑ N ❑. ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to..protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the'system is not functioning in a manner which will protect public health, safety and the environment: St ❑ 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 I. t5ins•3/13. I' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 OfficiALInsp ection Form _ Subsurface Sewage Disposal;S,ystem Form -Not for Voluntary Assessments a 435 Bridge Street I Property Address Judith Dow Owner Owner's Name information is MA 02655 10/31/14 required for every Osterville ;. page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a. eptic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a rseptic tank and SAS and the SAS is within 50 feet of a private water supply well. ;, I ❑ The system has a sepCic'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 deterrrine,distance: t, **This system passes if We well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates:'absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. E is n l It 3. Other. I i . A : q D) System Failure Criteria Applicable to All Systems: I i You must indicate`,`Yes" or".No"to each of the following for all inspections: Yes No ❑ ® Backup,of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent toIthe surface of the ground or surface waters ❑ ® due rto'*an overloaded or clogged SAS or cesspool ❑ ® Static Liquid level in the distribution box above outlet invert due to an overloaded or cogged SAS or cesspool ❑ ® Liquid;depth'in cesspool is less than 6" below invert or available volume is less thari"M day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 t li t. kk 1• Commonwealth of Massachusetts Title 5 Officiai` Inspection Form Subsurface Sewage Disposal�.I$ystem Form - Not for Voluntary Assessments 435 Bridge Street Property Address �' '• Judith Dow , Owner Owner's Name 1. information is llletery required for every OS MA 02655 10/31/14 page. City/Town State Zip Code Date of Inspection B. Certification (cost.)`; Yes No i. ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any potion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from;a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000'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.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be 6' n.sidered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems., you musty indicate either"yes" or"no"to each of the following, in addition to the questions in,Section D. Yes No p ' ❑ ❑ 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 E] the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone ll of a public water supply well If you have answered "yes" to.any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 ij Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 a, ti • r r i i " Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal'System Form -Not for Voluntary Assessments 435 Bridge Street Property Address V Judith Dow Owner Owner's Name information is required for every Osterville MA 02655 10/31/14 page. City/Town ! State Zip Code Date of Inspection C. Checklist it t I Check if the following havesbeen done. You must indicate"yes" or"no" as to each of the following: Yes No El El Pumpipg,information was provided by the owner, occupant, or Board of Health r .. ❑ ® Were 66y of the system components pumped out in the previous two weeks? I ' ® ❑ Has ttlesystem received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® El Were as,built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was thelfacility or dwelling inspected for signs of sewage back up? ® ❑ Was tie`site inspected for signs of break out? I i 1" ® ❑ Were'all`system components, excluding the SAS, located on site? it ® ElWere the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site-has been deter..mined based on: ® ❑ Existing'"information. For example, a plan at the Board of Health. ® ❑ DeterPnihed in the field (if any of the failure criteria related to Part C is at issue appro�imation of distance is unacceptable) [310 CMR.15.302(5)] D. System Informatibih Residential Flow Conditions: i Number of,bedrooms (design): 4 Number of bedrooms (actual): 4 .�DESIGN flow based on 31'0 AMR 15.203 (for example: 110 gpd x#of bedrooms): 440 it t5ins 3;13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 ii Commonwealth of Mass'ichusetts Title 5 Offciald Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments {l '°M�,••''- 435 Bridge Street I Property Address S• Judith Dow Owner Owner's Name i information is required for every Osterville MA 02655 10/31/14 page. City/Town State Zip Code Date of Inspection D. System Information �p Description: 1. j , it I j , Number of current residents,; Does residence have a ga'rbge grinder? El Yes ® No t Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected?. El Yes ® No �1 4 j Seasonaluse? ' ` ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: unavailable ij i Sump pump? ❑ Yes ® No Last date of occupancy: k currently Date Commercial/Industrial Flew Conditions: i Type of Establishment: } Design flow(based on 310,CMR 15.203): Gallons per day(gpd) Basis of design flow(seatsfpersons/sq.ft., etc.): i; . Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? El Yes ❑ No is Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings; if available: l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 t • Commonwealth of Massachusetts W Title 5 Officials Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;i 435 Bridge Street Property Address Judith Dow Owner Owner's Name information is required for every Osterville MA 02655 10/31/14 page. CitylTown State Zip Code Date of Inspection D. System Information. (cont.) Last date of occupancy/use: Date Other(describe below): t General Information Pumping Records Source of information: ° Unknown Was system pumped as past of the inspection? ® Yes ❑ No If yes, volume pumped: E.' 1500 f: gallons f How was quantity pumped•;�determined? maintenance Reason for pumping: Type of System: i ® Septic tank,'distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system s y (yes or no) (if yes, attach previous inspection records, if any) ii ❑ Innovativd/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest insipection:,of the I/A system by system operator under contract ❑ Tight tank Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 t; i; <,e'� Commonwealth of Massachusetts Title 5 Official., Inspection Form Subsurface Sewage Disposal rpystem Form -Not for Voluntary Assessments 435 Bridge Street Property Address Judith Dow " Owner Owner's Name information is MA 02655 10/31/14 required for every Osterville i page. Cityrrown i State Zip Code Date of Inspection D. System Information (cont.) ,I Approximate age of all components, date installed (if known)and source of information: installed on 3/1999-per as`'built Were sewage odors detect�d,when arriving at the site? ❑ Yes ® No Building Sewer(locate on,site plan): Depth below grade: 1 ± feet Material of construction: ❑ cast iron ® 40P.VC ❑ other(explain): i Distance from private wateI-supply well or suction line: feet Comments (on condition of:joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): 16" Depth below grade: feet Material of construction ® concrete ❑ metal ❑fiberglass ❑ polyethylene Elother(explain) l; t If tank is metal, list age: ' years i Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: li 1500 gal. it Sludge depth: (! 2 ii t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of M.ass,achusetts Title 5 Officiot Inspection Form Subsurface Sewage Disposal.System Form - Not for Voluntary Assessments 435 Bridge Street F a Property Address Judith Dow Owner Owner's Name information is required for every 0sterville MA 02655 10/31/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 30 3 Scum thickness . E, 6 Distance from top of scum 4atop of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 12 How were dimensions determined? measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tees were present. There,were no sign of leakage. } r n . f, l; Grease Trap (locate on site plan): Depth below grade: feet it Material of construction: ❑ concrete ❑"metal-:. ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: i Scum thickness F, Distance from top of scuAcll tqp of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date E; t5ins•3/13 ! Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i; r. Commonwealth of Massachusetts W Title 5 Official:' Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 435 Bridge Street Property Address Judith Dow r Owner Owner's Name information is 1 - required for every Osterville MA 02655 10/31/14 page. City/Town State Zip Code Date of Inspection D. System Informaliftn'(cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,.evidence of leakage, etc.): y. J t sit • • fi t, Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): t, i , Depth below grade: Material of construction: cr , ❑ concrete ❑,.m;etel. ❑fiberglass ❑ polyethylene ❑ other(explain): N/a l: t Dimensions: i Capacity: gallons Design Flow:. . gallons per day Alarm present: ❑ Yes ❑ No 1 Alarm level: —f Alarm in working order: ❑ Yes ❑ No Date of last um in p p g' 1 Date Comments (condition of alarm and float switches, etc.): rt 6 Attach copy of current pumping contract(required). Is copy attached? ❑.Yes ❑ No t: r l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 • is t _l e Commonwealth of Massachusetts W Title 5 Officia[Anspection Form Subsurface Sewage DisposalISystem Form - Not for Voluntary Assessments k 435 Bridge Street Property Address i Judith Dow Owner Owner's Name information is required for every Cisterville MA 02655 10/31/14 page. City/Town State Zip Code Date of Inspection D. System Informatip'16(cont.) Distribution Box(if present:must be opened) (locate on site plan): Depth of liquid level above outlet invert even Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into.or.but of box, etc.): The D- Box was clean a' t 1 ,� • Pump Chamber(locate on'site plan): . I. Pumps in working order: ® Yes ❑ No* Alarms in working order: ® Yes ❑ No* Comments (note condition hf pump chamber, condition of pumps and appurtenances, etc.): I cycled the pump and it wa;s working normal A steel cover was 5" below grade. I * If pumps or alarms are not in working order,system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain;'why: 4 {Fi 11 , h t5ins•3/13 ll Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 is Y'. n 1• Commonwealth of Massachusetts Title 5 Official' Inspection Form Subsurface Sewage Disposal'System Form -Not for Voluntary Assessments i 435 Bridge Street Property Address Judith Dow 6 Owner Owner's Name information is required for every Osterville . R; MA 02655 10/31/14 page. City[Town State Zip Code Date of Inspection D. System Information'(cont.) Type: } t ❑ leaching pits; number: leaching chambers number: Infiltrators- 12x50x2- ❑ leaching galleries number: i. ❑ leaching tre►"aches number, length: ❑ leaching fields, number, dimensions: ❑ overflow cesspool number: ❑ innovative4te'rnative system Type/name'of,technology: i. Comments (note conditionof:soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): There was no sign of failure.'A camera was used for the inspection. 1, r Cesspools (cesspool must ke pumped as part of inspection) (locate on site plan): Number and configuration:, Depth—top of liquid to inlet invert I' Depth of solids layer i Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 t Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 7- FI r r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments t 435 Bridge Street Property Address Judith Dow it Owner Owner's Name 6l ' information is Osterville MA 02655 10/31/14 required for every �� page. City/Town State Zip Code Date of Inspection D. System Informatipn (cont.) Comments (note condition.of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan) } Materials of construction: Dimensions Depth of solids Comments (note condition,of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i N/a li i .. I t 1, s ;l t5ins•3/13 j, Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 f. j � r ;. Commonwealth of Massahusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal,*System Form - Not for Voluntary Assessments 435 Bridge Street t' Property Address Judith Dow G' Owner Owner's Name information is required for every Osterville MA 02655 10/31/14 page. City/Town 1, State Zip Code Date of Inspection D. System Informatiol(cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent refelrence landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the areal below ❑ drawing attached separately "i '&ArAY �3a � 6 i , aYL3a �'` • F (Sins•3f13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 i; • Commonwealth of Massachusetts W Title 5 Official "Inspection Form Subsurface Sewage Disposal:System Form - Not for Voluntary Assessments 435 Bridge Street a Property Address Judith Dow Owner Owner's Name information is required for every Osterville MA 02655 10/31/14 page. City/Town i. State Zip Code Date of Inspection D. System Information (cont.) t. Site Exam: ❑ Check Slope ® Surface water t; ❑ Check cellar ❑ Shallow wells 1 Estimated depth to high ground water: 9 +/- feet Please indicate all methods u"sed to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: Topo and water contours map ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS;database -explain: You must describe how you established the high ground water elevation: see above I t- ii Before filing this Inspection Report, please see Report Completeness Checklist on next page. i; t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 P Commonwealth of Massachusetts W Title 5 OfficiA Inspection Form Subsurface Sewage Disposal,System Form - Not for Voluntary Assessments 435 Bridge Street ? Property Address Judith Dow Owner Owner's Name information is ,;` required for every Osterville r MA: 02655 10/31/14 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A;:.B, C, D, or E checked ® Inspection Summary D`.('System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater I. ® Sketch of Sewage Disoosal System either drawn on page 15 or attached in separate file +(F t 1� i l i ' R • n: 4.. e is • t5ins-3113 ` Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 r: i TOWN OF BARNSTABLE LOCATIONS l^�,fir r� SEWAGE# 99'— FO VILLAGE 0 +,C.rV t I I-e ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. Z66 n A Aa La SEPTIC TANK CAPACITY it oo 6A L. -4 pump dal LEACHING FACILITY: ( ) 1 (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: qq Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Watei 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 1_y ` 4 lit i .T�c�7 p A ii �-- i 000 o � o O 'a • No.mot / �6 T 1 r V FeeTHE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es ,✓ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Rpprication for )Digpozar *pztem Con.Mruction 30ermit C4 Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. s� Owner's Name,Address and Tel.No. y3s ��.'� Assessor's Map/Parcel c-4 T 61W 141 /247z.., O Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. SOH A4Ila �S"o ftia/h�v` sf Type of Building: Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank SDC-) A Type of S.A.S. 4e4e4 bed Description of Soil -�rd Nature of Repairs or Alterations(Answer when applicable) 14 jg e Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system j in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this B d of Health. Signed61-41 Date 3—2' 9q Application Approved by Date — 9 Application Disapproved for the following reasons Permit No. ® Date Issued �� I ; ��// Lf M .7m�.�' r-•.'y ter- s ;./� o. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes •' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE.,�MASSACHUSETTS L/ 4 - 01ppYication for Migozar *pgtem Conaruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System Individual Components Location Address or Lot No. �s Owner's Name,Address and Tel.No. _ 5�3s ljr.•�yp ,Assessor's Map/Parcel Of7irv.//� Chi-�1 yvo� /✓Ddi! 0 9'3 ' a4 Installer'ss Name,Address,,and Tel.No. Designer's Name,Address and Tel.No. "94 i/O Pool' f���'✓Qn �r0 lq/s//+✓'f j'' Type of Building: Dwellings No.of Bedrooms _ Lot Size ? sq.ft.' Garbage Grinder( ) l Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures` Design Flow gallons per day. Calculated daily flow gallons. Plan Date, Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 4*el+ btki l AA Description of Soil .► o(ca r Nature of Repairs or Alterations(Answer when applicable) P � G► - 1 Date last inspected: �. Agreement: 1 The undersigned agr es to ensure the construction and mainten cerof the afore described on-site sewage disposal system in/accordance with the prow sions of Title 5 of the Environmental-Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this B and of Health. Signed Date ' 2- 9g Application Approved by Date Application Disapproved for the following reasons Permit No. 4 Date Issued �t�''• THE COMMONWEALTH OF MASSACHUSETTS - BARNSTABLE, MASSACHUSETTS �- - �erttfirate of Compliance �--� THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by V'� 4/ _ at <411 - 1 e^ Oe&&�ehas been constructed in accordance with the provision of Title 5 and the for Disposal System Construction Permit No. dated Installers 174 Designer The issuance of this e t shal t e construed as a guarantee that the system will function as designed. Date Inspector No. " � ---------------------------Fee '<2,02P THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 'Wi5po5af *pgtem Conwtruction Permit Permission is hereby granted to Construct( )Repair( . )Upgrade( don System located at `� ^" `' t �✓r�r 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 Re-hriit06 . y Date: Approved —, 70 1 ask AN �'"� GNP •".-••i :Y":r,I`•� Z \ 9 Nye � , • 3 >o ; PLAN VIEW '8 Leo Scale: I"= 50' CIF 41�1n, eR L i t e L�A�k OF FEILI TERIt o ��\ ao o� VIM SULLIVPv. K o _ .�� I �10.29A3 �`�. PETER en J5. ° » SULLIVAN " CIVIL g BOG a, ' __' NO.29733bQrs °�► 9��5 �``�; CIVIL v� LOCUS PLAN SITE PLAN Scale: I' = 2000 SEPTIC SYSTEM UPGRADE Assessors Map 93 AT Parcel 435 BRIDGE STREET OSTERVILLE, MA FOR CLI FFORD W. DOW RwrsioN 's/29/9q AQOEO puMP CNAMdtR SCALE:AS SHOWN DATE: JAN. 4, 1999 SULLIVAN ENGINEERING INC. SHEET I of 2 OSTERVILLE MA f NOTES DESIGN DATA Single Family- 4 Bedroom L Water Supply ForThis Lot is Municipal Water. With no Garbage Grinder 2.Locallon of Utilities Shown on This Plan Are Approx. Daily Flow=110 x 4=440 GPD At Least 72 Hours Prior to Any Excavation ForThis Septic Tank:440 GPD x 200%=8806PD Project The ContraclorSholl Make The Required Use 1500 Gallon Septic Tank Notification to Dig Safe(1-800-322-4844) LEACHING AREA 3 The Contractor is Required to Secure Appropriate 440 GPD/0.74=595 SF Required Permits From Town Agencies For Construction Defined byThis Plan. Bottom Area=12'x50'= 600 S•F. 4 Install Risers as Required to Within 12!'of 600 S.F.Total Provided Finished Grade. LEACHING BED DESIGN 5.All Structures Buried Four Feet or More or Subject' All Pipes to be Schedule 40.PVC to Vehicular Traffic tobe H-20 Loading. Perforated With Capped Ends.Use 3-4" Septic S tem to be Installed in Accordance With Be Distribution Line in Leaching 6 310 CMR 15.00 Latest,Revision And The Townof Bed in a 12'x 50'Washed Stone Field as Shown Barnstable Board of Health Regulations. T. All Piping lobe Sch 40 PVC . NOTE: Engineer to Verify Soils at Time of Installation•, EG.10.0 F.G.10.0 See Note No.4 •5 Inv.8.5 7.3 15000allon 71 Pumn Top El.9.0 Septic Tank 6.9 Chamber 9.9 8.7 ° Bot.El.B.O Sodding as Psr Tills 5 6.0' 12' Ground Water a EI.2.0 . DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Not to Scale Finish Grade x - 0 -Compacted'Fill 3 Maximum Filler � Pobric N Pea Stone a 0 .-j 0 °0 Perforate "-I 1/2Double '"� ``" 4 3/4 ate - PVC Pipe Washed ,. PEpTE'yR ro SOA LRA!14 NO.23i 33 =a 3�-0�� `� CIVIL P� 12-d' �iST � `� g°� p CROSS SECTION OF LEACHING BED Not to Scale There are no wetlands within 100 feet of the proposed leaching facility. There are no private wells within 150 feet of the proposed Septic system. 435 BRIDGE ST. There is no increase in flow and/or change in use proposed. OSTERVI LLE ,MA There are no variances requested or.needed. SHEET 2 of 2 f NOTES DESIGN DATA Single Family- 4 Bedroom L Water Supply ForThis Lot is Municipal Water, With no Garbage Grinder 2.Location of Utilities Shown an This Plan Are Approx. Daily Flown 110 x 4=440 GPD At Least 72 Hours Prior to Any Excavation 1brThis Septic Tank:440 GPD x 200%=880GPO Proiect The ContraclorSholl Make The Required Use 1500 Gallon Septic Tank Notification to Dig Safe(1-600-322-41344) LEACHING AREA 3 The Contractor is Required to Secure Appropriate 440 GPD/0.74=595 SF Required Permits From Town Agencies For Construction Defined byThis Plan Bottom Area=W 50'=600 &F, 4 Install Risers as Requiredto Within leaf 600 S.F.Total Provided Finished Grade. LEACHING BED DESIGN 5 All Structures Buried Four Feet or More or Subject- All Pipes to be Schedule 40.PVC to Vehicular Traffic to be H-20 Loading. Perforated With Capped Ends.Use 6,Septic System to be Installed in Accordance With Distribution Line in Leaching Be 310 CMR 15.00 Lotest,Revision And TheTownof Bed in o 12'x 50'Washed Stone Field as Shown Barnstable Board of Health Regulations. 7 All Piping to be Sch40 PVC NOTE: Engineer to Verify Soils at Time of Installation., EG.10.0 F.G.10.0 See Note No.4 5 _ Inv.8.5 ' 7.3 1500 Gallon Top E1.9.0 Septic Tank 619 Pumping r ° Bo.E1.8.0 Chamber 8.9 't• 8.7 Bedding as 6.0� Per Title 5 r Ground Water a El.2.0 DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Not to Scale OF A4 ot PETER SULLIVAN cLop N0.29733 t Finish CIVIL Grade 9 Is P j, x ��OffAL 0 --Compacted,Fill 3! Maximum Filter � Fabric a Pea Stone p 4!'0 Perforate i _ PVC Pipe 3/4°-I U2�Double Washed C' I✓L C 40 5LL`�i��;.ti"a ` ,� c I+60.2gii3 �+ 3'_p" 3-0 " CIVIL 40 9- /STE�� CROSS SECTION OF LEACHING BED Not to Scale _ ��✓ `./'`+ r wetlands within 100 feet of the proposed leaching facility. There are no There are no private wells within 150 feet of the proposed septic system. 435 BR I DGE ST. There is no increase in flow and/or change in use proposed. OSTERVI LLE,MA There are no variances requested or needed. . c�� • SHEET 2 Of 2 :._.� , 5sn� JT 8 j' _��,,,• Sbcn � X cam• N\ � �o\. 70 r � _ •.\ `ate "'/. ;'.. � �-� � / �\ . 5P f A, 4 PLAN . VIEW Scale: I"= 50' r /n o - - gR� L i 't e �� �g� •:wad. o \,o/ FETTER • SLLLIV Aft 11 I o° � ��. t40.2 1 33 GJ� :o° ��, — >;..o CIVIL b^ ` .. a 1 % LOCUS PLAN SITE PLAN = Scale: I' 20o0' SEPTIC SYSTEM UPGRADE Assessors Map 93 AT Parcel 435 BRIDGE STREET OSTERVI LLE, MA FOR CLI FFORD W. DOW RLVI51oN 3�29�99 ADDED PIMP CNAMQCR SCALE: AS SHOWN DATE: JAN. 4; 1999 SULLIVAN ENGINEERING INC. SHEET I Of 9 OSTERVILLE MA TOWN OF BARNSTABLE f LOCATION !�f3ig SEWAGE # VILLAGE -e ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 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AIL x O 51-r L4.-Il- V-7' II Zd-O° I a''D' V O F = c 24'-0' 4&-a ,�, SCALE R y A B GENERAL NOTES: FI K5T FLOOR PLAN I J CONTRACTOR I T VERIFY ALL EXISTING CONDITIONS s' DATE k DIMENSIONS N THE FIELD ' � �-`9/ i-- 2.) CONTRACTOR TO VERIFY MATERIALS,DETAILS k FINISHES 2/I I/201 5 FIRST FLOOR 2035 S.F. IN THE FIELD WITH OWNER f a SECOND FLOOR 3.) ROUGH OPENING HEgp HEIGHT OF WINDOWS AT- 2008 S.F. �{ d '�` PR GARAGE = G32 S.F. FIRST FLOOR TO BE 6'-I I"ABOVE 5U5FLOOR "7TI1/4.) ALL WORK 5HALL CONFORM TO THE MASSACHUSETTS 201 4-72 1 O ' ® 5MOKFJCAR5ON MONOXIDE DETECTORS STATE BUILDING CODE AND ALL OTHER APPUCABLE ® HEAT DETECTOR LOCAL CODES EXPOSURE B MANUAL DWG. THE WFCM I 10 MPH DWG, NO. 5.)ANY DISCREPANCIES,ERRORS AND/OR OMISSIONS IN THE NOTES, DIMENSIONS,AND/OR DRAWINGS CONTAINED ON THESE DOCUMENTS SHALL BE BROUGHT TO THE ATTENTION OF THE DE5IGNER PRIOR TO COMMENCEMENT OF CONSTRUCTION.PROCEEDING WITH CONSTRUCTION (E)COPYRIGHT 2015 CONSTITUTES ACCEPTANCE OF THESE DOCUMENTS AND ANY DISCREPANCIES, 0 5 10 15 20 A I BY THOMAS A. NIOp� DESIGN CO. ERRORS AND/OR OMISSIONS BECOME THE RESPONSIBILITY OF THE BUILDING CONTRACTOR. 7 y 2'47 � 2d 5° -" -16-d °w>.: ..I 3yT" - 2d-O•` � -.. .. .r-�-r T` U U p-F- r #- - � �,. W W W W ROOF zl iE No =-u 3 DECK Z d' 7 0 \ N 12',0, 4'_2' Ow. Z' AeR) (DORMER) iV 3'-2'"' 2'-I d 2'I d 3'4' 2'-9' 3'-A'- 3'-4" N.1. _ 3'-A° 3.4' 6 w 4 1 d 4-!0" 3 4 f »p' O Q2 O J O Q2 O H ANDER5EN w K 2 W Z Q - , • u ROOP I _ b - aeLow O in GT - .. n. z' BEDROOM'#4 BEDROOM#3 - . N • 1 - Z MASTER V 2 r C7. ° e � ' - a 4 a) WW a - b b BEDROOM#2 - ,,. 1 a. °l1 ` _ . ..m b x n _ CD c r" AOCESs DOOR _ - v DOOR " - 1 -9' 2'�' J '-6' I d'S^,. 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FLOOR PLAN' _ - : yy e i i• , Ef WINDOW 5CHEDULE WINDOU� 5'CHEDULE" ?' v, LL , s l 2/1 1/2015 TYPE MANUFACTURER' UNIT ROUGH OPENING REMARKS TYPE MANUFACTURER'S UNIT ROUGH OPENING REMARKS s A / M' A ANDER5EN OVL 2030 2'-0 112'x 3'-0 112"' _' OVAL F ANDER5EN TW 21 o46 '-0 1/8',x 4'-8 /8 DOUBLEHUNG R N B TW 21052 3'-0 1/8'x 5'-4 7{8" DOUBLEHUNG G 1W 2446 ^ -2'6 J/8"x 4'-8.7/8" DOUBL>HUNG /�Y - C Tuv 2432 2'-6 1/8"x 3'-4 7/8" 3'-0 1/8"x 5'-0 7/8' DOUBLEHUNG �+i � :k= 'y 2014 72 O DOl1BLEHUNG . . H ". TW 21041 O D TW 24310 2'-6 I/8"x W-0 7/8" DOUBLEHUNG J TW 21042 3'-O'I/8"-x 4'-4 7/8' " -0OUBLEHUNG "` } DWG. �� E AW 251 2'-4 7/8°x 2'-4 7/8" AWNING ' J. NOTE#I:CONTRACTOR TO VERIFY ALL OUANTITIE5 AND 51ZE5 OF NEW WINDOWS WITH OWNER AND ROUGH OPENINGS WITH WINDOW MANUFACTURER PRIOR TO ORDERING OF WINDOWS -A NOTE#2:CONTRACTOR TO PROVIDE PLYWOOD PANEL5 FOR EACH WINDOW.INCLUDING PRE-SET O 5 10 15 20 ©COPYRIGHT 2015 - FA5TENERS PER CODE.PANELS TO BE MARKED AND 5TORED IN BASEMENT. `' 2. 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IIIII IIII • -- 11111II1111111111t1r11111111111/1111111IImuI11r1111111111I111tl11r1{gl/IU111IIIIu111/1111r1t 1111IIIIYnnuununrll/IIIr116llnun■nnllllllgt 11111u11111r11 r L, I II11111u111Iu1 1111111nuununn1111111111111nu11■mn■Iilml Rill IIII -- FLOOR IIr1111I1/IIIIIrlllrm111tu1111uloltt/111/I11UIIrlptl 1111111u11111m1 I 1 111r111g1111111 IIIIII1111tu111g11111111U11rI11r11111u111111111111111 mltl 11u111111111I1111t11/11111111111/I11II1111/I/IIIII/III/I1111II11O11/11111/1111111111u111111111111 'IIIII11111I/11111rI11111lo11u11111111111ppq/1lplrpl i111111111m111111 I� �II.--'unrlu111nu_. - -- - .. .. \aunu Ills. _._.-•-..._,_._•.._...-._....,_....._....._..._,_..._._. �•..�..r..�.n.. --. , ,,,,.�..rr.�..., -I/Itlllrlllg111111/1111ImI11g111111111111rI1111111111r1 Ilrl MIN MENNEN • • • • • • -r .d1111•,. 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V w �' � — — — — ---- FOOTING 3T6 f or z o ' I (VERIFY I MELD) - w y��ppyy BASEMENT __.—J 4'9' 9T E LEDGER W/3 5/8' cn w w ..-.. —_ _-------- p .. .>: .. .. -:: :• + ....,..; L i ti 9Rr BMAKi AGG RED BOFLA3n BEII1ND.o. , N I � z In16' VENx1 — w I I cRA�1/L r U n T U I �'=coN aFoonNGs N m b I I I SPACE 24• 24'x I I W/3 BAR9 .I I NC.P0017NG I •: I 3-4 BOTTOM (3'CONC.SLAB) ®� I O 7117/8' JOISTS I -o.c I I I I �yO�U.N�DgAggro��N9°wNAiL -��, z m I I I I I c I BOTTOM AND MIDDLPE • -t§u I (BLOW OUT - -J ------------------� _ I� O _ 0NCN, I III i I x m �0 6'-5 8 1Y O' - 8' 8• �. I .. Z �p p o I o T OPFI OOOOFND.WALL I _— OS UP —— T U. .. — • O I J Q �- N . Y I I n55 POST U 3-I 4• 1 I !8' G� W x 21 5L 13-I 3%4' 178' L , GIRT I c�z - -J 1 !T14N x 5 4 x I r P05TUP P Li' T(k k I/ I — J ICAL 9EAMI5 AL LLY 1 U N 4 k I I I_ F•••� O r�¢pL w/5)/4'x 5 I/4•x /4' 24 x 2 'x I .� io I 1 GARAGE 1 NC.FO�N - TOP PIA NC ING L : I - O w (4•CONC.5LA5 ON GRADE - PRCFI z TO O.H.Doow i I quo°x as x za I I 14 x d - I I I I I x CRAWL I I I I I SPACE I I I � � � - 1 '' I � W F•Wil �1 L ------------ ----------J .•.. I (- I � O cn ----- — per— —� r-------- --- -- --� -- Z c1 WINDOW I I P05 M55'x 4•z,I/4' I WINDOW O'� 1 - 4' NC.S D ---- ——_ k " x -40 SK e ; � 1/LJ11= 1 1-011 T-d• D TE 5 14.0' 2av Iw-O' . ., 211 1/201 5 PPOJ. NO. 2014-7210 DWG. NO. FOUNDATION PLAN ©COPYRIGHT 2015 0 s 10 15 20 A5 13Y THOMAS A. MOORE DESIGN CO. NORTH BAY LOCUS BRIDE NORTH BAY �p `' OYSTER HARBORS EXISTING IMPERVIOUS COVERAGE ----�— WITHIN 100' BUFFER V-202 EXIST. DWLG. 108 S.F. CONC. PATIO 148 S.F. WEST BAY PAVED DRIVE 268 S.F. -204 TOTAL 524 S.F. /G� \ \ 4 LOCUS MAP v-201 / Eo .�\ �/� SCALE: I IN. a 2000 FT. v-2o3 PROPOSED IMPERVIOUS COVERAGE \� WITHIN 100' BUFFER � DWELLING 171 S.F. 5 ................... '''" PORCH 235 S.F. TOTAL 406 S.F. 6 REDUCTION OF IMP. COVERAGE 118 S.F. (22/0 50' BUFFER BRIDGE _.ST. __ _ BENCHMARK � \ ` �3 '� � 4, TOP OF CBF EL-6.15' \ \ ¢ c J NAVD 88 \ a r� / DATUM \ 3. 100.00 - \ A•35.26 r \ ` .. 4 FF � 100 R PAVED ( DRIVE i PROP. WX 10' / Op STONE"SHELLco 4u r r LOT 9 UNDERGROUND AlY' l '' - PROPANE TANK 20,103 S.F. 7 0- *. 3 19— _. SETBACK _� M 1Q-, — 4� \ 00 0) .` ..L =_ -.4 ­ r co cD / I ` EXIST. DWLG - a► r s — — - 1 I \ T, P VED�� RIVE / FF ELEV. 10, EXIST- pm_ r�STONE RET. WALL 1 CRAWL SPACE SLAB ( s't` \PROP. S ONE/SHELl PROP. DWLG. r T1 �� FF ELEV.- 12.74' 1 I �'� .— �\ TOP FNDN.•1 1.50' -f �c IN `� FNDN/RET. WALL I 10' I MIN. i I T PRO % h x ` . POTH `�` O�NC PATIO SED �- ``� INV PGN\� 4' LE 4 V-103 /'� �� EXISTING DWELLING, SHED, AND \ PATIO TO BE REMOVED o Fa \ WORK LIMIT . \�o INSTALL STRAW WATTLE ALONG 50' WETLAND BUFFER COASTAL BANK \ V-102 9 WEST BAY J v-101 NOTES SITE PLAN 1. LOCUS REF: D.B. 1 1517/49; FOR PROPERTY AT P.B. 168i 109F2 2. ASSESSOR'S MAP: 93/2 435 BRIDGE STREET, OSTERVILLE, MA. 3. ZONE: RF- 1 4. WETLAND DELINEATED BY JACK VACCARO 5. ENTIRE PROPERTY IS IN FLOOD ZONE AE , r °�� APPLICANT: EQWARD ACTON (ELEVATION 12 ON NAVD 88 DATUM). ; "A SCALE: I IN.=20 FT. DEC. 17, 2014 REV. 1/ 16/ 15 f rr ,4* f y �jp Cry RIS p REV. 2 25 15 SOULE LAND SURVEYING xkO a x.. Fl .l kiv ON (1,4A 103 VESPER POND DRIVE r-p (' BREWSTER, MA. 0263 (°4-; 23l (508)255-4728 PROFESSIONAL LAND SURVEYOR PROFESSIONAL ENGINEER PETER W. SOULE STEPHEN A. HAAS ENGINEERING, INC. 1051 r-3 i i