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HomeMy WebLinkAbout0029 DAVID STREET - Health PO 29 David Street e p ° t.Osterville A= 141-081 , y , ° ° + ^ ° , a o u° 4e ° ^ , a , m r ^ + o ^ ° • H a A p a ° .a ° . ° ° Commonwealth of Massachusetts', f 01 Title 5 Official lnspectio'h Form" i Subsurface Sewage Disposal System Form.-Not for-Voluntary Assessments M ,• 29 David Street, Osterville, MA Property Address Regina A Faass s. z , Owner Owner's Name ji, - information is required for every OStervllle State Zip Code Date of inspection w " MA 5 02655 - 10/03/2014 page. Cityrrown ;. P P ction • .ham e 4' R. .. ' �- 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 f mng t outforms When A. General Information - on the computer, use only the tab 1. Inspector: key to move your ". cursor-do not .. r REID C. ELLIS' key the return Name of Inspector r ELLIS BROTHERS CONSTRUCTION "ICI Company Name 23 ENTERPRISE ROAD•", ? Q Company Address v � YARMOUTH PORT. MA •F,�,�Q •02675 ,_ CI /Town r* ry State { �; Zip Code 508-362-6237 ,. 4: r 'S121891A , Telephone Number t License Number B. Certification I certify that I have personally inspected the,sewago disposaP system'at-this'address and that the , information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. i am a DEP approved system inspector pursuant to Section 15.340 of Title 5(31 'CMR 15.000).The system: n =3 9J� rt Passes ❑ Conditionally•Passes i ❑aFails ❑ Needs Further Evaluation by the Local Approving Authority A- �- � 1 •• - . Inspectors Signature Date 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 ttiensystem 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•approvng authority. ' "w . :: • A ****This report only describes conditions at the time`of'inspection and under the conditions of• use at that time.This inspection does not address how the system will perform in the'future under the same or different conditions of use. t5ins•3113 ,: +% Title 5 Official Inspecti Forth:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official. Inspection Forms Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 29 David Street, Osterville, MA . Property Address Regina A Faass Owner Owner's Name information is required for every Osterville MA 02655 10/03/2014 page. City/Town State Zip Code Date of Inspection B. Certification (cons.) Inspection Summary: Check•A,B,C,D or E/always complete all,of Section D A) System Passes: I have not found any information which indicates that any of the failure"criteria described in 310 CMR 15.303 or in,310:CVIR 15.304 exist.Any failure criteria_ not evaluated are indicated below. Comments: 14 13) System Conditionally Passes: M ❑ One or more system components as Jescribed 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. c Check the box for"yes",."no"or"not detei mined" (Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 year old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial.infiltration o exfiltration or.tank failure is7imminent. System will pass inspection if the existing tank is replaced ith a complying septic tank as approved by the Board of Health. F: *A metal septic tank will pass inspection it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is les than 20 years old is available. ❑ Y ❑' N ❑ ND(Expl in below): k t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 29 David Street, Osterville, MA f Property Address Regina A Faass Owner Owner's Name informatifor every on is required Osterville MA 02655 - 10/03/2014 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired... B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out/ors ighf static water level in the distribution box due to broken or obstructed pipe(s)or due to a bro n, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y. ❑ N ❑ ND(Explain below):, distribution box,is leveled or replaced ❑ Y ❑ N :❑ ND(Explain below): ❑ The system required pumping more than 4 tiME s a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of I he Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below)- ❑ obstruction is removed a ❑ Y -❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Boa d of Health: ❑ Conditions exist which require further evaluat on by the Board of Health in order to determine if the system is failing to protect public health, E afety or the environment. 1. System will pass unless Board of Healt determines in accordance with 310 CMR 15.303(1)(b)that the system is not fnctio ling in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of i surface water ❑ Cesspool or privy is within 50 feet of bordering vegetated wetland or a salt marsh . t5ins-3/13 riftle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 9 Commonwealth of Massachusetts Title 5 Official Inspection Forma + r Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 David Street, Osterville, MA _ Property Address p Regina A Faass Owner Owner's Name information is Osterville MA r 02655 10/03i2014 required for every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont:) 2. System will fail unless the Board oealthnd Public Water Supplier, if any) determines that the system is functiomanner that protects the public health, safety and environment: ❑ The system has a septic tank and soil at sorption system (SAS)and the SAS is within _ 100 feet of a surface water supply or tributa to a,surface water supply. ❑ The system has a septic tank and SAS E nd the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS z id the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and I ie SAS is less than 100 feet but 50 feet or more from a private water supply well'"`. Method used to determine distance: *' This system passesA the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presei ice of ammonia nitrogen and nitrate-nitrogen is equal to or less than 5 ppm, provided that no other-failt re criteria are,triggered.A copy of the analysis must be attached to this form. t t 3. Other: E D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No �j Backup of sewage into facilityor system component due to overloaded or ❑ clogged SAS or cesspool ` ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool `r Static liquid level in the distribution box above outlet invert due to an overloaded f or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins-3f13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments. �M 29 David Street, Osterville, MA Property Address Regina A Faass Owner Owner's Name information is Osterville MA -02655 10/03/2014 required for every page. Cltyrrown State Zip Code Date of Inspection B. Certification (cont.) ; Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number.of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ' s ❑ Any_portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Any portionof a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR .303, therefore the system fails. The system owner should contact the Boa of Health to determine what will be necessary to correct the failure.,,/ E) Large Systems: ,To be considered a large system t system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ 4, the system is within 400 feet of a s irface drinking water supply ❑ the system is within 200 feet of a t butary to a surface drinking water supply El 0 the system is located in a nitrogen ensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E he system is considered a significant threat, or answered"yes" in Section D above the large system s failed. The owner or operator of any large system considered a significant threat under Section E o failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The syste owner should contact the appropriate regional office of the Department. t5ins-3113 Title 5 Official Inspection Fomr.Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 David Street, Osterville, MA Property Address Regina A Faass Owner Owner's Name information is required Osterville MA 02655 10/03/2014 page. Cltyrrown State Zip Code Date of Inspection C. Checklist r Check if the following have been done.-You roust indicate"yes"or"no"as to each of the following: Yes No.. * Pumping information was provided by the owner, occupant, or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? ❑ . Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? El Were as built plans of the system obtained and examined? (If they were not available note as N/A) EY Was the facility or dwelling inspected for signs of sewage back up? El Was the site inspected for signs of break out? El Were all system components, eluding the SAS, located on site? ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? El Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on.- MY ❑, Existing,information. For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: _ Number of bedrooms(design): M .} Number of bedrooms(actual): - DESIGN flow based on 310 CMR 15.203(for'example: 110 gpd x#of bedrooms): h l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17, Commonwealth of Massachusetts UTTitle 5 Official Inspection Form ',' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 David Street, Osterville, MA Property Address Regina A Faass Owner Owner's Name information is Osterville MA. 02655 10/03/2014 required for every -_ page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes Is laundry on a separate sewage system?(Include laundry system inspection , ` El YesVNp information in this report.) Laundry system inspected? , ❑ Yes Seasonal use? 0 Yes No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? 0Aj47A�-�3• � r ❑ Yes No � Last date of occupancy:. Commercial/Industrial Flow Conditions: ` Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑,Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑` No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5,6.w Inspection F.Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts ;. Title 5 Official Inspection Form ! Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 David Street, Osterville, MA Property Address Regina A Faass Owner Owner's Name information is Osterville MA 02655 10/03/2014 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: G on Other(describe below):' General Information Pumping Records: Source of information: Wass stem pumped as art of the inspection? Yes ❑ No Y P P p p If yes,volume pumped. gallons ^- r How was quantity pumped determined? 9 �� Reason for pumping: � ��'l dad Type of System: , Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑. Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operators under contract Tight tank.Attach a copy of the DEP approval. g.- ❑ Other(describe): e t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form iA Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 David Street, Osterville, MA - Property Address Regina A Faass ,R Owner Owner's Name information is required for every Osterville MA 02655 10/03/2014 page. City/Town State Zip Code a Date of Inspection D. System Information (cont.) ay Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes` No Building Sewer(locate on site plan): Depth below grade: p' feet Material of construction: ❑cast iron W0 PVC ❑other(explain): , Distance from private water supply well or suction line: feet , Comments(on condition of joints; venting, evidence of leakage, etc.): ol L/ ,4 i Septic Tank(locate on site plan): - �� ° �t Depth below grade: feet Material of construction: .; Vconcrete . ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) r If tank'is metal, list age.,.. years age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No 4 Dimensions: — L- Sludge depth: t5ins•3113 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17. Commonwealth of Massachusetts Title 5 Official Inspection Form. n . Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 David Street, Osterville, MA Property Address Regina Faass Owner Owner's Name 'information is Osterville MA 02655 10/03/2014 required for every _ page. Citylrown state Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle r r! Scum thickness- Distance from top of scum to top of outlet tee or baffle" Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? "� Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as rejated too tlet invert, evidence of leakage, etc.): W j `� r 41 Grease Trap(locate on site plan): Depth below grade feet g ' Material of construction: ❑concrete ❑ metal' , 0 f berglass ❑ polyethylene ' ❑other(explain): Dimensions: . Scum thickness Distance from top of scum to top of outlet tee r baffle I - Distance from bottom of scum to bottom of out et tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 . x Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 David Street, Osterville, MA r Property Address Regina A Faass Owner Owner's Name information is Ostervtlle MA 02655 ' 10/03/2014 ' required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cost.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related.to outlet invert, evidence of leakage, etc.): k Tight or Holding Tank(tank must be pumped&L time of inspection) (locate on site plan)` Depth below grade: Material of construction: ❑concrete ❑ metal ❑fi erglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: .� gallons per day Alarm present ❑ Yes ❑ No Alarm level: Alarm in workingorder: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switchE s, etc.): , *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes' ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 ' o Commonwealth of Massachusetts - J. Title 5 Official Inspection Forlm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 29 David Street, Osterville, MA Property Address Regina A Faass Owner Owner's Name information is required for every Osterville �` ' MA, 02655 10/03/2014 - . page. City/Town State Zip Code Date of Inspection ` 1 H D. System Information (cont.) . Distribution Box(if present must be opened){locate on site. Ian): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equa,any evidence of soli nyover, any evidence of leakage into or out of box, etc.): -- �� A// `� Pump Chamber(locate on site plan): i Pumps in working order: a 0 Yes' ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, con ition of pumps and appurtenances, etc.): 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: t5ins-3/13 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 f - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments' aF 29 David Street, Osterville, MA Property Address Regina A Faass Owner Owner's Name information is required for every Osterville MA 02655 10/03/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cono, Type: y leaching'pits number: f ❑ 'Teaching chambers number: ❑ leaching galleries ;number: ` ❑ leaching,trenches 'number, length; d ❑ leaching fields number, dimensions: ❑ overflow cesspool. �" number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,.et !!�r-l ---t, , ✓ram .-.�A - a ' a Cess s(cesspool must be pumped A pan of inspection)(locate on site plan):LI Number and configuration w Depth—top of liquid to,inlet invert p Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow El Yes [I No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 29.David Street, Osterville, MA Property Address Regina A Faass Owner Owner's Name information is required for every Osterville MA 02655 10/03/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 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 t ydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13. a Title 6 official Inspection Forth Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 David Street, Osterville, MA Property Address Regina A Faass Owner Owner's Name information is Osterville MA 02655 10/03/2014 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate 7whe public water supply enters the building. Check one of the boxes below: and-sketch in the area below ❑ drawing attached separately all gQ,q J ' 1 15ins-3113 Title 5 Official Inspection Forth.Subsurface Sewage Disposal System•Page 15 of 17 y Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 David Street, Osterville, MA Property Address Regina A Faass Owner Owner's Name . information is Osterville MA 02655 10/03/2014 required for every page. City(rown State Zip Code Date of Inspection D. System Information(coot.) Site Exam:. ° ❑ Check Slope --vt��/1�^ ❑ Surface water. El Check Check cellar .• ❑ Shallow wells a ` Estimated depth to high ground water. feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record r If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) . ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: he high round water elation: ` You must describe how you established g t g L,4 � or- Le q, Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 i Commonwealth of Massachusetts'_ Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-_Not for Voluntary Assessments 29 David Street, Osterville, MA Property Address Regina A Faass Owner Owner's Name information is required for every Osterville MA 02655 _' 10/03/2014 , page. Cityrrown State Zip Code Date of Inspection E. 7jnspecfionSummary:A,.B1'C, ort Completeness.Checklist D, or E checked nspection Summary D(System Failure Criteria Applicable to All Systems)completed F F. V stem Information—Estimated depth to high groundwateretch of Sewage.Disposal System either drawn on page 15 or attached in separate file a 7 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF.ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION a Property Address: 49 Oyster Way Osterville, MA 02655 o Owner's Name: William Callahan a Owner's Address: Date of Inspection: January 5. 2006 r C Name of Inspector: (Please Print) James M. Ford _ Company Name: James M.Ford . Mailing Address: P.O.Box 49 -- rW- Osterville.MA 02655-0049 rn Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the,sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the 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 Needs Further Evaluation by the Local Approving Authority , Fails Inspector's Signature: Date: January 5, 2006 The system inspector shall sA a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments t . ****This report only describes conditions;at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform'in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 I i Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 49 Oyster Way Osterville, MA Owner: William Callahan Date of Inspection:. January 5. 2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. s Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please. explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 49 Oyster Way Osterville, AM Owner: William Callahan Date of Inspection: January S. 2006 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: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or Tess than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 49 Oyster Way Osterville, MA Owner: William Callahan Date of Inspection: January 5, 2006 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than.6"below invert or available volume is less than'/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and,volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as , described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 3.10 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 49 Oyster Way Osterville, MA Owner: William Callahan Date of Inspection: January 5, 2006 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ Were as built plans:of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for,signs of break out? ✓ _ Were all system components,excluding the SAS,located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ _ Was the facility owner(and occupants'if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems.? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 . i ' Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 49 Oyster Way Osterville, NM Owner: William Callahan Date of Inspection: January 5, 2006 FLOW CONDITIONS. RESIDENTIAL Number of bedrooms(design): 5 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Number of current residents:. 0 Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed on 2128102-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 49 Oyster Way Osterville, MA Owner: William Callahan Date of Inspection: January 5. 2006 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 36" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500 Qal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or.baffle: 30" Scum thickness: 5" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): . Tees were present. No sign of leakage. Recommend installing risers on covers. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene -other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as.related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 49 Oyster Way Osterville. MA Owner: William Callahan Date of Inspection: January S, 2006 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): 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 out of box,etc.): The D-Box was level. There were no signs ofsolids. The cover was 4'below trade Recommend installing a riser. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION(continued) Property Address: 49 Oyster Way Osterville, MA Owner: William Callahan Date of Inspection: January 5, 2006 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: ✓ leaching galleries,number: .7-500 gallon ywells 12'x62'per as-built leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): The Drywells were dry and clean.. There did not appear to be any signs of failure. The bottom to grade was 7 5' A Camera was used for the inspection. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments .(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 i Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION.FORM PART C SYSTEM INFORMATION(continued) Property Address: 49 Oyster Way Osterville, MA Owner: William Callahan Date of Inspection: January 5, 2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 1r�unT �I JS 2- s JL co; ! ►� 30 v� 3 SI I l!o 4/ yg My S� Qa 10 Page.11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 49 Oyster We Osterville, AM Owner: William Callahan Date of Inspection: January S, 2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 12 +/- feet Please indicate(check)all methods used to determine the high ground water elevation: ✓ Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps,and design plan the maps were showing approximately 12'+1-to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees,either expressed,written or implied,relating to the system, the inspection and/or this report. 11 TOWN OF BARNSTABLE LOCATION �,'�S'� SEWAGE VILLAGE (�, ! ��`�%�� ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.,&2C6l�,r ec nl . SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) /G NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: / � ��. `..5 DATE COMPLIANCE ISSUED: ''� � VARIANCE GRANTED: Yes No D ' - a O ASSESSORS MAP NO• C No...----.1 � ... PARCEL NO. F......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratio,t for Divjipoittl Workii Tontitriirtion ramit Application is hereby made for a Permit to Construct (✓�or Repair ( ) an Individual Sewage Disposal System at: . . L \ Location :\ddress or Lot No. ......................_................ .......................... W ..Y/ v Q� Address t a ......................................................`------------------------------------------ ...---------{-.---........_. Installer Address UType of Building Size Lot_._.`. . W.._..Sq. f ►� Dwelling—No. of Bedrooms.__----�--------------------------Expansion Attic ( a® Garbitige Grinder a`4 Other—Type of Building A.........__. No. of ersons_______________________._-- Showers yp g ---------- - -- p ( ) — Cafeteria ( ) 04 Other fixtures -------------_-.------- ------------------------------------------------------------- ------------------ W DePign Flow......................5 r� ...gallons per person etr d�v. Total da ly �ow_..._.__.___._....�......._..........g�llon�s. WSeptic Tank—Liquid capacttv.l-��gallons Length_-_6 . Width__ . _. Diameter...0 .X... Depth... .r!�►11'� x Disposal Trench— No. -----0 .P.._.. Width...........:........ Total Length._.. _�__...�___._. Total leaching Irea...__._ ....�.sq. ft. Seepage Pit No............._1�-._.. iameter-U.-i-zl.a;+ e 1iwlow inlet.. Total leaching area.i�?4i.q sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------- Y �.!......-�-- ------------ Date-----��Z'�'a a------ a Test Pit No. I--__--.44____mmutes per inch Depth of Test Pit-----1�_._._... epth to ground water.- ... DYI' 44 Test Pit No. ------ !` _ minutes per inch Depth of Test Pit-------A_Z._.... Depth to ground water. .---Bt[ wj-u)-6�© -----._.____'________________________________________•-------- - - O D _.� i escription of Soil----•--- '= 11 �icv....!%yp----„- Steal.. _to.....0?x) V::::'i X? m. t2 ------------------------��"la---- Rlp-l..) �.DIVm__.SA.I�bo 1 -IVI U Nature of Repairs or Alterations=Answer when applicable................................................................................................ ------------------------------------------------------------------------------------•--••------------...--------------------........--•--------•.----------•--------•--------•--•---•------------------. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of CompliaFcc has been issued by t e boa> o. lth. Signed - - ...............- --------- Application Approved BY ��� ! `.. / 'i ..................�.�......r.r�� ................. ...__.�'"..-.....----- --........... ... .................... .......... .........----'-------- Dace Application Disapproved for the following reasons- ------------- ---- -- ---------------------------------------------------------------------------------- ........................ Permit No. - Issued -..........�`�----------------- Date THE COMMONWEALTH OF MASSA.CHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou for Di-nipntittl Works Towitrnrtinn [rrmit Application is:hereby made for a Permit to Construct (� ) or Repair ( ) an Individual Sewage Disposal System at: ..... tR1.....---.."/..... ......` e E ---- ....................... --•---•---d"` z.=----...A.k=�k---•-------------��—� . K4., .1............................ _4 �� .�d 55.1�►. - o ------------------••••. Loca idn, \ddress or Lot No. Y-E. � .O..'T Installer Address Type of Building _ Size Lot..__ 3 -....Sq. feet ~ Dwelling —Type Bedrooms._-... ..__ ._..__.-------------------Expansion Attic ( 0)C Gar ge Grinder ( � g— ayp _L of-Building _._..� A------------- No. of persons---------------------------- Other �:howers ( ) — Cafeteria ( ) Otherfixtures --------------- ------------------------------------- •---------------------------............------. --- W Design Flow...................... ----..-.--____gallons per person eir duty. Total daily #''w_.__........__�-�__ .........................g�llonls. WSeptic Tank—Liquid capacity l gallons Length_-. .� z. Width__— Diameter---N�.A._. Depth___ ..t7►in x Disposal Trench—No. __._ ..P..... Width...............•._.. Total Length_.._ t_.....__---__ Total leaching area..___.......-4_-.sq. ft. Seepage Pit No........ -____ iameter.�.-.a -s..,iilp Telow inlet_4__�..L�....... Total leaching area. sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by.-_____.��21 ...... Xr.-���_�• Date.__._1".z-�-�. �...._.. Test Pit No. L__.___� ._-_minutes per inch Depth of Test Pit_____ >..�..�. Pep th to ground water. . ---- .. 44 Test Pit No. 2...... ._. .minutes per inch Depth of Test Pit-------_f.�...... Depth to ground water. ...__enCQL.I_tl�etleG( ----------I.......................................................... txJ � j � - . D Description of Soil-- =� � L��-- �AJD----. ........r-----_- d...•-------------------- .... ..1:2,=am----- .... .......bo---------......----...------------. ------------------------------. ------------......... U Nature of Repairs or Alterations—Answer when applicable......................................._....___.___..........__................._...........__. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the �! system in operation until a Certificate of Compliance has been issued by the boar�of-he'alth. Signed 1- ,---- _i ',_ ! :. _.. s LQ,} ---- ------------------- L.... /rA Dare A lication Approved B Ia//(A//n J—� �I y 1 � .... / �v....-�� PP PP Y - - . ........- f Dare Application Disapproved for the following reasons- ------ --------------------------------------------------------------------------------------------------------------------------- ........................................ . .................... ......._.._------------------------------------------------------------------------------- ........................................ Dare Permit No. �/ U ,Z s......... s....................... Issued Dare ®6—r_`_---i__—---------- ---------------------------------------------- THE COMMONWEALTH OFMASSACHUSETTS BOARD OF HEALTH TOWNOF BARNSTABLE U cr firat> of V l!..��.IImplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (A ) or Repaired ( ) by ..... `Q �-e+`f------ ---...----------.._--------------- --------------------------- ------------------------ ------------------------------.._-------............................... - Instiller at .......... --------- aUL � //- ------------- jt ...... � 0 �J has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ---- ----------------------- dated ---/........3D------g.-s'_.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ---� DATE...... -j.....'`.�/....�/...`_'....�.:.�.........- - - InspeCtcar •---------...---------- --------------------- - -��- •�Y./...."........... .. ... ._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ) No......................... FEE........................ Riploal Workii Tunitrudivit "amit Permission is hereby granted...... -------•-•------••----------------••------•-•---------•--......._. to Construct (k) or Repa' ( ) an Individual Sewage Dispo�4system at No.... Q,cil _..-S GC `5 4�1.1. - ...... -------------- street _ as shown on the application for Disposal Works Construction Permit No.___ S_` ��Dated.....�................................... ........................................ f 3>------------------------------------------------- oarc of Health DATE............ - _?- -----•---•-----------------------------•- FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS c., NOTES: 1.) CONTRACTOR IS TO VERIFY ALL EXISTING COTAH ao'o' 10'-0" s-o° &DIMENSIONS IN THE FIELD 2.) CONTRACTOR TO VERIFY ALL INTERIOR&EXTS, DETAILS,&FINISHES IN THE FIELD WITH OWN ""3.) VERIFY ALL PLUMBING&ELECTRICAL DETAILTHE SITE DURING FRAMING CONSTRUCTION D�rl4.) ALL CONSTRUCTION TO CONFORM TO 780 CM -LSSTATE BUILDING CODE,8TH EDITION AMENDE 4 p� ILYI Al ACCESS ACCESS _ PANEL PANEL 0 ACCESS 7.-4" PANEL 5'6"HIGH WALL EXISTING - .:+. 64" HIGH WALL STUDY s c H<....0.-_.. NEW - _ / v \ (UUUI gNDERSEN WINDOW - TW24310 # EXIST. NEW ® - 3ATH VENT BATH FAN TO OUTSIDE LINEN Y - CABINET ACCPANESS ON. ITO"HIGH WALL' - ACCESS - ACCESS - - .PANEL PANEL INSTALL NEW SPRAY FOAM INSULATION INTO EXISTING 2 x 8 RAFTERS(R49) 2 x 6's @ 16'D.C. q Al 12 v EXIST. NEW 46'-0' ,6-0 BATH - _ NEW2x4 WALLS W/ IECC2012 RESIDENTIAL ENERGYEFFICIENCY DETAILS NSU'I�TONMR2o, &1!2'BLUEBOARD CLIMATE ZONE 5A(USE EITHER PRESCRIPTIVE VALUES OR RESCHECK CALCULATION SECONDFLOOR P LAN TABLE 402.1.1(MINIMUM PRESCRIPTIVE INSULATI6N&FENESTRATION REQUIREMENTS) — FENESTRATION SKYLIGHT CEILING WOOD FRAMED WALL FLOOR =: EASEMENT WALL BASEMENT SLAB CRAWL SPACE WALL LEGEND: FACTOR U-FACTOR R-VALUE R-VALUE R-VALUEI RVALUE R-VALUE R-VALUE 0.35 0.60 49 20 30 10/13 10(2 FT.DEEP) 10/13 , o EXISTING WALLS NOTES: SECTION @ NEW BATH CONSTRUCTION TO BE REMOVED 1.R-VALUES ARE MINIMUMS&.U-FACTORS ARE MAXIMUMS! A NEW CONSTRUCTION 2.10/13 MEANS R=15 CONTINUOUS INSULATED SHEATHING ON THE INTERIOR,OR EXTERIOR,MM A� OF THE HOME OR R=13 CAVITY INSULATION AT THE INTERIOR OF THE BASEMENT WALL COTUIT BAY DESIGN, LLC N E • RE�®D E L I N G ®R m THEOEDRAWINGSIGNER SPRIORTALL BE OSTARTOAM SCALE : DRAWING NO.: ERRORS OR OMISSIONS ARE FOUND CA NY lCA COTIFIED IF THESTRUCTIN.THEB ITO STAATTR 43 BREWSTER ROAD CONSTRUCTIONSIBLEFORTH CNTRAOTOR 1/4" 1'-0"WILL BE RESPON518LE FOR THE CONTENT IN THESE DRAWINGS IF CONSTRUCTION MASH PEE ,MA. 02649 //w�� RESIDENCE COMMENCES WITHOUT NOTIFYING THE K CT THESE R OFANY ERR ORS OR OMISS DNS. DATE PH. (508 274-1166 r THESE ORAWINGSARE SANYOLELY FOR THE USE — Al q; ) - TTHESE DRAWINGS REEQUIREGH EEWRITTE F FAX(508)539-9402 29 DAVI D STREET OSTERVI LLE, MA CONSENTITECTU THEA.CO RIGHTUNDER PROTECTION 12/23/2014 ARCHITECTURAL COPYRIGHT PROTECTION ACT OF 1990. T - 11111 7 0�M'o 0[El 01. _J_ REMOVE EXISTING - DECK 8 INSTALL NEW PATIO,VERIFY REAR ELEVATION _----_ - - DETAILS ----OWNERS \ 10,6" I I I I ANDERSEN C14 ABOVEAl SHORTENED CND ABOVE TV AN21 COMBO °i 1 . 12 DECK o AN21 COMBO BUILT-IN CABINET TO MATCH O1 I�! c TO MATCH EXIST i EXIST.II�. EXIST. I j _ 1 1 I I - 4 ANDERSEN ` C14 ABOVE I AN21 COMBO t TO MATCH EXIST. - I 12 DEXIST. EXIST. DINING B-0 IL ® EXIST. EXIST. FM W.I.C. BATH NEW W.C.SHINGLE NEW TRIM TO H R O O M PLAN RIGHT ELEVATION SIDING TO MATCH MATCH EXISTING EXISTING ERRORTHE SIGNEORO OMISSIONS BE NOTIFIEDFOUND IF ANY SCALE : DRAWING NO.: COTUIT BAY DESIGN, LLC NEW REMODELING FOR: ERRORSO TION.THE IONS MEFOUNOON THESE DRAWINGS PRIOR TO START OF 43 BREWSTER ROAD CONS FOR CONTRACTOR �� 1. WILL SE RES?ONSIflLE FOR THE CONTENT 1/4 1 -0 IN THESE DRAWINGS IF CONSTRUCTION MASHPEE MA. 02649 KRAFT RESIDENCE CDESIGNER OF MY OMMENCES NGSAR SOL OR ELY NG FOR TH �� THESEORAWINGS ARE SOLSELY OMISSIONS. VSE PH. (508 274-1166 OF THE OWNER NOTED.ANY OTHER USE OF DATE �////��� THESE CRAWINGS REOUI.RES THE WRITTEN 12/23/2014 29 DAVID STREET ®STERVILLE, ItlYA CONSENTOFTHEO"RIHUROTECE FAX(50 )539-9402 ARCHRECTURALCOPYRIGHTPROIRTHEN ACT OF 1SS0. .. .. f ---------- I I I j I s I I I NEW NEW WORKSHOP WORKSHOP I I 4 0 I 3'0"DOOR I z � O i 0 E VERIFY DOOR LOCATION NEW 2 z 4 WAL TI W/ &INSTALL WALLS 4"AWAY 3"BATT INSULATION FROM THE DOORS I , I ( N EXIST. BASEMENT 1 I l —— I EXIST. �I- 4 GARAGE I , N I ( UP o 43 4 BASM' NT PLAN 22'-0" 29'-2" 16'-0" COTUIT BAY DESIGN, LLC N E y REMODELING ®R• THE DES DRAWINGSPRORT NOTIFIED STARTOFANY SCALE : DRAWING NO. ERRORS ORONI.THENSAREfWND R THESE DRAWINGS PRIOR TO START OF 43 BREWSBA ROAD CONSTRUCTIONSIBLEFORTHBUILDIN CONTRACTOR 1/4" = 1'-0"WILL BE RESPONSIBLE FOR THE CONTENT IN MASHPEE MA. 02649 KRAFT RESIDENCE DESIGNER OF ANY ERRORS CON RO TION COMMENCES WITHOUT NOTIFYING THE o '�7 Cam` TDHE EDRAWMGS ARE SO E V�ORTroES. USE OTED,ANY OTHER USE OF PH. (508)274-1166 THESE DRAWINGS REQUIRES THEWRITTEN DATE -rr FAX(508)539-9402 29 DAVID STREET ®STERVILLE� �YIA OFTHECTURAL OWNER COPYRIGHT CONSENT OF THE DESIGNER UNDER THE 12/23/2014 A3 ACT OF ICTURAI COPYRIGHT PROTECTION ACT OF 19w, NACKETIC O \ 60 0 I I I I I l l i l IIIIIIII IIIIIIIIIII � � .,y' I � �� � � \ 1 I I I I I I I I I V •� �J \ I I I I I I I O I , �p IIIFIIIIIIIII \ IIIIIIIIIIIIIIIIIIIIIIIIII ®� `� � O \�r�a O 0 y I I I I I I I I I I I 11111111111�� IIIIIIIIIIII '( - o IIIIII I I I I� �Ir I I I I O � V o / p I I I I I I I�I TJ o. to IIIIIIIIIIII �� J � IIIIII I � I I � 0. . ` 70 r o rna3Xo s C,' cr wCTN � fl, w� mow , c� , cv b N ofs N,��, O y tzll 09 9lOD cn o ( o � � � �, y y O � y -52 2 PROPOSED TOP OF FOUNDATION T 20' MIN. CONCRETE COVERS 2"LA YER OF 51.5P 51. 3E 2 1/8 1'-1/2" CONCRETE COVERS WASHED STONE / / / ♦ E 4" CAST IRON 12"f / 50. 7/ / OR SCHEDULE 40 P. V.C. PIPE 4" SCHEDULE 40 P. V.C. 12" S=0. 02, D=13. 4' PIPE — MIN. DIS M N. S=O. O2 D= BOX 7 FLOW LINE 6° 4 S=0. 02, D=13. 4' INVERT 1 10" PRECAST " MIN. 19 6~ o o LEACHING 00 EL.__ 48.89 INVERT CRUSHED SS g W EQUIVALENT STONES oo8888SSoS o O INVERT EL.= 48. 37 q 3° - 48. 62 EL.=_48. 07 0. � O� - ° 6 V O( 3/4'" TO 1-1/2'" 1000 GALLON _ 48.24 EL =-47 80 °° w °c WASHED STONE SEPTIC TANK O W c 41.8 LEACH PIT 13 3" 6" PROFILE OF 12'DIAM.- SEWAGE DISPOSAL SYSTEM — NOT TO SCALE BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE EL=_37. 3 ALL ELEVATIONS ARE ASSIGNED EDWARD KELLEY WITNESSED BY: JERRY DUNNING .I HEALTH OFFI c �v -~ TO WN OF BARNSTABLE "vLti' SOIL LOG CIVIL GENERAL NOTES ►� ,a,. y P NO. 6853 _ PERCOLATION RATE _ 2 _ MIN./ INCH 1. THIS PLAN IS FOR INSTALLATION OF NEW SEWERAGE DISPOSAL SYSTEM. 'gvy DATE 2. PLAN REFERENCE BOOK LC 18366E. 3. THIS PLAN IS FOR INSTALLATION/ REPAIR OF SEPTIC SYSTEM TEST HOLE I TEST HOLE 2 AND NOT TO BE USED FOR SURVEYING OR ZONING PURPOSES. DESIGN DATA. EL. = 50. 5 EL. = 51. 3 4. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. — TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS O' WOOD LOAM 0 WOOD LOAM NUMBER OF BEDROOMS THREE (3) FOR THE SUBSURFACE DISPOSAL OF SEWAGE. and SUBSOIr777- 5. .ALL COVER TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 20" and SUBSOIL 12" OF FINISHED GRADE. 24 GARBAGE DISPOSAL NONE 6. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE FINE'' SAME, UNLESS NOTED BY FINAL CONTOURS. SANE, TOTAL ESTIMATED FLOW 330 GPD 7. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE MEDIUM ( _110 _GAL./BR./DAY x _3_ BR.) OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER 84" OR WITHIN 10' OF DRIVES OR PARKING AREAS. H-20 LOADING SAND SEPTIC TANK CAPACITY _1000 _ SHALL BE USED UNDER OR WITHIN 10' OF DRIVES OR PARKING. UNLESS NOTED. ' LEACHING AREA REQUIREMENTS 8. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL MEDIUM 144" BE MORTARED IN PLACE. SIDEWALL AREA 227- GAL./SF 227x2.5=567 9. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH 156" SAND BOTTOM AREA 113 - GAL./S/F 113x1. 0=113gpd DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO LEACHING CAPACITY (BOTTOM & SIDEWALL) 680 GAL. OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 10. THE EXCAVATOR�CONTRACTOR SHALL VERIFY THE LOCATION OF ALL UNDERGROUND NO W.q TER ENCOUNTERED UTILITIES PRIOR TO ANY EXCAVATION. THE WATERGATE WAS NOT FOUND, THE GENERAL RESERVE LEACHING CAPACITY 680 - GAL. CONTRACTOR SHALL VERIFY LOCATION WITH WATER DEPARTMENT. SHEET 2 OF 2. 50633