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HomeMy WebLinkAbout0056 FARM VALLEY ROAD - Health 56,farrn-Valley Road` 'Oste`rville,4",P A 097 034 i 1 TOWN OF BARNSTABLE iOCATION r L)&)7 SEWAGE# 0(6 L- VILLAGE ry>` —ASSESSOR'S MAP.&PARCEL©Q'�— INSTALLER'S NAME&PHONE NO. �r,1 SEPTIC.-TANK CAPACITY LEACHING FACILITY. (type) 3- SZ (. (size) _311 � NO.OF BEDROOMS OWNER b M",V-yt I PERMIT DATE: 1 7n COMPLIANCE DATE: 47 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist Cc 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 J_C L r D 3 �4L N O r ' � a TOWN OF BARNSTABLE LC E:TION J l0 F/arM V4 SEWAGE # VILLAGE CSTew, I ASSESSOR'S MAP & LOT Oft! ' 03 INSTALLER'S NAME&PHONE NO. . SEPTIC TANK CAPACITY f S� LEACHING FACILITY: (type) �' �X 6914:s (size) ��• _N2.OF BEDROOMS 7 r BUILDER OR OWNER 0 , f I q PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by .�jr-45,[ un F0� D lb — J� 1a 0 m }�e 'T 4, 1. No. w i r Fee d THE COMMONWEALTH OF MASSACHUSETTS Entered in com .ter: �Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2ppYitation for Misposal *pstem Co=stern Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Individual Components Location Address or Lot No. &L FG.r^ va\Xe'] ` 0o & Owner's Name,Address,and Tel.No. Mok-1;3 M J O �► (nGb C,\,.N Z9v` Assessor's Map/Parcel 0al7 ®3\J< S (h 'n2 Installer's Name,Address,and Tell..No. ,�c"„ Designer's Name,Address,and Tel.No. �, (CA( C, 1 p 0 Th—\-�Zqq o Type of Building: p Dwelling No.of Bedrooms Lot Size `�)C30 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 44 o gpd Design flow provided 4 1-F-C gpd Plan Date O\ 0\.F Number of sheets 1 Revision Date Title y Size of Septic Tank J 5 Q�o (IOl kkS2—k c.) Type of S.A.S. C:1)�Zp 1>°ct& C"a C.0 S Description of Soil SPPs far, J Nature of Repairs or Alterations(Answer when applicable) Af C'A,! Sysfit(ln ��C.Q.,t l� � Date last inspected: Agreement: The undersigned agrees to ensure the c:nironmental ction and mai ance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 o the a and not to place the system in operation until a Certificate of Compliance has been issued by this Bo X Signed Date P1 Application Approved by Date I Application Disapproved by Date for the following reasons Permit No. 0 I U l Date Issued ( ' No. Fee '` ~ ; _` i 1 t , � -.! tl V' t. r •.y ' Entered in com uter: THE COMMONWEALTH'OF`MASSA�HUSETTS Y es PUBLIC HEALTH DIVISION -TOWN:OF BARNSTABLE, MASSACHUSETTS t \ application forAbiSPOSAI *pstrm ColtBtCU -ion permit 1 Application for a Permit to Construct( ) Repair( ) Upgrade(. Abandon( ) Complete System Individual Components Location Address or Lot No. F4t, t VAk•� ✓ QO�wner's Name,Address,and Tel.No. o Ij ptl. o��s w ' �. • �`V 1��� M d�'d.{�G�'fl�''�� �(,�"1`'�0� �9pA'��'-,�t..dye'- �wt.a.,•.,. 6+e�."k. �s,r Assessor's Map/Parcel = 17 3i `';e' e.ec e 2 Instalier's Name,Address,and Tel.No.^ ;c Designer's Name;Address,and Tel.No. J ZSCa�'1c?tiZ (r�g ��C. t5r C�Qra•p -c Type of Building: t� w _ 4' k Dwelling No.of Bedrooms ice`; `r`t� ,, k�i 4, Lot S,z� :Y6} "sq:ft. ^'Garbage Grinder Other p� -*,TypetofBui'ldmg• ry , , ; "r` '%,t,'Noagf Versons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required)\,44 O `gpd Design flow provided 4 S gpd I Plan Date n\(per l to Number of sheets Revision Date Titler:{ Size of Septic Tank Type of S.A.S. ( 3 �-L0 1 eg& C�Cf. ),r c c Description of Soil1'+?i ' tit k Nature of Repairs or Alterations(Answer when applicable) � �- l'-mod �- \"\. C_ ''t �n a''t tl�e.:✓�f cam( (�9�'�iS,.trs�� �* c1 Q� ��. k,^ Date last inspected: r Agreement: ,t t„. (,�. it,+� e �����'^�' ,' �"a •The undersigned ag4to-ensuresthe construction and main - ance of the afore`7lescribedonsite sewage disposal-systemLinaccordance with the provision Environmental C e and not to place.thesysfem in operation until a Certificate of Compliance has been issued b lth. A Date Application Approved by A Date r Application Disapproved by Date for the following reasons 1 I Permit No. a o I G ► Date Issued I / I U ----------- - - - --- =- ' - ---- - -- ------------------ ------ I�O -QUrfi Y 1 2,7'i f��' r �„( THE COMMONWEALTF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS IIT Cate of Coluplialtre THIS IS TO CERTIFY,that the O - '' e Disposal system Constructed( ��Repaired( ) Upgraded(�) Abandoned( )by 4,6 S k' t r a I«. ,C. at C t lr/ l i 4 l _ has been construct with actor ance / with the provisions AEWt`le 5 and e for Disposal System Construction Permit No. dated I Nnstallerx, _ Designer $ E Desi ner C,(,, �k: l L C #bednooms+,t r (#App' ioVeOd End flow t- ( The issuance of this(permit shall not be construed as a guarantee t, at the system will : nc'o{n jas designed. Date ��{ J?•4� Inspector/ IA •� l 1 No. 7 tr ID n j 2 Fee /VC/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal .pstem Construction 3pPrmit Permission is hereby granted to Construct( ) Repair( ) / Upgrade( Abandon( ) System located at („ [`� _. I �,- 1„ . 1/� / III L ..^/(A i and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. w Provided:Construction must be completed within three years of the date of this permit. (� Date { 111>Il�„ Approved by +� b% v J Town of Barnstable Regulatory Services anaxsreate. Richard V.Scali,Interim Director • • MAIM e Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644. Fax: 508-790-6304 Installer&Designer Certification Form Date: z 1 tiv Sewage Permit# Q61 b`-'012— Assessor's Map\Parcel17, 7 Designer: 3cy-I r n r:(;AonJ..,) Installer.- Address: Address: On ILL— 1�9M OA, Lmh _was issued a permit to install a (date) V (insta er) /� /� septic system at 5& I'arnn j A f'� /`co ct1 based on a design drawn by (address) c75TL 7 t- S�ZE �i�r/ri: dated Jdtjt, 1� a i k e (designer) I certify that the septic system referenced above was installed substantially according to Ile design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. ' I certify that the syste�renced above was constructed in compliance with the terms : . f th I app etters(if applicable) kk n is Si ature `ac.°2k4 (Designer t afore) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BAR [STABLE PUBLIC HEALTH DIVISION THANK YOU. Q:1S*c'Dcsigncr Certification Form Rev 8-14-13.doc it Town of Barnstable P#_i Department of Regulatory Services Public Health Division Date / 30 a01, te39 �� 200 Main•Street,Hyannis MA 02601 A�fll►Aid f' a y Date Scheduled 2- Time Fee-Pd._ , vy Soil Suitability Assessment for Sew • e Disposal. Performed-BY: � �C� C C�i.l `�� �� 1"� '/S4 Z Witnessed By: fss�'r LOCATION&.GENERAL INFORMATION Location Address .���� ���/ Owner's Name /V� • ®Jr I"� v j /It Address �p w ti/ s�I�r` �ly1A►U`�— Assessor's Ma /Parcel: °', ,. 3 iEngineer's5®V 4,k hOro Jul L 1•' b 1 7. Z P / Name e-0_L yl(����+I�p� NEW CONSTRUCTION REPAIR 'V a ' Telephone p g TTZG, — - 7 5?� Land Use 5 ,_IQAA�` Slopes(96) —�' Surface Stones Distances from: Open Water Body";�:,Zap ft Possible Wet Area_Dp�_ft Drinking Water Well j� jA ft Drainage Way N ft Property Line �ft Other �— ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests a wetland {n proximity to holes) � r2� Parent material(geologic) /y�� 'S Depth to Bedrock rvd�2 Depth to Groundwater. Standing Water in Hole: d'� Weeping frolA Pit Fpce AJ6/t e Estimated Seasonal High Oroundwater 3 ti DETERIVIINATION FOR SEASONAL'HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: In. Depth to soil mottles: In. Depth to weeping from side of obs.hole: In, Groundwater Adjuatment ft. Index Well-# Reading Date: Index Well level Adj,-Actor, Adj.Groundwater Level, ,e PERCOLATION TEST Duty_.______, Time.��, Observation 2 Hole# Tlmo at 4" � 176 Depth of Pere � Time at 6" Start Pre-soak Time @ 24C3 �aAS Tim6(9"4") ;End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed Lo� Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back-------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:1SEPTIC\PERCFORM.DOC A1AD DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Sdil Color Sol]. Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones,Boulders. onsistency.%'aravel) 6-- (- 1 a Ya2 yjZ �(- 20 2d DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% L Z. ki 2s E- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (MunSOII) Mottling (Structure,Stones,Boulders. Consistency, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color SDII Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones:Boulders. o e Flood Insurance Rate Man: Above 500 year flood boundary No— Yes Within 500 year boundary No x Yes Within 100 year flood boundary No.— Yes,:— Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring perv10 , s material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on if I4 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required t 'ning,expertise and experience described in�10 CMR 15.017. Signature Date 1 Z 22 t <Q Q:WEPTICAPERCFORM.DOC i P Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System form-Not for Voluntary Assessments. 56 Farm Valley rd Property Address Louis Moll Owner Owner's Name information is required for every Osterville MA 02655 7/2/2014 page. City/Town ss State Zip Code Date of Inspection 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. Important:When filling out forms A General Information on the computer, use only the tab 1. Inspector: '- key to move your ' I cursor-do not Trevor Kellett use the return key. IJaiiie of l`nspec3o"r Aardvark Environmental Inspections Company Name —� PO BOX 896 -� Company Address Cn East Dennis MA 1 r4- City/Town State Z Code 508-292-1056 S113744 Telephone Number License Number «M -. Certification 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: i ® Passes .. , ❑ Conditionally Passes. ❑ Fails Y 0 Needs Further Evaluation by the Local Approving Authority Inspector's 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 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 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•3/13 t Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Farm Valley rd Property Address Louis Moll Owner Owner's Name information a Osterville MA 02655 7/2/2014 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection.Summary: Check A,B,C,D or E/always complete all of Section.D A) System Passes: 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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. Check the box for"yes',"non or"not determined" (Y, N, ND)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. ❑ Y ❑ N ❑ Np(Explain.below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 W � Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form=Not for Voluntary Assessments . 56 Farm Valley rd' Property Address Louis Moll Owner Owner's Name information is Osterville MA 02655 7/2/2014 required for every , page. City/Town 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 or,high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,•settled or urieven 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 El"Y' ❑, N ❑ ND{Explain below): ❑ distribution box is leveled or replaced " ❑ Y ❑ N "❑ ND(Explain below): ❑ 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 - ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ 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 Boaid of Health determines in accordance with 310 CMR t 15.303(i)(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 t5ins•3l13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-'Not for Voluntary Assessments. 56 Farm Valley rd Property Address Louis Moll Owner Owner's Name information is required for every Osterville MA 02655 7/2/2014 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 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 welts`*. Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory., for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: 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 to the surface of the ground or surface waters due to an overloaded or clogged SAS"or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow t5ins•3113 Title 6 Official inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 a Commonwealth of Massachusetts + , Title 5 Official Inspection Form f Subsurface Sewage Disposal System form-Not for Voluntary Assessments .• . 56 Farm Valley rd 4 Property Address Louis Moll Owner Owner's Name information is required for every Osteryille MA 02655 7/2/2014 page. City/Town + State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOTdue 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-aa-private water supply well-with no acceptablewater quality analysis. [rF is system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, 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 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 considered 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 must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D: Yes No ❑ ❑ the system is within 400 feet.of a surface drinking water supply ❑ ❑ the system is within 200 feet of 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 11 of a public water supply well If you°have answered"yes"to any question in Section E the systemis 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 15.804. The system owner should contact the appropriate regional office of the Department. t5ins•3/13• , Title 5 Official Inspection Forth: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 S 56 Farm Valley rd Property Address Louis Moll Owner Owner's Name information is required for every Osterville MA 02655 7/2/2014 page, City/Town State zip code_ Date of Inspection, C. Checklist - 1 1. . Check if the following have been done. You.must indicate"yes"or"no"as-to.each,of the following: Yes No ❑ [g 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: ® ❑ 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): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 440 p gpd x#of bedrooms): t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17 i Commonwealth of Massachusetts n` AmEh Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4 56 Farm Valley rd Propefty Address Louis Moll Owner Owner's Name information is required for every Osterville MA 02655 7/2/2014 page. City/Town state Zip Code Date of Inspection D. System Information _ Description: This is atypical Septic system(Septic tank, D box,SAS) Number of current residents: 2 Does residence have a garbage grinder? E ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection,- El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump?. ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: + Type of Establishment: Design flow(based on 310 CMR 15.203): canons per day(gpd) " Basis of design flow(seats/persons/sq.ft., etc.): t Y Grease trap present?" 6- _ ❑ 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•3/13 Title 5 Official inspection Form: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 56 Farm Valley rd Property Address Louis Moll Owner Owner's Name information is required for every Osterville ' MA 02655 7/2/2014 page. City!Town 6tete Zip code Date of.Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ 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/Afternative 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 operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): - t5ins•3M3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 f • e Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Farm Valley rd Property Address Louis Moll Owner Owner's Name information is Osterville MA 02655 7/2/2014 required for every - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: 4118/95 per DOC Were sewage odors detected when arriving at the site? ❑ Yes N No Building Sewer(locate on site plan): - Depth below grade '• 1 feet e Material of construction: ❑cast iron 0 40 PVC ❑other(explain):. . Distance from private water supply well or suction line: feet Comments(on condition,of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan).- Depth below grade: 1.2 feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene'' ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate)' ❑ Yes ❑ No Dimensions: 1500 gal.- • 1„ Sludge depth:- t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 l Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Farm Valley rd Property Address Louis Moll Owner Owner's Name information is required for every Ostetville MA 02655 702014 page. City/Town, state Zip Code Date of Inspection. D. System Information (coat.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 10 , Distance from bottom of scum to bottom of outlet tee or baffle 14, How were dimensions determined? Measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic Tank is water tight and working properly Grease Trap(locate on site plan): Depth below grade: feet 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: Date t5ins•3/13 Title 5 O fidal Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts A:*-. a %. Title 5 Official inspection Fora ; _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 56 Farm Valley rd Property Address Louis MOIL Owner Owner's Name required for 5 Osterville MA 02655 7/2/2014 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) y _` Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as*related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(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 per day Alarm present: ❑ Yes ❑ Nor Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 OM dal Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official- Inspection Form a ` Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w ,f 56 Farm Valley rd Property Address Louis Moll Owner Owner's Name information is required for every Osterville MA 02655 7/2/2014 page. CitylTown. state Zip Code Date of Inspection D. System Information (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 out of box, etc.): D box is level and water tight with no signs of carryover Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No'" Comments(note condition of pump chamber, condition 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 I i� Commonwealth of Massachusetts Title 5 official Inspection f=orrh Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Farm Valley rd Property Address Louis Moll Owner Owner's Name information is required for every Osterville MA 02655 7/2/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) _ } Type: ® leaching pits number: 2 ❑ leaching chambers number., ❑ leaching galleries- number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions:, ❑ overflow cesspool number: ' ❑ innovative/alternative system Type/name of technology:. Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): (2)6x6 precast pit with staining up 6" Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 t Tibe 5 Offidal Inspedion Form:Subsurtaoe Sewage Disposal System•Page 13 of-17' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Farm Valley rd Property Address Louis Moll Owner Owner's Name information is required for every Cisterville MA 02655 7/2/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cost.) 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.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official insp ection l=orhi . Subsurface Sewage Disposal System form-Not for Voluntary Assessments 56 Farm Valley rd Property Address Louis Moll Owner Owner's Name information required for every Osterville MA 02655 7/2/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) ' _ *. . ., , ' r, - . Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below. ® hand-sketch in the area below ❑ drawing attached separately B ' 1 O A 3 . A1)48' O A2)37' A3)36' A4)68.5' a A5)18' B1)19' B2)26' B3)29' B4)38' B5)32.5' t5ins.3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 _ Commonwealth of Massachusetts Title 5 official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Farm Valley rd Property Address Louis Moll Owner Owner's Name information is required for every Osterville MA 02655 7/2/2014 page_ City/Town State Zip Code. Date.of Impection. D. System Information (cont.) Site.Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water. 25 feet Please indicate all methods used 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: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS Maps show GW at about 25' Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•M3 Tide 5 Official Inspedton Form:Subsurface Sewage Disposal System•Page 16 of W i Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments -��;�a 56 Farm Valley rd Property Address Louis Moll Owner Owner's Name iequiredfo a Osteryiile MA 02655 7/2/2014 required for every 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 ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 f . r Commonwealth of Massachusetts Title 5 Official Inspection Form A "s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments; . 56 Farm Valley Road Property Address Louis Moll Owner Owner's flame requir required for Osterville MA 02655 10/27/11 required for every page. Citylrown State Zip Code Date of Inspection 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. filling out forms A. General Information 'filling out fours on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael Kellett use the return Name of Inspector key. Aardvark Environmental Inspections VkA Company Name P.O.Box 896 Company Address East Dennis MA 0264.4 City/Town State Zip Code 508-385-7608 S13742 Telephone Number License Number B. Certification 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 r�' sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340-®f Title 5(310 CMR 15.000).The system: o� C'> r, ® Passes ❑ Conditionally Passes ❑ Fails �W 3 t ; ❑ Needs Further Evaluation by the Local Approving Authority Co 2-t71G 10/27/11 CO 17111 Inspecto i 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 the system,is,a shared system"or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submitthe 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 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. �c t5ins-11/10 Title 5'Official Inspection Form:Subsurface Sewage Disposal,S stem-Pa e 1 of 17 IIL _ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Farm Valley Road. Property Address Louis Moll Owner Owners Name information is required for every Osterville MA 02655 10/27/1.1 page. Cityl"rown state Zip Code Date of Inspection B. Certification (cont.) 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. Check the box for"yes","no"or"not determined (Y,N, ND)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. ❑ Y ❑ N ❑ ND (Explain below): t5ins-11/10 Title 5 Official Inspection Form:subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form "s Subsurface Sewage Disposal System Form-Not for Voluntary Assessrnents- 56 Farm Valley Road Property Address Louis Moll Owner Owner's Name information is Osterville MA 02655 10/27/11 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water levet 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 0 Y ❑, N ❑. ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled orre laced ❑ Y ❑ N ❑ ND(Explain below): P ( P ) ❑ 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 D Y ❑. N ❑ ND (Explain below): ❑ obstruction is removed [] 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: ❑ 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage.Disposal System-Page 3 of 17 it Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Farm Valley Road Property Address Louis Moll Owner Owner's Name information is Osterville MA 02655 1027/,11 required for every page. Citylrown state Zip Code Date of Inspection B. Certification (cont.) 2. System.will fail unless the Board of Health(and Public WaterSupplier,if any) determines that the system is functioning in a manner that protects,thel 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 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. 3. Other: D) System Failure Criteria Applicable to All Systems: 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 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 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form s, Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Farm.Valley Road Property Address Louis Moll Owner Owner's Name information is required for every Osterville MA 02655 1027/11 page. Cityrrown State Zip Code: Date oUtnspection 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. ❑ ® 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 wellr with no acceptable water quality analysis. [This system passes if the well water analysis,performed at 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.j ❑ ® 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 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 considered 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 must indicate either"yes"or"no°to each of the following,in addition to the questions in Section D. 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 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•11/10 Title 5Offcial Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts IJ Title 5 Official Inspection Fora s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Farm Valley Road Property Address Louis Moll Owner Owner's Name information is required for every Osterville MA 02655 10/27/11 page. CityrTown state Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"non 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 receivedl normal flows in thel 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: ® ❑ Existing information. For example,a plan at the Board of Health. ® ❑ Determined:in the field (f 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): 4 Number of bedrooms:(actual):' 4 DESIGN flow based on 310 CMR 15.203 (for,example: 1'10 gpd x#of bedrooms): 440 t5ins•11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Farm Valley Road Property Address Louis Moll Owner Owner's Hame information is required for every Osterville MA 02655 10/27/11 page. City/Town State Zip Code Date of inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes 0 No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date CommerciaUlndustriat 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: 1nspectim Fcsm:Subsulace­e^^e.^;s=s c„s sm=Rage 7 o!'? Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Farm Valley Road Property Address Louis Moll Owner Owner's Name information is required for every Osterville MA 02655 1027/111 page. CiWrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® 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)and a copy of latest inspection of the VA system:by system operator under contract ❑ Tight tank.Attach a copy of the DER approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments % 56 Farm Valley Road Property Address Louis Moll Owner Owner's Name information is required for every Osterville MA 02655 10/2:7/11 page. Cdyrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed (if known)and'source.of information: 04/18/95 per BOH Were sewage odors detected when arriving:at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.8 feet Material of construction:. ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line feet Comments(on condition of joints,venting,evidence of leakage,etc.): Septic Tank(locate on site plan): Depth below grade: 1.3 feet Material of construction: ® concrete ❑ metal ❑.fiberglass ❑ polyethylene ❑ other(explain) If tank is metal,.list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal Sludge depth: 4" t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 56 Farm Valley Road. Property Address Louis Moll Owner Owner's Name information is required for every Osterville MA 02655 1OW11'1: page. Cityrrown 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 26" Scum thickness 2" 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 115 How were dimensions determined? measured n pumping recommendations inlet and outlet tee or baffle condition structuralinte integrity, Comments(o p p g g ty, liquid levels as related to outlet invert,evidence of leakage, etc.): The tank was sound and tight with tees in place and liquid at outlet invert.. Grease Trap (locate on site plan): Depth below grade: feet 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: pie t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Farm Valley Road Property Address Louis Moll Owner Owner's Name information is required for every Osterville MA 02655 10/27/11 page. Cityrrown state Zip Code Date of inspection D. System Information (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.): Tight or Holding Tank(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 per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes. ❑ No Date of last pumping: Date Comments(condition of alarm and,float switches,etc.): "Attach copy of current pumping contract(required). Is copy attached? El Yes ❑ No t5ins•11/10 Trtle 5 Official Inspection Form:Subsurface SewageDisposal System-Page 11 of 17 f Commonwealth of Massachusetts Title 5 official Inspection Form sk Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Farm Valley Road Property Address Louis Moll Owner Owner's Name information is required for every Osterville MA 02655 10)27/11 page. City/Town State Zip Code Date of Inspection D. System Information (cant.) 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 box was level and tight with no sign of carryover. Pump Chamber(locate on site plan) Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑; Yes ❑ No Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (Locate on site plan, excavation not required): If SAS not located,explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments, 56 Farm Valley Road Property Address Louis Moll Owner Owner's flame information is required for every Osterville MA 02655 1t)127/11 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number:. ❑ leaching trenches number,length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp.soil,condition of vegetation,etc.): This system has two 6'x6'precast pits surrounded by 2'of stone.The pits had a foot of liquid. Cesspools(cesspool must be pumped as part of inspection) (locate:on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 113 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Farm Valley Road Property Address Louis Moll Owner Owner's Hame information is Osterville MA 02655 10/27/11 required for every 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 hydraulic failure, level of ponding,condition of vegetation, etc.): t5ins•11110 Tdle 5 Official Inspection Form: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 56 Farm Valley Road Property Address Louis Moll Owner Owner's Name information is required for every Osterville MA 02655 1027/11' , page. Cityrrown State Zip Code Date of Inspection D. System Information (coot.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system,including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 37 t � t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 ' a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments, 56 Farm Valley Road Property Address Louis Moll Owner Owner's flame information is required for every Osterville MA 02655 10/27/11 page. CityJTown State Zip Code .Date of inspection D. System. Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 20.0 feet Please indicate all methods used 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: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS maps show an elevation of over 20.0 feet.- Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•11110 - Title 5 Official Inspection Form:Subsurface Sewage Disposal.System-Page 16 of 17 L Commonwealth of Massachusetts u Title 5 Official inspection Form is. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Farm Valley Road Property Address Louis Moll Owner Owners Name information is required for every Osterville MA 02655 1027/11 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 ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Tide 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 17 of 17 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED JAN '0 6 2004 TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 56 Farm Valley Road Osterville, MA 02655 MAP Owner's Name: Mary Pilicy PriRCEL, �}- Owner's Address: LOT Date of Inspection: December 5, 2003 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the 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 Condit' Ily Passes Needs her Evaluation by the Local Approving Authority ails Inspector's Signature: Date: December 11, 2003 The system inspector shall subm a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page l Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 56 Farm Valley Road Osterville, AM Owner: Mary Pilicy Date of Inspection: December S, 2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health, will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined", please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 56 Farm Valley Road Osterville, MA Owner: Mary Pilicy Date of Inspection: December S, 2003 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 i 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 less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of. i l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 56 Farm Valley Road Osterville, AM Owner: Mary Pilicy Date of Inspection: December 5, 2003 - 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 '/2 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 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of l 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 56 Farm Valley Road Osterville, MA Owner: Mary Pilicy Date of Inspection: December 5, 2003 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)J. 5 Page 6 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL:SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 56 Farm Valley Road Osterville, MA Owner: Mary Pilicy Date of Inspection: December 5, 2003 FLOW"CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):, 440 Number of current residents: 0 Does residence have a garbage grinder(yes or no): n1a Is laundry on a separate sewage system (yes,or no)- 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): pd 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: Apr. 18195-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 s SYSTEM INFORMATION (continued) Property Address: 56 Farm Valley Road Osterville, AM Owner: Mary Pilicy Date of Inspection: December 5, 2003 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: 16" 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 gal. Sludge depth: I" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 8" 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. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage 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.): 7 Page 8 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 56 Farm Valley Road Osterville, AM Owner: Mary Pilicy Date of Inspection: December 5, 2003 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. No solids were present. 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: 56 Farm Valley Road Osterville, AM ' Owner: Mary Pilicy Date of Inspection: December 5, 2003 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number:. 2-6'x 6'(1000 gal.) leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation,etc.): One pit 04)was dry and clean. No scum line was present. The bottom to grade was 9'. The cover was 12"below grade The other pit 05)was dry. No scum line was present. The interior was clean. The bottom to grade was 9'. The cover was 16"below grade. There did not appear to be any signs offailure in either pit. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) L Number and configuration: Depth -top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic.failure, level of ponding,condition of vegetation, etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 56 Farm Valley Road Osterville, AM Owner: Mary Pilicy Date of Inspection: December 5, 2003 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. A. A 8 - a O ► y� �9 a sa a� y 3 S 3 SS Q- y y0 38 10 I Page 1 1 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 56 Farm Valley Road Osterville, AM Owner: Mary Pilicy Date of Inspection: December 5, 2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25 +/- feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ 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 the Barnstable topographic map and the Cape Cod Commission water contours map, the maps were showing approximately 25'+/-to ground water at this site. I 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 andlor this report. ]1 TQWN:OF BAR of Vol gI NSTABLE � LOCATION''//�` .ate, d�" SEWAGE # VILLAGE Oyg ASSESSOR'S MAP & LOT �l wl INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) -T&-C (size) NO. OF BEDROOMS PRIVATE WELL OR".PUBLIC-WATER, u BUILDER O-R1OWNER Gp DATE PERMIT ISSUED: ;•-� ra '` � V t `' 2 DATE COMPLIANC,E6ISS_UrED: : VARIANCE-G,RAN:TED: Yes • =`.No t :� 4 - 77 N . b �� L 3�C ., ��� S � Ci. � .- ��r- ®�1! �a, ' ; ri. .., Y r '�/ �V - .. 4� I .S._ Fas. No.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1.veal.�2...............OF..... r!'?.5..ezCz .:.....------..:..------=-----•-•--......----.......----- Appliration for Uiipniittl Works Tnniirnrtinn ramit Application is hereby made for a Permit to Construct (K ) or Repair ( ) an Individual Sewage Disposal 5� System at ........... sscsso ._ gyp. 7....00kn s1_. s.'....-------- Location.Address or Lot No. ..�C."x .liil% 2.,p.............................................................. --o'wi c!n_...-1'?,lxr-h17,11ciCrc__. _ Owner A dress IM , S'_5........................................ a Installer 1 Address Type.of Building - Size Lot-----j�-teTj25--7.1....Sq. feet U Dwelling—No. of Bedrooms------fv.L:-_____________________________Expansion Attic wo) Garbage Grinder (�,) Other—Type T e of Building No. of persons `:..:............ Showers — Cafeteria a yP g ----•---•---•-•--•.... P ( ) • ( ) G4Other fixtures ----------------------- .......................................... Design Flow..................................5:45...gallons per person per day. Total daily flow..........:..................4�....gallons. WSeptic Tank—Liquid capacity_P�_gallons Length Width. . "... Diameter__...._-...—.. Depth.� `..... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...Av.-=...__.. Diameter......1.0......... Depth below inlet....6R............ Total leaching area..534.....sq. ft. Z Other Distribution box (h ) Dosing tank ( ) aPercolation Test Results Performed ................... Date_�Z_.��s_c:n�✓._�y�� 1 Test Pit No. 1...nk&-a.....minutes per inch Depth of Test Pit----._JZ........ Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit _---: _:----_.Depth to ground .......... W ..............................••-•••••--_- ------------------•. . 0 Description of Soil........?_ -t- .1.410 0$•I•g.s boas_(.............................................................. V } ---------------------------•----•••-----••-• . ------ALLY f__..... W -...------ .................. ......WJLSOA-. V Nature of Repairs or Alterations—Answer when applicable.------------------------------------------__ .30216 ...--•---...--•-----------•----------------•-----•-•-------•---•--•-------•-•••--.----•_-----= ..................................................... t-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal'Syste in i cordance with the provisions of TITLE 5 of the State Environmental Code—T e under•• rther agrees not to place the system in operation until a Certificate of Compliance i ed b rd of health. . Signed ... ...... - ------ ------------- ------ -- ------------ .... ...... f Application Approved By .. .. ... ...P...... - ...... . Dace Application Disapproved for the following reaso ---------------------------------------------------....................................---.:.................---...................... ...................................... ................................................. ...... ... ... ............................ >� o— Dace . Permit No. - .... ..... .. . .........`....... Issued .. . .... dt..... r � No................_....... ........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ .... ......OF..... Q�orasl�l�._............-...-... Appliratiun for Disposal Works Tonstrurtinn rrrutit Application is hereby made for a Permit to Construct (x ) or Repair ( ) an Individual Sewage Disposal System at: -•1»s�T..l.l.2y F�r.�.....h2G.1 - -.&TJr_--r•-o-rr-1�--------.- SSrSsnfs__ �p..J.7...�x�c��'` .......................•- Locatil•AddrA or Lot No. / .............wner....r.---•--•-----............................ •��! QU LuC..._ s G�Js7cp�S�.... y5Lt 11G[<./i. O A ress r W Installer Address Type of Building Size Lot-___--Z4I237-'--...Sq. feet aDwelling—No. of Bedrooms......Fovr.............................Expansion Attic (A/�,) Garbage Grinder (A/o) aOther—Type of Building ............................ No. of persons--.________.____-__-__..__ Showers ( ) — Cafeteria ( ) Otherfixtures ---------------------------------------------------------------------------------------------------------•--•----------------------------.----------- W Design Flow...................................55-_gallons per person per day. Total daily flow.-_---------_---------_--q 0...gallons. WSeptic Tank—Liquid capacity..moxxgallons Length_I _=p_'_ Width__S-J_c."._ Diameter________________ Depth.:;YAA(....... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....# ,...._.. Diameter......4&_...... Depth below inlet----_(o............ Total leaching area-.-S3.4.....sq. ft. Z Other Distribution box Dosing tank ( ) Percolation Test Results Performed by__S yy ,,...A..-_1�;.e., .�_. ----------------- Date.22-.,0x-.e,.J. ...../--EF4L ,tea Test Pit No. 1...- ____minutes per inch Depth of Test Pit.......1Z'...... Depth to ground water........................ Lzl Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a'V •-•--•-e--t••s1--11--X-k-_rromQa�a..w.a. ,••----•--------•-••---•-•.....--•...............................:....................................._ ..........,........ O Description of Soil ---- ----------------------------------------------------------- W t --------------•----- ----•-•--•--••----------------------•-------•-------•--••-•-•--•-----•----------------••--••----•---- •-----.......•-•---•----••------•----......---••------- U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------ _ A.............. ....... Agreement: Lo y S The undersigned agrees to install the aforedescribed Individual Sewage Disposal yste the provisions of TITLE 5 of the State Environmental Code—The undersigned further agre""-: 4t� Cetthe system in operation until a Certificate of Compliance has been issued by the board of health. Signed ...--- .�/)----- ..................... - ---------------- Q Date Application Approved BY . ...... -- �.' /I) . --_------_------ ------------------------------ r vv' Date Application Disapproved for the following ream - . .................................................................................. ----------'—......... ........ - 11..... ,.......... ................................-------.......................................---......... ....... '..Date-.-...-........... ......... ------.... - Permit No. .. -�� ....................... Issued --------- ' 1 ............ - Dace THE COMMONWEALTH OF MASSACHUSETTS / lwBOARDOF HTH.................o�� .. OF ------- .A--M .-... A ................ �e�#Y�t�tt#e of .oz�t�1><ttnre THIS TO CERd Y, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ..........._. .:F~ ] �t/�� � - /....--------------s--------------------------.........................................................../ . �.�� ............................................... at .............{^1..1... :.f i(......l.......iF .:".. .. V'i v'. X� ..j!..s[aller .. �-......_Iy��?...ll..J-{�S-. /..l r! .....................:........_... has been installed in accol?dance with the provisions of TITLE f'lhe State Env' onmental Code as described in the application for Disposal Works Construction Permit No. .... ..........."r.�.. . .-e. ,, dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT E �ONSTRVE A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........... ' c � ... Inspector L � s �' .'J THE COMMONWEALTH OF MASSACHUSETTS OARDl-OF......./1//QF HE -LT No fi. ............ off L !� / FEE..... .5.1.00 ............. .... .. .D Disposal Works Tuntrnrtiun Prrutit Permissionis hereby granted------------------------------------------------•-----•---•--••---••-•.........------••--••---•--•-•........:._...._............ to Construct ( or Re air ( ) an Individual Sewage Disposal System at No....... f � � } �:� �- -lC� U�L -------------------------- Street as shown on the application for Disposal Works Construction Permit No..-�_ __./t'>Dated.......................................... .........--••--•---.......•-----•---------------------------------------•---...----...-----............_ Board of Health DATE................................................................................ 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O /�1 N 3 m fDi rQttl D z Z E z1NAD D m f �$ci f AZl 0 DNA A , r?U m O z __-L 56 FARM VALLEY ROAD CADZ®O�S ARGHITEGTURAL. GRAPHICS Z OSTERVILLE/ MA -pl 10 SEABOARD LANE HYANNIS, MA 02001 a PLAN PHONE: 508-775-roG31 U z D z fW- Z RIDGE VENTTL ' 2x12 RIDGE -2-211,RIM IIST 4x4 P T POST GALV METAL POST ANCHOR TYP. ROOF Lu "1 12" SONO TUBE"PIER TYP " _ 2x10'e @ 16"O.G. - �Y — — R30 F.G. INSUL./ z ASPWALT SOH NGLES MAITCH EXISTING - I- r——Z - —————— — -----112 \/B'x46"CONCRETE WALL - m 127 10"xl6°CONTINUOUS FOOTING I' in FRAME DORMER W/2x4 STUDS t ry 2.6 RAFTERS I I A1 I m0` UNFINISHED o �+o MATCH EXISTING TRIM ® c0 PT 2x6 I 2x10'e / /�. ° ATTIC p TYP. EAVES .. 12 O 1 @ 10OC C �T 12 ��. 1x8 FASCIA/Ix4 SECOND MEMBER OL �+/Os Qi O i @ 16"O.C. I 0 4p °Y '-2" CONTINUOUS VENTING SOFFIT < O) CRAWL SPACE I t' I @60C F.G. INSU , CEILING JOIST WAN BR5 Ix0 FRIEZE BD. W/BED MOULDING 1 6 MIL VAPOR BARRIER I ,A�Be _ _. -__ - - 1e \\■ CD I I 2"CONCRETE DUST CAP 1/ it lr+ 2z8e @16°O C. 2x8'e @16°O.C. LJ.J I . I -I _ "HURRICANE CLIP° I�/. I 2-2x8 II BEAD.BD. I - FASTENERS AT ALL W 1 1.3 STRAPPING RAFTER/TOP PLATE Ix3 STRAPPING I 3-2x10 GIRDER �-7 _:I —�• '.'. 3 I/2"DIA STEEL COLUMN II/ a�j, I 1/2°GYP. BOARD JUNCTIONS TYP. 1/2"GYP.BOARD 7 j I - 30 x30 z12' CONCRETE PAD L-��' I j. O - ... - Q I I PORCH BEDROOM TYP. EXTERIOR WALL ((1 O 2x6 EXT. 5TUD5 @*'O.C./ RI9 F.G. INSUL./ m 1/ I 13'-It" 4 9 I II I/2°PLYWOOD BREATHING/ - o' I TYVEK WRAP/N.C.SHINGLES 3/4"T4G PLY SUBF"OR O 3/4" TAG PLY SUBFLOOR— r— in L1!___ - -� � I NAILED 6 GLUED TO JOIST' NAILED 0 GLUED TO JIOISTV -I I I I PT 2x6'.@ 10 C.C..2x10's @16°O.C. 2x10'e @16"O.C. I 2-2x8 RIM JOIST S-2x10 GIRT ( - I 4x4 P.T. POST 3 1/2"6 LALLY� — GA V. METAL P05T ANCHOR CRAWL SPACE TYP FOUNDATION WALL 2"CONCRETE SLAB 2''BONE TUBE"PIER T P. 13_II" P.T.SILL ANCWORED 4'-O" O.C. 6 MIL VAPOR BARRIER/ of B x3'--I CONCRETE I 2z10'e I -I - _ �__ NI .,��. DAMP PROOF BELOW GRADE I C I I I I . I.�. 10°zl6"CONTINUOUS FOOTING @ 16°O.C. - p � 30° I I _ 4-bi 20i_Oii igi_On °✓ Q d a/ d EXISTING I I O BULK HEAD -- �� SECTION ''All SECTION IISn W i ( SCALE: 1/4" = I'-0" SCALE: 1/4" - I'-0" w E E ACCESS AT ——- - EXISTING - \ ' WINDOW OPENING 4'-0" 5'-O° ~ d ILLpOL U/ EXISTING BASEMENT FOUNDATION PLAN SCALE: 1/4" - I'-0" rI _ SHEET 4 OF 4 1 I k 1 I ° 111 I 1 JOB: 0601 DRAWN BY: KN DATE: I/14/06 r 3 R Z 2 .�•'-...-...-;,-�-� .,,.,,,_F,�'-..V.,.. �. _-, _- ,., .._. �� �s�::+.-..;. ...: - - � -• - .�I-t a .. �; 8-_ 3; -..Q^� -'8�_ �,`g � .. .. IT11 1-1 I , v ca - �•t01 - pm Fro Llitr, W-0. ti 11; 56 FARM VAL.LE ROAD ' _ �-'' — � `� I^ f 3 R i r-`3 - � 0" 9T VI I-L E M - - 11 € � �'E r- -1 155 c'7 FLASHING AT CHIMNEY FCGITI"l Is aDG€verve _ NEW ASPHALT SHINGLES TO SCOPE OF WORK: 0 MATCH FASTING 1. EXISTING RED OAK FLOORING ON FIRST AND SECOND FLOORS TO BE REFINISHED-SAND,BLEACH, —Tel GRAV STAIN TBD. 2. FOYER TO BE EXTENDED TO SECOND FLOOR _ 2.1. NEW MAHOGANY STAIR-RAILS AND BAILUSTERS;SQUARE NEWEL POSTS. 2.2. WP1K4N CLOSET IN BEDROOM M3 TO BE ELIMINATED: __�_ � Z.4. FOYER WALL:WAINSCOTTING 5.6'HIGH,TO FOLLOW THE STAIRCASE UP. 2.5. RECESSED LIGHTING IN FOYER CEILING. 3. LIVINGftOOM 3.1. BUILT-IN WALL UNIT FOR 55'N,FLANKED BY BOOKSHELVES 3.2. EXISTING BRICK FIREPLACE FACE TO BE REFINISHED WITH STONE VENEER _ 3.3. WIDER PLAIN MOLDING TO REPLACE E%ISTING DENTIL MOLDING. ].4. RECESSED LIGHTING. ,}� a. DINING ROOM _ DINING ROOM TO KITCHEN-6'-0-CASED OPENING L 4.2. DENTIL MOLDING TO BE REMOVED-MATCH TO NEW MOLDING FOR LIVING ROOM. 5. KITCHEN 5.1. KITCHEN TO FAMILY ROOM WALL TO BE REMOVED-ADO POSTBHALF-WALL. 5.2. NEW WALL E%TENOS KITCHEN 5 FT TO REM.EXISTING BAV WINDOW UNIT REMOVED;ADO 4 CASEMENT WINDOWS TO MATCH EXISTING KITCHEN CASEMENTS ® ® ® ® ® 1 ® 5.3. NEW KITCHEN CABINETRY STYLE ET MATCH EXISTING ® 5A. EXISTING CABIN ETSLE BE PAINTED WHITE 5.5. GLAZED CABINET DOORS TO BE DETERMINED 5.6.. NEW CABINET HANOLESIKNOBS AND SLOW PULLS I-' 5.7. KITCHEN ISLAND E%PMDED AND RECONFIGURED FOR SEATING _ 5.9. NEW APPLIANCES(NEFRIDGERATOR IS RELOCATED) ' S9. NEW GRANITE COUNTERTOPS WH-, ' S.10. NEW TILE BACKSPLASH 5.11. ADDITIONAL RECESSED LIGHTING AND PENDANT FIXTURES ABOVE ISLAND 6. FAMILY ROOM VAULTED CEILING INNISHED SPACE ABOVE TO BE ELIMINATED) 6.2. BUILT-IN CABINTRY FOR 60'TV FLANKED BY WINDOWS 6.3. NEW 3 PANEL 8W8 PATIO DOOR UNIT 7. FIRST FLOOR BATH/LAUNDRY HOE CEO AN SHINGLES®Stts - 7.1. NEW SINK NEW BATHROOM T.W.TO MATCH EXISTING RELLl ENTRY DOOR 7.2. NEW TILE BACKSPLASH " LIB�W WrtAMp AND STEPS / I 7.3. E%ISTING BELOWWINDOWTO BERILLED)DWITH NINE{IGHT ENTRY DOOR(BASEMENT WINDOW Win TO GRADE 5'GEED KITCHENRREAKFAST AREA ACn— I. DEEP FAMILY ROOM AODRIGN I, OPENING BELOW TO BE INFILLEO) 7.4. BFADBOARD WALL FINISH 8. ALL BATHS-NEW TOILETS 9. ALL EXISTING DOORS TO BE REPLACED WITH SOLID WOOD DOORS PROPOSED REAR ELEVATION 1a MASTER SUITE LIBRARY 0.1. EXISTING WINDOW TO BE REPLACED WITH 3 AWNING WINDOWS(RELOCATE IN REM LIBRARY WALL) 111.2. REMOVE DOORS TO OFFICE. L 10.3. OFFICE AND CLOSET TO BE REMOVED 10.'I NEW DESK 11. MASTER BATHROOM . tt.t. NEW GRANITE VANITY TOP 11.2. E%ISTING TUB TO BE REPLACED W/DEEPER,FREESTANDING TUB 11.3 NEW TILE FLOOR t EXISTING MIRROR TO BE REPLACED WITH 2 MIRRORS t1.5. NEW TILE BACKSPLASH 12. SECOND FLOOR BATHROOMS 12.1. TUBS TO BE REPLACED 12.2. NEW SHOWER STALLS WITH FRAMELESS DOORS AND NEW TILE ,.' 12.3. NEW TILE FLOORS 43. BEDROOM 1128 M3 t 3.1. MOVEEWRY OOORWALLS ---- 13.2. NEW CLOSETSEDROOMN3 13.3. ADD ATTIC ACCESS TO CEILING BEDROOM p2 t4 GARAGE ADD ACCESS TO BONUS ROOM 15. BASEMENT 15.1. NEW HOT WATER HEATER TO DOUBLE EXISTING CAPACITY 15.2. WHOLE HOUSE IN-GROUND DEHUMIDIFIER 16. ROOF _ 16.1. SHINGLES TO BE REPLACED AS NECESSARY 17. LANDSCAPING — 1 _ 17.1. POOL INSTALLATION 17.2. PATIO 17.1 LANDSCAPING 2- 5.7 1 GENERAL NOTES: 1.CONTRACTOR TO VERIFY ALL DIMENSIONS IN THE FIELD PRIOR TO THE START OF CONSTRUCTION 2.BASEMENT UTILITY WINDOWS TO PROVIDE GLAZING TO MEET STATE REGULATIONS. 3.GUTTERS AND DOWNSPOUTS TO BE PROVIDED WHERE REQUIRED. 4.PROVIDE FLASHING ABOVE ALL WINDOWS AND DOORS. 5.DOUBLE JOISTS BELOW ALL PARTITION WALLS. 6.VENT ATTIC SPACE TO MEET STATE CODE REQUIREMENTS. 7.ALL CONCRETE TO BE A MINIMUM OF 25GO PSI STRENGTH AT 30 DAYS. 8.OWNER AND CONTRACTOR SHALL ASSUME ALL RESPONSIBILITY FOR CONSTRUCTION - ENw tulGKr AND CONFORMANCE WITH ALL STATE AND LOCAL RULES AND REGULATIONS. Rr DOGR .STEPS TO GRADE _ I, vROOM AGGTOON 1 4 PROPOSED LEFT ELEVATION L ELEVATIONS GREYWING DESIGN DATE: SEP 42015 PROJECT: McNIAHON RESIDENCE SCALE: 1/4"=1'-0" 56 FARM VALLEY RD..OSTERVILLE,MA 131 QUAKER MEETINGHOUSE ROAD,EAST SANDWICH,MA 02537 ©2015 Greywing Design 508 888-0886 ADDITIONS&RENOVATIONS www.greywing.com (508)888-0886 w ""•i6Y'�"" r. 4"O1 'd' PROJECT NO:G750710 SHEET: A10F4 AI , WALK-IN CLOSET NEW DOOR SCHEDULE ❑ DTV. DOOR SIZE REMARKS LOCATION REDucEo /'� FREESTANDING- 1 TA'X 6'A' 15-LIGHTENTRYDOOR R-SMIN. FAMILYROOM I`•11 1 2'b'AB.- BPANELINTERIOR DOOR BEDROOM] T YDOOR - MI BATHILAUNDRY — i 9 MASTER BATH y — '0 N E IN I N D OVn DSCHEDULE V S ZE D U L E REMARKS VERIFY WINDOW BRAND TION 9!, RELOCATED RELOCATED TOILET DOOR OTY MASTER Z xso• EMENT(1L fR) FAMILr ROOM `� ❑ BEDROOM 6 H 4 ]'-Z'xJ'<' CASEMENi(3L,zRl TO AIATCH EXISTING KITCHEN 3 r-B'XJ'-0' AWNING LIBRARY - nt0e USH BEAM ABOVE _ J REPLACES EXISTING 3rs EXTERIOR WALL «B POSTS DOWN TO FOUNDATION WAIL r. I AWrv11 *, v LIBRARY INc SLI WSNoows.I ' \ / MULLIONS c y RT • e RECONFIGURED MASTER BATHROOM ,� ,•.,. B.B. 6'-0- Is— — WALK-IN CLOSET _ t6'E' Z05 41J• _ 5'.10'B 9 - a CASEMENT WINO—TO mATCH RELOCATED a CASEMENT WINDOWS STHDId T1+SIT:EMErvT EXISTNG SOL.. rt- VB,MATC � aB B] HOLDDOWN --^'"'�'1__ wIE���,_ I•.r�� MOVE—STING o BASE TENT — MASTER BATH WINDODOCl"CFWARG ENTRY 1 BASEMENT S 1 a es M r BCg1LASF6ew'N ..� +, a�- 9 'n f©L8 N Y NEW BTE ISI OGRAO RELOCATED t+Li E E J/ U EREMO N WINDOW q 4PP1 P y � T L BRAHY i i E OVEI )ate _ ' I .... .......+NEW IB60,� aXBPOST UP' J_ I(// �Is IIGHT.a. -_- i-�_ -_ e IS I. BREAKFAST. _ - I ' AREA � Ja I r 1jJ/+ 1 �G CAPF WA LL . O EXISTING OFFlCE' PGu-DOwC i w KITCHEN TO STNR Arnc .---_— —_— DCLOS NEwzsw ACCESS AM _ - ... -- "� 6 WMNG H �O ..............'� i - �,, m F A ff _ � �cLosET BE .- ,�..l�ExrErvr oFF unG�...•a.Y .� I o O 9 BATH/LAUNDRY LIO Y MULLIONS DOws.l +..xs // L ATTIC ALCEBB / PORT LOCATION MAv R ----------------------- / VNyv WXST NG ExTERIDR "�' w0 U w_" �I ' PLL TO BE REMOVED r ----- W 4 FAMILY ROOM ] _ CDRELOCATE_ t NEw CEILING VAULTED TD tT-0' REDUCED REFRIDGERATOit r—CABINETRY RELOCATE EXISTING EXISTING 2-CAR GARAGE ---_--__-_I-.-- Y TING ]Yl' DOUBLEHUNG`MNDOw • G CASE '',6 CASED OPENING: TORE N \ EXISTING 3aa CENTER BEARING WALL(-1]a BEAM BELOW) 9 `V EXTENT OF FLAT CEILING u �EXDIRREMXVEDDOOR T-BE DOWN - R - EXISTING GAS ...FIREPLACE § - ' • CE ` .—CEILING ' EXISTING CLOSET EXISTING BRICK SOLID FUEL NEW OPEN FIREPLACE TO BE FACED WIrH ' MAHOGANY RAILS STONEVENEERAND WOOD TRIM TO FOYER NEWEL POSTS - BE MODIFIED DINING ROOM O LIVING ROOM - - � � � O u•.r OPEN TO ABOVE 3 r EXISTING CAMD OPENING 9 TO BE REMOVED DEFINES EDGE - 'I Ir OF OPEN FOYER-VERIFY DOUBLE lw JOIST ABOVE ra• r-r x)' o • ssa FIRST FLOOR PLAN GREYWINGDESIGN DATE: SEPA ZOIS PROJECT: MCMAHON NRESIDENCE • $GALE: 1/4'=1'-0" 56 FARM VALLEY RD..IONS ILLE.MA 131 QUAKER MEETINGHOUSE ROAD,EAST SANDWICH,MA 02537 _ ADDITIONS&RENOVATIONS - www.greywing.com (508)888-0886 ©2015 Greywing Design 508 888-0886 P /� ROJECT NO:G150710 SHEET: �20F9 2-11]u'-.IeVIn•LVL HEADER ....... .... El-3/1'.9 tla'LVL DROP BERM I]0'6') ® r EXISTING—RTTERS®ITOG. / 4y 3� Imim) p I I I I ROOF FRAMING LAYOUT DETAIL - SECOND FLOOR FRAMING LAYOUT DETAIL I I I I I O O n O BATH IIIO BATH#4 I _ BEDROOM#2 EXI - STING WALL REMOVED FOR wRu ExlsnrvG DOOR ' i♦ - ` - VAULTED FAMILY ROOM CEILING RELOCATED 4 RELOCATED Ew ms IGNTEzsse DODRs BEDROOM#4 — ON OWALL AT ULTEO ACCESS _ CEILING CT ABOVE Yd DOWN •, -------------------- FOYERCLOSET ��SHL LF ICE LING BE OW • I 3fi6B INT - -- -J • --------------- EXISTING BRICK O ;� ]'� EXISTING BRICK CHIMNEYETACK EXISTING WALL CHIMNEYSTACK BONUS ROOM w BEDROOM#3 REMOVED - t Y �ITYPICALI O ..........�; :i OPEN TO ---- ........_........._........................__....:......................._......_............_.. NEW BEDROOM - :: - - . WALL Y<' FOYER BELOW ---- EXTENT OF FULL O S HEIGHT CEILING - _- ^_—_.r—_� ^ I I I I LI JF i^-r= SECOND FLOOR PLAN GREYWINGDESIGN DATES SEP I'-G- PROJECT 56 FARM NRESIOENCE SCALE: 1/4'=1'-0` 5D FARM VALLEY OVATIOTERVILLE.MA ADDITIONS 8 RENOVATIONS 131 QUAKER MEETINGHOUSE ROAD,EAST SANDWICH,MA 02537 www.greywing.com (508)888-0886 02015 Greywing Design 508 888-0886 a nlm..�.a..<mw„o>••+I.n.-r�++m•.+..mn�.+®.. PROJECT NO:G750710 SHEET: A3pFa CONTINUOUS J RIDGE VENT 2x8x)'-Y W CORTIES 18'O.C. 12 UNHEATED ATTIC TYPICAL wgu cC 5.75 MATCH TOEXISTNG RIDGE 0 ER ECK'OVERlQ'EXTERIORPLYWOOD OVER r x 8•STUDS 2ae x11 M'CEILING JOISTS®te'O.C. 12 O.C. 2 TOP AND I BOTTOM PLATE WITH 12 "q Iz� 5.7S NEW 2.10 RAFTERS®IFO.c. 'II EXISTING BEDROOM#3 EXISTING'B`D` O' M#2 Ir R]e INSUI:,, ASPHALT Oft FIBERGLASS ROOF SHINGLES 3• W OVER APPROVED SHINGLE BACKING OVER I - I?E%iERIOR FlrwOOD y._.,:.,...:: exe RAFTERS NEW 2a0 TEBACN 12 'O.C. . RAFTERS®t6'O.C. INSUL. - gR]O INSUL. 12 e ...WAS.EOWAS. g R]O ER EXISTING JOISTS TO B..REMOVED fOs®t6'0.4 HURRIGNEiIES®i6.O.C. 236 TOP PLATES \ CONTINUOUS SOFFIT BE R3—IN'LVL DROP 12R30INSUL. HURRICANF nES@ t O.c. _ 1 VENT EXISTING SOFFIT HEIGHT TO A61 ha EXTERIOR WALL CONTINUOUS MATCH EXISTING SOFFR VENT EXISTING zaa EXISTING DINING ROOM EXISTING KITCHEN i EXISTING FAMILY ROOM EMEWO0.REMOVED - FAMILY ROOM r ' KITCHEN eEft �'' ADDITION ADDITION JOISTHANGERS-OR- ANGERS-OR. 'I _ EIS EwBTNG BAND JOIST t INSUL - EMOVE EXI STING BA ND JOIST _ - FLOORING TO MATCH ANO BEM ON EXISTING P.T.SILL - - - - —_ AND BEM ON EXISTING P.T.SILL ! 5.5'R2t INSUL. EXISTING >O INSUL EXISTING EXISTING2 x10z®16.0.4 EXISTINGL 0JOISTS@4TO. FRONT BRICK at0 6 2F.I.SILL PLATE SHELF 1M P T SILL PLATE Y w51LL SEAL � NEW 2a1040 STS �� LL SEAL NEw] MATCH EXISTING ANCHOR BOLTS WITH ]x -Mcn1R BOLTS NEW la'PLATEWASHER®sI• _ C.EMBED In CONC 7'MIN 9 NEW 6 P.C.FOUNDATION WALL EXISTING BASEMENT D.C.eraeeoiriwwcR®I EwB Pc FDunognoN WALL - CRAwLSPACE P.O.EXISTING NEW CRAWLSPACE EXISTING BASEMENTzX.•KErwgv OPTIONAL) EXISTIG 3 IR•0 f S 2%<•KEYWAYIGFT NALI [ - 1 STEECONL FILLED E !1 NEWS'%10'PC FOOTING STEEL COLUMN EXISTING FOUNDATION - - COLUMN �. FO WALL AND \ O fRSR 6M0 POLY VAPOR BA ,< ' D ` �/` NlV B I6•PCFOOTING FOOTING GMIL.POLTVMORBM EXISTING _. • I, _ _ ADDITION. _ 10%16 CONTINUOUS PC FOOTING - ~ 5'-0'ADOITIOry 20(30') FAMILY ROOM SECTION B 30(35')BUILDING SECTION A JT'-r KITCHEN 6 FAMILY BOOM ADDITION - FOUNDATION NOTES: 1 \ EXISTING t_11 BLOCK FIRST 2 BAYS OF JOISTS @ 40'O.C. - I _DECK 8 FOOTINGB ................................................. TO BE REMOVED - NEW INTERIOR CRAWLSPACE AREA=23fi S.F. III t TJi' tt'S WINOLOADCALCS.L=99WSJA=1.57 ANCHOR BOLTS®sro.C. NAILING SCHEDULE - ___ _______________ ROOF FRAME: . I - I a DRAFTER(TOENNLEO) - - T �I _ r29 j TOP PLATES ATINTERSECTONS(FADE.VNLED) E 4'L" W SP E siu0 To siuD(FACEJaNLEO) - -HEADERTO HEADER(FACE+iNLED)OwINO RGI ICE T TN TCHE STN FLOORFRAMH ____—____________ ELATE OR GIRDER(TOE-NAILED)DOCKINGTO JOIST(TOENNLED) BL LEDGEBLOCKINGTOSINORGIRDER(FAOR TOP PLATE E-NAINLE— LEDGERTOBEAMTOBEAER(FACENNLEO)JOIST® JOISTOIV LEOGERTOBEAMROEYVAILEDI 6•I H b I I EXISTING EXISTING BASEMENT RIM JOIST TO SILL OR ODP KATEI(TOEaVAILE0) }1� "Bd peA cool ---- l n I 1 BASEMENT .DOWOPENINGTO I6e }16e ______________________ WINDOW BE INFhLED FOR NEW m I DOW DOOR ABOVE ROOF SHEATHING: ____________________ ______ I t?MYw0000R 706'O58 _ 4 .OR LESS EXISTING F P.G.FOU WALL WITH GABLEENOWALLL C NDATION RAKE(NO OVERHANG mwt STRUCT.OUTLOOKERS) tb 1. b'e Je S. A BITUMINOUS ASPHALT FINISH ON _______ ______ J A 8'X 16'P.G.FOOTING 4- r D - , CEILING SHEATHIrvG: MIN.BELOW GRADE(TYP.GARAGE) - GYPSUM WALLBOAR re09e tggeq I I WINDOW ALsHo OR lose I 1 Noow - III EXISTING FULL BASEMENT wI STUDS G 24'O.C.OR LESS ralBa rGBH ENLARGE FOR NE; III 1?GYPSUM WALLBOARD - Tetl9e Ig GMtl CRAWL9PACE ACCESS I EXISTING 12at2z FLOOR$XEATI NG: PLYWOOOOR OSB VORLESS GREATER THAN I' 10J geOge G MH OCON4FO A , COMINuOUSPL FOOTry Ew5nNG 2at0 STEEL COLUMN ONE FOOTING t2 JOPSTS G 2.10O.C. III EXISTING PoURED LONLRET I Tr CAL FIRST I DROP BEAHhW�O FLOORFRAMING I I I III I-LI_____I I I_ I HEADER SCHEDULE �— Eazst BaG L J L J L J L _ I v O VL EXISTING 2-CAR GARAGE DROP BEEAAMOD K I I _ I I�___ I __i I I S.tO• bw .. I I 6XI a P III ' EXISTING FULL BASEMENT I I ------------------------ ___________________ ___________ I P A <•BRICK SHELF BELOW RAGE. WALL F RONT ONLY FOUNDATION PLAN DETAIL _______-________________ ___________ .-y BUILDING SECTIONS & FOUNDATION DETAIL Y."=1-0 L_______ ___________ _____ ________________ DATE: SEP 42015 PROJECT: MOMAHON RESIDENCE GREYWING DESIGN 50 FARM VALLEY RD..OSTERVILLE.MA SCALE: 1l9"=1'-0" ADDITIONS A RENOVATIONS 131 QUAKER MEETINGHOUSE ROAD,EAST SANDWICH,MA 02537 www.greywing.com (508)888-0886 ©2015 Greywing Design 508 888-0886 /�J� ` wt" "'w ' m ° "° PROJECT NO:G150710 SHEET; /yY OF f 20' MINIMUM OR AS INDICATED ON PLAN <1 10' MIN. MASONRY EXTENSION TO 12' BELOW GRADE BA f1LL MATH /Q•S TOP OF FOUNDATION B' MIN. 2 d ��' • /9. O MASONRY EXTENSION TO 12' �- BELOW GRADE 4" SCH. 40 PVC PIPE MIN. PITCH 1/8' PER FT. a 2" LAYER of I FLOW LINE ER FT. 1/8' - 1/2' 1 10" TEE /000 WASHED STONE 5 r /7,/ 3' MIN. 17S 2'-0• ; 2' WN. LEVEL Pa] LEACH 4'-0' /lo. '' r PIT 3 4' 1.4 2" r. 9 LIQUID MIN. /6.4 ` F WASHED STONE , LEM! DISTRIBUTION ' BOX' /D. O { /5-00 GALLON SEPTIC TANK Z LIQUID DEPTH IN SEPTIC TANK DEPTH OF OUTLET TEE BELOW FLOW UNE BOTTOM OF TEST HOLE ;f 4 FEET 14 INCHES OR USGS PROBABLE HIGH WATER LEVEL J�! 5 FEET 19 INCHES6 FEET 24' INCHES ,a SEWAGE ' DISPOSAL SYSTEM PROFILE ` y` NOT TO SCALE _ a. w It • �,r / j r e ,. ,//, tea, PAN .r Q 1 DRAINAGE i ��2� �� �• . / ` ' , �� Q� �r EASEME i' _ / •' /' I > , Q cot �. ba n eV -' ' LOT 117 / �� 26�037 S.F. 0.59 C: 125.00' LOT 116 e 44 04' • L = t?' = 25,067 -S.F. 0.'57 AC. !� BENCH MARK ELEV. L=57.18, gip. 76 / A, RK SET = 1 9.4 INGVD .'Q=5250. 20 'S ELECTRIC k PHONE HYDRA T r SITE PLAN , m NEW fNGL AND RFPROGPAPHICS A 5UPPL V CO TOP Of FOUNDATION 24" DIAMETER CONCRETE COVERS EL=50.0± RAISED TO WITHIN G" Of FINISH GRADE Proposed 05TERVILLE (OR AS NOTED) Vent MA Zone ReferenGe,5: so EL=47.8± EL=47.5:� x Zone: Rf- I M E Minimum Area: 43,5GO 5f 500 Minimum frontage: 20' LOCL15 4G.7 Minimum Width: 1251 45.3 =E GEOTEXTILE FABRIC (IN PLACE OF 1/4"- 1/2' PEA5TONE) Setbacks \Ce, .. . . ..... r Fro nt: 30' SITE LOCUS 45. 17 45.0 -4G.O �\45.35 3/4" to NOT TO SCALE 51de: 15 0 44.3 Proposed 44.8 c N L; Rear: 15 1 - 1/2" STONE (Double, wash) New Outlet ib D13-3 References: GAS BAFFLE H-20 Rated CONCRETE THREE (3) H-20 SHOREY FRECA5TCON' Assessor's Map 97 Parcel 34 2.8 LEACH CHAMBERS WITH 4' Of STONE ON D-150x LC Plan 5725-45 5ht 3 7777l J ENDS AND 4' ON SIDES 12' -4 41 15' G.01 Thl5property 15 in a Zone 11 Longest Run I of a Public Water Supply SEPTIC TANK LEACH CHAMBER5 (END VIEW) Flood Zone X 25001 C0544J 1500 GALLON FLOW PROFILE E 4G NOT TO SCALE EL=3G.8 Bottom Test Hole LEGEND CUN5TRUCTOIN NO-NTE5 46 ....... ........ ......... ....... EXISTING CONTOUR 1 .) ALL WORK SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE, TITLE 5 (3 10 CMR 15.000): (52.9) EXISTING SPOT GRADE STANDARD REQUIREMENTS FOR THE SITING, CONSTRUCTION, INSPECTION, UPGRADE, AND EXPAN51ON Of ON-SITE SEWAGE TREATMENT AND DISPOSAL SYSTEMS AND FOR THE TRANSPORT Lot,54 (47.8) 24x5 PROPOSED SPOT GRADE AND DISPOSAL Of 5EPTAGE, AND THE LOCAL BOARD Of HEALTH REGULATIONS. TIP FENCE TEST HOLE LOCATION 2.) ANY SEPTIC SYSTEM COMPONENT INSTALLED IN A LOCATION WHERE THERE 15 POTENTIAL FOR (45.1) ST SEPTIC TANK VEHICLE5 OR HEAVY EQUIPMENT TO PASS OVER IT SHALL BE DESIGNED TO WITHSTAND AN H-20 DB DISTRIBUTION BOX LOADING. IF UNDER AN llv1PERVIOU5 5UPTACE, SYSTEM SHALL BE VENTED TO THE ATMOSPHERE. cc Note SAS SOIL ABSORPTION SYSTEM 4 3.) TO MINIMIZE UNEVEN SETTLING, SEPTIC TANKS SHALL 13E INSTALLED ON A STABLE (47.3) PrOP05CCI MECHANICALLY-COMPACTED BASE ON 51X INCHES Of CRUSHED STONE. 42.6) 44.9) Patio 4.) COVERS OVER THE INLET AND OUTLET TEES OF THE SEPTIC TANK, THE DISTRIBUTION BOX, AND (47.9) i. ProrGat� Lot 1 18 THE SOIL ABSORPTION 5(5Tf-M SHALL BE RAISED TO WITHIN G" Of FINAL GRADE. LEACHING Proposed f FIELDS, TRENCHES, AND OTHER 501L ABSORPTION 5Y5TEM5 WITHOUT ACCESS MANHOLES SHALL HOU5C #15 -CTION PORT CONSISTING Of PERFORATED 4" PVC PIPE PLACED 4 Beciroorn HAVE AT LEAST ONE (1 ) 11`45PE 44 Pool TOf EL 50.0 VERTICALLY TO THE BOTTOM Of THE 501L ABSORPTION SYSTEM WITH A CAP, TIED WITH MAGNETIC ...... .... (see Pool MARKING TAPE, ACCESSIBLE TO WITHIN 3" Of FINAL GRADE. Plan) . ...........47.7) Proposed Draina6ic Easement 5.) PIPING SHALL CON515T OF 4" SCHEDULE 40 PVC OR EQUIVALENT. PIPE SHALL BE LAID ON A H-20 Chamber "' :; V.-1 - *&. A/ (47-E�) MI NIMUM CONTINUOUS GRADE Of NOT LESS THAN 2% FROM THE BUILDING TO THE SEPTIC TANK, Pat-Ao 4 G (47.7) 0 WISE., -'i (4G.9) Prop Go' AND NOT LESS THAN I%OTHER Garage 46 b, 77 7. 7- 'o, TP G.) DISTRIBUTION LINES FOP,THE 501L ABSORPTION SYSTEM SHALL BE 4" DIAMETER SCHEDULE 40 7777 ............ TP 1 ST 4 7X9 0 FVC OR EQUIVALENT) LAID AT 0.005 FT/FT. UNLESS OTHERWISE NOTED. LINES SHALL BE CAPPED AT END OR AS NOTED. (47.0) Catch Basin DR TBM El 45.5 7.) LINES FROM THE DISTRIBUTION BOX TO BE LEVEL FOR THE FIRST TWO (2) FEET BEFORE PITCHING TO THE 501L ABSORPTION SYSTEM. DISTRIBUTION BOX SHALL BE WATER TESTED TO vcr�t W D-Box 4 7X4, ASSURE EVEN D15TRIDUITON. SAS (4 2) 6.) GROUT TO 13E USED AT ALL POINTS WHERE PIPES ENTER OR LEAVE ALL CONCRETE STRUCTURES ed (47.0) IN ORDER TO PROVIDE A HATERTIGHT SEAL, .......... SYSTEM DESIGN CALCULATIONSPay 0 9.) HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS Of THE SEWAGE SEWAGE DESIGN FLOW REQUIRED: 4 BEDROOM DWELLING @ 110 GPD BEDROOM 440 GPD DI SP05AL FIELD DURING THE COURSE Of CONSTRUCTION Of THE SYSTEM. REQUIRED I O.) IN ACCORDANCE WITH 3 10 CMR 15.22 1 , ALL SYSTEM COMPONENTS SHALL BE MARKED WITH SEWAGE DESIGN FLOW PROVIDED: THREE (3) 500 GALLON LEACH CHAMBERS WITH 4' STONE ON 46 0) 7VC0 MAGNETIC MARKING TAPE. THE ENDS AND 4' STONE ON THE SIDES Lot 1 17 Vt = [(33.5 x 12.53) + 2(33.5 + 12.83) (2) x .74 455 GPD PROVIDED 2G,035± Sq. ft. I �,,IcGANN I I THERE ARE NO KNOWN WELLS WITHIN I 00' Of THE PROPOSED 501L ABSORPTION SYSTEM. .7) 4�� N 1224 455 GPD PROVIDED > 440 GPD REQUIRED Lot I IG 12 .) FROM THE DATE Of THE INSTALLATION Of: THE 501L ABSORPTION SYSTEM UNTIL RECEIPT Of THE CERTIFICATE OF: COMPLIANCE, THE PERIMETER SHALL BE STAKED AND FLAGGED TO PREVENT 5EPTIC TANK CAPACITY REQUIRED: 440 GPD X 200% = 580 GFD REQUIRED USE OF THE AREA THAT NIAY CAUSE DAMAGE TO THE SYSTEM. SEPTIC TANK CAPACITY PROVIDED: 1500 GALLON PROVIDED (MINIMUM ALLOWED) A GARBAGE DISPOSAL 15 NOT PERMITTED WITH THIS DESIGN FLOW "(44.0) 13 .) THE DESIGNER WILL NOT BE RESPONSIBLE FOR THE SYSTEM AS DESIGNED UNLESS CON5T-R,UCTfDA55HOVvN ON PLAN. ANY CHANGES SHALL BE APPROVED IN WRITING BY THE 48 DESIGNER, Proposed 51te- Plan 14 .) THE BOARD OF HEALTH REQUIRES INSPECTION Of ALL CONSTRUCTION BY AN AGENT Of THE TEST 1-101-f- LOG5 for BOARD Of HEALTH AND THE DESIGNER. THE DESIGNER SHALL CERTIFY IN WRITING THAT THE Test Hole I (EL=47.8±) 5ewage D15P05al 5y5teM FOOI SEWAGE DISPOSAL SYSTEM WAS INSTALLED IN ACCORDANCE WITH THE TERMS Of THE PERMIT I I I I CERTIFY THAT I AM CURRENTLY APPROVED 13Y THE DEPARTMENT Of AND THE APPROVED PLANS. 48 HOURS ADVANCE NOTICE 15 REQUESTED. Depth Elev. Layer Soil Class Soil Color Comme45 ENVIRONMENTAL PROTECTION PUR5UAMT TO 3 10 CMR 1 5.01 7 TO CONDUCT 5G Farm Valley Road 15 .) LOCATION Of UTILITIES 15 APPROXIMATE AND CONTRACTOR SHALL 13E RESPONSIBLE FOR 011-411 47.5 A Loamy Sand I OYR 4/2 501L EVALUATIONS AND THAT THE ABOVE ANALYSIS HAS BEEN PERFORMED 05terville, - MA Dff-TERN11NING THE LOCATION Of ALL UNDERGROUND AND OVERHEAD UTILITIES PRIOR TO 411-2011 4G. 1 13 Loamy 5and I OYR 5/5 BY ME CONSISTENT WITH THE REQUIRED TRAINING, EXPERTISE, AND EXPERIENCf- COMMENCEMENT Of ANY WORK. TH15 INCLUDES, BUT 15 NOT LIMITED TO, REQUESTS TO DIG5Aff, 20"-132" 3G.8 C Medium Sand 2,5Y GIG DESCRIBED IN 3 10 CMR 15.017. 1 FURTHER CERTIFY THAT THE RESULTS Of MY Prepared for: ANY PRIVATE UTILITY CONIPANIE5, AND THE LOCAL WATER DEPARTMENT. 501L EVALUATION, AS INDICATED ON THE ATTACHED 501L EVALUATION FORM, Jocyc Landscaping, Inc. I G.) CONTRACTOR SHALL VERIFY THAT ALL WA5TELINE5 ARE CONNECTED BY WATER TESTING Test Hole #2 (EL=47.8±) ARE ACCURATE AND IN ACCORDANCE WITH 3 10 CMR 15. 100 THROUGH 15. 107. G8 flint Street WITHIN THE DWELLING PKOR TO INSTALLATION Of ANY SEPTIC COMPONENTS. I Mar5ton5 IVIIII5, MA 02G48 17.) CONTRACTOR SHALL VERIFY EXISTING INVERT ELEVATIONS PRIOR TO INSTALLATION OF ANY Depth Elev. Layer Soil Class Sod Color Comment5 SEPTIC SYSTEM COMPONENTS. 011-Gil 47.2 A Loamy Sand I OYR 4/2 Prepared by: 15.) TEST HOLES COMPLETED PEP, STATE ENVIRONMENTAL CODE, TITLE 5. SOILS CAN BE G11-2411 45.8 13 Loamy Sand I OYR 5/8 PETER McENTEE, CERTIFIED 501L EVALUATOR All Cape, 5eptic. LLC VARIABLE AND TEST HOLE DATA 15 NO GUARANTEE Of 501L CONDITIONS IN OTHER AREAS. If 24"-132" 3G.6 I C Medium Sand 2.5Y GIG GRAPHIC SCALE G 18 Route 25 5011-5 DIFFER FROM TH05E SHOWN IN THE SOILS LOGS, DESIGN ENGINEER 15 TO INSPECT THE 5011-5 PRIOR TO PROCEEDING WITH INSTALLATION Of ANY SEPTIC COMPONENTS. DATE Of TESTING: 12/22/15 30 0 15 30 60 150 West Yarmouth, MA 02G73 501L EVALUATOR: PETER McENTEE 6-v v-s lill I I 10.) EYi,5TNNG SEPTIC COMPONENTS TO 13E LOCATED, PUMPED DRY, FILLED WITH CLEAN SAND AND IN (508) 77 1 -4200 or allcape5eptic@cjmail.com BOARD OF HEALTH AGENT: DAVID STANTON R5 I WIN E-2 ABANDONED IN PLACE OR REMOVED AS REQUIRED. AREA TO BE COMPACTED TO MINIMIZE SETTLING. PERCOLATION RATE: LESS THAN 2 MIN/INCH IN "C" LAYER AT GO/78" NO GROUNDWATER ENCOUNTERED IN FEET Date: 0 1/04/1 G Sheet I of I By: MA Check: 5M Project No. A�-132 1 inch 30 ft. -4G.O 4 Rev. Date: Jan. 12, 201 G Relocate 5A5, P.L. d5t'5, contours. 20' MINIMUM OR AS INDICATED ON PLAN I NOTES: 7 10' MM. 1 /� 1 . ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D-E-P. I MASONRY EXTENSION TO 12' I ' TITLE 5 THE TOWN OF _batns RULES AND , BELOW GRADE �� REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE; � TOP OF FOUNDATION 8" MIN. � ,. I BACKFILL WITH � � ! CLEAN MASONRY EXTENSION TO 12" f �— BELOW GRADE f AND THE REQUIREMENTS OF THIS PLAN. 1 1 f z � 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 12" OF FINISHED GRADE. 4" SCH. 40 PVC PIPE MIN. PITCH 1/8" PER FT N 3. ALL MASONRY UNITS USED TO BRING COVERS TO GRADE .J \ LA YER I SHALL BE MORTARED IN PLACE. !' 74p ER FLOW LINE 1/8' - 1/2' } 4. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE10" TEE� 3" MIN. 0" WASHED STONE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER ORGALLON WITHIN 10 FT OF DRIVES OR PARKING AREAS. H--20 LOADING2" MIN. LEVEL LEACH 4'_0' �; PIT 3/4" 1 1 z• SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR9 MIN. ` 4 L WASHED STONE PARKING. �LEVEL DISTRIBUTION /�. ,' � - __ Box u 5 NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDd W is. o RESTRICTIONS OR ZONING REGULATIONS. OWNER/APPLICANT SHALL Li /S00 GALLON SEP71C TANK OBTAIN SUCH DETERMINATION FROM THE APPROPRIATE AUTHORITY. LOCATION MAP z 6. HORIZONTAL AND VERTICAL CONTROL, SEE LEVY, ELDREDGE ASSESSORS MAP `17 PARCEL 34-- ---- --- /om & WAGNER FIELD NOTEBOOK LIQUID DEPTH IN SEPTIC TANK DEPTH OF OUTLET TEE BELOW FLOW LINE I J BOTTOM OF TEST HOLE 4 FEET 14 INCHES OR USGS PROBABLE HIGH WATER LEVEL i 5 FEET 19 INCHES 6 FEET 24 INCHES CURRENT ZONING INTERPRETATION: DESIGN CALCULATIONS I SEWAGE DISPOSAL SYSTEM PROFILE I MIN. FRONT SETBACK _34____—_ FEET NUMBER OF BEDROOMS �o �r NOT TO SCALE MIN SIDE SETBACK __1e___ __ FEET GARBAGE DISPOSAL UNIT TOTAL ESTIMATED FLOW MIN. REAR SETBACK _ 15 ___ FEET ( //V GAL./BR./DAY X _ BR.) GAL. /DAY REQUIRED SEPTIC TANK CAPACITY GAL. N I ACTUAL SIZE OF SEPTIC TANK GAL. LEACHING AREA REQUIREMENTS PERCOLATION SOIL TEST SIDEWALL AREA GPD./S.F. BOTTOM AREA GPD./S.F. DATE OF SOIL TEST Z z Dcc� u nce 1'Ts 4 SIDEWALL 2 rr 2 SF x Z. GPD SF = TEST BY _S rt ��, IsG�L — BOTTOM ( ?T (i) 2 SF x /GPD/SF = 4�9 GAL/DAY s j WI TNESSI=D BY Ea.Q a•-,•� _ s r _ PERCOLATION RATE — .� MIN./INCH x 554 SF //c�-.0 — GAL/DAY r` TEST PIT # TEST PIT #2 BREAKOUT CALCULATION: P ELEV.= ELEV.= 1 —0.00 —0.00 / / r 5° Nt - -------- - _20 - DRAINR E EASEMENT, �- ire Tcsl , �.' / — 5 r ' / I LEGEND : EXISTING SPOT ELEVATION 00.0 X EXISTING CONTOUR------ -00----- 1 FINAL SPOT ELEVATION 00.0 bats(r, FINAL CONTOUR 16 ,' I k <v' / TP SOIL TEST PIT LOCATION BOTTOM OF TEST HOLE BOTTOM OF TEST HOLE ,' ,'/- ,'� s '• i ' / <J OR WATER ELEV, S. OR WATER ELEV. TOWN WATER --W W 20 1 . / °' \, � ���; � � ,% � SEPTIC TANK o �, :�,�h El LOT 117 �/ / WATER LEVEL ADJUSTMENT: DISTRIBUTION BOX PRIMARY LEACHING PIT 26,037 S.F. I� / � RESERVE LEACHING PIT 0.59\AC R AvTEST DATE WATER LEVEL LOT 116 L — 4404' t�, ° INDEX WELL 25,062 S.F. ^ — ,' WATER LEVEL RANGE ZONE INITIAL ISSUE 54( J 0.57 AC. v �P DEPTH TO WATER LEVEL FOR INDEX WELL NO. DATE DESCRIPTION BY � \` 4� 5O' \ J '' BENCH MARK ELEV. FOR MONTH OF: 6=52.50 -- _ ��9 43$� - PK SET 19.47 NGVD T ,\ 20 _, v. ee� / WATER LEVEL ADJUSTMENT SITE PLAN & SEPTIC DESIGN � �.0 R:_ DEPTH TO HIGH WATER LOT 117 FARM VALLEY ROAD ELECTRIC ' / v & PHONE 18 0 S TERVILLE, MAS S AC HUS ETTS FOR HYDRA T LO NG HILL CORP. APPROVED: BOARD OF HEALTH ' STEPHEN ALLY WILSON SITE PLAN - No.3Dzis�1o � SCALE: —1 �� _ 4o' i JOB N0- 1768 / 1768 DATE AGENT LEVY, ELDREDGE & WAGNER ASSOCIATES INC. PERMIT # — — —— EIGMM LAFMC>SFS AB(,'i�t" PI AKM LWSURMOZ 586 STRAWBERRY HILL RD CENTERVU U MA 02632 NEW f NGLANO REPROGRAPHICS B SUPPL Y CO