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HomeMy WebLinkAbout0094 FIRST AVENUE - Health 94 First Avenue Osterville P A = 116 057 - i. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 94 First Ave. Property Address Sloane Owner's Name Osterville V MA 02655 6/13/15 City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information 1. Inspector: Frank Nunes III Name of Inspector saa .� a. a r Company Name Box 841 Company Address East Falmouth MA 02536 Cityfrown State Zip Code 508.272.6433 Telephone 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 sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority I ad- 1 6/13/15 Inspector'stAgEature 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. q6 94 First Ave.•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GM 94 First Ave. Property Address Sloane Owners Name Osterville MA 02655 6/13/15 Citylrown 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: Pumping suggested every 3 yrs to prolong the life of the system 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 exMtration 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: n/a ❑ 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 94 First Ave.•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 94 First Ave. Property Address Sloane Owner's Name Osterville MA 02655 6/13/15 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): I ❑ distribution box is leveled or replaced ND Explain: n/a ❑ 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: n/a C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ : The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 94 First Ave.•03108 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 3 of 15 I' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i 94 First Ave. Property Address Sloane Owner's Name Osterville MA 02655 6/13/15 Cityrrown State Zip Code Date of Inspection. B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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: n/a 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 ❑ ® 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. 94 First Ave.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 94 First Ave. Property Address Sloane Owners Name Osterville MA 02655 6/13/15 Citylrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No ❑ ® 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. [Phis 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 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. 94 First Ave.•03/08 Title,5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 94 First Ave. Property Address Sloane Owner's Name Osterville MA 02655 6/13/15 Cityrrown State Zip Code Date of fnspection C. Checklist 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: ® ❑ 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)] 94 First Ave.•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 1 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 94 First Ave. Property Address Sloane Owner's Name Osterville MA 02655 6113/15 Citylrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): n/a Number of bedrooms (actual): 3 I DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 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 Seasonaluse? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: seasonal Date Commercial/industrial Flow Conditions: Type of Establishment: n/a 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: Last date of occupancy/use: Date Other(describe): n/a 94 First Ave.•03(08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 94 First Ave. Property Address Sloane Owner's Name Osterville MA 02655 6/13/15 Citylrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Pumped 2 yrs ago per owner 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 I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: >1970 per materials used Were sewage odors detected when arriving at the site? ❑ Yes ® No 94 First Ave.•03108 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 94 First Ave. Property Address Sloane Owners Name Osterville MA 02655 6/13/15 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 18" Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 12 11 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: 1000g Sludge depth: 1/2 Distance from top of sludge to bottom of outlet tee or baffle >12' Scum thickness trace Distance from top of scum to top of outlet tee or baffle >211 Distance from bottom of scum to bottom of outlet tee or baffle >2'i How were dimensions determined? Measured 94 First Ave.•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 94 First Ave. Property Address Sloane Owner's Name Osterville MA 02655 6/13/15 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.): Pumping suggested every 3 yrs to prolong the life of the system Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): n/a 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): n/a 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): n/a 94 First Ave.-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 I Commonwealth of Massachusetts i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 94 First Ave. Property Address Sloane Owners Name Osterville MA 02655 6/13/15 City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) i 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.): n/a "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No D-Box Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 94 First Ave.•03108 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 94 First Ave. Property Address Sloane Owner's Name Osterville MA 02655 6/13/15 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located explain why: p Y Type: ® leaching pits number: 1 ❑ 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.): Leach pit was video inspected and is dry at this time, no adverse conditions, no indication of past backup, 2-3'stone surround 94 First Ave.-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 r Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 94 First Ave. Property Address Sloane Owner's Name Osterville MA 02655 6/13/15 City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 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.):, n/a 94 First Ave.•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Assessing As-Built Cards Page 1 of 2 y CJ1 TOWN OF B.ARNSTABLE ' � • "� "\OCATION 1 !'yr AI t. SEWAGE N \V`ILLAGE ASSESSOR`$MAP&LOT INSTALLER'S NAME&PHONE NO. L-67- 11-A SEPTIC TANK CAPACITY /Ow C-A LEACHING FACH ITY:(type) r1� Co X f$ /OW ze) 3• S7 CnL NO.OF BEDROOMS 3 BUILDER OR OWNER sIOAnQ PERMrrDATE 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 of within 200 feu of leaching facility) Feet Edge of Wedand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet -Furnished by_=n SOe. 0% FO'.) &C. By .0e° O a A B & ' O 3 s 3y l http://ww-w.town.bamstable.ma.us/assessing/HMdisplay.asp?mappar=116057&seq=1 6/10/2015 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 94 First Ave. Property Address Sloane Owner's Name Osterville MA 02655 6/13/15 Citylrown State Zip Code Date of Inspection a D. System Information (cont.) �I Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: >12' 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: per elevation of home 1 i 94 First Ave.•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 2'-0° ,•se.•x.'.slsti•x<•.sy' rya•x:•-sa• ,�.r.•x<as,s+a'x+'an• NEW DORMEN BATH / \o �\\Joc/po lu O ' 0 u'-low" / \ $EDROOM s { O W� � B • ry 1 1 I i I I 1� 1 1 I I I f 1 ! Wit STI Cs TAW S I ' PLAY ROOM I I 1 I I i O I S I 17 SITTING AREA 1 CLOSET p i i I 4 I I LDE CAPE IBUILDING 333 SERVICE ROAD = SAM: SC ALE 1/,{IW V1 1 /1W1 APPROVED DATE 7 /t ljo 1 t 11 ' • �1� I _ r 5 4 James M. Ford Title V Septic System Inspections Post Office Box 49 Osterville, MA 02655 (508) 862-9400 April 24, 2003 Town of Barnstable Board of Health Hyannis, MA 02601 Re: 94 First Avenue, Osterville i Dear Joan: On September 13, 1999,1 inspected the property at 94 First Avenue, Osterville;however, the report incorrectly stated the address as"100"First Avenue. If you have any questions, please call me. Very truly youzs, Jam M. Ford Commonwealth of Massachusetts �€ ► • t n Executive Office of Environmental Affairs kV Department of Environmental Protection , One Winter Street, Boston MA 02108 (617)29255M S fg `.O F t 1999 TRUD� �XE Secr tary ARGEO PAUL CELLUCCI �J D. I�D�B�STRUHS Governor " . cl 0 ti mmissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION- Property Address: 100First Avenue, Osterville,MA Name of Owner: John Gallagher` 4 Address-of Owner: 78 North Street. Date of Inspection: September 13, 1999 Hyannis, MA 02601 Name of Inspector: (Please Print) James M. Ford I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: James M. Ford - Mailing Address: P.O. Box 49, Osterville, MA 02655-0049 Map: Telephone Number: (SO8)862-9400 Parcel 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: ✓ Passes ` Conditionally Passes Needs Further Eval n By the Local Approving Authority Inspector's Signature: Date: September 17 1999 The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS , revised 9/2_/98 Page Printed on Recycled Paper f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 100 First Avenue, Osterville, MA , Owner: John Gallagher Date of Inspection: September 13, 1999 INSPECTION SUMMARY: Check A, B, C, or D A. SYSTEM PASSES: a + ✓ I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 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. IThe system,upon completion of the replacement or repair,as approved by the Board of Health, will pass. Indicate yes,no, or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank7' failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken'or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health) broken pipe(s)are replaced _ obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 revised 9/2/98 Page 2ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM,INSPECTION FORM . PART A CERTIFICATION (continued) Property Address: 100 First Avenue, Osterville, MA , Owner: John Gallagher Date of Inspection: September 13, 1999 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 the public health, safety and 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 THE PUBLIC_ HEALTH AND 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. ,. - i. .. it ... ,. • y -f i 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 AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet to a surface water supply;or tributary to a surface water supply. . The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has.a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for colifotm 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. Method used to determine distance (approximation not valid)_ 3) OTHER Y fl a revised 9/2/•98 Page 3ofII r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 100 First Avenue, Osterville,AMA Owner: John Gallagher Date of Inspection: September 13, 1999 3 D. SYSTEM FAILS: You must indicate either "Yes" or "No" as,to each of the following: - _ I have determined that one or more of the following failure conditions exist as described in 310 CMR'15.303. The basis for this deterrnination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less than'/z day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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. z _ 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for, coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: - You must indicate either"Yes" or"No" as to each of the following: " The following criteria apply to large'systems in addition to the criteria above: _ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the.system is a significant threat to public,-. health and safety and the environment because one or more of the following conditions exist: 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 - The owner or.operator of any such system shall upgrade`the system in accordance with 310 CMR 15.304(2). Please consult the local regional- office of the Department for further information. revised 9/2/98 Page 4of11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 100 First Avenue, Osterville, MA Owner: John Gallagher s Date of Inspection: September 13, 1999 - Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No }. ✓ — Pumping information was provided by the-owner, occupant,or Board of Health. ✓* None of the system components have been pumped for at least two weeks and the'system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the-system recently or as part of this inspection. * (The property is vacant.) n/a As built plans have.been obtained and examined. Note if they are not available with N/A: ✓ — The facility or dwelling was inspected for signs of sewage back-up. ,w s ✓ The system does not receive non-sanitary or industrial,waste flow. Y — Y . . ✓ _ The site was inspected for signs of breakout. ✓ All system components, excluding the Soil Absorption System,have been located on the site. ✓ — The septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for conditions of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been deternuned based on: ✓ Existing information. For example, Plan at B.O.H. - s ✓ — Determined in the field(if any of the failure criteria related to Part C is at'issue,approximation of distance is unacceptable) [15.302(3)(b)]• w, ✓ _ The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of. SubSurface Disposal Systems: revised 9/2/98 Pages ofll r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C t SYSTEM INFORMATION Property Address: 100 First Avenue, Osterville, MA Owner: John Gallagher Date of Inspection: September 13, 1999 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom. Number of bedrooms(design): n/a Number of bedrooms (actual):, 2 Total DESIGN flow n/a Number of current residents: 0 Garbage grinder(yes or no): No Laundry(separate system) (yes or no): No ; If yes, separate inspection required Laundry system inspected(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available(last two year's usage(gpd): None available per Water Department` Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gpd(Based on 15.203) Basis of design flow 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: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: r Pumped on May 12197 and July 19194 per treatment plant. K System pumped as part of inspection(yes or no): No If yes, volume pumped: gallons f Reason for pumping: TYPE OF SYSTEM ✓ Septic tank/distribution box/soil absorption system Single cesspool - Overflow cesspool Privy s Shared system(yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components;date installed(if known)and source of information: Unknown . - F Sewage odors detected when arriving at the site: (yes or no) No revised 9/2/98 Page 6ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 100 First Avenue, Osterville, MA Owner: John Gallagher Date of Inspection: September 13, 1999 BUILDING SEWER: (Locate on site plan) — Depth below grade: T t Material of construction: cast iron _40 PVC _other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 9" ° Material of construction: ✓concrete _metal _Fiberglass _Polyethylene _other(explain)T If tank is metal,list age Is age confirmed by Certificate of Compliance_(Yes/No) g .. , Dimensions: 8'6" x 4'10" x 5' (1000 gal.) Sludge depth: I" Distance from top of sludge to bottom of outlet tee or baffle: -- „ Scum thickness: 1 Distance from top of scum to top of outlet tee or baffle: -- Distance from bottom of scum to bottom of outlet tee or baffle_: -- How dimensions were detemained: Measuring stick Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) Both of the baffles were present The liquid level in the tank was one-half full. The tank has roots growing inside. The water has been off for some time Recommend pumping and removing roots. 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:. r Date of last pumping: z. =, Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage, etc.) A revised 9/2/98 Page 7oftt r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION..FORM PART C SYSTEM INFORMATION (continued) ' Property Address: 100 First Avenue, Osterville, MA Owner: John Gallagher Date of Inspection: September 13, 1999 ` TIGHT OR HOLDING TANK: None (Tank must be pumped prior to,or at time, of inspection) µ . (locate cn site plan) Depth below grade: Material of construction: _concrete _metal Fiberglass "Polyethylene _other(explain) Dimensions: Capacity: gallons Design flow: gallons/day' ` Alarm present: Alarm level: Alarm in working order: Yes No_ Date of previous pumping: Commends: r (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: None (locate on site plan) Depth of liquid level above outlet invert: ' Comments: a.. (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) T y 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.) revised 9/2./98 Page 8oflt SUBSURFACE SEWAGE DISPOSAL.,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 100 First Avenue, Osterville, MA Owner: John Gallagher Date of Inspection: September 13, 1999 „ SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan, if possible; excavation not required, location may be approximated by non-intrusive methods) If not located,explain: Type: leaching pits,number: I -6'x 6' leaching chambers,number: leaching galleries,number: R leaching trenches,number,length: w' leaching fields,number, dimensions: ' overflow cesspool,number: Fl Alternative system: Name of Technology: + ; Comments: , (note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.) The pit was dry and had no signs of failure. The bottom to grade was 9'. CESSPOOLS: None { (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: v ` inflow(cesspool must be pumped as part of inspection). 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: F Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding,"condition of vegetation, etc.) revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 100 First Avenue, Osterville, MA a Owner: John Gallagher Date of Inspection: September 13, 1999 x - . Map: Parcel: F x , SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) AQ, M1 . E F • -E t - revised 9/2/98 Page 10of I ', r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION'(continued) Property Address: 100 First Avenue, Osterville;,MA Owner: John Gallagher Date of Inspection: September 13, 1999 NRCS Report name Soil Type Typical depth to groundwater 4 USGS Date website visited Observation Wells checked " Groundwater depth: Shallow Moderate Deep SITE EXAM Slope a Surface water µ ,: Check Cellar r' Shallow wells Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation Obtained from Design Plans on record y " ✓ Observed Site(Abutting property,observation hole,basement sump etc") Determined from local conditions a Checked with local Board of Health Checked FEMA Maps ' Checked pumping records Check local excavators, installers a" ' ✓ Used USGS Data r �, Describe how you established the High Groundwater Elevation. (Must be completed) ' Hand augered down in the middle of the pit to 13'below grade and no water was observed. Using the Cape Cod Commission Technical Bulletin, the high groundwater adjustment for this site (M1 W 29, Zone B, 7199)was 3.6'. This report has been prepared and the system inspected and passed as of.the date of inspection. This report is not a warranty -or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. revised 9/2/98 Page 11ofll 4 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED MAY 1 5 2003 TOVVHEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 94 First Avenue Osterville, MA 02655 . Owner's Name: Bob Sloane Owner's Address: Date of Inspection: May 5, 2003 Name of Inspector:(Please Print) James M. Ford Company Name: James M. Ford, Map: 116 Mailing Address: P.O. Box 49 Parcel: 057 OsterviUe,MA 02655-0049 Lot: 11 A Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes N s Further Evaluation by the Local Approving Authority Fai Inspector's Signature: Date: May 7, 2003 The system inspector shall su it a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 r Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 94 First Avenue Osterville, MA Owner: Bob Sloane Date of Inspection: M S 2003 Pce � 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: I 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 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 94 First Avenue Osterville, AM Owner: Bob Sloane Date of Inspection: May 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—W(l)(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 waterf Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has aseptic 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 I Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 94 First Avenue Osterville, AM Owner: Bob Sloane Date of Inspection: May S, 2003 D. System Failure Criteria applicable to all systems: You must indicate either`des"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility.or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. • ` ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable.water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 1;Pd• You must indicate either`des"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 H 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 i Page 5 of 11 OFFICIAL INSPECTION FORM =NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 94 First Avenue Osterville, MA Owner: Bob Sloane Date of Inspection: May S, 2003 Check if the following have been done: You most indicate`yes of"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 ucicovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? ✓ Was the facility,owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems?` The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)]. 5 • Page 6 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 94 First Avenue Osterville, MA Owner: Bob Sloane Date of Inspection: May 5, 2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 4+ DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): No 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): Weekend use Water meter readings,if available(last 2 years usage(gpd)): 2002-'9,000 gals.:2001-3.000 gals. Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCI LIMUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gad 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: ¢allons—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: Unbwwn Were sewage odors detected when arriving at the site(yes or no): No 6 f • Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION (continued) Property Address: 94 First Avenue Osterville. MA Owner: Bob Sloane Date of Inspection: May S, 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: 9" 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: 1000 gal. Sludge depth: 2" - Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: I" 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: 12" 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.): Baffles were present. The liquid level was even with the outlet invert. Roots are growing inside the tank Recommend pumping and cleaning out the roots. 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 11 h OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 94 First Avenue Osterville. AM ` Owner: Bob Sloane Date of Inspection: May S, 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: None (if present must be opened)(locate on site.plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP 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: 94 First Avenue Osterville, MA Owner: Bob Sloane Date of Inspection: May 5, 2003 SOII.ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: .1 -6'x 6'-1000 gal: with 3'stone leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool;number: Innovativelalternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): The pit was dry and the interior was clean There were no signs offmiure. 1 dug around the pit and probed for the thickness of the stone. The cover was 3'below grade. The bottom to grade was 9'. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or,no): Comments (note condition of soil,signs of hydraulic.failure,level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) ` Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 I Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 94 First Avenue Osterville. MA Owner: Bob Sloane Date of Inspection: May 5, 2003 Map: 116 Parcel:057 SKETCH OF SEWAGE DISPOSAL SYSTEM Lot: 11-A 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. t7 V- BACI� y a . A 8 3 . 3y 10 • Page 11 of 11 OFFICIAL INSPECTION FORM-NOT-FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) " Property Address: 94 First Avenue Osterville, MA Owner: Bob'Sloane Date of Inspection: May S, 2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water, 20 +/- 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: to and water contoursmaps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: T&e bottom ofthe leach pit to ffade was 9: Using the Barnstable topographic map and the Cape Cod Commission water contours map, the maps were showing approximately 20'+/ to ground water at this site. . This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees,either expressed,written or implied, relating to the system, the inspection and/or this report. lI TOWN OF B ARNSTABLE a LOCATION ` 1 rST A VC. SEWAGE # VILLAGE OS ZI-V►1 ASSESSOR'S MAP & LOT C0 O S INSTALLER'S NAME&PHONE NO. 11-A SEPTIC TANK CAPACITY I T (SA I. LEACHING FACILrN: (type) P,7— 6 X Maze) 3 NO.OF BEDROOMS 3 I J BUILDER OR OWNER 1.5U� - Off) 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 lea chin facility) l Feet Furnished by�/1 Sr0 tom �D�C Cy O a a a� CI O 3 3 3a.6 3y } TOWN OF BARNSTABLE f `OCATION 'f� �"`r r�✓e• SEWAGE # VILLAGE OS-"e<VAt ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.- SEPTIC TANK CAPACITY folio LEACHING FACIL=:.(type) 1P , (size) (o�C NO. OF BEDROOMS BUILDER OR OWNER O�n G eAl')Ati�te- 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 , ` - 19 , .m C$ CS C6 M M cd s J � k t� t� i M1+ ,4 e ay y ASSESSORS_REF. ZONE: Map t16, Parcel 057 RC Area (min.. 87,120 SF(RP00) > ; Fronts a min) 20' OVEMAY DISTRICT.- Witnkrn) 1v0' ..m Setba .. r F a • • • y jY AP. — Aquifer Protection District Front. 20' Side 10' .:. .... .. : _. Rear 10 •p•¢ b J ¢ FLOOD-ZONE: Q Zone X .(not a flood.zone) FEMA Map Number 25001CO757J - Effective July M 2014 :moo "{ Prepar�al-For. x Lawrenw& Sharon Mccadlhi .Loca n Map. 1"=2r000f' Fnd Legend: HW— Overhead. Wires El CB/bH - Concrete Sound Ode Public} �" Survey Marker 4 ® Guy . ,F-rst . ( �� Utility:Pole O Gas Gate (round) ;i'�►ernent . . .. 1 Hydrant ® Water date:(round)' a, � f E ; 100.50 Zee FA bill t Ila Ix PRPOSD WWd .10 O' NS - - - - - - ADDITI - a ®.�_.. caraert- - #94 - ihl f . WI Mew y i Dwelling -� y I bi o o � o "1" �� V sue fw - S ........... .... ' v! (Di St New P t10 1Vew Addltton j - a ' f t~.... o m .. � tso�t.om,dJ ....... . ::.:....:... .: . y m teWtt o` �� sir a�5 NAW'Bs. � r Of� i4fea•. 10,084t Y 1_ CByt 1 Fenix.:, '_ 6. w.. CB S81101'400W 101.1.9' Fnd N/F Richard D. & Laurina A Sonia o _ NOTES: 1'.) The structures shown were located ;on the groundRp R • by conventional survey methods on. .(or, between). ,26/SEP/1:8 and. 03/OCT/18. 03�31 24 The property line :information shown hereon was cornpiled from: available record information.. ; 3.) This plan is not for 'recording and is not to be used for construction layout or deed description purposes. 0 5 10 15 ZO Jo 40' Fir Sheet CapeSul Titles p�,gPlan ShowingProposed Add ion UC435 13 l of" y At First.Avenue: Scale 1 =20 23 'Wesf 8a Rd, Suite .5: ' Osterv3lle MA 02655 f5os 2a (saaJ¢zn ass ter B/�RNc7TA�7LE(OsterWle) �7.e7`, sate 261SEP/1,9 � 33-7 (`4 "'` / vJl ��v1 l ( C o C) �. 411�1� (0/ � PERMIT SET THE McCARTHY RENOVATION Progressive Designs ns a a OSTERVILLE, MASSACHUSETTS Falmouth, MA 508-566-5348 September 30, 2019 t2MWIN6 1.15f VCN1WUt;Al, 12MWING5 Abbriviations COV�I?%Eff A �XtOOP ft,�VAWN5 AW WIM20W 5CHWIF ADJ. ADJUSTABLE EX EXISTING FTG. FOOTING PICT. PICTURE Q AT A2 �Xtt; k�L�VA110N5 ASPH. ASPHALT EXIST. EXISTING GALV. GALVANIZED POLY. POLYETHYLENE CL. CENTER LINE AWN. AWNING EXP. EXPOSURE GARB.DISP. GARBAGE DISPOSAL PROD. PROJECT S.S. SIX SHELVES A3 FOUNIWON PLAN BLDG. BUILDING EXT. EXTERIOR G&N GLUED&NAILED RAD. RADIUS L. LINE GLOO��LNV/��,I BSMT. BASMENT F.G. FIBERGLASS G.L.L. GAS LOG LIGHTER RAFTS RAFTERS 1R-1S ONE ROD-ONE SHELF BTM. BOTTOM FIN. FINISH HDR. HEADER REFRIG. REFRIGERATOR 1R-2S ONE ROD-TWO SHELVES G A4 1 1P5f f BTW. BETWEEN FIXT. FIXTURE INSUL. INSULATION RM. ROOM 2R-2S TWO ROD-TWO SHELVES A5 ` CONf7�L00�PLAN CANT. CANTILIEVER F.J. FLOORJOIST INT. INTERIOR R.O. ROUGH OPENING S4S SURFACE FOUR SIDE C.J. Kl( CEILING JOIST FLR FLOOR JST. JOIST R.S. ROUGH SAWN 2S TWO SHELVES A/ POOL PLAN CLG. CEILING FLOUR FLOURESCENT KITCH. KITCHEN SEC. SECTION 5S FIVE SHELVESCER CERAMIC FTG. FOOTING I DE CH M. CHIMNEY GALV. GALVANIZED LAVL LAVATORY. LAMINATE VENEER LUMBER S.L. S DELIGHT 3W THREE WO IWIDE Al ff5f FL00P FLAMING PLAN C.M.U. CONCRETE MASONRY UNIT GARB.DISP. GARBAGE DISPOSAL LIN. LINEN SLDR GLIDER 4W FOUR WIDE A8 5ECOW FLOOP FLAMING PLAN C.O. CASED OPENING G&N GLUED&NAILED LIV. LIVING STA STATION 5W FIVE WIDE COMP. COMPACT ON HDR HEADER LOG LIGHTER MAX MAXIMULAZY M N STL. STEELDARD W/ WITH A9 5FCONn FLOOP OILING F MING PLAN CONC. CONCRETE INSUL. INSULATION MBR MASTER BEDROOM STRUCT. STRUCTURE AIO t;00� ��AMING PLAN CSD. CASED INT. INTERIOR M.C. MEDICINE CABINET T.C. TRASH COMPACTOR CT. CERAMICTILE JST. JOIST MICRO. MICROWAVE T&G TOUNGE AND GROOVE All (3UILf71NG `. C110N5 DBL. DOUBLE KITCH. KITCHEN MIL. .001 INCH TRANS. TRANSOM DET. DETAIL L.V.L. LAMINATE VENEER LUMBER MIN. MINIMUM TRAP. TRAPAZOID AIZ 6UILnING S�C110N5 MI?f7�1'ALS D.H. DOUBLE HUNG LAV. LAVATORY MISC. MISCELLANEOUS U.L. UNDERLAYMENi nG DIA DIAMETER LIN. LINEN M.O. MASONRY OPENING UNEX UNEXCAVATED AI3 V DISH. DISHWASH LIV. LIVING NO. NUMBER WASH WASHED 12�1'ALS DN. DOWN L.S. LAZY SUSAN N.T.S. NOT TO SCALE WD WOOD: AID} V f��AILS DRY. DRIER MAX MAXIMUM O.C. ON CENTER W.F. WIDE FLANGE EA EACH MBR MASTER BEDROOM O.H.D. OVER HEAD DOOR W.H. WATER HEAD AI5 �1�51'�LOOt;���L�C11;n OILING PLAN -Not included ELEV. EACH M.C. MEDICINE CABINET OPNG. OPENING W.W.M. WELDED WIRE MESH ENT. ENTERTAINMENT MICRO. MICROWAVE P.C. PULL CHORD A16 5�CONI7 FLOOP MUCTW CFILING PLAN -Not Included 12WOLWN I7MWIN65 190 FOUWAWN I7WOLMON PLAN 191 Fl6f FL00P 12WOL1110N PLAN I72 5�CONI? FL00P I7EMOLMON PLAN WOOD 5VUCTUM5 OMWIN65 W51 I10 W000 FPAME C0N5VUC110N 12� All.5/50VnULEV CHt CK U5f W52 5NFAI?WALL C&CULA110N5- MOW AN12 0a f UVAWN5 W53 51d Af W&L CAACULA110N5- ITW AN19 Lfff UVA10N5 5VUC1UM ASAP �NGIWPING -LfffU OATW 5�PTW IZ , 2019 i N CN N m N - 27Z a'-T lir-T u , : a m6 ' r i i . ' amp I q: 9 3I� a 9m a s-IuJ ; a ... .. .. O i r D10 m ..__..__.. gg i qq a w + m2 3� 4 0 - 12.7 a D7 - » m N (7 ti 101Z wa is zva �m u ym>m NX 3 � m= ZI\ o �v7 .%af S'c rn En f= r s m 0 ` v; D MI v Nc 0 yr n Z w ° �m G) v °� �m Sz m tn D ID2 o D N m xN ® O O Ip � ` g c� m D N m �€ o� Qqy �D�cQ�$jiy$ Z D r w ° z 0s u�o Ham= U Z. b Z n em mf �g.�nm0 m . _ 9 ° OP ° O pp 0° m Zc ; � � U - a) 17, cn m r D N UPLIFT m® Z G) 3 Progressive p THE MCCARTHY RESIDENCE FOUNDATION PLAN D e s i g n s OF DATE: September 30,2019 PREPARED BY: DK 94 FIRST AVENUE 16 FILE NAME: OSTERVILLE, MASSACHUSETTS 5o8-5e6-5348 SCALE: /+'•1'-0' ------------------------------------------------- NOTE CONTRACTOR OR SUPERVISOR RESPONSIBLE FOR THE /� Permit Set VERIFICATION AND COORDINATION OF ALL DIMENSIONS,ROUGH A 'S OPEMNGS, ELECTRICAL HVAC&STRCTURAL SYSIUS. \./ o t a e 12 ALL CONSRUCTION SHALL COMPLY WITH FEDERAL, STATE AND C7 etr.Jt LOCAL BUILDING CODES CN h .e`riTOk -0 N F N [m_­0 v zss i Bo ac ,� � t B'iP 8-T � ao V~ h xW o ya�O �I 0Ir�l 09 -- q w m rs "= a " Ca 8 L. Aua W 4WBABN 4d'BAM DOOM P � i o'^ ID 0z j @ toI=I O (ml - ---ms --- z �m mix �9f�� d f s m � I III x z 3 QI� I I e H MAI ED $�5 P -.............. _._.._.._.._.. ' iii C s o m .......__..--- ._......__- 49 Do9 �I� mga � -------------- -------------- O::jr E '--------- - o z m " ----J ----; -------- ------ a Q E,, iii 8 iii i zs D ® O © o F G N �� Np C)DZGQ)�� O m G�G�"DC -i 555�7777 =Si p x� m�m _ -Z - �O m N 9 1 o o LA a M. m M. ® m � m 1. 4 Progressive OF DATE: September 30,2019 THE MCCARTHY RESIDENCE e FIRST FLOOR PLAN D e s:g Its PREPARED BY: DK 94 FIRST AVENUE 16 FILE NAME: OSTERVILLE, MASSACHUSETTS 508-s66-5.348 SCALE: I/.-r-ar ---------_M�__���----------__---- NOTE: CONTRACTOR OR SUPERV M RESPONSIM FOR THE A4 Addendum Set VMCAIDON AND COMMATION OF ALL DUNSI K ROUGH a"�°" WOOM OECTRICAL NVAC R STRC M SMIEMS o s s a ALL C@iSRIJC M SHALL COMPLY TM1H FEDERAL.STATE AND ors.H z`o`� LOCAL affln G COOES F N m v 28'p• �' O O _._._........ _....................... ..._................_ .--.......... ..........................' 01 W o z = ...__.._. i D .... .. .. _ D a,• O le co _ W To— k C-) Qz m m =Z 0 El FQ m m cK rx pm 3 z N D ® © O a M II m m N 2 O O OA O r °z G) Z —Mffiar� O F b !S m B° '� o`° °z O (b 0 O $Om �F m M; fl 5 Progressive P THE MCCARTHY RESIDENCE SECOND FLOOR PLAN D e s i g n s OF DATE: September 30,2019 PREPARED BY: DK - 94 FIRST AVENUE . 16 FILE NAME: OSTERVILLE, MASSACHUSETTS 508-566-5348 --------------------------------- NOTE CONTRACTOR OR SUPERVISOR RESPONSIBLE FOR THE SCALE: a„,io it A5 Permit Set VERIFICATION AND COORDINATION OF ALL DIMENSIONS.ROUGH OPEMNGS, ELECTRICAL HVAC R STRCTURAL SYSTEMS. 67 ALL CONSRUCTION SHALL COMPLY TMTH FEDERAL, STATE AND ctrn LOCAL BUILDING CODES I � b � �N 1n sr` m ' c.J `••'•= P.A 1cn 1 2 3 A11 A B A/1 A11 G` A2 2%10 FLOOR JOISTS 16'O.C. WO FLOOR JOISTS @ 16'O.C. EXISTING BOOR JOISTS 0 16'O.C. HFAlPOBTTO ,^ DO u 1 ABOVE V Al2 Be I .I_ 1. G Be Dis 13 AV .I s vasrTO LL < t7 � ' LVL BEAM ABovE Za U :01Iq 11 Ill nil mllml _ � c 3- FRAMING NOTES: Z 2 POST TO BEAM WNECDON 1. 1.PROVIDE METAL JOIST HANG[725 IMSTALLED INrecv+AL I FOR PERPENDICULAR CONNECTIONS An wrm WALL FRAME I i OF JOISTS OVER SUSPENDED AREA I' l 2.DOUBLE ALL JOISTS®OPENINGS i AND @ PERPENDICULAR CONNECTIONS. ® ® j UNLESS OTHERWISE NOTED E I E 3. HEADERS TO BE(3)2X10 UNLESS OTHERWISENOTED i it I! ,; x FRAMING MEMBER E Al 1: I. V ......... _. ._ _._... ... ® FR ... ... .... POST TD HEADER _--_-_=- = 1 = _"_._— r�ll�IIWII�I.11mil mllr(I� ..... LEGEND V 2 Z f/) • I�Ilmllmuwnmnm (#) 2X12 BEAM W i ._ "_ .. - POST TO PoDCE ' I AZ Z 1 - �••�••� LVL BEAM � fA I uj I :i:: F—�a`� utuuwuwuu 2XiD HEADER = I U ' ■MMMMMMMM■ STEEL BEAM Q EXISTING B Al2 = U i l BASEMENT Q I I ;—.�' osr TO HE/1�1i ........ ......... LLJ j �+ Q AwI,, PROVB]E.6549(49(Y.- pp ! TEAT W W BEAM TO POST CONNECTION - 'I 2 A J w/Rl h'TIFeu ears 3 PERASAPIETTERDATED : E%ISTDIG BIB BEAM :.__..________.._: E3IIefD3G BOB BEAM �'I�n^ SEPTEMBER S,20/B 1. ....... ,..�. ,'"1 U) li. I •� N GENERAL NOTE: 2L W I PROVIDE MIS a•1(a•1(J:' LLIIC� F w RMY T RU eOL ceaN ALL SHALL COMPLY WITH ALL STATE,LOOCAL AND FEDERAL ch 0 I L PER•ASAP ENGBEEWNG' BUILDING CODFS. O ' a t':::::::....................:::::::::...................::::::::::..... LETTER DATED SEPTEMBER 5.W18 2.ALL PLUMBING AND HEATING TO BE COORDINATED BY CONTRACTOR. 3.ALL ELECTRICAL TO BE COORDINATED BY CONTRACTOR. 4.)ALL INTERIOR WALL DIMENSIONS ARE MEASURED ------ ------ FROM OUTSIDE BOX TO FRAME FRAMETO FRAME Al2 NOTE: ALL SMOKE DETECTORS SHALL BE O 3:•x ill PSL [fF 3 : HARD WIRED. POSTTOBIl CONME!MON LB®180.c ! j N e INSTALLED INTEtWAL Q HEAT SENSOR p' WTM WALL FRAAE __. .___ __.. ..._. .. _ ..__. CM PER'ASAP EIY:BEEPoNG /.... ..,. ....... ....._ _._.._.... ..._. ...... ._......... ....... ...... `_. `..: 5Q SMOKE DETECTOR �T TO [AlB@ SMOKE B CARBON MONOXIDE SENSOR INSTALLED BITE(;IiAL E MULTIPLE 1�4"BEAMS pm-ASAALL FRAMIE PE.C.MEPoNG. Y LETTER DATED SEPTEMBE S.MID LEGE/O EXISTING FLOOR JOISTS IW O.C. ..................... `Jf.C;t%;.B!^.(:K'A:111. ....................... I--, ............_m: 2 MEMBERS-2 ROWS OF 16D NAILS @ 17'O.C. s 1 A B 2 3 c F m I o A13 Att Atl Att Ai Al2 A T ❑ W \ ti j�( Q Q W 1n < LLI W Q N J ❑ dLL � � 3 MEMBERS -2 ROWS OF Y2'DIA.BOLTS @ 12"O.C. TYPICAL LVL/GLULAM BOLTING/NAILING LL. I` SCALE: 1"=1'-0" o Q I ggE E < yWy Egg ms o P Q e�eanc z 29-T 1 FOUNDATION DEMOLITION PLAN D'eg igsnvs DATE: .September 30,2019 THE MCCARTHY RESIDENCE OF PREPARED BY: DK 94 FIRST AVENUE 3 FILE NAME: Ihr-1,-C' OSTERVILLE, MASSACHUSETTS 5o8-566-5348 -------------------------------------- NOTE CONTRACTOR OR SUPERVISOR RESPONSIBLE FOR THE SCALE: o 1 3 e u GS ,�rdaII DO Permit Set VERIFICATION AND COORDINATION OF ALL DIMENSIONS, ROUGH OPENINGS,ELECTRICAL HVAC dt STRCTURAL SYSTEM& ALL CONSRUCTION SHALL COMPLY WITH FEDERAL,STATE AND eldr LOCAL BLALDING CODES Ir---_______ --_-II II II II tl I 11 It it it II II og II m yX H II F = II s o i II ij II II ii II ------------------------- ............. I, t, 1, 1, QQ O --__- m Ili x 'V -- --�1 A Z� A g� I I 0 I I 11 II -- --------- IHE y' I la I ``� Dx I pbp 4FM L---- I l I i ii r I I .............__.___....._...._.._._._...... O= 3 G) I I u ill i jai c Z z F-T- I I I I I I T M Z 9 x c) I Oz I I ------------------------------ I i I -------------------------------- z raa II II y � � b b R : �i Progressive 2 DATE: September 30,2019 THE MCCARTHY RESIDENCE FIRST FLOOR DEMOLITION PLAN D e s i g n s OF PREPARED BY: DK 94 FIRST AVENUE 3 FILE NAME: +/+'-+'-Q OSTERVILLE, MASSACHUSETTS 508-566-5348 -- ---------------------------------------------------- NOTE CONTRACTOR OR SUPERVISOR RESPONSIBLE FOR THE SCALE: 0 Y 3 6 is as I7 D 1 Permit Set VERIFICATION AND COORDINATION OF ALL DIMENSIONS, ROUGH OPENINGS, ELECTRICAL HVAC#STRCTURAL SYSTEMS. �y ALL CONSRUCTION SHALL COMPLY WITH FEDERAL, STATE AND LOCAL BUILDING CODES �i T x y m mx xZ c� F� EP Im m 04 z O z F b 0 3 Progressive DATE: September 30,2019 THE MCCARTHY RESIDENCE SECOND FLOOR DEMOLITION PLAN D e s i g n s OF PREPARED BY: DK 94 FIRST AVENUE 3 FILE NAME: Ile-1'-W OSTERVILLE, MASSACHUSETTS 5o8-566-5348 --------------------------------------------------- NOTE CONTRACTOR OR SUPERVISOR RESPONSIBLE FOR THE SCALE: o 1 3 e lx D 2 Permit Set VERIFICATION AND COORDINATION OF ALL DIMENSONS, ROUGH �� e"'I OPEMNGS,ELECTRICAL HVAC&STRCTURAL SYSTEMS ALL CONSRUCTION SHALL COMPLY PATH FEDERAL, STATE AND sick LOCAL BUILDING CODES