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HomeMy WebLinkAbout0103 GARRISON LANE - Health M. 1 03 Garrison Lane Il 14-003-002 Osterville fy; 1; .ast Bay Rd., Osterville =140 - 166 UPC 12134 gdsTlNQBr MN a i No. C% �/ - Fee �v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0(ppficatiou for Misposar 6pstrm Construction permit Application for a Permit to Construct( ) Repair(�) Upgrade( ) Abandon( ) ❑Complete System AIndividual Components Location Address or Lot No.10J GAA":500 a Owner's Name,Address,and Tel.No. J AV IL 13 0 LLB Assessor's Map/Parcel 1 l 0,9 ®D;x L1 - t PE StV A®v XT- i Installer's Name,Address,and Tel.No. ®g y 14 1 - Z 1 Designer's Name,Address,and Tel.No. 153 co ei4<1 S�& N /fI Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) t-01 N t400 G tRGrLAC& D"004 4Z)i 7W ?-156k(am) RAW HOUSE 6C—/4C. L- iC l��ztlG �irf�1J�. �,C C�/I �lt0Zt- -M -b-GOX r caea�3� �va� � Chet IN GJ - aiG S� owi Tbl X 0f.'<, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o lth. Signe s Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued No. �v: s Fee Entered in computer: F THE COMMONWEALTH OF MASSACHUSETTS p � PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,MASSACHUSETTS Yes # '' .2pplication for -isposal Opstem (Construction i3ermit Application for a Permit to Construct O Repair(Ik--•Upgrade( )/Abandon( ) [:]Complete System [XIndividual Components Location Address or Lot No.i 02P CzA90-15o 4a1 0,S7 r Owner's'Name,Address,and Tel.No. _ Assessor's Map/Parcel �p p d�Z. :• 1 Lo D ,V'64a4 kjW-_ 52 JX-5 STk 2®2> 44T Installer's Name,Address,and Tel.No. • 'T �' $.�7 Designer's Name,Address,and Tel.No. - 1 Is c ook,ota vac. Sr N 1 N 9 j4A O X&4 1 Type of Building: Dwelling No:of Bedrooms Lot Size sq.ft. Garbage Grinder(... ) OtherTyge of Building No.of Persons Showers( ) Cafeteria( ) w Other Fixtures d Design Flow(min.required) gpd Design flow provided ,...*.� gpd . � r:_ 1, t - Revision Date Plan rDate �Number_ofsheets � Title Size of Septic Tank Type of S.A.S. `t Description of Soil f~ E r Nature of Repairs or Alterations(Answer when applicable) MAI N Hoas E y f�C;rt:atc: �' i f•`t.15a�`F#0A4l1 // �„. . AfAIP HOUSE SGAt, L6 4V_/A,6 ,5WT1c. 44xe frurok TA C,11 -M -b-v�gx rrv&s-:r CLCAr, Aey97S tw D-80-5 4 56WJ WITbA t4j u�- Date last inspected: 1 Ccttis '"' Agreement: i The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place,the system in operation until a Certificate of ' I, Compliance has been issued by this Board of Health. ,. '- SigneeC�r� � !C TC Date .3 V D M. Application Approved by \ �` ) Date . . n. Application Disapproved by Date for the following reasons .✓u•r Permit NO s' �/ �J"°.� s^>�, n�-'- '��^"�r,-Date-Iss_ged'"' a -- -- - ' - - i--- ---- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance { THIS IS TO//C��E��RTIFY,'that the On-site Sewage Disposal system Constructed( ) Repaired(x) j . Upgraded( ) Abandoned( )by at (0.3 62AW l SOIL) (,406 0S`r has been constructed in accordance with the'provisions of Title 5 and the for Disposal System Construction Permit No:Xt a—691 dated f 0 Installer d AP6N x D 6 &_)U_&W 4 fY6! Designer plA #bedrooms i Approved design flow, and The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date �,�M-9 // 7 Inspector ---------�-- -- --- ------------- --- -- --- - Fee + ,. THE COMMONWEALTH OF MASSACHUSETTS 11 t1A c - UBLIC HEALTH DIVISION-BA T(�P RNS ABLE,MASSACHUSETTS - MispoBal *pstem Construction Vrrm'it Permission is hereby granted to Construct( ) Repair( Upgrade,( ), Abandon( )) --- System located at J-U 3 G-4A?j>_15dt! LAB E 05 1sp y&4 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. Provided:Construction must be completed within three years of the date of this permit. t Date ,�30 f/� �� Approved by Commonwealth of Massachusetts Title 5 Official Inspection FormMl M Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �a teh�a 103 Garrison Lane (Rear System) M � �i Property Address Sam Bayne rt Owner Owners Name , .information is required for every Osterville; MA 02655 4-13-17 page. 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. Please see completeness checklist at the end of the form: Important:When A. General Information filling out forms g on the computer, �� / a 2 6-/ OF use only the tab 1. Inspector: �.�`°�� N M key to move your Ass°''�., cursor-do not O;: yG use the return James.D.Sears _ JAMES m key. Name of Inspector S Ca ewide Enterprises ; co z " SI Company Name I•••.. RTIF .• •p �.� 153 Commercial Street PY Address ���'��,�s INS PEC Company Addr �� nmtra�� Mashpee MA 02649 Cltylrown State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification '1 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: Z Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 4-13-17 spectors 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 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. t ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev,6116 Title 5 official Inspection Form:Subsurface sewage Disposal System•,Page T of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 103 Garrison Lane (Rear System) Property Address Sam Bayne Owner Owners Name information is required for every Osterville MA_ 02655 4-13-17 page. Ci Irown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E I 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: The system is a 1000 Gal. Tank D Box and pit 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.doc-rev_6/16 Title 5 Offidal Inspection Form-Subsurface Sewage Disposal System-Page of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form subsurface Sewage Disposal System Form -Not for Voluntary Assessments 103 Garrison Lane (Rear System) Property Address Sam Bayne Owner Owners Name information is required for every Osterville MA 02655 4-13-17 page. Cityfrown State Zip Code Date of Inspection B. Certification (Cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if Pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out 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 b pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below).- obstruction is removed. ❑ Y ❑ N ❑ ND(Explain below): distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below)-. ❑ The system required pumping more than 4 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): ❑ obstructior�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.doc•rev.6116 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 y` 103 Garrison La ne S Rear stem ( y ) Property Address Sam Bayne Owner Owners Name information is required for every Osterville NIA 02655 4-13-17. page. Cityfrown 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 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 ofthe 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 ❑ z Liquid depth in is less than 6"below invert or available volume is less than %day flow p/7" t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal Systems Page 4 of 17 I Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 'r 103 Garrison Lane(Rea_ r Sim) Property Address Sam Bayne Owner Owners Name information is required for every Osterville M page. Cityrrown A 02655 4-13-17 State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ® Any portion of cesspool or privy is within 100.feet of a surface water supply or tribut ary 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 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. _t5ins.doc•rev.6r16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 103 Garrison Lane(Rear System) Property Address Sam Bayne Owner Owner's Name information is required for every Osterville MA 02655 4-13-17 page. City/Town State Zip Code. Date of Inspection 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? ❑ 0 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 NIA) ❑ 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, dPmensions, 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 NA 5 (design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 15ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I� Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal.System Form-Not for Voluntary Assessments 103 Garrison Lane (Rear System) Property Address Sam Bayne Owner Owners Name information is required for every OStervllle MA 02655 4-13-17 page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal. Tank D Box and pit Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 2015-537,000Gal 2016-1,028,000Gal's Detail: Sump pump? ❑ Yes No Last date of occupancy: NA Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15203): 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: 15ins.doc•rev.6116 Title 5 official Inspection Form:�Subsurface Sewage Disposal System•Page 7 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 Garrison Lane (Rear System) Property Address Sam Bayne Owner Owner's Name information is required for every Ostervllle MA 02655 4-13-17 page. City/Town 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: NA 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): V t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 s Commonwealth of Massachusetts Title 5 Official Inspection Form R Subsurface Sewage Disposal System Form-Not for Volunt ary tary Assessments aY 103 Garrison Lane Rear System) Property Address Sam Bayne Owner Owner's Name information is �Sterville required for every MA 02655. 4-13-17. page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1985 Were sewage odors detected when arriving at the.site? ❑ Yes Z No Building Sewer(locate on site plan): Depth below grade: 2' feet Material of construction: ❑ cast iron IZ 40 PVC ❑other(explain): Distance from private.water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): _ Pipeing is4" PVC SCH -40 Septic Tank(locate on site plan): Depth below grade: 14" 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: 1000.Gal. Precast H-10 Sludge depth: 1" t5ins.doc•rev.6116 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 103 Garrison Lane(Rear System) Property Address Sam Bayne Owner Owner's Name information is OsterVille required for every MA 02655 4-13-17 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet fee or baffle 29" Scum thickness 011 Distance from top of,cum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Asbuilt-Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank and covers at 14" below grade. Inlet tee outlet baffle 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.doc•rev.6/16 Title 5 Official inspection Form:Subsurface'Sewage Disposal System•Page 10 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 Garrison Lane(Rear System) Property Address Sam Bayne Owner Owner's Name information is every Cisterville required for eve � MA 02655 4-13-17 page. City/Town 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 pet 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? ❑ Yes ❑ No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface.Sewage Disposal System-Page 11 of17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 103 Garrison Lane(Rear System) Property Address Sam Bayne Owner Owner's Name information is Ostervtlte required for every MA 02655 4-13-17 page. City/Town 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 0 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 16"x16"-2' below grade w/one.line out. Box is clean and solid. No sign of overloading or solid carry over. 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.doc•rev.6/16 Title 5 Offi;ial Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 103 Garrison Lane(Rear System) Property Address Sam Bayne Owner Owners Name information is required for every Osterville MA 02655 4-13-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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.): Leaching is a precast pit. Pit and cover at 29"below grade. Clean wall's dry. No sign of over loading or high stain line. 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 El Yes ❑ No t5ins.00c•rev.6116 Tide 5 Official Inspection.Form:SubsurfaceSewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary.Assessments M yv. 103 Garrison Lane Rear System) Property Address Sam Bayne Owner Owners Name information is OSteryille required for every MA 02655 4-13-17 page. Cdyrrown State Zip Code Date of inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 15ins.doc•rev:6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 r Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 103 Garrison Lane(Rear System) Property Address Sam Bayne Owner Owner's Name information is required for every Osterville MA 02655 4-13-1.7 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately I t5ins.doc-rev.6116 Title 5 Official Inspection Form:subsurface Sewage Disposal System-Page 15'of 17 coy 5,0� g EAR s y5 F CAtPA A a UW ova 0 P..9, 3-o f Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 Garrison Lane(Rear System) Property Address Sam Bayne Owner Owners Name information is required for every Osteryille MA . 02655 4-13-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells N© 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: Auger T.H. 12' no G.K. Bottom of pit at 8' below grade Bottom of pit at 4'above T H Depth Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 • 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 Garrison Lane(Rear System) Property Address Sam Bayne Owner Owners Name information is required for every Osterville MA 02655 4-13A 7 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 l5ins.doc-rev.6116 This 5 Official inspection Form:Subsurface Sewage Disposal System Page 17 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form IND Subsurface Sewage Disposal System Form Not for Voluntary Assessments w 103 Garrison Lane (Front System) . � Property Address ti• •ems Sam Bayne Owner Owner's Name information is Osteryille t/ required for every. MA 02655 4-13-17 page. Cityrrown 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 A. General Information filling out forms / � ��� trMgs on the computer, H OF ��7�1t` oZ��3 ��� use only the tab 1. Inspector: .`�y� '' key to move your ? �'y =�� MES N` cursor-do not ,James D:Sears JA ;m use the return = _ key. Name of Inspector Capewide Enterprises Company Name 153 Commercial Street ''i�,F 9 INS? �G��`��`,` Company Address Mashpee MA 02649 Clty/'rown State Zip Code 508-477-8877 S1623 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 maintenanceof on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 16.340 of Title 5(310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs further Evaluation by the Local Approving Authority 4-13-17 1 spector'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 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 DER. 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. I t5ins.doc•rev.6116 Title 5 Official Inspection Form_Subsurface Sewage Disposal System•Page 1 of 17 /o jgtd s - Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 103 Garrison Lane(Front System) Property Address Sam Bayne Owner Owner's Name information is required for every Osterville MA 02655 4-13-17 page. City1rown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary:Check A,B,C,D or E I 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: The system is a 1500 Gal. Tank D Box and pit 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 Ileaking and if a Certificate of Compliance indicating that the tank is'less than.20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-.Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 Garrison Lane (Front System) Property Address Sam Bayne Owner Owner's Name information is required for every Osterville MA 02655 4-13-17 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 uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 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 ElY ❑ N [I ND(Explain below): ❑ obstruction its 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.doc-rev.6/16 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 . Commonwealth of Massachusetts Title 5 Official ns ectiOn. Form - p Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 103 Garrison Lane(Front System) Property Address Sam Bayne Owner Owner's Name information is Osterville required for eve MA 02655 4-13-17 page. Cityrrown 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 aseptic 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 t I` ❑ ® 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 is less than 6" below invert or available volume is less ❑ ® than 1/day flow®,T t5ins.doc-rev.6/16 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 103 Garrison Lane(Front System) Property Address Sam Bayne Owner Owners Name information is required for every Osterville MA 02655 4-13-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of.times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Eg 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. ❑ Z Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 0 Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ Z 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 g,pd 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 watersupply ❑ ❑ 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 15.3,04. The system owner should contact the appropriate regional office of the Department. t5ins.doc-rev.6/16 Tille 5 Official Inspection Form: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 103 Garrison Lane(Front System) Property Address Sam Bayne Ownfoner Owners Name requred fo is every Osterville required for eve MA 02655 4-13-17 page. Cityrrown State Zip Code Date of inspection 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? ❑ 0 Has the system received normal flows in the previous two week period? ❑ X 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? ❑ Z 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: Z ❑ 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: z Number of bedrooms(design): NA Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 550 t5ins.doc.•rev.6116 Title 5 Official In6pection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 Garrison Lane(Front System) Property Address Sam Bayne Owner Owners Name information ati is required for every Osteryille MA 02655 4-13-17 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal. Tank D Box and pit Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes Z No Is laundry on a.separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes Z No Laundry system inspected? ❑ Yes 0 No Seasonal use? ❑ Yes ® No Water meter readings, if available usage last 2 ears d 2015-539,000Gal ( y g (gp ))Detail: 2016-1,028,000Gal's Sump pump? ❑ Yes ® No 'Last date of occupancy: NA Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 3110 CMR 15.203): y(gpd) Gallons per da Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the.Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6116 Title 5 Baal 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 103 Garrison Lane(Front System) Property Address Sam Bayne Owner Owners Name information is required for every Osteryille. MA 02655 4-13-17 page. Citylrown 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: NA 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): t5ins.doc-rev:6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface,Sewage Disposal System Form- Not for Voluntary Assessments M 103 Garrison Lane(Front System) Property Address Sam Bayne Owner Owner's Name information is required for every Cisteryille MA 02655 4-13-17 page. Cityfrown State Zip Code Date of Inspection, D. System Information (cons.) Approximate age of all components, date installed(if known)and source of information: 1985 4-2017 New D Box. Were sewage odors detected when arriving at the site? ❑ Yes 0 No. Building Sewer(locate on site plan): Depth below grade: 2'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.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): ' Depth below grade: 1 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 Precast H-10 10 Sludge depth: t5ins-doc-rev:6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17' Commonwealth of Massachusetts WM� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 103 Garrison Lane (Front System) Property Address _Sam Bayne Owner Owners Name information is required for every Osterville MA 02655 4-13-17 page. City/Town State Zip Code Date.of Inspection D. System Information (cont.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 29 Scum thickness 1" .Distance from top of scum to top oL outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 17 How were dimensions determined? Asbuilt-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank at 1' below grade. Both cover's at 1'. Inlet tee, outlet baffle. No sign of leakage or over loading. 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts L Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 Garrison Lane(Front System) Property Address Sam Bayne Owner Owner's Name information is required for every Osterville MA 02655 4-13-17 page. City/Town 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 y El 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 f l5ins.doc.rev.6/16 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 f . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 Garrison Lane (Front System) Property Address Sam Bayne Owner Owner's Name information is required for every Osterville MA 02655 4-13-17 page. City/Town. 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 0 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 2' below grade w/one line out Box is new 4-2017 w/cover at 6" below grade. I 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.doc•rev.6116 Title 5 Official Inspection Form`Subsurface Sewage.Disposal System•Page 12 of 17 Commonwealth of Massachusetts TTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 Garrison Lane Front System) Property Address Sam Bayne Owner Owners Name information is required for every Osterville MA 02655 4-13-17 page. Cityfrown State Zip Code Date of Inspection D. System Information (cone.) 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.): Leaching is a precast pit w/3'stonie. Pit and cover at 27"below grade. Pit is dry w/clean wall's. No huh stain line. 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments. 103 Garrison Lane(Front System) Property Address Sam Bayne Owner Owners Name information is required for every Osterville MA 02655 4-13-17 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page14 of 17 Qe, A RR So Al �.N Y.s!fIM 1 0. 0 ,9-1 - 3 3' � i�,r YJ 4-+ 37 P it J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface.Sewage Disposal System Form -Not for Voluntary Assessments 103 Garrison Lane (Front System) Property Address Sam Bayne Owner information is Owners Name required for every Osterville NIA 02655 4-13-17 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 1 15ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System.Form-Not for Voluntary As 103 Garrison Lane (Front System) Property Address Sam Bayne. Owner Owner's Name information is required for eve Osterville 4 every MA 02655 4-13-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells jV0 Estimated depth t 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: Auger T.H. 12' no G.W... Bottom of pit at 8' below grade Bottom of pit at 4'above T H Depth Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6116 Title 5 Offical Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 103 Garrison Lane(Front System) Property Address Sam Bayne Owner Owner's Name information is required for every Osterville MA 02655 4-13A 7 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.doc•rev.6/16 Title 5 Official Inspection.Form:Subsurface seviage Disposal System-Page 17 of 17 /I JI aD3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments way 103 Garrison Lane (Guest House ' M 4 ) uv.4 Property Address x> Sam Bayne Owner Owner's Name r, t information is required for every Ostervillev"'" MA 02655 4-13-17 ' page. 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. Please see completeness checklist at the end of the form. Important:When q. General Information filling out forms on the computer, OF�rS use only the tab 1_ Inspector: . key to move your ` �� 0 `•9��. cursor-do not a ?: James D.Sears �: JAMES yN: use the return m key. Name of Inspector y_ Ca ewideEnter'rises —� Company Name 153 Commercial Street °''�.�F s t N Spy;'\ Company Address Mashpee MA 02649 City/Town 508-477-8877 State State Zip Code 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 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 4-13-17 ;sp::ne=dcftorsSignature Date The system inspector shall'submita copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd 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. . tt, ****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. t5insaoc•rev.6116 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 Garrison Lane (Guest House) Property Address Sam Bayne Owner Owner's Name information is required for every Ostervllle MA 02655 4-13-17 page. Cityrrown 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.- The system is a 1500 Gal. Tank D Box and two chambers 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.doc-rev.6/16 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 17 t Commonwealth of Massachusetts v p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 Garrison Lane(Guest House) Property Address Sam Bayne Owner Owner's Name information is required for every Osterville MA 02655 4-1.3-17 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 uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND.(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 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.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.doc-rev.6M Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 r Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 Garrison Lane (Guest House) Property Address _Sam Bayne Owner Owner's Name information is required for every Osterville MA 02655 4-13-17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cone.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank'and,SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for 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 ❑ E 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 4914=11is less than 6" below invert or available volume is less than '/2 day flow A WWZAt 15ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface stem Sewage Disposal System Form-No t of for Voluntary Assessments 103 Garrison Lane(Guest House) vroperty Address Sam Bayne Owner Owners Name information is required for every Osterville MA 02655 4-13-17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply., ❑ ® 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 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. 15ins.doc-rev.6/16 Title 5 Offiaal Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 Garrison Lane(Guest House Property Address Sam Bayne Owner Owners Name information is required for every Osterville MA 02655 4-13-17 page. City/Town State Zip Code Date of Inspection 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 NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage backup? ® ❑ 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): NA Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example:110 gpd x.#of bedrooms): 220 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 Garrison Lane(Guest House) Property Address Sam Bayne Owner Owner's Name information is required for every Osterville MA 02655 4-13-17 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is at 1500 Gal. Tank D Box and two chambers Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes _ No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last2 years usage(gpd)): NA Detail: Sump pump? ❑ Yes Z No Last date of occupancy: NA Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.)` Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No I Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6116 Title 5 Offinial Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 0 103 Garrison Lane(Guest House) Property Address Sam Bayne Owner Owner's Name information is required for every Osteryille MA 02655 4-13-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/user Date Other(describe below): General Information Pumping Records: Source of information: NA 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 l/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc.•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts RON Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M s•`°� 103 Garrison Lane (Guest House) Property Address Sam Bayne Owner Owners Name information is required for every Osterville MA 02655 4-13-17 page. CitylTown State Zip Code Date of Inspection D. System Information (coat.) Approximate age of all components, date installed (if known)and source of information: 2005 Permit # 2004-516. Were sewage odors detected when arriving at the site? ❑ Yes 0 No Building Sewer(locate on site plan): Depth below grade: 281" feet Material of construction: ❑ cast iron Z 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage,etc.): Pipeing is 4" PVC SCH -40. Septic Tank(locate on site plan): Depth below grade: 181, feet Material of construction: N.concrete ❑ metal ❑fiber lass 9 ❑ 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. Precast H-10 Sludge depth: 1" t5ins.doc-rev:6/16 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 r Commonwealth of Massachusetts `.i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for'Voluntary Assessments 103 Garrison Lane(Guest House) Property Address Sam Bayne Owner Owner's Name information is required for every Osterville MA 02655 4-13-17 page. C1tyrrown State. Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlettee`or baffle 29'" Scum thickness Dr, 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. 18 How were dimensions determined? Asbuilt-Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank and outlet cover at-18"below grade whnlet cover at 6". In and outlet tee's. No sign of leakage or over loading. 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.00c-rev.6/16 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 103 Garrison Lane(Guest House) Property Address Sam Bayne Owner Owner's Name information is required for eve Osterville q every MA 02655 4-13-17 page. Cltyrrown 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? ❑ Yes ❑ No t5ins.doc-•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 f - Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-.No P y t for Voluntary Assessments 103 Garrison Lane(Guest House) Property Address Sam Bayne Owner Owners Name information is required for every Osterville MA 02655 4-13-17 page. Cltyrrown 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 0 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 20"x20"-20"below grade w/one line out. Box is H-20. Box is clean and solid. No sign of over loading or solid carry over. 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.doc•rev.6/16 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 Asse ssments essments °M 103 Garrison Lane(Guest House) Property Address Sam Bayne Owner Owners Name information is required for every Osterville MA 02655 4-13-17 page. City/Town —Zip Code Date of Inspection D. System Information (coat.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ 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.): Leaching is two 500 Gal. Dry well chambers Camera out and prob. Chambers are clean and dry. 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.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 103 Garrison Lane(Guest House) Property Address Sam Bayne Owner Owner's Name information is Osterville required for every MA 02655 4-13-17 page. City/Town State Zip Code Date of Inspection D. System Information (coot.) 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.doc•rev.6/16 Title 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 103 Garrison Lane Guest House M oy` 1 Property Address Sam Bayne Owner Owner's Name information is required for every Osterville MA 02655 4-13-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately r t5ins.cloc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 103 0 s7" , o GAR a r n jy — ' Q /A a3 -- 3 ' , /v 3_ G `yl 30 A -51 ' 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Su bsurface Sewage Di _g Disposal System Form Not for Voluntary Assessments 103 Garrison Lane(Guest House) Property Address Sam Bayne Owner Owners Name .information is required for every Osterville MA 02655 4-13-17 page. Cltyfrown State Zip Code Date of Inspection. D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 0 Estimated depth t high ground water: 12' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on re-cord 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: Auger T.H. 12' no G.W.. Bottom of chambers at around 5' below grade. Bottom of chambers at T above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pagecl6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 Garrison Lane (Guest House) Property Address Sam Bayne Owner Owner's Name information is OStefVllle required for every MA 02655 4-13-17 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.doc-rev.6/16 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE C UYCATION /x)e- SEWAGE # ' )— ` ✓ 4 VILLAGE / ASSESSOR'S MAP & LOT L INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACELITY: (type) �/i�w� �%��®(sal (size) NO.OF BEDROOMS -2 a BUILDER OR OWNER, !' PERMTTDATE: "UY COMPLIANCE DATE: Z 0 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 an aching Facility(If any wetlancls exist within 300 feet of ac ' f ty) Feet 9� Furnished by 5� 56 , a � �6 2, '7 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BAMSTABLE, MASSACHUSETTS Yes Zipplitation for Migonl *pztem (Construction Permit Application for a Permit to Construct(x)Repair( )Upgrade( )Abandon( , ) ❑Complete System ❑Individual Components. Location Address or Lot No. ►d3 &.46/'t SaN,.L N Owner's'Name,Address and Tel.No. os-reRVILL's `M%3 1I O N d� ."�j'/9/V& lao`OELL. Assessor's Map/Parcel V�1T A�✓j(�) I o 3 a a r.r i s o/V t-N ,aM—I H-1 ,#S f Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.5S2 S"42 0LI ' 1 SULLIVKIN a A1&6Vtxt-'RJ:la%G-4w<_.)• 7 PARrcGR ROAD 40 STE IZV 1 L LAFe.IW SS Type of Building:.NO 44 1 t c'h EIV-- Dwelling No.of Bedrooms 2— Lot Size 7?,7 qe sq.ft. Garbage Grinder(N 4) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3 6 gallons per day. Calculated daily flow 'Z,;2 d gallons. Plan Date ALI CG. 2:—& 20-0 N Number of sheets 1 Revision Date Title Pro Post P Fru ESrt HbV.5.E Size of Septic Tank l 645;6��6:A,6L oA,5 Type of S.A.SA,2.'X 2S't_&.gdf we charm2 Description of Soil -O'-7_4�t L0 NA9 d- 5 U.65_&1 L 1-Lf = t=N�► C LEh3/V 01)1 Um Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The under ' agre s ction and maintenance of the afore described on-site sewage disposal system in accordance wi rovisions itle 5 o t Environme al Code and not to place the system in operation until a Certifi- cate of Compliance has`,;. sued bv this oar of Health �w Si t~_ / Date Application Approved b Date Application Disapproved for_tk following reasons Permit No. 5�3 Date Issued QL I � - ,.. -t ✓'+.,,oy v.r e .. _ - .-.. a _ �..`l..J' �'F"i��. "'� r F A f No. 516 j Fe _ l 1• THE.COMMONWEALTH OF MyA��SSACHUSETTS Entered in co?mpute_ - PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE. MAS-SAC14USE17S ZIpprication for Diopooa.Y *poten� CCon5truction Permit y Application for a Permit to Construct(X)Repair( )Upgrade( )Abandon( ): ❑Complete System El Individual Components Location Address or Lot No. 1 r '�'�' caner' Add�res� Tel�lo. OsTI_RVILLE., M/95� / os `�`�'a r otactt_ Assessor's Map/Paz el 7 s. v e N D:Sir). r IN / 3-2�,yrrstcrf/rLL�, In,4S-f Installer's Name Address and Tel.No. Desi ner's N e Addr ss and Tel.N - �. Gi r iW !iV G -7 PAf2KE R l2GAD O5TLRl/tL_Lr' / /Yll15S Type of Building:—No 1<1 T C h 1E fV — t • Dwelling No.of Bedrooms 72�7y,:'- ft. Lot Size sq. . ' Garbage Grinder N Other Type of Building No.-of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3 U gallons per day. Calculated daily flow �'�' gallons. Plan Date A t 1 G- Z Gi 2-a G Ll Number of sheets Revision Date , ± t Title ProPosoEn Co-[JEST Hauser Size of Septic Tank 1500 Do 6ALLp/v5 Type of S.A.S. f 2-l.X ZS' LEgcAj" CAPIN136 Q_ 0 -2- Lo/�M d- 54350�� � y 1 14 14 CL6,9A �b1,L 1) Uwt Description of Soil i -5/9 AID Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site.sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. p Si e Date c� Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued . - , THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed Repaired( )Upgraded( ) Abandoned( )by 1o3 G4rns c LA ly — ., UsTG2 /L_L� tVI - s s at / V r has been constructed inj�'ccordance with the provisions of Title 5 and the for Disposal System Construction Permit No. V t ~ Pig—dated 11 21 1)(V 54LLivlaN /VG�19�6t i�I/1/1i IIV Installer Designer F The issuance o th(s pe i-shall not be construed as a guarantee that the sys m wi funiction as esigned. Date 'f a 0 Inspector L. W 77 No.C9 Fee _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mi5po!gal *p5tem CCou5tructiou Vermit Permission is hereby granted to Construct( X)Repair( )Upgrade( )Abandon( ) System located at !O i"n S US i-tv.. ovs re f2-V1 L.L t and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructionjimist be completed within three years of the dat of this 't: Date:_ `� Approved by TOWN OF BARNSTABLE LOCATION " II)e- SEWAGE # VILLAGE C�t:�C1 ASSESSOR'S MAP & LOT //q / INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (side) 4W NO. OF BEDROOMS BUILDER OR OWNERdGP' , L PERMITDATE: COMPLIANCE DATE: (J 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 an aching Facility(If any wetlands exist within 300 feet of ac f �+) Feet Furnished by tfi � ( W A, Z Pig I, k • a Town of Barnstable `"E'°w Regulatory Services . Thomas F. Geller,Director WAM Public Health Division FEo ° Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax; 508-790-6304 Installer & Designer Certification Form Date: 5 Designer: S u L_L i V fy B1V6-I rEn ry Installer: gn � ► � Address: '7 PA R K e R. ROAD Address: t��� oa6y00 pn 2O y CO was issued a permit to install a (date) (installer), septic system at lC3 Gprri SoPv L/y based on a design drawn by (address) SL6LL i VAIV CiV_P1MFFD_I Nv I—T dated�U� 2.0o q (designer) I certify that-the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. -M i s c E Rt i r J s CGIN nL J A lve-c LV t-t H e®I L.tr v v N e.y `thus D®�S vertc -a1'iF,-7comPl-01vCG wItti PLUAlaiNys-GL�CtNCAL 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. e OF tt; n PETER ti SUL W".1 ' (Installer's Signat NO.2973 ure) civil : ca ONAi.. (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTMI THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PURLIC HEALTH DIVISION. THANK YOU: Q:Health/Septic/Desiper Certification Form LO N ' ------------ ------------ OD � v , I LI I L.l 1- r , ryCWT G-CVATIOJOf PADDELL F!LSIDGt6'G r .. O � I , � IQYl]A.tlIJNNYYUry I I \Y I,o - ---------------- . CV - - - -- `-J ELEVA'fK*iSt SEGTKMIS C CL W CO (, &-VINELEVAIICN ® ��� ` C J `•/ v a LO N 00 °. OD II cc, - - OO V+ESf 61F.Vh7KH - - _ BODELL RESIDENCE I' Cif VATILMS N CL o A6 1A a N 00 ) 00 LO IME I , f. -- I -'-- W I I ( 1�e _ -}r— tr LO j i 11,1 -3 II —1 -- - -- ------'--' --- N I N O O � j I N --�---- ---- ------ —.-�— --- ------ ------ ---.._.._. --- � I vc.n�nrrorin.v: ��\ N.;ttivvu eis�—__1 Cn L o A2 i v COMMONWEALTH OF MASSACHUSETTS 91 r EXECUTIVE OFFICE OF ENVIRONMENTA AIRS � ® ' DEPARTMENT O F ENVIRONMENTA OTEftral�N ; ✓ ONE WINTER STREET. BOSTO`. MA 02108 617- 55*U Jow o 1 6 1997 ef+ '96R49,v irABz f N W'ILLIAM F.VELD CDY CORE Governor A A. Secretary ARGEO PAUL CELLUCCI E ti DAVID B.STRL'HS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner ' PART A CERTIFICATION Property Address: 103 Garrison Lane, Osterville Address of Owner: i Date of Inspection: 6/13/97 (if different) Name of Inspector: Arl ana M Wi 1 cn .1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) ' Company Name: A.M. Wilson Associates, Inc. Mailing Address: P.O. Box 486, Barnstable, PIA 02630 Telephone Number: (508)375-0327 ' 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: X Passes Conditionally Passes Needs Further Evaluation By the'Local Approving Authority Fails Inspector's Signature: Date: /3 ' The System Inspector shall subm a copy of this inspection report to the Approving Authority 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. INSPECTION SUMMARY: Check A, B, C, or U AI SYSTEM PASSES: i I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR t5.303. Any failure criteria not evaluated are indicated below. COMMENTS: There .are two systems at the site. Both Pass inspection ' BI 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. 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 tank failure is imminent. The system will pass inspection if the existing septic tank is repiaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:Avww.Magnet.state.ma.uwdep ' Z� Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 103 Garrison Lane, Osterville Owner: Regina Silvia Date of Inspection: 6/13/97 6I SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water level observed in the distribution box is due to roken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspecti if(with approval of the ' Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced t _ The system required pumping more than four times a year due to broken or strutted pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s).are replaced ' obstruction is removed ' C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Boar f 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 D ERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH A SAFETY AND THE ENVIRONMENT: Cesspooi or privy is within 50 feet o' surface water Cesspool or privy is within 50 fee f a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BO D OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT ' THE SYSTEM IS FUNCTIONING I MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a tic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a su ' ce water supply. _ The system h a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. _ The syste as a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The sys has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a priva water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that th ell is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or ss than 5 ppm. Method used to determine distance (approximation not valid). 3) OT R ' (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART A CERTIFICATION (continued) Property Address: 103 Garrison Lane, Osterville ' Owner: Regina Silvia Date of Inspection:6/13/97 D] SYSTEM FAILS: ' You must indicate ew.er "Yes" or"No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined i 310 CNIR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determin what will be necessary to correct ' the failure. Yes No Backup of sewage into facility or system component due to an overloaded or gged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface w ers due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or availabl volume is less than 112 day flow. Required pumping more than 4 times in the last year NOT ue to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool r privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 et of a surface water supply or tributary to a surface water supply. _ _ Any portion of a cesspool or privy is within Zone I of a public well. Any portion of a cesspool or privy is wi in 50 feet of a private water supply well. _ Any portion of a cesspool or privy i ess than 100 feet but greater than 50 feet from.a private water supply well with no acceptable water quality analysis. f the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organ compounds, ammonia nitrogen and nitrate nitrogen. ' E] LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as o each of the following: The following criteria apply to rge systems in addition to the criteriaabove: ' The system serves a facili with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety nd the environment because one or more of the following conditions exist: Yes No the sy em is within 400 feet of a surface drinking water supply th 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 owne or operator of any such system shall bring the system and facility. into full compliance with the groundwater treatment program require nts of 314 CMR 3.00 and 6.00. Please consult the local regional office of the Department for further information. (reviaed 04/25/97) 3 Page of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART B CHECKLIST Property Address: 103 Garrison Lane, Osterville Owner: Regina Silvia Date of Inspection: 6/13/97 This information Dertains to each of the two systems on the site. Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: I' Yes No X _ Pumping information was provided by the owner, occupant, or Board of Health. & Sewer Dept. X _ 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. X As built plans have been obtained and examined. Note ;f they are not available with N/A. X _ The facility or dwelling was inspected for signs of sewage back-up. _ _ The system does not receive non-sanitary or industrial waste flow. X _ The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. X The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of ' baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. X The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. X Existing information. Ex. Plan at B.O.H. ' X _ 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)] r (revised 04125197) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 103 Garrison Lane, Osterville Owner: Regina Silvia Date of Inspection: 6/13/97 ' FLOW ONDITIONS RESIDENTIAL: System 1 khouse) System 2 (garage) Design flow: e.p.d./bedroom for S.A.S. 110 110/QDd/bdrm Number of bedrooms: 3 0 ' Number of current residents: 9 0 Garbage grinder (yes or no):_ V N Laundry connected to system (yes or no):_ Y N Seasonal use (yes or no): Water meter readings, if available (last two (2)year usage (gpd): 1996/639,000 1995/624,000* Sump Pump (yes or no): i1 N *includes irrigation system for +1AC of lawn and swimming pool ' Last date of occupancy: rilrrPntly occupied COMMERCIAUIN DUSTRIAL: Type of establishment: ' Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes no)_ Non-sanitary waste discharged to the Ti 5 system: (,yes or no)_ Water meter readings, if available: Last date of occupancy: ' OTHER: (Descri Last date of cupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: ' Owner confirmed by rmtni yi:al sewer dept. System pumped as part ofli� rom.(yes or no)-Z _ System 1 only If yes, volume pumped: allons Reason for pumping: __" 1- at time of inspection/ never previously pumped. ' TYPE OF SYSTEM — This information is the same for each system X Septic tank/distribution box/soil absorption system (1000 gal. pit and 1 stone) ' Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) ' I/A Technology etc. Copy of up to date contract? _ Other APPROXIMATE AGE of all components, date installe (if known) an sourc of inf rma o May/June 1984 systems therefore 13 years old. I=rmation `from Board oT ke Building Department records. Sewage odors detected when arriving at the site: (yes or no) N (revised 04/25/97) Page 5 of 10 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C SYSTEM INFORMATION (continued) Property Address: 103 Garrison Lane, Osterville Owner: Regina Silvia Date of Inspection: 6/13/97 BUILDING SEWER: (locate on site plan) (See attached Exhibits A & B) Depth below grade: + ' ' Material of construction: _cast iron X 40 PVC_other (explain) Distance from private water.supply well suction line Diameter 4" ' C` 'O evi(4l iti°off Teakage'"g' evidence of leakage. etc.) nce' SEPTIC TANK:_ (See attached Exhibits A & B). (locate on site plan) Depth below grade: systen 1 - 12" : system 2 - 161, —Material of construction: v concrete metal — —Fiberglass Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No). ' Dimensions. 10.51x5.71x4.5' both systems system 1 system 2 . Sludge depth: 18" 2" Distance from top of sludge to bottom of outlet tee or baffle: 11,5" 27.5" ' Scum thickness: 4" . Q" Distance from top of scum to top of outlet tee or baffle: 3" N/A Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: yiStj@l iizSpertion ' 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.) system was paged following i ns=Pnti nn for rPo,1 ar mai nt•ananr'.- All CnmpnnPnt-q in a cCal e Laundry-was being run just prior to lnsp coon & i ely contributed to tank being full No inflow observed after t�ping. ' GREASE TRAP:X L (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 t baffle: Date of last pumping: Comments: (recommendation for pumping, c uion of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakag tc.) revised 09 25 97 ( / / ) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 103 Garrison Lane, Osterville Owner: Regina Silvia Date of Inspection: 6/13/97 ' TIGHT OR HOLDING TANK:��� (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) ' Depth below grade: — — — Material of construction: concrete metal fiberglass _Polyethylene _other sin) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Alarm in working ord _Yes; No Date of previous pumping: Comments: (condition of inlet tee, conditi of alarm and float switches, etc.) 1 i DISTRIBUTION BOX:',, (See attached Exhibits A & B) (locate on site plan) Depth of liquid level above outlet invert: flet r either system rComments: For both systems (note if level and distribution is equal each of solids carryover, evidence of leakage into or out of box, etc.) Boxes appear level; each services a single pit; no evidence of leakage or carry over. i PUMP CHAMBER:N/A (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.) 'Aa.qPmPnt hathrnnm annaarg to hacra an intprnnl rnimn as a pliim in flxtj.>.re (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C , SYSTEM INFORMATION (continued) Property Address: 103 Garrison Lane, Osterville ' Owner: Regina Silvia Date of Inspection: 6/13/97 SOIL ABSORPTION SYSTEM (SAS): ' (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: System 1 (house) System 2 (garage) leaching pits, number: 1 1000 v+11 stone 11 1000 R + 1' stone leaching chambers, number. NA NA leaching galleries, number: NA NA leaching trenches,.number,length. NA NAleaching fields, number, dimensions. NA NA overflow cesspool, number: NA NA Alternative system: ,dA NA Name of Technology: Comments: (note condition of soil, s ns of hydraulic failure, level of ponding, condition of vIONT,SM has more than adaquate No evidence o Wq dulic failure at either site. te'ddrtlig 1;c'1jcLL;-LL-Y tortne 3Tectrooms ai it services. The garage system ' only services a slop sink as t e second story space was never tini-phed and there is no grout-: —level bathroom. Tts capacity would haudle 3 bpdrooms, ' CESSPOOLSNA (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 (cesspool must be mped as part of inspection) Comments: (note condition 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 hydrauh ailure, level of ponding, condition of vegetation, etc.) (revise 04125/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C SYSTEM INFORMATION (continued) Property Address: 103 Garrison Lane, Osterville Owner: Regina Silvia Date of.Inspection: 6/13/97 . SKETCH OF SEWAGE DISPOSAL SYSTEM.: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) SEE ATTACHED EXHIBITS A & B _' II 1 (revised OS 25 97 � � ) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C SYSTEM INFORMATION (continued) Property Address: 103 Garrison Lane, Osterville ' Owner: Regina Silvia. Date of Inspection: 6/13/97 Depth to Groundwater +16F4t ' Please indicate all the methods used to determine High Groundwater Elevation: -t Obtained from Design Plans on record . ' X Observation of Site (Abutting property, observation hole, basement sump etc.) X Determine it from local conditions . Check with local Board of health X Check FEMA Maps ' Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) Test pit logs on the plan show no water within 12' of the surface. USGS topographic quadrangle shows average site elevation of +25' . ' Topographic plans for property immediately across the street show road elevations of +24' MSL. The septic systems located +550 and +750' landward of MHW, respectively where MHW is +el 1.5 MSL and the adjacent wetland edge is +3' MSL. USGS advises adding up to 2' to obtain seasonal high groundwater for this area and using Mashpee index well #29 for comparison. The April reading for that well was 2.1' over normal at 6.4' . Design plans show the system bottom 8' below grade or + el 17' MSL. If gw is as per the index well plus 21 , it .would establish a record seasonal high of 8.4' which would still be 8.6' below the bottom of the systems. 1 (revised 04/25/97) Page 10 of 10 CX L-I.l 3 r T- P. Flo 04 lNsjRczr=—r25 L'�k�D ON. . .F602-b Oa t7,g770 US.: A. M. wrLSO.tl. ASSe0 7.1 : �.. . Db►tt:.•y• Ft+o�.•/ s t10 �t 3 •{-50���G,•p.L't. ... t•. � '•r t ' ► l . . r . . � 4.t.r. y.r;.: 'ES�P't:tc TA+,.►tt:�3�Ip Y'L00 %as �liri0 � : . . t p � . - � ,.• ; 1 t { � �..k ��_ ( r� IotSPaSaLi' ptT V;7c (Op0 3 SfBt� ( � . .. { l ; :G , :;•C'"ts T. _ . -- _.. _�ZZe► Xz.S .'SAS./��.�:. - ; «" �'{�-•..'- • • ► ` • ..: : ..: . . t ' f.,..• �;_-,� 41 P6Y.cc t. T t ct_1' p��•C �I.t u Z Mu.tit 'tx it : :".: t: r•o. _.. j•:�. .v - r t! �•. � - - I• -.T.�.4qFtl r l _.. RrcH RQ ;. : .BAXjER-;_ i �o .. �l/I1Jle.. ;.• - .: ' ': I ' ��-.'.-_�+-._ I �� ! �R;«" --y_' III �_• • •' ._ � ' '::�� •: :;.:� �:r . • .:.: FG� . .. � ioP FWD.• to2,. . .: tItr i.. Pff tth/ 80>l. . ' .!p'G TAt1VL I /Q t , t._•, yy V. gP• ::.. .. . : ,,bay. - ;:Q�^Z piT I . ; ; . � . . . . . . , . :. _ . . ...f .... . f UjAlrwao 1-71 ns SGALG- Ll/ FY: .T>Wr T-%-� Vvi CLLZ W-. 1-iE2>.= j.4 'CAM PL-Y S W t TH A►•tD St=1"9ACrC i�6Quie�MfsLtT'i GF TLJE i� , . 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' :.: :.fL• G.r G:; : .'ZTo.6.�- � �•O _., .. c.t..�.,_.. ��tsr� �» E_A.►�1� �v2vE.;o2y TUIS PL_a" ter =T $y5EX> ou t.0 WVTZZAAS"T A,(JLA f' I Li9 +-- AsBuilt Page 1 of 2 TOWN OF BARNSTABL.E [f LOCATION Ike SEWAGE a ZGd 7 �I� VILLAGE ASSESSOR'S MAP&LOT ✓Z INSTALLER'S NAME&PHONE NO.// SEPTIC TANK CAPACITY. l-S LEACHING FAC1LrrY:(type) {size)X2f NO.OF BEDROOMS BUILDER OR OWNER a Ta PERMITDATE: COMPLIANCE DATE: U 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 an aching Facility(If any wetlan*exist within 300 feet of ac f ty) Feet Furnished by • i a - 56 /7 2- 7 5 5 'q 0 eX�t41 y�f -7 j http://issgl2/intranet/propdata/prebuilt.aspx?mappar=l 14003002&seq=2 6/2/2017 v�- �o�� f ` LOCATION SEWAGE PERMIT NO. io �G 3 r �rri so h �e VILLAGE 603 kn INSTALLER' NAME & ADDRESS OHN A. AALTO B.ACKHOE SERVICE ;West ,Barnstable, Mass. 02668 BUILDER OR OWNER Co'rlie wyl f i � DATE PERMIT ISSUE D DATE COMPLIANCE ISSUED Z sir 3 � ijl y I y it 3 -NJ .......Z Fim.........r®............ THE COMMONWEALTH OF MASSApCHUSETTS BOARD OF HEALTH s - �...OLV l ..........._0F.........�.. ?J 7.i. .............................. ApplirFation for Disposal Works omilrnrtion ami#, Application is hereby made for a Permit to Construct (�r Repair ( ) an Individual Sewage Disposal System at: _ ONoej = ��tlT 001 ......................... Locatior Address or Lot No. - _....- ! iL�_:... .1 '................... - �'-� T 1�:�-�:-................-- O ner Address 1.4 .............................. = .7 ............................ ----...------------...-----...............................................-It ..-..------- nstaller Address Type of Building Size Lot ....... _ StI-felt V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder �+ Other—Type e of Building ............... No. of persons.................. Showers — Cafeteria P� YP g ------------- P ( ) ( ) PaOther fixt xes •----•-•••-•-••••••-••••.............•-•••......•• .--•••`•••••••••;•-•••••-•-•••-•---••-••----•-•••••..... ; .:...------•------- W Design Flow........... 5.............�....__gallons per person per day. Total daily flow..................-�_.��_.................gallons. WSeptic Tank—Liquid capacity/S—O.gallons Length................ Width................ Diameter-___-___--___.__ Depth................ x Disposal Trench—No. .................... Width..... ..y......... Total Length___......yy.,.../.... Total.leaching area....................sq. ft. Seepage Pit No-----------J------- Diameter....... Depth below inlet.....5..�......... Total leaching area....33-7..sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by �'�- �Jy mate a Test Pit No. 1......`Z�__-minutes er inch Depth of Test Pit•_____-_ f'�-__ Depth to round water .............. . � P P -f•------ P g - ti, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water____=__--__.___•....___- ------------------------------------•---............................------------•-•-------.................---•--.......------...........I.................... ODescription of Soil----------------------------------------------------------- ------------•------------------------------•--- .. ----------------------------------------------------- U U Nature of Repairs or Alterations—Answer when applicable........................... --------•---------••-----------•----•------•--•-• ------------------------------------ .--.----------------------------------- --------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of L ITiL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance hasYbeesue by the board healt Signed_ ... .................. .. ...........-•-•-.---- --•-••.................. Application Approved BY••••• -------------•••••• . -----•--•----•-•---••••••••. ........................................� date . .............••.... D ate Application Disapproved for the following reasons---------------•---...........--•----•-------------------------•--•----------.._..--------------------.....------ .......................................................----------•-------...•........-_.....-------•-•-----••-••---••......-•••=•--------.............................................................. Date PermitNo......................................................... Issued....................................................... Date e• n FES..`�...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..-n.W-0.--•-----'----OF..-...a: -..`:.'? .............................................. Appliratinn for Diipnoa1 Works Tonstrnrtinn ramit Application is hereby made for a Permit to Construct (v) or Repair ( ) an Individual Sewage Disposal System at: _ Cd-P R I�.>o v-) 1 ................_........._...-_---.. . -------------....------•-�`-?-�= --•---•--------•---•-•--•••------•••••-- -------••----.-----......------•-:....-- ----------- -------- - ------ - Location-Address or Lot No. _. -_. �5 ! �! ... ... .j L,-.-. ------------- -----•--•----------......-•-•---••--•-•-/?S -c rZ... a •-----......-•-••--- W A Own Address Installer Address /� Type of Building Size Lot___�'6_7 /�_sirmt �-, Dwelling—No. of Bedrooms............______..........................Expansion Attic ( ) Garbage Grinder aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixt es -----------------------•-----------------•-••---------•----------------------------------------------------_- W Design Flow............. _ _._._._.___�„______gallons per person per day. Total daily flow................. WSeptic Tank—Liquid*capacit}�!_Od_gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No_____________________ Width 4 ....... Total Length........ __.J ... Total.leaching area_______ ... ........sq. ft. Seepage Pit No-----------/........ Diameter......._!__.......... Depth below inlet..... .......... Total leaching area.....3. sq. ft. Z Other Distribution box ( ) Dosin tank ( ) '-' Percolation Test Results Performed by dXT !i.-.__�.1)'"4 ___.__. :-_�NUL�!J-��ate.________�r17.------ Test . a Pit No. L____Z'___minutes per inch Depth of Test Pit......../. ... Depth to ground water...... ""............. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 -------------------------------- -•--•....... -------------- ---------- •----------- -...... •----------- --------------••.......-------- •------------------------- 0 Description of Soil.......................................... -----------------------------•---------- ---------- �f f��........................................... PP Y U Nature of Repairs or Alterati s A �wer when applicable 4.rr Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code—The undersigned further agre not to place the system in operation until a Certificate of Compliance has bee sue by the board h It ,{ t Q Jam.- .� i: wL7 Signed....Y ........ Application Approved B ` d_ �atey .^ PP PP Y -;' -----------------•-- ----- --------------------- Date .. •h ••-•-----••-•-•••-••--••.-..-t--•••-•-•--•••----- ' Application Disapproved for the following reasons___________________________ •___-:--_____ ,. -----------------------------•--------------•---...---------...-•--------....------------.•----•--.._....__.....---•----•-----------------•-----••-------- Date .. P it No....--••................ ---------,--------_ Issued_.......................................................•.' Date ' THE COMMONWEALTH OF MASSACHUSETTS ° if BOARD OF EALTH YJ� rQ�a► .(2 ........:....OF..............:/ 1J 7 Tv,difirtt#p of Tuntpliattre THIS IS TO CERTIFY, That the Indivi ual Sewage Disposal System constructed' /) Or Repaired by ... ..... ...................................••••....-•------- --••---........._...---•-•-------- / Install at........................4_O�-...... 2 d C � C? has been installed in accordance with the provisions of TLT R rryfof he State Sanitary'Code s ides gibed in the application for Disposal Works Construction Permit No_________________________________________ dated_...-__,,_-__1 / .................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS RUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE DATE.---•----•••••---.. .. ,.L-........................._....__ Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH L1.. ,�� ............... No... ................... FEE...--••--•-•--.......... �i��n��1 nrk� �nn��rnr#inn rrntt� Permission is.>ereby granted................. !y _.__ G: ..... __ ---------- ---------•• ........... to Construct ( or�Repair ( ) an Individual Sewage Disposal System at No. ........ f"rh r,j_rr � a ---•--------- ... �_... Street +y�.<< 'J ✓ r as shown on the application for Disposal Works Construction Permi b_____________________ Dated....... ._ .............. (� ---------- f--• ..................................--------------•-----•-------------•---------- DATE----- = " ............................................. Board of Health FORM 1255 A. M. SULKIN• INC.. BOSTON l�►1J C L� - ... W I T'A aAMA -6 G¢1 Lrov-z _ oAt��r Fti�o.A. , tta t 3 +50I.-Wa rt -- r ( : : : : . ; I �- .SEFC'tG TA�.itL-■3� ><2.00 ��m■, ��O r : . � ..f . . ,. . . ( ' ! �'k e vt S PoSAL' PIT V't t= I npU lc 3 SfA I : .: . : C.! ► ; I: ' r ` ��is s 1 f . 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' q � �{ �' � �✓ "��*�d� ��gL f9�b y"�t.'� �a a `�^��F+ R�",®it•� r r � T i z n.. -,+ D '-•� .y',Y N- = a' r 7.� 'll �.,�°�i tt;::8 � T� r(r'•Q,a^'. �� J'.r -f,;[i � s't ,q m+ .a l..ui`i„r. .;��.. ,n..�` rra-. �^avPY •.,1,t;r�!,....n � era^v� a C f is C 't R.}: t•'l_*.'r ...; '�y ...la��,U:ef[ ,V B:p,.s�y ` % >md'�n ,u'D { � i• d"`r �Q 2 N®..............F-•------ FBi&........................... f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -. down...... ........ ..OF......Barnstable ,� iiralivn for iii osal Works Towitr ivat Permit 11 Application is hereby made for a Permit to.Construct ( ) or Repair ( ) an Individual Sewage Disposal System at:' ...... q©3....CiarxIBan,.Jerre......IdaMo.,....mu s.................. ................ ..1. 1.k..................... ..................... Location•Address t No ,e.Mr.•, J,,,,P, Birmingham ... ................ Garrison Lane...V'anno. Mass. ....... ................. ........... .................. Owner Ad ress W Alfred A. - Fuller Cotuit Rd. Mars�ons Mills, Mass. Installer Address U Type of Building Size Lot...1?.0,400 :Sq. feet Dwelling—No. of Bedrooms............021e.......................Expansion Attic ( ) Garbage Grinder ( ) "4 Other—Type of Building -___-.--- No. of persons............................ Showers — Cafeteria Q+ Other fixtures ------------------------------------------------------•--._...--- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacitp00.-gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—,No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit NOI.M.__981 Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by a -•--------------•-•---•--------•---......._.....••--...--•----••••-•-- ... Date----•-•-•----------------- ,4 Test Pit No. I................minutes per inch Depth of Test Pit------.............. Depth to ground water_:.______-___-__-__.__.. rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ••---•-•••-•----------------••-••-•••---•-•••-•-...........---•---•-••--••--•------•-••--.............----•----•-•.........................._.....--••••-•--- Descriptionof Soil =.......... Sarid•-•-••••--•----------------•---------------------------------------------------------------------------------------•--- W U Nature of Repairs or Alterations—Answer when applicable....._.......................................................................................... ---......................................-............................................................................................................................................................. Agreement: The undersigned agrees to install the aforedescribed In idual ge •sp al System in accordance with the provisions of Article XI of the State Sanitary Code nd igne f ther rees not to place the system in operation until a Certificate of Compliance has been ' u y t oar Signe _..._.. ... ........ ......................... ........ Application Approved By....._=_. _ _ � . __ ______ :.____. � at 7 Application Disapproved for the following reasons--............................................................................................................... --------------------------------------------------------------------------------------------------------------•--------------------------------- ---------------- ----------------. Date Permit No...................•••. - ................................. Issued._�. .............................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town ...------ - -----. OF.......&W.Wtable-----.---...-_.................................... Apofiration far Rapasal 10orks Tonotrudian Vrrntit Application is hereby made for a Permit 1:0 Construct ( ) or Repair ( ) an Individual Sewage Disposal System at:. ..... , .............. "-----..:..---................q................................................ Location..Address or Lot Ao. ....Mr.,...Ze...p :.Mxmlnghsj ..................................... ..Garx.1sDrL.1ww....Via>mo&:...Mass:........,........._. Owner Address ....A ft.0.&AA...?Ell Fr............................ Q ...R!'A...., V.0AM...X!1;kqA...XAAgP-- Installer Address d Type of Building Size LotJ.?0.#A 0.....Sq. feet U Dwelling—No. of Bedrooms.............One.......................Expansion Attic (, ) Garbage Grinder ( ) a Other—Type of Building ...:........................ No. of persons.................. *.......... Showers ( ) — Cafeteria ( ) Otherfixtures . ---------------------------------------------•----•----------------------- W Design Flow............................................gallons per person per day. Total daily flow._............................._...._.......gallons. WSeptic Tank—Liquid capacit}Lf)Q.Q._gallons Length................ Width................. Diameter................ Depth................. x Disposal Trench—No_____________________ Width.................... Total Length........:,.......... Total leaching area....................sq. ft. Seepage Pit N6100.0.. �1.Diameter-------------------- Depth below inlet.................... Total leaching area....................sq. ft. z Other, Distribution box ( ) Dosing tank ( ) Perc t-ation Test Results Performed b ............................... Date............................... atest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_---__--___-_-____---- 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........:--------------- -----------------•---------- •---•------•-----.•-----•------------•••---------------------------------------------------------- ...._....------- •.......... --A O Description of Soil-•-•-•--••••......•.................•� :fld_-•--•--•-•----•-••--•-•-•--._.....------------------..... •-•-•-•--•------•-•-••--•-•-•--------•----•----------------- x W UNature of Repairs or Alterations—Answer when applicable................................................................................................ ..........•. -----•---••-------••-•••-•..................•-•••-•-•-•-•-•-------•--••_..--••._._...•---•--•--------------------------••------••••••••---------------..---••-•.....-••••-............. Agreement The uhdersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisioris•of Article XI of.the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. g . .' y ' i% ate °�idr�• Application"Approved BY ;� (�.: t P '` -- =""---------- ......- � j�-�' Application Disapproved for the following reasons: y�•-------•---------•-•--••--•-----•---------•---•-•--.........nate_.......--•--- .............................................................-••-••••---•--•-•-••••..._..-•-••••••••••__............................................................................................... Date Permit No.-•-•--••-•-••• Issued--••-• 7_ ... ..._ z. ......--••...... /a�tc THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA1,ru �iP............O F... ....... ......................... Trrtifiratr of Q0tgtpliattrr II, I TO EKT FY, a-the Individual Sewage Disposal System constructed ( ) Repaired ( j by �' t , _... � 1 st iller ---- has been installed in accordance with the provislons of Article 1I of The-State Sanitary Code.as desFril2Ad in the application for Disposal Works Construction Permit No:.................. --------- dated..: _ .! ........... .THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM. WILL FUNCTION SATISFACTORY. DATE.................. r ---------------- Inspector..... � •-- THE COMMONWEALTH OF MASSACHUSETTS C20ARD Q HEALTH .......... * O No....... FEE...............•--...... �fr * ! �,Permassio ^ ...._...As hereby ran e x :........... to Construc� ) or Repahr , .bran In vidual Sewage Disposal System at NO...._ ...._ '' yr SF• :. _. :N:S"..-�i�, .. , •-;,3 ;.fW;ry+.'�:»`s'"T;,F.'.:t'w3'.i!r•8,,r� ... . •-- .. Street �-�•� as shown on the application for. Disposal Works Constructio- rmit �o�.,F _._ ... Dated- �. ....... ......... Board of Flcalth DATE-=----------- ---------------------- FOW,j 1255 HO'S S B ARREN, INC.. PUBLISHERS Ulm= {ypp-ICRY Q1UHP�lC OdFi RO *._-- I I 1 I I 1 I I I I I I 0@HR Or 4W � � I 1 I 1 I 1 w aT. BAM r-----1 - MA4IFR b I m..rs mm�1 I ,y�.l * • O - Wl4fER�DR001 t I I POIIOER RY IOfOmI M SIM SffTM b I I Ivnaml�suldr ROOM r------- 000 I s r O a 000 ti � l/tlIImRT I i I r ---- R s-o,n ------------- Uu - . omm ROOM - J • i •__—__ I �I as I I QI6f 6FDROQI AMMO ROOT OnRT FOTLR I I m OAIFI6/64' OCFI6�' 4fi a"�' i Y/57ER SRIDT- - 2O2 . GOIFIC E0 OOIH6 Eti I _ I OONFIC EA WO-R.1!!D �� OlOF6 E2! OGFi" WC " OOFi E4 OYFi 2O' OORi mm' ,.+,��r . $. �,.°' 4a. 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I I I I I I I I CUIFD12068 L--_-_J LJ LJ COOLER 3'-15 1/2" 8'-4 1/2" 3'-0 1/2" n CUIFD6068 a TOILET iv ROOM MASTER BATH I a r� ---------- MASTER BEDROOM I MASTER SITTING Z KITCHEN/FAMILY ROOM ---------------------------I i 5 NEK i I 1 it I I I I I I I • WASHER III IiI DRYER GUEST BATH ------------- `------------3 5-0 1/2 iIII III '-3 1 4" 14 J LAUNDRY ro I I I I I I I I I I I I I - ------------� I I ` ------' - I--------------- `-------' , - I ----------------- ll CID �I z a a N I MASTER CLOSET Z 04 = N U I I 3'-3" ---i I I I I I II I I II I GUEST BEDROOM i--i II ENTRY FOYER LIVING ROOM I I BASEMENT I I 2ND EXIT I I (EMERGENCY EXIT) 'I I C 2012 COMPLIANT I MASTER STUDY I I � II j CUDHT-NG 3620 CUDHT-NG 3620 WINDOW ABLE A VE CUDH-NG 3628* CUDH-NG 3628* C HP-NG 40M '.* CUDH-NG 3632* CUDH-NG 3632* 1 ,� 3 3z• e I I ams� aoFle� anfR� aof,s� I i ' BATH MASITR JUTCHEN Y/3,FA BEDROOM I Rlmml/FMLLT Row °"6T eem 111111 -- �. 1 I ummnr � I ( tl fl � I ^�+ _ I I , outer+a»gr DPW ROOM I lg■� b BB � � I I f f■ S-T I ___ apt a"•\ ` I f-j uoW Row i i Fxmr'ro\n �� !J rwq,w snror wolsaa mrs _iTM I �, _l_. . n \I ! 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EXISTING 2X8 WALL EXISTING 2X8 WALL � BEYOND KRAFT FACED t2l � . jt l P S�KRS�FACE WALL NEW 2X4 _ LOAD BEARING PARWON _ m yyyyvyv kYyvvv -----y -- -------- ----- ------ -----�------- (-V-'�-------------Y.Y-Y-V-- I�-sTINGKRFT FACED R19 Y- 'f MYI TO REMAIN EXISTING 8'CONC.FOUNDATION WALL - EXISTNG 3'CONCYRIM LALLY COL EXISTING 3'CONC. LN1Y COL. STING 8'CONC.FOUNDATION WALL I I I I I i I I I I I I I 1 I I I I I I I I I I I I I I 1 I 1 I I I I I I I I I i I I I I I I 1 I I I I I I i i I (2) 2•x 8- I 1 (2)2'x 8- I I (2)2'x 8' I N N I I N N I I I I N N I m m I ao to I I 5o io I x x 1 x x ——L—._ol eL—L--�� • I I I I L-- -. .-. --- ,� I I .-. ---- .-.--,�— �--T--�--� ---- .. I I I I I I I I I I --- .. T-'-- I�—� T--T r� - 11 I I 1 1 i i 1 (2)2-x 8_1 i i 1 (2) 2-X e' 1 i T 1 i 1 (2)2'x B' low IG 1� _ I■■ BEAM I , II 1 B-3 ; I ��1� BEAM B— I Ip POSTEDIO BEARING WALL BELOW I 11I I -t—T EXISTING 1 RAFTERS --� 4`I I 11 i I I 1 I 1 N I I I 1 I 1 I I I I I I � 1 j � 1 1 m EXISTING RAFTERS I I I I I 1 1 I 1 a 1 I I I 1 I I I i I � ' m i I � � I - I � I I I I I I I I I I EXISTING RAFTERS o x m l I 1 I 1 w l I I I p I I I I I W 1 1 1 m W I 11 I I I I m I I I 1 I I , I E*ISTING IRAFTEgS I I I I I I I I I K I I 1 � I •I I I I I I , I I I I I I i I I I I I I I � 1 I I I 11 I I I L. BEAM B— ,4 I 1 I — - - - I I 1 � I .1, �+ I - I. 1 I- I ' 1 I 1 I- 1 1 I ■ 0s1m M BEARING�— W(M BnonELOW 1 I I � ✓ I I I , � i I I 1 ; � � I � � � ' � � 1 � � � � non I I 1 �J ✓ I ; I I 1 I I I I ' 1 I I I I I � � � � � � � � ; ■� ; � � ; ■�i i 1 , 1 I 1 1 1 1 � 1� - 1 1 1 1 1 1 I �XISTING R�FTERS ' I I 1 I I I = 1 I 1 I I I 1 I I I I I I I I I (2)1.75+X 9.25-Llj EADERVon 1 F I I I I I I I I I 1 I N N I i I N I i (2)1.75'X 7.25'LVL HEADER (2)1.75'X 17.25"LK HEADER01101 Sol on 1015 ■ q I I I I I ' I 1 I I I I I I I 1 Id. tar 1 1 1 � 1 14a 1 1 1 1 Ir I I I N I I I I I I I I I 1 n inl N I I I �� NI I I I -I---+— EXISTING 1 RAFTERS 1 1 1 I 1 1 I I I I I I I I n l I I i I N I I N , vl 2'Xto• RAPIERS 2'X10' SP RAPIERS I N I I I I I I I I I 1 I I I I I I I I I I I I I I 2'X10' SPF RAPIER& 1 I I I I I I I I I j 1 1 I I I I I I I I I I I I I I I I I i 1 1 I I I I I I I I I I I , -fat _ t} NEW ENTRY DORMER DOR ERS NEW DORMERS _ �• ' k ` A I CLOSET CLOSET BEDROOM BATH 2ND FLOOR ABOVE 3 CAR GARAGE 3 CAR GARAGE BALCONY BEDROOM t?II P:EoHd LTOZ zo Nn ` BALCONY DOWN CLOSET � e imirwa aa.�r s'e„ew,yaN EXISTING CONNECTOR Pi o I V OS7 rSro011 eAlH 2ND FLOOR ABOVE 3 CAR GARAGE 3 CAR GARAGE ewcai aumo� eucar oogro aoinaa� awme gowi�i r-----1 r-----i glpp-NG awoas i i i i i i - L'g'g.. z �ag��n arHo av aws am aws� anHe� a Y � , '� o°s'�n ffi Y § r�s�m emx L) DIA 711 Fl r-----i Y � w..m'„"1° cw,uow O Y/SIF11 BLrM T i smro Lai e 000 �: w 000 *aucsr aim s i-o vi I uy�i. I aeowr ib yr sue^ ooa/o aoo� urxo Hoar m rom 00HY 64 )wm OYM1i�Q 0MHD 3M OWiJ� OOFIC� __ i� 1 mw� aaw>� mfc30 LU LEGEND 134' 134" 19'•10" 134° . NEW 2 X 5 WALL CONSTRUCTION NEW 2X4 WALL CONSTRUCTION A y - ® NEW CONCRETE CONSTRUCTION � MATERIALS NOTES 22 DRIVEWAY 23 PEA E WALKWAYGRAVEL DRIP PATIO 2.4 PEA GRAVEL DRIP ' 25 WOOD FENCE•4' 26 WOOD FENCE•8' 3.1 CONCRETE FOOTING-CONTINUOUS 3.2 CONCRETE FOOT ING-2-DIANETER 3.3 CONCRETE FOUNDATION WALL 4.10 STONE STEP 9.5 CERAMIC FLOOR TILE 9.9 WOOD STRIP FLOORING 10A WOOD CABINET 11A REFRIGERATOR 11.2 ICE MAKER 15.2 SINK 15.3 WATER CLOSET 15.4 BATHTUB ISS SHOWER .. - 16.7 TELEVISION 16.9 STEREO EQUIPMENT r______________________________ I ______________________________I 4 y,.^-@ A✓x+'m Y4 {>, � � I I �— '7tiMa la'uo fft I"I� e�� ,..� , 1 � i � ti � � NOTES 0 1 ------------- ------------ 1 Q' t I T'----- 1 — ---I '9 EXIT Ifs E%ff t A. IINPROVIDE IMMEDIATE SMOKE VICINDETECTORSAREGIARED. b I b 4 1 IIN ALL BEDROOMS VICINfTV OF AIL BEDROOMS - •y I I I I 1 —__ I I I I 1 -v 'k.: •! ^ay^.c i {; �: � <� IIN ALL BEDROOMS jI I -------------- — -- — 1 I I I ----- ---- I I 1 I YilA4 "Vt'1 ••...aJ,o-y •T5�'.!q'k+..' � v nms.. h°.;.'.... .l�'i., T: ;. CABINETRVDESCBPTIONS 1 �_L________________a._ ___L I I i, I ":w ,,. C101 MEDIA CABINET-PAINTED WOOD DOORS AND _____________ EX1EflK%1 8&iCH PLYWOOD INTERIOR DRAWERS FOR CD AISD VHS STORAGE ADJUSTABLE BOOKSHELVES,BULT-01 RL'FflIGERATCR AND 1 u Tit ICE-MAKEfl TV BEHIND I CTABLED.B. C102 LNENCLOSET-BIRCHPLYWOODINTERIOR, I I 1 I I T ADASTABLE SHELVES. C103 SEE C102 b 1 I I I b X BEDROOMI BATH BATH BED I DOM2 1 C104 CLOTHES CLOSET-PAINTED WOOD DOORS, g 001 1 I 1 0 I p I 102 SDQ 104 1W QSD 105 B0ICHPLYWOOD BWTEIOfl,ADJUSTABLE a 4 I HANGING HODS(2 POSRIONS),FIXED SHELF. N - ':,..1 cios SEE CIE . _-__-_______1 I_____________ I ®-1 _______1 ______--_—_ 1 ` 10 0 113 DI N CARNET BEVELED EDGE MIRROR 1 T.____— r j T-1—J___—__ r.lh-j_—_____ €' - APPLED TO DOOfl BSHELVES._ T a RCH PLYWOOD INTERIOR ADJUSTABLE 8,M K, L@o1ESTONECOUNTERTOP PAINTED WOOD DOORS I LAW VANIIV-PURI:EI.AIN UNDERMLA/NI SIN 1 1 jM1f+if 091CI I PLYWOOD OVTERIOII. SE C109 SEE CIOS EC 07 10 CRAWUSPAGE I 1 1 I HA ® 11 S O6x 1141 I 1 I V•i ro `s,S, 1 „ 1 — I 1 I �— ---- ---------- r—I I )�� Vim: ,. --- �' 10 :..... ._.,. .-..........., •.._.. ,..._ ..��f I I I I I ... 1' 1 I I r—T-1 4 I 1 I I '•''S :1..1..i- .I_i Dare I— 5 b FAMT.VROOM L 55 .. K I—J--1 1 ti `` 101 ;:4:f..Y FR(1A{2E- . —rt—' }: f RESIDENCE I I 1 I I IL I r--T---------------- 1 1 —• �, .. OsumLe.dfirchumue ..................::.....° ..: 0.................... r . . I ................................_......_.----........._........---............_............................. ,�+',RF.•, ...................................................... ..........................._.............................. I............................ .............. `., hart;:— ._.. REED A.MORRISON I I ... ....: ... ..... .. �.�� ..., 1 ... ...,- fI f J Arclumol ----1 --------- --------------� � ,• . ,v:�vy.y, 1��er 4 I t �I�r 31�, I . � No. P-OC17 y BOSTON, t~u L:,y":.E..;.a..j..;:: �i MASS I L Os, 26M Nlr 7 ►� Ir • 4' 6'•9' 6••9° 4' 4' 618° 6'•8' 6'-9• 4• FLOOR PLANS 20'-9• 12, 20'-B• Date: Scale: OFOUNDATION PLAN O FLOOR PLAN �1 D FT 1 x a 9 1 2 ✓/ LEGEND OSD SMOKE DETECTOR �A CEILINGFAN EXHAUSTFAN OA CEILING LIGHT-HALORECESSED LOW VOLTAGE DONNLIGHT,MR16,#HAL1416P,OPEN COILEX,WHITE. y © CE ILING LIGHT.PORCELAIN SOCKET-SURFACE W,CAGE THEPrTT.TP76M-1000WAV-WP.SHOWER. © ERT 7�N1p FACE WAGET . 000WAV-W O CEILINGLIGHT.SHIPLIGHTS,CCM-#R-1, OIL RUBBED BRONZE. WALL LIGHT-SHIPLIGHTS.COM-#FLI, OIL RUBBED BRONZE. V WALL LIGHT•SHIPLIGHTS.COM-#H1 Z OIL RUBBED BRONZE. GFIe- DUPLEX OUTLET-GFI _ & DUPLEX OUTLET.BASEBORD Ae. DUPLEX OUTLET•3'-6•AFF Be. DUPLEX OUTLET•316-AFF-GFI C& DUPLEX OUTLET-EXTERIOR .......................... ........................ ................. ................................................. ..... .-.. ........... ... +. GUADRIPLEX OUTLET _ R At>-- TELEPHONE-4LINES ® CABLETV {� �•F A, h ,d..t��11 1• �#. L.. ......-... .............................. ..................... — RCH,M1t6'AFFERNEf/DSL S 3W Y., �i3.` � gtl— SWITCH•DIMMEfl .e: - ... ..4...... .. SWITCI}THREE WAY I I ,I I fl S d SWRCH•DIMMEfl THREE WAY Y ¢ ......1 ............ ,..., bk .. ......... .... - A BEDI900M1 ? :t B ! BEDfl60M2 A BEDR000M1 ....... �I,........ ... ..... eED 105 HOSE BIB .T ® % Iq ��7 .�............. BATH 1 % r BATH 2 TBATH 1 BATH 2 $� STEREO SPEAKER �A SD p 104 / :' Ip7 OSD &p i &A SD O 1. 107 OSD mp ...� .. .... �...:'...,`.. ;. 1 ®— DOORBELL • ® •-. i".. S 1 1 S Stl Stl Stl ; G - Stl Stl SO CD t�:�" NOTES F , 1 A PROVIDE SMOKE DETECTORSASREOUIRED. ...... ..... .... .. 11N IMMEUVITE VICNrTYOFALL BEDROOMS anyit 11 f`4�� .iiRf{3 tp� •v-a =.I r 7 a-� I d m� �,1 ©'-_ 1 IN EALL BACH S ROOfv6 •` BASEMENT i i ~�_ �1J ' Fsµ - IPER 1,2 SFOFFLOOR AREA • EACM�9TOfl I Pl YINDLDDPIG THE Sp.......�... .._..©_nALL .lzbsp.... �...... �r r j yy ........... ........................ _.......... --..-... r } u .................. A' ........ l.:- I .........................A .-. Q 4:.. ;�'�. .F I I '�_;.1.: (�..... Q Q.............. r - Daze L.. 4' FAMILY ROOM :-:: - .r.::i::IR9AGHtac'.r.'.:c:ccc_r.:i. FAMILYROOM TERRACE 191 ....-,..L.::...., ::i .....I A l..t.....,..1..,..t..i '' � � ...............t�®. ....-..........3a,...............®O..............._ , ,.... .,.....L.,.:, , ..............t9 ...-... .......{,�... .. mA. .... ....... BODELL ,..1.. RESIDENCE it fl A , {ti......... .............. ......................... ..........._............. b.... p.......... i t �$1 StlStlstlse r -I ...._....................................... :.-::::::::::. ............I......_..-............ I: a'a!, : ............................-......................................--...--................__......_-............ ......................j....-.................,...............,..-.....-...................._.......--._......... I�., .' ..-:':......................... .. ..i::...................... I....;v I •. h ;..' ORGH........................ I'. 4 .......................................... ... .............-..... ............-...-._....... ...-...............-....... ....... .-.-........ t��a ........:.................................................. _..6 REED A.MORRISON A ;. R,� t' ofy ................................... .... w tiJ 0 t 0 BOSTON, W MASS j FLOOR PLANS-PTE/ REFLECTED CEILING M Date: Scale: - I O28/04 1 14'=1'-P O D I 2 a B FLOOR PLAN-PTE O FLOOR PLAN-REFLECTED CEILING Fr © A4 NOTES A. FRAMING MEMBERS WITHIN 24"OF GRADE TO BE PRESSURE TREATED. B. HORIZONTAL O BE DOODUGLASSDFIR LRATRICH(NORTH),I RAE MEMBERS OR BETTER, C. ALL EXTERIOR WALLS TO BE FRAMED WITH 2 X 6. D. WINDOWWALL AND FLOOR CENTERSSTO ACCOMMODATEMNO NOT OCE ALIGN WITH CEILING LIGHTS AND WALL OUTLETS. E. ALL DOOR AND WINDOW HEADERS TO BE(2)2X8 UNLESS OTHERWISE NOTED. LEGEND OA 2X 801a-0 C. OB 2X 8016"0.0 © 2x 10016'0.C. OD 2X 12016'OC. • -------------------------------I ------------------------------1 � I I r_________ ____ __________t I____—____ ____ ____--____1 I I I I I I I I I •1 I I 1 I I ' I 1 -_-_ ______________-_ I I I I I I I 1 I - 1 I 1 I I I I I I I I I I I I I I I I I I 1 I I I I I 1 1 I I I I 1 I 1 I 1-L. _1 P) NO I 1 TJ) 10 r— —I I i I I I - Y_ — 1TFF I I - 1 1 I I I I I 1 I 1_ _— _ _ __ _ __ _ I I 1SIM I I I „I L---------------------- ta) to r t t (a) to I �----J - -- 2.8 ryp \ I 1 I I I 1 I I � I 1 � i Date Iseoe 1 I I I I 1 I BODELL RESIDENCE l j 1 1 I I I I I I I I I 1 I I 1 I I I -- — -- — ---'1' -- - — -- -- —h--T----------------- on I' 1ISC—f tare I I 1 - 1 orrerwtre0l'�smluvene -- —I ..................._.....:........_--.....................-.................................-..-..... •a_a .......... r REED A.MORRISON .. ... ..... _............ f> I________________ --------------- No_ No 809 � 4� O i!J l� 80STON, 5. 1 MASS a� F,y Q '---- — • �i�^i� 026£S W8428-8379 P FRAMING PLANS 11 Date: Scale: 10/24,04 1l4"=1'-P O FIRST FLOOR FRAMING PLAN ROOF FRAMING PLAN o 1 z a e FT © A5 MATERIALS NOTESFJ I 3.1 CONCRETE FOOTING-CONTINl10l1S i 32 CONCRETEFOOTING-24"DIAMETER 3.4 CONCRETE SLAB FOUND4TION WALL 4.6 GRAVEL 4.7 DRAIN PIPE 4.10 STONE STEP 6.15 OGEE MOLDING-6" I+ 6.17 WOODTRIM-5/4 6.23 CEDAR SHINGLES 6.25 WOOD DRIP -314`%11IT 6.30 MOO BOARD-FASCIA 6.31 MOO BOARD COLUMN 6.32 MOO BOARD--SKIRT I, 7.9 COPPER FLASHING 7.10 COPPER SCREEN I VENT 7.11 COPPER DIVE RTER 7.15 RED CEDAR HOOF SHINGLES 7.19 RIDGE VENT 8.1 GLASS-LOWE 8.2 WOOD DOOR 8.3 WOOD AND GLASS DOOR 17'-6' 8.4 WOOD5 Wool)WINDAND SCREEN DOOR T.O.RIDGE 8.9 WOOD SHUTTER-OPERABLE HUNG _ I II 10 2` TO,PLATE l i I ll I I o - o 1,• T.O.FIN FIRST FLOOR _______________---___ __________________________________ —_—__—_._�_________=_ I I I I I I I I I I I I I I I I ___________-__-___________ r' --------------------------T-- -----------------�--, n1 WEST ELEVATION Date Lsaae { BODELL RESIDENCE 20 6" T.O.flIDGE 17 6° T.O.flIDGE - 103 G—i—L- 1 13'-0`, - Oswnw.Af...h 1, 02655 T.O.PLATE I I I - T.O.PLATE I rS r'� ❑❑❑ ❑® F� C.:ft� J �1h��� REEDA.MORRISON �g� �m, a cc0110 No. 8097 80S70N, W MASS j ---------- --------- -------------------- rA 11 4��'I o T.O.FIN FIRST FLOOR Twb 028-8p SOBale-837D I1___.L__L L-J ELEVATIONS i Date: Scale: 1024/04 114"=1'-0" 0 1 2 4 8 O EAST ELEVATION Fr © A6 MATERIALSNOTES 3 3.1 CONCRETEFOOTING-CONTINUOUS 3.2 CONCRETE FOOTING-24'DIAMETER A8 3.3 CONCRETE FOUNDATION WALL 3.4 CONCRETE SLAB•4' 4.6 GRAVEL 4.7 DRAINPIPE 4•10 STONE STEP 6.15 OGEE MOLDING-6' 6.17 WOODTRIM-5/4 6.23 CEDAR SHINGLES 6.25 WOOD DRIP-3.N'X 11R' " 6,30 MOO BOARD-FASCIA 6.31 MOO BOARD•COLUMN 6.32 MOO BOARD•SKIRT 20'-6' 20' 6' 7.11 COPPER FLASHING T.O.RI E T.O.RIDGE 7.11 COPPER SCREEN/VENT 7.11 REDCOPPER DARDIVERTER ROOF 7.19 RED CEDAR ROOF SHINGLES 7.19 GLAS VENT 8.1 LOW E WOOD y G 17 6° 8.2 WOOD DOO 17R 8.3 WOOD AND GLASS DOOR E T.O.RIDGE 8.5 WOOD AND SCREENDOOR T.O.RI WOOD WINDOW DOUBLE HUNG R9 8. WOOD SMUITEfl-OPERABLE i 13'•0' �• •� l 131-0' - � �\ T.O.P TE T.O.PLATE 10'-2' \`. 10'-2' .' T.O.PL kTE 'iii ii :Ia.:•I T.G.PLATE j / \`\\ ❑ !i ❑❑❑❑❑❑ i•. ❑❑❑ j ❑❑❑ ❑ ❑❑ ❑ ❑ ii ❑❑❑❑❑❑ ii ❑❑❑ ❑❑❑ �n I u I ❑❑❑ I I � ❑❑� I ....... I I I I1100 I I 1 I I ii ��� �nn�jj ❑lJ i ❑ ❑ ❑ ❑❑ ttt ❑�� I � I�=II I IJ❑H I I I I I I I I �� l it I I I I � : Ii; T.O.FIN FIRST T.O.FIN FIRST . ------------------------_________----- ________________________________ I 1 1 i i I I ' r' 0 SEC O NORTH ELEVATION Daze Issue BODELL RESIDENCE 20'-6' T.O.RIDGE 17 6° T.O.RIDGE •� _________________________________ Osrervil� mNumte T.O.PLATE I I I 1 T.O.P T 1" REED A.MORRISON HT L_AJ r ~,• l ❑® m0 �i Pvfl. 3,09' ®❑❑ ' �r�� BOSTON, R FAASS `� T.O.FIN IRST BOOR 0_11e0 GSSaolwane I Ix•l '+,. '. X8428.8379 ELEVATIONS/ SECTIONS Date: Scale: 102CO4 114'-1'-0' O SECTION O SOUTH ELEVATION o 1 z a e FT © A7 MATERIALS NOTES I1 I a.1 CONCRETE FOOTING:CONTINUOUS 3.2 CONCRETE FOOTING 24'DIAMETER 3.3 CONCRETE FOUNDATION WALL 3.4 CONCRETE SLAB-3' 4,6 GRAVEL 4.7 DRAW PIPE 4,10 STONE STEP 6.1 2%6 P RESSURE TREATED 6.2 2%4 6.3 2%6 ............................_� 6.5 2%10 6.6 2%12 T...................... � 6.7 BLOCKPNO i 6.6 MAHOGANY S/4 DECKING I 6.10 PLYWOOD SHEATHING 6.11 3.BEAD AND BEAD BOARD 6.12 BIRCH VENEER PLYWOOD 6.14 CROWN MOLDING-3' 6.15 OGEE MOLDING•6' 6.18 CORNERBOARD•4'XS/4 6.17 WOWTRIM-5/d 12 6.t8 WOW TRIM-3/4' 6.19 WOOD T GROOVE 3 6.20 WOOD BASE•6' ' 8 6.23 CEDAR V SHINGLES SIDING 6.23 CEDAR THRESHOLD 6.25 WOOD THfl-314'X WITH DRIP • 6.25 MOO B DRIPOAR-314'XI Ir2' 6.31 MOO BOARD•FASCIA ...................... ..................................._...........®i 6.31 MOO BOARD.COLUMN 6,32 WOO LANCE SKIRT .... ............................ ................................� 6.33 WOOD ATICE-3/4°%11/2° 7.1 VAPOR BARRIER 7.2 WSULATION-R•11 7.3 WSULATION-R•19 ' 7.4 RIGID INSULATION �a3 7.5 ASPHALT ROOFWGSHINGLES 13'-0' 7.8 WATERPROOFING 4 7.9 COPPER FLASHING T.O.PLATE 7.10 VENT 5 7.11 COPPER DIVERTER 7.12 ROOF NO FELT i ® 7.14 BUILDING PAPER 7.19 RIDGE VENT 1 i 8.1 GLASS-LOWE i.................................... ib 8,2 WOOD DOOR E 8.3 WOOD AND GLASS DOOR ............................................................. � 84 WOOD AND SCREEN DOOR 15 WOW WINDOW•DOUBLE H UNG 9.1 OD BOARD-518" ... .............._......................._....................� 9.8 WOW SMTRIP FLOORING - 9.10 WOW WALL PANEL-PAINTED LACQUER ... .............................................................� ---' . : i ! ....... ..........._........... .4 - - ......_,. -...............---- ---..3 I b ❑ E 6 Dae Issue i : .P BODELL RESIDENCE 1 6' � T.O.FIN FIRST R.001 n ....... f03 Geromlmu M02d5e5 iw mue T4.. ......................................®8 REED A.MORRISON ,.worm/ 'D ;a em o r. u, 5094268779 1� R •1 1 'P F d a At .2 5 1` WALL SECTIONS u� a y Date: Scale: 1024,04 3/4'=1'-0" O / 2 ,- OMILY ROOM --- © A8 , . r•, A.• \ ASSESSORS REF: ,-- ,. Neck A b s ' ` \\ Map 114, Parcel 3-2 CUS bto Is \ ° OVERLAY DISTRICT. \ \ a \ e e \ \ p AP - Aquifer Protection District ,...,• ' . ,s o r As Shown on Plan Entitled ° "Revised Groundwater Protection l� \�A\ Lce \\ °'. \\ araB Overlay Districts" - April, 1993 O 4 \FNDIN, as / io a A LOCATION MAP: \ °,�� o FLOOD ZONE. Scale: 1" = 2000'f Zone C Community Panel No. #250001 0018 D N 03 \ July 2, 1992 ZONE: c - / 23 \ ` r;o. \ Area (min.) 87,120 SF (RPOD) / \ Frontage (min) 20' Lawn �~�) � Width (min) 125' arc Setbacks: A f \ \) � / ` °� `o,� � Front 30. e c Sys ' Oo t \ \y Septl(approx. by card) \*\ I \ o� \ Rear 15' Bit5,3,3t2 \\I 23- ' y ` '�� 4 \\ LEGEND: Pgton 23t6 / / / / \\ `\ -4 Guy Wire 2y�2 `�ete ea°` 03 O Guy Pole A 25.8' � 2��2 .� \ �2� '°' \ Utility Pole Gas Gate � ; ` LceO Water Gate a / �g6 \ < \ � � Pea � tp� FWD O Land Court Bound Found 9Fck Z -acwhead Wires - Gas r Line (approx) 0 / /23 \ 1 a \ \ w - Water Line (approx) noo wow / \ / o6 2F / ' ' \ _ / pole \ ' \ �{ Deciduous Tree 2 °I� i LCB `r FND Lawn \ Tit t1v Lawn \ Coniferous Tree - #103 Ott \ I \ \ \ I \ 1 Sty w/f \ °s Dwelling / Slate tt \ \ / Patio \ o Lawn Lawn z LA • - � \� 2 Sty w// Garage 10 F.G.23.0 (� r Septic system F.G.22.0 (approx. by cord)ni in. \ ® \ \ \ \ 21.0 20.0 a� ti z2*t .11 j 1500 Gallon ° Top El. 21.0 0 0� 20.8 Septic Tank 20.6 a, �03o P�`Q Bol.El. 18.0 20.4 20.2 P .: 7.0 0� 2? / O� ,a6 9 Beddingas .o� q \ Bottom T.H.EI. 11.0 A �' 0 -+21 Per Title 5 - Nia N m own S No Groundwater 7 \\ o 00 DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Oao �- oP- .0o`�* Not to Scale "', Qq �g�t�� 2 O 0°7oJ`% \ o o p �� t0 as • rho• � i ��° Q O NOTES ' DESIGN DATA 1. Water Supply For This Lot is Municipal Waters ' oca 2.Lti m of Utilities Shown on This Plan Are A credo Guest House-2 Bedroom Approx. A t i P t 72 Ho urs Prior o n Excavation or s P No Kitchen At L y E ti F This ° Project The Contractor Shall Make The Required i d Daily Flow= 110 x 2 = 2 20 pd \ Four �_Compacted Fill �_ Notification to DIG SAFE-I-888-344-�233. , ea in Fabric Septic7ank:220 gpd x 200/o=4409pd Use o 1500 Gallon Septic Tank 3.The Contractor is Required to Secure Appropriate \0 5 i 6 N _ ~ Permits From Town Agencies For Construction 2 Z6 "E Poo Stone LEACHING AREA Defined by This Plan. 220 9Pd/0.74= 298 s.f.Required 4.Install Risers as Required to Within 12°of Finished Loathing 3/4"-11/2"DalN 3idewall =2(12�+25)2=14Bs.f. Grade. o_ i •t Chamber ' '�� i eel 01096) N washed Bottom Area=12 x25 = 300s.f. 5.All Structures Buried Four Feet (4)or More or I ♦-io I 448 s.f.Total Provided Subject to Vehicular tobe H-20 Loading. Ote Strc Doc #9 rke ' LEACHING CHAMBER DESIGN 6.Septic System to be Installed in Accordance With P�Iv d see L Id Mor 23 All Pipes to be Schedule 40. Use 2 310 CMR 15.00 Latest Revision And The Town of ina{e 0°"Ctf Ito CROSS SECTION OF CHAMBER 12 x 25 Washed Stone Field as Shown;504 Gal.Leaching Chambers Ina Barns able Board of Health Regulations. C �clally EIiM 22*" SITE PLAN tNOF''&s�y 7. All Pitying tobe Sch.40 PVC. � Pa � a NOT TO SCALE G 22�6 Scale I = 20 PETER I o� R1crR. �, NO. COVft3� � LH[UREUX N N34312 i / \ es tl/fGan=Ol / F s VA O T c •H. GL_�V. 23,O ' at f 542t8 t_OAM Edw°rd ct( C LGP.N MEDIUM SAND 12' - Notes/Revision: PREPARED FOR: PREPARED BY. Title: i NO GRouNDWATER { 13Y' �AXTERd-NYC -3z'd 1.) The property line information shown was Joseph J. Jr. & Jane L Bodell Sullivan Engineering, Inc. CapeSurav PROPOSED GUEST HOUSE r compiled from available record information. 103 Garrison Lane PO Box 659 7 Parker Road Osterville, MA 02655 Osterville MA 02655 103 GARRISON LANE o 2.) The topographic information was obtained Osterville MA 02655 OSTERVILLE , MASS. from an on the ground survey performed on (508)428-3344 (508)428-3115 fax (508) 420-3994 (508) 420-3995 fax r or between 11�JUL104 and 211JUL104. PSu11PEc�bol.com capesurvc�apecud.net 3.) The datum used is NGVD '29, a fixed mean 20 .0 10 20 40 80 Draft: MJ D Field: WHK/JPM ai sea level datum. s ' Comp.: Date: Scale: Comp.: WHK RRL August 26 , 2004 As Shown Review: PS Drawing # C626 1 oo Areek \\ ASSESSORS REF.. Pond . -= \ Map 114, Parcel 3-2 _ e a .e 0, o r ` \ \� � \ OVERLAY DISTRICT: \\ \\ AP - Aquifer Protection District 1`' i • .39 o f"'` " � As Shown on Plan Entitled z�-19 \ \ �'\ s \ "S "Revised Groundwater Protection \� � \\ ��"�� Overlay Districts" - April, 1993 •` uerlt iceFND ,b 22+6 ��\ ` ICI LOCATION MAP: \� v FLOOD ZONE: Scale: 1" = 2000'± Zone C Community Panel No. #250001 0018 D cV July 2, 1992 ZONE: RF-1 c — �2 \ \ �� \ Area (min.) 87,120 SF (RPOD) eo \ — — \\ \ \ Frontage (min) 20' Lawn r`` \ '� \ Width min) 125 Setbacks: Front 30' '� \ \ \ Septic system Side 15 c1 po \ (approx. by cord) I \ ' N�a,, \ _ \ \ \ Rear 15 h �Q B<<"'I'3�'�Z \� ` �23' _ `� '' \ i 4 \\ LEGEND: \ \ -0 Guy Wire I +2 6`e?o°r PPf°r 111.6 i -� °31.- \ 0 Guy Pole 2 \ 3 25.B' a°ncf 23�' �,.•.• '"" � �2 � \ \ Utility Pole } sm 2� Gas Gate Lce O Water Gate <�%� \\ F►vo 0 Land Overhead Court WiBoundWires Found \ x• °w Gas Line (approx) i ° \ \ — w — Water Line (approx) Flog - }- \ \\ / \ o 2 LCB // \ to VIo�R / Pole H. \ \ �a \ ° \ t{ Deciduous Tree N� � l Lawn Lawn \ \ Coniferous Tree 1 1 Sty w1f � ' \ \ \ W 04 \\ 65` \ / Dwelling �� \ Slote Patio 1 \ \ 0ECD \ Lown AIX Lawn � \ x \ \ 7- 2 Sty w/f r\ / Garag \ o r � i Septic System F°G.23.0 ® \ F.G.22.0 "` (oPProx. by card)n n n \ 0 0 / � / / � 01104 \ \ \ \ I yed \ 21.0 20.0 oa+ 1500 Gallon Top El. 21.0 -o °20.8 Septic Tank 20.6 a o pro c,:> Bot.EI. 18,0 :•c�.: r ,� 20.4 20.2 17.01 wJ� c Zy O� P,6 3 1r+9 \ Beddinga3 rNr 7� \ Bottom 1.H.E1. II'0 �'y e 7 -tZl \ Per Title 5 rT dawn No Groundwater moo.ate, o 0 DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM O. $ Z�O t� O ��P / / 1 0? o Q. ,��Gv ,m �- 4 ° Notto Scale eG�i�r r, D roo��./� 1 \ "0.-A t,O SIN' (i� / G A 0. 13 O p NOTES I. Water Supply For This Lot is Municipal Water to DESIGN DATA �G \ 2.Location of Utilities Shown on This Plan Are A rox. erode Guest House-2 Bedroom At Least 72 Hours Prior to Any Excavation FopThis y�h•`'� \ ' ' ' No Kitchen Project he Contractor Shall Make The Required Doily Flow= 110 x 2 = 220 pd \ m in Fabric ---comoeded Flu --r— �, Notifica'ion to DIG SAFE-I-888-344-7233. , Septic Tank 220 gpd x 200 Tank 440gpd 3.The Contractor is Re wired to Secure Appropriate .N ve"-1/2" Use a 1500 Gallon Septic Tank permits From Town Agencies For Construction 21O \ 26g'2 Pea Slane LEACHING AREA Defined+jyThis Plan. \ r+9 7 .1223re - _ - ;n 220 gpd/0.74 = 298 s.f.Required 4.Install Risers as Required to Within 12"of Finished \ z N Leaching SidewalI = 2(12*t25)2=148s.f. Grade. t 6) � ' 3/4"-1I/2"Doable , , ee 010g i N Chamber Washed Bottom Area=12 x25 = 300s.f. 5.All Structures Buried Four Feet(4)or More or �, tr 9 448 s.f. Total Provided Subject ioVehicular tobe H-20 Loading, o dte 5 C Doc ice Ile-a" I I LEACHING CHAMBER DESIGN 6.Septic System to be Installed in Accordance With `r' Prw ate see L. aId M 5623 All Pipes to be Schedule 40, Use 2 310 CMP 15.00 Latest Revision And The Town of ,, inat Donau Nt0 Barnstable Board of Health Regulations. 0,101 �1. � �1 OF CROSS SECTION OF CHAMBER ;509 Gal.Leaching Chambers Ina Tally 'NOT To SCALE 12 x 25 Washed Stone Field as Shown 7 All Pipiii3 f0be Sch.40 PVC. SITE E PLAN / / (Pate / ' ' �SHOFM,to_c PETER Its" Scale: 1 20 RICHARD yGa+ SULLIVAN R. Ni 33 LHEUREUX H CIVIL i i1t34312 Pv I nZpjes 9aF S� Go i L O a T•H . GL_w• 23.o � �ff�5 qt8 � i � �, su•gsoir_ _ � � _ C LGAN MF—r>JL1M BAND Notes/Revision: PREPARED FOR: PREPARED BY Title: NC) GRouNOWATER 1�Y' Ci�X'TERd-NYC CapeSurov 1.) The property line information shown was Joseph J. Jf & Jane L Boded Sullivan Engineering, Inc. compiled from available record information. PO Box 659 7 Parker Road PROPOSED GUEST HOUSE r 103 GQrriSon Lane Osterville, MA 02655 Osterville MA 02655 103 GARRISON LANE o 2.) The topographic information was obtained Osterville MA 02655 OSTERVILLE, MASS. from on on the ground survey performed on (508)428-3344 (508)428-3115 fox (508) 420-3994 (508) 420-3995 fox or between 11/JUL/04 and 21/JUL/04. PSuIIPECbol.com capesurveapecod.iiet 3.) The datum used is NGVD '29, a fixed mean 20 0 10 20 40 80 Draft: MJD Field: WHK/JPM N sea level datum. Comp.: Comp.: WHK/RRL Date: August 26 , 2�04 Scale: AS Shown Review: PS Drawing # C626 1 i