HomeMy WebLinkAbout0120 HOLLINGSWORTH ROAD - Health 1.20 HOLLINGWORTH R' iSTERVILLE
.r
o
c
.55
SU';aid u
Z
U
o �
-------- -- -= — ------a— a X. s
� ZW
2 jCITCHEN 1. I 7 ENTRY 1310 9D-0 1411
3 LIVINGA, OWING
I I
5. MUDROOM
5 LA�U��NDRY I I ,
7 NALFBATH I I
B .M-BEDROOM I I R x
BATH 6-0• b B_5. 11 �" N I ° x a=.
16; *_'CLOSET
—
q 1 GARAGE
' 12 DECY
13 PM, OOR I I ! ; s�,
� PWER
'�,'
7i�t I
2
3
-,�
I I !
i
15'-T _ 23'-W 7'-0' t
J LL 4s-V j 5T FL-60R PLAN-OPTIO,.-
S .
CALE:18".=1'Q° .
qN_1ST FLOOR PL8N O
SCALE:14&
C)
r
Q
I
- '`
1IlI
. D
i
AV_
TOWNW BARNST LE
LOCATION � v'4 SEWAGE #
VILLAGE ASSESSOR'S MAP&LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
s
LEACHING FACILITY: (type)
NO.OF BEDROOMS ig
,,--�� �,, ,, L --�
BUILDER OR OWNERP.IFI 42-T. AY Nf:
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 fe of lea fac' ty) Feet
Furnished by
a
�5 ' ?
t�
v �
_ o
057
Y
DATE: 6/14/99
PROPERTY ADDRESS:_______________________
120 Hollingworth Road
Osterville, Ma.
------------------------
t above date I Inspected the septic stem at the above address.
On he b e p p y
This system consists of the following: C�
1 . 1 -6X8 Cesspool
Based on my inspection, I certify the following conditions.
2 . This is not a title five septic system. .`
3 . This is a sewage system. That is 45-50 years old .
4 . The cesspool is presently dry .
5 . For any other use than seaonal the the sytem would
not function .
6. For year round useage on more than 12 weeks . I -;,would
rec ; that the system be upgraded to title give
septic system. SIGNATURE:2
Name:_,�L�_ Macomber Jr--______
Company: Jose.2h_P. Macomber—& Son , Inc .
Address: Box 66
Centerville , Ma . 02632-0066
Phone: 508-775-3338
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
,o
LH P. MACOMBER & SON, INC. ggTanks-Cesspools-Leachflelds IiEvvfQPumped & Installed
Town Sewer Connections JUL 1 3 1999x 66 Centerville, MA 02632-0066
775-3338 775-6412. 1VVNOFBft!,gj
E
f
COMMONWEALTH OF MAS SACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON MA 02108 (617) 292.5500
.RUDY COX
SK.eca.
ARGEO PAUL CELLUCCI DAVrD B. STRU,
Governor
SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM
PART A
CERTIFICATION
Property Ad&"4:1 20 Hollingsworth Road Name of Own,,john Leahy Jr.
Osterville Ad&&"of Owrw:Box 249
Data of lnspection: G �1 Derry, N.H. 03038
Nartse of inspector: (Ptbaba r 4,9oseph P. M acomber Jr.
I am a DEP approved system inspector purauam to Section 15.340 of Title 6 (310 CMR 15.000)
Company Name: Joseph P. Macomber & Son, Inc.
l+bIg Addrass: Box 66, Cen vi Ile.,P, Ma _ 02632-0066
T ereprwrx Number:5 0 8-7 7 5-I I_�R
CERTIFICATION STATEMENT
I certify that I have personally Inspected the sewage disposal system at this address and that the Information reposed 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 tuncuon end
maintenance of on•site sews a disposal systems.
�T//��hee system:
Passes C2ce
Condidonally Passes
Needs Further Evalua on By the Local Approving Authority
Fails
CNOTESuAN,
$ignaPh
� 4 Date:
Inspell sub it a copy of this Inspection report to the Approving Authority (Board of Health or DEP)whhin thirty (30) days of
this Ir, . If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owns,
t the report to the appropriate regional office of the Department ot-Envitonmerual Protection. The original shouid be sent to Trsa
ner.and copies sent to the buyer, If applicable, and the approving authority.
D COh1MENTS
ase note that we have Rec ; That a new title five septic system
be installed at this location . Reasons .
1 . Age 45-50 years ols .
2 . Seasonal use only .
3 . 12 weeks .
4 . Not large enough for year round useage ..
5 . Cesspool is presentlt dry .
Has not been occupied .
i
revised 9/2/98 PaevlofII
�� Pmted on Rtc}cltd Pap.,
,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
PropertyAddre.ss: 120 Hollingsworth Road, Osterville
Owner: John Leahy Jr.
Data of Inspection: 6/1 4/9 9
INSPECTION SUMMARY: Check A, B, C, o/ A
A. SYSTEM PASSES: 6 F�
pp � '
j I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure
criteria not evaluated are Indicated below.
coMMENTslf house is to be used morn than 12 weeks a_year (Se220n]�
`i e s stem must be upgF$de a a }- ti _ t_ _ .
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.
Indicate'yes,l no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined', explain why not.
e, 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 exfiluation, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
Q� Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health).
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced .
Nv - The system required pumping-more than-four-dmes v yeardue to broken or obstructed pipe(s). The system VO4jesr-
Inspection if(with approval of the Board of Health): -
broken pipes) are replaced
obstruction is removed
i
revised 9/2/98 Page 2orii
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (oorrtirx,wd)
120 Hollingsworth Road, Osterville
°,, John Leah Jr.
j��� 6/14/99 Y
C. FURTXER EVALUATION IS REOUtRED By THE BOARD OF HEALTH:
AV, Condidons exist which require further evaluation byths Board of Health In order to determine If the system It falling to p(otrct Cho
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETFR1dINES IN ACCORDANCE WITH 310 CUR 16.303 (1)(b) THAT THE SYS
IS NOT IFUNCTIONIN0 IN A{.MANNER WHICH WILLPRt1IE.CT rriz PUBUC 8.EALrtiAND SAFM AND ME 0,CK 0NW. T.
..ci�[i Cesspool or privy Is within 60 feet of surface water
Cesspool or prlvy Is wlthln 60 foot of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WIU FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, tF ANY)DETt3WNES THAT THE SYS-M
RINCTIONINO IN A LUJ"ER THAT PROTECTS THE PUBUC HEALTH AND SAFETY AND THE ENVIRONMEXT:
The system has a septic tank and soil absorption system (SAS) and the SAS Is wlthln 100 feat of a surlace water svpat
vlbuury to a surface water supply.
The system has a sspdc tank and soil absorption system and the SAS is wlthln a Zone I of a public water supply weu.
The system has a saptic tank and soil absorption system and the SAS Is within 60 feet of a private water supply weu.
The system has a sapdc tank and soil absorption system and the SAS Is less than 100 feet but 60 feat or more from a
private water supply wall, urtlsss a will water •nalysla for collform bacteria and volatile org"c compounds ind;catei vu
wall Is frse hom poiluUon from that facility and the pre encs of tsmmortia rdtrogen and Mists Nvogen Is eQua1 to or lass
than 6 ppm. Method used to determine distance _ (app(ox)madon not valid).•
3) OTHER
•. y l L✓- 5 l> S
revised 9/2/98 Paee3of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
PropartyAddra": 120 Hollingsworth Road, Osterville
OWfl : John Leahy Jr.
Date of Irupecdon: 6/1 4/9 9
D. SYSTEM FAILS:
You must Indicate either 'Yes' or 'No' to each of the following:
_ I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this
determinatlon Is Idendfied below. The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
Backup o4eewage into 10ci9"r••v"tem component•duerto an overloaded orcbgged•SAS-or•c ass pool.
Discharge or ponding of effluant 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.
J/ Liquid depth in cesspool Is less than 6' below Invert or available volume is less than 11.2 day flow.
Required pumping more th 4 times In the last year NOT due to clogged or obstructed pipets).
Number of times pumped�.
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy Is•within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply wall.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, anach copy of well water analysis for
coliform bacteria, volatile organic-compounds, ammonia nitrogen and nitrate nitrogen.
E. LARGE SYSTEM FAILS:
You must indicate either 'Yes' or 'No' to each of the following:
The following criteria apply to large systems In addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
Yes No/
the system Is within 400 lest of a surface drinking water supply
_ the system•la-within 200 feat of a Hibutary to a ourfaoP�rK +g �t��u9f�Y ---
_ the system Is located In a nitrogen sensitive area(Interim Wellhead Protection Area -IWPA) or a mapped Zone II of a public
water supply well)
The owner or operator of any such system shall upgrade the system In accordance with 310 CMR 15.304(2). Please consult the local regional
office of the Department for further infor,lttauon.
revised 9/2/98 Paee4of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
PropertyAddre": 120 Hollingsworth, Road, Osterville
Owner: John Leahy Jr.
Date of Inspection:6/1 4/9 9
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes No
Pumping information was provided by the owner, occupant, or Board of Health.
None of the system-compoaants i awbaen puaMwd4ors4Jeast two weeks sni-tbe'rystem hasbeeca+eceitr+wgwssaal flow
rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
Inspection.
As built plans have been obtained and examined. Note If they are not available with N/A.
_ The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow.
_ The site was inspected for signs of breakout.
_ All system components„i4luding the Soil Absorption System, have been located on the site.
The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles
or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System orrthe site has been determined based on:
Existing information. For example, Plan at B.O.H.
_ 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)J
�- _ The facility owner.(and.�•psts,if diffaraW froat-.oucner).WW&prnW d.with infnrrnatioann ha p� imaintanaaaa.,Of
SubSurface Disposal Systems,
I
• r.
revised 9/2/98 Page 5of11
l
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
PropertyAd&"s: 120 Hollingsworth Road, Osterville
Owner: John Leahy Jr.
Date of Inspection: 6/1 4/9 9
FLOW CONDITIONS
RESIDENTIAL:
Design flow: fid g.p.d./bedro?T.
Number of bedrooms( sign): i Number of bedrooms(actual):
Total DESIGN flow
Number of current :1( ,�r �res dentsf1
Garbage grinder(yes or no):" ,�
Laundry(separates.ystem �9qZ
h
s or 4l' If yes, separatelrupection•re fired
Laundry system insecteor no) I = � �(�QQ�11'a.S -� = O�
Seasonal use(yes or no): J
Water meter readings,If av ilable (last two year's usage(gpd): I —I �� ��
Sump Pump(yes or no):
Last date of occupancy:*
COMMERCIALANDUSTRIAL:
Type of establishment: AM
Design flow: d ( B ed on 15.203)
Basis of design flow
Grease trap present: (yes or no
Industrial Waste Holding Tank present: (yes or no).A!0
Non-sanitary waste discharged to the Title 5 system: (yes or no),:P�7
Water meter readings,if av iI ble: A
Last date of occupancy:
OTHER:(Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of infor tion:
System pumped as part of inspection: (yes or no)
If yes, volume pumped: gallons
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)
I/A Technology a c. Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other Ale
APPROXIMATE AGE of all components, date instalrediif known)-and source of4aformation: �-
Sewage odors detected whemarriving at the site:(yes or no)
revised 9/2/98 Page 6of11
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
PropoMA""s: 120 Hollingsworth Road, Osterville
OWE: John Leahy Jr.
Date of Inspection: 6/1 4/9 9
BUILDwo SEWER:
(Locate on slts plan)
Depth below grade:
Material of cons u ti : cast Lon _•,40 PVC_other(explain)
Distance homrPriv to wets s p y well or suction line
Diameter. _ _,•
Comments:(condition of Joints, venting, evidence of leakage,-etc.)
s C x: e n
t .
(locate on site plan)
Depth below grader
Material of construction;gconc etMmata14Flberglass4j2Polysthylenoo Qothariaxplaln)
If tank Is Enetal, list age • Js,aga.conflrmad by Csrtsficats of Compliance (Yes/No)
Dimensions: 100
Sludge depth: —
Distance from top of slud a to bottom of outlet tee orbatfle:�
Scum thickness: z
Distance from top of scum to top of outlet tee or batfla:--Ak
Distance from bottom of scum to botto f outlet tea or batfl
How dimensions were datermined:
Comments:
(recommendation for pumping, condition of Inlet and outlet tans or•batfles, depth of liquid level In relation to outlet invert, svucturel-:ntepritY
evidence of leakage, etc.)
Septic tank is not Present
GREASE TRAP:
(locate on site plan)
Depth below rade:/ ,
Material of constructions o cret&matat��iberglasstaPoiyethylenoaolherlexplain)
Dimensions:
Scum thlcknass:
Distance from top of scum to top of outlet tea or batfls:,�
Distance from bottom of scyEm to bottom of outlet tee or botfle
Date of last pumping:2•
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.)
Grease
revised 9/2/98 Page 7ofll
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 120 Hollingsworth Road, Osterville
Owner: John Leahy Jr.
Date of Inspection: 6/1 4/9 9
TIGHT OR HOLDING TANK:A"Tank must be pumped prior to, or at time of, inspection)
(locate on site plan)
Depth below grade:.,
Material of construction-' concretj2metaLQWFiber9ias&4JAPolyethylene other(explain)
IVA
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm present
Alarm level: Alarm In working order:Yes/V,* No.Vf
Date of previous pumping:�1
Comments:
(condition of Inlet tee, condition of alarm and float switches, etc.)
Tight or holding tnnkc aro n6Lt—ppIzeseRt..
DISTRIBUTION BOX:II le,
(locate on site plan)
Depth of liquid level above outlet Invert:_
Comments:
(note if level and distribution is equal, evidenoe of solids carryover, evidence of leakage Into or out of box, etc.)
Distribution box is net nrpcpnt
PUMP CHAMBER:A�/eel
(locate on site plan) ,,�
Pumps in working order:(Yes or NO2/1K
Alarms in working order(Yes or No)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances,etc.)
ump Chamber is not present _
revised 9/2/98 Page 8ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
PTopemAddrass: 120 Hollingsworth road, Centerville
Owrw: John Leahy Jr.
Date of kupection` 6/1 4/9 9
SOIL ABSORPTION SYSTEM(SAS):_�I��/%<�/IG�!�l/
(locate on site plan, If possible; excavation not required,location may be approximated by non-Intrusive methods)
If not located, explain:
Type:
leaching pits, number:,,
leaching chambers,number:
leaching galleries, number:
leaching tranches,number, length:
leaching fields, number, dime Ions 0--
overflow cesspool,number:
Alternative system:
Name o1 Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.)
o signs ot hydrauiic
failure or pon ing , oil is dry . Vegetation is normal -
CESSPOOLS:_
(locate on site plan)
I
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 pumped as part of Inspection)
Did not plimp i of l nw Ce4ST^.00.1 �Drjr
Comments:
(note condition of soil, signs of hydraulic failure,level of ponding,condition of,vegetation, etc.)
Sala .as above -
PRIVY:6t/e—
(locate on site plan)
Materjals of constructi n: Dimensions:____J��_ .
Depth of solids:
Comments:
(note condition of soil, signs of hydraulic failure,revel of ponding, condition of vegetation;etc.)
rivy is not present .
revised 9/2/98 Pige9ofII
V SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continuod)
ProgoMAda &44: 120 Hollingsworth Road, Osterville
Dom^°' John Leahy Jr.
Dau orinapocd n: 6/1 4/9 9
� SKETCH OF SEWAGE DISPOSAL SYSTF.M:
include ties to at laast two p armanant relersnce landmarks or benchmarks
louts III walls within 100' (Locate whirs public water supply comas Into hours)
Centerville Osterville Marstons Mills
Water Company
428-6691
3 7
� I
/Ao y6 /I11163woRTfl RD. 05
revised 9/2/98 Pip 10ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 120 Hollingsworth road, Osterville
Owner: John Leahy Jr.
Data of Inspection: 6/1 4/9 9
NRCS Report name
Soil Type_
Typical depth to groundwater
USGS Date website visited
Observation Wells checked
Groundwater depth: Shallow Moderate Deep _
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to Groundwater Feet
Please indicate all the methods used to determine High Groundwater Elevation:
]0b,erved.Site
ained from Design Plans on record
(AMocal
property, bservation hole, basement sump etc.)
Determined fromnditions
Checked with local Board of health
Checked FEMA Maps
Checked pumping records
ZChecked local excavators,installers
Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed)
Used water contours map .
Gahr ty & Miller Model
12/1( qt�
revised 9/2/98 Page 11of11
`a•1�.a\T�nITRtT—\ll�/�Ilfa'/.1PITT.TJIRJ►I�f111rIT1fr/TIT'IaT/ATL1�1i\�a�'I'. .TT�T'r'�vT�—.. r—
I TURN OFBARNSTABLE UUARD OF HEALTH
'I � �-.Tn-.•..:''-'•t'n- UIISUI{FACR 9FWA(;E DISPOSAL SYSTEM INsiECTION FORM - PART D^- CEI{TI�FI^CATIUNr1 - I
-TYPE OR PAINT CLEARLY- 1
PROPERTY INSPECTED
STREET ADDRESS _ 120 Hollingsworthi Road, Osterville
ASSESSORS MAP, BLOCK AND PARCEL #
OWNER' s NAME John Leahy* Jr.
PART D - CERTIFICATION
NAME OF INSPECTOR Joseph P. Macomber, Jr.
COMPANY NAME Joseph P.-Macomber & Son, Inc.
COMPANY ADDRESS Box 66, Centerville, Ma. 02632-0066
street Town or City Scat• tlp
COMPANY TELEPHONE (508 )775 -3338 FAX ( 508 )790 -1578
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at
this address and that the information reported is true , accurate , and
complete as of the time of ,inspection . The inspection was performed and any
recommendations regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems .
Check one :
Systeui PASSED
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
he-R1t11 or the environment as defined in 310 CMR 15 , 303a Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form .
System FAILED#
The inspection which I have conatrcted has found that the system fails to
protect the public health and the environment in accordance with Title
5 , 310 CMR 15 . 303, and as specifically noted on PART C - FAILURE
CRITERIA of .this inspection form .
Inspector Signature Date
One copy of this certification must be provided to the OWNER, the BUYER
( where applicable ) and the DOARD OF IIEALI'll:
• If the inspection FAILED, the owner or"roperator eha11 up
grade eyatem
within one ,year of the date of the inspection , unless allowed or required
otherwise as provided in 3.10 CHR 16 . 306 .
partd . doc
Health Master Detail Page 1 of 1
.y
^tm
Logged In As: TOWN\health Health Master Detail Monday,December 1 2014
Application Center Parcel Lookup Selection Items
Parcel Septic Perc Well Fuel Tank
Parcel: 140-080 Location: 120 HOLLINGSWORTH ROAD,OSTERVILLE Owner: EFSTRATOUDAKIS,STEFANOS&ELEANORA P
Business name: Business phone:
Rental property: r Deed restricted: r Number of bedrooms : 0
Contaminant released F) Fuel storage tank permit: rl
{ — ,..,
ges .
I
Save Parcel Chan Return to Lookup I
Parcel Info Parcel ID: 140-080 Developer lot:LOT 10A BLOCK A
Location:120 HOLLINGSWORTH ROAD Primary frontage:85
Secondary road: Secondary frontage:
village:OSTERVILLE Fire district:C-O-MM
Town sewer exists at this address:No Road index:0726
Asbuilt Septic Scan: 140080_1 Interactive map: � 7 �
Town zone of contribution:AP(Aquifer Protection Overlay District) State zone of contribution:OUT
Owner Info Owner: EEFSTRATOUDAKIS, STEFANOS& ELEANORA Co-Owner.%VEITAS, RIMAS
Streetl:24 MANN STREET Street2:
City:HINGHAM State:MA Zip: 02043-1316
Country:
Deed date:7/8/1999 Deed reference:.1 23 94/1 8 5
Land Info Acres: 0.30 Use: Single Fam MDL-01 Zoning:RC Neighborhood: 0110
Topography: Road:
Utilities: Location:
Construction Info Building No Year Buil Gross Area Living Area Bedrooms Bathrooms
1 1951 1950 868 12 Bedroom 1 Full
Buildings value:$50,400.00 Extra features: $18,800.00 Land value: $280,100.00
http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=140080 12/1/2014
ul 2714 09:51 p p.1
Commonwealth of Massachusetts
U
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
120 Hollingsworth Road
Property Address
Eleanora Efstratoudakis
Owner Owner's Name
information is Osterville 'MA 02655 7-25-14
required for every
page. CityTrown 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:out
When A. General Information
filling out fops I q
; �jt10FIM
on the computer, (� `���..
use only the tab �;'
key to move your 1• Inspector. , o.. _
=� JAMES
cursor-do not James D.Sears g c
use the return key. Name of Inspector
CapewideEnterprises,LLC _ �.;J'F.,_
Company Name IN S
153 Commercial Street
Company Address -
Mashpee MA 02649
Cityfrown State Zip Code
508-477-8877 S1623
Telephone Number License Number
r.
B. Certification a
I certify that I have personally inspected the sewage disposal system at this address and tQ the p
information reported below is true, accurate and complete as of the time of the{Inspection.7De inscti 13
on
was performed based on my training and experience in the proper function and`maintenancof oi
e• ite
sewage disposal systems. I am a REP approved system inspector pursuant to SectionxI,5.348 f
Title 5(310 CMR 15.000).The system:
® Passes ❑ Conditionally Passes ❑ Falls
❑ Needs Further Evaluation by the Local Approving Authority
7-26-14
spe tol's Signature Date .
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, 'il applicable, and the approving authority_ ,
*""This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins•3113 Title 5 Official inspection Fw :Subsurface Sewage Dis?osal System•Page 1 or 17
y
Jul 2714 09:51 p p.2
a
Commonwealth of Massachusetts
I: Title 5 Official` Inspection Form
Subsurface S Sewage Disposal stem Form-Not for Voluntary Assessments
p Y
120 Hollingsworth Road
Property Address
Eleanora Efstratoudakis
Owner Owner's Name
information is
required for every Osterville MA 02655 7-25-14
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:
Tank covers should be raised for maint. pumping.
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 eAltration 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 Q ND (Explain below):
i
[Sins•3M3 Title 5 Official Inspection Form_Subsurface Sewage Disposal System-Page 2 of 17
Jul 2714 09:51 p p.3
Commonwealth of Massachusetts
Title 5 Official Inspection Form
f
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
120 Hollingsworth Road
Property Address
Eleanora Efstratoudakis
Owner Owners Name
information is Osterville MA 02655 7-25-14
required for every -
page. CitylTown State Zip Code Date of Inspection
S. 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 ❑ NO (Explain below):
❑ obstruction is removed. ❑ Y ❑ N ❑ NO(Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO (Explain below):
s
❑ 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 ❑ NO (Explain below):
❑ obstruction is removed ❑ Y ❑ N Q 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•2113 Title$Official Inspectlon Form:Subsurface Sewage Disposal System•Page 3 of 17
Jul 2714.09:52p p.4
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not#or Voluntary Assessments
120 Hollingsworth Road
Property Address
Eleanora Efstratoudakis
Owner Owners Name
require for
is Osterville MA 02655 7-25-14
required for every
page. Citylrown state Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health(and Public 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
❑ ® 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 ink is less than 6"below invert or available volume is less
than Y day flow/E4ellIN C
t5ms-3113 Title 5 Of icia'Inspection Forn[Subsurface Sewage Disposed System•Page 4 of 17
Jul 2714 09:52p p.5
Commonwealth of Massachusetts
Title 5 Official . Inspection Form
- Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
120 Hollingsworth Road
Property Address
Eleanora Efstratoudakis
Owner: Owner's Marne
information is Osterville MA 02655 7-25-14
required for every
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.]
❑ M 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
4 ❑ ® 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 r
❑ ❑ 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 7 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•3F13 Title 5 foal Inspeclior Form:Suhsurfaoe Sewage Disposal System•Page 5 of 17
Jul 2714 09:52p p.6
Commonwealth of Massachusetts
Title 5 Official. Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
120 Hollingsworth Road
Property Address
Eleanora Efstratoudakis
Owner Owners Name
informations
required for every Osterville MA 02655 7-25-14
page. Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or'now 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 back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ ® Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System JSAS)on the site has
been determined based on:
® ❑ Existing iinformation. For example; a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5))
D. System Information
Residential Flow Conditions.
Number of bedrooms(design): 4 Number of bedrooms (actual): NA
DESIGN flow based on 310 CMR 15203 (for example: 110 gpd x#of bedrooms). 440
15ins-3113 Title 5 Otflcdal Inspection F m. Subsurface Sewage Disposal System-Page 6 ct 1:
Jul 2714 09:53p p.7
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
120 Hollingsworth Road
Property Address
Eleanora Efstratoudakis
Owner Owner's Name
information is 0 terville MA 02655 '7-25-14
required for every
page. Citylrovm State Zip Code Date of Inspection
D. System Information
Description:
The system is a 1500 Gal.tank D.Box and three chambers'
0
Number of current residents:
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system?(Include laundry system inspection El Yes 0 No
information in this report.)
Laundry system inspected? ❑ Yes ® No
F
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage(gpd)): NA
Detail
No water usage-vacant since 2007.
Sump pump? ❑ Yes ® No
y Last date of occupancy: 2007Date
Commerciallindustrial Flow Conditions:
Type of Establishment:, -
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑' No
Water meter readings, if available:
15ins•3rl3 Title 5 Official Inspection Form:Subsurrece Sewage Disposal System•Page 7 of 17
Jul 2714 09:53p p.8
Commonwealth of Massachusetts
Title 5 Official; Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°( 120 Hollingsworth Road
Property Address
Eleanora Efstratoudakis
Owner Owner's Name
information is
required for every Ostetville MA 02655 7-25-14
page- Cityrrown 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: t 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)
❑ InnovativefAltemative 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):
i5ins•3113 Title 5 Official Inspection Fo-m:Subsurrace Sewage Disposl Systen•Page 8 or 17
Jul 2714 09:53p p.9
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
12D Hollingsworth Road
Property Address
Eleanora Efstratoudakis
Owner Owner's Name
information is required for every Osterville MA 02655 7-25-14
page. City/Town State Zip Code Dale of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
1999 Permit # 99-820.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 3'feet
Material of construction:
1
❑ 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: 28„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
Sludge depth:
t5lns.•3I73 Title 5 DtkWl Inspection Form:Subsurface Sewage Disposal System Page 9 OF 17
Jul 2714 09:54p p.10
Commonwealth of Massachusetts
Title 5 Official Inspection Form
-- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
120 Hollingsworth Road
Property Address
Eleanora Efstratoudakis
Owner Owner's Name
infoffnation is
required for every Osterville MA 02655 7-25-14
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank (cont_)
P
Distance from top of sludge to bottom of outlet tee or baffle
29"
0P
Scum thickness
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 1 S"
How were dimensions determined? Asbuilt-TapeSludge 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-.All water. Tank and covers at 28" below grade. In and outlet tee's. No
sign of leakage or over loading.
k.
Grease Trap(locate on site plan): .
Depth below grade: feet
f
Material of construction:
❑ concrete ❑ metal ❑fiberglass El '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
15ins-3113 Title 5 O ficiaf Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17
f
Jul 2714 09:54p p.11
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "
120 Hollingsworth Road
Property Address
Eleancra Efstratoudakis
Owner Owner's Name
information is
required for every 0ster41e MA 02655 7=25-14
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or,baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):,
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of:alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•3113 -n0o 5 Offidat Inspecllon Form:Subsurface Sewage Disposal System•Page 11 017
f
Jul 2714 09:54p p.12
Commonwealth of Massachusetts
Title 5 official Inspection Form
R' » Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
120 Hollingsworth Road
Property Address
Eleanora Efstratoudakis
Owner Owner's Name
information is required for every Osterville MA' 02655 7-25-14
page. Cityfrown 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'xW-38"`below grade. Box is clean and solid wlone line out. No sign of over
loading or solid cant'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:
Mns-3113 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
k
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
120 Hollingsworth Road
Property Address
Eleanora Efstratoudalris
Owner Owner's Name
Information is
required for every Osteryille MA 02655 7-25-14
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 3
❑ 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 three 500 Gal. dry.well chambers. Chambers and cover at 40"below grade.
Chambers are clean and dry. Clean walls and bottom
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 y
Indication of groundwater inflow ❑ Yes ❑ No
tSns•3113 Title 5 Orricel Inspectior Fo-m:Subsurface Sewage Disposal System•Page 13 Df 17
6•d d00:01 t,I•LZ In
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
120 Hollingsworth Road
Property Address
Eleanora Efstratoudakis
Owner Owner's Name
information is
required for every Osterville MA 02655 7-25-14
page. Cityrrown state Zip Code Date of Inspection
D. System Information (cost.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins-3/13 Tine 5 Official Inspecticn Form:Subsurface Sewage Disposal System•Page 14 of 17
Z.d d00:0l, t,l LZ Inr
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
'( 120 Hollingsworth Road
Property Address
Eleanora Efstratoudakis
Owner Owner's Name
information is
required for every Osterville _ MA 02655 7-25-14
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
3-J 47
I
9 01
�3
3-Ll-
❑ 0
.3
15Ins-3113 Title 5 O(Gcal Inspection Form:Subsurface Sewage Uis3osal System-Page 15 of 17
£'d d00:01 t76 LZ Inf
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
120 Hollingsworth Road
Property Address
Eleanora Efstratoudakis
Owner owners Name
information is required for every Osterville IMA 02655 7-25-14
page. CitylTown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
p
❑ Check cellar
❑ Shallow wells ,
No
Estimated depth to high round water: 11'
P . 9 9 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 propertylobservation 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:
Hand auger T.H. 11' below grade dry. Bottom of chambers at 6' below grade. Bottom of chamber's
at 5' above T.H. Depth.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3113 Title 5 Offidal inspection Fafm Subsurface Sewage Disposal System•Page 16 of 17
t, d dl•0:0I, bl•LZ Inf
1
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
120 Hollingsworth Road
Property Address
Eleanora Efstratoudakis
Owner - Owner's Name
information is
required for every Osterville MA 02655 7-25-14
page. Cityfrown 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 ) completed
Systems)
Y
® System Information— Estimated depth to high groundwater .
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
i
. .r
r "
t5ins•3113 Title 5 Offiial Inspection Form:Substuface Sewage Disposal System•Page 17 of 17
g•d d l,0:0l, V l, LZ Inf
TOWN OF BARNSTABLE
LOCATION.. l�a II :i c.� �` Ktr SEWAGE# 'o
VILLAGE� !� ASSESSOR'S MAP & LOT �-,� (/
INSTALLER'S NAME&PHONE NO._1�n !ti 4 a �L 5-- 07 I fZ
SEPTIC TANK CAPACITY __ �D ► _
LEACHING FACILITY: (type) (size)
( ) ✓�" ��-f' I S"'
NO.OF BEDROOMS ll
BUILDER OR OWNER G /1'S 12.t� f 6 G C/
PERMITDATE: , , �~' ! `7 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of eacl?ng Facility, Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) _ Feet
Ede of Wetland and Leaching Facility If any exist
8 Y we
within 300 feet of leaching facility) .Feet
Furnished by
Cl
8 �
yr.
T {
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01pplitation for Disposal *pstem Construction permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System k Individual Components
Location Address or Lot No.J'A Q L40Li.i&)y$(�;90rrE4 RD Owner's Name,Address,and Tel.No.
Map/Parcel I (� MIMMIU6' MmAS VavrAS
Assessor's Ma
P O20 dLq oso v �Cl S MPE
Installer's Name,Address,and Tel.No. 502-47 T Designer's Name,Address,and Tel.No.
a AipCw f tbE amw " L 04P J^
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of ealth. _
Signe Date
Application Approved by ' Date
Application Disapproved by Date
for the following reasons
Permit No. � Date Issued
a, f
j
No. r�v/✓ � Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION'-TOWWOF BARNSTABLE, MASSACHUSETTS , Yes
01ptlYitatiou for Disposal 6pstem Construction Permit _
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System Individual Components
Location Address or Lot No. I a o H OLLIo&$ mW Rb Owner's Name,Address,and Tel.No.
Vc As
Assessor'sMap/Parcel 1L40 ogo OS'�E�tXr , aq oevlEw Dk.- d0o4,&;tT MA t
Installer's Name,Address,and Tel.No. 502-47 7-12 17 ,Designer's Name,Address,and Tel.No.
CA,PGwo& P01SsS LLC,_ J
y 7 pe 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)
C o�N6►LT C.t�c.� I=Rcxc( �S� � T�1�
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 of ealth.
Signe Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit NO. � 5 O Date Issued
-- -- ------------------------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
C.) o (Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned( )by QAPC—1 t Jt n 6 &J-re djs&-s U—'e
at I;L U r4 0 LA j PCxS C oe_-t4 'Ab C)ST• has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.c,C/6_-;'El�iated a t f!
Installer C G /7 IQjs U4 Designer 1.1 A
#bedrooms Approved design flow gpd
The issuance of t is pe it shall not be construed as a guarantee that the system will ctt n designe 2
Date Z j Inspector V,
1 /
---------------------- ----------------------------------------------------------------------------------------- ----------------------
No. Dr-15_0L 9 Fee c)
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal 6pstem Construction Permit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( )
System located at (�U �f(7(,LIK,it s([) "t-{ (�yE� d.SZ.Ey_yt4G-
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 becompleted within three years of the date of this permit.
Date R/d �� / Approved by
No. �7 — rl Fee 5 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _�/
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Zipprication for ;igpogal *pgtem Congtruction Vermit
Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
ocation Address or Lot No. Owner's Name,Address and Tel_,No.
20Hollingsworth Rd . , Osterville Stefano E:fstfd'toud.akis
Assessor's Map/Parcel 1 ` 6 ✓ 0
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Wm. E . Robinson Septic Service
P 0 Box 1089, Centerville
Type of Building:
Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil S and.
Nature of Repairs or Alterations(Answer when applicable) New Title-5 septic system,
consisting of a tank, D-box and. 3 leach chambers with stone
all around.
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 ar f Health.
Signed A b 1, ' � Date
Application Approved by Date TDt.
Application Disapproved for the fo owing reasons
Permit No. — ao Date Issued
No. // — �':L� F..�,•. ,. Fee $50
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
. Y
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
0(pplication for �Dizpooal Opztem Construction Permit
Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Tftd A s or Lot No. s:; Owner's Name,Address and Te No.
o� ingsworth Rd.. , 'Osterville Stefano Efstrfttoud.akis
Assessor's Map/Parcel / 96 — Q p�
Installer's Name,Address,and Tel.No. o Designer's Name,Address and Tel.No.
Wm. E. Robinson Septic Service
P 0 Box 1089, Centerville
Type of Building: .;.
*; Dwelling, . ' No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
4,Other Type;of Building No.of Persons Showers( ) Cafeteria( )
!' Other Fixtures
1Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil Sand.
Nature of Repairs or Alterations(Answer when applicable) New Title-5 se p�is system,
consisting of a tank, D-box and. 3 leach chambers with stone
aii arou d.
Date lasQnspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
h 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 oarj&Health. 12
97 Signed . Date
Application Approved by Date 1
Application Disapproved for he fo owing reasons -
Permit No. s Date Issued
------------------------------------- - ---
THE COMMONWEALTH OF MASSACHUSETTS
' BARNSTABLE, MASSACHUSETTS
Efstratoud.akis
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(X )Upgraded( )
Abandoned( )by Wm. R. R n b i n-,`n`n S P..Dt 1'C S s ry]pc e
at 120 Hollingsworth Rd.. , Osterville has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. .Q a dated
Installer Wm. E. Robinson S r. Designer n
The issuance of this pe sal no be construed as a guarantee that the s fe � will function� desig '�dl/ „&LI
CJ c,
Date i Inspector ! ���`1'
sr
-----p�----------------------------------
No. O egi L o Fee$50 Y
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Efstratoudakis
Xi.5po.5af *pgtem Construction Permit
Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( )
Systemlocatedat 120 Hollingsworth Rd.. . Osterville
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit.
Date: j �. - 9,� Approved by !)6 s!)
r
u6/99
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only. t
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
I William E . Robinson,S,rhereby certify that the application for disposal works
construction permit signed by me dated �✓ concerning the
property located at 120 HollingsworthRd-. , Osterville. meets all ofthe
following criteria:
• Th failed system is connected to a residential dwelling only. There are no commercial or business
associated with the dwelling.
• soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch.
• Jere are no wetlands within 100 feet of the proposed septic system
• ere are no private wells within 150 feet of the proposed septic system
• ere is no increase in flow and/or change in use proposed
• Are are no variances requested or needed.
O The bottom of the proposed leaching facility will not be located less than five feet above the
maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor
method when applicable]
• If the S.A.S.will be located with 250 feet of any vegetated wetlands,..the bottom of the proposed
leaching facility will not be located less than fourteen()4)feet above the maximum adjusted
groundwater table elevation,
Please complete the following:
A) Top of Ground Surface Elevation(using G1S information)
B) G.W.Elevation +the MAX. High G.W. Adjustment.
DIFFERENCE BETWEEN A and B J
SIGNED : 1 � ��" DATE:
[Sketch proposed plan of system on back]. _
q:health folder:cert
1
Ell- � t
n� � l
FOUNDATION NOTES: ,
50'-6" -g
I. REFERENCE FIRST FLOOR ELEVATION SHALL BE
1„ ELEVATION O'-O OR AS NOTED ON THE PLAN.
'2. MINIMUM.BOTTOM IOF FOOTING ELEVATION SHALL BE -4'-0'
BELOW FINISH GRADE
S-4 r TEWN TG _ 5-2 3. ALL INTERIOR'WALL FOOTINGS SHALL BE,CENTERED UNDER WOOD
- - - - - - - - - - - - - - - -- - - - - - - - = - - = -.BEARING WALLS.
lily — — — — — — — — — 2 _ 4. SEE ARCHITECTURAL, ELECTRICAL, PLUMBING AND L'ANDSGAPING '
8 CONCRETE S-2 DRAWINGS FOR LOCATION5 AND ELEVATIONS OF FOUNDATION WALL
I I I FOUNDATION WALL I I OPENIN65. FOR FOOTING DETAIL AT PIPE SLEEVES,UTILITY SLEEVE
— — — — DETAIL AND UTILITY CHASE DETAIL, SEE TYPICAL DETAIL SHEETS.
O _ = L — — _ _ 5 GENERAL CONTRACTOR SHALL COORDINATE DEPTH OF ALL SLAB
SLOPE SLAB Ya PER FOOT I I O -
- DEPRESSIONS SHOWN ON PLANS
1
f 6 "` I ` In
I J I u) In b. FOR LOCATION AND EXTENT OF FOUNDATION INSULATION SEE
S_4 ARCHITECTURAL DRAWIN65.
1 I I Iml�r FOOTING I — — = — -
1-STEP FTG
DOWN ,
a
J
_
. • � PROVIDE 2'-O"(W I'-O" - _ • • -
- O 6'-0"' I i ADDITIONAL 2-#5 (T)•GONGRETE
MID HEIGHT OF
_1=00T1 NG
IO-0 I L WALL W/ CORNER
. • ;I BARS'- - - S-3 � .., 4' .u� -. � • -, '
— = - - - -- - - -.- - - - - - - - - - -
L, I r— — _ _
a
4 ml�r� ( I • � �
(T) CONCRETE '
r
2 _ -
O - FOOTING
6 6
r,
L - - - --- - - - - -
— � I J I - - - -:-- -:- - - - - - - ; _
• I I •_ • � - I :I SLAB CONSTRUCTION:" 4 `
4" CONCRETE SLAB ON:6RADE �.: V,"
TUBE / 2
= REINF. W/WWF &x&-W2AxW2.9 .. BIG F OT FTC.,
I., I ON 6 MIL. POLYETHYLENE VAPOR �'
BARRIER ON MIN. OF-5 COMPACTED = ® '
5TRUGTURAL• FILL
TOP OF SLAB EL. VARIES:
Rt
UT AL
. 34028
1l I .. r
22 -62 s, 7 -52 6'-6 �. - `
�rt Jo
54'-6"
,t
REV. 1 11/11/14
m� ^ SCALE DATE 5HEET PLAN NO. FOUNDATION PLAN 5HEET NO.
r. r El
� � / ` .. I/8" 10/51/14 1 OF I
engineers 120 �O�LING5WORTH ROAD —�
DRAWN BY GHKD BY APPD BY DISK REF NO.
-
[3.,wrte w w w OYSTERVILLE, MA
• WALL SHEATHING _ — WOOD STUD WALL WALL. SHEATHING WOOD STUD WALL
SEE PLAN SEE PLAN SEE PLAN SEE PLAN `
CONT. 2x12 FLOOR 5HEATHINCG 2-CONT. 2x12 FLOOR SHEATHING
RIM BOARD SEE PLAN RIM BOARD SEE PLAN
2x8 PRESSURE 2x8.PRESSURE
TREATED SILL TREATED SILL'
FSlk7.O.W. EL." FORTT-.O.W. EL.
SEE PLAN A SEE PLAN
2xIO FRAMING 2xIO FRAMING
SEE PLAN SEE PLAN
a
A x l'-O" ANCHOR Y2" D I A x l'-O" ANCHOR
- PLACED A MAXIUM °a ROD PLACED A. MAXIUM d 4 t
2" FROM PLATE END - OF"12"'FROM PLATE END -
INTERMEDIATE WITH I NTERMEDI ATE -�
T5 AT 2-0 O.C. TYP. BOLTS AT 2-O `O.C. TYP.
° PAPER JOINT ° . PAPER JOINT..°
SEE PLAN a '(TYP.) d e (TYP.)_SEE PLAN ,
a FOR SLAB a FOR SLAB
` d° EL. 4 REINF- . EL. 4 REINF.
, SEE PLAN: ' SEE PLAN
a d °: d _ _ -
2-#5.T4 B a d 2-#5 T4$ a." a.a -
.
Q a a Q
fi w . .. _
BOF EL. VARIES) SEE PLAN BOF EL.'VARIES SEE PLAN
SEE PLAN SEE PLAN
SECT 1 ON SECT 1 ON 2
5/4
sr-ALE
VNIT s�•r PLAN NO. SECTIONS 4 DETAILS s�NO.
V E I TA S I V E I Tn S 1,8• I0/3I/14 I o I
engineers PROP05ED.RE5I DENCE0
639 curate Street s„i1e 101 MAM BY °"K°BY A"V BY DISK REF NO. 120 HOLLINGSWORTH ROAD 5-2
Braintree—Ma'ssachux'tts02184 OYSTERVILLE, MA
,Iu.,('731)843 2863 FAX(78 BS49-2065 W W W
PROVIDE SQUASH - WOOD STUD WALL
JD WALL AT — BLOCKS AT ALL POSTS (oxbSEE f?T POST °- SEE PLAN
,ME LOCATIONS AND COLUMNS AND AT SEE PLAN
E PLAN THREE OR MORE JACK 24"XIO A LEDGER W/ FLOOR SHEATHING
OOR SHEATHING FOR DECKING 2-�":LAG SCREWS .
STUDS. SEE ARCH DWGS. p 2'-0" O.C. SEE PLAN
2-2X10 PT LET
INTO &x(6 POST I I
POST..BASE
FOR'TOP OF :: 2x8 PT JOISTS
FOR BEAM SIZE PIER EL. SEE
10 FRAMING-BEYOND SEE PLAN ARCH. DHSS 2xIO.FRAMING
E PLAN SEE PLAN
D I A•x 1'-O"'ANCHOR-
.LLY COLUMN GAP
- SEE PLAN ROD PLACED A MAXIUM
¢ OF 12 FROM PLATE END -
'.- WITH INTERMEDIATE,"
BOLTS AT 2'_0" O.G. TYP.
3
II
SONATUBE PIER.
I I - ,M
4 e d °
.t
,SEE PLAN
CONCRETE FILLED _
LALLY COLUMN
III SEE PLAN F
SEE PLAN
°; PAPER JOINT,
d: °
FOR SLAB Q' FOR SLAB
,I EL. REINF. °° EL. 4 REINF°.
SEE PLAN SEE 'PLAN
. . ,
2-#5 T$B b`d A °
' _ -
d
d — -
— d °
—1
3 4G CONT.
d -
i d
w
SEE PLAN BOF EL. VARIES SEE PLAN
lu tu
SEE PLAN ,
SECT I ON s -SECT I ON 4
v _ - s►�T NO.
GATE SHEET PLAN No. SECTIONS 6. DETAILS
scAl.e
VE I TA S I V E I va. 10MIA4 1�I _
engineers PROPOSED RE5IDENCEG G
DRAMsr a"Ka�r APPa BYalsic tx "°• 120 HOLLINGSWORTH ROAD 5—�
ti,i9 Gi ani-.JI 'i•t„SUife I(?1 ,
Braintree,Massac'hwwtt.l.1'_'1B4 OYSTERVILLE, MA
1'I:;L.(r3L!.943-2dt"i;i FA\1r80849-2065 W W W
WALL SHEATHING
SEE PLAN WOOD. STUD WALL
SEE PLAN' ti
2x8 PRESSURE ,
TREATED 51LL
A PLATE PAPER JOINT '
FOR T.O.W. EL. (TYP.) WOOD.STUD.WALL
SEE PLAN, "� BEYOND
'
FOR SLAB ,
42". DIA XI'-O" ANCHOR
ROD PLACEDrA MAXIUM rt 5EE .PLAN •, t PITCH
OF 11` r i-
KUM >LA I t END - ,. SLAB— ELOPE 51.�74Fs
1
WITH INTERMEDIATE
BOLTS,AT; 2-;oil O.G. .TYP. d 4
#4
12"o.G.
d
2 1oil x2-6
il
•z"
#
Q41,
2 S
. - -
Z
z a
tu ..
-
d a
� t W
r'
O 2-#5 T8B 2-#5IL
f
� .
,
.Q c *• p d
"F
f .
BOF EL. VARIES . EQ. PLAN EQs
PLAN; EQ.
SEE, PLAN: °
SEE ,PLAN SEE PLAN -
n
,
, j.
a � �T I ON s
SECTION_ _
t
5_4 3/4 a_ -I i 0��
,
n
�l
SCALE DATE SMMT PLAN NO. SECTIONS B DETAIL'S SHEET NO.
VE I Tn5 = VE I TnS .y
I/8' 10/31/14 I OF 1
engineers PROPOSED RESIDENGEG
Do-)c;r<mitr s <<t.suite 101 DRAW BY GNKD By APM BY DISK REF NO. 120 HOLL INC75NORTH ROAD 5-4
Ri aintme, 02181 'OYSTERVILLE,.MA
I.A..r751ls t,f 863 FAX us08-0 206,, w w w
ZONE: DEVELOPED LOT PROTECTION - DEMOLITION
Rc AND REBUILDING ON NON-CONFORMING LOTW �:
Area (min.) 87,120SF (RPOD) ,�
Fronts a (min) 20' (ZONING: SECTION 240-91) + k
Width min) 100
Setbacks: Allowed Proposed
Fron t 20' '
IBM El 34.2' MSL (approx) Side 10' Lot Coverage: 207• (2,585SF) 19, (2,549SF)
=
+ top of MN Rear 10' Floor Area Ratio: 307 (3,877SF) 29% (3,863SF)
2�z Story or 30'
h Building Height: i 2 Stories
2• � f nri u txO�23 a + a T a �� 6 ��5 ��,
R=34.3 /F s
.............. �-_ Location Map:
qnn M
<^?g36/ r
Qw /y) 1 2,OOOt'
0 C I P, 11.0'
o w
a� o / Sri posed S
Qo % e `� Pork ng ............................... x
Road, o ;. -,_,_,
`awn ASSESSORS REF.;
G Map 140, Parcel 080
CT Propos6d. OVERLAY DISTRICT.
2 sty W/F
z % /25.7'
�� 16.1' , / � � AP - Aquifer Protection District.
:..:House o � r
FF=36.8'(Some as a, re Into Q ; 4 FLOOD ZONE:
®' i o . �Ir Existing Septic 34,15
I "v o Original) �: System / / Zone X
M / Location as Per l l Map Number
( Lot 10A
W — Q TOB & Inspection) / 25001 C0752J
/ (/2925 sff) July 16, 2014.
34x
JC Lawn Pro
,dosed, .•./V � Legend:
r wok
Original House '/ c
J �a%!....................................... o o°i
To Be Demolished ........---
�/� � 34x8 � •/ + •
ter/ Ed98..°f•... ��(7Q/��
a
c p ry, f \ = Q N Deciduous Tree
1m o G
1 Z 0 O Stockode Fence—_ f ai Coniferous Tree
Qo . �` � � _ /f
Catch Basin
Water Gate (round)
Collin &
OHW— Overhead Wires
R bi°h F 4�2¢r7„ �\
ptlGHARD — 25— — Elevation Contour
22 K f p LHFUREUX ..........G.......... Underground Utility Line
596/319 a�thouser �I0. 34312
� Guy
0
GISS�A� Q,� Utility Pole
J -
r:
a.
She .t # Title: Prepared For: Notes/Revisions:
U. Plan Of Proposed Dwelling Capesury 1.) The property line information shown was
p g Scale: 1 =20 Vida Veitas compiled from available record information.
of t
At 120 Hollingsworth Road in 23 West Bay Rd, Suite G Date: 2.) The topographic information was obtained
Osterville MA 02655 20/NOV/14 from an on the ground survey performed on
Barnstable ( Osterville) Mass. (508)420-3994 (508)420-3995 fox Dw or between 11/AUG/14 and 12/AUG/14.
copesurv@capecod.net gC599_7G1 3.) The datum used is approx. mean sea. level.
1
r;
F- �
W 3
A301 WO °*4 S3` '
un
f V yy ''E..}Ta•'lHY' .
W
F- O
L) w Ce
11 1111111 1 MIz W ---1 O
T
1. BEDROOM 1 `r "'
2. BEDROOM 2 - -
L" N
3. BEDROOM 3 _
4. BATH 1
5. BATH 2 ,
6. OFFICE NOOK
1 I 1 Y
205
-'202
— -.a.z•.vv..nssac. ave+a:am..r.+sYrn-ea.-a: v`F.. _ ,
LJ
-1N ' 6�o 1D .
2
L? 201
II _
I
3 I ¢
I I °
I
f = — e
0
co — — ( N O o�
io I S I 3:
N w
15'-0„ - -C- 1 13-10 Q z JU
J
Q , J 00
o = 5 ' I I nano J
2 I O w
Co
y 209
N
It ogx\0�
— 212 , u
41'-0" 1 7-0 G0�
- C
48'-0" i
P
• z
J
I r O
A30, -i
ILL
Z
N
N .
2ND FLOOR PLAN
1 SCALE: 1/8"= 1'-0" O
0
r
Q
A301
w
z
O
cn v
50'-6" 3: Z:)
LINE OF OPTIONAL COVE CEILING z Z
o �
} O
a F—
t0, - - - - - - - - - - - - - t02 103 "" U W U
U Lu ce
1. ENTRY 23'-11" - "
2. KITCHEN I ILn
3. LIVINGCD
4. DINING s
o I - -' I� I o
b oa
5. MUDROOM I i I 11 ,(� ; 9 Ilf I 0 I I05
6. LAUNDRY I _
7. HALF BATH 8 I I
8. M. BEDROOM I I tt I II t " I I II I
9. M.BATH �-0-- — J6-10 8-6 -0 Fir
10. M.CLOSET -
I c
11. GARAGE
12. DECK I 7I II li 10 3'-7"
13. OUTDOOR I °° -- - - 5 -ti y m= 6 106
SHOWER
I 1 �104 1
El
- - e a - - - CV - 0� . .
i Ii w
-- 0 ww
El
2 I - - cn cnW
A3t 00 to — I '
z ZJ
~13 3 000
------- I rJ A O p}14 107
cfl „°I 4 -
IEEFz
I a
L - - - - ,os - - - - O
15'-0" 23'-0" 7'-0" LL
I-
48'-0" 61-611 cn
N
1ST FLOOR PLAN
SCALE: 1/8"=1'-0" O C
0
A301 t
z