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HomeMy WebLinkAbout0138 HOLLINGSWORTH ROAD - Health 138:H,ollingswortWRoa&- Osterville A ='140. 082 NO- ea- c " Commonwealth of Massachusetts Title 5 Official Inspection Form it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 138 Hollingsworth Rd Property Address Colleen Callen Owner Owner's Name AD information is required for every OsterVllle MA 02655 7-10-19 < page. City/Town State Zip Code Date of Inspection rAy 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. A. Inspector Information Shawn Mcelroy Name of Inspector '. Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that:l am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000);I have personally inspected the sewage disposal system at theproperty address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes , 3. ❑ Needs Further Evaluation Eby-the Local Approving Authority 4. ❑ Fails •7-10-19 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Ir Title 5 Official Inspection Form it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 138 Hollingsworth Rd Property Address Colleen Callen Owner Owner's Name information is required for every Osterville MA 02655 7-10-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: System is in good working order with no sign of failure. 2) System Conditionally Passes:. ❑ One or more system components as described in the "Co nditionalPass"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 exfrltration 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): t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 II Commonwealth of Massachusetts Title 5 Official, Inspection Form '. ,�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 138 Hollingsworth Rd Property Address , Colleen Callen Owner Owner's Name information is required for every Osterville MA 02655 7-10-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if 'pumps/alarms are repaired. ❑ 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 El ❑ ND (Explain below): ❑ obstruction is removed ❑ Y El ❑' 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 El ❑N ❑ ND (Explain below): ❑ obstruction is removed ❑Y ❑N ❑ ND (Explain below): • M1 3) 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.^ a. 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: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 r r Commonwealth of Massachusetts f Title 5 Official Inspection Form C�'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 138 Hollingsworth Rd Property Address Colleen Callen Owner Owner's Name information is required for every Osterville MA 02655 7-10-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts ,w,, Title 5 Official Inspection Form i-'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 138 Hollingsworth Rd Property Address Colleen Callen Owner Owner's Name information is required for every Osterville MA 02655 7-10-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes, NoEl . El or liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ` ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑, ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. , 5) 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. I ' For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts 3 Title 5 Official Inspection Form ''� i► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 138 Hollingsworth Rd Property Address Colleen Callen Owner Owner's Name information is required for every Osterville MA 02655 7-10-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The . owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Wasthe 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form } , A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 138 Hollingsworth Rd Property Address Colleen Callen Owner Owner's Name information is required for every Osterville MA 02655 7-10-19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: - Number of bedrooms (design): 3 Number.of bedrooms (actual): 3 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 5 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include(laundry system inspection El Yes ® No information in this report.) ' Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 7-2019 Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 18 e ti s Commonwealth of Massachusetts Title 5 Official Inspection Form w.� Coll Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 'Y 138 Hollingsworth Rd Property Address Colleen Callen Owner Owner's Name information is required for every Osterville MA 02655 7-10-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): canons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Owner----pumped 2018 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts 3 Title 5 Official Inspection Form 1.1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 138 Hollingsworth Rd Property Address Colleen Callen Owner Owner's Name information is required for every Osterville MA 02655 7-10-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: , ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator,under contract ❑ , Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2005 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 36"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.): Good condition. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts ' Title 5 Official Inspection. Form ,�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 138 Hollingsworth Rd Property Address Colleen Callen Owner Owner's Name information is(required for every Osterville MA 02655 7-10-19 ,page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 30"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape 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 is in good condition with baffles installed and no sign of leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Ii Title 5 Official Inspection Form N Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 138 Hollingsworth Rd Property Address Colleen Callen Owner Owner's Name information is required for every Osterville MA 02655 7-10-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts w., Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 138 Hollingsworth Rd Property Address Colleen Callen Owner Owner's Name information is required for every Osterville MA 02655 7-10-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) 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 9. 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.): Good condition with water at working level and no sign of back-up from chambers. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form N Subsurface Sewage Disposal System Form -Not for Voluntary Assessments } „n 138 Hollingsworth gsworth Rd Property Address Colleen Callen Owner Owner's Name information is required for every Osterville MA 02655 7-10-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 3-500's ❑ leaching galleries number: ❑ leaching trenches number, length: . ❑ leaching fields - number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 s Commonwealth of Massachusetts r� 3 Title 5 Official Inspection Form w' C�i Subsurface Sewage Disposal System Form Not for Voluntary Assessments 138 Hollingsworth Rd Property Address Colleen Callen Owner Owner's Name information is required for every Osterville MA 02655 7-10-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach chambers in good working order and empty at inspection with no visible stain line. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 I _- Commonwealth of Massachusetts r� Title 5 Official Inspection Form �� rill Subsurface Sewage Disposal System Form -Not for Voluntary Assessments W 138 Hollingsworth Rd Property Address Colleen Callen Owner Owner's Name information is required for every Osterville MA 02655 7-10-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, conditior of vegetation, etc.): 4 I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 s Commonwealth of Massachusetts Title 5 Official Inspection Form 'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,� 9 p Y rY 138 Hollingsworth Rd Property Address Colleen Callen Owner Owner's Name information is required for every Osteryille MA 02655 7-10-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 Yto Tb Tip r Yb r A . �Ft t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 c Commonwealth of Massachusetts 3 Title 5 Official Inspection Form irk Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 138 Hollingsworth Rd , Property Address Colleen Callen Owner Owner's Name information is required for every Osterville MA 02655 7-10-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells , Estimated depth to high ground water: 12' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database - explain: I i You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form �1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 138 Hollingsworth Rd • Property Address Colleen Callen Owner Owner's Name information is required for every Osterville MA 02655 7-10-19 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Ott* 339Z Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 138 HOLLINGSWORTH; Property Address SUSAN JENKINS FERRIMAN . Owner Owner's Name information is required for OSTERVILLE MA 4-5-14 every 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 filling out A. General Information forms on the ' computer, use only the k 1. Inspector: e tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. DOUGLAS A BROWN INC ' Company Name P.O. BOX 145 ,. Company Address ,CENTERVILLE '. t MA 02632 Coen -Cityrrown State Zip Code -508-420-4534 S14297 Telephone Number '' License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and thafthe 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 a ❑ Conditionally Passes ❑.Fails ❑ Needs Further Evaluation by the Local Approving Authority 4-5-14 Inspe s Sign re 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 1 0,000 gpd or greater, the inspector and the system owner shall submit the' report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the.buyer, if applicable, and the approving authority. ****This report only describes conditionsat the time of inspection and under the conditions of use at that time.This inspection doesrtnot�,addr.`ess,bb V-the system will perform_ in the future under the same or different conditions of use. ` y t5ins•3/13 Title 5 Official lr4J on orm:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments' �M 138 HOLLINGSWORTH Property Address SUSAN JENKINS FERRIMAN Owner Owner's Name information is required for OSTERVILLE MA 4-5-14 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) r Inspection Summary,Check'A,B,C,D or E/always complete all of Section,D ' A) System Passes: i ® 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: ' LEACH CHAMBERS WERE DRY AT TIME OF INSPECTION 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•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 17 x. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments : 138 HOLLINGSWORTH Property Address SUSAN JENKINS FERRIMAN . Owner Owner's Name information is ; required for OSTERVI LLE MA 4-5-14 every page. Cityrrown 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` ❑ Yi:.-❑ N ❑ iND (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•3113 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 138 HOLLINGSWORTH ` Property Address SUSAN JENKINS FERRIMAN ` Owner Owner's Name information is required for OSTERVILLE MA 4-5-14 every 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. ElThe 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 ay 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 El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded ❑ ® or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available vol ume is less El ® ' than '/z day flow t5ins•3/13 Title 5 Official Inspection Four:Subsurface Sewage Disposal System-,Page 4 of 17 r,. Commonwealth of Massachusetts k Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �< 138 HOLLINGSWORTH n Property Address SUSAN JENKINS FERRIMAN Owner Owner's Name information is required for OSTERVILLE MA ' 4-5-14 every page. CitylTown 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: ❑ Z 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. ❑ E 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. El ®. The system fails. I have determined that one or moreof 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 j the system is located in a nitrogen sensitive area(interim Wellhead Protection Area—IWPA) or a mapped Zone 11 of a public water supply well If you have answered "yes"to any question in Section E the 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. F Inc t5ins•3/13 Title 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 138 HOLLINGSWORTH - Property Address SUSAN JENKINS FERRIMAN Owner Owner's Name information is required for OSTERVILLE .' MA _ 4-5-14 • every 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 ❑ Z Were any of the system components pumped out inthe previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of ❑` ® this inspection? ® ❑' Were as built plans of the system obtained and examined? (If they were'not- available note as N/A) ® ❑ Was,the facility or dwelling inspected for signs of sewage 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, avid 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: r } Number of bedrooms(design): 3 , Number of bedrooms(actual): 3 330 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of•bedrooms):. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official. Inspection Form.._• j _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 138 HOLLINGSWORTH Property Address SUSAN JENKINS FERRIMAN Owner Owner's Name information is OSTERVILLE • MA 4-5-14,. . required for every page. City/Town State Zip Code Date of Inspection D. System Information Description: SYSTEM CONSISTS OF A 1500 GALLON TANK D-BOX AND 3 500 GALLON DRYWELLS Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ❑- No Is laundry on a separate sewage system? (Include laundry system inspection El •Yes ® No information in this report.) Laundry system inspected? x ❑ Yes ® No.-- Seasonal use?' ElYes ® No t SEE BELOW ,. Water meter readings, if available(last 2 years usage(gpd)): Detail -,.2013------208GPD 2012------189GPD THERE WAS A LAYER OF RED SCUM IN THE TOP OF THE TANK THAT LOOKED SIMILAR TO A GARBAGE,DISPOSAL,WE DID NOT ENTER THE HOUSE SO I COULD NOT VERIFY SYSTEM NOT DESIGNED FOR GARBAGE DISPOSAL Sump pump? ❑. Yes ❑ No Last date of occupancy: CURRENT Date 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.): F Grease trap presents El Yes El 'No Industrial waste•holding tank present? ❑"Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑' No t Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Forth;Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts �• Title 5 Official Inspection Form t.rc Subsurface Sewage Disposal System Form -Not for,VoluntaryAssessments 138 HOLLINGSWORTH t' Property Address SUSAN JENKINS FERRIMAN Owner Owners Name information is required for OSTERVILLE ' t �' MA 4-5-14 every page. Citylrown State' Zip Code Date of Inspection D. System Information cost. .: ' to '•k '•, �:' CURRENT Last date of occupancy/use Date r Other(describe below): k a f m: General information' e, Pumping Records: .source of information: 4�� , �M %� Was system pumped as part of the inspecfion? - �` ❑ Yes ® No If yes, volume-pumped- gallons. . . 4 How was quantity pumped determined? Reason for pumping r IZ Type of System: t ® Septic box, soil absorption system { A . ❑ Single cesspoolA' r .. tE ❑ Overflow cesspool ❑ Privy Shared system(yes or (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 4 =r* inspection of the I/A system by system operator under contract - � n .. - 9 ❑. ' . Tight tank. Attach a copy of the,DEP„approval. ❑ 'Other(describe): t5ins•3/13„ • Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page B of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 138 HOLLINGSWORTH Property Address SUSAN JENKINS FERRIMAN Owner Owner's Name information is required for OSTERVILLE MA 4-5-14 ' .� every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known) and source of:information: 2005 AS PER AS-BUILT, Were sewage odors detected when arriving at the site? ❑ Yes ® 'No Building Sewer(locate on site plan): Depth below grade: A .feet , Material of construction: ❑ cast iron« ❑'40 PVC '❑ other(explain): Distance from private water supply well'or suction line: feet Comments(on condition of joints,venting; evidence of leakage;_etc.): Septic Tank(locate on site plan): `' r 2.5 r e Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene El 'other(explain) If tank is metal,list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No ' 1500 PER AS-BUILT Dimensions: Sludge depth` MODERATE t5ins•3/13 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 138 HOLLINGSWORTH Property Address SUSAN JENKINS FERRIMAN Owner Owner's Name information is required for OSTERVILLE MA 4=5-14 every page. CityTrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) - 'Distance from top of sludge to bottom of outlet tee or baffle Scum thickness RED LAYER ABOUT 1"THICK Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? WOODEN POLE Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): , RECOMMEND PUMPING EVERT 2-3 YRS Grease Trap(locate on site plan): = Depth below grade: - feet Material of construction:- El concrete El-metal ❑fiberglass, ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle -Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 r — Commonwealth of Massachusetts r v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 138 HOLLINGSWORTH. Property Address { SUSAN JENKINS FERRIMAN Owner Owner's Name information is required for OSTERVILLE MA 4-5-14 ` every 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 El metal ❑ fiberglass ❑ polyethylene. ❑ other(explain): Dimensions: Capacity: gallons Design Flow: r 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 e p _ t5ins-3I13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 138 HOLLINGSWORTH Property Address SUSAN JENKINS FERRIMAN ' Owner Owner's Name information is required for OSTERVILLE MA 4-5-14 every 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 011 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.): BOX LEVEL NO LEAKAGE Pump Chamber(locate on site plan): a , Pumps in working order: ;, ❑ -Yes El No` Alarms in working order: ' ❑ Yes ❑ No* Comments(note condition'of pump chamber, condition'of pumps and appurtenances, etc:): f * 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: VIEWED BY CAMERA DRYWELLS WERE DRY AT TIME OF INSPECTION t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 138 HOLLINGSWORTH Property Address SUSAN JENKINS FERRIMAN Owner Owner's Name information is required for OSTERVILLE MA 4-5-14 - - every page. Citylrown State, ; Zip Code' Date of Inspection. D. System Information (cont.).- Type: r..,. i .J r .."- • ❑ leaching pits., number: ®y . leaching chambers numbei*: ❑, leaching galleries' , number: ❑ leaching trenches number, length:, ❑ leaching fields number, dimensions: overflow cesspool number. ❑ innovative/alternative system Type/name of technology: Comments(note condition ofzoil, signs of hydraulic failure, level of ponding, damp soil;condition of vegetation, etc.): DRYWELLS WERE DRY AT TIME OF INSPECTION i 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 , r Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts , Title 5 official Inspection Form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 138 HOLLINGSWORTH Property Address SUSAN JENKINS FERRIMAN ' Owner Owner's Name information is required for OSTERVILLE MA 4-5-14' - ' every page. Cityrrown 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.): • i • a f a t5ins r 3113 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 138 HOLLINGSWORTH Property Address - t SUSAN JENKINS FERRIMAN Owner Owners Name information is required for OSTERVILLE MA 4-5-14 _ . every page. City/Town State• Zip Code Date'of. Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system,including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately i t5ins•3/13 . 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 Assessments M 138 HOLLINGSWORTH Property Address SUSAN JENKINS FERRIMAN Owner Owners Name information is required for OSTERVILLE MA 4-5-14 every page. City/Town State Zip Code Date of inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells. Estimated depth to high ground water: AT LEAST 5 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: 4-2014 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: t ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you;established the high ground water elevation: . DESIGN PLAN Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official 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 138 HOLLINGSWORTH Property Address , SUSAN JENKINS FERRIMAN Owner Owner's Name information is required for OSTERVILLE MA 4-5-14 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A,`B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed. ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspecti5n Form:Subsurface Sewage Disposal System•Page 17 of 17 f , Assessing As-Built Cards Page 1 of 2 TOWN OF BARNSTABLE Ur u/Oq/u LOCATION SEWAGE# r i VILLAGE QjL1' U� ASSESSOR'S MAP&LOT. INSTALLER'S NAME&PHONE NO. kati1S47Kd See LJod(j D 4 SEPTIC TANK CAPACITY !S'a d LEACHING FACB.TTY:(type)T3� ,L"t (Size) -20 0 NO.OF BEDROOMS 3 / BURDER OR OWNER Qz' l tv PERMITDATE: D D ' 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 r within 300 feet of leaching facility) Feet Furnished by 4 V• V-•C.(N„a Q'Vic/hII�/ • • of a http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=140082&seq=1 4/8/2014 i 3 - No. 5 .'© S '` Fee �© �— ,. t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - y , PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pprtcation for W5pool *pgtem Conotruction Vermt Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 13 Owner's Name,Address and Tel.No. Assessor's Map/Parcel �S Installer's Name d�dress,an Te. o. Designer's Namee,�A)ddr and Tel.N1o. 444 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cieteria( ) Other Fixtures 1 Design.Flow 6a.e( r)0 gallons per day. Calculated daily flow -gallons. Plan Date Number of sheets �i Revision Date Title r P� Ot Size of Septic Tank , 5rU ---Tvme of S.A.S. Description of Soil Su 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 e 5 of the E vironmental Co nd not to place the system in operation until a Certifi- cate of Compliance has been iss is oard alth. Sig ed Date I`" Application Approved by Date 1,26 o Application Disapproved for the following reasons Permit No. -C�3 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS _ N � Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed (T-)-Repaired ( ) Upgraded( ) Abandoned( )by at `�i Q-r'`� has been construct in accordance with the provisio 9 o Title And the for Disposal System Construction Permi No..2m5 o 3-5 dated i _ Installer h Designer 4 The issuance of thi ermit shall not be construed as a guarantee that the s stem u tion as designed. Date �- ��Cc� �2 Inspector A. No. —Or3 5 q{ .. FeeVA A4 V THE COMMONWEALTH OF MAS°ii'ACHU- ETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Y s 01ppYication for IDig;p0al *pgtem Con0ruction Permit Application for a Permit to Construct( , )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 13� ' ( '��((f (1 Owner's Name,Address and Tel.No. GSA�V� I I -P Svc /� R�� j� ,;n T kt_ Assessor's Map/ParcelCf Yar4o A Installer's Nam,Address,and Tel.No. '"Designer's Name,Address and Tel.No. Type of Building: 1 v�/ Dwelling No.of Bedrooms Lot Size�sq.ft. Garbage Grinder(�,(j1 Other Type of Building I No.of Persons Showers( ) C` etena( ) Other Fixtures Design.Flow �U d rr1 gallons per day. Calculated daily flow gallons. Plan Date (4 U�1 '4Number of sheets � Revision Date Title �.P l 4J O C*4 Size of Septic Tank Ty e oA.S. Description of Soil �� r _ O A Q::tb C Led - r 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 rhle 5 of the E vironmental Code-and not to place the system in operation until a Certifi- cate of Compliance has been iss , by this 'oard o alth. l Sig a Date r. ok- Application Approved byl Date A Application Disapproved for the following reasons, Permit No. Date Issued —THE COMMONWEALTH OF MASSACHUSETTS — S g5 r BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ?*-)-Repaired ( )Upgraded( ) Abandoned( )by at has been cor_struct d in accordance with the provisio p ot iitle,5 and the for Disposal System Construction Permi No..2(�50 3 5 dated Installer 'AQ r,1 Designer � . The issuance of thi permit shall not be construed as a guarantee that the s stem fun tion as designed. Date TM 15/Q f2 1. Inspector �t D -y� No. S `035 ----�--------------------,_.. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS �Mpo.Zar *pgtem Con5truction Permit Permission is her granted to nstruct Repair( )Upad )Abandon( ) System located at 139 i nct g vac- V< d��4-r 1 ' V,) _ 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 datQby _�I�­�� hisDate: �<'S Approved -- `T�DWN OF BAJNSTLE. - SEWAGE /YLLA ASSESSOR INtie EIt'S NAM 3 P iONB I+tO. SBPT1fCAPIi CAt'�4C1'I" l�akc Nov CYMY::(�):.. *r BULDEE OR OWES 1BRZT3 .TE• (".C9Nt1�C.�41�iCE DAM ...:+. lAI1�e10Y1 II�iSEtiYfrrO$tstVlesn��: ,,,. :>. Msxlmucn -doWGrOUIR water Towel, the&foam 6f Le ing at:i(rt}+. PllvaSd'Ullpt4r Stiffly W @t d Lwohiuo.pacility Of anY�reils;oxtst aet s�t�ce w�ttpin?AO fiaat of t�actai��fst��}�y' ' Eden#.18f and lLaAc9tin$ ac Ifany`wet{�nd�ex�se ivttl in Poe Sat)d pf teagR1)of �Y 3�utalahed bywipe aI Back I 1 LOJ 2 �f U .5 —1— �o °• I3—!- 3,e TOWN OF BARNSTABLE tLOCATION %M SEWAGE # 'ILLAG ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONENO. ) a./ade&j ✓d 66& 1 q SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ��, ���wt%,//r (size) S� NO. OF BEDROOMS 3 BUILDER OR OWNER Oe'P - :e— PERMITDATE: D dS' COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility), Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet G Furnished by I L,�-- o'i'- 3 3 1: f TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE 1), Ile ASSESSOR'S MAP & LOT. ` INSTALLER'S NAME&PHONE NO. % Wd Sc� 'o &p SEPTIC TANK CAPACITY � � d LEACHING FACILITY: (type) —lam) Of L✓e s (size) -S7 C) NO. OF BEDROOMS 3n / BUILDER OR OWNER `tee_ � Q i°c-1 / & PERMTTDATE: 1170 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility), Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by } Town of Barnstable �OpfHE lob; Regulatory Services vrP O h Thomas F. Geiler,Director • enruvsiasre, • 9 Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 5087790-6304 Installer & Designer Certification Form Date: Designer: Installer: 0 Address: go 3o`k -" Address: 20 �«.�� �✓�ar L��e_.. —T . On ) t o was issued a permit to install.a (d te) (installer) septic system at 13 kle),'�k based on a design drawn by (ad ss) Fe, 00 fir L dated l Zat� (designer) X 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. 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. a VjH OF U48.0 a'M DAVID to-ler'sSignature) o B. LAJOIE v No. 1038 0 �FG/STERN AR igne e) (Affix Des•gner's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL B0T# THIS FORM' AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Desiper Certification Form FEL CO, ,NC. ENGINEERI G LAND SURVEYING 1 Namskaket Road N P.O. Box 1366 N Orleans, MA 02653 N Tel:508-255-8141 9 Fax:508-255-2954 N info@felcoengineering.com March 16, 2005 Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 Re: 138 Hollingsworth Road, Osterville Map#140, Parcel #82 Dear Board Members: { With reference to the FELCC Site and Sewage Plan #04137, prepared for the installation of a new septic system, the following was verified: X Installed system substantially meets design requirements for Title 5 310 CMR 15.000 and/or as approved by the Board of Health This Certificate of Compliance shall not constitute a statement that the system will function as designed nor shall it in any way limit the powers or responsibilities of the local approving authority or the Department to enforce any requirement, or to take any other action to protect public health, safety, welfare or theenvironment. ..Please,contact me if you have any questions. Sincerely, b � David B. Lajoie Registered Sanitarian DBL:cs DEEP OBSERVATION HOLE.LOG Hole# . .., Depth from . Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) .w Mottl'mg (S1ru re,Stones.Boulders, tency 5,�o el 30' l2Cw tn` pEEP'OBSERVATION HOLE LOG Hole'# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA)" (Munsell) Mottling (Struc re,Stones,Boulders. Consikeniny- ve to Y2 3/3 ;;:= nntD inn • r DEEP OBSERVATION HOLE LOG. Hole# Depth from Soil Horizon Soil Texture Soil Color Soil O Surface a (in.) (USDA) '' (Munsell) Mottling (Struct re.Stones,Boulders., Consig,tency. Gravel) DEEP OBSERVATION HOLE LOG Hole#------- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell)_ Mottling! (Struc Stones,.Boulders. Consnck %Gravel) it Flood Insurance Rate.Map: Above 500 yearflood boundary No_ Yes X— Within 500 year boundary No Yes Within ilt year flood boundary No X' Yes Depth of Naturally Occurring Pervious Material Does at least four-feet of naturally occurring pervious material exist in all areas observed+throughout the ' absorption system? area proposed for the soil -- If not,what is the depth of naturally occurring pervious material? Certification / .I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental.Protection and that the-above analysis was performed by the consistent with the required training,expertise expe 'ence described in 310 CMR 15.017. Y Signature Date 2� 7 O`f Q-\SBPnCTERCFORM.DOC 010 x Town of Barnstable P# Department.of Regulatory Services r • Public Health-Division a i Dater 6.1 � 200 Main Street.Hyannis MA 02601 lu, It 0 y Time /O :00 Fee Pd. 1 t)0-,.. " Date Scheduled � •_•,.._,_..----"" M atP Sdil Suitability Assessment for Sewage Disposal Performed By: Witnessed By: �= LOCATION.&GENERAL INFORMATION Location Address 3 Owner's.Name wort-rJ J E1Nk t�15 /. 8- ollliS wo 2-rH 35z�8 I..A A�22o Die rn A '°iddress G,V�%M C L • cA Engineer's Name �iJG Assessor's Mao,ar : /YQ/ F1'aZ g � NEW CONSTRUCTI N X REPAIR Telephone# Land Use ��1 Fj l'dl t. Slopes.(%) Surface Stones Distances from: Opdn Water Body 1 O+ ft Possible Wet Area 00 ft Drinking Water Well oo ft -F-Drainage Way 2 S ft Property line (O A Other ft SKETCH:(Strd t name,dimensions of lot,exact locations of test holes&pere trsts..locate wetlands in proximity to holes) Ste. Sty '`' * 0` 13'7 Parent material(georgic) 0&rrwA5ff' Pl h7rJ Depth to Bedrock �— Depth to Groundwate- Standing Water in Hole: Nb/J( Weeping from Pit Pace �o�� r Estimated Seasonal F gh Groundwater tot RNIINATION FOR SEASONAL HIGH WATER TABLE Method Used: In. De th to Soil mottles: !n• Depth 0 ed standing in obs.hole: p A. Depth to ping from side of.obs.hole: In. OrttundvJater Adjustment .factor..•....... Adj.Groundwater Level,.,, Index Well# Reading Dater Index Well level,,,.�........ Ad j PERCOLATION TEST Tim--- Observation Time at 9" Hole# Time at 6" Depth of Pere Stan Pre-soak lime _ _ Time(9"-6") — ------- End Pre-soak 21 f C�kt.S I$ M hl� Rate MinJlnch 2 MP► Site Suitability Assessment: Site Passed — _. Site Failed: Additional Testing Needed(YIN) Original: Public Hcailth Division Observation Hole Data To Be Completed on Back.-----=--- ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable.Conservation Division at least one(1)week prior to beginning- Q:\SEPT10PERCFC)RM.DOC Locus is �. f ► ,,. a (NO SCALE) f NOTES: FINAL GRADING AROUND DWELLING AND DRIVE TO DISTRIBUTION LINE TYP. BE DETERMINED BY OWNER AND BUILDER ON SITE. \ O VERIFY BUILDING HEIGHT AND PROPOSED FOUNDATION 1 ELEVATION WITH BUILDING DEPARTMENT PRIOR TO w/qN CONSTRUCTION. D-BOX \ NO y0 �r q N 2� NVF t O , lo LEACH CHAMBER TYP. OGOOc` 02 LOCUS 30 EXISTING ' O �0 i i DRIVE PCL. 81 S i 2.6' 1YP. 10 , a N 0z -Or 26• ' x142.29 x 30 __ , LEGEND x LEACH AREA DETAIL PROPOSE i x NO SCALE OR VE R, 12 —/ O EXISTING SEPTIC F" _ — _ PROPOSED , �� 30 — — — EXISTING CONTOUR 0: DWELLING BENCHMARK 0 --� _W 76 /r E�32 - DECK o TOP OF STAKE SET —e--s— PROPOSED CONTOUR 3 yy � j 0 \ N i EL. 29.9' MSLt WATER LINE �H � DtNE TINE � \` j � ��' LUNG N % \ C9 ;n -� TEST HOLE 0) TO BE O 2 ° 2j REP PCL. 91 LACED • ni. O o o SEPTIC TANK J O 1 En 41 PROPOSED TREE 0 1�-� / 1-L I # t (SEE DETAIL) LOT 11 A O = 11,086t S.F. (0.26t AC.) 10. 24. ED 14198 - 30 • PCL. 83 23' PCL. 90 f SITE & SEWAGE PLAN `� SH OF* MA J,pNIARESTi. �pZ. � DAVIDGm I No.36 a B `� I LOCUS: 138 HOLLINGSWORTH ROAD U OI cf' 1 I OSTERVILLE, MA IPREPARED �} FOR: REEF REALTY 4NITARIP •� 24 SCHOOL STREET P. 0. BOX 186 c /� INC. EST DENNIS, MA ALL. WELLS NOT SHOWN EXCEED. 20 FROM LOCUS SEWAGE. FL Ll�O, li t REFERENCE: ASSR'S MAP 140 PARCEL 82 VERIFY ZONING AND UTILITY SETBACK DIMENSIONS PRIOR TO CONSTRUCTION. ENGINEERING - LAND SURVEYING THIS PLAN IS PREPARED FOR COMPLIANCE WITH 310 CMR 15:000 ONLY P.O.BOX 1 366 ORLEANS.. MA 02653 SCALE 1"=20' DATE : 1 1-19-2004 AND SHALL NOT BE USED FOR ANY OTHER PURPOSE. (508) 255 x 8141 (FAX) 255-2954 REVISIONS SHEET No. 1 OF 2 JOB No. 04137 EL. 32.0'ETOP OF l; FOUNDATION OUT FINAL SEPTIC TANK GRADE DESIGN LOADING H-10 •pa BOX LEACH CHAMBERS eL. 29.0' EL.29.9t FINAL . . DESIGN LOADING H-10 GRADE DESIGN LOADING H-10 ACCESS INSTALL GAS BAFFLE EL: 30't 17't PORT ® OUTLET TEE OF CCESS ACCESS DOUBLE WASHED t/STONE APOR T -+... IN PORT OUT IN :' QI1T 3/4' - t t/2"- - - IN DOUBLE WASHED STONE E1.2].75' EL 27.SO' O 000000000 - EL.27.37' EL.27.20' 2.0 OOOOOOOOO 1.500 GALLON EL.27.00' EFFECTIVE 000000000 DEPTH OOOOC70000 EL.23.25' - ''"• `'-_ - ALL INLETS EL.25.00' TOTAL EXTEND INLET TEE 10" (MIN) BELOW 8't 12't STONE LENGTH STONE �}tOF S FLOW LINE. y��• Sq WHEN SYSTEM IS DOSED OR SLOPE OF INLET - 30' , 0? y EXTEND OUTLET TEE BELOW FLOW, .LINE:,:, PIPE EXCEEDS 0.08'/FT INSTALL INLET TEE CUT-OFF SEE SEE DAVID DETAIL DETAIL B. � PER TITLE 5 31'0 'CMR 15.227 (6) ONE INCH ABOVE OUTLET INVERT. • �� �t PROVIDE 20" MANHOLES OVER CENTER OF INSTALL OUTLET LEVEL TWO FEET MINIMUM. No 0 8 TANK, INLET, AND OUTLET WITH READILY REMOVABLE IMPERMEABLE COVERS. PROVIDE A MINIMUM SUMP OF 6" BELOW OUTLET INVERT. p INSTALL ACCESS PORT OVER LEACH CHAMBERS INSTALL ACCESS PORT OVER INLET AND OUTLET INSTALL ACCESS PORT OVER "D" BOX W\PRECAST CONCRETE (OR EQUIV.) WATERTIGHT W/PRECAST CONCRETE (OR EQUIV.) WATERTIGHT W/PRECAST CONCRETE (OR EQUIV.) WATERTIGHT RISER WITHIN 6" (MIN) OF FINAL GRADE. N� RISER WITHIN 6" (MIN) OF FINAL GRADE. RISER WITHIN 6" (MIN) OF FINAL GRADE. SECTION VIEW - SEPTIC SYSTEM COMPONENTS ( N. T. S. ) DEEP OBSERVATION HOLE LOG GENERAL NOTES DESIGN CONSTRUCTION NOTES SOIL EVALUATOR: D. LAJOIE 1. ALL CONTRACTORS AND/OR INSTALLERS ARE RESPONSIBLE FOR. FLOW DETERMINATION BEDROOM DWELLING 1 EL 29.9' DATE: 1 1-9-2004 HEALTH DEPT. WITNESS: D. STANTON PROVIDING AND MAINTAINING A SAFE WORK AREA. • LOWEST 2. CONTRACTORS AND/OR INSTALLERS: VERIFY ALL UTILITY LOCATIONS GARBAGE GRINDER 0NO ❑YES DEPTH ELEVATION HORIZON TEXTURE STRUCTURE MOTTLING CONSISTENCE PRIOR TO CONSTRUCTION. FLOW RATE = 330 GAL/DAY 0.0' A LOAMY NO NO LOOSE 3. CONTRACTORS AND/OR INSTALLERS: VERIFY ALL WASTE LINE LOCATIONS 1.0' 28.9' SAND PRIOR TO CONSTRUCTION. SEPTIC TANK SIZING: 4. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH STATE SANITARY B LOAMY NO NO LOOSE CODE 310 CMR 15.000 AND TOWN BOARD OF HEALTH REQUIREMENTS. 330 x 2.0 = 660 GAL/DAY SAND 2.5' 27.4' 1 1 5. ELEVATION DATUM IS FROM U.S.G.S. QUAD. MAP. N.G.V.D. .USE: 1,500 GAL MEDIUM 6. MUNICIPAL WATER IS AVAILABLE QX YES M NO SAND I LEACHING FACILITY CALCULATIONS: C NO NO LOOSE . ANY ALTERATIONS TO DESIGN MUST;:BE APPROVED BY..FELCO;•-INC. AND,'-.. i,> i, ,, S/I F-•<:,t:� - *` TOWN BOARD OF HEALTH. PERCOLATION RATE IS < MIN/INCH a <2 CLASS P 8, ALL EXISTING SEWAGE TO BE PUMPED AND FILLED WITH CLEAN MEDIUM <2 MIN/ININ/IN SAND. SIDEWALL = 160 t0.0' 79.9' (S.F.) X - 0.74 340 GAL/DAY SOIL EVALUATOR: D. LAJOIE 9. SEPTIC TANKS, DOSING CHAMBERS, GREASE TRAPS, AND DISTRIBUTION BOTTOM = 300 2 EL. 29.9' DATE: 1 1-9-2004 HEALTH DEPT. WITNESS: D. STANTON BOXES SHALL BE INSTALLED WATERTIGHT. (S.F.) •DEPTH LOWEST HORIZON TEXTURE STRUCTURE MOTTLING CONSISTENCE 10. WHEN SEPTIC TANK, DOSING CHAMBERS, GREASE TRAPS, AND DISTRIBUTION ELEVATION BOXES ARE PLACED IN FILL, PROVIDE A LEVEL STABLE BASE WHICH HAS BEEN MECHANICALLY COMPACTED. VIRGIN GROUND WITH A 6" CRUSHED USE: 0.0' A LOAMY NO NO LOOSE STONE BASE IS OTHERWISE ADEQUATE. (3) 4.8' X 8.3' LEACH CHAMBERS SAND 1.0' 28.9' 11. GROUND COVER OVER SEPTIC SYSTEM COMPONENTS SHALL NOT EXCEED 36". W/ STONE AS SHOWN IN DETAIL B LOAMY NO NO LOOSE 12• WHEREVER SEWER LINES MUST CROSS WATER SUPPLY LINES, BOTH PIPES = 30' LONG .X 10' WIDE X 2' DEEP SAND SHALL BE CONSTRUCTED-OF CLASS 150 PRESSURE PIPE OR. EQUIV. AND 2.5' 27.4' SHALL BE PRESSURE TESTED TO ASSURE WATERTIGHTNESS. - MEDIUM SAND C NO NO LOOSE JOB No 04137 NAME REEF REALTY PERC RATE. 10.0' 19.9' <2 MIN/IN FELCO, INC. DATE : 11-19-2004 SHEET 2 OF 2 ENGINEERING - LAND SURVEYING REVISIONS WJ No. ��// Fee THE COMMONWEALTH OF MASSACHUSETTS Entere d in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplifation for Misposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) [:]Complete System ❑Individual Components Location Address or Lot No. 3z LCb Owner's Name,Address,and Tel.No. (qoi, n Assessor's Map/Parcel 0 5�1 e_r V('1-C - � v� Con n auq��� •� —�Z 3 Z Installer's Nr;�Zjdress,and Tel.No. Designe 's Name,Address,and Tel.No. 3+)3 Address,and n L50 9-9 7 7 5-3 A 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) /)a eGE- new 4- 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 issuedgiged oard H Ith. A Date Application Approved by P> Date Application Disapproved by Date for the following reasons Permit No. Date Issued -  - - - ------------- No. D - . ,' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplicatlon for Disposal *pstpm Construction Vprmit Application for a Permit to Construct( ) Repair Upgrade Upgrade( ) Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. 13 Z SCL bd C Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 054 e_(V d 1 f, '� � e✓� t�n�r7 �)h / r 3 _ C�3 , Installer's Name,Address,and Tel.No. Design er's Name,Address,and Tel.No. �-t Q ��«I✓Cc.�ior1 SD��Y77-0�53 ✓� � Type of Building: i 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 1 Plan Date Number of sheets Revision Date j i Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) On fl E'Gf n-ew 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 EnvironmentalCode and not to place the system in operation until a Certificate of Compliance has been issued b this Board of Hellth. ed Date °2 Application Approved by 4 Date Application Disapproved by Date for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS j BARNSTABLE,MASSACHUSETTS f \ Certificate of Compliance THIS IS TO CERTIFY,that t e On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by + �{ ►/ A at C("( !toy ;1 ) �C'�e has been cons accorciance with the provisio '"of Tile S and the for Disposal System Construction Permit No. ed „)Installer �'s�X ) ' Designer #bedrooms Approved design flow / gpd The issuance of this-permit shar-Nll not be construed as a guarantee that the system wil� ton as dggesiigned. r '� Date V I Inspector iAA � (��/ I I /4 i ~l No. / - Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS bis iosal *pstem Construction 'Vermit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( System located at 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:Constructio mus ,e co Meted within three years of the date of this permit. Date Approved by ! / I / r 1 r F Aso, NO c J1 i 10.3' o, 000 Ya 1 +� EXIST. DE 'y{q.� S /� � `��N S6 62 W.�" n CA U +�6 ,.. •ems ,;:.. . 3• •9� .�� 4f O F �R •�E ,i� � .L OS '>o 0�c Os �i C / Sr . ti OG�FO �q,,� •9S; �R �tisJ r' 6 � TOWN OF BARNSTABLE LOCATION 3 uAct c r SEWAGE# 01013 - /O;L VILLAGE OS-1 cru'. I 1 e- ASSESSOR'S MAP&PARCEL 14J0 $d!. INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1500 LEACHING FACILITY: (type) C Hams cr S (y (size) f a x Sl 2 X Z NO.OF BEDROOMS tirj' OWNER S . Cl o RRp,Uqb8 On PERMIT DATE: 3•Z 8-)3 COMPLIANCE DATE:Ty- 13 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private.Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility)" Feet :M FURNISHED BY jtn� A 31 ' IS AZ• Fron-1 A a A3. 33' a9'� r 84 3 No.20 13' �Z * Fee* THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: a✓ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIppYication for -Misposal *pstem Construction Permit Application for a Permit to Construct( ) Repair(,4 Upgrade(✓ Abandon( ) ❑Complete System ❑Individual Components Location Address or Lost No.l 32, SCUd�p% Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ��( J qQ �Q,1" S f`p Co7p_d �n�C�h�l� Installer's Name,Address,and Tel.No. esigner's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms S—S Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.rM-R-71 red) 5 (.1 gpd Design flow provided ��� /� gpd Plan Date IL/ 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 Health. Signed Date 3 q Application Approved by Date i Application Disapproved Date for the following reasons Permit No. 201 7:5 0 2- Date Issued 3�Z€��Z ?� No.Zo�� _ (�Z Fee computer: ; THE CCrIVII�AOIWEALTH OF MASSACHUSETTS Entered in com p Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,-MASSACHUSETTS ftplitatlou for -MIsposal 6pstetit 6netructlon Permit Application for a Permit to Construct( ) Repair(✓f Upgrade(✓j Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3Z ScWtitz Owner's Name,Address,and Tel.No. Assessor's Map/Parcel �W� he z.C0�7ncutg1?f019 �� � )`�0 -p' r l �P Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 7318 ieA6oVahon awn nee.,- /nI Type of Building: Dwelling No.of Bedrooms !S Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 6-A 6 gpd Design flow provided h �> gpd Plan Date jZ7 jZ Number of sheets RevisionfDate- r ' ` Title I Size of Septic Tank Type of S.A.S. r I. 'i 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 oPTitle 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 Health. x Signed Q Date Application Approved by U Date __:f Zo 1 Application Disapproved Date for the following reasons Permit No. `01'� !t�� Date Issued 3�ZV I Dt THE COMMONWEALTH OF MASSACHUSETTS - BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( [-f Upgraded(�f Abandoned( )by - ``i b ( L at 3 2_ 5[Ud( .3 t IC'z .or S-i e(N(��steen constructed in accordance with the provisions of Title 5 and the for Disposal'/System Construction Permit No."2b 13—/p 2 dated 312e/2--at:5 Installer L( Designer r V #bedrooms Approved design flow gpd The issuance of this permit it hall 6t be construed as a guarantee that the sy�eamw cti a e igned.Date j 15L 5 Inspe ---------------- _ ------ ------------ --- --- -------- -- --- -------- ---- -------_--- No. ZO('j — 10 Z _ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Misposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair( (�' Upgrade( V/ Abandon( ) System located at 3 2 S r I d(��'r ��()d 0 5 Lac:NI t I � iN J 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. Date 1z �, Approved by FROM :!down cape engineering inc FAX NO. :15083629880' Apr. 04 2013 03:40PM Pi .V I P Ili N.9.53 ru WAZB. a Ith Di i"I'M(i u 260,Nfitiu 591-oct,hp luni+,,MA.02601 0iffvA! '419-111,62-4644 ax: 508-740-6"M4 IMStaneir & DesiLner C'Ev Won.. Permit-4 -2013 Ae q.A "s- Cr AddreBs" A IEe Adr.brem. 011 was s ismi a cW snptiuxystom at IZ-. <j ou,-i df-sigu clrawii by ."t— deed. eT.) I utfAiiy fhgt the sends, syscau rcd`Lle.uc,�--:,d abovo was icisfRIleci Fmhitan-t ally ac.C.Urdiiig to dvsib, wsdcfi may. ar.Mur (,,hLiug(,,s smcb. as lateTal relocation ul Ilar box Ind/m.-self(lu Unk. Ge-lify that thn septic syAum Tdormucs.1 A-uvu wn ui_i8lalled wi.th rn ajor chang.j (i.c. Lr.Veat-j -LILM 10' lstr,.[ .I.-elorab ol ,Dflhe SAS or iny vz�-I-.al j rtjncaJJ.n n of any(()Mja)ILCvlt of thn Septic sy:ilcm)luot.La State w. T,O',Ltl RUgL11,3fl0JCIS, P1.81.1 CCVi9iOn Cl by(Icsigari:to lbLmv. DANIELA.. 0JAUN uj Sl 0 CAAL No'46502 IST A 't, -,P Leif,, T UF, PUBLIC OF (",()AVf,j,4T4CE •`NfUls) -NDT BY, 9�,STIVI iTNT.Uj, :PoOTH TRTS', FUR-A A.K.0 AS BUILT (7?,IU A.W R _BiR.'MK.AUY,'E 1PIMILYCITEALTHDIVIS10711. A MK 11011. 14,,m,­,t,',,TV­;-nip. (',-rH RrArui I"m r,)I W;04-14ir, l Town of Barnstable # Departitntent of Regulatory.Services r Public Health Division Date MAM ,r�D h1ti 200 Main Street,Hyannis MA 02601 ` Date'Scheduled // PimPd.- Soil # / a_i^ Fee ( OQ • Q Suitnbiiio AI ssessment f ar S e Dz,�p®,gal Performed By: . Witnessed By: LOCATION& GENERAL INFORMATION Location Address 3c C ('C�k, J // Ro Owner's Name Fly Address Assessor's Map/Parcel: yU ZZ /l Engineer's Name U p �- NEW CONSTRUCTION REPAIR Telephone# l�(���36 o- ca n Land Use: Slopes(%) CZ U Surface• Stones Distances from: Open Water Body R possible Wet Area --ft Drinking Water Well ft Drainage Way ft Property Line ft Other ------— ft SIMTCH:(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands fn proximity to holes) c• .� d, o ti. �75 2. '== M DAP ' Parent material(geologic) f/ e lj' Depth to Badmck Depth to Groundwater. Standing Water Weeping from Pit Nce "L , Estimated Seasonal High Groundwater DET ERMINA'I'ION FOR SEASONAL HlOH WATER TABLEMethod Used: Depth Observed standing in obs.hole: 41 j 14 la, Depth to soil mottles: jtt Dcpth to weeping from side of obs.hole: hi, Groundwater AdJustment Index Well# Reading Date: Index Well Ipval _ A dj.Act-or.,,,�.,_ �. Adj,Graundwaterl_evel t n V� ]PERCOLATION TEST batp'�/L `AIM Observation Hole# 1 Timo at 9" Depth of Pare �3 1 _ Time at 6" Start Pre-soak Time @ ,'0 U 10 f 2U Time(9" G") End Pro-soak Rate Min./Inch G Z G•Z% Zy 7 i�l�i( G.' ; I,�;v_, Site Suitability Assessment: Site Passed^ SitF Failed: Additional Testing Needed(YIN) original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation testis to be conducted within 100° of wetland,you must first notify the Barnstable Coxzsgvatiou Division at least one(1) week prior to beginning. Q:\S EPTIC\PERCPORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .SO Color Soil. Otlrer Surface(in.) (USDA) (Munsell) Mottling (Structure, Stones;Boulders, o i tc w.%'Oravel� a L1 _— /&yp`IF 120 h7o , y`r I)EEP OBSERVATION HOLE LOG Hole# 3 _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. _Consistency,%Gravel) 1�6 ]DEEP OBSERVATION BOLE LOG Hole�. [D.,pth from Soil Horizon Soil Texture Soil Color Soil Other uface(in.) (USDA) (Munsell) Mottilnv {Sr.nrsture,Stones,Bo dens. o 510trnry,%p e 10 C —IZU c 2, � �- ]DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color loll Other Surface(iri.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders, Qorlsi3topcy, —170 �' a Flood Insurance hate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes ' Within 100 year flood boundary No_ Yes LcrAl:or r:t-.:.ul;r Oc ur -g P--r-nmas 1.4alo -1 Does at least four feet of furally occurring pervious material exist in al I areas observed throughout the area"proposed for the-soil absorption system? _ If not, what is the depth of naturally occurring pervious matarial? Certification I certify that on (date)7 have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in�10 CUR 15.017. Signature / Date &Z7 �Z Q:1S.LPTlC1T ERCF0RM.D0C r Assessing As-Built Cards Page 1 of 1 TOWN OF BARNSTABLE LOCATION 3S Sc uaAa(e r' PA SEWAGE#_c?o)3 -!D 2- VILLAGE ®s-t cr u, I I s. ASSESSOR'S MAP&PARCEL /NO-2a. INSTALLER'S NAME&PHONE NO. R 4,Q £xCoua4�0 n q77-DL-s3 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) C Agm_lh cc S w) (size) /3 x N Z X•Z NO.OF BEDROOMS S OWNER PERMIT DATE: 3•Z 8-)3 COMPLIANCE DATE: q• J3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility Of any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility Of any wetlands exist within 300 feet of leaching facility) ,t Feet FURNISHED BY 64-6 154'�yeif+vst 3 I • !S AV We, Front BZ• A 4 A3- Ay•SG's�� S34. n r4 3 i http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=140022&seq=1 2/4/2014 (^/ JgETTS y� V ! E u w �i r s m oaQoo�SE it W a � ��'w�y cn c = ty W J UA G M e - p tp f. -U �C9 R a 3 0o h • B"m z 4'O"gJonotubem/Pj gfoa+m 1 B y y S ' --F 4 poured LanLre+e Lolumnfao+mg - NOTe.All a%posed hwrwaro+a be rw+ed. wnd roimpsonm AP�Ulolo pos+base. For exter or.a%posure and PT LontwG+ �T of V 3 E I : p nl < Ora T.o.F B"far P�ilLom"G"bul head - - O O - - B"z] 1 O Pou d ancro+e faundwt on -�; u v %x 9'�x IIO/a APla+e walshers footing w/2 x 9 keyw y + U.1 ? �VI _ a. • f +.gw/2xq keyway. i u •� ) - - L - ------ -Cl- P mIp `` %N p uP - . _ _ . I �I %"PauredLonarete si b n I I -- ----- -- •q%1 0"rebar p ns dr lied n+a - Andcrenm 2 B 1] mil poly vapor ba -� j. - old founds+an and poured n+o new. .. - • - -1 %'x%'opening _/ - v - O v %19 1/2 Y rswLam® � I O �L LU � Q - /2 maiteeV Gowrete L • - - I'Lolumn w/lo xlo'x 1/2'bear;nq r� I I, -. -/ - - .. O • , - F W+es set on%O'x90xi S' 4'%" 'r w - / P ��� -I - �XIr�TING FOUNDATION - 11�i- O _ - P I poured LonLre+e foo+'nq(+yp.l 4' ` . • - _ ` - a. UP O r , r- -, 2"Poured LonLre+edus+Ldp .. - - w/G m palY�wpar barrio Adjust T.O.F'+a align / - - . I -- subfloar Ievefz. / ---------------- I 1 m /S'm ratecV Gowre+e 1 r! • - .r'� J 1_ • LoWm w/m'xto'x I/S'bearmq' r• i�--� _ n F I I PWtes set on%ro"x%!o'xI S foo+nq� �" 3 0 m I poly vapor L—r er " -75 J[0 B J I y o f tl o.2'- 1/q"z 1'-] 1/9" i' _ " / " „ U. V u Q,n c m 0 .I I 5 1/q"%9 I/2"ycrswLa I t T ' W 1 - 0 rRA4WL _ _ _ 1/4"Flare wwshers �, " A FOUN-ATION PLAN ' aZ"oLxand a'From sill plwte ends. � c A UH-iion Aspen+R-aYio(L/W)- I.OB - t - This plwn was designed n aLLordawe with / +he In+erns+,anal des don+al Gode 2009 - - edition and+hc 11wsz:.Lhuset+s]BO GI-r- 1.00 B+h Cdl+o Wooer S All)'4esuremen+a l Dime a+o be site ve Ifle b en s Gan+raLtar - d eral r G_ Y 3 J O X \ \N S wt time OF Lonz+rllG+lon ...Q Y m �0 ry gi`a @�02° m, s d lu U Kd`ddi1� DRAWING TYPE: Poun.W-ion Plan - SHEET NUMBER: - Eli NOre.All a%pond har wre}o be rested 1 w m n t o } �5E 1 a� for e%}error expos—and F'T Lon+ac+ �� of meson®LMaza LUh 2 B I!o" = m Use F—Ir p+ile Pes den+'ul Wood _ LLI N Peak GonstNG+'an Gu do OGACo-09 .. Z u 'o v W bwced an the 2 009 1n+ernatlanal - - Z z O> - o =esident al Gode,to bu Id deck. - Q Z O Pw♦♦,� 10 Q � ' ---- F.r.2% I O Peak Joists E 1!o"o.L. - - < " PI b aLinq 0 4 j -O" Floor brwcinq N 9'-O"a him %e.2�i C" 1 Ca"O.G. _I' psonm Tr I I I I for panel .Ir -_______, r ., 1/4"x 9 1/2 V —Lamm%1 00 2.Oe hofid blaLkingm E Q�Lt ^,t - - m -- m oiatfd blacking under dormer wwll - - 0 E � wL' + --- ---- ----- f w� himpsan®rTT%9.9 I!o"O.G. -_- ----_-_ III ♦- .m .. .. _ d 11 y I haled btoc "un kder dormer wall I '-, king qir� IL blacking z Ir __ O V vg Floor bracing m 4'-0"o.L. _ - .Floor liracmq a 4'-O"o.c. - CL - - , for panel LonneL}ions ,.: -. I : For panel Lonnettians - FLOOD FF-A"e - I �A�FI��T FLOOD F�AP'Tf- + Ilow - to LOU ndflwsh g Q oilmpcon H 2:5 hurrioane}ies e I!o"a.L. ., • ., _ - •C.O 'mn U 3 0 • r - .• hlmpson N 2.5 hurr Lane Ymc e I!o"n.L. # 0 _ \ � W O �- - I=oof br.wing o 4'O"o.L. 2I�L dder raF+ers e I fa L-: I _ - .i 2%IO�wf+ers®,Ito I( far panel Lonneet�ans - m .: _ -_� - d .. - . / " m o i .. oJlmpson H 2.1�,hurr cane om O a - u a I I I + me a 0impsona Lh-A 2 1 straps 6 I!o". ' I I I S a .I - I I II • mono vo @ .L c ohms 2.9 p on N N ties® 1!o"o L. I m I R I I himpson H 2.5 hurricane+iec e Z a Q a•� j I� + 1 + � 10 I� I�' 3 •. Jwn°-m'o�n N E @ n�f Kb`nLa.�J I 0 himn canm.�F- ol DRAWING TYPE: ' „r 2%!o Ladder rwfters®.1!o"o.L. ooF-IIon ect� Firs+Floor Frame plan one pa I� hecond Flaor Prame plan L.-. P-aaf Frame plan P-OOF FF-AI-la PLAN - - SHEET NUMBER: aocE a ^ �J�ETTS & °gnu°T o600aCEmo v i o'�'o''V C @ yyam,, W W_J!V yA. < o "�' 8��,°wog° Ur Y it O CO q•-9" �'-ci" B'-9" %'_1 1" d °°,`-'a`m Z U =�I` p T `o Lu 0 ' 00 zm - i5 zm Q o < 0 c Q O s h+ep E •{ �T h+ep o o 0X 0 E % Q -1O .,�• pnrio rJeak S S +i.LL oi L v L Move existing ou+door J' j + E v %shower+ohero 3 L; W Ol a N :r ' _ J N N x S of ei I/2"x 9 1/2"VersnLnm®Fender ° x\ W N 4 _ a .>ndersenm Nnrrohne 209l0 +hr Jac 9 3 both sides.e i N ® P n ' Henr-N 41ao h r - F Z - 's O.V Gns Fireplace p - .`. O m FAMILY P-OOM g a / w F S 2%'-O"X 1 I %" P a Anderseno Nnrrahne 204lo O LA Y/UTILITY 9'-41•X I 2'-0" S IJ- up P r. .. a . v/o x a/o n/o x m/m 0 I. oti v F:amra a]•i/O•• o ..: I o r�..e.• lu' ry 8 0 I'men P J ° O g Andcrsena'AW 2 1 a W m m m N 2'-O /eiB"z 2'-4 7 Z. o ,y li s Andersen®Nnrral ne 2 4' P�e;fJ(=00M•I var.a..m.bs.de�. a / 4' 1/9"9 1 19'-9"% 1 O'-O" Eo< 4- .r�+ m a f N f 0. //- - U V V m vw to s - c tuIL U °•- / m - remove exre#Vnq ou#side shower - � n° and relocn+e#o break of house FLOOP-PLAN . r / � Neale: 1/4••_ 1._O.. 9 4•i oJ.Pt.Hnbltnl hpnae Add4tlon hq.F+.Hnb4+nl hpnee �- O, Addition Aspect R-ratio<L/W 1• I.OB _ -� �� P s s�_ m This pinn was designed in nccordnnce with o v nnd+ the In+ernntlonnl den+i91 Gode 2 009 <a ," u P Cdi#ion he M�asnehuse+ts BO GMT - ><°•,'c m '° _ LL � c - � Q ` Window ro+ection+a conform wi+h 1^o °=3° c Z Z m I.2.1.2 Pro+ration of openings. ®��H�n m .use Proscriptive Fesiden+'uxl WoodoPeek Gonstrue+ion Guide OGAl-09 ..E oQbnsed an the 2 00 ai#a buildsQ Q i Noteo` All Mesuremnta}pt-lops rare to be site verified by General Gontrnetor rat+ime of conatructlon 1 V-4 7/4" b B'-7 1/4" - 9'-!0• OS eimoke veteetor R-eyuired DRAWING TYPE: First Floor Plan SHEET NUMBER: A200 - v Oc@u �`000a�eO o y S m w Z �ucs2� w W UJ•JINN W N J�'i fic Ot JEu Z 7 -`3n0`on�eU Z S u! 4 b J b /• P Q L P- "s � 0 v o o x v S zm E q E ♦ % c X d E .E tS u `�` nL < o v L ___ __ ______ ______ _____ _ __ _ ___ ______ _ (_ ----- ----- __.______- N N z L ---- W d -- — --- '-- ---- --- - -- -- ------ - 1 I O II II --------------- ---- ---- — 1'--- ---' -.. ----1 I s I. a Q _- - - I I i 11 Andersen®AW 2 1. -- _____-__i . 1 I I , v 5 C II f NW Q '' II ~ n / n Z p mK m Anderson®AW 2 1-%(4"Mull) �edroam•2 Andersen®AW 2 1-%(4"ryulh a �. •� p W tt`^ 3 1/2"x 2'-4 ]/B"n - I i • E ,-Izs m u v N y I .L - ----- r--- ---- ; 0. N E U ®m UJ O a c 0 mED o II O II d T T P_ d s h�q�hEGOtJI�FLOOD PLAN - ... z9 2 7 1 hq.F}."A'A'4I-P.a. f the In+ler e+ional R-es den+:I Gada 2 009 - `u V r u Q1 Cdl}lcn end+he 1-14ss4ohuaetts Qd ei 1.00 B+he-A+lon.4` Window Pro}ca+ian+o ao f with - %O I.2.I.2 Pro+ea}ion of openings. O n^�•` v S J\+ 6 All rtesuromen+s 1 plmenaions Ore to - _i 4'-O" 1 m'-O" 4'-0" be site�eriFled by 4enerwl Gan#rwc}or n � a Q � 1� 4+time of banstruction o m m e n u J)` u Q c 2 W 4'-O" O smoke pere.;r�r Feyuie—I a K ° d DRAWING TYPE: heaond Floor Plan SHEET NUMBER: AP00 N OO�cu3�aou �anoECJ ovvoo�;EUI n Z W.4 at.0 w ii W WJN W 7 -"moo �i L aca"o� oo� W Z = < OV r� O °yruoCc) e Gon}inuous ridge n+ .olmpsonm LhTA 2 1 straps e I lo"o.L. Architectural w.phal+shingles(}yp.) 1/2"GOX plywood shewthmq(typ.) 1 2"F.4.Insulw+ion 9 B 2 xB Fwf#ers e If,"O.L. Ice and water shield(typ.) 12 Proper ents e I!o"O.L. himpson H 2.9 hurricane+i..e 1!o"O.L. y, 2 xB Ge I,ng Joists e I CO"o.c Aluminum qu+}ers to drywalls q.. _ 1 x_PVG trim boards _ Gon+inuous 2/2 xB HewderS roim L�iTAI B s+ra Gantmuaus soffit van+(+yp.) - E Q / ullton s#uds(+ ) psonm ps p w I`1 rP. Gani-muoUs height plywood shear-wall panels "s .4- upoPan�nq`' d f II h h h h .de 7 .x#and onto raf+er blocking. .r 1/2 APA r.4 u- q seat , 9 YP I/2"APA rated"full height"sh.athmq(+yp.) .� woof-2-Wau ven} 3 E O 4 GJim LonneLtO e 1!p"'O.L. O� psonm 2.e,Wall.#uds e I lo"o.L.(typ.) p '�-LX 12 2 x 1 0 Fwf+ers a vent I.la'•O.L.'• 5I/2"NO.Insula#ion-�2fill 3 IL v 'Proper s e I!o o.c.Ins+wll rolmp.onm LhTA 1 B strap ,D,l` L +ies 6on-4,mq+he bo+tom wall plate and suds \9 liJ +hru+he subfloor to the solid blocking below '/4"APA rated+.<q.subfloor r�lmpson N 2.9 hurnLwne+,es e 1!e" Aluminum qu++ars 2."AJ�im 1 ri joists C9 1!o"o.L. v ' ....__. 1 x_PVG 4-rim boards _._ Gontmuous soffit PanYP}yp.) - O B"N.O.InsulaY�an 90 g es YP Tyv'ek-hou ewrw (t tu 2"APA rated"full-heigh+"sheathing(+yp.) Q O C 0 .........!. - 2 xeo Wall studs e 1 e",a.a.(4-yp.) m . n i m Z o0 Z IL2"H.O.In.ulation•P-2 1 J v a ..... .^ KI W Q N m .................... 9/4"APA ra+edt.Oq.subfloor ill ° p Z ��o� • -"" glued and nailed.. VI w N Z 9 I/2"AJhm2O joistse IG"o.c. Too 3n ......... 5/B"x l O"A P hor bolts w/ # N U o late wash... 4 .r�� m Q i a� f B"HD.In.UIw+i—•F-90 4 nd e"from sill plate ends. U V -) ai ei 1/4"x 9 I/2"VerswLamm _ �. < Z O• J m N „ - • 1 c, W 1O ,. _ - • - Tuff-N-Orym foundwtion—e Ier(+yp.) G_ LL LL U j v _ % I/Z"m�itsel/Goncre+e n- O Lolumn w/!o"z!o"x 1/2"bearing d plate set On 90"z 9 O"x 1 2" t B"x 7'-1 O"Poured Lonar.+e foundwtion set an 1!n"x I 2" pound concrete footing -- oz Lan+inuous Lancre+e footing w/2 x 4 key way. - 9"Poured Lancre+e slab w/F,bermeshm an CO d mil. ..... e -- --.--- poly vapor barrier. i OZ5 \h .1 m O COyt3p - t §t\ 6 t3UILpI1�C��EGTIoN„A„ o N r; 6 o TvmWooa z tn"s9, Gale: 1 /2 1 '-O" ve N E f W.0'_ dnL IL a DRAWING TYPE: 1'�Uildiny GJeG•I'ian l^ SHEET NUMBER: A400 11L s OpEc43R �� `oaoo o y / - Loom ° a W Lu J Lu two Uz- En Z � i� J • Q d b<3 mOoj°xn IZ W�P E d E E Lr I. J 3 4 I I I � / f��NORTH ELEVATION '�` O ram---------------- , r'- ` tu L---------------------_------------------------J LRAW ` �G�EAhT ELEVATION �O�// U J ry n •� Q W 3� 0•.�, FEEI 0 d vpa�� \p N • _ \S V moo mac 6` c �\ p d I I I I I I I I 1 nv�v mm,° '� c�3 d m I I I I I I - I I I Jl Z d � @ x c w c o`m J r d c a+ r________________� I _______________ I I I I I I 1 °I L-----------------------------J-________L__J I hOUTH ELEVATION �r7�WEhT ELEVATION DRAWING TYPE: 2 � GJLAI¢: I/4"• 1'-O" - � GJLAI¢: I/4"- f'-O" EIevA'I"IOns • e SHEET NLJM13ER: X - A500 SYSTEM PROFILE ALL SD WITH COMPONENTS SHALL BE MAR ALL MEANS FOR FUTURE LOCATION. NOTES t tie5 (NOT TO SCALE) es �p PROVIDE MIN. 20" DIAM WATERTIGHT ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE 1. DATUM IS APROX. NGVD \ TOP FOUND. EL. 37.5' FILTER FABRIC OVER STONE 2. MUNICIPAL WATER IS EXISTING cus 0 35.5' MINIMUM .75' OF COVER OVER PRECAST 2� SLOPE REQUIRED OVER SYSTEM 35.3' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. PRECAST H-10 PROP. TEE BLOCKS OR West a ' RISERS (TYP.) PRECAST RISERS 4. DESIGN LOADING FOR ALL PROPOSED PRECAST 2'o 4"0SCH40 PVC MORTA�a ALL H-10 UNITS TO BE AASHO H-1Q r PIPES LEVEL 1ST 2' 4' COMP(ENT(TYPS) 4, Lay \v NDS SIDES 32,3' 5. PIPE JOINTS TO BE MADE WATERTIGHT. \*34.0t' 10" 1500 GAL H-10 14p .1, ➢O rP049°.fO eP ,. ... .° . " f. .. '0000o0ooe ° ° ° 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE a ' 33.50' TEE SEPTIC TANK TEE ®®®® ®®® ®®®® -�®®® °o (PROP.) \33.25 0000�000°0 6" MIN SUMP >�:.. :.. ®®®®®®®®®� ®®®®®®®®®® WITH 310 CMR 15.000 (TITLE 5.) GAS BAFFLE::. °00000000000 0 ®®®®®®®®®!� ®®®®®®®®®® "000°oo°oo°o 12" MIN. INT. DIM. ° ° ° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND °o°o°o° 29.5' NOT TO BE USED FOR LOT LINE STAKING OR ANY 4' LIQ. LEVEL (ACME OR EQUAL) 31.85 31.68 ° ° ° ° OTHER PURPOSE. � 000000000000000000�000 00000°00000 00000°0°0 . f c ,o 0 0 0 ono 0 0 0 ' o 0 o „ `H-10 500 GA_. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. 8, PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. ,o,,o1o_�. n.o.n o 0 0 0 _ 3/4"-1-1/2 DOUBLE WASHED STONE 4 MIN. (4) UNITS REQUIRED ALL AROUND PRECAST STRUCTURES 9. COMPONENTS NOT TO BE BACKFlLLED,OR antucket 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 42, .X 12.83' SeovieW Ave COMPACTION. (15.221 [2]) CONCEALED WITHOUT INSPECTION BY BOARD OF Sound Ld HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. ( 4+ % SLOPE) ( 14 % SLOPE) ( 1 z SLOPE) 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP FOUNDATION 11 SEPTIC TANK 10' D' BOX 20' LEACHING 24.5' BOTTOM TH-4 CALLING DIGSAFE (1-888-344-7233) AND FACILITY VERIFYING THE LOCATION OF ALL UNDERGROUND & NOT TO SCALE *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL NO GROUNDWATER FOUND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS WORK. PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM ASSESSORS MAP 140 PARCEL 82 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED 5' BENEATH AND AROUND THE LOCUS IS WITHIN FEMA FLOOD ZONE "C" PROPOSED LEACHING FACILITY. TEST HOLE LOGS 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. ENGINEER: ARNE H. OJALA, PE, SE BENCHMARK: USE MAG NAIL AT EL. 36.1 WITNESS: D. DESMARAIS, RS 36.0 DATE: NOVEMBER 27, 2012 PERC. RATE _ < 2 MIN/INCH / I 13801 p�►� /x15,34 SYSTEM DESIGN: CLASS SOILS P# �R / 35.22 ELEV. ELEV. O� / GARBAGE DISPOSER IS NOT ALLOWED on DESIGN FLOW: 5 BEDROOMS ® 110 GPD 550 GPD A A x.3�3 34 - �.31 35.97 - / USE A 550 GPD DESIGN FLOW LS LS \ / b. 10YR 4/2 10YR 4/2 x 33.9 � )�` SEPTIC TANK: 550 GPD 2 = 1100 GAL. " B " B \ / / 1 'o- ,� 4 6 \/ 13.42 y ,1'�' $ 35.78 3•�.06 x, USE (1) H-10 1500 GAL. SEPTIC TANK LS LS / \ \ x�3q a h a LEACHING: x'S'2.78 �i TH \ �'�' �' � SIDES: 2 42 + 12.83 2 .74 = 162 GPD 10YR 5/6 10YR 5/6 x 36 1 36" 32.3 36" 32.0 !o. / TH 3 A 3fi 1� o BOTTOM 42 x 12.83 (.74) = 398 GPD yap* 35'' TOTAL: 756 S.F. 560 GPD C C 36.44 x 36. REMOVE EXISTING STRUCTURE IN USE (4) 500 GAL. H-10 LEACHING CHAMBERS (ACME OR EQUAL) ITS ENTIRETY. REMOVE/REPLACE WITH 4' STONE ALL AROUND MS MS fqp 45 EXISTING CONCRETE SLAB AND 36.65 67 FOUNDATION AS REQUIRED. (SEE PROPOSED BUILDING PLANS) 10YR 7/4 10YR 7/4 x 33.68 OO �� � .ss 37 x 06 622 EXIST. DWELL. FF EL 38.7' 120" 25.3' 120" 25.0' �j'Sz�35.56 `TOP FNDN. EL 37.5' 9i 3s.5s NO GROUNDWATER ENCOUNTERED PROP. 1500 GAL M '�• ,�CiG `! M A ELEV. ELEV. H-10 SEPTIC TANK 37.64 v 36.56 APPROVED DATE BOARD OF HEALTH x 37.30 o" 34.6' o" 34.5' x 34.20 A A 'S 3 .76 x 37.17 PROP. STAIRS TITLE 5 SITE PLAN LS LS ' s. -51 OF 4" 1 OYR 4/2 6" 1 OYR 4/2 � 3�\ REEZ BREEZEWAY 5s B B 95 WITH LANDING 32 SCUDDER ROAD OSTERVILLE LS LS x 36. 36" 10YR 5/6 10YR 5/6 REMOVE EXISTING STRUCTURE; Ss ` N-oFNJ 36" 31.5' OF M 31.6 FLOORS WITHIN PROPOSED) (2 7.70 GA��(E!AyGN qss� `;� PREPARED FOR x 06 l �r DANIE' G� $ oaA:A A. S. CONNAUGHTON n�a ,10. ('E� OJALA i02_ C C . � A No.ru`OI�C ERC INVERT INTO CP = EL. 34.6' LOTiAR�A x .91 ` ` .`�r EXISTING CESSPOOL(S): PUMP AND �^'� ���-i�,�,, `' � �c� o �' NOVEMBER 27, 2012 15,491±SF REMOVE O-2.'�- 12 off 508-362-4541 MS MS N Assgcy � s9c fox 508-362-9880 DANIRLA. o DANIEL yc I downcape.com �, 10YR 7/4 ,OYR 7/4 OJALA A.CIVIL OJALA down cape engineering, lac. o . 502 q No.40 x 6.27 civil engineers ,> ��GJSTE� � 'oF5� ��� Scale:1 = 20 ss� qN� y ,�o y land surveyors 120" 24.6' 120" 1 1 24.5' 939 Main Street ( Rte 6A) 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 NO GROUNDWATER ENCOUNTERED 12-286