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HomeMy WebLinkAbout0584 MAIN STREET (OST.) - Health ° '584 Main Street (Ost.) ,' :Osterville P ':'064 b ° c , TOWN OF BARNSTABLE LOCATION 5g SEWAGE# VILLAGE 0 ASSESSOR'S MAP&PARCEL 1 N I INSTALLER'S NAME&PHONE NO. ' i SEPTIC TANK CAPACITY /S 00 LEACHING FACILITY.(type) 3—So65 (size) 3 5 X \\� NO.OF BEDROOMS 3 OWNERatv�S �� .c�o�cw�, PERMIT DATE: 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 P 33-1 ;1 3A' 43-0 4 Li 3- ya- 5'f - co av No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zippricatiou for 3Disposal ,6pstem Construction Verutit 1 Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. L M/}//v S T Owner's Name,Address,and Tel.No. 0-7 4) Assessor's MapTarcel 144 31 Snr-A D 4..jE IZ I D G.E.- R-D D n V RoC /vt,A- 2-0 3 a Installer's Name,Address,and Tell N�. Designer's Name,Address,and Tel.No. -Con 5AUIC-7 Q/VJ ghLW�IVTV M N 4 1IVv E Iz(/V FAtrn av 7+ ro A- 4-4 S-t 2 ZS 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) of_3® gpd Design flow provided 3 ._- gpd Plan Date 12-4) .. Number of sheets 2.- Revision Date Title Sysm* 4 /W t4f_//L1 �7% O S T Size of Septic Tank �' � O Type of S.A.S. O iV C, blr,F -'r Description of Soil . cot As,,E �ti Nature of Repairs or Alterations(Arg t when'applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenancrto f the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environment place the system in operation until a Certificate of Compliance has been issued by this of Heal e Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Po r Date Issued tp 9 _ 17 i No. Fee TKE COPMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpIitation for Mispo'sal *pstem Construction Permit Application'for a Permit to Construct( ) Repair O UV rade(13 Abandon( ) ©Complete System ❑Individual Components - Location Address or Lot No. S M A I N S T v 1/ Owner's Name,Address,and Tel.No. (71 di) 913 -4 0 2$ bsTEek/,-tr- _ .yam`-. � 'rOw" 4- A4A•QySt0 rTFn/ Assessor's Map/Parcel ( 41 p , , 1 $,P'p p&_E 1? o V rrc set ro P_ to 3 a Installer's.Narie,Address,and Tel,.No! f �� Designer's Name,Address,and Tel.No. j2yN G`�'4�7 ETC t�/V `vf� FR,I-r"IV T+ G. Type of Building: f l Dwel-ing No.of Bedrooms Lot Size 1637(j sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) .. Other Fixtures Design Flow(rain.required) 1-3 O gpd, Design flow provided gpd 2 e Plan Date S Number of sheets Revision Date t Title SE10m e- Sy5m Im -5-84 /W/`,I n, s 7 . Cj% T Size of Septic Tank S� a Type of S.A.S. O A.•C �3 P Description of Soil l� ,_ Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenances of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental.,Code and oY to place the system in operation until a Certificate of Compliance has been issued by this Board o h. Signed ,✓ $' `"� y Date, .Application Approved by( � { Date Application Disapproved by Date for the following reasons Permit No. f Date Issued __ - ----- -------- - ---------- ---------- - --- - ------- ------------------ -- -- --- - -- -- --- ----------- - -- -- - _ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On Sewage Disposal system Constructed(� Repaired( ) Upgraded( ) Abandoned( by } .,at a7 / , $.;T (fie.- has been constructed in accordance with the provisions of Title p5 and the for Disposal System Construction Permit Noes Tdated 9Installer �'f A/ t` lJr1vST,�1�- r� Designer r19Z M� y r #bedrooms 3 Approved design flow _ and- The issuance of this permit shall not be co'strruue}d as a guarantee that the system will-func"t on as desi�gr�ied. Date 1 ,/ > I` / Inspector -: - 1- � 1-�--------- -- ----- ------------------ ------------ ---------- - ----- -------------- ---------- -- No -�G"i� . "�/_i�� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION;,BARNSTABLE,MASSACHUSETTS gyp. Misposal *pstrm Construction Permit Permission is herebyanted to Construct Repair Upgrade Abandon �' ( ) P ( ) P�' ( ) ( ) System located at and as describec in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the f)llowing local provisions or special conditions. Provided:Construction must be completed within three years of the date of this perfnit. Date Approved by� "`- -1 � i �� V � � � t . �. �"�.._ ., II Town of Barnstable Regulatory Services Richard V. Scali,Interim Director snxxsTnei.e. *" 9 M'S g Public Health Division Thomas McKean, Director .200 JMain Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: :9-oW-r7 Sewage Permit# 200- Zel"� Assessor's Map\Parcel Designer: FALVy ovTti CQ G1MC- ' Pubbstallem C6aS"�o&t3 ii./c. Address: r PCC)an ay. i'K) , Address: 99(,, 9r #xif 5v t;T-F_ Z o -,z> 9444 'f=ALVvLovTf , (YL On was issued a permit to install a (date) (installer) septic system at � IY1 11J ST�E�`r based on a design drawn by (address) ��lrtnnay l 1JCtP aerd — Z� J-7 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the IAA approval letters (if applicable) tN Of tijgs sy MICHAEL (Installers CIVIL Signature) 90I LLI m o vl 9 No,35054 IS T tAesign is St a (Affix Des p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION.' CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc Town of Barnstable P# Department of Regulatory services s r �wea Public Health Division Date Z5 MAM �a3f� 200 Main Street,Hyannis MA 02601 h 1 v ' "? 4� Date Scheduled Time Fee Pd. m M Sort Suitability Assessment for Se e Disposal Performed-BY: Witnessed By: LOCATION&.GENERAL INFORMATION Location Address.f ./� N S T, Owner's Nama�OM t 106 2t/ ®TrEAJ ®Sj 44Vfl•1•r_ Address c>VC_, •D/19A- D 0-X Assessor's Map/Parcel ` f6 I�RLp1OVTN €NG//uEX-41A,(a / �- Engineer' /me/IfF�e{, I3o/L S EGL,/ NEW CONSTRUCTION � REPAIR Telephone# et �� ? Land Use• Slopes(96) Surface Stones Distances firm: Open Water Body ft Possible Wet•Area ft Drinking Water Well ft Drainage Way i ft Property Line ft Other ft SIMTCH:(Street name,dimensions of lot,exact locations of test holes&Para tests,locate wetlands•t'n proximity, to holes) X •Y X .x JC A OF S4 `, 9 per' MICHAELJ. cti BORSELL'I cGn y� CIVIL -\ o p No.35054 /STEe�c���`' FFSS�ONA NG�� Parent material(geologic) Depth to Bedrockv Depth to Groundwater. Standing Water in Hole: 0 hJ 15— Weeping from Pit Face l7 N Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL'HIGH WATER TABLE . Mcthod Usod: WL P Depth Observed standing in ohs:hole: _ lu, Depth to soil mottles. Deilth to weeping from side of obs.hole: In, Groundwater Adjustment ft. Index Well-# Reading Date: Index Well)oval _,__„ Adj._fhotor- , T, Adj.Groundwater-1aval,,_ PERCOLATION TEST Date : Time Observation ' Hole# 1 Tlmn at 9" ' al ' Depth of Pero Time at 6" Start Pro-soak Time @ Time(9"•6") End Pro-soak ?vU I_r,!n. 4a GAtt..o v%�S Rate Mru./Inch Site Suitability Assessment: Slto Passed SitF Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back-- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(i)week prior to beginning. Q:\SEPTIMERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# _ Depth from Sall Horizon Soil Texture Sdil Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stoned;Boulders. o Islatency.%'Oravell 0 I J. N i..° r a' Gi sfw . I1 b DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sol]Color Soil they Surface(in.) (USDA) (Munaoll) Mottling (Structure,Stones,Boulders, DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Sall Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Structurc,•Sloncs,Boulders., Consistency,11 Gravel) AWE DEEP OBSERVATION HOLE LOG Hole# , Depth from Soil Horizon Sall Texture Sall Color 5011 Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Slopes;Boulders, i Flood Insurance Rate Map: Above 500 year Mood boundary No— Yes z , Within 500 year boy idary Nov, Yes Within 100 year flood boundary No.7 Yes y Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring ervious material? ___.�..� Cer'ti� Lt 9� ZN OF I certify that on�P + . t l (date)I have passed the soil evaluator examination approved by�h �P\ Mqs Department of Environmental Protection and that the above analysis was performed by me coral OHgt:L J sy�y the required traini ,expertise and experience described in�10 CUR 15.017. a BaR�sELLi m l IL A 9.No,35054 Signature Datt= o� 7 �o� ,, TEP`�a �; F^SS/0NAL ED1�\�� Q;W"EPT1C\PERCFORM.DOC Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments — 584 Main St Property Address fi CA Paul Hickey Owner Owners Name t•-+ information is Cr) required for every Osterville Ma 02655 8/1.5/2016 a page. Cityfrown State Zip Code Date of Inspection da .. t.Jt Inspection results must be submitted on this form.Inspection forms may not be altered iiftny way. Please see completeness checklist at the end of the form. Important:when A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. i S.M.Jones Title V Septic Inspection Company Name VILA r 74 Beldan Ln. Centerville f Ma 02632 .`541 Cltyrrown f State Zip Code 774-248-4850 _smjonestitle5@gmail.com SI.4522 w Telephone Number License Number I _ _ B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000).The system: ® Passes E Conditionally Passes ❑ Fails �. Needs Further Evaluation by the Local Approving Authority 8/15/2016 Inspector's Signature" Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board ` of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or z has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DER The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. "***This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. i t5ins•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 1-of 17 r. Commonwealth of Massachusetts -- Title 5 Official -inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 584 Main St yV Property Address - Paul Hickey Owner Owner's Name information is required for every Osterville Ma 02655 8/15/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary:.Check:A;B,C,D or E/always complete:all of Section D A) System_Passes: ® 1 have.not found any information which indicates that any of the failure criteria described in 310 CMR.15 303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are i indicated below. Comments: system consists of a block cesspool with a precast pit overflow. B) System Conditionally Passes: i. ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or.repaired.The system, upon completion of:the replacement or repair, as approved by the Board of Health, will pass. 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,$ replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurallysound, 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-3113 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments , 584 Main St Property Address Paul Hickey Owner Owner's Name information is Osterville Ma : 02655 8/15/2016 required for every page. City/Town -- State Zip Code Date of Inspection B. Certification (cont.) ❑ Pum Cha mber. amber pumps/alarms not,operational. Systerri 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 pipes)are replaced. ❑. Y ❑ N ❑ ND (Explain below)` :i removed, Y N. ND:(Explain below):. `p obstruction s e ed, 0 ❑ ❑ ( p ) ❑ distribution box is leveled or replaced . '❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if,(with approval of the Board of Health): ❑ broken pipe(s)are replaced ® Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) 'Further Evaluation is Required.by the Board of Health: ❑ Conditions exist which require.further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless_Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system.is not functioning in a manner which will protect public health,, safety and the environment: ❑ Cesspool or privy is:within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 15ins•3/13 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 584 Main St Property Address Paul Hickey Owner Owner's Name information is required for every. Osterville Ma 02655 8/15/2016 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. <System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has.a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. El The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. Q 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 io other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. -D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ;,,• ® Backup of sewage into facility or system component;due to overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due town overloaded or clogged SAS or cesspool ® Static liquid level in the distribution box above'outlet invert due to an overloaded or clogged SAS or cesspool ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins-3/13 Title 5 Official Inspection Fonrt Subsurface Sewage Disposal System Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Foy Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 584 Main St Property Address Paul Hickey Owner Owner's Name information is required for every Osterville Ma 02655 ' 8/15/2016 page. Cityrrown State Zip Code. Date of Inspection B. Certification (cone.) Yes ' No El ® Required pumping more than 4 times in the last year NOT due to clogged or t obstructed pipe(s). Number of times pumped: ❑ ®' Any portion of the SAS, cesspool or privy is below high groundwater elevation. ❑ 0. Any portion of cesspool or privy is within 1,00 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. Fj ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ® Any portion of a cesspool.or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy.of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility.with a design flow of 2000gpd- 10,000gpd. 0 ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the,Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpdto 15,000 gpd.' t For large systems, you must indicate either"yes" or."no"to each of the following, in addition to the questions in Section D. Yes No ❑ ' ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑- the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection ❑ ❑ Area.—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes°to any question;in Section E the system is considered a significant threat, "yes" filed.The owner or operator of an large large system has a Y 9 or answered yes. m Sectoon D above the g y p r system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3113 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System.-Page 5 of 11 , Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M . 584 Main St Property Address Paul Hickey Owner Owner's Name information is required for every Osterville Ma 02655 8/15/2016 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes. No ❑; Pumping information was provided by the owner, occupant, or Board of Health E ❑ ® 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 backup? ® ❑ Was the site inspected for signs of breakout? ® ❑f Were all system components, excluding the SAS,,located on site? S" ❑ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface Sewage disposal systems? The size and location of the Soil Absorption System(SAS)on.the site has been determined based on: ® `. ❑ Existing information. For example, a plan at the Board of Health. Determined in the field if any of.the failure criteria related to Part Cis at issue approximation of distance is unacceptable)[310 C,MR.15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): l DESIGN flow based on:310 CMR 15.203(for example: 110 gpd x#of bedrooms):- t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 584 Main St Property Address Paul Hickey Owner Owner's Name information is required for every Osterville Ma 02655 8/15/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ 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 current Last date of occupancy:p . Y _ Date . Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq:ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes El No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings,if available: t5ins.3/13 - - - Me 5 Official Inspection form:Subsurface Sewage Disposal System-Page 7 of 17 . b ' ' Commonwealth of Massachusetts Title 5 Official .Inspection Form 1-. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 584 Main St Property Address Paul Hickey Owner Owner's Name information is Osterville Ma 02655 8/15/2016 required for every page. Cityrrown State Zip Code Date of Inspection. D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): ,1 General`Information 3; Pumping Records: Source of information Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: _ gallons` How was quantity;pumped determined? Reason for pumping check for structural integrity of cesspool Type of System: El Septic tank, distribution box,,Soil absorption system El Single cesspool overflow"cesspool El Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) 0 ' 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): Block cesspool with precast pit overflow t5ins•3113 TNe5 Official Inspection Form:Subsurface Sewage Disposal System.•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official. Inspection Fo M Subsurface Sewage Disposal System Form-Not for Voluntary Assessments N • 584 Main St Property Address Paul Hickey Owner Owner's Name information is required for every Osterville Ma 02655 8/15/2016 page. City/town State Zip Code Date of Inspection D. System Information (cont.) ' Approximate age of all components,,date installed (ifknown) and source of information unknown Were sewage odors detected when arriving at the site? ❑ .yes ® No Building Sewer(locate on'site plan): 2 Depth below grade: . feet Material of construction: ' El cast iron Z 40 PVC ❑other(explain): Distance from private water,supply well or suction-:line: feet .Comments(on condition of joints, venting, evidence of leakage, etc.): Sewer line was replaced with sch 40 pvc, permit#2016-275 Septic Tank(locate on site plan) Depth below grade: Meet Material of construction: El concrete 0 metal ❑fiberglass 0 polyethylene ❑other(explain) i} If tank is metal, list age: years Is age confirmed by a,Certificate.of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 584 Main St Property Address Paul Hickey Owner Owner's Name information is required for every Osterville Ma 02655 8/1.5/2016 Pe. 9 City rroym State Zip Code Date of Inspection page. D. System Information,(cont.), Septic Tank(cunt.) Distance from top of sludge to bottom of outlet;tee or baffle 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 ` How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as.related to outlet invert, evidence of leakage, etc..) Grease Trap(locate on site plan): Depth below grade: feet Material of construction: El concrete ❑ metal El fiberglass ❑'poiyethylene Elother(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•3113 Title 5 6iNdai Inspection Fonn:"Subsurface Sewage Disposal system•Page 10 of 17 - - Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments' 584 Main St Property Address Paul Hickey Owner Owners Name information is required for every Osteryille Ma 02655 8/15/2016 page. City/Town - State Zip code Date of Inspection D. System Information (cont.) . Comments(on pumping recommendations, inlet and outlet the or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): ' Tight or Holding Tank(tank must be pumped at time of inspection)(locate on.site plan): Depth below grade: Material of Construction: concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: . gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping:. Date Comments(condition of alarm and float switches, etc.): *Attach copy of currentpumping contract(required). Is copy attached? ❑ Yes ❑ No bins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 11,of 17 Commonwealth of Massachusetts DIM Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary.Assessments 584 Main St Property Address Paul Hickey Owner Owner's Name information is Osterville Ma 02655 8/15/2016 required for every page. Cityrrown 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 Comments(note if box is level and•distribution'to outlets equal, any evidence of solids carryover, any -evidence of leakage into or out of box,etc.): Pump Chambe.r,(locate on site plan,): • • , Pumps in working.order: ❑ Yes ❑ No* Alarms in working:order: - ❑ Yes ❑. No* Comments(note condition of pump chamber,:condition of'pumps and appurtenances",,etc.): "If pumps or alarms are not in working order, system.,is a conditional,pass. Soil Absorption System(SAS) (locate on site plan, excavation not'required): IfSAS not located, explain why: _ r t5ins•3/13 Tilla$Official Inspection Form:Subsurface Sewage Disposal System'.Page 12 of 17, F. i ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 584 Main St Property Address Paul Hickey Owner Owner's Name , information is Osterville Ma 02655 8/15/2016 required for every page. City/Town state , Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 x1000 ❑ leaching chambers number: ❑ leaching galleries number; El leaching trenches number; length: ❑' ' leaching fields number, dimensions: overflow cesspool number: El innovative/altemative system } Type/name of technology: Comments(note.condition of soil, signs of hydraulic failure, level of,ponding, damp soili condition of vegetation, etc.): Leach pit was found to have I'of standing water with a stain line 1' higher. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 1 Depth-top of liquid to inlet invert 6 Depth of solids layer, 011 Depth of scum layer 6x6 Dimensions of cesspool Materials of construction cesspool block Indication of groundwater inflow ❑ Yes No i5ins•3l13 Tale 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 SV•'. 584 Main St Property Address Paul Hickey Owner Owner's Name information is required for every Osterville Ma 02655 8/1.5/2016 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.): Cesspool was structurally sound. Privy(locate on site plan):. Materials of construction, Dimensions Depth of solids Comments(note condition:of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3l13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 or 17 i ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary,Assessments 584 Main St Property Address _ - Paul Hi ck ey Owner Owner's Name , information is required for every Osterville Ma 02655 8/15/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (conf.) 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 - E drawing attached separately P� l - r t5ins•3/13 Title 5'Dtficial Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 f Commonwealth of Massachusetts Title 5 Official Insaection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 584 Main St Property Address Paul Hickey Owner Owner's Name information i every required for e Osterville Ma 02655 8/15/2016 page. Cityrrown State Zip Code. Date of Inspection D. System Information (cont:) Site Exam: ❑ Check Slope ❑ Surface water Check cellar, f ❑ Shallow wells Estimated depth to high ground water: . 12+ feet Please indicate all methods used to determine1he 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: P ❑ Checked with local excavators, installers-(attach documentation) - ❑' Accessed USGS database-explain; You must describe.how you established the high ground water elevation: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. Before filing this Inspection Report,please see.Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17.' r Commonwealth of Massachusetts - - Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 584 Main St Property Address Paul Hickey Owner Owner's Name information is required for every Osterville Ma 02655 8/15/2016 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist , Inspection'Summary: A, B, C, D,or-E checked ® inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn.on page 15 or attached in separate file t5ins•3113 Title 5 official inspection Form:Subsurface Sewage Disposal System Page 17 of 17 'i F THE COMMONWEALTH OF MASSACHUSETTS SACHUSETTS �<< i�nl� NM �V1-� -_ 17 ua � (fPrtif iratt of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired) Upgraded( ) Abandoned( )by at !��& mG., n ZA EJ` i`1 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. G ` —.)2Ydated Installer V-v f�� ✓'(� Designer #bedrooms Approved design flow i�- gpd The issuance of s petmjt shall not be construed as a guarantee that the system will ct n esign Date Inspector - ----------------------------------------------------------- f i TOWN OF BARNSTABL--E pp LOCATION ,y G �� SEWAGE# C90`b VILLAGE 0,_) r I ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SGQAA SEPTIC TANK CAPACITY 6,C1.%PO Q AnU lo7G GwC P'� LEACHING FACILITY:(type) vv (size) NO.OF BEDROOMS DJ 1 `` OWNER 04 QLy 6 c' PERMIT DATE: I/ 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 i FURNISHED BY l ; 3a6 vs ��Ile No Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipplication for Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair(d Upgrade( ) Abandon( ) ❑Complete System 21n"dividual Components Location Address or Lot No. S-Ty (L ,.r, Sit Owner's Name,Address, d Tel.No. Assessor'sMap/Parcel Gr.���`!` 0�elr4 �C InstalleUs- 1 rne` ss,tnd Tel.�N`J Yr.r Rj Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building r No.of Persons Showers( ) Cafeteria( ) Ott er Fixtures Design Flow(min.required) gpd Design flow provided A111k gpd Plan Date Number of sheets Revision Lad Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Reaairs or Alterations(Answer when applicable) Q,pi G %R p Ni L L�nQ �� Vxo,.!S R, k-d Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance wi-.h the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance hEs been issued by this Board of Health. r( Signed Date g `C) 1(co Application Approved by er�S Date mot? Application Disapproved by Date for the following reasons Permit No. U Date Issued d ol No. 110 Fee 715, THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �/ Yes PUBLIC HEALTH DIVISION- TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for Misposal *pstrm (Construction Vermit Application for a Permit to Construct( ) Repair(L/ Upgrade( ) Abandon( ) ❑Complete System �dividual Components Locat_on Address or Lot No. �Vq m G`,�n �� Owner's Name,Address and Tel.No. Assessor's Map/Parcel Instal4er's Name, f 1 Address, d Tel.No..) J. J Designer's Name,Address and Tel.No. '3 G ��rJ RkA 'O$' 3.5 Ut OV 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) r gpd Design flow provided All gpd Plan Date Number of sheets Revision Date Tile Size of Septic Tank Type of S.A.S. Descriplon of Soil " 3 Nature cf Repairs or Alterations(Answer when applicable), eC2QAj G(A f•5�,2p cc A-0 c25S 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 Datej V 1 co Applicatic n Approved by rvv)06`�,61 Date 'D Application Disapproved by Date for the foLowing reasons Permit No. 0 Date Issued \f u -------------- y---------------------------------------------------------------------------'-- �-------------------------------- klu M N ,,t THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS 4-P tertificat>e of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired) Upgraded( ) Abandoned( )by 5 C1�t r— ('c a y(.-. at � ( (`1 C„ /� .. ('�c, \ has been constructed in accordance i with the prcvisions of Title 5 and the for Disposal System Construction Permit No.)G(� ?Ydated Z16 Installer Designer #bedrooms pJ Approved design flow gpd f, The issuance,of his'pe' 't shall not be construed as a guarantee that the system wil chon�a's design Date ( � Inspector ----------c--------O4 `-,-, � !---------------------------------------------------------------------------------------------------------------------- No. o '.�. 1[/ S Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS misposal 6pstr (Construction 3permit Permission is hereby granted to Construct( ) Repair(V) Upgrade( ) Abandon( ) System located at a (� C-\(N S} 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:W-struction must be completed within three years of the date of this permit. t/� C i Date t v Approved by � •`- AsBuilt r; Page 1 of 2 7 " TOWN OF BARNSTABLE . CATION . Sg 1 �9�� ST SEWAGE fi VILLAGE_-_- o�tN►�� ASSESSOR'S MAP& LOT 19 D6 } INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY CLIC120oi LEACHING FACILrrY: (type) p T �co'C (size) /OtlO NO.OFBEDROOMS BUILDER OR OWNER C- , IM0 , y PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: 'Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachipg facility) Feet Furnished by A (3 3� Sa S6 S I . t a http://issgl2/intranet/propdata/prebuilt.aspx?mappar=141064&seq=1 8/10/20.16 Town of Barnstable Barnstable �T►+e ram, ,. � Regulatory Services Department BARNSrAB1.E. �. $ Public Health Division i639. �e 2007 200 Main Street,,Hyannis MA 02601 Office: 508-862-4644 Richard V.Scali;Director FAX: 508-790-6304 Thomas A.McKean;CHO CERTIFIED MAIL# 7012 1010 0000 r2848 2169 July 25, 2016 Paul W. Hickey 584 Main Street Osterville, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 584 Main Street, Osterville,MA was last inspected on 07/13/2016 by Sean M. Jones, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that,the system "Conditionally Passes' under the guidelines of 1995 TITLE V (310,CMR 15.00) due to the following: • Sewer line from house to cesspool has root blockages and needs elevation changes. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. ' _ Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE OARD OF HEALTH Thomas McKean, R.S..CHO Agent of the,Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\584 Main Street Osterville.doc I Town of Barnstable •A NSrasM Regulatory Services. Department '°rfa�• Public Health Division 200 Main Street, Hyannis MA 0260.1 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 . e DEADLINES TO REPAIR FAILED SYSTEMS (Town Code§360-44 and Title V: 310 CMR 15.0100) An"x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground l ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. o Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or t clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public-well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis ' ; indicates the well is free from pollution). `TWO(2)YEAR DEADLINE CRITERIA ❑ Single Cesspool `❑ Any"conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-l0 components, etc) ❑ Leaching pit or cesspool with high liquid level, <12" below inlet(per Town Code §360-9.1) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town i` Code §360-20 h) OTHER Vje d, �i,�e. T�'ar�, �� l� CQI/ uc�l I AJ �'c,v b(oc U� d tniQdJ e r'�V&44 S� �- Repair deadline: Q:\SEPTIC\DEADL►NES TO REPAIR AILED SYSTEMS.doc f Commonwealth of Massachusetts w Title 5 Official .Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 584 Main St r— Property Address EU Paul Hickey Owner s:r, Owner's Name / �y information is required for every, Osterville Y Ma 02655 7/13/2016 $ page. City/Town State: Zip Code Date of Inspection W Inspection results must be submitted on this form. Inspection forms may not be altered in any "'•way. Please see completeness checklisfat the end of the form. Important:out forms A. General Information / f� �� filling out forms on the computer, use only the tab 1. ' Inspector: key move your our cursor-do not Sean M. Jones use the return Name of Inspector key. • . S.M.Jones Title V Septic Inspection Company Name 74 Beldan Ln. .m t w ; Centerville Ma 02632 Ci /Town State Zip Code ty P 774-248-4850 smjonestitle5@gmail.com SI4522 s Telephone Number License Number ti B. Certification i I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 7/13/2016 Inspector's Signature Date The system.inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or.DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the x< report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 f _ t Title 5 Official Inspection Form:Subsurface Sewage Disposal System+Page 1 of 17 o Y i Commonwealth of Massachdsetts Title 5 Official Inspection Form 4 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 5 584 Main St Property Address Paul Hickey Owner Owner's Name information is required for ever Osterville Ma 02655 7/13/2016 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 31.0 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ®! One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 584 Main St Property Address Paul Hickey Owner Owner's Name information is required for every Osterville Ma 02655 7/13/2016 page. Cityffown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ® broken pipe(s)are replaced ® Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): Sewer line from house to main cesspool is has root blockages. Line need to be replaced. Outlet pipe is higher than inlet resulting in the inlet being underwater, this line needs to be lowered. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 584 Main St Property Address Paul Hickey Owner Owner's Name information is required for every Osterville Ma 02655 7/13/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply 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: a D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No" o to each of the following for all inspections: - Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form d) Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 584 Main St Property Address Paul Hickey Owner Owners Name information is required for every Osterville Ma 02655 7/13/2016 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system.must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well. If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•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 �M 584 Main St Property Address Paul Hickey Owner Owner's Name information is required for every Cisterville Ma 02655 7/13/2016 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. Z ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): _ Number of bedrooms(actual): 2 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 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 584 Main St Property Address Paul Hickey Owner Owner's Name information is required for every Osterville Ma 02655 7/13/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number'of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments GM 584 Main St Property Address Paul Hickey Owner Owners!Name information is required for every Ostervlle Ma 02655 7/13/2016 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: check for structural integrity of cesspool 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): Block cesspool with precast pit overflow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 i Commonwealth of Massachusetts C Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 584 Main St Property Address Paul Hickey Owner Owner's Name information is required for every Osterville Ma 02655 7/13/2016 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: unknown Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ® cast iron ❑40 PVC orangeburg ® other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Sewer line was found to be blocked with roots, needs to be replaced. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: i ❑ 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: Sludge depth: 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 584 Main St Property Address Paul Hickey Owner Owner's Name information is required for every Osterville Ma 02655 7/13/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to.bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from m f bottom o scum to bottom of outlet tee or baffle � How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M ' 584 Main St Property Address Paul Hickey Owner Owner's Name information is required for every Osterville Ma 02655 7/13/2016 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 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 584 Main St Property Address Paul Hickey Owner Owner's Name information is required for every Osterville Ma 02655 7/13/2016 page. Citylrown 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 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.): PumpChamber locate on site plan): ( P ) Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 584 Main St Property Address Paul Hickey Owner Owner's Name information is required for every Osterville Ma 02655 7/13/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1x1000 ❑ leaching chambers number: ❑ leaching galleries . number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions:- ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit was found to have 1' of standing water with a stain line 1' higher. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): . Number and configuration 1 Depth—top of liquid to inlet invert see comments 611 Depth of solids layer off Depth of scum layer Dimensions of cesspool 6x6 Materials of construction cesspool block Indication of groundwater inflow ❑ Yes ® No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 I Commonwealth of MassachUsetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7M 584 Main St Property Address Paul Hickey - Owner Owner's Name information is required for every Osterville Ma 02655 7/13/2016 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.): Cesspool was structurally sound.Water level was even with outlet but at 1 inlet and above the other inlet invert. Outlet line needs to be lowered. 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.): l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 584 Main St Property Address Paul Hickey Owner Owner's Name information is required for every Osterville Ma 02655 7/13/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 1 r r t � \ r ,A-I w32 52 U � A Z`- t t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachosetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4 M 584 Main St Property Address Paul Hickey Owner Owner's Name information is required for every Osterville W 02655 7/13/2016 page. Cityrrown 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: 12'+feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within'150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. 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 I� a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 584 Main St Property Address Paul Hickey Owner Owner's Name information is required for every Osterville Ma 02655 7/13/2016 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 ` Z System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file f t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ap -1tiaCE�. ®L�l- TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 594 Main Street Osterville. MA 02655 Owner's Name: Catherine Moriarty i 1 Owner's Address: ' Date of Inspection: November 29, 2004 C-3 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford a'- Mailing Address: P.O.Box 49 C) rat Osterville.MA 02655-0049 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection, The inspection was performed based on my training and experience in the.proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs rther Evaluation by the Local Approving Authority Fails Inspector's Signature: IM406 Date: December 1, 2604. The system inspector shall sub4 a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 594 Main Street Osterville, MA Owner: Catherine Moriarty Date of Inspection: November 29, 2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,'exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND exp!ain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 594 Main Street OsterviHe. MA Owner: Catherine Moriarty Date of Inspection: November 29, 2004 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. S(stem will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a _.urface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has aseptic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance .:**This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Y Page 4 of 11 t OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) k Property Address: 594 Main Street Osterville, AM Owner: Catherine Moriarty Date of Inspection: November 29. 2004 > D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No / Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool M ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool,or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] J No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of. Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 - 1 Page 5 of 11:y i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 594 Main Street r- Osterville. MA Owner: Catherine Moriarty Date of Inspection: November 29, 2004 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? _ ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? n/a Were as built plans of the system obtained and examined?(If they were not available note as N/A) F ✓ _ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS, located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR,15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 594 Main Street Osterville�MA Owner: _ Catherine Moriarty Date of Inspection: November 29, 2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n1a Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n1a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): -2003-0 gals.:2002-19.000 ag_is Sump Pump(yes or no): No Last date©f occupancy: Unknown COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: None on file-per treatment plant Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system Single cesspool ✓ Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age,of all components,date installed(if known)and source of information: A nit was added on 818184-per as built card Were sewage odors detected when arriving at the site(yes or no): No F 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 594 Main Street Osterville, MA Owner: Catherine Moriarty Date of Inspection: November 29, 2004 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ ' (locate on site plan) (Cesspool acting as a septic tank) Depth below grade: Material of construction: concrete _metal _fiberglass _polyethylene _other;explain) Cesspool block If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 6'W x 7'T x 9'bottom to Qrade Sludge depth: 10" Distance from top of sludge to bottom of outlet tee or baffle: -- Scum thickness: 0" 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: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): The cesspool had Y o liquid on the bottom An outlet tee was present The cover was 10"below garade The cover was cracked and needs to be replaced. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 n' Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 594 Main Street Osterville, MA Owner: Catherine Moriarty Date of Inspection: November 29, 2004 TIGHT or EOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day , i, Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): f DISTRIBUTION BOX: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comment3(note condition of pump chamber,condition of pumps and appurtenances,etc.): i 8 's Page 9 of. 11 n. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r PART C SYSTEM INFORMATION(continued) Property Address: 594 Main Street Osterville, MA Owner: Catherine Moriarty Date of Inspection: November 29, 2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leeching pits,number: 1 -6'x 6'(1000 Qal.) leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: otierflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): The pit wcrs dry and clean. The scum line was approximately 2'up from.the bottom. There did not appear to be any signs of failure. T'he bottom to Qrade was 10'. The cover was 18"below Qrade. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number aad configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication.of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): I� f PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 i Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 594 Main Street Osterville, MA Owner: Catherine Moriartv Date of Inspection: November 29, 2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Eck Q, f I I , B 1 3� Sa S6 S a 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 594 Main Street Osterville, MA Owner: Catherine Moriarty. Date of Inspection: November 29, 2004 SITE EXAM Slope Surface waver Check cellar Shallow wells Estimated depth to ground water 18+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed:, Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps, the maps were showing pproximately 18'+1-to-groundwater at this site. Us n the Cape Cod Commission technical bulletin, the high Around water adjustment for this site WW 29,Zone A, 10104) was 2.P This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees,either expressed,written or implied,relating to the system, the inspection and/or this report. 11 r TOWN OF BARNSTABLE t -y " Sqy /►�At� sr I;�,fCATION SEWAGE # V,,.LAGE o y iry,16, ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. M SEPTIC TANK CAPACITY Ct i rn 041 LEACHING FACILITY: (type) '"rT (JxG (size) UUO NO.OF BEDROOMS 0 BUILDER OR OWNER C PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility" (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachipg facilityy)).- Feet Furnished by tt✓ n J �b/ � Q A(X �► C3 S6 S ► _ ik 3 �� SSµEES I tqN s PROJECT I 7NE a1 WIRACIEW.SMALL EA'OO VA IF 5'ALL ARGY/ND ANO DDA V 70 IMI Bq LOCATION i &A7DBAL AAVAV A'Ef3AaF wy aFAV MAR-W S44V I/P AWNFALL 0ABLE 7W Or ,. 7AF SJSIEN 7NE AMAffA0Vr A(A7DWYAL 5VALL LTWMW M 7NE . 7canavS•WrAWM 7N J70 OWR 151855(J)(77W s) LOT 91 w1ANNo _ - GOLF i LOT B - N/F CLUB N/F JOHN & SUSAN FARRINGTON LraE PATRICK J. & Ez7s77Nc sEa)7C Srs7EA( � v awuo MOIRA - L76WPIOVD Ts m BE �;.. t aiA(lo MCCULLOUGH, REAiorm .anv ZONE X 2,2g•�O E ZONE 0.3" cv1uK v LOT 89 m LOCUS . 3- N NOT TO SCALE' _ . .. SIZW AU ARWND JUSTIN M& UNDA. 1vPGrll CIE. yJR F. CIRRONE, JR. PR ` 0 .> o ITT a� 0 N LOT 903( LEGEND I F _ F VEGETATED i��TR 1% �L_ �' %��.. �.fl PAR�_g._12- apt" _--_-- EXISTING 2' CONTOUR �v \ I \\ oF\ 1� a 16,376t SF. iw �L crAeaNnrEa�r-7J/£AQCY�F7PlW --zo EXISTING 10'•CONTOUR E rn m zw7mr rLLr'A770K4 If/E`PYLd/�TG•LYW7RAC7AP .9YALL Al;---AW;Z-77/E.Q7Sl^W His 70 Err AWw oVE - a C 0 poCv \\��� "VarA AMMAATMURW01IAES 7M +ts.s EXISTING SPOT ELEVATION ` O(E.9'7E COM,,40M 5VALL A4OX.s 1NEAl'SB/9'7E `\ �; r—A� � - PP EXISTING UTIUTY POLE . 11-YIA49 7NE/0 OR718 W Y. 1f1E - -QVALL N07BLLrM'ALYlSS 7L7 WO-vAND.SVALL RL'PAR \ \ s CON I �� ` i Qs EXISTING SEPTIC COVER SVELL aW"AYAS NELl`�LORY UibV PIWLECr \ - PpnO, LYWAMMO! NNE REPAIRS.SVALL/NCY6VFAf-9YCZLdYG \ �� S.nHG . ANO HAND.AAK7Nc 01 SYM LWYNEWAY. �i � \ fA � � \ -;' - yr � � 15 \ � � .EXISTING HYDRANT H ¢ T.H. EXISTING TEST PIT FOUND E1 CONCRETE BOUND VEGETATED i Y .`PIPE •.N PIP - FOUND IRO E \ POST&'RAIL sr°ti, /b cal. F \' \/ LAWN - Pp "� CIS GENERAL NOTES: PARCEL 61 w� \ I �� i ---- ---- `� FOUND N/F i.. ASSESSOR'S-INFORMATION: MAP 141, PARCELS A & B, LOT 90 II I BRIGID H. DOHERTY, TR.' 1� y.\ DRIVEWAY - -e� 2. FLOOD ZONES: X & 0.2% (FEMA MAP 25001 CO544J) 3. ZONING DISTRICT: RC I �N uHE ,a I ji r,;226�G A`N ` 4. OVERLAY DISTRICT: AQUIFIER PROTECTION OVERLAY DISTRICT . 20 gg11� o.' BENCHMARK' TOP OF HYDRANT <� 5. LOT COVERAGE BY: EL 19.e2' A. STRUCTURES: 1,752 S.F./16,376 S.F. = 10.7% -WATER _ 52 / EDP GATE FEND 6. STREET ADDRESS: MAIN STREET (,a'ODE) _ 7. HOUSE NUMBER: _584 I A 8. TOPOGRAPHIC INFORMATION COMPILED FROM AN ON THE GROUND SURVEY I Rpro r 9. ELEVATIONS SHOWN ARE BASED ON NORTH AMERICAN VERTICAL DATUM 1988. PIPE IFOUND _ _ - coot" CB ! FOUND i \• ' P P Spv � LOT LAN FOR #584 MAIN STREET PREPARED FOR BARNSTABLE HARBOR BUILDERS IN kl—N OSTERALLE MA PLAN DATE: AUGUST 25, 2017 PLAN SCALE: 1"=20' 7- :Y"p4 Fi 0 CIVIL ENGINEERING T *,{O i WETLANDS PERMITTING " MIGNAEL J. nG WASTEWATER DESIGN P L lvi V j� COASTAL ENGINEERING BI GL U _ �7 y No.85o5J c TITLE 5 PLOT PLANS G PIERS AND DOCKS �NGINEr7 • I 20 0 10 20 40 n OST EKG��� LAND USE PLANNING COMMERaAL/RESIDENTIAL 11.1 r V Sm�ph9 Cope.Cod and Sw6Wst&n A(a"7k:*a vtts i SCALE: 1 INCH = 20 FEET 17 ACADEMY LANE, SUITE 200 - FALMOUTH, MA - 02540 - 508.495.1225 F PROJECT NUMBER: 17047 CAD FILE NAME: 17047SP DRAWN BY: L.M. 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'.: . . 0 ' ' . i . . , . . F. "1�V..�:"f.-:I'.....-��'-.-1:1�"...l.! . .. . iienove A«4 REPLACeeX19TWG . .-_ .. : .. DOOR ..: .. �D .Ref10V2 eX18TMG .. V .. :-'WWt10e.AND W Z :. ' .. - - . . ' "" :. I WALL A9 RlOIlIR� O " :: . .. W I 1 I " - .'. .. .- .. .: , .... - D"TO SE ', : .:: ,. .'::. RE71 DOOR .. _ >t..;W.�_ �eE . . .. . , .. .. : -. EXIBTWGA411iL1' .. - , a .. 3 f . .. . ..' : ..-. . . . . :. .. . - : . . REMOVE AND REPLAC!WINDOW... - : .: RlMOVB FENCE" - -. .. .. .. '. ..-. _ .. .. . , ,,. .. .. - e� . . : ..- . . ,.,, " _ ':s^RUCRT�IILRAL,�WL N' .:-.. - TNu DAY ONLY IQ h' i�Di w z:. q4W. r , - .. ( :: .. REMOVE:W ITS., .. 0,.�4 ..<F W. .. ;. :. , .. .:.. ,.. .. :r F . ,a. . - .. .. .. .. , . . . . .. . .. . . .. . t.... _. .., ':. ,, .:. .. .. t' O - .. .. .: _ n OLdN uY .�. iC/ .�.; z .... .. .�. . '. ��.� RlMOV!AND. , �. �� qzr ...., _ ,: RePLACl:e>(IB,TING.::.: d.:.. W . :. . . . .- , . _ _ . 000R, .. r: . m J ' W . 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Imo'-- -:--_-___ _-___- -_- _ _J � _ - .. : - - . . :. .. .. a.:...®..m. - - i� . .. . .. .. . .:. ::, Hove ND - _ _. _ ._ to _ I REPLACE OCTAGON ENDOW -, - .. • ... .. . _ '.. RlPLACP ALL y. . .: ' MGItE9 - ...._. ' -. _ - . ,' SEGOIdiD FLOOft2 PLAW EXf9TING .�.,,�.,:-I 11�1.-I,-:A..0'..�-II 1I��%,."1...�.z�.I..i.I:':.:i'.:'1.".*�.I�...'.",:,.�.:...'.��..1.'..L�..:....,.,,.-...II:...I,l.1,..�I','�:..,....,�'..�..I1I..�'-....."�1*..I,.�..';:........�...j.:'wI.:....';-��..�p1'...-w.i-...,1 I.i::..-:,.�...:e*.....�,-,:..�...1�.::'F'.'..'�..I.�.....1�-...I.��..1%,-�'.,.-i..,-"--��'-1:.i�r.I.':..F..�,.-.�."...:.,::..:!...�:.�:II.:,l...".�'-.*.i."�:I.-.':.'I-'.I I:�,..I I.�..-.I":.�I..-.�.:.I�,..I.I-"..--t--...%.I.:.i..'.i-.Ii-I�*�:1-I...-�...........I.I�..-..-.1..:..-!...bI�I.D....-..--'..,i��­..I',. .: . .., . - . x. o z. a .• . , - . : . ..alb. .. .. .. .. -.. . , ., .- c �"� . . t/a 1 0'. .. III - ,. .-. - .. . . . . . . - . . . . : : . . - . I I 77 GENERAL NOTES: I. CONTRACTOR SMALL VERIFY ALL O11'IE5ION5 AND -1 NOTIPY 50 DESIGN ASSOCIATES OF ANT '4o'-d{' - DISCREPANCIES.AMBIGUITIES,OR INCONSISTENCIES - PRIOR TO PROCEEDING WITH THE WORK. 1 Z 2.STAIRWAYS, O A)REQUIRED STAIRWAYS SHALL NOT BE LESS THAN Id-+• E'-i;• 4'-2;' 1•_P j• Y-+• i•-r i'-2• 1'-0• 2'-T 4'-4' T'd;. 1'-43' S'-O'IN CLEAR WIDTH. MAXIMUM RI5E SHALL BE W 8-1/4. MAXIMUM RUN SHALL BE 9':WITH NOSING NOT TO EXCEED 1-1/4'. MINIMUM HEADROOM SHALL BE - i'-i'. B)HAND SYSTEM RWITLISI SHALL' N LOCATED, I EACH STAIR ' HEIGHT WITH MORE THAN THREE(3)RISERS,AT A p HEIGHT LL 30'MIN.1 30'MAX,SING F SHRED - Y VERTICALLY FROM M THE NOSING OF THE TREADS. GUARDRAILS.34 MIN:IN HEIGHT,SHALL BE INSTALLED E FLOOR,PORCH,'AND/OR BALCONY AREAS MORE THAN THIRTY MAX INCHES ABOVE A FLOOR OR GRADE BELOW. MAX.CLEAR HALLOPENING - = H H 'R BETWEEN RAILS)BALUSTER$OR FLOOR SHALL NOT . EXCEED FIVE(S)INCHES. STEPS T GRADE j R - 9..WINDOW SIZES SHOWN WITHIN ARE BASED SIMONTON. r WINDOW SIZES 1 O SHALL BE VERIFIED AS EQUIREDFIED BY hh ' THE GENERAL CONTRACTOR R PRIOR TO ORDERING. T '� THE WINDOW MANUFACTURER SHALL PROVIDE THE ' (COMP CKING) M ROUGH OPENING SIZES. WINDOWS MUST MEET THE - POLLO WING CRITERIA, W A)GLAZING CLOSER THAN IS'TO THE FLOOR AND O o O= EXCiPER N SIX(,i)SQUARE FEET IN AREA MUST BE W J *C B)EMERGENCY EGRESS: SLEEPING ROOMS SHALL j ).W HAVE AT LEAST ONE IU OPERABLE WINDOW OR EXTERIOR DOOR TO PERMIT EMERGENCY EGRE58 _ W WI 8� OR RESCUE. A REQUIRED WINDOW MUST BE !" - -.-._— ._-. _-_ _ _ _ _ - __- .._.__ _._ a W U. g F SEPARATE PROM THE INSIDE WITHOUT THE USE OF ; I v i ®i �_._.___.- -I i W SEPARATE TOOLS AND SHALL CONFORM TO THE M �- POLLOWING: I POST IN WALL r.FAN/VENT yy SOLID 4•X i' ` L THE SILL HEIGHT SHALL NOT BE MORE THAN' - I I A ® W �� i e I .I „ sfI M m J FORTY-FOUR M4)INCHES ABOVE THE FINISH SpTaILTEu Q FLOOR.14E WINDOW SMALL PROVIDE A MINIMUM NET F i .I, - a T � CLEAR OPENING AREA OF 3.3 SQUARE FEET DINING ROOM. WITH A RECTANGLE HAVING MINIMUM NET - A DWO I W=W CLEAR OPENING DIMENSIONS OF TWENTY(20) SAND AND WHITE p �„I J _;W INCHES BY.TWENTY-FOUR(24)INCHES IN W WASN EXISTING 'r:4 IO O Of EITHER DIRECTION, IF A.DOUBLE HUNG UNIT IS %3 X<j I '1 ® MAPLE FLOORS m .IU W USED THEN SUCH DIMENSIONS APPLY TO THE - ': CAR GARAGE O \m,I - SD I! Q 4 p= BOTTOM HALF. ( ,R„ ® ® .,. 1 I F.. a 17!3 m CONCRETE SLAB ON > I CO 5D U O S.DIMENSIONING STANDARDS USED WITHIN THE. COMPACTED GRAVEL 131 I-3/4 ±9 1/4.OR(2 A 0 W NOCUMENTS ARE AS.FOLLOWS.UNLE55 OTHERWISE - I ( _ - _ -!.�--.— j -�9�l ��-1 ------.------ O -�+�"W 1 aDj of A)EXTERIOR DIMENSIONING AT BUILDING CORNERS P ' I W BM A V __�. _ .q� 1 3/4'X II V LVL r I i mm REPRESENTS AN OUTSIDE OF STUD DIMENSION. F ' 1 POOLID 4 X 4 I I I j m W O BE EXTERIOR DIMENSIONING AT WINDOWS AND DOORS I (' I• 5T IN WALL I =U REPRESENTS A DIMENSION TO THE CENTER OF NEW I, THAT OPENING.FROM THE CENTER OF ANOTHER CONCRETE I n QQ W OPENING,OR THE OUTSIDE OF THE STUD. PAVERS REF. i i U CI INTERIOR DIMENSIONING AT STUD WALLS j .+•-..� 1 I I REPRESENT$A DIMENSION TO THE MIDDLE OF THE I �___._-__. ® O STUD. - ® ® I 4- POSOLIST N•WALL SD _ D)INTERIOR DIMENSIONING AT 5TAIR5 REPRESENTS .'y HEAT HEAT r I I! $ A DIMENSION TO THE FINISHED PACE OF THE STAIR. r____----_, r-----_--- 1 I LIVING ROOM i.STRUCTURAL HEADERS 1 BEAMS SHALL BEAR ON THE I I I I WG RAGE DOOR I I BGARAGE DOOR I I I I i. x I D m FOLLOWING: (11 G 4ffi.cBm A)DOUBLE HEADERS SMALL BEAR ON 4:A WOOD I; I I I I I O POSTS. b ^"! �'. _ Bl TRIPLE HEADERS SHALL BEAR ON 4d WOOD ! L I! I I L _ POSTS.' OPTIONAL BENCH I �! .^^a G STEEL BEAMS SHALL BEAR ON 3-I/2'0 STEEL' I I I I OR CUBST _ E - PIPE COLUMNS. I I I REPLACE I �M ® ® q NEW WALL ITYPJI,I m DI LAMINATED VENEER LUMBER ILVL)PRODUCTS Y CO SD SPECIFIED WITHIN ARE SIZED FOR MICROLLAM - BRAND. IT 15 THE SOLE RESPONSIBILITY OF THE GENERAL CONTRACTOR TO VERIFY AND —�__- COORDINATE ANY SUBSTITUTIONS. LAMINATED - i VENEER LUMBER SHALL BE HANDLED AND INSTALLED IN STRICT ACCORDANCE WITH THE I. L MANUFACTURER'S SPECIFICATIONS.. 1.BEARING PLATES SHALL MATCH OR EXCEED THE - - - - W 'WIDTH OF ALL BEAMS THAT BEAR UPON THEM. 0.ALL DUCTWORK AND HOT 1 COLD WATER PIPING SHALL BE INSULATED AND WHERE NECESSARY A VAPOR BARRIER FOR THE DUCTWORK TO PREVENT CONDENSATION. - S'-� �•-0l. S'-0' i'-F '�-"l. 6-4' !'-3]• Y-1' Y-%• i•_ID' !'-']' T'1. T-r 10'-4' KY-I• e-L]• 22'-'Z• W-4k G GENERAL . STRUCTURAL NOTES: FIRST FLOOR PLAN — PROPOSED V Q Z I I.STRUCTURAL LUMBER - - SCALE,V4'4-O' O I ALL STRUCTURAL LUMBER SHALL BE 10-400 Is MIN. 2.CONVENTIONAL LUMBER, O ALL FRAMING MUST BE 2'MIN,CLEAR FROM ALL MASONRY. <W J Z W< 0'�� 3.DOUBLE FLOOR.JOISTS UNDER WALLS RUNNING - PARALLEL TO THE FLOOR FHAMIN4 TYPICAL. - I LIMBER,- ^, ALL EQGIN EREO LUMBER 9NALL BE fN7AG0 Fe MIN. - 3 MINIMUM UNIFORMLY DISTRIBUTFD LIVE LOAD. , ATTICS/ROOF SLOPE.NOT STEEPER THAN 3 IN 12-NO d Ex O + STORAGE-10 PSP ATTICS(LIMITED STORAGE)-20 P5P O W L LIVING AREAS 0 PSF(EXCEPT SLEEPINGROOMS)-40 ESP, _ S BEDROOMS-30 PSP STAIRS-40 PSP' ROOF uVE LOAD, - 1 V/O LIVE LOAD_30 P3F V ow {L SNOW LIVE LOAD, 'rp�11 Z LIVE LOAD-30 PS P - V w J �. I Ali Cedarville .Deal wF,I.noe,llne. . �7 Lace a : T-v s•-`] 3,_T 3-_3• ],-O• cn w N =C �w In OCWU di OOC4 W a.W a E- Q�< 'n0 2�� z W r Ul C z m m•t J_ d) W.V O. Ir------------ ---=-774' . --- ---------n— _ H u m___ __ Nznc' m73E - I -crow — -- -- — r— — - - —' — p r- O U JSOLID r X Y 'I ® �//\�� SOLD 4'SI l• h POST EACH SIDE !� ® ® '• j •1^}v\\ R ` . I I I FAMILY ROOM P CO SD SD Po EACH XV I3)I-3/4'X n-VT .. (3)I-3/1'%P-Vi',. I xt- I I LVL HDR.LWTH - to HDR-mRH p.1 . P I I L SOLD 1•X L• POST TO RIDGES $ '--- ---'- POST TO RDGE' OPEN RAIL - T X 4'SOLD Te PwpG2 FROH To a . I BI3LT-INS BASEMENT - .x• . I, fi i __� Il�ll�X IIII N fill I IIII 9 a I I 11 --- ` ---_� -- 'I---- --- -- --- - ---_� -� — --- a. w o= J.� ,I < - a lil w Q'a 0 Z�. 1 L 4 W N3< Q� O=U 00`n Q= UQ O� NZ SECOND FLOOR PLAN - PROPOSED III 4 .. SHEET: e A41 •� op-7 I S�EE'C �qN� 9s ROJECT LOCATION ME CAN1R40rCR -91AU EA20AVA7F 5'ALL AR011W AND 0010V 70 IHE 9q C2 LAYFR(ES17M.47F0 AS 60S�)ANO R"OW ALL UN-WITABLE q A/ATERYAL AND REPLACE N1rH aEAN COARSE SANG UP 70 1HE r6P Or THE SYSIEA/. rNE RFaACWDNr A(ATERIAL SJYALL COVIK PA/ 70 7/YE G .ScEIaRCAflaVS SET FM7N IN J10 O WR 15.2M(.3, ()I11E s) WIANNO LOT 91 LOT B N/F GOLF CLUB N/F JOHN & SUSAN FARRINGTON ARI(ER C POiV'0 PATRICK J. \ & EXS17NO SEP11C SYSrFA/ \ �oNO . —�....) MOIRA c6wpwEN1l5 m BE MCCULLOUGH Pll&RF,0 ANO REA/O" --/ Hp,ZpTtO ZONE X � �6.�o•E ��� HpZpRp ZONE 0.` n .�= say cALLav �39.2;0 / &D �� LOT 89 w -LOCUS QV4,VBERS WH 9'L ; ,G N/F rn NOT TO SCALE srOvE ALL ARCX/NO cE v v � � JUSTIN M. & LINDA I pRwpct ��� ` /ERR N F. CIRRONE, JR. N o IT T.H. �� O w LOT 90 w LEGEND N I I / PARCELS o, ' - ` VEGETATED I T rH L' ��5 / o A i 2 - �" CIE ———————— EXISTING 2 CONTOUR — 16,3766 S.F. TWWASffamscrmm)zrAswrflCNeVs�-f 20 EXISTING 10' CONTOUR \ I rn o? a MrLal" 77aVS 1HEa4VA lNG CGW7RAC9W \ o n �ToE� f I 10 +15.5 EXISTING SPOT ELEVATIONO GA$La 1a L"TIA MVavNI'At"o n4r MS noN CAN aF AGLaPYsvfp RAW rO INSrALA770V Or N SW&W PP `a' / E-VIEaWRAMW WALL AC12W 711-j4 Sf7F EXISTING UTILITY POLE USr/NG 1t/E,*i'02 OR/WW4 r 7t1E.A'rE GMMACrl i4 -n SJ'IALL NOr&00lr ACCESS 70 jV02",0 .9VALL REPAIR \ \ �8 CONC \ " �� \ (D EXISTING SEPTIC COVER S VM aRi WWAY AS NEac3S4Rr UPON PA19LCCr \ P A11 D j \ IRV LL'M/PLEAGYY 7HE REPAIRS WWALL INCY!/OE RE-.SHELL/NGs \ nN AND HAN,0 RING C�'SJ'IELL DRIWWAY. \\ tiYo EXISTING HYDRANT �. HOv 19• �'',, T.H. I I EXISTING TEST PIT <11 �/ CB FOUND o CONCRETE BOUND I \\ Rp�`4�' j I I VEGETATED -'' PIPE IRON PIPE S68 1$• BR\C� � � `"'� �'' LNG uNE FOUND 9• POST & RAIL- / LAWNpp \ A2ARa �1oN GENERAL NOTES. CB PARCEL 61 �� \ I _ _ __`_`_-- FOUND N/F ��'' \ `, f` T _ �, 1. ASSESSOR'S INFORMATION: MAP 141, PARCELS A & B, LOT 90 BRIGID H. DOHERTY, TR. -� \ DRIVEWAY _ ��\ 2. FLOOD ZONES: X & 0.2% (FEMA MAP 25001CO544J) po' �p �G `� 3. ZONING DISTRICT. RC •10"w /;y �No U N 4. OVERLAY DISTRICT. AQUIFIER PROTECTION OVERLAY DISTRICT �p, gV\�A o I / S�Z BENCHMARK: r o TOP OF HYDRANT 5. LOT COVERAGE BY: �• I pF ° EL. 19.62' A. STRUCTURES: 1,752 S.F./16,376 S.F. = 10.7% / WATERCB 6. STREET ADDRESS: MAIN STREET S2•g6' // Ep GATE FOUND (A � 7. HOUSE NUMBER: 584 8. TOPOGRAPHIC INFORMATION COMPILED FROM AN ON THE GROUND SURVEY O PO PIPE 9. ELEVATIONS SHOWN ARE BASED ON NORTH AMERICAN VERTICAL DATUM 1988. R FOUND CwCBp ` FOUND v PLOT PLAN SO FOR #584 MAIN STREET �Q PREPARED FOR 2 BARNSTABLE HIARBOR BUILDERS ��. OSTERVILLE MA PLAN DATE: AUGUST 25, 2017 PLAN SCALE: 1.,=20' CIVIL ENGINEERING * O r T WETLANDS PERMITTING j H OFF` ' WASTEWATER DESIGN COASTAL ENGINEERING °ass MICHA£LJ. yG TITLE B PLOT PLANS PIERS AND DOCKS d BORS£LLf U �rT�T CIVIL LAND USE PLANNING vj j�EER COMMERCIAL/RESIDENTIAL 20 0 10 20 40 No,35054 Se-Mg Cope Cod and Sar&W$t*M MaiWahasetts S� SCALE: 1 INCH = 20 FEET 17 ACADEMY LANE, SUITE 200 FALMOUTH, MA -- 02540 -- 508.495.1225 PROJECT NUMBER: 17047 CAD FILE NAME: 17047SP DRAWN BY. L.M. SHEET 1 OF 2 I I f7N1.9V QPALE,SK"ALL SE 2X M/N/MUM OWR ALL .SE"PAC SYSTEM aWPA1/ENTS ZI-W 4 A914 SOVEDULE 40 Ply' 6W CAST/ROV P/PE 20'M/N/MUM SETBACK fJPUI/EDGE"Ac'STANE TO Ll�LLAR WALL -SOIL :TEST REM004ecE COVFRs sEr 10 M/N/MUM SWTBAQ'r REMO{1ABLE 0012'RS S25 T TO NfIWIN f7N/.SJY 6"GF Date of soil test: 8/15/17 6" F1N/.SJS� GRALTE('TOTAL GYM'�f1 T12 WHIN GDPADE fM/N. A-2)7ary =16.0 f Test taken by. MICHAEL BORSELLI, P.E. EZE"t! =180 f ELEY =>7.5.t Results witnessed by. DON bEMERS i Percolation rate: < 2 MIN./INCH Ground water NONE EZE 16. f QQADE .r'MA . /NY ELEY =12.17 2"LAYER O-1/S" lO 1/2" TEST HOLE 2 1500 GALLON ����� wrRRSr wAswEo srOVE " TEST HOLE #1 # SEPTIC TANK o®® O oa®® Q 0 17.0 0 17.0 c A h h ®®®®®®®®®®®®® O/A » / ST. BOX SZOPE I�AR/ES ®®®®®®®®®®®®® 18" 15.5 18 15.5 , q , S - .Of M/N. ELEY = 10.17 W W N 4 �' F P{�C INSTALL .T/4f'70 1 1/I'DIG!%BY.E 22" E 15.2 22" E 15.2 W e e SET SEPT7C TANK AND D/STR/BUTTON BOX t. �A Xf"M, OWISVED SIZWF ALL LOAMY SAND LOAMY SAND ON 6 LAYER OF CRUSHED STONE � ti, , PIPE YA; "T"FOP AR61W O VAWDU AW DI0111V '� » 10 YR 7/6 » 10 YR 7/6 W O9SERt�AAAV PO4T )D 7NE BO17aw i2r 7AF OVANW? 48 13.0 48 13.0 _ W � i., � S13'lfa/. iPEfL7P 1Tl LAlLY/T'Ar C1 C, SY51E�f/FUP*APE DETAILS LOAMY SAND _ LOAMY SAND 60" 2.5 Y 6/4 12.0 60" 2.5 Y 6/4 12.0 NOT TO SCALE (BOT7ta!/ a- TEST HGi!E EL. -so,) C2 C2 J - REMOYA"24 f'01A. GOWRS REMOYABLE 24'0/,4. GYJ WP COARSE SAND COARSE SAND ; ,. - y : , ,„ ..•.. 2.5 Y 7/4 2.5 Y 7/4 ':. • .•_ ,• - .. ..• - : . . .. 7EE LIEN AT 7LV' SET 132" 7.0 132" 7.0 INLET KNOIGY(alr 3"MIN. fRQI! TANK CD�£R L/ J GY/7LET KNOG aIr ` r JNLEr 7EE SET GY/11ET TEE SFT 10"Aft. BELOW 14"BELOIF LIall'o L 6-;a LIalJo LEW p TEST HOLE #3 TEST HOLE #4 cAs eAFFZE I �0 4" Ob 17.0 0" 17.0 '� ¢, h 2 - OUTLETS 1 3 4 �I I y. ,•' / " OUTLET 18" 0/A 15.5 18" O/A 15.5 `� It 9 O INLET TYPICAL OF 5 00- INLET 22" E 15.2 22" E 15.2 4 cv N B B 6" 4. 8" LOAMY SAND LOAMY SAND 10 YR' 7/6 10 YR 7/6 :�.. " a.. t .<. •. .� .:..� 4 2 - OUTLETS 48 . 13.0 'Q 13.0 24 10'- 0' 24" LOAMY SAND LOAMY SAND i 60" 2.5 Y 6/4 12.0 60" 2.5 Y 6/4 12.0 10'- 6" 5' - 8" PLAN VIEW CROSS-SECTION coARSE SAND coAR E2sANo 1500 GALLON SEP11 (H-10 LOADING) DB-5 DISTRIBUTION BOX (H-20 LOADING) 2.5 Y 7/4 2.5 Y 7/4 NOT TO SCALE NOT TO SCALE 132" 7.0 132" 7.0 8 - 3 ,/rsm BASIS FOR .DESIGN: rorAL 41L Y fZON/S BASED ASV 3 BEDROOW$ NO GARBAGE,01-90 4L ' OF A4 70,rW DA/L Y FLOW- 110 6MI&6 R"X 3&WOWS = .UO GPD ® ® ® ® ® ® ® ® ®_® ® ® ® " '�,P1� Ass " ® ® ® ® ® ® ® ® ® ® ® ® ® 34 1 � y�ICHREtJ. qc�� B0771af/AREAPRGiPGLSEO = QB,T'x .Z:TS'= 295.8SF. CONSTRUCTION NOTES: 24 -d[ BoCIVIL LI SrDE AREA PROPOSW = K2 x 2 x 88.32 f 12 x 2.r -U..5, = 169..3.SF. ® ® ® ® ® ® ® ® ® ® ® ® ® av v 0.3 ., TOTAL LEAG�Y/NG AREA P� _ �f65.1 Sr 1. /NSTALLA77GW ar 771E PRGWOSEO -qcPI70 SYS'TFM STJALL BE/N AGl^GROAoVGE /NTH T77ZE 5 8 - 6 hA FF isT G�`� APPE104AGN RATE= 0.7f 6PD/.SF. AND )NE BOARD G'"HETH AL REGYILAGYV.S "A 2. THE G'GWIRACTI.7'P ST,�ALL DE7ERA/JNE 7NE LOCA77UN L�' 7h/E IYATER .SE"R19G�'AND �`�'�LEAQS//NG GAPALYTY= .74 Gi�O/.�x f6.r 1 .SJ�'_ ,3f�42 Gi�O � .3C30 Gi�O 1 CROSS-SECTION .21TPE IN ALL AREAS LESS' )WAN 10'FROW IHI-AWPOS M SEP170 SYSIFX! x 8# _ 6» J A cavy 6r 71le PLANS,SMALL BE,4vuABLE ON SJ7E FOP REfFRENa AT ALL 77MES DURING THE/NSTALLAAGW - 7NE SYSITM. .. x 7 ASEPTIC SYSTEM DETAILS • a .. f NO 01ANG-"S r0 7NE DESJ&V-WAU BE PDRFGS' 1V Of/Wa/r NE APPROI�AL Or 2?07N 5" KNOCKOUT FOR #584 MAIN STREET FALMGk/7X ENGYNWWN12i INC AND THE BOARD Or HEAL Th! PREPARED FOR 21" DIAMETER COVER BARNSTABLE HARBOR BUILDERS 5 THE S�PAC SYSTEM/S S7/B�,E�CT lU/N.SpECAGW BY FALMLX/7H E7Vl�'NEER/NG, INC AND T ll-BOARD Or HEAL 17L o IN 6 7NE 6WW,4Cr6W SHALL N071FYFALMLYJ77/ENGYNEER/NQ INC AND 7NEBMRD OFHEALTN I 5" KNOCKOUT 5" KNOCKOUT OSTERVILLE MA ro JNSOECr 1H£SEPnC SYSTEM/PR/OP 70 9400/LL. /N 5 W/E/NSrAN= V6WF NAN OW PLAN DATE: AUGUST 25, 2017 PLAN SCALE: AS SHOWN /N-9cFCT7ON MAY BE NEEDED. 1NE CO'VTRAC7i'a'P SS/ALL GWL Y BA W,U 7HE PGRI7OVS 0r NNE a S)s" 771AT 114 w amv/NSpEC1Eo AND APPR04ED BY FAL v6v1N ENGYNEERJNa INC AND THE BOARD Or HEAL 711 5" KNOCKOUT 7. CIVIL ENGINEERING �T � o r 7� WETLANDS PERMITTING JF T7JE COVTRACr6W DV6WNTERS ANY YAR/A7JOVS/N SJ7E CGWo/)70V9 MOM AS DIFFERING WASTEWATER DESIGN C, l.�1Vi lJ j T COASTAL ENGINEERING sa&T ravo ,4AvY, N£7LANOS a? omo? emo/AGWS 7NA T MAY REalmr RE-eyw11A)76W Or :• .: 1 THE OE.9'G V, 7NE COVIRACTOP SJYAU INVEDYAIEL Y CGWTACT FALMGY/1N Ma0%ffZW1NQ INC TITLE 5 PLOT PLANS � �}�` PIERS AND DOCKS CLAN VIEW �GINEER�� LAND USE PLANNING COMMERCIAL/RESIDENTIAL 500 GALLON LEACHING CHAMBER (H-10 LOADING S�rwbg Cve Cod 0/70,-15butbeastm" 'vm" %v$v is NOT TO SCALE 17 ACADEMY LANE, SUITE 200 -- FALMOUTH, MA - 02540 - 508,495.1225 PROJECT NUMBER: 17047 CAD FILE NAME: 17047DT DRAWN BY: L.M. ISHEET2 OF 2 i