Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0612 MAIN STREET (OST.) - Health
612 MAIN STREET, OSTERVILLE - - A= 141 061 TOWN OF BARNSTABLE j LOCATION SEWAGE# VILLAGE IGLU/L L 0 ASSESSOR'S MAP.&PARCEL%4/l 6 f f INSTALLER'S NAME&PHONE NO. �// O?�ij� YO7, a5-O ' IA2 T SEPTIC TANK CAPACITY LEACHING FACILITY:(type) f- 0 SQ��S (size) l c� NO.OF BEDROOMS OWNER E PERMIT DATE: 3 COMPLIANCE DATE: Separation Distance Be een e: Maximum Adjusted Groundwater Table to the Bottom of Leaching'Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist orf` " �/ site or within 200 feet of leaching facility) / i Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY w i I w , No. V 1 - I rD, Fee I v� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 4pf ration for Mispo8al fps m Construrtfun Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) b n( ) ❑Complete System ❑Individual Components Location Address or Lot NoC)d_ 5 wner's Name,Address,and Tel.No. Assessor's Map/ParceI K,/j V1 — , ZFA1,F 7:5_ooV 9,S Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. lk)&L-r a v rch - LS'bK o2 7- . Cb2 a) GGE G�Ss�C: Type of Building: Dwelling No.of Bedrooms� Lot Size sq.ft. Garbage Grinder(� Other Type of Building A11A No.of Persons Showers( ) Cafeteria(--}- Other Fixtures Design Flow(min.required) ® gpd Design flow provided C;7 3 , y gpd Plan Date I _ Q q SCO Number of sheets Revision Date Title S/!/'F — $ 4,,/+6- R4hX Size of Septic Tank _: Type of S.A.S. Description of Soil 57 Nature of Repairs or Alterations(Answer when applicable) lOKA / 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 an t to place the system in operation until a Certificate of Compliance has been issued by this Board He Signed Date O Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued L b .� No. ( Fee / �� THE COMMONWEALTH OF"MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Misposal bpsidn Constructton Permit Application for a Permi-,to Construct'( ) Repair( ) Upgrade( Aban on( Y. ❑Complete System ❑Individual Components Location Address or D)t No f O vdec's Name,Address,and Tel.No. Assessor's Map/Parcel — Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 7� E`GEs� soG . Type of Building: / Dwelling 1`o.of Bedrooms Lot.Size/ l" �.1 _ sq.ft. Garbage Grinder(—) Other Type of Building A No.of Persons Showers( ) Cafeteria.(,)- Other Fixtures / t Design Flow(min.required) (} gpd ' Design flow provided / 23 gpd Plan Date . _ qn Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil en g2v4j, Nature of Repairs.or Alterations(Answer when applicable) 71 L L a 4'101=7 1 s 7 l _ Date last inspected:' ` f " 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 tint to place the system in operation until a Certificate of Compliance has been issued by this Board o Healt . igned Date O Application Approved by Date Application Disapprove]by Date for the following reasons ,r _ Permit No. - � I 1 Date Issued L s ---- :--.--—-.----- ------- ----------- - -------_,-_--- ---------------- --. - ---- - ----- -------------------------------- Thi'E COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance �- THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(�) Abandoned( )by Sono IZZ 5 at OSI C LK alias been constructed in accordance with the/protops' T_ e 5 an e r Doo isposal System Construction Permit No;:�t 1_' (1 a-. dated �) 5�) 3 Installer Designer #bedrooms Approved design flo �/"- `� gpd The issuance of this permits a�lI noot`be co?nstrj as ' Luarantee that the system will fu tion as designe . Date `7 //'?" 7 / Inspec Gr. C / / .•�' , ,��No. / a r Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS y Disposal fppstrm Construction permit Permission is hereby granted to Construct( ) Repair( ) Upgrade(� Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must a completed within three years of the date of thLby Date Approve r P k 27208 rr _ P9 206 T 1 S66S 3 1S 2r-�13 a 49:26cx DEED RESTRICTION WHEREAS, Rene F. Jones and Brigid H. Doherty, of 21 Longleat Parkway, Eggerstville New York 14226, are the owners of the property known and numbered 612 Main Street, Osterville, Barnstable County, Massachusetts 02655 and described in a deed recorded with the Barnstable County Registry of Deeds in Book 26926 Page 219, and shown on a plan of land entitled"Plan of land in Osterville, Mass. Surveyed for John W. Williams Scale 1 in—40 ft 1925. Nelson Bearse—Surveyor—Centerville", recorded with the Barnstable County Reg Deeds in Plan Book 15, Page 47; istry of WHEREAS,Rene F. Jones and Brigid H. Doherty,as the owners of said property,agreed with the Town of Barnstable Board of Health to a restriction as to the number have of bedrooms which can be included in any home built on said property as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code,Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; and WHEREAS,the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.000, State Environmental Code, Title V,Minimum Requirements for Subsurface Disposal of Sanitary Sewage and authorizing the issuance of a building permit for the construction of a pool associated with the single family home with all appurtenant accessory structures, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the property be put on record with the Barnstable County Registry of Deeds by recording this document; NOW THEREFORE, Rene F. Jones and Brigid H. Doherty do hereby place the following, restriction on said property in accordance with their agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: 612 Main Street, Osterville,MA may construct upon the lot a house with appurtenant accessory structures containing no more than six(6) bedrooms. Rene F.Jones and Brigid H. Doherty agree that this shall be a permanent deed restriction affecting the property e located at 612 Main Street, Osterville, MA, more particularly described in a deed recorded with the Barnstable County Registry of Deeds in Book 26926, Page 219,and shown on a plan of land entitled"Plan of land in Osterville, Mass. Surveyed for John W. Williams Scale 1 in-40 ft 1925. Nelson Bearse-Surveyor—Centerville", recorded with the Barnstable County Registry of Deeds in Plan Book 15,Page 47. The foregoing restriction shall remain in force only so long as the property is serviced by a. private septic system, and said restriction shall terminate and be of no force and effect upon connection of the property to a public sewer system. Additionally, if the owner of the property ` upgrades to the existing septic system to accommodate seven (7)bedrooms,this restriction shall be amended to reflect a seven(7)bedroom deed-restriction. c Executed under seal this & day of March,2013. Rene F.Jones Brigid H.Doherty STATE OF NEW YORK County On this 13 day of March 2013, before me, the undersigned notary public, personally appeared Rene F. Jones and Brigid H. Doherty, and proved to me through satisfactory evidence of identification, which were(.?,g?am eaL, 1!4-tD,-A� to be the persons whose names are signed on the preceding or attached document, and acknowledged to me,that they signed it voluntarily for its stated purpose. Notary Public I My commission expires: {nVIIC.M f"YK M i q. �AMof"M� � NIyODaw�efo�►�gihes �� . tq r s \\ mow ewn o \ i 3 waem. a er.+em.w 3 _ o�n►w+ ,ipyb I d* p,..,.b, ? , D p �Ili Haii Lean � I it I o I n p I o i i ❑ • i l 4 ❑ ` O 60'x6a'-Pjay Lawn - i i + A + ♦ + r r + r + r r + fl �lamas ` i 4 Main Street Preliminary Landscape The Jones Residence 612 Main Street,Osterviile By:Philip L Cheney 5oS-394-1373 Scale:1"=1o'-o" 12/21/2012 ri Town of Barnstable Regulatory Services Thomas F. Geiler, Director ���• i Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: — /3'` Sewage Permit# O'assessor's Map/Pa'rcel ��� Installer& Designer Certification Form Designer: wE 44� - dais Installer: Address: 5V-7 Address: On i4�-cvr was issued a permit to install a (date) (installer) . septic system atf/Z '64"% J based on a design drawn by (address) dated 7 (designer) 4 k I certify that the septic system referenced above was installed substantially,according to the design,w-lich may include minor approved changes_such as lateral relocation of the distribution box and/or septic tank. :Stripout (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)ibut in accordance with State & Local Re i ns. Plan revision or, certified as-built by designerto follow. Stripout (if requir ed and the soils were found satis ory. �� moo` DARREN M. Ir�a ri (Installer's Signature) t L tf G`/Ste,, jn ffl esi er's Si nature rj, (Affix Designer's Stamp Here) PLEASE RETURN TO B STABLE 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. gAoffice fomsWesignercertific:tion form.doc r 1.V TV 1■ Vl Lui AAv« — - • Department of Health,Safety,and Environmental Services Public Health Division Date 367 Main Street,I lyannis MA 02601 ` S eewvarests t _ Fee Pd.' ,B • �� Date Schedule T�me� i6 d _ a I „t } €'"k4 s ^j ^ �1 -• Y �. {�3 t 'ti - Soil'Suitabili ''Assessment`xor°S e'Disposal .4-- G Performed By: - ` �i ', `" —/' Witnessed By: ---� LOCATION & GENERAL INFORMATInON ' /1 Location Address Owner's Name ./ N�• �/�.4J AddressR Assessor's Map/Parcel: f'5i�.:.—_ ` Engineer's Name NEW CONSTRUCTION _ µ REPAIR Telephone# 7 ^� —S AJ Land Use / ,uy/�� Slopes(0/U)- Surface Stones ti(F ,y Distances from: Open Water Body> �Cx� ft t,Possible Wet Area ft, Drinking Water We1J� Drainage Way �� '� {ft Property Line 7 A> �ft '{Other SKETCH:(Street came,dimensions of lot exact locations of test holes&pert tests,locate wetlands in proximity to holes) t. j; , ..iy by .. t"t#•1K�, „���'.£._a r °;'�.ro ��Yj,r�-� �,.° �'� "J {-.-.. ._ .. - ,�.. } Parent material(geolog.c)c^ /Ae-%c- ca�T1 s� Depth to Bedrock Depth to Groundwater:RStanding Water in Hole: ��.G/ '. ' "` Weeping from Pit Face n��i9, Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER T'ABL, ,,,,741. Method Used: Depth Observed standing in obs.hole: in. Depth to'soil mottles: ' '� 4-` ' in. -� Depth to weeping from side of obs.hole: in. Groundwater Adjustment Index Well# Reading Date:_ Index Well level. Adj.factor " "'' Adj.Groundwater Level— ' PERCOLATION TEST bete ! 7ime Observaiion ;t+ ,fir. .` m trv.c ' ,Q Hole# , r`0; ,,Time at 9", , Depth of Perc° p Time at 6" {' Start Pre-soak Time @ J ' ! Time(9,6>.) ¢: ' • End Pre-soak �. /��d R• F rt Rate Min./Inch Site Suitability Assessment: Site Passed• .� Site Failed: Additional Testing Needed(Y/N) Original: Public Healtl;Division-". Observation Hole Data To Be Completed on Back----�. Copy: Applicant DEEP OBSERVATION HOLE LOG Hole# Soil Co'lor Soil other Depth from Soil Horizon Soil re (Mi nsell) Mottling (Structure,Stones,Boulderes.- Surface(in.) Con istency.° o &IP� r � I IV r DEEP'OBSERVATION HOLE LOG Hole# 2_ Other Depth from {' Soil Horizon I Soil Texture Soil Color ( A4'ttGn rctnsctEere,Stores,Boulderes. Surface fin., I (!JSDn) z:rse.., g n istency.° ry to 1�R3`v to 4YK, �l60 2.s Z1,3 U DEEP OBSERVATION HOLE LOG Hole 4 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. n i DEEP OBSERVATION HOLE LOG Hole# Soil Horizon Soil Texture Soil Color Soil other (USDA) (Munsell g eres. Depth from Mottling (Structure,Stones,Bould Surface(in.) ) ° l I Flood ln§ura ce Rate Man: / Above 500 year flood boundary No Yes Within 500 year boundary No z Yes Within 100 year flood boundary No '// Yes ¢ Depth of Naturalll 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 pervious-material? Certification I certify that on �� ! (date)I have passed the soil evaluator examination approved by the Department of Environments Protection and that the above analysis was performed by me consistent with the required training, x ertise and////pyll(Axperience described in 310 CMR 151/ 43 017 e. ��� Date Signature ' COMMONWEALTH OF MASSACHUSETTS EXECUTIVE:OFFICE O.F ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL_ PROTECTION TITLE 5 OFFICIAL INSPECTIONTOR . -NOT'FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 612 Main Streets Osto ville, MA 02655 � Owner's Name:' i Paul Birn inQham x ` Owners Address: r 7P Date of Inspection Julie 29. 2012 J, Name of Inspector: (Flease Print) James M..Ford . U ;.. Company Name: Jain es M. Ford Mailing Address: P O.:Box;49 Osteiwille,MA:02655-0049 Telephone Number: (508) 862=9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.:The inspection.was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. :I am a.DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000.). The system: ✓' Passes onditionally Passes. ,.beds Further Evaluation by the Local.Approving Authority t ils' Inspector's. Signature; 1AAAA, Date: . Jul v 8,2012 The system inspector shall s bi ita copy of this inspection report to the.Approving Authority(Board of Health'or DEP)within 30 days of com ing.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 Folin ;. /15/2000. page l Page 2 of 11 OFFICIAL INSPECTION FORM .,NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.A CERTIFICATION (continued) Property.Address. E 612 Main Street g l. Osterville.MA Owner: Paul Birmingham Date of Inspection:` June 29, 2012 Inspection Summaryi Check A,B,C,D or E/-ALWAYS complete all of Section D A. System Passes:. z I have not found any information which'indicates that any of the5failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any'failure criteria not evaluated are indicated below. Comments: H B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to b1 . e replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board.ofHealth,,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 Goinplianee. indicating that the tank is less than 20 years old is available; t. i ND explain. } Observation of sewage backup or breakout or high static water level in`the'distribution box due to broken or•` obstructed pipe(s).or due jo'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 pipes) The system will pass.inspection if(with approval of the Board of Health): I broken pipe(s)are replaced obstruction is,removed ND r explain + 1 a s Page 3 of I 1 F f OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - . PART A .CERTIFICATION :(coritiriued) :Prop erty Address: 612 Main Street.'; ; Osterville.MA Owner: Paul Birni ink,win Date of.Inspection: June 29 2012 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'enviroriment. L Systern will ipass unless Board.of Health determines in accordance with 310 CMR 15.303 (i)(b)that the system is not functioning in a mariner,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 nail 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. , ' I The system has a septic tank and SAS and the SAS,is within a.Zone l 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 but50 feet'or more from a - private water,supply well**:' Method used to:determine distance' *This s'ysterl passes`ifahe;well water and ysis,''performed at a DEP certified laboratory,: for colifonri bacteria and-olatile 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:, ; s ' 3 I Page 4 of 11 OFFICIAL INSPECTION FORM-.NOT FOR VOLUNTARY ASSESSMENTS : SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 612 Main Street ` Osterville.MA Owner: Paul Birn in-ahain Date of Inspection: June 29, 2012 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 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 cespool _ ✓ 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. ✓ An,)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 qr privy is within a Zone 1 of a public well. ✓ And portion of a cesspool , privy is within 50 feet of a private water supply well. ` ✓ Any portion of a cesspoohor.privy is less than 100 feet but greater than 50 feet from a private water supply well with.no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is'free from pollution from that facility and the presence.of ammonia nitrogen and nitrate nitrogen is equal to or less than 5.ppm,provided that no other failure criteria are triggered..A copy of the analysis must be attached.to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 151303,therefore the system fails. The system owner should.contacf 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 inapped 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 oroperatorof 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 contactthe appropriate regional office of the Department. 4 Page 5 of.l 1 OFFICIAL INSPECTION.FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property t y Add ress: ess: 612 Main Street Osterville MA Owner: _ Paul Birmin-wham. .. Date of Inspection: June29. 2012 Check if the following have been done: You,must indicate"yes"or"no"as to each of the following.' 9 - Yes No Pu_hping 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? ✓ Ha- e 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? ✓ We re all system components,excluding the SAS;located on site? We-e 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(aiid occupants if different from owner)provided with information on the propef 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. Dete.rmi.ned in.the"field(if,any of the failure criteria related to Part C is at issue approximation of distance, is unacceptable) [3.10 CMR 15.302(3)(b)]. ' t ti. 5 .. Page 6 of.I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .. PART C SYSTEM INFORMATION Property Address: 612 Main Street Osterville, AM Owner: Paul Birmingham Date of Inspection: - June 29, 2012 FLOW CONDITIONS RESIDENTIAL 4. Number of bedrooms(design): 6+ j NumberHof bedrooms(actual): `6 DESIGN flow based.�n 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 Number of current re&idents: 2 Does residence have a garbage grinder(yes or no) N%d Is laundry on a separate sewage system(yes or no): N/a `[if yes separate inspection required] Laundry system inspected(yes or no): not" Seasonal use(yes or rro): no Water meter readings,if available(last 2:years usage(gpd)):'.' Unavailable Sump.Pump(yes or' 'no):_ 1Vo Last date of occupancy: Cttrrently COMMERCIAL/INDUSTRIAL Type of establishment Design flow(based or'310 CMR 15.203) gpd f. , -Basis of design flow(:,eats/persons/s' etc.): " r Grease"trap present(ys or no): Industrial waste holding tank present(yes or no)'' Non-sanitary.waste discharged to the Title 5 system(yes`or no):n' Water meter readings,if available: ; Last date of occupanc./use: OTHER(describe): i - GENERAL INFORMATION Pumping Records Source of information:" Unavailable Was system pumped as part of the inspection(yes or no):" If yes;volume pumpec:. gallons"--How was quantity pumped;determined? . .Reason for pumping: TYPE OF SYSTEM. ✓ Septic tank,distribution box,soil absorption system Single cesspODI -t Overflow.ces'pool Shared systetri(yes or no) (if yes,attach previous inspection"records if any)sy , , Imiovative/Al-ernative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system cwrer)' Tight,Tank Attach a copy of the DEP approval Other(describe): F Approximate age of all components, date installed(if known)and source of information: Date of installation unknown Were sewage odors detected when arriving at the site(Yes or no): No 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:% 612 Main Street Osterville.MA . Owner: Paul BirnrirZQhmn , Date of Inspection:. .June 29, 2012 . 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 condi ion of joints,venting,;evidence of leakage,etc:):, SEPTIC TANK: ✓. (locate on site plan) , Depth below grade: 9' Material of construct:on:. ✓ concrete _metal fiberglass _polyethylene _other(explain) If tank is metal list age:. Is age confirmed by a Certificate of Compliance,(yes or no): (attach a copy of certificate) Dimensions: 1 S00 zai. Sludge depth: , „ . Distance from top of.Mudge to bottom of outlet tee'or baffle:' `30" Scum thickness: 3, Distance from top of scum to top of outlet tee or baffle: 611 Distance from bottom of scum to bottom of outlet tee or baffle: 10,, How were dimensions determined: Measurini stick Comments(on pumpi ig recommendations,inlet and outlet tee or baffle condition structural integrity liquid levels as related to outlet mi,>ert,evidence of leakage;etc.), „ The tees were 12reser:t. The liquid level was even with the outlet invert There did not appm-to be any signs of leafage GREASE TRAP: . tVone (locate on"site plan) Depth below grade. y Material of constiucttr-in: _concrete =metal fiberglass _polyethylene _other (explain): Dimensions: Scum thickness:.. Distance from top of scum to top of outlet tee or baffle:. Distance from bottom Df 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 i Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESS MENTS SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address-: 612 Main Street Oster-ville,MA Owner: Paul Birmingham Date of Inspection: June 29,2012 TIGHT or HOLDING TANK: 'None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade Material of constru tion: _concrete _metal `._fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons -Design Flow: g allons/, a g Y Alarm present(yes or no): Alarm level: Alarm.in:working order(yes or no): Date of last pumping: y Comments(condition of alarm and float switches,etc.):. DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) . Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence"of leakage into or out o=box,etc.): The D-Box was nor-r-ial note caution when"dizging i4D the D-box the gas line is right next to the cover PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or.no): Alarms in working order(yes or no). Comments(note concition of pump chamber;condition of pumps and appurtenances,etc.): - L. 8 �. +... 1 Page 9 of 11 ' OFFICIAL INSPECTIO FORM'- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.0 SYSTEM.INFORMATION(continued) Property Address: 612 Main Street Osterville MA - Owner: Paul Birrninzhani Date of Inspection: June 29 2012 SOIL ABSORPTION SYSTEM(SAS) { ✓ (locate.on site plan,excavation not required) If SAS not locates.explain why: Type ✓ leaching pits,number: 3- 1000 gal. leaching c_zambers,number: ` leaching:galleries, number: ' leaching trenches, number, length; leaching fields, number, dimensions: overflow cesspool, number: Innovative`alternative system, Type/name,of technology: Comments (note coadition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Pie nits had Y of wafer on the bottom: Diem ivas no sign of failure from the Pits A camera was used to insvect CESSPOOLS: .None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert:. Depth of solids layer: Depth of scum layer:` Dimensions of cesspool: Materials of construction: Indication of groundwater.inflow.(yes or:no) Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation;etc) PRIVY: None. (locate on site plan) ' Materials of construction; Dimensions: Depth of solids:: . Comments{note condition of soil'r signs of hydraulic failure, level of ponding;condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECT'ION FORM PART C SYSTEM INFORMATION (continued) Property Address: 612 Main Street Oster ville.MA Owner: Paul BirnunQhain Date of Inspection: June 29, 201 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._ S vt on r Page 11 of 11 .f OFFI-CIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEMINFQRMATION (continued) Property Address: 612 Maiiz Street s. Osterville.MA x Owner: Paul Birmingham Date of Inspection: June 29, 2012 r SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groiuid water 25+/- 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): 77717-- ✓ Checked,with local Board of Health-explain: 'Tovozravhic and water contours maps Checked with local excavators,installers-(attach`documentation) Accessed USGS database-explain: You must describe how you established the high gromid water elevation: =Using Barnstable topographic and water cbntours trans�the mays were showing azir roximate1' 25 +/ to gt ound water at this site. . P 6 Till's report has been prepared only for the septic system and components described here This septic system has been iirspected aird passed as of,the date of inspection. This report isnot a.wa-ram or giea-aIwee.that the system will , f mc.lion properly in the fiitur•e. There have been no par r.•alities or guarmitees,erther expressed, written or implied relating to'the eptic inspection,ahis report andlor airy components of the septic system wlric/r ha-i�e.riot , been located and in pected. , - t . a A. " 4 " 11 Excerpt from the video of the Board of Health Meeting on November 12, 2002. Board Members: Dr. Wayne Miller, Chairman, Susan Rask, and Sumner Kaufman. Also in attendance, Thomas McKean, Director of Public Health Division. Transcribed on March 12, 2013 by: Sharon Crocker Administrative Assistant RE: Six or More Bedrooms Address: 612 Main Street, Osterville William Weller, Weller&Associates, was present. Mr. Weller reviewed his plan being proposed. He had identified 6 bedrooms and described the proposed septic system repair of replacing the D-box and some tees. Susan Rask stated there are seven bedrooms as the room marked"library" qualifies as a bedroom according to the health codes. Mr. Weller confirmed there is ample flow to handle the 7 bedrooms. The septic tank is 1,500 gallons and there are three leaching pits. Each pit is 6 x 10 with 2 feet of stone and handles 580/day/ea. The full capacity is 1,740 gallons. Ms Rask mentioned that Zoning may have an issue with the room with a wet bar as it could easily be converted to a second kitchen. Mr. Weller stated that the Building Department had already approved of the plan. Mr. McKean will confirm with the Building Department in the morning that they are ok with the wet-bar. Upon a motion duly made by Dr. Miller, seconded by Susan Rask, the Board voted to grant the approval of the plan (seven bedrooms acknowledged). (Unanimously, voted in favor.) Q:\MINUTES\EXCERPT OF MINUTES\Excerpt BOH Nov 2002 612 Main St Ost.doc AsBuilt ► Page 1 of 1 r TOWN OF BARNSTABLE Y :.t7C I0N L may hlt 5lr c r SEWAGE # ZON VILLAGE b'S.1 CC_1zi Ile- ASSESSO 'S MAP & LOT �' 6 INSTALLER'S NAME&PHONE N0. 2 SEPTIC TANK:CAPACITY �.�04 4rp l ly fD LEACHING FACILITY: (type) 3 /0001��S (size) NO.OF BEDROOMS BUILDER OR OWNER r PERMITDATE: COMPLIANCE DA Separation Distance Between the: �� t t^ '13oX a tt�� Gi5 V c✓,� 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 ,1 �dVS,e J =q ' 3W - 3. 3Y� http://issgl2/intranet/propdata/prebuilt.aspx?mappar=141061&seq=1 1/11/2013 TOWN OF BARNSTABLE �O' , 1iCN I eZ SEWAGE # Z003 d I ? 7iy VILLAGE d l CC LI I r- ASSESSO)'S MAP & LOINSTALLER'S NAME&PHONE NO. -42ZU SEPTIC TANK CAPACITY Z iD0 I H LEACHING FACILITY; (type) 3 /000 ,cka l n�`'!s . (size) NO. OF BEDROOMS BUILDER OR OWNER ! C>r PERMITDATE: f COMPLIANCE DA .2 Separation Distance Between the: ��� i1r n'1JoX lgca•G G.btred'i 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 360 feet of leaching facility) Feet h Furnished by a �y. 31 3y 3 r, �. No. 2W r7 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYtcation for Migonl bpotem Conotruction Permit Application for a Permit to Construct(V/)Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. t S Q (��i O}vnD �am Address an Te1.y" Assessor's Map/Parcel (O' l �J �/ Y/1, aller's e,Ad and T 1.No. t 5� �b� 3j Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of 3edrooms \ _ Lot Size sq.ft. Garbage Grinder(✓� Other Type of Building � w 6 Rixoa No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 550 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature oflepairs or Alterations(A swe when applicable) t; Date last inspecte Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been.issued by this Board of Health. Signe _ Date - - Application Approved by Date Z Application Disapproved for t e following reasons Permit No. ?cog--riq Date Issued 2 d' 2oU3-I e +a..No. '7 '`,. ?'�,' Fee F THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE} MASSACHUSETTS Rppricattori for Digonl *p5tem Congtruction Permit Application for a Permit to Construct(Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name;Address anO Tel.No. Assessor's Map/Parcel / Installer's Name,Addre s,anc Tel.No. IS� �J�z Jj� Designer's Name,Address and Tel.No. �o`rts�r�c-t►nh Ty V� u Type of Building: Dwelling No.of Bedrooms Lot Size+�T sq.ft. Garbage Grinder(L') Other Type of Building t ue)6e� Re" No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flows gallons per.day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil P r Nature-of }Repairs or Alterations(Answe when applicable) 1 Q V �1 Q1 tGt.A ,. Q 1 U 1'` 6 n{t D h r 10 li/t 1 A 7-,1 �. iG1d f J Date last inspected: rro Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system :F. in accordance,with the previsions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Iv Date Application Approved by ; Date Application Disapproved for the following reasons 1 + 1 Permit No. 2CO3- ►nfq Date Issued 412 406 ------------------ --- --------------- -- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance. THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( U)Repaired( )Upgraded( ) Abandoned,( )by C 00 GeplE C—o 7 at 41 2 n6 a i r C )r p y► � n I e r l.,'l l AA l� ?2-��"� 4` has been constructed'in a ordance with the provisionsof Title 5 and the for Disposal System Construction Permit No._M3—L7q dated Z, G Installer Designer The issuance of his pe it shall not be construed as a guarantee that the system a,designed. Date Z 6 Inspector --— — — -----------------------—--------- — �— Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC iHEALTH DIVISION - BARNSTABLE} MASSACHUSETTS Ii5po5al *pg;tem Construction Permit Permission is hereby granted to Construct( V/ Repair( )Upgrade( )Abandon( ) System located at 611 yvA a e K �,f e e j 0 c Te f tii d' ji/-A 0 0-2' and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constr cho/n ust be completed within three years of the date of this pe Date:_ �� 2�I C) Approved by v • /A/ • 1�,x 3�' � �o cf.w,asa ri � �N6RovND 35' �RoQoS� O pE� . �{' Q O o RaO a �RTES N o CERTIFIED �L�� F'Il I CERTIFY THAT THE SHOWN ON THIS PLAN IS LOCATED ON _--- THE GROIIND .AS SHOWN HEREON AND THAT IT CONFORMS TO THE MIlVIMUM �,._ P 35 M•9�c' iyl� ,ca9.�: �/ BUILDING SETBACK REQUIREMENTS OF THE TOWN OF,6 e- PREPARED FO G 9 VEN SCALE: 1" suR Weller �-& AsSOciat 1"5 Falmouth Rd.—Suite 4C Center dle,Ma.eM32 (546).775-4135 N IKIErqy, Town of Barnstable RARNSTABM 9 39. Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,MSPH • Wayne Miller,M.D. BOARD OF HEALTH MEETING AGENDA Tuesday November 12,2002 Basement Conference Room School Administration Building x 230 South Street, Hyannis, MA 7:00 P.M. I. Wastewater Treatment Plant Capacity Limitation—Robert Burgmann, Town Engineer and Mark Giardano,Special Projects, Department of Public Works 11. Continued Business: A. Dennis Cotto-Hawthorne Condominium, 272 Craigville Beach Road, Hyannis,one of the two existing septic systems failed inspection, 40 bedrooms total in the entire condominium complex, requests permission to repair the failed system with a conventional Title V system. B. Edward Stafford - Proposed Building at 195 South Flint Rock.Road, located within 3,000 feet of a town sewer line, variance requested from Part Vlll, Section 6.0. C. Myer Singer-Cape Cod Five Cents Savings Bank-209 Falmouth Road, Hyannis, requests permission to use holding tank until December 31, 2003. III New Business Tim Driscoll-93 Ocean Avenue Centerville, septic system repair IV. Six or More Bedrooms William Weller—612 Main Street Osterville, renovations proposed to garage/dwelling unit , existing septic system inspected and "passed" according to Michael O'Loughlin. V. Micheal McGrath, P.E."= Update regarding RUCK systems at Falling Leaf lane, Osterville. VL Thomas Broadrick, Planning Director- Presentation regarding proposed revisions to Town Ordinance Article XLVII, Regulation of Wastewater Discharge. DATE: 'n I G• s FEE: G(2vM J' • 8"NSTAHLE Y KAS& 059. `0� REC. BY .Town of Barnstable SCHED. DATE: Board of Health 200 Main Street,Hyannis MA 02601 Office: 508-8624644 Susan G.Rask,R.S. 'r FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Wayne A.Miller,M.D. VARIANCE REQUEST FORM LOCATION Property Address: :57.— L- Sr- Assessor's Map and Parcel Number: Z:EZ--- 90 Z Size of Lot: J Z Z 3 T 5 Wetlands Within 300 Ft. Yes Business Name: No 4,`- Subdivision Name: APPLICANT'S NAME: Phone '. Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSON Name: ,UG 8/�il�/•�JG/�,9.y Name: 1/ 441ee-1 Gv�'G G cal 7 .;-5 rsc, Address: 44ddress:_�a .Ses'C 51.17 Phone: 8 Z — yZ Z� Phone: —'527>E3- VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) NATURE OF WORK: House Addition ❑00000 9miCe Renovation Repair of Failed Septic System 0 Checklist(to be completed by office staff person receiving variance request application) _ Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e g.septic system plans) _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) T Variance request application fee collected (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/leasee only],outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Wayne A.Miller,M.D. Q:\HEALTH\WPFILES\VARIREQ.DOC R - _ y o + R ---�Ro�OpsE'O o , pEv` N , o b 82' CERTIFIED PLOT PLAN TIFY THAT THE SHOWN ON THIS PLAN IS LOCATED ON LFO THE GROUND AS SHOWN HEREON AND 357Z /t-4,4',WTHAT IT CONFORMS TO THE MINIMUMBUILDING SETBACK REQUIREMENTS OF THE TOWN OF PREPR _ y-s/oE W. N ?� / 7,P Z m SCALE: i" _ '�"o ' S y o o RUMBA 7 Weller & Associates ' °' � "► - t4 - Z 1645 Falmouth Rd. -Suite 4C Centerville, Ma. 02632 (508) 775-0735 October 9, 2002 I hereby authorize William Weller, from Weller & Associates to represent me before the Barnstable Board of Health with regard to my property at 612 Main Street, Osterville. Paul Birmingham s Commonwealth of Massachusetts Executive Office of Enviroiunental Affairs Dept. of Environmental Protection One winter Street Boston Ma. 02108 .Jolui Glt�ci ' MY,Title V Septic Inspector P.O. Box 2119 ' 1 Teaticket, MA 02536 WILLIAM F.WELD (508)564-. Governor ARGEO PAUL CELLUCCI Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 612 Main St.Osterville Map 141 Lot 61 Address of Ow6er: Date of Inspection: 8/24198 (If different) Name of Inspector: John Graci 7 Cooper I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name,Address and Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this.address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: x_. Passes This Inspection Is based on criteria defined In Title V Conditionally Passes code 310CMR16.303.My findings are ofhow the system Is performing atthe time ofthe Inspection.My Inspection does _ Needs F rt r Evaluation By the,Local'Approving Authority not Imply anywarrentyor guarantee ofthe longevity ofthe. Fa11, septic system and any of Its components useful life. I 3,i r Inspector's Signature: Date: 8124198 The System Inspector shall bmit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authori y. INSPECTION SUMMARY: r QD P16EEIiVEO �® Check A, B, C,or D: /a .q A] SYSTEM PASSES: AUG .h . 99+$ t� TOWN OF BARNSTABLE x I have not found any information which indicates that the system violates any of the failure criteria ;{{ HEA defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. LTHDEPT. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes, no, or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Co7hpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection-,or the septic tank,whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltfation,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04127)97) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 a Telephone(617)292-5500 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 612 Main St Osterville Map 141 Lot61 Owner: Cooper Date of Inspection:8124198 — Sew.aae backup or.breakout or high static water level observed.in.the'distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced _The system required pumping more than four times a year due to broken or obstructed pipe(s). They system will pass inspection if(with approval of the Board of Health)` broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by theBoard of Health in order to determine if the' system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND,.. SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a'surface water. Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 160 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. — The system has a septic tank and soil absorption"system and the SAS is less than,100 feet but 50 feet or more from a . private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that, the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: - You must indicate either"Yes"or"No"as to each of the following' I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage in`facility or system component due to an overloaded or clogged SAS or Cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged . cesspool. ` ` _ SAS is in hydraulic failure. y (revised 04117)97) SUBSURFACE SEWAGE DISPOSAL SYSTEiINSPECTION FORM PART A CERTIFICATION (continued) Property Address: 612 Main St osterville Map 141 Lota1 Owner: Cooper Date of Inspection:snalss!; D] SYSTEM FAILS(continued) Yes No # _ 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 1/2 day Mow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers 3f times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater .elevation.- - — Any portion of a cesspool or privy is within 100,feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well'. ' Any portior 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 f— eet bu t greater than 50 feet from a private water ate=supply w acceptable water quality analysis.* at Y well with fno o ._ q Y Y If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bai:teria,volatile or compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: - Y The following criteria apply to large systems in addition to the criteria: The system serves a'acility with a design flow of 10,000 gpd or greater(Large System),and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist:. 6 Yes No the system ie within 400 feet of a surface drinking water supply " the system isAwithin 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 Il of a public water supply well) The owner or operator of any su,.h system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5,00 and 6.00. Please consult the local regional office,of the Department for further information. (revlsed OR27197) 1 , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM, PART B CHECLIST { Property Address: 612 Main St Osterville Map 141 Lot 61 Owner: cooper Date of Inspection:8124198 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: _c_ — Pumping information was requested of the owner, occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal flow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this inspection. - x — As built plans have been obtained and examined. Note if they are not available with N/A. x — The facility or dwelling was inspected for signs of sewage back-up.;. x The system does not receive non-sanitary or industrial waste flow. —x— — The site was inspected for signs of breakout. x All system components,excluding the Soil Absorption System, have been located on the site. x The septic tank manholes were uncovered;opened:and the interior of the septic tank was inspected — , for condition of baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge,depth of scum. x _ The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, If different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. a e x — Existing information. Ex. Plan at B.O.H. f x Determined in the field(if any failure criteria related to Part C is at issue;approximation of distance'is unacceptable)(15.302(3)(b)) 2 (revised 04127197J b ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 512 Main St.Osterville Map 141 Lot 81 - Owner: Cooper Date of Inspection:9124196 FLOW CONDITIONS RESIDENTIAL: Design flow: 440 g•p•d.'bedroom for S.A.S. ; Number of bedrooms: 4 " Number of current residents: z Garbage grinder(yes or nog: No Laundry connected to system(yes or no): yes Seasonal use(yes or no): 1w Water meter readings, if available:(last two(2)year usage(gpd): Na Sump Pump(yes or no): No Last date of occupancy: nia 4 COMMERCIAL/INDUSTRIAL F Type of establishment: nia Design flow:o gallons/day n Grease trap present: (yes or,no) No Industrial Waste Holding Tan,(present: (yes or no) No r Non-sanitary waste discharged to the Title 5 system:(yes,or no) No Water meter readings,if available: n1a Last date of occupancy: n1a OTHER:(Describe) Na Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Ne , System pumped as pErt of inspection: (yes or no).No If yes,volume pumped:o gallons Reason for pumping: va TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system ._ Single cesspool . Overflow cesspool r ., Privy. Shared system(yes d no) (-if'yes, attach previous inspection records, if any) ' I/A Technology etc'.Co;,y.of up to date contract? ' Other: APPROXIMATE AGE of all comionents, date installed(if known)and source information 1996 Sewage odors detected when arriving at the site: (yes or no) No (revised 0427197) ;# SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM :F. PART C SYSTEM INFORMATION (continued)' Property Address: 512'Main St.Osterville Map 141 Lot61 h Owner: Cooper Date of Inspection:8/24t98 SEPTIC TANK: x (locate on site plan) Depth below grade: S„ Material of construction:r concreate metal ,FRP Polyethylene_other(explain) If tank is metal, list age r±a .1s age confirmed by Certificate of Compliance No (Yes/No) Dimensions: 1.1016"H57••we s° Sludge depth:a„ - Distance from top of sludge to bottom of outlet tee or baffle: 23 Scum thickness:o r Distance from top of scurr to top of outlet tee or baffle:s Distance form bottom of scum to bottom of outlet tee or baffle:a How dimensions were dete mined: measured Comments: - r (recommendation for pumping,condition of inlet and outlet tees or baffles, depth'of liquid level in relation to,outlet invert, structural integrity, evidence of leakage, etc.) Se tic tank and all components are structural) sound and runctlonln `p p y g properly.Recommend pumping every years. , GREASE TRAP:_ (locate on site plan) Depth below grade: rda Material of construction: concrete metal FRP Polyethylene_other(explain) Dimensions: rya — Scum thickness:rva Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scup to bottom of outlet tee or baffle: rda Date of last pumping;(, Comments: f r (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) BUILDING SEWER: t. (Locate on site plan) Depth below grade: 1- Material of construction:_cast iron x 46 PVC- other(explain) Distance from private water supply well or suction line? r s Diameter: a' E Qmments: (conditions of joints,venting,evidence of leakage,,etc:) (revised04127197) „f r; SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 612 Main SL Osterville Map 141 Lot61 Owner: Cco er 1 p Date of Inspection:8124198 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: r9a Material of construction:` concrete—metal_FRP_Polyethylene_other(explain) Dimensions: nra s Capacity: nla gallons Design flow: rda gallons/day Alarm level:_nia Alarm in working order?_Yes No . Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) Ma - - - DISTRIBUTION BOX: x a (locate on site plan) Depth of liquid level above outlet invert: liquid level vvithbottomofpipe: Comments: t 1 (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) D•Box Is structurally sound. - -- PUMP CHAMBER: i (locate on site plan) ; Pumps in working order.(yes �r no)No Alarms in working order(yes or no)_ve: `. Comments: F (note condition of pump chamber',condition of pumps and appurtenances, etc.) nta 1 (revleed 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ; PART C SYSTEM INFORMATION (continued) Property Address: 512 Main St Osterville Map 141 Lot 61 Owner: Cooper Date of Inspection:8t241913 SOIL ABSORPTION SYSTEM(SAS):x (locate on site plan, if possible;excavation not required,•but may be approximated by non-intrusive methods)' If not determined to be present,explain: Type leaching pits, number: three 1000 gallon leach pits. " - leaching chambers, number:Na leaching galleries.number: Na leaching trenches, number,length: Na leaching fields, nL�mber, dimensions:Na overflow cesspoo;, number:Na - Alternate system. . Na Name of Technology:_Na Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) Leach pits and all components are structurally sound and funetloning properly. - e CESSPOOLS: (locate on site plan) „ Number and configuration: l Na Depth-top of liquid to inlet invert: nla Depth of solids layer: Na Depth of scum layer: nla Dimensions of cesspool: " Na r Materials of construction: Na '•. Indication of groundwater: n1a inflow(cesspool must be pumped as part of inspection) 4 Na Comments: (note condition of soil, signs of hydraulic failure,level of p6ndi6g;•condition of vegetation, etc.) Na PRIVY: (locate on site plan) Materials of construction: Na 'I_ Dimensions rda ` Depth of solids: n1a Comments: (note condition of soil,signs of hydraulic failure',level of ponding,condition of vegetation, etc.) Ne (revised 0427197) it l l _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 612 Main St Osterville Map 141 Lot 61 Cooper 8124198 SKETCH OF SEWAGE DISPOSAL SYSTEM: ,Y include ties to at least two permanent references;landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) AA P'D Pe 1� Of H (revisedW27197) Page P of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 612 Main St.Ostervllle Map 141 Lot 01 Cooper 9124198 , a Depth of groundwater 12 Please indicate all the methods used to determine High Groundwater Elevation; Obtained from design plans on record Site(Abutting property,observation hole, base ment sum etc. Observation of Sit p ) ( 9p P Y , Determine it from local conditions Check with local Board'of Health Check FEMA Maps h Check pumping records Check local excavators, installers' X Use USGS Data Describe in your own'words how you established the High Groundwater Elevation.(MUST be completed)' USGS Maps and Charts F (revlaedW27W) x " - -page 10 OL 10 . b Town of Barnstable .�rts�nacs, Board of Health P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,RS. FAX: 508-790-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. November 21, 2002 Mr. William Weller Weller and Associates P.O. Box 417 Centerville, MA 02632 Dear Mr. Weller, You are granted permission, on behalf of your client Paul Birmingham,to connect the proposed renovated garage/guest suite to the existing soil absorption system at 612 Main Street, Osterville with the following conditions: 1. The applicant shall obtain permission from the Building Division prior to any construction work to the garage/guest suite. The Board members questioned whether there would be a zoning violation regarding the potential additional dwelling unit at this property. 2. A licensed disposal works installer shall be hired by the applicant to obtain a disposal works construction permit and to properly replace the piping,to replace the distribution box, and to redirect the sewer pipe into the septic tank. Si erely yo , a e Miller, M.D. Cha an BOARD OF HEALTH TOWN OF BARNSTABLE Q:HEALTRVP/Sixbeds ti COMMONWEALTH.OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: Owner's Name: Owner's Address: Date of Inspection: 0 31 p 1\ 1 Name of Inspector: (please print) LD i(� 0j j,r�'v Company Name: Mailing Address: Telephone Number: -7'1 Ll CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant/Passes to Section 15.340 of Title 5(310 CMR 15.000). The system: Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: L )off The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. / e IjA N Notes and.Comments A p w I%e ****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: i Owner: n Date of Inspection: -� Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: V I have not found any information which indic ate 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. Comm�tn� 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 explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution'box. System will pass inspection if(with approval of Board of Health): broken pipes)ate 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: 'F µ ,�, 2 . ` Page 3 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: rl'i�IAM, Owner: VA , Date of Inspection: 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(l)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface 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 tang 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 ar3A`the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and th'"AS is less than 100 feet but 50 feet or more fronl a private water supply well". Method used to determit�distance "This system passes if the well water analysis,per-forme at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the �11 is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equa w 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: j 3 Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:--(,13. rn�m a Owner: �i Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static-liquid level in the distribution box above outlet invert due to an".overloaded or clogged SAS or cesspool, Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high.ground water elevation. _Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. , 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 than100 feet but greater than 50 feet from a private water supply well with no acceptable ater 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�ollution 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 mst be attached to this form.] (Yes/No)The system fails. I have/determined tha -pne or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: /' �, To be considered a large system the system must serve a facility with a`design flow of 10,000 gpd to 15,000 gpd. i You must indicate either". or"no"to each of the following: ��. (The following criteria/apply to large systems in addition to the criteria above) yes no ��� _ — the/ rnfis within 400 feet of a surface drinking water supply — th system is within 200 feet of a tributary to a surface drinking water supply _ _ he 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 f Page 5 of I 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: f, 1 1^ nn r n Owner: Date of Inspection: 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 V 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 1. 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 Potation of the Soil Absorption System(SAS)on the site has been determined based on: Y no 7/ _ 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 CMR 15.302(3)(b)] 5 Page 6 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: `r' I!{,Irn J{' Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): _ DESIGN flow based on 310 CMR 15.203 (for example: 110 god x#of bedrooms):LED—(ZyCt11� Number of current residents: `1l� Does residence have a garbage grinder(feijor no): Is laundry on a separate sewage system yes or(n�c :— [if yes separate inspection required) Laundry system inspected(yes or no): Seasonal use: 0 or no): Water meter readings, if available(last 2 years usage(god)): 5-1-74 0_ 0 00 Sump pump(yes or no :— y ` OCjO O Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310_CMR 15.203): Basis of design flow(seats/perssns/4gft,tc.): gPd Grease trap present(yes or no): Industrial waste holding tank present(yes or n6):*_� Non-sanitary waste discharged to the Title 5 system(Y8"or.no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): ��- GENERAL INFORMATION Pumping Records , Source of information: I�� Was system pumped as part of the inspection(yes o n :_ If yes, volume pumped: , gallons--How was quantity pumped determined? Reason for pumping: TAIE OF SYSTEM eptic 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.ofthe current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval -Other(describe): Approxim to ase q1f all componentsq,�date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or o '" 6 Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 6 1 Owner: � Date of Inspection: ` BUILDING SEWEE ate on site plan) �- Depth below grade: Materials of construction:_cast iron _40 PVC-`"vihe explain): Distance from private water supply well of suaion line: Comments(on condition of joinp vefiiing,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: Material of construction: ,.,"concrete_metal_fiberglass polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) {� Dimensions: BC_`x� ) c Sludge depth: 1' 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 botto�t of outlet tee or baffle: How were dimensions determined: U&4', 1 r P lr-, Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leaka e,etc. ` GREASE TRAP:_(locate on site plan) Depth below grader 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.bafTle: 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 r Page 8 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: , i k" .� Owner: 'n Date of Inspection: ,Ij TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: �. Material of construction: co or te\ metal fiberglass Polyethylene other plain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes.or no): Date of last pumping: Comments(condition of alarm and float"switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) u - 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,gtc.) zi PUMP CHAMBER: (locate on site plan) Pumps in`working order , S-o no): -- Alarms in working order(yes or no 1--- Comments(note condition of pump chamber,con�itian-of pu nps and appurtenances,etc.): I ,; E Page 9 of 1 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 t I//un" Owner:-�21 ) POA1n Date of Inspection: t SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why:. Type ✓ leaching pits,number: leaching chambers,number. leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cess?ool,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.): v -AAAj t2r cJ1JAA �tl-�-� •.?� '. �rt �ifspection)(locate CESSPOOLS: ( sspool must bepumpe ap on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer, Depth of scum-I �er:Dimensions ofceMaterials of constion: . Indication of groundwater inflo y s or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: (locate bn site plan) Materials of construction: . Dimensions: Depth of solids: Comments(note condition j soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 Page 10 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: i 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. ILL, ,t F� �I I r y3"� L} 2 1D., i ..a r t 10 Page 1 1 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: I Owner: `` rrn�„ Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water ' feetrt��^•^ 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: Checked with local excavators, instal grs- attac docy�m n ti ).. Accessed USGS database-explain: 42--ol ' W- Ctl�A rM�. You must escribe how you established th high o ind w elevation: -' ( J 11 z TOWN OF BARNSTABLE i ,LOCnT.DN ��01 �i�/� seyt� EWAGE,# VILLAGE GJ�, /�/,�� ASSESSOR'S MAP & LOTI� - i INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY ?4" J LEACHING FACILITY:(type) A- /i /D (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: 1 Z (p DATE .COMPLIANCE ISSUED: I ��2��yCB VARIANCE GRANTED: Yes No X .. . -- `� � / � / I is cy i � �� ® � i ,�` ; g3 � � j ` . � � 3 Y� -st 1 S�a � ` \ I ``\ ��� �, I ��� \ �a ® - _ _ � �' I w � t � l� � _�` . ..,..� v '�� — __ SSESSORS MAP NO: A// _ "ARCEL NO.- _ O� C THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH VA. ..............OF...../ / �1�. ... . ... _. Appliration for Disposal 10ork,5 Tonitrurtion Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( /-Y-**an Individual Sewage Disposal System at: all. ...Akv.... ................ .------•-----------------------•---------------- ' Location Address ..or Lot No. �Cf/i�6.a .......... -- •-- �Jwn --.--•.-•--•-•--.Address .._._.1 ------------- •-----•-•-•-----------•-•-----.........•••. Installer Address Type of Building Size Lot............................Sq. feet U Dwelling: t o. of 3edrooms--- ................... .Expansion Attic ( ) Garbage Grinder ( ) ..........................._ No. of ersons..........................__ Showers — Cafeteria Other—Type of B-�ilding p ( ) ( ) Q' Other fixtLres ............................... .. W Design Flow...................._......................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area-_-__----.--•-------sq. ft. Seepage Pit No---------_---------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) ' Dosing tank ( ) aPercolation Test Results' Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water---_---.--_-____•-___-_. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ - ------------• n O Description of Soil........ ------------ - -- x U •---•-•••••--•••---••••-----••••••--••-----........................................................................................................=-••---•-•---•-•--•----•------------••-••-•---•-•••- x •••--•-----------------------------•--••--. ............................................................................................ U Nature of Repairs or Alterations—Answer when applicable._....�2_0—_��� ________________________________________ ----------------•-------------------.............••......O&AP....-�"�-�--------------------------------------•-----••------• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i T T jE5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ssued by he eofalth. _ _. .. ........... ........................ ... / d Date Application Approved By.......... �:::��=r.................. Date Application Disapproved for the following reasons---------------------------------•-----------•---------......................................................... ••---•••------•--•-•••-•--.....••---------••-•••••--••-•--------•-•-•-•-•-----••----••-------•---•---•---'-----••---•••-••--------•--. ------•.._...---••--••••--••--••-•••---••---------•-•••--••-•----- Date PermitNo. .... ...... Issued-....................................................... Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) M Afit C DATA No._�: . -(..2 O� Fizis ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f . ....... OF. .�.t.�./i�l.i.' . � f� Appliratinn for Disposal Workii Tonotrn.rtiun 0" rtni# Application is 'hereby made for a Permit to Construct ( ) or Repair (: ) an Individual Sewage Disposal System at: ♦. .r' Location-Address or-Lot-No- ` i .r► Owner Address Installer Address UType of Building Size Lot____•----•---_____._-•-_.-•-Sq. feet 1-1 Dwelling=No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building --'-'-'--------------'------ No. of persons............................ Showers ( ) — Cafeteria ( ) P4Other fixtures -------•-----------------------•-------------------•--•-•--------••-••-••------•-----------••--•-•--•-........--_...-- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench— No..................... Width.................... Total Length.................... Total leaching area....................sq.-ft. Seepage Pit No------_.........:... Diameter.................... Depth below inlet..................... Total leaching area..................sq. it. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1 ...............minutes per inch Depth of Test Pit.................... Depth to ground water_-___________-__---____. 44 Test Pit No. 2_..............minutes per inch Depth of Test Pit.................... Depth to ground water........................ = = '-----------------------•------ f-------------•---------------------•-----•-------------•------•-----._---- DDescription of Soil...:...................................................................................................................................................................... x U --•------------------------------------•-•---•---•-••--•----••----.........•----•••---------•-••---•-••---•----------------•-----•--:---•••--------•---•--•--•--•----.................................. W UNature of Repairs or Alterations—Answer when applicable_.... - = ...................................—...................................................................... / /�' r Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iT' IE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Cer-ificate of Compliance has been issued by the board of ,h/ealth. s • F , --.-. ...................�._..............�/.._ .._............. ......_..r,.----Srgne�- -,�'Y_%• f f� '--Date -.... __._. A Approved PProved By cy- %..A. Vie'. ,..._.�-,........... �2 Date Application Disapproved for the following reasons---------------------------------------------------------------------------------•-----------....-----••-•••••... -----------------••-----•-----•---•----••----....---------..... Date Permit No: -----�.7 C —' Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH J Trrtif irate of Toutpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired i / t/ l 'Il f''r ,r? ..._. -•---•-•....................................•---•---•••••-•---.......•--••--••••- . Installer , has been installed in accordance with the provisions of T i T iE 5 of The State Sanitary Code a rl scribe •n the application for Disposal Forks Constriction Permit No�° �4' .._I_._ da.ted_......... l,_ _- __----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAR NTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. Z. z 11 DATE........... - e.6.............................. Inspector. :_==•== ,.................. THE COMMONWEALTH OF MASSACHUSETTS BOARDF HEALTH '57"� r ti o..... �� ° FEE.L... .`:::.... �i��rr��tl rk���nn,�#rnr�ua anti# Permission is hereby granted �4'` '.' 1....... ....... to Construct ( ) or ,-pair�t IndivlduaL.Sev�Tag,e.�i� dal System /` at No..'/,✓ _..... �� `.t!L ...._:� f� "....1 .__ _'" d.'_ f Street _—' as shown on the application for Disposal Works Construction Permit N ,_.�:"'.... ated:--_I � 4 .............. Board of rlealth DATE----- �7� 7i. �i SZO........... -------a1%,------ . 't X' FORM 12 5 HOSES & WARREN, INC:, PUBLISHERS;. i QL.AT I O.N. " 5EW O C E PERMIT U O j - - N ILL 4GE. -__iMSTALLER�5-IJ�,I�/l-E_ _A_DDRES_S_ �U1_LDE.R.S_1J_A►�IE_�_AD.QRE.SS __DATE_PER_NAV_T 1.55U.ED�- G� `o f r 1 J 1 . �r S - � L R nd No..... ...... L Fluc.. THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH . ........ O F... �r"�Gc.... --................................. Apphration -fur J%ipoiial Workii Tomitrurttuu Vleruiit Application is 1-.ereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: --------az .................. ................................................................................................. o n-A�ddrepss� or Lot No. W7�zi-V- -. ...... ................. .................................................................................................. Owner ' Address Installer Address Type of Building„ Size Lot............................Sq. feet �-, Dwelling If No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type cf Building _______________________---- No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other -ixtures W Design -Flow..............:.............................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter__-......-.____ Depth....----_-_ --- x Disposal Trench—No_ ____________________ Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------------------_- Diameter.................... Depth below inlet.................... Total leaching area------------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by------- ------------------------------•----...-------•-------•--•-------- Date......................................... W Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water..._.____._-.-__---- fi Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water................_-_--__. ----- GDescription of Soil......-- ------------------------------------------------------ ---------------------------------------------- x ----------------------- VW --------------------------------------------------------------------------------------------------------------------------------- Nature of P.epairs terations—Answer when applicable.......1_�-.-._.._-�__ _- _ - -_ ----------- ------------ ----------------------------------------•------------------------...---------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article X1 of the State Sanitary Code— The undersigned further agrees not to,place the system in operation until a Certificate of Compliance has be n issued by hoard of health. Sie ------------- ------------Da---------------- Date Application Approved By....:.. ... .... :.. �_ �� `..7- -- - - - -- - - -------------------------------- ---------- Date Application Disapproved for the following reasons---------- - --------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------•-•-----•-•----••------•-•---•....-----....--••-•......._.._..--------------------------....----------------------._.._...•--- Date PermitNo......................................................... Issued----- -S'...�"z ............... Date ------• Fps. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C ........OF..........1.0...... .. ... .... .. �Ia........................------ Appliration -for 130posttl Works Cnnnutrnrtion Vrrniit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at: �N� _ae4_4-----Y --------I...........Azol/. ............._......................I............................................................, ," - Locao - ress --- ---------•---•••--•--•-•-•----------------or Lot No. W O er (3 Address Installer Address UType of Buildings Size Lot.................._---------Sq. feet Dwelling No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.--------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures W Design Flow.............................................gallons per person per day. Total daily flow.........................-..................gallons. WSeptic Tank—Liquid capacity---__._.--_gallons Length................ Width................ Diameter................ Depth_............. x Disposal Trench—No. ____________________ Width-------------------- Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area....-____.--__-_sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date---------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit.........._......... Depth to ground water._..____.--_-_-...__.- (s, Test Pit No. 2........._......minutes per inch Depth of Test Pit.................... Depth to ground water-_---._--__--_-----_.... 0 --------------- onof Soil---------Descripti --- ----- _ __--- - - ----------------------------------------- ----------------------------- --------------- x � _P or —Answer Natue s - ( � en applicable._ _..__. -_-_-_--------------------- _.____._.._._._... _" . r---------4 1�-�---'_�------------------------------------------------------------------------- -_-- ----__------------ -- \. Agreement: ff The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha/bbee issued by e b d of health. f �Signed "=--•----------••••-..._-_.... Date ApplicationApproved By.................................................................................................. ---------------------_-- ------------- Date Application Disapproved for the following reasons-----------------------•-•--•----•• •----•--•---.............._._..__----------------•-------•---•---------•----- --------------------------•-•---•----------------------------••------•----------•--------_-----------------•--•-------------------------------•-------------------------••----•------------------------- Date PermitNa......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS „�, BOARD OF HEALTH ..... �� �.............OF.................. ..... ..... .. uIrnifiratr of Tomplianrr THIS S TO C fIFY 1 Individual Sew We Disposal Svstem const,rOlted ( ) or Repaired � nstaller at------------------ ---------- ---�_�� =-� K e--- - -----------------------------------______----•-------•--•-------------------- has been installed ir_ accordance with the provisions of Ar,icl. -XA of The State Sanitary Code As described in the application for Disposal Works Construction Permit No. '`� _._____�___G____-._-_. dated..___!- _ 7_5 ............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............................................................-------........ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS �k BOARD OF HEALTH 7� . . �.... O F........,. ®- '....... ` ............. .. .......... �� No.._.. _�^1 FEE__ BinVoiitt Workii C t ian pr ntit , Permission is hereby granted______ .._.___ to Construct ( ) o- Repair ( Indivi ual Sewage Disposal System atNo............................................................................................................................................................................................... Street as shown on the application for Disposal Works Construction Perrin No___ ____________ Dated....-------------------------------------- ----------------------- Board of Health DATE--- _. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ...,.:.Emeu�bamnbab.doba:gb.� 8 WEST BAY ROAD.OSTER-E,AIA 02655 NOTES: CONSTRUCTION ..... - =. DOCUMENTS FOR PERMIT SET 441 EXISTING 612 MAIN STREET w � Nw OSTERV I LLE MA 02655 Z Q � N UJ L7 Q ADDITION - SET 4550E BATES ' GATE 1584E h # DATE OESCFIPTinry E 3 1 - F —.. r a ,3 COVER SIEET i 1 OF 5 PROPOSED AO -_ - - __ FINE P 509 20-1296 WEST My ROAD,OSTERALLE,f.1A 02555 NOTES: CONSTRUCTION DOCUMENTS FOR PERMIT SET ............... ............................... ......................... .......... ............... ............ ............................... ...................... ........... .................. ............... ........... .................. ......... A.- ............................. in .-.l..---............... .......... ...................... 41. .... ......� ........ . .... ........... ................ ................................ .......... ........... ...................... ............ .............. ... .............. ................ .......... ............... ............. ................- .............- .......... .......... ............................ .............. .......... .......... .......... ....................... *.......... ...... .............. .......... ................. ................ ................. .......... ............................ =::--. ::.�:�4,-.-b,::-, ............................ .................... ................................. ... ........ ..... ..... ................................. ................. .............. .... ... ... ..... .................. ......... ..... ................................ .................... .............. "aE Fm Am.1 LIM WEE .............:........... ALI .......... ... ..................... .................................... - � RIGHT ELEVATION LLJ CV Lu CD F- M C13 LU 2M C14 LU CD W W 0 ......... ... ........................ ........... ... ...... ............. ................ ............ ........... ........... .......... .................... .......... .=:::..� --,--.- ;.............................. ............................. ............ ................ - EEE ....................... ..............--: ............. ...................... ...... ................ ........... ADDITION ................................. ......................... .......... ................................ MT ISSUE DATES ...................................... .......... ............................... ...............................I.. .- DATE ISSUE UASIMS H FER I mm DESMIPTION II El = MA RIGHT ELEVATION& LEFT ELEVATION SHEETS 20 5 2 LEFT ELEVATION GA _ _p A 1 DATE!1111412018 FIB r LINE P 50B 20.1296 xxw.FlneLineArtiiltedunlDaal9n,olm 9 WEST BAV ROAD,OSTERVILLE,MA 02655 NOTES: = -_._,.... CONSTRUCTION DOCUMENTS FOR PERMIT SET \�—Q4 . .... .....:...... _.. _ ............................................................_...:.....,.... I El El 'A AA mS%/.R"m�/ FXISITNb NEVI PORCH E%ISTING L(� ~ CV w O REAR ELEVATION Lu ¢ c w N w cfl U) N slMPson H]s O PASTENERS AT ALL ' - RAFfER/TOP PLATE JUNLTON3 T1P. RED LFDAR 5HINbLE5 21B LOLLAR T9S (])41/4'LVL - MF�FRS N6 RIDGE (5)9 I/4'LVL BM NDY(])11 VB'LVL—E TANDINb SEAM ROOP ADDITION (3)II,/B-LVL BM y. �Yq•_ cy 7Y)O's H/H'TNRCUbH �^ R4a P6 WSUL �16.0 (2)�11//45E- )T 1/4-LVL H[>li - SET ISSUE DATES )91/4-LVL EW OATE ISSOE M AIEK %�� /e LVL HDR E�USTMb✓TAIL . IV—OR -fB)_91/4ILVLHDR� ter, n ! N t A® I REVISIONS d oF Pi HxH P05T Q II i °° S - I�br:: SIMP.METAL P5T BASE " o` ROBE T ]'S0N0 TUBE nER YI/ at V > E JR. m UCTURAC y m mPOUNDATIG ^o. 13834 0 REAR ELEVATION& OPONAL SECTION Li SHEET 0 30F 5 SECTION 2 = _ A 2 SGAL : 1/4 1 O DATE.W14018 ti r - FINE REMOJE EXISTING DOOR\ � a .y. r 3068 (', DESK WINDOW SEAT i/ // BUILT INS 1 xww.FlneLlneAMitecW2lDeel n.com NEW ENTRY 2668 / NEl^fti1UDROOM %� / S WEST BAY ROAD.OSTERALLE.MA 02655 n NOTES: CONSTRUCTION v / DOCUMENTS FOR -- MUDRooM ,D k PERMIT SET . � � sHoro=lz / / �% EW LAUNDRY./ I SHOWER _ aXa to�rsc+'�PPm wrRwPeonFxp,.eovE ry�VEWFY DMENSIONS M FlE ' ( GL � � � o I. -•..... {{ GAB GAB GAB �,..," / I ry � h �I� $I + GL i i% / -SLREEN DDOR5 / /] Y'RAPPEp WITH SHINGLE r7!7 i 246 BATH PANTRY I 6AR I = / GL �VAULTFD I GEILIN6 I FLAT GEILINb CEILING i / 1 f 21068 O. A2 _____ II _ ____-——-._ DECK _ KITCHEN CD W O I � �� w FADE(STONETLE) � Q I }i ND GRILL TBp I REAM 0 ,.GRILL d I a! � F�u°ce: I lid-.- Y,3�✓.. Z J Lu 5'-6' - - C Lu DINING DINING " � { - � MASTER €' MASTERS BATH [ BATH i. W cove adds _ __�`_.,_ _.... ...... ii 266a MASTER 2668 i MASTER SUITE SD, sus»»>� ADDITION d 5068 lid �68 n 4 SETISREDATES 6 8 1 468`: � GATE ISSUE I I I [ LIVING r1- FIRE ' LIVING \ n 1, �r... l ' �.� ( �� ", ( %�AlE DESCRIPTION _ �. ' (3F s9c ;% sru�Y m ; STUDY C� R W., G ENNIS JR. TRUCTURAL Zl C NO. 13834 cn ® EXISTING&NEW , I •O. ,4 FLOOR PLANS �® ONAL ®a SK.#10F5 - 3068 3068 1 EXI5TING FLOOR PLAN z NEW FLOOR PLAN A3 DA>E:nuusom 1 UNate..,. PS6&a241296 ww.v.FineLlnefvrhl,ecluralOaslg�.�gn I 6 WEST BAY ROAD,OSTEROLLE.MA ONES r NOTES: CONSTRUCTION DOCUMENTS FOR PERMIT SET S 1/II• 5 1n' B ln• .3. DOUBLE LONTINUGVS ROR R M JOIST 9 1/4•F7 L '1' LVL RAFTERS ---------------------- "///�////////////i///� ////////' / Pf 2.10 BN -------- - t 1 " ur0 FR ExlsnN ---- - %%///%///%MIM/// f „� � bPT PST " I --- --- %/////i%/%/////,/ �, /////,".•/ • -'- .. ; %//j%j%/ j j %///., „T/b•LVL BM --_ OWN (S)9 1/a'LVL BN /f - / / /��% // / (S)T 1/4•LVL NOR ___ _ -__ ' / / ___ //-WAI//// ----- -- ---- -- - --------------- - y OONOxETE SLAB-FOA ..1. 'A-`/ / " -- --. -- - t■ UJ N d�:? B 1n• B 1/Y S 1/S " - (S)R V4'LVL Z J �. CONTINUOUS ROR 1 a,o RDR Q J_ 4-1• s'_tr 53 RIMRIMr - Lu CV W CG c/) 0 ADDITION SET 15511E BATES DATE ISSUE F A RTE 6ESMIMM OF1 o= R B RT X yG I IS JR. , o UCTURALd. --'i 13834o Q DECK FRAMING& IST�e.Fi �t`�® ROOF FRAMING NAL ®® SNEET A S°F S �DECK FRAMING RA 2 ROOF FMING A4 GA GALE: 17-4 _ -O EATS:1111412010 N _ INSTALL RISERS COVERS TO PIPE5 TO BE LAID LEVEL FOR r77WITHIN G" OF FINISH GRADE 2' OUT OF DISTRIBUTION BOX 4 i tiM1e ;; -� (SEE PLAN VIEW FOR LOCATIONS Lu 2" LAYER OF PEA5TONE OVER WATER TEST D-BOX FOR 3/4" - I %2" DOUBLE WASHED ''` LEVELNE55 + FLOW w Q STONE ALL AROUND EQUALIZATION a Q.- Fti A Ln 71 EL. 29.7 Q T.O.F. @ — — — — — — — — — — — — — — — — — — — — EL. 2G.5 _ 4" SCH ' EL. 30.8 4°sCH 4o PVC 40 PVC TOP @ EL. 23.7 4" SCH 40 PVC L� OC 101, I Q, ,o z 0 (5) 500 GALLON PRECAST DRYWELL5 J INSTALL GAS BAFFLE 27.67 27.50 Za BOTTOM @ EL. 2 1 .00 0-LOCUS (L `W IN OUTLET TEE 27.90 23.00 �j (EXIST.) INSTALL D-BOX ON G" LAYER OF 51 EXISTING COMPACTED GRAVEL 1 500 GALLON PR<ECA5T DEi-9 501L AB50KPTION SYSTEM SEPTIC TANK BOTTOM TH #I @ EL. I G.0 SEPTIC 5Y5TEM PROFILE 24 22 2G � / / DE5IGN DATA GENERAL NOTES /26' 28 DAILY FLOW: (G) BEDROOMS x I 10 GPD = GGO GPD SEPTIC TANK: GGO GPD x 200% = 1320 GPD I . SEPTIC 5Y5TEM 15 TO BE INSTALLED IN ACCORDANCE WITH �s \ I / USE: EXISTING 1 500 GAL. PRECAST SEPTIC TANK 3 10 CMR 1 5.00: TITLE V EXISTING LEACH PITS j / DISTRIBUTION BOX: 2. TH15 SEPTIC SYSTEM 15 NOT DE51GNED FOR THE USE OF A TO BE PUMPED DRY GARBAGE DI5PO5AL. * REMOVED, ALONG / USE: DB-9 ^- (9) OUTLET DISTRIBUTION BOX 0 1 WITH ANY CONTAMINATED I / 3. THIS PLAN IS NOT TO BE USED FOR PROPERTY LINE DETERMINATION. / 1 \ 501E ( / SOIL ABSORPTION SYSTEM: 4. CONTRACTOR SHALL PROVIDE 48 HOUR NOTICE TO DESIGN USE: (5) 500 GALLON PRECAST DRYWELL5 LINED WITH ENGINEER FOR ANY REQUIRED INSPECTIONS. n EXISTING I500 \ I 4' OF DOUBLE WASHED STONE ALL AROUND I F v GALLON PRECAST \ \ I 5. CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION OF ANY 1 I (O 0 I CAPACITY: U T ILI-i Y' ABOVE OR UNDERGROU'NU"'PRIORTO ANY EXCAVATION SEPT TANK(TO REMAIN) I I EL 3 I \ 51DF-WALL: 127 x 2 x 0.74 = 188.0 GPD OR CONSTRUCTION. I I I i +�`) \ \ PROPOSED BOTTOM: 50.5 x 13 x 0.74 = 4,55.8 GPD 1 I I ` • \ POOL TOTAL: G73.8 GPD 297 / I I3.50' ' '� • ; TH##I\ 1 N 1 �\ / OF hfA6, DARREPJ cyGN� N �y / i 1 Y • TH#2 \ \ o• \ / \ I \ /\ No. 30 EXISTING STONE CIRCULAR DRIVEWAY TO BE REMOVED \ / /i / DEEP OBSERVATION HOLE LOGS DATE: 01-08-2013 P-13833 TEST BY: D. MEYER, R.S. WITNESS: D. DESMARAIS, HEALTH AGENT � ITE --- SEWAGE PLAN \\ \ It PERC RATE: < 2 MIN./ INCH \ \ _ _ 1 DEEP OBSERVATION HOLE#I EL. 27.0 FOR DEPTH SOIL SOIL SOIL COLOR SOIL SUff ROM RFACE HORIZON TEXTURE (MUNSELL) MOTTLING OTHER 6 12 MAIN STREET 05TERVILLE, MA O" 9" A LOAMY SAND I oYR3/2 PREPARED FOR 9"- 20" B LOAMY SAND 10YK5/8 RE N E J O N E [� H F Q��/20"- 132" C MED.-COARSE SAND 2.5Y7/3 S I B ICI G I D D O 1 1 L 1\ 1 1 N\r SCALE: DATE: DRAWN BY: -,-'' 23. 1+ / I " = 30' O I -09-20 12 TMW JOB NUMBER: 1 2-05G REVISION: SHEET'NUMBER: 5P- I --' DEEP OBSERVATION HOLE#2 EL. 27.5 ' DE H SOIL SOIL 501LCOLOR SOIL WELLER * ASSOCIATES PROM HORIZON TEXTURE OTHER SURFACE (MUN5ELL) MOTTLING I G45 FALMOUTH RD., SUITE P9 �- P.O. BOX 417 CENTERVILLE, MA 02G32 0"- 10" A LOAMY SAND I OYR3/2 2 WINDY WAY, #232 NANTUCKET, MA 02554 I O"-30" B LOAMY SAND I-0YR5/8 30"- 132" C MED.-COARSE SAND 2.5Y7/3 TELEPHONE: (508) 328-4G92 EMAIL: trisweller@comcast.net NOTE: NO GROUNDWATER ENCOUNTERED IN ANY OBSERVATION HOLE REGISTERED LAND SURVEYORS * ENVIROMENTAL CON5ULTANT5 Traverse PC kiLX.F_ VENT 2x 12 RIDGE BOARD ! . e a'-u" IZ .. i ., - ASF'NALT 5NIN4LE5 14 56 3/4 x ,y 3/4 2q i;/4" x 7, 3/4" 5/fj" COX 51-IEATNING 1 T JOB !i�S C.J. HANGER i i S 2x$'s , � __ _ R30 IN5UL. C "� _ 53 3/4" PTD 2%3 o i� _ 2q 3/4j1 x 3/4" , i Il GUEST GUEST _ ! 1 \a} '� !► GEDRCCM �9 BEDROOM RIB INSUL. I R'00I' 3/4" PLYwOOD I t ` - RIq IN5UL. I ��_ +C _ 2xO's--- 6''O - - - - -, � �' �� - CONT. VENTING DRIP EDGE : -- -- Ix8 FASCIA c 1 C ALUMINUM GUTTERS AND UQbvN bf-OU-i 2 I ` 2� ' W10x22 STEEL BEAM LNdG 2 , I FRIEZE E30ARD AND MOULDINGS Q _ BAR { /d FIRE RAT1 D NET I 2� -:�_:_ :-� � ! � „ l 2x4 EkT STUDS dd 1�," O.C. 1 \ 3Q GYP BOARD , \ q bETWEEN GARAGE 1/2" PLYWOOD S+aEATNING 5 i i JAND LIVING SPACE C TYVEK WRAP (OR EQUAL) LITE i �� CEDAR CLAPE50ARD5 T't'P. r _..l - - _ _ -- - . _ - - - — -— - - --- - - --- � TILE � �)TTI NG � � _. - _ .. �_� _ � PITCH TO DOO � I PI R5� " 'I} rslFtsr Fa..00K: PTD2'�53 " � � � _ '�`„ •-*-- _._.__._...._...___.._.__.__ ____. ____.-. _--_-. __ _ ___ _.. ... .-------_--_-- .__....___:..__ ,i ''^" ,'_^" � t ti 1 �I III I�� ! 26! 3r4 x 53! 3 � 14 1.. tY + I 2 PTD COMPACT FILL � i 4N r P r — - _. , 41 3/4" x 53 3/4" 2cl 3/4" � � E34T{-{ I.-. + !_. 6M PKT ._.. . 8xIb VENT I I TILE { d ! e (5) 2x10 GIRT I E 2XV5 t V . ; t 1 I { o 1(o"O.c I I $ I r� PKT 'r ` I l 10'- III—a" bit GUEST PTD '?�a3-2 ( ( I SUITE ,, I ox* VENt 1 i' 58 3/4" ,x 53 3/4" I d"x4w" CONC. wAL,L. 0 xl(v CONTINUOUS MOOTING TYP. GA AGE � ; t I GARAGE I CRAWL SPACE I q 4' CONG. 5LAb I 2" CONC. DUST CAP - I PITCH TOWARD DOORS <1 Y 8"x46" GONC. WALL 10"xV CONTINUOUS FOOTING:, TYP. ( �; r�tATC_i-,I GCE55 0 q I ( 4"I I ti I i N' J 2%3 I -,--- LITE i I i { I `T _"1 3/4" x 53 3/4" a F- tj tv h i UP 7'aa' O.H. DOOR xq' DCx:+k _ _.-_ ___. .._. -----.f �___ __�:. �__:_CJ H J r oil �� I E i i i L�vtt,�C, tea© vt y �4vrcAT< t I L hC t P�1 ! ,c C) LL-7- ..i, - 000 �,�`�-.� -���►��, ._______` Kam,� � LE: y M�STc 7Z S U tT'G { `� i t. I 4 Y� EZ 0