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0045 MAYFLOWER LANE - Health
45 MAYFLOWER IUCZE)STERVILLE i r 5: 0 i :a TOWN OF BARNSTABLE LOCATION rsJQ SEWAGE# a D I b , VIf,i!AGE ASSESSOR'S MAP&.PARCEL INSTALLER'S NAME&PHONE NO. Poi ®.� IE SEPTIC TANK CAPACITY LEACHING FACILITY: (type) yCS00 A Z (size)',J'3 lr;'ZZ a NO.OF BEDROOMS OWNER 6rdlembemeirr-, PERMIT DATE: 117 COMPLIANCE DATE: ' 7 7` Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) (,c% Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching cility) i Feet FURNISHED BY r� 4 (_ � N W TOWN OF BARNSTABLE LOCATION /7av P da/er✓ ne. SEWAGE # Q7- VII.EAGE —&f" ASSESSOR'S MAP& LOT F• INSTALLER'S NAME&PHONE NO. A;e%-e5! &o v— 1 74' SEPTIC TANK CAPACITY LEACHING FACMITY: (type) (size) NO.OF BEDROOMS - BUILDER ORt_IJV� PERMTTDATE: Z 9 COMPLIANCE DATE: Z—Iza I47 Separation Distance Between th,>: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet. Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet+. Edge of Wetland and Leaching Facility(If any wetlands exist r d, within 300 fe of leaching facility Feet Furnished by `� r� �. _ o j� o- � (' M h��. W Z .,.,.,. Town of Barnstable : P2Z3 ' Department of Regulatory Services $ F I1 snrwaTeal�a Public Health Division Date 1 sd3f� 206 Main Street,Hyannis MA 02601 ' CD Date Schedtded Time_/0 Pr Fee Pd._� Soil Suitability Assessment for Se wa e Disposal Performed By: ft;z Witnessed By: lel LOCATION&:GENERAL IENFORMA.TION Location Address Owner's Name `5 �Ll-����ow��e . �9.v t—m1J t d l�Q Ga/t<!�•4 �7171 Address Assessor's Map/Parcel:` vt� l� Engineer's Name d S7�c�vccGe �, ' NEW CONST _RUCTION Z REPAIR Tele hone# 3ZT7_ S- p Land Use- Slopes(%). L- Surfhco Stones Distances tfiom: Open Water Body possible Wet Area a ft" Drinking Water Well L;.01 ft Dralhage Way - ft Property Line 7 ��_ft Other ft SIKETCHC(Street name,dimensions of lot,exact locations of test holes&pore testa,locate wetlands I'n proximity to holes) li t i � kl. o .r'i`— — Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water In Hole: b.1,1 cr Weeping*otn Pit F'ca ^� Estimated Seasonal High Groundwater. 7 3. DETEWMAITON FOR SEASQNAL'HIGHWATER TABLE Method Used: Depth Obso d standing in obs.hole: In, Depth to soli mottles: Delith to weeping from side of obs.hole: In, Groundwater AdJustmdnt fr. lndex Well-# Ronding Dato:_ Index Well loyal • .- Adj,•factor- Adj.Gro4ndwatdr•Level,,,,_, PERCOLATION TEST DAN 12I Ttmu,.A Observation Hole# 3 _ Time at 9" Depth of Pero 4�i' A. ' Time at 6 _ t �._0 Start Pro-soak 71mo @ LO',00 Timo'(911.6") End Pro-soak t 1 1.a t RateMin./Inch Site Suitability Assessment: Sitd Passca J Site Failed; Additional To sting Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back----. ' ***If percolation test IS to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SBPTIC%PERCFORM.DOC DEEP.OBSERVATION.HOLE LOG Hole# Depth from Sall Horizon Soil Texture Sdil Color Sall. that Surface(in.) (USDA) (Munsell) Mottling (Structure,Stone;Boulders, Cotlalit=3� Z ' 6/it DEEP OBSERVATION HOLE LOG Ho1e# Depth from Sall Horizon Soil Texture Sall Color Soil U Other Surface(in.) (USDA) (Munsell) Mottling (Structuta,Stones,Boulders. - 3.2 7S to 30 - 3 Zit -.A e-v, DEEP OBSERVATION HOLE LOG Hole#liz Depth from Sall Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, O --G SL tc"lQ: ti -► lrut-�64Z 5 3a- 32 �cRs,'.;A1447® 7. 0_f k 0__ tlia - L DEEP OBSERVATION HOLE LOG Hole# Ac Depth from Sall Horizon Sall Texture Sall Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, • -' 4 rLaNr Ls t.:.sbiz 0 4 7 Flood Insurance Rate Man: Above 500 year Mood boundary No— Yes •. Within 500 year boundary No Yes ' Within 100 year flood boundary N0.7 Yes - Depth of Naturally Occurrinta Pervious Material Does at least four feat of naturally occurring pervio s m iterlal exist in all areas observed throughout the area proposed-for the soil absorptlbn system? If not,what Is the depth of naturally occurring pervl us material? .,.. Certification I certify that on 34 C4/ (dote)I have passed the soil evaluator examination approved by the Department of Enviro mental Protection and that the above analysis was performed by me consistent with . the required training,expo 'se and experience described in 410 CMR 15.017. Signature <f Datt; Q:13RFr1WB11CPORM.DOC =. Commonwealth of Massachusetts., Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -,Not for VoluntaryAssessments ents rr,, 45 MAYFLOWER LANE Property Address ~ DACUNHA ANTONIO AND ELIZABETH ► Owner Owner's Name information is . required for every OSTERVILLE '� MA 02655 09/02/2016 �. page. City/Town State Zip Code Date of Inspection m QD Inspection results must be submitted on this form. Inspection forms may not be altered in'.any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, v O use only the tab 1. Inspector: 1-v to move your p se or the r not use the return urn JOHN P GRACI SR key. Name of Inspector GRACI SEPTIC INSPECTIONS LLC rab . Company Name PO BOX 2119' Company Address TEATICKET MA 02536 City/Town State Zip Code 508-641-6694 S1468 Telephone Number License Number r i B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of-the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 16.340 of Title 5 (310 CMR 16.000). The system: ® Passes Conditionally Passes Fails ❑ Needs Further Evaluatio y the Local Approving Authority �0 _ 09/02/2016 Inspector's Signature Date The system inspector shall s it a copy of this inspection report to the Approving Authority (Board of'Health or DEP)within 30,d of completing this inspection. If the system has a design flow.of 10,000 gpd or greater, the ins ctor and the system owner shall submit the report to the appropriate regional office of the DEP. The riginal should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. *""*This report only describes conditions.at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal'System Form - Not for Voluntary Assessments ,M 45 MAYFLOWER LANE Property Address DACUNHA ANTONIO AND ELIZABETH Owner Owner's Name information is required for every OSTERVILLE MA 02655 09/02/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 115.304 exist. Any failure criteria not evaluated are indicated below. Comments: I SYSTEM PASSES TITLE V INSPECTION B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): NA t5ins.doc•rev,6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 ra 4 Commonwealth ofMassachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 MAYFLOWER LANE Property Address DACUNHA ANTONIO AND ELIZABETH Owner Owner's Name information is required for every OSTERVILLE MA 02655 09/02/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont) - ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.). ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): 1 ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): NA ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): NA C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or,a salt marsh t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 45 MAYFLOWER LANE Property Address DACUNHA ANTONIO AND ELIZABETH Owner Owner's Name information is required for every OSTERVILLE MA 02655 09/02/2016 , page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has aseptic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: NA ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis.must be attached to this form. 3. Other: D) System Failure'Criteria Applicable to All Systems: You must indicate "Yes" or"No"-to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑. ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 ` Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 45 MAYFLOWER LANE Property Address DACUNHA ANTONIO AND ELIZABETH. Owner Owner's Name information is required for every OSTERVILLE MA 02655 09/02/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times'pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high groundwater elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. i ❑ N Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® /The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a-significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 f Commonwealth of Massachu.setts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 MAYFLOWER LANE Property Address DACUNHA ANTONIO AND ELIZABETH Owner Owner's Name information is required for every OSTERVILLE MA 02655 09/02/2016 - page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑, ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® El available as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank f inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information 1 Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 r ' Massachusetts Commonwealth of W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 45 MAYFLOWER LANE Property Address DACUNHA ANTONIO AND ELIZABETH Owner Owner's Name information is required for every OSTERVILLE MA 02655 09/02/2016 page. City/Town State Zip Code Date of Inspection i D. System Information Description: 1500 GALLON SEPTIC TANK DISTRIBUTION BOX AND (3)THREE FLOW DIFFUSORS MEASURING 30'X 10'X 2' Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes 0 No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d TOWN ( Y 9 (9p ))� Detail 2015 69,000 2014 48,000 Sump pump? ❑ Yes ® No Last date of occupancy: OCCUPIED Date Commercial/Industrial Flow Conditions: Type of Establishment: NAB Design flow(based on 310 CMR 15.203): NA Gallons per day(god) Basis of design flow (seats/persons/sq.ft., etc.): NA Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: NA t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 ' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 45 MAYFLOWER LANE Property Address DACUNHA ANTONIO AND ELIZABETH Owner Owner's Name information is required for every OSTERVILLE .-MA 02655 09/02/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: NA Date Other(describe below): NA General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: NA gallons How was quantity pumped determined? NA Reason for pumping: NA Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy- ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): l5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 8 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 MAYFLOWER LANE Property Address DACUNHA ANTONIO AND ELIZABETH Owner Owner's Name information is required for every OSTERVILLE MA 02655 09/02/2016 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1997 I Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: (18) EIGHTEEN INCHES feet Material of construction: ❑ cast iron ® 40 PVC 40 PVC ❑ other(explain): Distance from private water supply well or suction line fe e ett: 1 FEET Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: fee ONE FOOT feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: NA years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 GALLON Sludge depth: (10) 10 INCHES t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 ' Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 45 MAYFLOWER LANE Property Address DACUNHA ANTONIO AND ELIZABETH Owner Owner's Name information is required for every OSTERVILLE MA 02655 09/02/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle (24)TWENTY FOUR INCHES Scum thickness (6) SIX INCHES Distance from,top of scum to top of outlet tee or baffle (6) SIX INCHES Distance from bottom of scum to bottom of outlet tee or baffle NA How were dimensions determined? MEASURED Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): SEPTIC TANK APPEARED TO BE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY AT TIME OF INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS. Grease Trap (locate on site plan): Depth below grade: NA . feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): NA Dimensions: NA Scum thickness NA Distance from top of scum to top of outlet tee or baffle. NA Distance from bottom of scum to bottom of outlet tee or baffle NA Date of last pumping: NA Date t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 MAYFLOWER LANE Property Address DACUNHA ANTONIO AND ELIZABETH Owner Owner's Name information is required for every OSTERVILLE MA 02655 09/02/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): NA Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA I. Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): NA Dimensions: NA Capacity: NA gallons Design Flow: NA gallons per day Alarm present: ❑ Yes ❑ No Alarm level: NA Alarm in working order: ❑ Yes ❑ No Date of last pumping: NA Date Comments (condition of alarm and float switches, etc.): NA "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No l5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 ' Commonwealth of Massachusetts W Title 5 Official Inspection Form F Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 45 MAYFLOWER LANE Property Address DACUNHA ANTONIO AND ELIZABETH Owner Owner's Name information is required for every OSTERVILLE MA 02655 09/02/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert BOTTOME OF PIPE Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of,box, etc.): DISTRIBUTION BOX APPEARS T&BE STRUCTUARLLY SOUND AND FUNCTIONING PROPERLY AT TIME OF INSPECTION. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): NA * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: NA t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 45 MAYFLOWER LANE Property Address DACUNHA ANTONIO AND ELIZABETH Owner Owner's Name information is required for every OSTERVILLE MA 02655 09/02/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: i ❑ leaching'pits number: NA ❑ leaching chambers number: NA ❑ leaching galleries number: NA ❑ Teaching trenches number, length: NA ❑ leaching fields number, dimensions: NA ❑ overflow cesspool number: NA ❑ innovative/alternative system Type/name of technology: NA Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): (3) THREE FLOW DIFFUSORS FIELD MEASURING 30'X 10'X 2'. SYSTEM APPEARS TO BE STRUCTUARLLY SOUND AND FUNCTIONING PROPERLY. NO VISABLE STAIN LINES. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA Depth—top of liquid to inlet invert NA Depth of solids layer NA Depth of scum layer NA Dimensions of cesspool NA Materials of construction NA Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 f � Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 45 MAYFLOWER LANE Property Address DACUNHA ANTONIO AND ELIZABETH Owner Owner's Name information is required for every OSTERVILLE MA 02655 09/02/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): NA Privy (locate on site plan): Materials of construction: NA t Dimensions NA Depth of solids NA Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): NA t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 45 MAYFLOWER LANE Property Address DACUNHA ANTONIO AND ELIZABETH j Owner Owner's Name information is required for every OSTERVILLE MA 02655 09/02/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Aj_104 A2-11 A3-214 82- i2- A Pic 00 v� 3 1z asoo Gallon 3�low 0114AS►rS Se 11C f �o.rdOL. r - t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Forme Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 45 MAYFLOWER LANE Property Address DACUNHA ANTONIO AND ELIZABETH Owner Owner's Name information is required for every OSTERVILLE MA 02655 09/02/2016 page. City/Town State Zip Code Date of Inspection , D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water:_ 10+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked,date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water,elevation: HAND AUGER Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 . Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 MAYFLOWER LANE Property Address DACUNHA ANTONIO AND ELIZABETH Owner Owner's Name information is required for every OSTERVILLE MA 02655 09/02/2016 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ®_System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on,page 15 or attached in separate file t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Ilk Massachusetts Department of Environmental Protection •• 100253213 BWP AQ 04 (ANF-001) Asbestos Project# Asbestos Notification Form r Project Revision r Project Cancellation �o N A. Asbestos Abatement Description s 1.Facility Location: HENRY DUCUNHA 45 MAYFLOWER ROAD Instructions 1.All a.Name of Facility b.Street Address 41. sections of this form BARNSTABLE l (V c)1 must be completed in MA 02655 0000000000 l7e ([ order to comply with c.City/Town d.State e.Zip Code f.Telephone MassDEP notification x x requirements of 310 CMR 7.15 and g.Facility Contact Person Name h.Facility Contact Person Title Department of Labor Worksite Location: ATTIC Standards(DLS) notification i.Building Name,Wing,Floor,Room,etc. requirements of 453 2..Is the facility occupied? rl a.Yes r;b.No CMR 6.12 3. Is this a fee exempt notification(city,town,district, municipal housing authority, state facility, or owner-occupied residential property of four units or less)? r a.Yes r b.No MassDEP Use Only 4.Blanket Permit Project Approval,if applicable: Date Received Approval ID# 5.Non-Traditional Asbestos Abatement Work Practice Approval, 2.Submit Original if applicable: Approval ID# Form To. i Commonwealth of Massachusetts 6.Asbestos Contractor: P.O.Box 4062 Boston,MA 02211 NEW ENGLAND SURFACE MAINTENANCE LLP 850 WASHINGTON ST a.Name b.Address WEYMOUTH MA 02189 7813372117 c.City/town d.State e.Zip Code f.Telephone AC000196 h.Contract Type:r' 1.Written r 2.Verbal g.DLS License# 7. JOHN P.VAWQUETTE AS060773 a.Name of,Contractor's On-Site Supervisor/Foreman b.DLS Certification# 8 RICHARD K BOWEN AM061044 a.Name of Project Monitor b.DLS Certification# 9 Fu ENVIRONMENTAL INC AA000144 a.Name of Asbestos Analytical Lab b.DLS Certification# 10. 11/2/2016 11/2/2016 a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYYY) 8-4 N/A c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday 11.What type of project is this? r. a.Demolition r' b.Renovation r c.Repair r: d.Other-Please Specify: Revised: 11/13/2013 Page 1 of 4 Massachusetts Department of Environmental Protection Project Cancellation100253213 BWP AQ 04 (ANF-001) # Asbestos Notification Form Asbestos Project r Project Revision A.Asbestos Abatement Description: (cont.) 12.Abatement procedures(check all that apply): r a.Glove Bag r b.Encapsulation r c.Enclosure r d.Disposal Only r e.Cleanup r f.Full Containment r g.Other-Please Specify: 13 Job is being conducted: W a.Indoors r b.Outdoors 14 a.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or encapsulated: 650 1.Linear Feet(Lin.Ft.) 2.Square Feet(Sq.Ft.) b.Boiler,Breaching,Duct, c.Transite Pipe Tank Surface Coatings 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. d.Pipe Insulation e.Transite Shingles 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. f.Spray-On Fireproofing g.Transite Panels 1.Lin.Ft 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. h.Cloths,Woven Fabrics i.Other-Please Specify: 1.Lin.Ft. 2.Sq.Ft. j.Insulating Cement VERMCULITE 650 1.Lin.Ft 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. 15.Describe the decontamination system(s)to be used: AS REQUIRED 16.Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (g) AS REQUIRED 17.For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency: a.Name of MassDEP Official b.Title of MassDEP Official c.Date of Authorization(MM/DD/YYYY) d.Waiver# e.Name of DLS Official f.Title of DLS Official g.Date of Authorization(MM/DD/YYYY) h.Waiver# 18.Do prevailing wage rates as per M.G.L.c. 1.49,§26,27 or 27A—F apply to this r a.Yes r b.No project? Revised: l 1/13/2013 Page 2 of 4 Massachusetts Department of Environmental ProtectionANF-001) 100253213 --� BWP AQ 04 ( __ _ Asbestos NotificatiANFon Form Asbestos Project r Project Revision r Project Cancellation B..Facility Description 1.Current or prior use of facility: RESIDENCE 2.Is the facility owner-occupied residential with 4 units or less? V a.Yes r b.No 3.SAME SAME a.Facility Owner Name b.Address SAME MA 00000 0000000000 c.City/Town d.State e.Zip Code f.Telephone 4.X X a.Name of Facility Owner's On-Site.Manager b.Address X MA 00000 0000000000 c.City/Town d.State e.Zip Code f.Telephone 5.X X a.Name of General Contractor b.Address X MA 00000 0000000000 c.City/Town d.State e.Zip Code f.Telephone X g.Contractor's Worker's Compensation Insurer X 1/1/2017 h.Policy# i.Expiration Date(MM/DD/YYYY) 6.What is the size of this facility? 1500 2 a.Square Feet b.#of Floors C:Asbestos Transportation & Disposal 1.Transporter of asbestos-containing waste material from site of generation: a.Directly to Landf Il or b.To Temporary Storage Location/Transfer Station NEW ENGLAND SURFACE IVIAINTENANCE,LLP 850 WASHINGTON STREET c.Name of Transporter d.Address Note:Temporary storage of Asbestos WEYMOUTH MA 02189 7813372117 containing waste e.City/Town f.State g.Zip Code h.Telephone material is only allowed at the place of business of a DLS 2.If a temporary storage location/transfer station is used,list name of transporter of asbestos containing licensed Asbestos waste material from temporary storage location/transfer station to final disposal site: contractor or a transfer P �' g P station that is permitted by RED TECHNOLOGIES 10 NORTHWOOD DRIVE MassDEP and a.Name of Transporter b.Address operated in compliance with Solid BLOOMFIELD CT 06002 8602182428 Waste Regulations 310 CMR 19.000 c.City/Town d.State e.Zip Code f.Telephone Revised: 11/13/2013 Page 3 of 4 Massachusetts Department of Environmental Protection- 100253213 BWP AQ 04 (ANF-001) � Asbestos Notification Form Asbestos Project# (- Project Revision r Project Cancellation C.Asbestos Transportation&Disposal: (coot:) 3.Name and address of temporary storage location/transfer station for the asbestos containing waste material: RED TECHNOLOGIES 203 PICKERING STREET a.Temporary Storage Location Name b.Address PORTLAND CT 06480 8603421022 c.City/Town d.State e.Zip Code f.Telephone 4.Name and location of final disposal site(asbestos landfill): MINERVA ENTERPRISES MINERVA a.Final Disposal Site Name b.Final Disposal Site Owner Name 9000 MINERVA ROAD c.Address WAYNESBURG OH 44688 3308663435 d.City/Town e.State f.Zip Code g.Telephone D. Certification JIM DOYLE JIM DOYLE "I certify that I have personally 1.Name 2.Authorized Signature examined the foregoing and am PARTNER 10/19/2016 familiar with the information contained in this document and 3.Position/Title 4.Date(MM/DD/YYl'Y) Note:Contractor must 7813372117. NESM,LLP sign this form for DLs all attachments and that, based notification purposes on my inquiry of those 5.Telephone 6.Representing individuals immediately 850 WASHINGTON STREET WEYMOUTH responsible for obtaining the 7.Address 8.City/Town information, I believe that the MA 02189 information is true,accurate,and complete. I am aware that there 9.State 10.Zip Code are significant penalties for submitting.false.information, including possible fines and imprisonment.The undersigned hereby states that I have read the Commonwealth of Massachusetts regulations governing asbestos abatement (453 CMR 6.00 promulgated by the Department of Labor Standards and 310 CMR 7.15 promulgated by the Department of Environmental Protection), and that I am aware that this permit application or notification shall not be deemed valid unless payment of the applicable fee is made." Revised: 11/13/2013 Page 4 of 4 d / No. . �.. FEE / 57® COMMONWEALTH Of MASSACHUSETTS Board of Health, �a �- ,MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade( )` Abandon( ) - El Complete System ❑Individ Compon nts c. (- f NJ Location 14 t,4a `" Owner's Name O CC/1�h Map/Parcel# a ` �i Address Lot# Telephone# Installer's Name yl Designer's Name Address / Address lr ` fa R. Telephone# 9-7-7 � V 7 Telephone# 7 t Type of Building �(� Lot Size sq.ft. Dwelling.-No.of Bedrooms Garbage grinder ( Other-Type of Building No.of persons Showers ( ),Cafeteria( Other Fixtures Design Flow(min.required) q YID, gpd Calculated design flow Design flow provided gpd Plan: Date Number of sheets Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above etPibed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to place the n ope tion i Certificate of Compliance has been issued by the Board of Health. Signed Date /t Inspections G '/�•��/ yor'awrr. No. -�rX ' FEE ' +' SAe :•'; :, . 0� COMMONWEXLTII OF MASSACHUSETTS r Board of Health, ]asv�31 �'� ,MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTIONPERMIT Application for a Permit to Construct( ) Repair( Upgttadel > Abandon O - ❑Complete System ❑Individual Components Location qy I a- F1 4&,er Owner's Name �� l r h Map/Parcel# ( f Address Lot# / v Telephone# Installer's Name lra " � ,. Designer's Name Q r ! �^- Address 00, Address 14 ' / IrG4 �r �, /— a� Telephone# "�'"7 �!''7`� Telephone# Ps.i r�rl Type of Building Lot Size sq.ft. Dwelling-No.of Bedrooms - Garbage grinder ( ) Other-Type of Building No.of person Showers ( O,Cafeteria( ) Other Fixtures Design Flow(min.required) q L/U gpd Calculated design flow !_ 'T1 Design flow provided gpd I Plan: Date Number of sheets Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation 1 DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not-top place the system>per lion untilpa Certificate o_f�}Com fiance has been issued by the Board of Health. Signedc--- Date Inspections No. 1-70/ COMMONWFALT14 OF MASSACHUSLTTS FEE Board of Health % MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired (. ) Upgraded ( ),Abandoned ( ) by: X 00 t ea-f l VI& ` —T`,A at L M has been installed in acc•rdance with the provisions/of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No.,-�7.It,— Vk 8-dated Approved=Design"Flow _(gpd) Installer lYr� k !'►r , � �1►�� e `� ,�� ��y �1�� Designer. e t Inspector: 1/ fJ �1 ./'f - �l Date: The issuance of this permit shall not be construed as a guarantee that the system wilrfunction as designed. Nod X V FEE � l J COMMONWEALTH OF MASSACHUSLTTS Board of Health, DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at (,� / ��(�'" �dj, as described in the application for Disposal System Construction Permit Nod`-�/6 " `lb ated Provided: Construction shall be completed within three years of the date of,,this pe-r..miitt.�A.11 local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date 154L-914 Board of Health L r Town of. Barnstable �tNWE' t.4 Regulatory Services Richard V. Scali,Interim.Director � L►nwsrescE. � ai 6'9. Public Health Division °r Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fan: 508-790-6304 Installer& Designer Certification Form Y t Date: q�z. t'5_1-� Sewage Permit# Assessor's MapkParcel 6vt> -\-r-c> 5TEPHEN D©YLE AND A55OCI Designer: oWIler:42 CANTER- LANE Address: EAST FALMOUTH,MA55ACHU5ETT5 02.'iress: f { TELEPHONE:508 54.0-2554 }. 1 On - ! -" was issued a permit to install a (date) - (installer) a septic system at 4�� r� ,_L- based on a design drawn by (address) - e! Li�.rr-- l �`Q 5�, r, [✓4 dated design 'r) �— certify that the septic system referenced above was installed substantially according to e design which may include minor approved changes such as lateral relocation of the p ' distribution boY and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory, i, I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory.V I certify that the system referenced above was constructed in compliance with the terms' ofthe I1A appro al letters (if plicable) (Installer's Signature B,MAS z r o a� { R7C �iGSg ► esigner's Signature) Gri s Stam�S '` + PLEASE RETURN TO BARNSTAB E PUBLIC CERTIFICATE -OF COr PLIANCE; VI'10, NOT BE ISSUED UNTIL BOTH THIS FORM .AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTARLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\[?esignerCerti.6c.Jtioti Form Rey 8-14-13.doc + + Town of Barnsiable P r De artment of Re p gulatory Services MAM F Public Health Division Date 1 1,63 200 Mein Street,Hyannis MA 02601 11] co Date Scheduled Time��� Fee Pd._ 1_ Sail Suitability Assessment for.Sews e Disposal Performed-By:_ -�9. .� `�pt f, Witnessed By: If LOCATION&.GENERAL wfORMATION Location Address Owner's Name Address Assessor's Map/Parcel:` Yl0 Engineer's Name d STE�d` 1 — �-;� NEW CONSTTRR�UMON _� REPAIR TTele h 5one# Land Use Slopes(96). L- y 3urfaco Stones Distancea from: Open Water Body D ft possible WetArea Drinking Water Well l ti ft Dralhago Way ft Property Line ft Other f1 SKETCH:(Street name,dimensions of lot,exact locations of test holes&pets fasts;locate wetlands 1'n proximity to holes) �•—�`.��'t,-caA.l'�•�.CL �--sir'�� a ' tot �1 . Az j " `��— SFr 4fA. .. • — rcl9t Parent material(geologic) C>MA X2 Depth to Bedrock Depth to Groundwater. Standing Water in Hole: 1�1>-"ct_ Weeping from Pit Fnea ® Estimated Seasonal High Groundwater DETE4MINATION FOR SEASONAL'HIGH WATER TABLR Method Used: De th ObscrAd standing in obs.hole: In. Depth to soli mottles: In., . Do th to weeping from side of obs.halo: In. Groundwater Adjusthtdnt tt. index Woltz RoadingDato: index Wall lmval Aetj hetor, Adj.0rauntlwater••1.evei,.,_ PERCOLATION TEST Date, Z.; 'xliYte,�Q Observation t Hole# #. 3 Time at 9" Depth of Para 4�J` 4� Time at 6" Start Pro-soak Time a . 10 Time(911.6") 1 `F End Pro-soak jD`_►S t o'•"3 —L Z Rate Min.Qnah L.7 , Site Suitability Assessment Sitd Passcd Sit;Falled: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on B ack-- -- ***If percolation test is to be conducted within 100' of wetland,you must first notify the f Barnstable Consarvation Division at least one(1) week prior to beginning. Q:\SBPTICVERCFORM.DOC G,[ DEEP.OBSERVATIONHOLE LOG Hole# Depth from Soil Horizon Soil Texture Sdil Color Solt. that y Surface(in.) (USDA) (Munsell) Mottling (Structure,Stonei;Boulders, iststency.%'aravell ' � 1 r 'a` 5 t— \cy�, 3�Z 1-•Sw �-{.��tr�st.,bt� - esY�C -4(' �. - oc , DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texhire Soil Color Soil that Surface(In.) (USDA) (Munsell) Mottling _ (Structure,Stones,Boulders. Ong nay 4slovr.. 1Z.lJ \• 0 - 3 7,1r %AC-v. -Ir7^%4V Z,yr. t. t} %W DEEP OBSERVATION HOLE LOG Hole# 3 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stonos,Boulders, 30u 30- -)zu G DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Motiling (Structure,Stottes;Boulders, 4 ct�+.r-ieLsL�.ArM "t D 13 7i� t r-9 �7kt' Z, 6 bL Flood Insurance Rate Map: Above 500 year flood boundary No_ Yea ,. Within 500 year boundary No Yes ' Within l00 year flood boundary No. Yes-. Death of Naturally Occurring Pervious Material Does at least four feat of naturally occurring pervio s material exist in all dress observed thrpughout the area proposed for the soil absorptibn system? If not,what ig the depth of naturally occurring pervl us material? ...�,..z.. Certification I certify that on (date)I have,passed the soil evaluator examination approved by the Department of Enviental Protecdon and that the above analysis was performed by me consistent with . the required training,expa se and experience described in�10 CMR 15.017. Signature Data; Q;\SEPTIC\PEACPORM.DOC D L7 D D m f, ao o o� o k g ox A a /4 z 4 n a f o m D � �rl 2 Z a Deco• I — r 7J — I► I m 00 3 i I C1'1 I r II is \ „ oa C 0 D Q S n ii u Q ri r Z b D m r n co m v m �1 O 3 SCALE ING FLOOR PLAN & PROPOSED I/4" =T - � DATE 142101 — UNLE55 NOTED ION/RENOVATION ----- 6RA1VId BY 5P[3 C ace., FEVISED BAY BUILDERS �APPROVED ►J � • 5P6 DESIGN M08I563-5661 10I.�Y�,►`o .� 4 at EIVED 7 J UL z 4 2000 ro►t:woFautixr COMMONWEALTH OF MASACHUSETTS ' EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS V DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY COXE Secretary ARGEO PAULCELLUCCI DAVID B.STRUHS Govemor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 45 MAYFLOWER ST OSTERVILLE, MA 02655 M140 P120 L275 Name of Owner LUSSIER Address of Owner: 9 BETTY LANE ATHERTON CALIFORNIA 94027 Date of Inspection: 715/00 Name of Inspector: JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02636 Telephone Number: 608-564-6813 FAX 608-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes Conditionally Passes _ Needs Further Evaluation y the Local Approving Authority Fails Inspector's Signature: Date:7/11100 The System Inspector shall sub t a copy off this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the ystem is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if'applicable,and the approving authority. NOTES AND COMMENTS "The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life." THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING THE SYSTEM NOW AND EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 45 MAYFLOWER ST OSTERVILLE, MA 02655 M140 P120 L275 Name of Owner . LUSSIER Date of Inspection: 7/5/00 INSPECTION SUMMARY: Check A, B, C, Ot D: A. SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. nLa The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank, whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. nta Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _broken pipe(s)are replaced _obstruction is removed _distribution box is levelled or replaced n& The system required pumping more than four 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 y revised /9 2/98 Page 2 of 11 'SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 45 MAYFLOWER ST OSTERVILLE, MA 02655 M140 P120 L275 Name of Owner LUSSIER Date of Inspection: 7/5/00 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS 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 presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance nta(approximation not valid). 3) OTHER n/a .7' revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 45 MAYFLOWER ST OSTERVILLE, MA 02655 M140 P120 L275 Name of Owner LUSSIER Date of Inspection: 7/6/00 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. - X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Q. - X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. - X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, _ X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. lc.t E. LARGE SYSTEM FAILS: , You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. Ot revised 9/2/98 ' Page 4 of 11 q s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 45 MAYFLOWER ST OSTERVILLE, MA 02655 M140 P120 L275 Name of Owner: LUSSIER Date of Inspection: 7/5/00 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X - Pumping information was provided by the owner,occupant,or Board of Health. X - None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X _ As built plans have been obtained and examined.Note 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. ill 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.The size and location of the Soil Absorption System on the site has been determined based on: X _ Existing information,For example,Plan at B4O,H, X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)] X _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. r revised 9/2/98 Page 5 of 11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION 4. Property Address: 45 MAYFLOWER ST OSTERVILLE, MA 02655 M140 P120 L275 Name of Owner LUSSIER Date of Inspection: 7/5/00 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual): Total DESIGN flow: 330 gpd Number of current residents:0 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO;,, If yes,separate inspection required Laundry system inspected(yes or no): NO,!� Seasonal use(yes or no): NO Water meter readings,if available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n/a CO M M ERC IAL/INDUSTRIAL Type of establishment: nla Design flow: n/a gpd(Based on 15.203) Basis of design flow:n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n/a Last date of occupancy:n/a OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source oei formation: n/a System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system _ Single cesspool _ Overflow cesspool _ Privy _ Shared system(yes or no)(if yes.attach previous inspection records,if any) _ I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:n/a APPROXIMATE AGE of all components,date installed(if known)and source of information: 1997 PERMIT 97-722 Sewage odors detected when arriving at the site:(yes or no) NO i revised 9/2/98 Kf j' Page 6 of 11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 45 MAYFLOWER ST OSTERVILLE, MA 02655 M140 P120 L275 Name of Owner LUSSIER Date of Inspection: 7/6/00 BUILDING SEWER:X (Locate on site plan) Depth below grade: 18" Material of construction: _ cast iron X 40 Pvc _ other(explain) Distance from private water supply well or suction line: n/a Diameter: 4" Comments: (condition of joints,venting,evidence of leakage,etc.) THE SYSTEM HAS TOWN WATER. SEPTIC TANK: X (locate on site plan) Depth below grade: 12" Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 160OG L 10'6"H 6'6"W 6'8 Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 33 Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. GREASE TRAP: _ (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_ Fiberglass Polyethylene_other Explain: n/a Dimensions:n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a Comments: (recommendation for pumping,condition of'inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, . etc.) n/a "^ revised 9/2/98 Page 7 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 45 MAYFLOWER ST OSTERVILLE, MA 02656 M140 P120 L275 Name of Owner LUSSIER Date of Inspection: 7/6/00 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other Explain: n/a Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level:N/A Alarm in working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:X (locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) THE DISTRIBUTION BOX IS STRUCTURALLY SOUND. PUMP CHAMBER: _ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a revised 9/2/98 Page 8 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 45 MAYFLOWER ST OSTERVILLE, MA 02655 M140 P120 L275 Name of Owner LUSSIER Date of Inspection: 7l5/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(n/a)n/a leaching chambers,number: (3) FLOW DIFFUSERS leaching galleries,number: (n/a)n/a leaching trenches,number,length: (n/a)n/a leaching fields,number,dimensions: (n/a)n/a overflow cesspool,number: (n/a)n/a Alternative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE FLOW DIFFUSERS APPEAR TO BE FUNCTIONING PROPERLY.THE SYSTEM SHOWS NO SIGNS OF FAILURE. CESSPOOLS: _ (locate on site plan) t Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer. n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 45 MAYFLOWER ST OSTERVILLE, MA 02655 M140 P120 L275 Name of Owner LUSSIER Date of Inspection: 7/5/00 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) IJQ�� © O PP 37 revised 9/2/98 Page 10 of 11 n - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 45 MAYFLOWER ST OSTERVILLE, MA 02655 M140 P120 L275 Name of Owner LUSSIER Date of Inspection: 7/5/00 NRCS Report name: n/a Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: n/a Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 10 Feet+ Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health _ Checked FEMA Maps - _ Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS 10+FEET unit, - revised 9/2198 Page 11 of 11 '�J It, No. / L" / G► p' Fee �J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for Oigpool *pgtem Construction Vermit Application for a Permit to Construct( )Repair( ofp—grade( )Abandon( ) ❑Complete System ❑Individual Components Locati Address or Lot No. . / Owner's Name,Address and Tel.No. `�J l /r1,9 Y� t✓e®— 4 vet r�. �rK l a e �,r�, iJ$S it✓r Assessor's Ma /PazceI Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. L- i,J4—,off SQ7, 14-1t e Type of Building: Dwelling No.of Bedrooms __"3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil C Nature of Repairs or Alterattons(Answer when applicable) A *�tJ� f —/s tP er^7 �2SS�dfs tv\5V c.kk ), )MD r a', &i / CL,A !K i AN-fMy of ^a Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi= cate of Compliance has been issued b this Board f Health. Signed =—=— Date_1 1 dr l 7 Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued �►� ` : �. No. / / �'� -tr.:1 i Fee Q THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS �. 0(ppYication' for Mfgpoe;ar *patent Construction Permit Application for a Permit.to Construct( )Repair( �<pgrade( �,)Abandon( ) ❑Complete System El Individual Components L$oc�ati Address or Lot No. / Owners Name,Address and Tel.No. �U Y� /►9st Y �vwti r /g K� d�T��vc(t� C�qrG L uSs,c r Assessor's i ap cel�4 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. l � C►o�s� �� �� Ws Sa/•Y �a.c Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other* Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date v _ Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) *142 � � « . -� P?�Is r.t 1 r?ess�al� C✓LS� 0.\� ►E )mod t�. dy--.._ 3� 3 =[owGl'ilGrs /✓� / vNr�tr Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system - in accordance with the provisions of Title 5 of the.Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued,b this BoardQ f Health. Signed ( . J1� t�...a-.. ,. { Date ��' 1cY 'Application Approved by r r Date { Application Disapproved for the following reasons _ t Permit No. 91 7-q Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS r A• Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by at c has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. , dated�.� Z " . Installer �'� 1 �V-C_,_, " C4 ° Designer The issuance of this permit shall not be construed as a guarantee that the system will f tion as designed. Date 1 �_ 3 2 7 Inspector h 0 , r V ---------------------------------- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 1=i9;poga1 *pgtem Conttruction Permit f Permission is hereby granted to Construct( )Repair( grade( Abandon( ) System located at 3-1 T`�e— Ile- and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of t ' rmit. Date: / Approve • 1019N1 NOTICE: This. Form Is To Be Used For the Repair Of Failed Septic Systems Only- C ERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) hereby certify that the application for disposal works construction permit signed by me dated concerning the � s r property located at meets all of the`�"' °`'tee following criteria: There are no wetlands located within 100 feet of the proposed leaching facility a There are no private wells within 150 feet of the proposed septic system There is no increase in now and/or change in use proposed e There are no variances requested or needed. If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the d less than fourteen(14)feet above the maximum adjusted proposed leaching facility will t>QI be locate groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division O.I.S.map) 3=— B)Observed Groundwater Table Elevation(according to Health Division well map) .C DATE: SIGNED: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan or the proposed system.Also If the licensed Installer posesses a certified plot plan, this plan should be submitted). q:health folder:art TOWN OF BARNSTABLE ., LOCAMN ' / a ,� a/e�—' n2 SEWAGE # QZZ VILLAGE ASSESSOR'S MAP&LOT ' INSTAI IrEEt'S NAME&PHONE N0: 4 SEPTICTANK CAPACffY LEACHING FACII.ITY: (type) 3 �� (size) 30 NO.O�:-BEDROOMS BUILO 0 r PERMTf DATE: Z- 9 COMPLIANCE DATE: o D stance Between th;.: Separat +# ? Feet Maxittiuiii;Adjusted Groundwater Table and Bottom of Leaching Facility . Private:>Weter Supply Well and Leaching Facility (If any wells exist • Feet on Trite-df within 200 feet of leaching facility) Edge of W-I hand and Leaching Facility(If any wetlands exist Feet wit "4 300 fee(�of leaching facij ) s 1� l.L '1� + Furnished.by. : ,�, xx 0C) `7� ' i fig• 1.ALL EX TERIOR WAULS SHALL BE 2xz C.1 0'O,C.UNLESS OTHERMSE NOTEM 2,ALL IWERPOR WALLS SHALL BE 2X4(9-16-O.C.UNLESS OTHERWISE NOTED. 1 3.CONTRACTOR SHALL VERIFY ALL 1VINOOW ROUGH OPENtMOS PRIOR TO ORDERING WINDOWS. A.CONTRACTOR SHALL VERIFY ALL DIMENSIONS PRIOR TO CONSTRUCTION.CONTRACTOR ------------ --------- - ASSUMES RESPONSIERUTY FOR ANY MISSING OR INCORRECT DIMENSIONS NOTBRO TTO THE ATTENTION OF THUGH DESIGNER, 2 12 F—J�kw 16011� --------------------------------------------------- -- GENERAL NOTES It NO, RE'ASION GATE 2.11 rp—jci--v CkC W-T U+T M1 ' wo ttl' r-BUILDER-Kendall Welch F-1 CONSTIRUCTF)N I.0 12 n,,-.uw,yc F'GES413NER: 7� NORTHSIDE IDEMN ----------- A—RSOCIATES - --------------- -------- ---------- PSTRUCTURAL ENGINEER-. TAYLOR DESIGN LLC STAMP: PROJECT: PROPOSED GALLENBERGER RESIDENCE 45 MAYFLOWER LANE OSTERVILLE,MIA. TfrLE; FOUNDATION) PLAN 1"IP—ROJECT W.- SHEET 16-23 A.1 DATE: jjJ6,117 L 1 A' 1 I..ALL EXTERIOR WALLS SHALL BE 2X6 a 10'O.C.UNLESS _ OTHERWISE NOTED, 2.ALL INTERIOR WALLS SHALL BE 2X4 @ 16'04,UNLESS HERMSE 3.CONTRA.0 NOTED. PATIO S.CONTRACTOR SHALL VERIFY ALL YftNT74'h'ROUGH OPENINGS q-n PRIOR TO ORDERING WINDOWS. ? op C CONTRACTOR SHALL VERIFY 27--i- ALL.DIMENSIONS PRIOR TO `vI� CONSTRUCTION.CONTRACTOR — � ASSUMES RESPONSIBFUTY FOR �W ANY W.IISSING OR INCORRECT A,$,2 -U" DIMENSIONS NOT BROUGHT TO r I THE ATTENTION OF THE DESIGNER. • w-- ............. �" i GEN ERAL NOTES t I I,_p,—) 1 AE160oEL� BEDROOM GREAT ROOM DININC 1 ___-------------------c.----- _KJTGHE.N-.___ _-__.-._._ I NO. RE'IISION OATS 1 rtxr,9Nc3 PYEWsaurta9&.YzJ r4Y.v 41w_K E rLeE'hFIbk tG xOS M'�E 1Rft�J'F-J 4 NEVNfi FiEHe BUILDER W BATH " t 4T L-1 BEDROOM _______-___ Kendall Welch Ntom PtO% CLIN5TAIA VIN 1- I 3 l`E dry 26 --------- I IIILUL��It-,...J1111 �L c�+ea(COD) B ATH 2MA L.E. DuDi1TE.{NgiSRgIiG:Y'N"3N=tTmzPflEa-6;EC2RM1=}'PYl: AUNDRY i i ENx1Th4'1s NIL[LLbflJ3OotJ.tDeR4A%Mtte.atCTM6.caam:I'H AnYPA ' StSM �LIaDNDfl_i1' bE $IGDESCTEE3 3 GARAGE llNF INLVIGEXOTN' $ STRUCTURAL ENGINEER-- M.BATH M.BEDROOM , TAYLOR 'a>N5 j A.5.1 _ .. __ - DESIGN LLC STAMP: I I 1 PROJECT: `—� PROPOSED e'Y4 GALLENBERGER RESIDENCE 45 MAYFLOWER LANE OSTERVILLE,MA. TITLE; FIRST FLOOR FIRST FLOOR PLAN PLAN _ ROJ^rCT k: SHEET 1&23 A.1 DATE: CIP vW17 7 �� fi, 1 1 � � _:� i � � O '� a,.:� � Y � � 1.ALL EXTERIOR WALLS SHALL BE 2X6 @ 16l'O.C.UNLESS OTHERWISE NOTED. - 2.ALL INTERIOR WALLS SHALL BE 2X4 @ 16"O.C.UNLESS OTHERWISE NOTED. 3.CONTRACTOR SHALL VERIFY ALL WINDOW ROUGH OPENINGS PRIOR TO ORDERING WINDOWS. 4.CONTRACTOR SHALL VERIFY ALL DIMENSIONS PRIOR TO CONSTRUCTION.CONTRACTOR ASSUMES RESPONSIBILITY FOR 1 0 I -___ I I ANY MISSING OR INCORRECT DIMENSIONS NOT BROUGHT TO I 1 I THE ATTENTION OF THE j t DESIGNER. I I ----------------------------------------- - I GENERAL NOTES I I I I I I I 1 I 1 1 I I 1 O I PROPOSED 1 BED ROOM ,I I 4 I I 1 I I I 1 V I I 1 I 0060 bi pass NO. REVISION DATE 6'-0° _ NORTHSIDE HEREBY IXPRESSLY RESERJES I ITS COMMON LAW COPYRIGHT.THESES 2666 I ` CH4 E_NOT TO BE COPIED REPRODUCE OR -- - -_ - M4NNERWHIrTSOENERWSTHOUT FIRST ------------------------------- 1 linen 3�_6• I I I I I1 - 1 DES .00E PERIIGSINPIADTE NBI—OF NO RTHDE 1 p' PROPOSED I 1 II BATH 1660� __ I IJ I,' ; BUILDER: N � I Kendall Welch CONSTRUC]TON I.C. 1 I !'=J' � • I 9ILC G1aw Stnn PoA i9U 1 C. I r , I Ovlcrv'illc,\IA 02G55 v 508 328-3900 ---------�J-----I ---------------------------------------w-------------------------------------, i DESIGNER: NORTHSIDE ———J I� DESIGN I I I I ASSOCIATES I------------------------------------------' - - i--- DKTINRNE RESIDENTIAL&COMMERCNI DESIGN 131 MAIN ST0.EET'YARMOUTHP00.T'MA 02676 (60013G2-221D (608I362-9802 O0.TM61DEDE6Ri N.COM I m I I I mrtMitlel@wmTxl.rret I PROPOSED '-0" I REC.ROOM I I I STRUCTURAL ENGINEER: I TAYLOR ------------------- --------------------H DESIGN LLC I I I I I I I I I I I I I I I STAMP: I I I I I I I I I I I I F--- I I 1 I I I I I I v i '------ I I I I I I I I I I I I I PROJECT: _1 EXISTING _ SECOND FLOOR PLAN GALLENBERGER RESIDENCE 45 MAYFLOWER LANE OSTERVILLE,MA. TITLE'. SECOND FLOOR �I�S( PLAN SCALE:1/11"=1'-0" 0 1 2 4 IS PROJECT#: SHEET 16-23 A.2 DATE: OF 1116/17 4 1, ALL 00ERIOR WALLS SHALL BE 2x6 0 16'O.C.UNLESS OTHERWISE NOTED, 2.ALL INTERIOR WALLS SHALL BE 2%4 C 16.O.C.UNLESS OTHERWISE NOTED. 3,CONTRACTOR SHALL VERIFY AL L'OANDOIN ROUGH OPENINGS — — — PRIOR TO ORDERING WINDOWS, 4.CONTRACTOR SHALL VERIFY t i I ALL DIMENSIONS PRIOR TO Ml CONSTRUCTION.CONTRACTOR !}— a .� ASSUMES RESPONSIBILITY FOR ANY MISSING OR INCORRECT w D16IFNSIONS NOT BROUGHT TO THE ATTENTION OF THE I DESIGNER. (BEN ERAL`^FIOTES- 1.. i1 I 'I TY 4 L j ^�7t� L t .1. ti' C'` i 5 I' l ll f t j. �. �. �i 7 n C T I rrt Y _ _ _ _ _ _ _ �tl t r NO, REVISION DATE Ei - nch cuar «•rotcE n'ya�r�snvur nesEnvss ,rs carxrrry�.M'c�wrw�a.Inea� F-r.rs itiE.XUP TG EE yEHY_ur.'"EG - �•,H ap'r Ftx4u'N CAa1x':E�t;h LiX E_ wrvYE4 Nt�13JE�R a'a(f tgJT AWE f LfEFT ELEVATION „ [)Ti.RFYs.re ra�xes nna-rea SOUTHEAST Fy A89v .r 5L kG EN/UF hTASEk CEs+`.n eE£RY_'lat Ei. wo BUILDER: Kendall Welch CON51T11CTHIN I— r. � '• 3iGC Mun'umrnf T38 ALt mJ,�'+yeMalkcdaei,kcem. Y� DESIGNER NORTHSIDE DESIGN ASSOCIATES r � T 'I - �7...,,_,�,� �, p5T1YCThtiF6C£XhALB.:AMM:PlJ�l Pc51'oH �,� '-'��--�.-,• � �m.� i `+ � It1 MR(.v 3'IhtCf MMtYJ9NtdM`Mr.h58Yn >I .+` .— - � � _ i \ - F - I`C6,G2-22L 1'•14?529Bht. OPOSED NE.�IERED ' f 1 PR `� STRUCTURAL ENGINEER- TAYLOR -{---; E-1 I-f— =�.'.?_�- DESIGN LLC Tj 44 FPROIJECT I y 1 I- , t : , : r EXISTING GALLENBERGER FRONT ELEVATION RESIDENCE a,s.t NORTHEAST 4s NIAYFLOWER LANE OSTERVILLE,NIA. TQUE FRONT& SOUTHEAST ELEVATION SCALE; 6 y a < 6 PROJECT M; SHEET 1&-23 A,3 GATE: C1F 1i9S117 7 1.ALL EXTERIOR WALLS SHALL BE 2X6 t,16'O.C.UNLESS _ OTHERMSE NOTED, 2.ALL INTERIOR WALLS SHALL BE 2X4 d'16'O.C.UNLESS OTHER1141SE NOTED, 3,CONTRACTOR SHALL VERIFY ALL NANDOVI ROUGH OPENINGS PRIOR TO ORDERING WINDOWS, ... 4.CONTRACTOR SWILL VERIFY ALL.DIMENSIONS PRIOR TO _l ,: CONSTRUCTION.CONTRACTOR ASSUMES RESPONSIBILITY FOR 7 r ► I ANY MISSING OR INCORRECT DIMENSIONS NOT BROUGHT TO ,..d' THE ATTENTION OF THE. t DESIGNER. GENERAL NOTES ITT r � � � � 1 11 I �- � I ''� i-i. {-1 rT_I i r s.o I I 1 0_�_ I 'l I' r I I 1 4 t =4 1 'r` - 7 •.�t I> ,; , t 4 III r IT. r�r r r _- �r�• __,. NO REVISION ❑ATE C tF�IUENyi�YE>YR-�`LY Nk YEFVES �"Y Ct'.nttYry M1S'!:]FrWtSR.f nk3� f Nw.YE4'.lnaf<i5kVER�vRnbJl'MP£f RIGHT_ELEVATION crlesurarmexsuWTCEY f•ya•.v E9kin-ti�izxrEkNF aF ntiNTn:.ic' 5lYtGR i2EY_'tat ES NORTHWEST BUILDER: Kendall Welch cDNsrxlrnoN Inc. el.;c nsi�sw.,?a1J air C4iSi�tlff.tA1 fCti)+ � yJt:4?t:•Nln `p rtn4?%cc JflNiO<'ck4mat OESiGNER' - - NORTHSIDE - - - - - DESIGN - - - ASSOCIATES �-1 D STiYCfM1'.:FES CEXT•AL A.COMM-PAaLDfSISM _ — — —.— f I icv 3taffi•vwai�tlJfWGvi•nia tli4T. I'4Bt mI-2aiJ IS4Wm2'9FAE. y — STRUCTURAL ENGINEER- t•`I TAYLOR DESIGN LLC t ��� JJ (� L 1 1I NA i lI I ;J II 111 � 11 . i4 is t i i , n „ ,,t 1 III � � i. V`4 F:' II'!'41 L � i i I I I r_ uv - -'-'- _L -1'r„ I ,L -II�,L1[I1._ rl rl , fn� ,II, 1 it 6 ,i ,Ir = _ _.-•_ _ PROJECT EXISTING GALLENBERGER REAR ELEVATION RESIDENCE SOUTHWEST 45 MAYFLOWER LANE OSTERVILLE,MA. TRLE, REAR& NORTHWEST ELEVATION SCALE:1lFI'-0' B f 2 4 8 PROJECT p: SHEET 16-23 A.4 DATE' or M V17 7 W2 Rlgpc ,.ALL EXTERIOR WALLS SHALL Root BE W 5 O.C.UNLESS • - ,;,.�r zx,o eelnnp.lasses OTF[EROTHERWISEE NOTED. , 2,ecm,r ncs • 2.ALL2X4 @ IEr D.C.WALLS SHALL All Uyau,s IE at unless; BE 2X4¢t6"O. UNLESS OTHERWISE NOTED. 3.CONTRACTOR SHALL VERIFY -- _ - -- - - —- 1-4 - _- - ALL WINDOW ROUGH OPENINGS PRIOR'10 ORDERING WINDOWS. � 4.CONTRACTOR SHALL VERIFY ALL DIMENSIONS PRIOR TO COOT �.g CONSTRUCTION.CONTRACTOR ASSUMES RESPONSIBILITY FOR Tw xsyR by,,ram ANY MISSING OR INCORRECT i { 4112 THE ATTENTION NOT BROUGHT iT TO r �� THE ATTENTION OF THE ' 1 DESIGNER. TYI 24310 _..;'_._............._._....._.........__........_ _.. GENERAL NOTES NO. REVISION DATE _ ... 2.12 RiJy. ._....._..._: „ORT*I IDE -MR Roar Rarxrs---F•••_.- UTM3U e6iEEY E}y4iEE£LYFA.ivE'a i 1 f P_N19 ARE NOT TO M REEPPDXO''EW S ' Ya,R Gel,ny Jokts : LH4N-uED[ft GDFIED I"NIY£9RM CR _ ':� / ;1 rA.M,rii,n l.1•w'YN4.R WIT ,. Y-JrU Cdlnr lips i 09TnnHGMEE%Mik3SY�PIT1Ev�il`,nr I A Z RIGHT ELEVATION ulL.r, l.,a vc„a...: oE�ouosvcw es.scN,nr i NORTHWEST f/ nnMd nRT BVILDER: I KenLla11 Weleh. 4A Yayy\-uMllet,dut'th.m 1 2 r DESIGNER: IN I f l 4�12 NORTHSIDE I t __-.....-- DESIGN i ASSOCIATES 141 MNrl STREET"YARIADUTHPDPi'I.IAP?*+l5 ' NWTHSMEECRIKODN, t rendaldeig,mR,orinn n1] I 1 7 STRUCTURAL ENGINEER: TAYLO R DESIGN LLC 10'LYL j ® ti STAt.1P: IEMI IULII im __— -- -- - EXISTING I GALLENBERGER A.7.2 REAR ELEVATION RESIDENCE SOUTHWEST 45 MAYFLOWER LANE OSTERVILLE,AAA. T— REAR& I NORTHWEST _ Section j SCALE:tllr=l'-0" i 0 1 2 4 8 i F'PROJECT Y' SHEET 16-23 A.5 DATE: Of 1111611 7 1 I 1,ALL EXTERIOR WALLS SHALL BE 2M 0 1V O.C.UNLESS OTHERWISE NOTED, STRUCTURAL PIPE COLUMN OR: 2.ALL INTERIOR WALLS SHALL 3 1/2 CON:. FILLED STL, COL. - BE 2X4 0 16`O.C.UNLESS 10T BACKF�u w.L_ BST.tr FILLER, NOT T E GEED 10 KIPS LOADING @ITUMINOUS JOINT FILLER, OTHERWISE NOTED. UNTIL CCnU^-FTE MS dlO' $ Et NBIGNY, ATTAINED DAY_TREN�T«I TOP GF. V!/FLP.XI@LE E+,, �7GP OFF Wi FLEXIBLE 3,CONTRACTOR SI{ALL VERIFY AND wTA TGP t 6^r'rcM • JGNT SEALANT •Tl'!EK`Nk7LY-EWRAP — Sn ClJWCR EYc.7?I1SJOINT o=w•LL ARE PRrmeR 'yI 6 MI POLY VAPOR R ROE SIKAFL_X IA•"T' PRIOR TO ORDERING WINDOWS. SER:=URFti, __ I 7v CDX PLYWOOD y^-.� 1 I.K;Xb 42.�'xH2.4 TOP Ira L. 'ETA. !++ GF SLAE 2n6•M,OC I 4 J d.CONTRACTOR SHALL VERIFY R"I11 Cf7NCRETE P(7i7fINC.+- J ALL DIMENSIONS PRIOR TO ao as RElaaxs,ca,T II I- A•cc~Nc.5LAb ! f r+'1 _O,x ( AF PLATE CONSTRUCTION,CONTRACTOR INSULATION ASSUMES RESPONSIBILITY FOR T7P t Eerr-a-Isl PER CODE L ti CcXb fl6 WWF', TOP 1!3 + JFF'' S1_AL� r ANY M1IISSING OR INCORRECT F 6'CCTT'ALTG' I 1 GRRr DAtP20dIAY. II II F MIL.Fr}LT VAr•CR.BARRIER � ❑IAIENS1gNS NOT BROUGHT TO a__R TOP OF _ :, �a THE ATTENTION OF THE w I FGA:'InY _��1=I, • I � �e...s._�_ „ 2Y.4 SEYWAY `4"TIC. St2FLTx:R - --------- - . .-"-=---------- —� f-.I VE A NAIL NAIL.TO-L';1..T5 �_� _ _. n GENERAL NOTES.., >o.�<eu, d.T. • • v.� ` tl 1•S KtIiAR= L 51IXNG SEE ELEVATION ,-EACH n.ATG (TYP•CAL;- _ .I 'II I'. - RIM-1015T OR Pa.P4=IMFTtx. 1 C_ '♦ 111 - I I I-I I I' I- �CD%P.,.PLrwD. _ _ �` _ -Ili II( T II-1 MULTIPLE REV. ftf2&IR 21,6 F.T _ILL ._ ? }Y / /d / N�4�\r},Ct"1 .r\r/�.+J-Y��/'�j-./ i�.F�'r I ENG NOTES 7t2R'15 I rII }i``3 / `�o � f 'ai/ ''� �, Sll.l, -F.ALER 1 I!Jr d! ut`a\l' �` ` ti �. x`' j '` �//fh r>/\r� r�r v`3kh>3i�ir/ f 1� trv�t No. REVISION garE "°•m c���A.R ;m j a`m�.r s:e•AN HOR WI TS - k ...�.I:: ' '�'X• :6�'n �ffn-..l,�kdv' ,' t'w� �y '/,«:;/.C.�i': Cr�,?j;`, wnr wnr IW5",TOIA'PL o 3, n TYFIG/-' SI-AB FOCTINGFIZL.1 TAMP 1'dFT.SLGP 1 eVueal c wr.Nrcvrgxtnsue ! 5G1LE 1-I+2'a I'-d t2"T,5 OF STOr'Im _ I,I, d tr 11N nIs9oc TL e'n ttcx / Hi1ERE GUTT NO ER@ z e us R®ARs _1 1 1 1 I I I BUILDER! AROUND ALL CPENta7CONT. I .ma mme.m I i ; jJLL "N F�OTING DETAILDAMPROOPIN3 SCALE 1-1/2' - 1'-0" 1. (q-\TTPICAL SILL DETAIL DESIGNER: t SCALE I-1/2" - I'-0" NORTHSIDE DESIGN ASSOCIATES pGTIMCrt1'E NSDENtELL 6 COMMExpPLDE VG/1 NA'SinExt•Y.4iXO trPOlf•MnnMT.'. E't]vT CONTINUES CCMFQ$FFF DFC-K,INO tat�X®13F3'o"o,.' n I5.'813'v398:i FOR CAI.UYP'1 for xsx:rr.mr. I1 r—C.OMP05ITE 05C JNG _ _— nmtGsclF.ox:zl.ner �J ,'7>rIO P,T DF-GK I' HEELER F.T. I JOISTS IG'G.C. 't 1�'�', STRUCTURAL ENGINEER: COPRD.DIM.IV 5EE FRAMING PLAN. TAYLOR ` REAM OUT FRLW1 tXICR IOCAFILN ! .� ' ' REAM TO gr^FNO DESIGN LLC 6' AVFtUN cr.Ln IJ t)' 1111 1 - SKIRT @D,FAST a CCC1i.C'PENING I -JOISTS P.T.DE (+ + YNSTs W'O I y 1 y! 7:MJTUBE GARAGE LX.L'1R r I HLOCIC wIP,T FLYWu<]D f SEE FRAMIMi LAN r — s MP�N 415LrAA STAMP: - 11 2S T-9 I CAIV.A I !r - e PERIMETER ? GAL V. -a E w&><h zJz.Io P. PERIMETER ANrs1I MAX a 3 a• I O,C,MAX, READER A I 6.x6 6J6 NVF F+11 TOP 113 Or 5LA8 6'+b'P.T_POST 1V+ AL1'L'RNATC CGNNEGYIT' I' wH"R® M NO PE LCC:ArLn PROJECT slriP=uN A66 PROPOSED --vim, t _ A A �Gallenberger •� 4 Rcsidonco 2r.4 KETWAT O.Ir iI AA. ~ t PW9✓IDE ID'DIAM.SONOTUBE m 1 't WIBLSPCOT POOTi"G(Br2<9) v 't Ar FOR.COLLi-N 5UP'r'ORT ABOVE a z TITLE 2 9 a5 RFPARS,COAT. ! ..,� %* C BUILDING V CCMP.FILLS f� '\,GARAGE APRON DETAIL ppOJEGTY J�OF ISCALE 1-112" = V-O" 15-04(l o�- ICAL EC- OS - A.ILDATE:�W18A5 6. 1,ALL EXTERIOR WALLS SHALL BE 2X6 Q IT O.C.UNLESS OTHERWISE NOTED, 2.ALL INTERIOR WALLS SHALL BE 2X4-0 W O.C.UNLESS OTHERWISE NOTED, a.CONTRACTOR SHALL VERIFY ALL WINDOW ROUGH OPENINGS PRIOR TO ORDERING WINDOWS. a.4 TOP PLATE DEL TOP PLATE A.CONTRACTOR SHALL VERIFY CONSTRUCTION.CONTRACTOR RAFTER 0 16' O,C. ASSUMES RESPONSIBILITY FOR 5N, (20 GA-) ANY MISSING OR INCORRECT 1/2" CDX 5t4EITH;N( IER DIMENSIONS NOT BROUGHT TO �US�4 EAr LE OPENINGS THE ATTENTION OF THE DESIGNER RAFTER GENERAL NOTES 'DER EX7E D HE, -----7Cfz PLATE NAIr Ed 0 'FULL 14G F- BTM PLATE NAI�5&3 G. TO KING STIJL' �HDR UPLIFT STRAP SI UU % HAI,- 7c�P FLATE -...... 2- %a' ANCHOR 5c,-T5 TO B71-1, OF HDR, ------ 2 R:DkS Id t�A�1-5".W'FLAlE HA51-IEP5 MULTIPLE REV. W21VIG 61 51 D.C. -UPI, -10155 51 BEA-75PEMNC. ENG NOTES T;2W%5 E' _tN ANCHOR OR 3k'O.C.0 C >Y.Y.;/#'PLATE WASHER NIS NO, RE ION GATE -Er' TQ PLATE CO'AKLCTION I-IN. EM5EDIIENT JOIST-5 FOUNDATION:-.. ti rz� 4 5'LL PLATE 12 tnk ANCW--k!g TIP, �Mf"L 112' COX. SHEATHING 4 SILL PLATE TO TOP PLATE -R RO A AL BR N L of A' 56E NAILING 504EDULL 5C-ALE-NT.6, BUILDER 5/8' ANCHOR BOI-75&396'O.C. TIIN 7' EM DMENT -/3,.3'r)/AE'EPLATE WASHER f�r' 1SILL TO PLATE CONNECTION w/ SHEATAINC- 00 SCALE'N.17.5. F-DESIGNER: —1144 NORTHSIDF DESIGN ASSOCIATES JOINT DESCRIPTION aw or NAt ENG 1,3111CIN NA 4A11.5 1E�JA21:m ROO= FRAMING FLO"XIN,TO RAFTER(TOE NAII.FC) F-STRUCTURAL ENGINEER: KII-1 WARW TV RAF1 E k;END NAILED 2 16d -�d LACH END WALL FRAMING TAYLOR TOP=1 ATES AT NTFR�R=i I NS(FACE NAU-ED; 4-141 A, jolw DESIGN LLC DER 1-0 I- DER(F2,'-Iz NAL-ED; Ibd I&d AL644c;EDGE2A STAMP: FLOOR FRAMING NAILS C. 'D.C. JOSI 10,_ILL, ICR FLATE iW.GIRDED.(TOE IAII-Z—) 4,Dd 4-Ind P JOIST BEAN 5TRAP 5im- -N BLoc�axf. rL�,J0115T rTOZ NWILED,` 2-ed 2_Kld EACH END w r,-,5, -C - ' - FACA BLOCK 51-,X�14-TO 61�-OR TOP P-ATE( -E 4AI-EDP I�d `1 &&d L5TA B EA. RAFTER LEOO STRIP To PrAl-OR CjlW0 CR(�ACE NAILED) n-NA .-f6d EACH JOIST 2%' F�w -0.ST ON LEWEl, To 6 E Am�'TO I-'I L E D 3_6d 5-Wd PER 10:�,T 04tSTANCE SAND-0!ST T -101�T[END NAILED) 5 r-i 41ki PER JO 5T OR F'PROJFCT: F14ND-Z ST To SILL TOP P-ATF(TOE NAILS;)) Mr, a U,I PER F� R00= 514EATH;Nr, PROPOSED WOOZI STRJCTURAL PANELS RIDGE BEAM G.IIpn'6erq4r- RAFTERS OR TRU55E5 SPACED L'TO 16'O.C. 6d j0d 6:EDGE/6-FIELD Rpsidpirim RAFTERS OR TRIk--SF5 SPACED OVER WOC. 6d all 4 EDGE/W FIELD N07E- RJDGE STRAPS ARE NOT 45 I-ARyFla Pr r.W,J. ENDAALL RAKE OR RAKE GABI.E OVERHANG ed IO3 6:EME,4-:FIELD RJEQUIRLD$JkLN COLLAR TIES De ()4peviEle"a 'ABLE EN ALL RAKE OR RAKE TV5-5 STRUCTURAL Ed 04 a EDGE A F ELD r.prtlNA6 116 OF 2-4 1-UMER -01JTLCOKER5 ARE LOCATED IN THE UPPER aAPLe ENPAALL RAKE GR RAKE EVES 1.0l<QJT FLOCKS' ed too 4-EDGE/4-FIELD THIRD OF THE ATTIC SP4fl!AN I I I ATIAC44 t TO RAFTERS USING TITLE 'FILING SI4EAj'WllAG S)tN NAILS EACH END FRAMING TIE r'r'PSIJM WALLBOARD ',,I COOLERS7-E%rzl*'FIELD DOWN DETAILS HALL SHEA-PING CORNER STUD 1-GLQ DOWN WOOD 51,12IA:TORAL PAIELS (D&—'D4 NT SCALE:I14*=V-4' FTup,SPACED UP TO 24'O.C. FIELD 0 1 2 4 8 )V:AND 2%� FIBERBOARD PANEI-5 ed o;Y Gy F�_UN IALLBOARD FIELD PROJECT —rH—pl—T *A FLOOR SPEA.THING H00:1 ST"JCTURAI- 15-04 A I'OR L-E55 6d IOD b' EDGE/P FIELD GREATER THAN I' IN Ibe 61 EDGF,9-'FIELD DATE: SEPTIC 5Y5TEM PROFILE VIEW N.T.S. N ' TOP FOUND. EL. 32.1' 0 Q_ ,�ry R FINISHED GRADE EL.3 I.O'± N FINISHED GRADE EL.31.2'± FINISHED GRADE EL.31.0'± 8 17/6„������ 11 I i /l llllllfllll 11 llllllll; I 1 IIIillll i l !llllllllll llllllllll 6" llllllllllll ! RISER r15 I.P.WITH SCREW TYPE CAP TO WITHIN FILTER FABRIC 3"OF FIN 15HED GRADE(ONE PER TRENCH) ONE RISER PER TRENCH INVERT EL. 20�' 20" 29.8' EL. ±29.0' 29.5' Dia. Dia. 8.5' LOCUS MAP EL. 28.0' � 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 INVERT EL. I INVERT EL. 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 INVERT EL. INVERT EL. INV. EL. ° °•a° o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ° ° ° 25.17 28.62' GAS 28.3T 28.07' Mln. 6" 27.87' 27.17' -+ BAFFLE um 48 3/4"- I I/2"DOUBLE WASHED STONE 48 Liquid Level 48" 5 ASSESSORS DATA: MAP 140 PARCEL 120 33.5' REFERENCE CERTIFICATE: 2 1 1303 DISTRIBUTION BOX PROPOSED CHAMBER TRENCH N REFERENCE PLAN: LC 2GG4-135 NUMBER OF TRENCHES = ONE I PROPOSED 1500 GALLON TANK NUMBER OF PRECAST UNITS PER TRENCH = THREE PRECAST'D15TRIBUTION BOX NOTES: FEMA DATA. ZONE"X' MAP 25001 C0757J 440 GPD @200% = 880 GPD-USE 1500 GALLON TANK INSTALL ON A LEVEL BASE BOTTOM OF TEST PIT EL. 19.5' i MAP DATE:JULY I G, 2014 MINIMUM WALL THICKNESS = 2" NO GROUND WATER OR REDOXAMOKPHIC MINIMUM INSIDE DIM. = 12" FEATURES ENCOUNTERED jj LOCUS IS NOT LOCATED IN A ZONE II I ZONING DISTRICT: RC OUTLET INVERTS SHALL BE EQUAL TO EACH OTHER AND AT DO ! BUILDING SETBACKS: SEPTIC TANK NOTES: 2"MINIMUM BELOW INLET INVERT. p�O' ,�' f FRONT-20' TEES SHALL BE CONSTRUCTED OF SCHEDULE 40 PVC AND SHALL EXTEND A THE DISTRIBUTION LINES FROM THE DISTRIBUTION BOX SHALL ,�' \`� SIDE #REAR- 10' MINIMUM OF G"ABOVE THE FLOW LINE OF THE SEPTIC TANK AND BE ON FLOODING THEY F MINED AS DETER BL THE CENTERLINE OF THE SEPTIC TANK LOCATED DIRECTLY UNDER THE ALL HAVE EQUAL INVERTS ,�' �� I OVERLAY DIST:AP AND RPOD CLEAN-OUT MANHOLE. DISTRIBUTION BOX TO THE HEIGHT OF THE DISTRIBUTION LINE \ +32.0 \ ` LOCUS IS IN WIND EXPOSURE ZONE"115" THE INLET PIPE ELEVATION SHALL BE NO LE55 THAN 2" NOR MORE THAN 3" INVERT AFTER ALL LINES HAVE BEEN SEALED IN PLACE. ABOVE THE INVERT ELEVATION OF THE OUTLET PIPE. +31.7 INVERT ADJUSTMENTS SHALL BE MADE BY FILLING WITH THE SEPTIC TANK SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL, STABLE BASE THAT HA5 BEEN MECHANICALLY COMPACTED AND ON WHICH DURABLE AND NONDEFORMABLE MATERIAL PERMANENTLY G"OF CRUSHED STONE HAS BEEN PLACED TO ENSURE STABILITY AND FASTENED TO THE LINE OR RECONSTRUCTING THE LINES TO PREVENT SETTLING. UNTIL ALL INVERTS ARE OF EQUAL ELEVATION. THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 12",WITH TWO \ \ 20"MANHOLES HAVING READILY REMOVABLE IMPERMEABLE COVERS 12.83' OF DURABLE MATERIAL AND SHALL BE PROVIDED WITH ACCESS PORTS. ° ° ° •° + \2 Q� +31.7 \`�31.2 ` ° o o Q o o BM: TOP CB O ` ° o 00 0 0 --'a.- -- - ��. 0` \ `� PLAN LEGEND: THE TANK OUTLET TEE SHALL BE EQUIPPED WITH A GAS BAFFLE. ° . • o 0 0 0 0 '° ° 24' EL. 313 - ° DATUM: BARN/GI5± a,` o O -� �� \\ ��'ll. RR 58 ---� +31.3 oj�`� 2F \ `� \ �d SOILS TEST PIT -+ 48" 48" Do \ i +31. +31.6 �S,�-� ��� \�� Ohl/ OVERHEAD WIRE5 PROPOSED LEACH TRENCH-END VIEW ____ '9 E o , , _ ,,w-� WATER SERVICE S49 00 00'W / /� - - - � �`� `� NUMBER OF TRENCHES = ONE 14.53' 31,2,�� j PROPOSED - 4-\30.5 F NUMBER OF PRECAST UNITS PER TRENCH = THREE / Ipr 3� 1 500 GALLON - _ \ \ 3 EXISTING CONTOUR INSTALL THREE 500 GALLON PRECAST UNITS /� / SEPTIC TANK - �, � �p�. \�� O WITH FOUR FEET OF DOUBLE WASHED STONE +31.2 _ - ; ` `�\ !��C' +31.3 EXISTING SPOT GRADE AT SIDES#AT EACH END % 30 ' �, +31.3 +31.6 16 D/B 1f�1 4 `- �C t31.6 +31.3 / ` -- EXISTING UTILITY POLE o GENERAL NOTE5: 0 _ +�30.7 �\ ! +30.8 o -- _ 1 . ALL THE WORKMAN5HIP AND MATERIAL5 SHALL CONFORM TO DEP W / +30. - ` TITLE V AND THE TOWN OF BARN5TA5LE RULES AND REGULATIONS ,� i i <' 1 ° _ �� fl FOR THE 5UB5URFACE D15PO5AL OF 5EWAGE. j 1 + 80 �- - 2G,_- ��� '�` �`` ����AA �� Q I / ' �/ �k29.7 2. ACCESS PORT5 OVER TANK TEES SHALL BE ACCESSIBLE WITHIN G SYSTEM DESIGN DATA: ° 1 i ; `�\ 9 ` i - <\ ��p� s �,+ 0.3 .� \ .o����C,\s FE �y OF FINISHED GRADE. - _ 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF r FOUR BEDROOMS = 4 x 110 GPD = 440 GPD REQ. FLOW 53 39 40'W s - � � I I , .� \ �i` \ �\ f� PSTEPNEN G�. WITHSTANDING H- 10 LOADING UNLESS OTHERWISE NOTED. USE ONE CHAMBER TRENCH, 1 2.83'W x 33.5'L x 2' EFF. DEPTH 5G.2 I ��\ 3 �s �\ <\ \` �o _ _ -�`� ,� t29 g o s DOYLE 51DE WALL: (33.5+33.5+ 1 2.83+ 12.831 x 2.0 = 185 5F I I I +30.6 `t ` �� > A L� \�'��'� :U Ivo. 3755g 4. THE EXCAVATOR/CONTRACTOR SHALL CALL DIG SAFE AND VERIFY THE LOCATION \Is F > \ f-- 9� _ e o BOTTOM: 12.83 x 33.5 = 429 SF OF 51TE UTILITIE5 PRIOR TO ANY EXCAVATION, AND SHALL BE RE5PON51BLE FOR , 14 ,� \ � � �� - ��� G 14 x 0.74 = 454 GPD TOTAL DESIGN FLOW PROVIDED I +30.4 �,� , X +30.9 ��No SU �iEy ALL MATTERS RELATING TO ELECTRIC AND/OR GAS EASEMENTS. / +30. _ 5. SEWER PIPE5 SHALL BE SCHEDULE 40 PVC, K' DIA. UN'LE55 OTHERWISE NOTED) NO GARBAGE DISPOSAL ALLOWED if I I �� G, ANY MASONRY UNITS U5ED TO BRING COVER-5 TO GRADE SHALL BEABANDON EX15TING \ \ \ \ iZ ✓ MORTARED IN PLACE. // ' SYSTEM PER TITLE V � ��,\%. �� +31.2 7. PIN15H GRADE SHALL HAVE A MINIMUM 5LOPE OF 0.02 FT. PER FOOT. ' / / +31.1 �-30. REQUIREMENTS I +30.4 8. EXISTING SYSTEM COMPONENTS - IF ANY - SHALL BE ABANDONED PER TITLE 5 REQUIREMENTS. I W I +30.1 , ems. 0• p , 9. THE EXCAVATOR/CONTRACTOR 5HALL BE RE5PON51BLE TO CONTACT DOYLE I i > I +30.6 AND ASSOCIATES 24 HOURS PRIOR TO ANY REQUIRED INSPECTIONS. I I �' DAVIJ 10. ALL COMPONENTS 5HALL BE MARKED WITH MAGNETIC TAPE OR ' ` +30,6 5� B. Zli .� COMPARABLE MEAN5 IN ORDER 30.1 LOT 275 TO LOCATE THEM ONCE BURIED. ! I I ( �r C + I I . ANY AT-GRADE COVERS 5HALL BE SECURED TO UNAUTHORIZED ACCESS. I .�` 1� 21,347t S.F. r,Tn..Y, , w 530 29' 30'W I I \ +30.3 53.37' i \ iM� 1 +30.3 1 1 I >1 L30` p +29.7 \ L Z Zl Zb l I \ II I Iy V r500 4G' 20'"W - -30-\ I .20.04' S 7\ z l 6 0„� +30.1 SOS oDATE: 12-12-1 G j 1`� I N�\° 26 3 ; SEPTIC SYSTEM PLAN 501L EVALUATOR: STEPHEN DOYLE HEALTH AGENT: DAVID 5TANTON 0 20 40 Feet PREPARED FOR PERC RATE 2 MIN/INCH (C HORIZON) ( I EASEMENT P#-1 5223 SCALE: I" = 20' TP I TP 2 TIP 3 TP 4 -I-- 53° 23' 00"E #45 MAYFLOWER LANE G.47 05TERVILLE, MA55ACHU5ETT5 o„ EL. 30.8' o„ EL. 30.8' O„ EL. 30.5' o„ EL. 30.5' / i A 5L I OYR 3/2 A 51. 1 OYK 3/2 A 5L I OYR 3/2 A 5L I OYR 3/2 DATE: DECEMBER2 I , 201 G 6„ 6„ 6i, 6„ BW L5 I OYR 5/G B, LS I OYR 5/G BW L5 I OYR 5/G BW L5 I OYK 5/G I SCALE: 1" = 20' 30" EL. 28.3' 30" EL. 253 30" EL. 28.0' 30" EL. 28.0' PERC 48" PERC 48" C MED. C MED. C MED. C MED. ) PLAN REVISIONS: SAND 2.5Y G/4 SAND 2.5Y G/4 5AND 2.5Y G/4 SAND 2.5Y G/4 132" 1EL. 19.8' 132" 1EL. 19.8' 132" t IEL. 19.5' 132" EL. 10.5' NO GROUND WATER OR REDOXAMORPHIC NO GROUND WATER OR REDOXAMORPMC NO GROUND WATER OR REDOXAMORPHIC NO GROUND WATER OR REDOXAMORPHIC FEATURES ENCOUNTERED FEATURES ENCOUNTERED FEATURES ENCOUNTERED FEATURES ENCOUNTERED I 5TEPHEN DOYLE AND A550CIATE5 42 CANTERBURY LANE EAST FALMOUTH, MA55ACHU5ETT5 0253G TELEPHONE: 508 540-2534 5J D5U RVEY@ AOL.COM i sQ � fn' 4 y1 No4y�, 0 LOCUS MAP A55E550R5 DATA: MAP 140 PARCEL 120 ' z REFERENCE CERTIFICATE: 2 1 1303 REFERENCE PLAN: LC 2GG4-135 FEMA DATA. ZONE"X" MAP 25001 C0757J MAP DATE:JULY I G, 20 14 it S LOCU5 15 NOT LOCATED IN A ZONE II ZONING D15TRICT: RC � 3� S . BUILDING SETBACKS: bO Oa �'�\ FRONT-20' 1 iS 4 � 51DE 4 REAR- 10' C. S O \ OVERLAY DI5T:AP AND RPOD +32.01�\ LOCU5 15 IN WIND EXP05URE ZONE"B" \�k31.7 \\.\ ' +31.7 \431.2 \ 2 BM: TOP CB 0 J ` /°1 PLAN LEGEND: DATUM: BAKWGI5± +31.3 �j�` �'F� `� \` SOILS TEST PIT +31. +31.6 /S ��• \� OhW OVERHEAD WIRE5 S49° OO' OO W O`y '�`� w--- WATER 5EKViCE 14.53' 31.2�3 / PROPOSED +30.5 Y J 0 1500 GALLON �/ .o �� 30 EX15TING CONTOUR t ' SEPTIC TANK i +31.2 1��, +31.3 .�' \� +31.3 EX15TING SPOT GRADE 30. d`• +31.6 ' 60 ° D/B 1���', 2C +31.6 +31.3 / \��\ �� EXISTING UTILITY POLE ' +30.8. +30. ' \+29.7 ' O �`\ \\ CO` i +30.5n 'P��� j \♦ _ 9�Ft�c j1 4 u\ O 0 p { r ABANDON EXIS \\\ SYSTEM PER TIT �� \\ �� \ +31. 30. REQUIREMENT < c \\ 0. +30.1 LOT 75 r. 6y 21,347 S. - , i \ :E 1 z zL I I I 50° G' 20V ;20.0 ' 85 V30N� +30.1 5EPTIC 5Y5TEM PLAN --� — ----- / 0 20 ao/ Feet PREPARED FOR� s (� EA5EMENT SCALE: 1° = 20' #45 MAYFLOWER LANE G.47 05TERVILLE, 1VA55ACHU5ETT5 DATE: DECEMBER2 1 , 201 G SCALE: 1" = 20' i PLAN PEV1510N5: 5TEPHEN DOYLE AND A550CIATE5 42 CANTERBURY LANE EA5T FALMOUTH, MA55ACHU5ETT5 0253G TELEPHONE: 508 540-2534 5JD5URVEY@AOL,COM