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0310 NORTH BAY ROAD - Health
310 (Main) North Bay Road Osterville P A = 072 005 y COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE'OF'ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PKOTECTIOI'�® DEC 21003 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:. 3)0 MAP Owner's Name: PARCEL r� Owner's Address. �— &� - LOT Date of Inspection: ,U 00 Name of Inspector• (please print !✓ Company Name. " Mailing Address: �y ( c;G� 0 Telephone Number: —21 - _ CERTIFICATION STATEMENT I certify that I have personally inspected the,sewag`e disposal system at this-address and that the information reported below is true, accurate and complete as of the time of the inspection: The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). 'The system: Passes Conditionally Passes Needs.Further Evaluation by the Local Approving Authority ails Inspector's Signature: _ Date: 610 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or, DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. . ... ._ Notes and Comments:: , ._,_... ... ,.._.. ....,_ .., ...'.. w. W.. . _ f ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will.perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) / Property Address: F-V NCd4� Owner: fJ Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in )10 CMR 15.303 or in 310 CMR 15,304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One'or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,N'D)in the for the following-statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existi:-ig tank is replaced with a.complying septic.tank as approved by the Board of Health. *A metal septic tank will pass inspection.if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: ..:. Observadon of sew.age,ba�,--.kur.or break out or high static-water level inthe distribution box due to broken or obstructed pipe(s)or due to a broken;settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than*4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health):_ broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 1'1 OFFICIAL INSPECTION FORM-:NOT FOR'VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: ( A Owner: Date of I spection: � y 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 I. 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 I of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100,feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria,'and velatile,organic compounds.indicates tbat.the•well�is fr,e-fro rpolhution from,that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A-copy of the analysis must be attached to this form. 3. Other: 3 ' i Page 4 of 11 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: C Owner�� (,41?4L,9Qo_hW,9.AhA1A Date • Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No/ V Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool^f 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 J cesspool _ Liquid depth in cesspool is less than 6"below invert or available volume is.less than ''/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _ J Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface 1 water supply. i v Any portion of a cesspool or privy is within a Zone 1 of a public well. _ Any portion of a cesspool or privy is within 50.feet of.a private water supply well. Any portion of a cesspool or.privy is less than 100 feet but greater than 50 feet from a private water supply well-with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen.is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E.' Large Systems: _. . . .. ;J�•To be considered a large'system the system must serve a facility with a-design flow of 10,000 gpd to 15,000 gPd• . You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes"in Section D above the large system has failed.The owner or.operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 f ; Page 5 of.1.1 OFFICIAL;INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE:SEWAGE.`DISPOSAL.SYSTEM INSPECTION-FORM PART B' CHECKLIST Property Address: Owner: Date nspeetion• Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No a7- Pumping.inform' ation, '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? V Have large.volumes of water been introduced to the system recently or as part of this inspection? __ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _ Was the facility or dwelling inspected for-signs of sewage back up _ Was the site inspected for signs of break out'? J. Were all system components, excluding the'S.AS,*located on site Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition oft e 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:- Yeo Existing information.For example, a plan.at the Board of Health. Determined in the field(if any of the failure criteria related to Part C.is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] 5 Page.6 of 11 OFFICIAL INSPECTION-FORM_NOT FOR VOLUNTARY°ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART C '! SYSTEM INFORMATION Property Address: vc) 1902AJ ( ' Owner: ,c Date o ,nspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): . Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: I M gpd x#of bedrooms): Number of current residents:1 Does residence have.a garbage grinder(yes or no):_ Is laundry on a separate sewage system (yes or no)L M44if yes separate inspection required] Laundry system inspected es or not" Seasonal use: (yes or no): .. Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no)/' y Last dare of occupancy: ✓/�2y�(�� COMMERCIA`UINDUSTRIA�, Type of establishment:. Design flow.(based on 310 CMR.15.203): gpd Basis of design.flow($eats/persons/sgft,etc.): . .. Grease trap present(yes or no):_ Industrial waste holdingtank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:, Was system pump ed as part oft a ins ction_(yes o6iio ` If yes, volume pumped: gallons--How was quantity pumped determined? Reason`forpumping: TYP AOF SYSTEM _VSeptic tank, distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system.(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _.Attach a copy'of the DEP.approval —Other(describe): Approximate age of all components,date installed (if known)and source of information. 10-r" /?d 9- P `Zr/ "*-1 Were sewage odors detected when arriving.at the site(yes or no 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL-SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: - O fiouj- �j-�(�• /�(. c i.1Mk2-k— . Owne C(' Date Inspection:Uzf J BUILDING SEWER(locate on site plan)✓ k Depth below grade: Materials,of construction:_cast iron _40 PVC_other(explain): - - Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.):' SEPTIC TANK: (locate on site plan) Depth below grade: Material of construction: concrete_metal_fiberglass polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: /0'5 x��`X�j Sludge depth: Distance from top of sludge to bottom of outlet-tee or baffle: 37—. Scum thickness: 011 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: " How were dimensions determined: iZAJ Comments(on pumping recomme dations, inlet and outlet tee or baffle condition, structural integrity, liquid levels related to outlet invert, v'dence of leakaa ,etc.): , V&Dhild �Ot"w GREASE TRAP: cate on.site plan) ✓�� ` `��� e , Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle:. Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural.integrity;•liquid levels as related to outlet invert,evidence of leakage,etc.): 7 ' 1 Page 8 of 11 OFFICIAL_INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: P Y �C. Gf,(,fN i Owner: Date o nspection: U?J TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons g Design Flow: allons/da g ,. Y Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: - (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert( ,,j Comments(note if box is level and distribution to outlt�ts equal, any evidence of solids carryover, any evidence of akage into or oul of box etc.): ii �. i qp I� , PUMP CHAMBER: locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition,of pump chamber,condition of pumps and appurtenances,etc.):` 8 k Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: q� �0,'00,V 'luOwn ,,lV Date �� Date nspection: SOIL ABSORPTION SYSTEM (SAS): locate on site plan,excavation not required) . If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: ching galleries,number: leaching trenches,number, length: leaching fields,number, dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil; condition of vegetation, etc.)- , x- Q CESSPOOLS: cesspool must be pumped as part of inspect ion)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids laver: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition ofsoil;si&nsTof hydraulic failure';level of pondin",con'difoh-o vegetation;etc.):- PRIVY (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition.of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 Page 10 of l 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner j Date of spection: 9A SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Q� 0 E 10 Page I 1 of 11 OFFICIAL INSPECTION FORM—'NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: �,�,� c�Q Owner: Date of 2spe4c"tionp: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water ,0 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: J You must describe how you established the�high groundwater elevation: fT 1` 11 Permit Number: . Date: Completed by: �O7 HIGH GROUND-WATER LEVEL COMPUTATIO N Site Location: > r Owner: dot No. r Address: Contractor: ;C�d1'9 Address: / Motes.: ----------- STEP Measure depth to water'table to nearest 1/10 i�. ..................... Date ® l6_ month/day/year STEP 2 I Using Water-Level Range Zone j and.1ndex Weil'MaP locate site aM determine: I A Aapro.priate index well................ Water-level range zone ......-................................................... SI EP 3 Using monthly report."Curren t Wafer Resources Conditions" I determine current depth to water level-for index Well ................ • month/Year S =P 4 Using Table of INaterdevel Adjust .Adjustjrn entsI for index well (STEP 2A), curr.ent depth to Water level for index.well (STEP 3)., i 'and water-level'zone (STEP 28) determine water-level adjustment•................ ........................... ST'=P 3 • estimate depth to high water by subtracting the water. .,level adiustment (STEP 4) from'measured'depth to water level at site'(STEEP 1) .:............ ............:................ . ....................................... Figure 13.--Repmducible computation Corm. i Town of 13, -jistable 1'It 10, ( y-� �— Departntent of Health,Safety,and Environmental Services �Yoft"E Public Health Division Date /01z Z�0� 367 Main Street,Ilyannis MA 02601 BARNFMAOM MA89. • � 9. t639' rE � Date Scheduled L 0 j Z 3./U z 'lime 0 o Fee 1'd. 4t(00 Soil Suitability Assessment for Sewage Disposal. Performed BY:'$UI Veiv1 CnJ;nierc,nr Witnessed By:�jny� Why t C LOCATIQN & �LNL,R - IIVTORIVIA' ION Location Address �j I O Nor}h ,,,I Owners Name� e Het-r'�c.k Os�er-��Ue, n1A. Address Zo i I oy�--\cc M<<cbovs Os�erv;1\e Assessor's Map/Parcel: 7Z-S Engineer's Namc' NEW CONSTRUCTION ✓ REPAIR rcicpi one N Sa$-`1 Za-3 3 y Land Use t'S��en�i�1 Slopes(%)_Q-/00% Surface Stones Non-e Distances from: Open Water Body 1615 -r Il Possible Wet Arca )(00± it �0 Drinking Water Well 0+ 11 Drainage Way Soo } R Property Line (DO t R Other n SKETCH:(Street name,dimensions of lot,exact locations of test holes Fe Perc tests,locale wetlands in proximity to holes ) � i } � 3- Parent material(geologic) C�,ALj�y\ 1�Jni Depth to Bedrock '`jU0 t Dcplh to Groundwater. Standing Water in llolc: Nate Weeping from Pit Pace /VA GstimatcdScasonalllighGroundivatcr EL. Z.S FILrn To cxo,,d., � frlr;l Y21VYINATIUIV X�CJYt SLASMAL Y>l�I� 'VVA'� Method Used: Npne (Ste rl3eve� Depth Observed standing in obs:hole: in, Depth to soil 1110HICS: Depth to weeping from side of obs.hole: in. Ground\valcr Adjustment It. ,Index Well N_ Reading Dale: Index Well level.-- Adj.factor Adj.Groundwater Level I'EItOIATION TEST' u>rtt l ntte Observation Tole N Z Timc at 9", Depth of fete - _ Time at G" Start Prc-soak'fionc© ZSt�-p�his Time(9"-611) End Pre-soak Rate Min./Itch Site Suitnbility Assessment: Site Passed / Site I-ailed: Additional Testing Need cd(Y/N) Original Public health Division Observation Hole Data To Be Completed oil Back + j Copy: Applicant llLL>i� o>�szxvn > Corr�zolr � - De lh from .. 1101c p Soil Itorizon Soil 1'exlure Soil Color Surface(in.) Sod' Olhcr (USDA) (Munscll) Moulin g (Structure,Sluncs,ISoufdcres. (;onsistcncv.%Grave 1=IC.L. LOAM 0y mep. sANt7 l/ -- -- ZZ-Z�j 3 5ok, rin �ti (OyR y 0 ND Z.S v Lx>ors .... Depth from Soil Itorizon Soil'fcxhrre Soil Color Soil Surface(m.) USDA Othcr ( ) (Munscll) Willing (Slructurc,Stoncs,ISouldcles. „ nsi trnc ^o 'iatcl) d-IS FILL_ L. OAW-\ 110 3 3 Sorrtc Ftlut: Ib t° y Y (O -- th rs ,tzvArixoty Depth from Soil horizon Soil'fcxttuc Soil Color Surface(in.) Soil 0111cr (USDA) (Munscll) Willing (Stricture,Stoncs,nouldcrc.s. Cvtis�Lsx.10(�asll llE +'�' OBSI!:yVA1I U1`V�X(�L +' LOG �tuXe## Dc lh from - P Smlllorizort Soil'1'cxlurc Soil Color Soil Surface(in.) Other (USDA) (Munscll) Mottling (Slructurc,Sluncs,I)ouldcres. -- CogSislcilcy_,^LGt_i�-cl) I 1390d Insurance Itate Mau Above 500 year flood boundary No_ Yes ✓ �:~+;"Y^ �� -- �h1u�5 P S ctbo,rsZ Soo ypgr �leoc� boon dnryi Within 500 year boundary No Yes ✓ ( t>-JV -the lokis `100 yesI Tieicl 'b0wAcfy Ya....._......., , Within 100 year flood boundary No Yes ! 1)cUth of Naturally( ccurriilg Pel vious M.tt r i rl Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption systcn17 yr5 If not, What is the depth of naturally occurring pervious material7 -Certification I certify that on Ajt\ 19 9S (date)l have passed the soil evaluator examination approved by the Department of> nvironmeulal Protection and that the above analysis was performed by file consistent jvith the required tra'ling,expertise and experience described in 310 CMR 15.017. Signature �+ Date C)C'; 1�7 No. 7, � 1 Fee — RZ) THE COMMONWEALTH OF MASSA USETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipprication for ;h5pooaf *pgtem Con6truction Permit Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) IJ Complete System El Individual Components Location Address or Lot No. -la ��f�l ���p Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms —� Lot Size sq. ft. Garbage Grinder( � Other Type of Building IfW3A , Le No.of Persons Showers( ) Cafeteria( ) Other Fixtures 'J Design Flow //0 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. v Description of Soil Nature of Repairs or Alterations(Answer when applicable) Z—)Ale, /"W'Z/- 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 y th' Signed Date Application Approved by Date Application Disapproved for the following reasons . Permit No. Date Issued ——————————— ———————————————————————--—— / TOWN OFBARNSTABLE LOCATIOND /I�DIr'l� h�//'GC, SEWAGE # VILLAGE � 2 '1/// ° ASSESSOR'S MAP & LOT pTZ INSTALLER'S NAME&PHONE NO. C� �~y — T SEPTIC TANK CAPACITY I `�" T LEACHING FACILITY: (type) I dP-e (size) I d X N C X �L NO.OF BEDROOMS /y BUILDER OR OWNER PERMITDATE: ���JC �`� � COMPLIANCE DATE: j Separation Distance Between the: 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 within 300 feet of leaching facility) Feet Furnished by '`JFI"5 :r d ,.-X• _... r", :: ".; -:. _;-.- _..T..�.::. ,+w-+ ._. .... w'ti;` s. o rq ar-n Yv � r:r n"., , ... .. ✓ f: No. ��� Fee THE COMMONWEALTH,OF MASSA USETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -'TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Mizpool *pgtem Construction Permit Application for a Permit to Construct( )Repair( V)Upgrade( )Abandon( ) [RComplete System ❑Individual Components Location Address or Lot No. 3�v ®� �/ Owner's Name,Address and Tef.No. He-17r>% Assessor's Map/Parcel OJ,� /�f////e Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. dot71,d `i -77�-9 9 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( � Other Type of Building 7ee.S/ erle"e No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets f Revision Date Title Size of Septic Tank �. ®Ole"' " Type of S.A.S. 1"f!5 X2 Description of Soil Nature of Repairs or Alterations(Answer when applicable) I—)rleX-✓G,��i.^ H" ti Date last inspected: Agreement: `' y 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 y thi d \` 1 \ / Signed _ �.. \ Date 1#4 l�/, Application Approved by Date Application Disapproved for the following reasons Permit No:- ,} Date Issued THE COMMONWEALTH OF MASSACHUSETTS 077- _ZW 5 BARNSTABLE, MASSACHUSETTS \` Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired (I/Upgraded( ) Abandoned( t010 0ov-11— at V - O57`�r�i has een constructed in accordance with the pro ' ns of Title 5 and the for Disposal System Construction Permit No. '� dated Installer �/✓ 1� � Designer The issuance of this permit shall not b o rued as a guarantee that the system w' func ion as designed. Date Inspector � � R --------------------------------------- ` No. �/` �--� , �f 07 Z �'W3 Fee -,/�•+ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mwigozal *psAem Construction Permit Permission is hereby granted to C,ousstruct( /)Re air( )Upgr de( )Abandon( ) System located at 3/� !V®/�7�fI Ci 1/ �"Q O 7 le- 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 thi� it. Date: z./ / Approved b l .�. 4n c �4 1019/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION 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 property located at z;, Ate• meets all of the. following criteria: /There are no wetlands located within 100 feet of the proposed leaching facility /There are no private wells within 150 feet of the proposed septic system e/ There is no increase in flow and/or change in use proposed There are no variances requested or needed. t� If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will not be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) B)Observed Groundwater Table Elevation(according to Health Division well map) c5� SIGNED : DATE: {/lr/f7 LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. .cent •health foIder - _ ASSESSORS MAP NO: ;7;,;; klr- PARCEL N0: L , No.- --- ---------------- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*r Melt Con5truction j3ermit Application is h reby made for a permit to Cons ruct (t/), Alter ( ), or Repair ( )an individual Well at: 0 o -N --------------------------------------------------- '. Location — Address / Assessors Map and Parcel ml s Ner G K 3[D 4Vo.,7 /5 J OS ��Ut C l r ----------------------- - - - - - — -- -- — - - - - - - ----------- // _ Owner /� //�� q/ Add ss Sll`_JC�Qo1r,(,( /� I,U, hox 60t��/J�2 ------------------------------------------------- -------------------------------------------------------------------------------------------------- Installer — Driller Address Type of Building Dwelling------------------------------------------------------------------- Other - Type of Building-------------------------------- No. of Persons------------------------------------------------------ Typeof Well—y --��e- -- - -- - -- Capacity--------------------------------------------------------------------- Purpose of Well_//!,'C �`'�°°'- --------------------------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Ce tif�f Compliance has been issued by the Board of Health. Signed ��C- - ------ - - ------ - -9 t f -- dat Application Approved B --= --- -- ` �__ `_�f Xy date Application Disapproved for the following reasons:---------------------------------------------------------------------------------------------------- ----------------------------------------- -------------------------------------------------------------------------------------------- --------------------- date Permit No. -- �__ "� ---------------- Issued ---- - - ------ ----------------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (H, Altered ( ), or Repaired ( ) by--------------------L✓ Gc� i� I-------------------------------------------------------------------------------------------------------------- - -- 0/14 Ao ��' Y Installer at -- - --- -�---- De !�c<0;/le-- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit N ----- _-MDated ` -----C THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- --- ---------- --- - ----- -- Inspector---------------------------------------------------------------------------- No.- -- y-'� � Fee-- � BOARD OF HEALTH TOW N 0-F -B A R-N S TA B LE--- . _ Appf fatton'�"br_Veil 1ctCon5trutt ion Permit j pp y p+ l�, Alter ( ), or Repair ( )an individual Well at: Application o/ rel� de f �-permit t�oc C Jnss�uct (' y - - --- - --- } ---------------- ----------------------- Location Address Assessors Map and Parcel Owner i r,Address y� / /t q / l\- CLe•ti„C/- I - ----------=-------------------------- �v----`�vX-_/--°D-- c.c L �-- M u ----------------- Installer - Driller. { Address Type of Building Dwelling------- -------------------------------------------------- Other - Type of Building ------ No. of Persons------------------------------------------------------- TypeYP Y--------------- = of Well— -- /-J -- - - --- - -- - Capacity ---------------------- --------------------------P Purpose of Well Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in ope-ration until a Ce tificate..of Compliance has been issued by the Board of Health. _ Signed - -- - -- h date - - _ Application Apn proved-B - ----------------- — -- ----= ��._ ...date - Application Disapproved for the following reasons:----------------------- - date Permit No. ------------ — --— ----------- Issued ---- -- date ' -..� "�^.�.-'���r�ays�s;aaa+m'rsecam�same»s.menrr�aa's»:e�4. s7�. c,ocsa�m�s��s:ssa,'as• ':. BOARD OF HEALTH TOWN OF BARNSTABLE Certtfirate ®f Compftaince THIS IS TO CERTIFY, That the Individual Well Constructed (H, Altered ( ), or Repaired bY-----------------��_-NO/ - '� -� ------ -- / — Insta11, r A-0 at- -- ---- -- he /'c /t�/� has been installed in accordance with the provisions of the Town of Barnstable'Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit N0..�--- - ��Dated- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE - - --— -- - — - -- Inspector- - - ------------------------------------------------- -- h BOARD OF HEALTH TOWN OF BARNSTABLE Vef[ Con5trutttonPernttt `..-_ No. ~- � � Fee-- `""---------- Permission is hereby granted SCo ti�� --------------------------------------------------------------------------------------------------------- F to Construct Alter ( ), or Repair ( ) an Individual Well at: ---------------------- ---------------------------------------------------------- Street as shown on the application for a Well Construction Permit OP No. - - ------ ------ --------------------------------- r" �----------- ------------ Dated------ --- -------- «-- ; M-"� ✓ Board of Health DATE-- -------- — P COMMONWEALTH OF MASSACHUSETTS r EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION EC ���pp�p,...�F(yyyyyy\Y E .. TUA N OF BARNSTABLE TITLES HEALTH JEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS C)J 2 SUBSURFACE SEWAGE DISPOSAL SYSTEMhPWRM PART A PARCEL , O D5 CERTIFICATION , Property Address: Owner's Name: Owner's Address: Date of Inspection: Name of Inspector: pleas print )^U—, Rat 4-0 Company Name: Mailing Address: Telephone Number: 82 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the:inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuantXPasses to Section15.340 of Title 5(310 CMR 15.00.0). The system: Conditionally.Passes Needs-Further Evaluation by the Local Approving Authority ails i Inspector's Signature: / Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments f ' ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will.perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 . T f. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner y' Date of nspection: Inspection.Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: i/ I have not found any information which indicates that any of the failure criteria described in 3.10 CMR 15.303 or in 310 CMR 15.304 exist.Any failure.criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND).in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a.complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out.or high_static,water,level.in the distribution,box-due to.broken or. obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with. approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is.leveled or replaced ND explain: The system required pumping more than times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health):• broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 1'1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Q2 Owner: Date of nspection: 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 2. System will fail unless the Board of Health(and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100.feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile'organic compounds'indicatesthatthe well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A,copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION.(continued) Property Address: � ��2Q�• Owner: Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes V Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluenC fo the surface of the ground or surface waters'due to'an-6verloaded`or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or / cesspool V Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number ' f of times pumped !/ Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water.supply or tributary to a surface water supply. _ v Any portion of a cesspool or privy is within a Zone 1 of a public well. _ Any portion of a cesspool or privy is within 50.feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but:greater.than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, Performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen.is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] /VV (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E.- Large 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• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) . yes no — the system is within 400 feet of a surface drinking water supply — — the system is within 200 feet of a tributary to a surface drinking water supply — _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—I WPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. .4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION'FORM CHECKLIST Property Address: am Owner. �7 Date of nspection: Zoo Check if the following have been done.You must indicate"yes" or."no"as to each of the following: _ Yes No Pumping.inf5rmation.was provideq!Aby.the,owner,,occup2nt,(y Board:of Health Were.any of the system components pumped out in the previous two weeks? _ _V,Has the system received normal flows in the previous two week period? _ Have large.volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined? (If they were not available note as N/A) `/ _ Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? , _L Were all system components; excluding the.SAS, located on site? Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions,depth of.liquid,depth,of sludge and depth of scum? Was.the facility owner(and occupants if different from owner).provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System:(SAS)on the site lias 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(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION-FORM-NOT FOR VOLUNTARYASSESSIVIENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: Date of I pection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(:design):,�. Number of bedroorris(actual): _ DESIGN flow based on 310 CMR 15.203 (for ekanrple: 11:0 gpd x#of bedrooms): �o7D Number of current residents:0&.CA LV- Does residence have.a garbage grinder(yes or n ) Is laundry on a separate sewage system (yes or no) -[if yes separate inspection required] Laundry system inspecte yes or no Seasonal use:(yes or no): q Water meter readings, i faN ilable(last 2 years usage ((.,pd)):O/- Sump pump(yes or no): Last date of occupancy':' COMMERCIAL/INDUSTRIA"o- Type of establishment: Design flow.(based on 310 CMR.15.203): gpa Basis of design flow('seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):— - Non-sanitary waste discharged to the Title 5 system(yes or no) Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system.pumped as Vp'artAo-fZjthe2i specti (yes or no): If yes, volume pumped: gallons--How was quantity pumped determined? Reasotrfor.pumping: TYPE F SYSTEM eptic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system.(yes*or.no)(if yes, attach previous inspection records, if any) Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be . obtained from system owner) _Tight tank _Attach a copy'. opy of the DEP:approval —Other(describe):_ Approximate age of all components,date installed(if kn wn and source of information: ► lY) — _ _ Were sewage odors'detected when arriving.at the site(yes or no) 6 Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of nspection: 3 BUILDING SEWER(locate on site plan) Depth beiow grade: Materials of construction: _cast iron 40 PVC_other(explain): Distance from private water supply well or suction line: Comments (on condition of joints; venting,evidence of leakage, etc): SEPTIC TANK: locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a.copy of certificate) _ Dimensions: Sludge depth: Distance from top?of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: 2 Distance from bottom of scum to bottom Qf outlet tee,or baffle' 3 How were dimensions determined: 4Ag kv eCA/a&ne� 1� Comments (on pumping recommen, tions, 'filet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leak tee,etc.): _ i 771v6tA /d I j'/�fJ� (yam. �rC 1�[ � / `-.7 (0� &W 1 GREASE TRA�locate on.site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY-ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continue ) Property Address: 6vu 1306,9�-' . Owner: 4 P-6 , Date ofXnspection: `ol c;co'3 TIGHT or HOLDING TANK '�"(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of bast pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX:-Z(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of kale i to or ut o box, etc , /I t �I PUMP CHAMBER- (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no):, Comments(note condition ofpump chamber,condition of:pumps and appurtenances,-etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION{t(continued) J Property Address: �c,,��. Owner: e Date of nspection: SOIL ABSORPTION SYSTEM (SAS): ,-'(locate on site plan,excavation not required) If SAS not located explain why: s Type ' leaching.pits,number:_ Ching chambers,number: leaching galleries, number: leaching trenches,number, length. leaching fields,number, dimensions: overflow cesspool; number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil;condition of vegetation, . etc.) 5_1 1Tb CESSPOOL�S% `cesspool must be pumped as part of inspection)(locate on site.plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note conditiod'of'soil, si6hs.,df hydraulic failure; level of pondiri&;condi'ti:on cf vegetation, etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 Page l0 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM .PART C SYSTEM INFORMATION"(continued) Property Address: 'J � Owner. Date of nspection: / 000 l SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. sc�v allo�n �� �� n� a� JA ��1��-��bc�,�-►mil �x /X 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATIQON (continued) Property Address: yn / M4 Owner: Date of spection: SITE EXAM Slope Surface water Check cellar Shallow wells j t Estimated depth to ground water / feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: �Necked with local excavators, installers-(attach documentation) ccessed USGS database_explain: You must describe how you established the high ground water elevation: s1 i ✓Up S ` 11 Permit Number: Date: Cornpleted by: HIGH GROUND-WATER LEVELCOMPUTAT-ION Site Location:_( la S/ /jI , �7"C��/ �r�K - Lot No. :Owner: -' ,Address: JJ,, • Con'tr2ctor: Address:7� Notes: ' STEP 1 Measure depth to water'table to nearest 1/10 . ...................... Date month/day/year STEP 2 Using Water-Level Range Zone I and,1ndex Wel1'Map locate site and determine: A Appropriate index Water-level rance zone ........ [/� S EP 3 Using monthlyre P ort "Curren Water Resources Conditions" determine'current depth to I wafer level-,or index well........................ month/year STEP EP ^ Using ,Table of Water-level Adjustments for index well (STEP 2A), current depth I i to water level for index.well (STEP 3)., 'and water-level zone (STEP 2B) determine water-level adjustment................. STEP b . estimate depth to hi t .gh'water by subtracting the water- level adjastrnent (STEP 4) i from measured'dePth to water level at site (STEP 1 Figure 13.--Reprcjueibie computation form. /Po j l 4v i TOWN OF BARNSTABLE Lai A I iON" 3/0 A101.1-i I.V�'vt- SEWAGE # VILLAGE Ile ASSESSOR'S MAP & LOT !!�Z20�-I-57-- INSTALLER'S NAME&PHONE NO. '4 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) _t��' (size) _ d X N®�C NO.OF BEDROOMS BUILDER OR OWNER ���`�`� PERMTTDATE: �/��`� COMPLIANCE DATE: Separation Distance Between the: 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 within 300 feet of leaching facility) Feet Furnished by :r X 0 Y, A �v„ r J Y TOWN CIF-BARNS ABLE :si�ATION' 3/ Y SEWAGE it �P1 � apVs. a VY, LAGE D y� r d dp ASSESSOR'S MAP & LOT ® � INSTALLER'S NAME&PHONE NO:_ LL- %42M52` "7�`�' � SEPTIC TANK CAPACITY l sev LEACHING FACILITY: (type) (size) NO.OF BEDROOMS L BUILDER ORO—WV- PERMITDATE: 1 "9.1 COMPLIANCE DATE: �. g Separation Distance Between the: e 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 within 300 feet of leaching facility) Feet Furnished by �1 v 6 b A!, -3` fla= 37� i3yc i�` THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) DATA �7 ASSESSORS MAP R ; y PARCEL tdO' Fes$..... .............. THE COMMONWEALTH OF MA BOAR® OF HEALTH TOW.A...............OF_... � 45T .c>� ............. .......... Applirafion for Disposal Morks Tnntrnrtion Prrmit Application is hereby made for a Permit to Construct or Repa' ( ) an Indi dual Sewage Disposal System at: .................) ....d ..........................�1.'1/1 LLB t/J �I- Location.Add ess / or t No. .; .rR 1.G�j�'....._.. �'{�•• _ ... ?/17� _1 j.1! a P Ie W 527z . ����v..... ................................. ....� �....L:.�l.L?.... .......... ---....................... Installer ddress Type of Building Size Lot.-----._�-�__2aa.Sq. feet U Dwelling—No. of Bedrooms_...................A.-___....__....Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures --------------- --------------- - W Design Flow................................�.5-...gallons per person per day. Total daily flow---_.........__.......... E�-......gallons. WSeptic Tank—Liquid capacity.!! gallons Length................ Width........ Diameter................ Depth................ x Disposal Trench—No. .......I........__.. Width......t 2-__._... Total Length_......3.5... Total leaching area....................sq. ft. Seepage Pit No--_---------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (X, ) Dosing tank ( ) l I I qo.V Percolation Test Results Performed by...._ A `C ... ...._!V ............. Date.... .__._I , 1 .... aTest Pit No. 1................minutes per inch Depth of Test Pit-------_............ Depth to ground water......................... 13, Test Pit No. 2................minutes per inch Depth of Test Pit._.................. Depth to ground water........._.............. P4 - ------- -------------------- ------•------ ............................................................... 0 �eser�ttrtl'--� .15�.�a.....�'. �1J----c�---��... 41�w11T1�._._t4 --- .1.a9�`rlo.�l---��`T----------------------- x -----------•-------------------------------••---------------------------------------... ------------------------------------------------------------------------- ------ w UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ ........................-.................................................-.......-.........................................-...... -----------•---• ..........-.......................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance h ee9jssued by the board of health. Signed --- --------------------M------------- ----------- -- ....... Dat Application Approved BY - ....... .......... ................a..---... f' `.�. Date Application Q ed for the follow;ng reasons: . .............. ........ - --. ........ .............. .... �.........-........-- Issued .......��....... _ Daze .mar v f , No._ �r, Fss.....t2(2.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH c�U-i-I...............OF.........�.-�..n!....1,141TA.......0 ...................................... App-11rFation for Biapwi al Works Tantitrnrtiun frrutit Application is hereby made for a Permit to Construct (K) or Repair ( ) an Individual Sewage Disposal System at: t a ------------------I 12-•--•- a _ ._ .....__..... ....- jLocation-Add�ess or Lot No. - .._._...•------- 3�.i- 1 ........--_..... { Owner "^•"' �dress Installer Address -7 dType of Building Size Lot------_-5-�_._/_Qj�W._Sq. -feet U Dwelling—No. of Bedrooms.......................'7'---------------Expansion Attic ( ) Garbage Grinder ( ) P4^ - - Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------- . - w Design Flow................................. ?.c_?___.gallons per person per day. Total daily flow........................._--.•-•-_Q......gallons. WSeptic Tank—Liquid capacity.1�5eRgallons Length-------_-_--- Width................ Diameter-_.__-__-___-_ Depth................ x Disposal Trench—No........I............ Width......1.:7-m....... Total Length........ '... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area................... ft. Z Other Distribution box (}� Dosing tank ( ) / ` ! Percolation Test Results Performed by.....~ '.`1?.)mp -._.4,_._...LX...__I (l............. Date.... d✓___._r.�.�_;_�'V.... Test Pit No. I________________minutes per inch Depth of Test Pit.................... Depth to ground water...................... fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .....rt _. v ix; A - �A..r M Ste----------------------- x ------ w UNature of Repairs or Alterations—Answer when applicable............................................................................................... -----------------------------------•••--•-••------•-----•--•-------•--••-•-•---•--••................-•----•----•------••--••-----------•---...------•---•-•---•-•-----•-------------------•-•••••-_-•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance hasfbeen,issued by the board of health. Signed �' ...- �.-------------------------------------------------------------------- -------�- ..�.... •""�� Dare Application Approved By41._,_---" _- .......I............ ------------------------------------------ -> Dace Application Disapproved for the following reasons- -------------------------------------------------------------------------- --------- - - ---------------- -- ------ -- Date Permit No. F/.--. - �1.� - Issued .......f.. .y.�. ...... Dace THE COMMONWEALTH OF MASSACHUSETTS ` BOARD OF HEALTH Certificate of Complianre THIS IS TO CERT'FfY, at the I dividual Sewage Disposal System constructed ( P� ) or Repaired ( ) by ......-..�z' I 1-- S-�-------------------------- ---- -------------------------------------....................................------......... ...................... ., �a^� at ....... ............Y ...�1✓� , :....`... 1..� �z-/............7 r��...... .....�------..... has been installed in accordance with the provisions of TITLE of The,State Environmental Code as described describcd in the application for Disposal Works Construction Permit No. - '-- _ lJ.----- dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE .. ............................ Inspector ------ --....-- ...`..`------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH j `` . No._1_ ...... FEE..........rJ: Dispos 1 nrkii Tonstrurtion rranit Permission is hereby to Construct ( or R pair ( ) a Individual ewa ;e_Dispos ystem � at No........ -.%k ,rr ...._ .!.��-. -__ Street -_... r as shown on the application for Disposal Works Construct ermit No___ _ t{ ated..��j°------�'-_ - _._. ... . - � Health ----------------..•-----.•._ Board of DATE......... r7 ......................................... -FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS • �SL� nATA, ��� ► o� Z s F"IL`{ �-_R>�acta�K E ILA I•J. oW BA4-4- 146-EOF Igo GA=3AL7. !.¢I�.br.2. I�o�1�1 �° • PJYs�,z.{��nsa¢5 DAaL- Flow = 4 x Ito =MD GPP LDT �d�ovSt 310 SQTG TANK` . 4.40 X 700 OW 4PD U I500 GAL. u 'a,PvG PIPS 1�5E CULZEG � 3�OCj{QWIBEPS�i�St vIST. -- -- — N 6-M 4 o 14 Ap tle4TtoN A¢sA DrNdPW �S 51ta---y1aCl. AMA- 41 x'�x2=l9BsF PLaIJ VI�1V - L�GI-llt� ��IAM8Ee5 t;5,T rlAj AMA = 351 12' = AZo-= -roTAL AMA s dog SF F�NIsW PE=oC.4TLN am L 5�tiv/IL,ya{ 3 4u %Z SH E STEPHEfV off,, a CUuE� 1�a a *5� WA ALLYFI '1330 0 ' 3T•oN� 41LA. WILSON �1_•: 2•� c4 BAXTER w No.I 226,Q Yo 24048 c ✓"� Z� e� 64AM}3EZ 1 l-- 5- 9-7 • - �rL L " � 23I L �� 234 l ING! �iOD IAL� 12►.3h•LY, �Sca, TAw- •. 'P VELCP'G) P toFU.C- • CEEIRGD PLOT PLAN! Loaxlaw oY,.tIE2 9AOW2s F tM ON. 13,lillpo 1 1 TLr-,y rr.14T 'T'NE FouNiDaTloO —290 t 4 PLWJ KEE—EVE�. SIG Q6puIQ6M6d1T OF TWG IDVJM OF P �l2 P -t- `a $Ai?�J Sq A i3 LE ,6.�Jb l S ' TAD ItJ l Tl�I N /� --P�J AL FL VOP HA7�� ZONE:. BA 2. f NyE: 1 NG �n�.�--�.,G � �.�., ►-ate SL�v�Yct�s • cu�►�t�s . �. oST�zvIL.Lt MQSS. aw5ers mom 'au IL.DI r ws SFbut-P NOT' Bra. APPuGANT: 1 crsea To Pwvp=-ry LtW&4. sTEPNe4I BIso i Pcoc , 5 PEEr S a 1f: Slav' S,t9V �oru MAP t Fig zA '3 CELL Cam„_ i5+ Za ! bail - . : . i iiiVVV 'SFA111GLf �,n15S5 u/o� i . . SH OF ENE • � ti 3 �-N ! 5TEPH ' ! ; ALLYN * 4K:HARD y . { W I LSON C` `c�3 OAxRTEit y "N6.3Q216 .� No 24WS a y V .16 �,�- VATA '5iI,464-.s FAMIL`( 4 132aca E t�La� oN B u�rr. qo GAIZUALQ 4QQvsi9L LOT ��� �310 doe �� �D 17AaLy VWW = 4 x �10 =Mv GPp 5WrT1G � X TANL • 4 TCO GPD U I500 GAL• 4'PvG ?I Ls--t L}lwo A,T-yu GATIoN A2EA 2GZP D. I ' xPPUG�ToN AM v�5t6� L€AG Slt�V1Qt-l- �= 4'7 x� PLaN V1 x2 �1�U - N•lt� CNAM8Ee5 J�OTTOM AM" = 35 - -TarAL. AMA dog SF C"L FiNrs41 4� P�Gai.ATlo�1 ATE L 5 titru�llJ�1 2�� 3�x „ . SOIL v � WAOO ALLYhI ' .• ✓ 9 � 'STbNL� c� BAXTER 'A No.30226 Q � r Vo 24048 .19 � �� I Z, . 4�o55-5E -1101,4 of 64AM55Z . 1(- S cJ•7 VWr �b= T . -b eau Ila Iw 8 i4 Ls.�WI CypMBC-iZ5 23 iul ► 23 23.G trxv 23•$ z Loa+r� SpNn 23 Z 4AA- 3JDy r It TAw- ` y M� lPtqElOf'Q�0 MFtLC— CEE IRGI) PLOT PLAN ►2 1A W Flo wA � 1acAT 1C*4 oy� 9 AOE!>= P °1036 t7AM ON. 13,1197 ,56AI.>= I"= 4d dal s,laq� 17,z oo po � 1ZGV aD0 ,13,1"7 1 LFZnr-V T'1-�AT •ri•IE (-ova�a-Tro0 -;,90 N FLAW R E- 4aZW►J CatpL j5 W I'M Tl;a stt*-uN9 A►•m P -43v- tom. `P� I 01 Zrwv. zwuiErxms T OF TWG IDvJN of h{,�P -l2 PA 2 CZ L 9Aa2ASTA}3C-E AQV IS gflz--ATED WIT"41N A 5?6caAL mrop HAZA -t:, zvNM. 4 HYM WC ��G � � LAI•ID 5UZVwCV4 • W61 4SE94 � os'I�ev111.z Mtuti. �i Mom 5VI[.DlWk5 490-x> NOT B6. APMjr-AWr' c>sea ,r, 9s-MZU-&N FlWVpM2Ty L►IJEK STl=NE41 1s i POe1c ,`���z• 7 'Z aF 2 t'T Ea F�fsN'p�eK • a�tAJE2; ALINE Ni:¢¢Ic�. f2a/. r!oa 13, 7 70 4E of-1 7 AP `. - corms M Al' '12 Pr-L. S va Z4 - } +, JlA 1 Jr.+ i Peop ; _ a _ Ci4AA45MIL w6 I , 1 t 14 OF tt t STEP1H N �_f, , ALLYN %ro 1 yY QECEtARD n ; WILSON A. H aAXTEA Vo 24U48 Ir BARTER IM9 INC. Professional Land Surveyors and Civil Engineers . 812 Main Street o Osterville, Massachusetts 02655. .Tel., (508) 428-9131 FAX(508) 428-3750 WILLIAM C. NYE, P.L.S.-President w PETER SULLIVAN, P. .,:Vice resident-Engineering RICHARD A. BAXTER, P.L.S. —Vice President November, 13, 1997 Mr. Jerry Dunning Town of Barnstable Board of Health P.O. Box 534 Hyannis, Ma. 02601 Re: 310 North Bay Road - Oyster Harbors Dear Jerry: Enclosed please find perc test results from our test on Nov. 13, •1997. I-have also enclosed two copies of our site plan with a revised date of Nov. 13, 1997. Please substitute these for the plans on file with Permit #97-640._ The original plans, prepared before the perc test, are dated Nov. 5, 1997 and should be discarded. ` Should you have any questions please call me at the office. Very truly yours, Baxter&Nye Inca _ Richard A. Baxter,P.L,.S. r - Vice President Encl: k cc: Stephen Bishopric ij v'e)0 44n j ai s i;t f7d re RABI slg ..{: i ,t, {,+7.rt �#Kf.:L��n ft.i:.'ni. �t��d� ; .i.� g,,•� ry+ ` ''� 4#�..' A , ti 4lSC.s i a MEMBERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS I AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS 97,/- L/ L/F3 Town of Barnstable 1�# 90 3 / coo w�ran. ✓ Department of Health,Safety,and Environmental Services Public Health Division Date Qra- 23 119-7 367 Main Street,I lyannis MA 02601 BARNaTABLK • _ 7` tea o .� / jV. _ /3,)997_ Time 10 Fee Pd. "�fotAw+'' Date Scheduled �Wws• t Soil Suitability Assessment for Sewage Disposal 13►�t2 f✓] �V 1JT�1 lu(� 1 ` OF Performed By: Witnessed By:�1P��1�-� � �—x�-- � LOCATION & GENIiJRAL INFORMATION;' - Location Address 3.10 O _.! RA Owner's Name A-oB Oy 9TZ a�IU3c92S Address t-lo p B,s�tf';'21C, `3t,DrtS Assessor'sMap/Parcel: '72 ?-1- Engineer's Name NEW CONSTRUCTION REPAIR Telephone# Land Use 5 tA,g471A• -rram Slopes( G %)�_ Surface Stones C� Distances from: Open Water Body oo ft Possible Wet Area Z®p ft Drinking Water Well ft Drainage Way ft Property Line 100 ft Other ft i SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) I l a Toe m ' v� � N t • , IN, \ Parent material(geologic) C)JTWA•SIrI Pt. tt4 Depth to Bedrock I Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater ^ ? I3ETE'TtIVIINATION FUI2 SEASONAL HIGH'VVATIJR TAI3T�E Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft• Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date ►t ime io Observation Time at 9" Hole# Depth of Pere (� Time at 6" Start Pre-soak Time Q iJR/( (lf / J/�T Time(9"-6") End Pre-soak ` M Rate Min./Inch Site Suitability Assessment: Site Passed ✓ Site Failed: Additional Testing Needed(Y/N) i Original: Public Health Division Observation Hole Data To Be Completed on Back—j Copy: Applicant DEEP OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. o 2 Gravel) p— 14�, q, cl i i - DEEP OBSERVATION HOLE'LOG Hole# Z Depth from Soil Horizon Soil Texture I Soil Color Soil I Other Surface(in.) (Munsell)' Mottling (Structure,Stones,Boulderes. Consistency, Gravel) _ I ° c— tt 5 D !til Al DEEP OBSERVATION HOLE LOG Hole"'# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. -Co❑ ' I i DEEP.OBSERVATION'HOLE LOG' Hole# P De th from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones Boulderes. Co ❑ ° Gravel)' t { Flood Insurance Rate Man: / Above 500 year flood boundary No_ Yes `z Within 500 year boundary No /Yes Within 100 year flood boundary No_ Yes I Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? 6( If not,what is the depth of naturally occurring pervious material? Certification I certify that on I (date)I have passed the soil evaluator examination approved by the ! Department of Environmental Protection and that the above'analysis was performed by me consistent with the required V-ainll1g,exp ise and experience described in 310 CMR 15.017. i Signature Q� Date ���'�� Ai ■■1 ■■'■ ■■■ i��� iii '■�� _ ■ ■■■ ■■';■ mom A ��� IIIIIIIIIIIIIitIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII � �� -+ ' �� ,;; ;� ■■■ ■■■ NOWoil �,,;,�.��, ,. I�II■I ���:���� s_�,�� � � iii u ��� �:, i i -01Ull mom 91 RUN =_ °°■ _ ��r Ri ■ ■■ Ili i■i Ilt 111' Iii i■■ IIII! 111 i■� i�■ ■1 �i iii iu I OWN mom Illllllllll IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIILIIIIIII IIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII III111 KIM mom mom 'IIIIIIIIIIIIIIIIIIIIIII • 9 m 'i �■■■ .■l� .�:: � :i: is iii I■` ��� III III oil 11 ��� I■I 111 Iii ■ _ 0�1 ■ l�I u iii U' ■ J u . U Ill oil iii IIi Ill IIi �ILIIIIIIIIIILI _ _ �j+��--- +�: +���j.���+• •ar�����1 IM.JM J J J►.I►Jr.ArMENNEN .1Ib�I`'!1Mjlr!lM!IfLIM!IM�I�� •j•J►, �� 'Levi, (III � �+. �,�, ■I 4 FM f£ ul LEFT ELEVATION SCALE: 1/4' . P—co, 46 Lu cl `- - - V - t LU SHEET 2 OF 9 ---j ® RIGHT ELEVATION SCALE, 114' - 1'—O' r :p 21 . 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' Idxt6'GVMIl1iU0UB Foortmr. YERIPY WALL N@t6MT OPI 91TE —_____—_.__—___ .. - - - _ _ ___________________________ -. __—_____ i p ., I I ' tl'rF-�N mU1GRtTE waLL / \ p�/Uj L A I sa i Q rt� wtu 1 / ----------J i _ C5b 9 Vl c � I I os vt = e trs'coricr�re.ans -I I I 1c L J I I I ovwr L J L J L J L —1 ' I I L J i LiJ I ALL COLLIMPI FOOTINGoB 12' TNIGK I I I g WALL _ I ' s F017TIkG5 42'x42' ¢ LARGER y'S' _ _ � ' � f • _ I I 1 TO NAVE REBAR�12'O.G. E W. �I 7-Y -� LvL GaRr--F�®—f- I I tsv�lsa•I I _ _ s_T - r_ t 1 L J I Ica) f I l L_J L-J I 1 PL:I WL eter I.1 eL T�— PL I LVL cttn � ---i® � I R —� L L �4Z9r42° �42'x4Y lu L J I iU (� )tt 7�LVL tlueµ�•• I I, tu J — ------� i 3 _ _ - e - - __ I ------ II I ° 1 ----------J I I I to ——————————————— -- 1----- ---- -------=------------------- - - -i , I SHEET 5 OF 9 -'i----- ---------- - ' aid-a'coNtrtEre waL 'taut/camwioue rrovm�w' _8• 9'-O' YBitpT.lMLL I�f Q!OITS _q• 16'-d u O la b y RIDGE v9w . E 14•LVL R RID IDGE BOARD Q E R,C.04WdJ9 SPACW US SMEAT14M6 _ ttvor— .. NIGA9 STM - r LU IA ATTIC RIDGE VE14T I✓/ / _ c t24 - FIX-SWNGLA5 RIDE WARD �. 9 3/0 LMWLOM RSS P PLY Si{.ASS I - E SPACED INS 9NE4TNIPK Wl - Mull 11111111 ax10's 1 tib.C_ � GOPIT.VENTNG DRIP EDGE HMO STEEL. STIMEL W FBOCOND MEMEFR AUJMNA4 GUTTERS AHD DOMN SPOUTS YYdOOD SMEATMIW✓W ROOFING UNDERLAY - O fW�BOARD AND MOtJLDIN6 �.' FLOATING P.T.DOM/ oG - - 'unV''{ TAPM GLMMS/ "aff mw" D Y n i n ii MA o f s .G. - v x W18BER MEI'F!'JtAltE/fLQATMS P.TDSC7C/ 0� RAtL _ SITTING 1-QFT OPEN Ri MTV SLEEPOM/MMMGCW DEYKING /// (a)n T/N LVL Y _ BALLSTRADE / —(ate KALL tt 7/M 1-.JOISTS / - 11 7A4•I-JOISTS q`, n v bM STRAPPM4 �_16R (1) 7B•LVL -Fn - F%A GYP.PQARD � FlASTtR l TYP. D a s STUD WILL/RA F.G.MUL./ Uyl KIT04 MUDROOM W MWATWW/TYV=(OR IY ALV I 6 N.G..SMRIW m - 3Fo4low PLOOR - - �WA,PLIr SL Mam Y PfBERGLAW MGM. J• n 71WLets T I_ - 2-9 1!2•WL QRT-- LVL Ju Q BASEMENT s + - s, BASEMENT Z1•`W t/a•DOWN fL SLAB e s �.r _ w a[ � 4a o- - -- ------------ LU LU 3 - 6t9 �Z SECTION SECTION SCALE, 1/4- - 1'-0• -SCALE: 1/4 - I'-o 5NEET 6 OF' 9 ul V , y V t (2)v In* 11 7/W AJS 20 I-.JOISTS t Q 16'O.G. 0!8 I� as (2)a tir (s)9 Id LV 1 � $ fl a �� >tu - a e yl I 11 7 LVL t9.i!&N t l I , Y M i 1 � ° � T 1 7P. to r FIRST FLOOR FRAP'IINC PLAN SCALE, 1/4' - r—o` 'SHEET 7 OF a i - ' (3) 9 112' LVL gg Z 4 t/1' AJS 20 I-J01ST9 3 I i �I ® lwo.G. 2 tl L 1 - 1 r tM1 � (2) 21rVs 206 1 261 (3) NDR 2a6 1 u It 7/100 LVL J 1 ® U tI (32,12 > 1 7B' AJ3 25 I-.DOt5T5 J � 1 P � ' It 7B' AJS 20 i-JOISTS AJs 20a 49 J , 1 1 1 �ry N e8 16'O.C. jl LLSL ~ JI 1 M 1 1 WlOxbB OR W12x50 STEEL Fl.U911 • (3) Il 7B' LVL FJ ----------------- 2 / 1 2ri 1 4 1 3 iL (2) 7 1/a• LYL (3) tG' LVL --lL —1 _-(1) 11 7B' LVL w1a>� sTFF1 1 p � Q r 1r TB LVL d O Z it 7B AJ9 20 I-J019T'3 LU 1 . •. - ti AJS � 1-JOISTS ® Ib O.G. }• Q 1 � Q tie? 1. V LVL - - g). - z tu a (3) 5 1/2' LVL labia BELOW 4 �4. A I/2' AJS 20 1-,JOISTS 3 .t es 16'O.G. SECOND FLOOR FRAMING PLAN SCALE, 1/4' . p-0' SHEET S OF Cl 2) Ii TB� LVL i U• I - - -- ------ --- -- -- - I 12 i I I 1 1ZTt JOIST5 TO BE 240's• 1G'O.G. I I 12 ' I - - p _ _ 2)1XA04 s ALL BEAMS FLUS 4 4 v 12 I �4 I t , ' v H� v q i �� �q i - - - T/N LYL HOIL , S I , I I x� s I II t t? Ulm l___________ . _____ (5)a w LVL wm ROOF PLAN SCALE: 1/8; . t._o. - - ATTIC FLOOR FRAMING PLAN SCALE: 1/6' P-O" 2c& RAFTERS 2d0 F71P5 (1) 11 7/80 LVL pJl • AT FLAT GEIUNG ix FLAT ROOF FLAT ROOF �9C ® � (3 2xb HDR SELQW I I^ 1 L_VL 'DIALD OVmI• I NtOA" STEEL VALLEr i w Z - - - - - - I I -- - - ---- 2f2aJ = - § ---- ---- , � . (2) 2A2s (� -- — — — — --- ----- OZ Au L a - I ol 74 IT r_ . SHEET q OF q m r s L 2r10 LL A MAJOR 141P5 TO BE 4y ®'ib'aC I ` NO ED 5 t/2� LVL NOR 'BUILD OVER' EyE BRC" I i f �- ; q4i JC i ) - I _ .Z� I • -fir 14 I �I �j�1 OF I MICHELE CUDILO �cti� -S—f—U-D-J-O. T W E N T Y o SIX I -T�----Architecture Inert rs Urban Design Planning - ' No. 34774 U STRUCTURAL 36 Nason Street Second Floor Maynard, MA , 01794 Q phone(978)461.2050 email S26 2x4®aoi.com fax(978)461.2052 9EZitSTEa� Q. stOra�0- RENOVATION TO UM THE T RESIDENCE • - t • J///�,/L/�/�/��1� !G, /�r/. yit-Olr APPROVED BY: DRAWN uJohnson • t' C• REV'SE0 none uA-nC*t rLA4 �-- DRAWING NUN8ER + 310 NORTH BAY ROAD OSTERVILLE �•0 STUDIO o TWENTY o SIX Archltect6re. Interiors -. Urban Design Planning 36 Nason Street Second Floor 'Maynard, MA • 01754 phone(978)461.2050 email S26 2x4@aol.com fax(08)461.2052 -7 Ali IV ! E _Q V • � %., N _ is IL -T;+J- - tzTt•-..ly t{OF MASS �3 MICHELE tiG - CU D47O74 r � N � ° No.3 RUC UR U 5T T AL � .. i 4-1 9cG P� ;0N AL - y1 �4�M , A. RENOVATION TO THE MARTIN RESIDENCE • ---��5 - "Lo V-0" APPROVED BY: DRAWN Bdohnson i REVISED none h BASEMENT and FOUNDATION PLAN _ DR—ND NUMBER 310 NORTH BAY R • STUDIO o TWENTY o SIX Architecture Interiors Urban Design Planning 36 Nason Street Second Floo --M ar4,MA • 01754 phone(978)461.2050 em5il 2A'P .com \,fW978)461.2052 14 -P M Cr nw (+ ,j I e *. --- . 0 r I � —..4 I 14 Q./�� _-___-�"•�-!1�- .� _ 1 _ a-Fes ---- - i_311�2low + - 1 _ I i fit.7� -, —_-- ._ .. ,. -- - . i RENOVATION TO I THE MARTIN RESIDENCE &AlmP 0" A.PROvmer: DRAWNadohuson • A REV19E0 none FIRST FLOOR PLAN DRAWING NUMBER 1310 NORTH OAY ROAJD' OSTERVMLE, • V.i • V t • .v k 3 j r. V I O .� \ —7x O — 1L ) I . v - 1o3�soe**hw,. � iC I �S��N OF NN �t9Ss W 9 S f _1 in 0 t6A I G CHELE II ^^ CUDILO m� OOZ . j I Rio.34774 STRUCTURAL_ _.. <g 7. . t I 1 _ ONA omm f-tL�•�z) (�%-`,� q'f¢�1•y��:�.Z STUDIO o TW,ENTY o SIX Ai Ntecture Interiors Urban Design Planning 36 Nason Street Second Floor Maynard, MA 01754 j phi ne(978)461.2050 email S26 2x4@aol.com fax(978,461.2052 b RENOVATION TO 1 THE MARTIN RESIDENCE `P 1 ^w�edohnson1 o� AhPROvflO er: * p�qr�� REV�BED SECOND FLOOR PLAN • ose•wwr,.v...� - 310 NORTH BAY ROAD OSTERVILLE A02 n•.. h 1 I I I I I 4)� oil Andrew I & Morire pa" Renard Drive N ) J/' •� I `� JR � //�� /'r _/ � p -. ❑ � / � I - o �i' � :c:3+an is It LOCATION MAP: /:. _I Scale: 1" - 2000.'f / ✓ a FLOOD ZONE: ASSESSORS REF.: ZIN ones A1.3 el=12 & C Ma 72, Parcel 05 •//� -25— - I u0 A „ / munity Pane N Com I o. -26--- - _--_ Lo it II #250001 0018 D July 2_1992 I•� I /`j/j,,;,� -26- OVERLAY DISTRICT: ZONE: AP Aquifer Protection District RF-1 & RPOD -- y I As Shown on Plan Entitled Area (min.) 87,120 ' ti I " I "Revised Groundwater Protection Gow„ �i' WCz Overlay Districts" - April, 1993 Widtha�min)t12520 31 / Setbacks: Front 30' Side 15' D/RECT,I0NS Rear 15' r/�rl: rli IIII a I a " E l I r 1/1i11/1111 '� 1 , x From Hyannis - Take Route 28 towards Osterville; r Ili/ ll it 1111 ea.p y� `\ I ° a Take a left onto Osterville West Barnstable Road and follow to the end; Take a left onto Main Street, and then bear right onto Parker Rood; At the stop sign take a right onto West Bay Road, and then // //!/ !//1 \ I 1 _ -2s- \ - _ p o I a V bear left onto Bridge Street; Continue through the I St the # 10 ___� Site is on e • ~- gates at Oyster Harbors, and then take a right I 3 � onto North Bay Road; right 3 , (mil I�III I I I f ` 7 o ' .. Porc I 13 ..NOTES / f I •I o a. I — — 0 1. The topographic information shown hereon was obtained 4 r sa.ayncva) -� ) o from an on the ground survey performed by CapeSury 2 Sty W/F I o a. Dwellingon or between 191OCT101 and 2010CT103. a #310 I N o 2.) The datum used is the National Geodetic Vertical ll lI IIII I / r I I ! O I Datum of 1929 (NGVD) a fixed mean sea level datum. 1/7 ,,,[yr— _ _ rr 1 $ I Is 1-1 'HILT`Ill S I _ I 3.) Location of utilities shown on this plan are approx. E KP' r 15' Setback _ o ,\ Z Y -� _ I a ` At least 72 hours prior to any excavation the' 1 .i.,.I•,,1 r/ �Cr' I -- --__ - 1 contractor shall make the required notification to DIG SAFE: '1-800-344-7233. " /�_ /� I� � 305t by Recard � o I' N 6571'00" �y I 4.) The contractor is requied to ensure+the protection of 4 the existing septic systems, and other utilites which �F c�'STEFFv F \\\ �� N/f. 5.00 II are to be reused. FS Top of Coastal Robert & Terr leu&L- 5.) The.intent of this plan is for a building permit S/OIVAL EN Bank y L. Madden rcP Of CS%bse�r�wJ for the proposed pool as shown only. TITLE.• PREPARED BY.• PREPARED FOR: Site Plan Sullivan Engineering, Inc. CapeSury Shown D. Martin, Tr. Proposed Pool Replacement PO Box 659 7 Parker Road 363 Far Reach Rood Osterville, MA 02655 Osterville MA 02655 y - At (508)428-3344(508)428-3115 fax (508) 420-3994 (508) 420-3995 fox Westwood MA 02090 2�0 North Bay OOQ�J _ PSUMPEHnol.com capesurvOcapecod.net 7 �1 3 Road O Barnstable (ostervilife), MASS. Draft/Design: JOD Field: MHD/WHK 30 0 15 30 60 _ �1 DATE February 29, 2012 CALF Scale: "=30' Review: PS Comp.: MHD/RRL Project #• 27027 Drawing # C522xl i 7 M h'. 4 roposeal (See /V ianfings An e N/F .° \ to 6 dr w F a bA /2 :. 5 • ' Cove o 2 i`b Red I 1 / t� o •o' r a, Ord j�0 +�o+ 1515etf� ck \� F"� �'� Pc 36' 30J' Zo -� + + 0 3 /: Proposed/ I t + + + + qg�/ / Q I a I M LOCATION MAP: + + — R=2s.s 2�.o I Scale: 1 — 2000 f 20.5 + _ . ' 23' r o p o s e d I / ° FLOOD ZONE. ASSESSORS REF: + \ / Paved I o N Zones A13(e1=12) & C Map 72, Parcel 05 IN + \ /..•' j o Community Panel No. —2s— \ 72 - Drivewa : Cd #250001 0018 D �► /////�//�//�j ,� + + Lo / 1 D � rn July 2, 1992 } + + / / �l.$'f I OVERLAY DISTRICT. ZONE. � o U � AP — Aquifer Protection District RF-1 & RPOD a > 0 rO a) a I I I Area min. 87,120 Proposed As Shown on Plan Entitled (min.) :+ + o o a p d CIO / I Revised Groundwater Protection Frontage (min) 20' + v d a > ' N 1 I Overlay Districts" — Aril 1993 D c J I I Y P Width (min) 125 w I I 3 Setbacks: Proposed •..' /I � Dwelling I i n g � � , � °posed 10, Fron t 30 + piannWde 15' 14' Side 15' + i1 (See9 Strp O Rear 15, + dote CC I I IIIIII — I DIRECTIONS ( l� ll'�1�111111j�ji From Hyannis — Take Route 28 towards Osterville; I I l I I I I I I + + \ 50:Buffer = \ c 2 Take a left onto Osterville West Barnstable Road -+ \ \ ` _ — _ —� i L, o and follow to t end; Take a left onto Main Street, + \ 100':Buffer \ I� _ ` W �, and then bear right onto Parker Road; At the stop / I \ +\ sign take a right onto West Bay Road, and then -I U / \ 1 + + ` J _ _ 26 _ \ I o bear left onto Bridge Street; Continue through the a gates at Oyster Harbors, and then take a right /I lI l►I I I�I I ++ R=2s 3 m onto North Bay Road; Site is on the right, #310. + _ Cis �-- 40' o _0 it o ///IIIIIII I III y + �a — I— -- ° a I 3 NOTES I P -- Porch + + + aa� P�rO dSe — - I _ ( /1111 I I I ++ : ° o- � p I �: Q) N FF= 2g•2'(NGVD 0 1.) The topographic information shown hereon was obtained °- Pool o 2` — o from on on the ground survey performed by CapeSury t \ Q.a .sty W/F I o + lop o f 2,5 ° o- Dwelling i ^ .�� on or between 191OCTIOI and 20%CT/03. ++ Coostai Bonk 1 ° w ,#310 i � o 2. The datum used is the National Geodetic Vertical �l71 l _III 1 l + ++ \ 1 70' I / I O Datum of 1929 (NGVD) a fixed mean sea level datum. l 111 11 I + - - - - _ _ _ — _ — I -- — — _ — I I \ 3.) Location of utilities shown on this plan are approx. II / + 15' \ _ _ 1 + + I Sefback _ _ — I o At least 72 hours prior to any excavation the + — �� — — — — — — _ _ 1 contractor shall make the required notification I + I \ \ to DIG SAFE: 1-800-344—7233. ( lill � Ilrllll /l � I 305f'byRecord \' � oIo I N 65.11'00" W I 4.) The contractor is requied to ensure the protection of / \ I the existing septic systems, and other utilites which / \ \ IF 5.00 I are to be reused. \ Robert & Terry L. "Woo reu f�._ 27.63 5.) The intent of this plan is for permitting purposes only, den TOP of CB/Disk (Frd�) l and should not be used for construction. q L 6.) Proposed plants to be low shrubs from the Conservation Commission's approved list. Title: Site Plon PREPARED BY. .PREPARED FOR: CapeSurV Anne G. Herrick Engineering, Inc. ,.: PornProposed La out PO Box 659 7 Parker Road Osterville MA 02655 2044 Oyster Harbors SS Osterville, MA 02655 S ra2973a3 } At (508)428-3344 (508)428-3115 fax (508) 420-3994 (508) 420-3995 fax Osterville MA 02655 CIVIL31 0 North Bay Road PSullPE@ool.com copesurv@copecod.net IPTIE�Q Barnstable Osterville MASS. 0 � �' Draft/Design: JOD Field: MHD/WHK 20 0 10 20 40 80 ' Date: Scale: Review: PS Comp.: MHD RRL November 20, 2003 Scale: 1 =20� p / plantings per ConCom s request [01129104 Project #: 21027 Drawing # C522xl Revisions: Add (Sheet 3 of 3 Only)