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HomeMy WebLinkAbout0208 OYSTER WAY - Health 208 Oyster-Way r. Osterville F/R r. r A = 071 007AM e ° gr ° �i I 9 c o ° n n a a b ° e ° w .. .o N ° a V Z Commonwealth of Massachusetts Title 5 Official- Ins ection Form m Subsurface Sewage Dis os`I System p � ,y m Form Not for Voluntary Assessments 208 Oyster Way Property Address I Joseph Pelle rino � Owner Owner's Name information is , required for every Osterville i; MA 02655 M..- page. City/Town 6/17/15 State Zip Code Date of Inspection b 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, use only the tab 1. Inspector: key to move your cursor-do not James Ford E' use the return key. Name of Inspector Company Name 1 P.O. BOX 49 Company Address I Osterville Cityrrown MA 02655 f, State Zip Code 508-862-9400 S12482 Telephone Number , License Number II t. R Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,:accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am'a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further E luation by the Local Approving Authority i. . 6/18/15 Inspe s ignature Date The s em inspector shall submit a copy of this inspection report to the Approving Authority(Board of Hea 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. ****This report only describes ponditions 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•3/13 I' �D� V Title 5 Official Inspection Form:Subsurface Sewage Disposal Systbfh a�P ge 1 of 17 I I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 208 Oyster Way j Property Address Joseph Pellegrino Owner Owner's Name information is required for every Osterville % MA 02655 6/17/15 page. Clty/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: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or ip 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: ii i i t� t' t 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", "nos:or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain:; is 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 i❑ ND (Explain below): i� i• i� f i is i I, t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 i {r I Commonwealth of Massachusetts Title 5 Official{ Inspection For Subsurface Sewage Disposal System Form Not for Voluntary Assessments ry 208 Oyster Wayr Property Address Joseph Pellegrino I Owner Owner's Name information is required for every Osterville City/town t MA 02655 6117/15 page. State Zip Code Date of Inspection B. Certification (contj ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if Pumps/alarms are repaired. B) System Conditionallyy'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) re replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution boxl'isleveled or replaced ❑ Y ❑ N ❑ ND (Explain below): I+ ' is ❑ 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 i. rt , {n, ❑ Y ❑ N ❑ ND (Explain below): I' u 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.pi•otect public health, safety or the environment. ,i 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: El Cesspool or privy•it within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh (sins 3H 3 i Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 6' i commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 208 Oyster Way Property Address Joseph Pellegrino Owner Owner's Name information is , required for every Ostervllle MA 02655 6/17/15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.)' i i 2. System will fail unlss 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: , ElThe system has a serptic 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 sept c tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private wa�r supply well". Method used to determine distance: Y 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. it 3. Other: fi a a D) System Failure Criteria Applicable to All Systems: f' You must indicate"Yes" gr"No"to each of the following for all inspections: Yes No ii ❑ ® Backdp 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 El ® Static,liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '%:day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 r- Commonwealth of Massachusetts Title 5 Officia'1 s Inspection Form Subsurface Sewage Disposal.System Form-Not for Voluntary Assessments 208 Oyster Way i Property Address Joseph Pellegrino Owner Owner's Name information is required for every Osterville MA 02655 6/17/15 page. City/Town 1 State Zip Code Date of Inspection B. Certification (cont.)" Yes No I: ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any ptortion 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. El ® Any portion of a cesspool or privy is within a Zone 1 of a public well. I . ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply wellEl . ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from 1,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 amgnonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, proviged 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- 10'006gpd. ❑ ® 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 neceS§ary 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 io l5,000 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 ; is ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply j El ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-T!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 signific,`ant threat under Section E or failed under Section D shall upgrade the system in accordance with 3,10 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 i Title 5 official Inspection Form;Subsurface Sewage Disposal System-Page 5 of 17 p I iI: i Commonwealth of Massachusetts Title 5 Officia'I> Inspection F Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments i' ssessments r 208 Oyster Way Property Address Joseph Pellegrino Owner Owner's Name information is required for every Osterville MA 02655 page. Cayt I own State 6/17/15 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 ahytof the system components pumped out in the previous two weeks? I. ❑ ® Has th6system 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 they site inspected for signs of break out? t; ® ❑ Were allsystem components, excluding the SAS, located on site? t: ® ❑ Were th6'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? it ❑ ® Was the;fiacility 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 Informatiort- Residential Flow Conditions: . , 4 4 Number of bedrooms (design,: Number of bedrooms (actual): DESIGN flow based on 310 GMR 15.203 (for example: 110 gpd x#of bedrooms): 440 li li it t51ns•3113 r Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I' C Ip G� ' u Commonwealth of Massachusetts Title 5 Official' Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary {I Assessments •'' 208 Oyster Wayii Property Address ; Joseph Pelle rino Owner Owner's Name I information is required for every Osterville I' MA 02655 page. City/town 6/17/15 State Zip Code Date of inspection D. System Informati®n Description: i' it Number of current residents 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.). '. ❑ Yes ® No Laundry system inspected?11: p ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if avalilable(last 2 years usage (gpd)): Detail: unavailable ` Ij I; Sump pump? G , ❑ Yes to No Last date of occupancy.: unknown • Date Commercial/Industrial Flov Conditions: R' Type of Establishment: t Design flow(based on 310 CVIR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No II Water meter readings, if available: t5ins-3113 �1 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 r' Commonwealth of Massachusetts Title 5 Officil Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 208 Oyster Way fl Property Address Joseph Pellegrino Owner Owner's Name information is required for every Osterville MA 02655 6/17/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4 • Last date of occupancy/use: Date Other(describe below): �4 i• 6 (1 r , ?s General Information Pumping Records: s , Source of information: Unknown It � Was system pumped as part of the inspection? El Yes ® No If yes, volume pumped: gallons How was quantity pumped getermined? Reason for pumping: Type of System: . ® Septic tank ;distribution box, soil absorption system ❑ Single cesspool ❑ Overflow ce'sspool ❑ Privy ,r ❑ 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 ofi the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): F t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 i it Commonwealth of Massochusetts Title 5 Officiaj Inspection Form Subsurface Sewage DisposalffSystem Form-Not for Voluntary Assessments 208 Oyster Way Property Address u Joseph Pellegrino k Owner Owner's Name {, information is required for every Osterville - MA 02655 6/17/15 page. Cltyrrown {'. State Zip Code Date of Inspection D. System Information (Copt.) Approximate age of all combonents, date installed (if known)and source of information: system installed- 11/8/2001- per as built card i. Were sewage odors detected when arriving at the site? ❑ Yes ® No A{ Building Sewer(locate on site plan): Depth below grade: E! feet Material of construction: I. . ❑ cast iron 040 PVC El other(explain): Distance from private water6upply well or suction line: {, feet Comments (on condition off''oints, venting, evidence of leakage, etc.): I . � Septic Tank(locate on site 6'n): I� 12" Depth below grade: feet Material of construction: is . h , ® concrete El metal, El fiberglass ❑ polyethylene ❑other(explain) S' p ' If tank is metal, list age: '. g years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: A 1500 gal.? i; 2 Sludge depth: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 ti Commonwealth of Massachusetts Title 5 OfficiAl Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 208 Oyster Way Property Address « Joseph Pellegrino i; Owner Owners Name information is i required for every Osterville page. CitylTown MA 02655 6117/15 �i 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 27 f: Scum thickness I Distance from top of scum to top of outlet tee or baffle 6 a : Distance from bottom of scum;to bottom of outlet tee or baffle 10 How were dimensions determined? measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tees were present. There were no sign of leakage. ii l.. l i is � ..r Grease Trap (locate on site,plan): 1 Depth below grade: n/a feet Material of construction: li ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): f Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle tl Distance from bottom of scurn to bottom of outlet tee or baffle i . Date of last pumping: ?' Date 151ns•3l13 Title 5 omcial Inspection Fort:SubsUtrece Sewage Disposal System•Page 10 or 17 Commonwealth of Massachusetts Title 5 Officidl ':InsN„ection Form Subsurface Sewage Disposal System Form- Not for Voluntary ry Assessments lug208 Oyster Way Property Address Joseph Pellegrino Owner owners Name information is required for every Osterville MA 02655 page. City/Iown ii 6/17/15 State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping ree`ommendations, inlet and outlet tee or baffle condition, structural inte rit liquid levels as related to outlet invert, evidence of leakage, etc.): g y' i f. F i. Tight or Holding Tank(tangy{ must be pumped at time of inspection) (locate on site plan): 1 F Depth below grade: i Material of construction: 1, ❑ concrete ❑ metal ❑fiberglass 9 El polyethylene El other(explain): N/ais li Dimensions: Capacity: is gallons Design Flow: ` gallons per day Alarm present: ❑ Yes ❑ No Alarm level: R Alarm in working order: El Yes ❑ No Date of last pumping: ii Date Comments (condition of alarm and float switches, etc.): 6' • i' r *Attach copy of current pumping contract(required). Is copy attached? Yes ❑ ❑ No R: l5in3.3113 _ f, Title 5 Official inspection Form:Subsurface Sewage Disposal system•Page 11 of 17 t, II • Commonwealth of Massachusetts upTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 208 Oyster y ter Way , 1 Property Address r Joseph Pellegrino Owner Owner's Name a information is required for every Osterville MA 02655 6/17/15 page. CitylTown t State Zip Code Date of Inspection D. System Information.(cont.) fi Distribution Box (if present must be opened) (locate on site plan): ii Depth of liquid level above outlet invert even !' Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The D-Box was normal I s. a . i, 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.): r Ih. k� 7 * If pumps or alarms are not in working,order, system is a conditional pass. s : Soil Absorption System (SASS) (locate on site plan, excavation not required): If SAS not located, explain why: i i 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I, Commonwealth of Massachusetts Title 5 Official = Inspection Form Subsurface Sewage Disposap System Form -Not for Voluntary Assessme nts 208 Oyster Way Property Address ) Owner Joseph Pellegrino information is Owner's Name required for every Osterville page. CityfTown MA 02655 6/17/15 State' Zip Code Date of Inspection D. System Informatior;n;(cont.) Type: l . ❑ leaching pits!! _ number: ® leaching Chambers 3 chambers- I, number: 13'x 33.5'x 2' ❑ leaching galleries number: ❑ leaching trenbhes number, length: ❑ leaching fields number, dimensions: f ❑ 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.): The chambers were dry. There was no sign of failure A camera was used for the inspection i! i I . t 4 j Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration k Depth—top of liquid to inlet invert Depth of solids layer si Depth of scum layer if Dimensions of cesspool i, Materials of construction l i Indication of groundwater inflow ❑ Yes ❑ No ; ; . i t5ins•3/13 Title 5 ofririel Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 f. II Commonwealth of Masa`chusetts Title 5 Official; Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 208 Oyster Wa �1 Property Address p Joseph Pellegrino r Owner Owner's Name information is required for every Osterville . page. City/I Yn MA 02655 6/17/15 D. System Informa State Zip Code Date of Inspection tldn, (cont.) Comments(note condition pf soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I k i, Privy (locate on site plan): Materials of construction: Dimensionsa Depth of solids }} Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t N/a r . i; I . i ; i r . 11 l t5ins-3113 E Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 y 1 Commonwealth of Massachusetts Title 5 Official Ins ection Form Subsurface Sewage Disposal1iSystem Form Voluntary m -Not for Volunta Assessments sments 208 Oyster Way �i Property Address Joseph Owner Owners Name information is 1 required for every Osterville r. MA 02655 6/17/15 page. Cltyrrown 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: a . ® hand-sketch in the area below ❑ drawing attached separately i. f i i A �3 o 0 - 1 l it P I i. l ?CM1 3 i Q i t . L 3 �71 3; f is I t5ins•3/13 t` Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 t,. s' Commonwealth of Massachusetts Title 5 Offici [ Inspection Form x Subsurface Sewage Disposal Form -Not for Voluntary< ol S ry Assessments it 208 Oyster Wayi Property Address I! Jose h Pelle rino ,; Owner Owner's Name information is �s required for every Osterville MA 02655 page. Cityrrown 6/17/15 State Zip Code Date of Inspection D. System Informatign (cont.) i� Site Exam: ❑ Check Slope ❑ Surface water i ❑ Check cellar Shallow wells I ' i Estimated depth to high grountd water: 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: Topo and water.contours map ❑ Checked with local'excavators, installers-(attach documentation) ❑ Accessed USG$database-explain: fr i You must describe how you:.established the high ground water elevation: see above j I. t F p P' a t Before filing this Inspection;Report, please see Report Completeness Checklist on next page. t5ins•3/13 Ij Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 1' ,i i. Commonwealth of Masgachusetts ugTitle 5 Offidit" Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 208 Oyster Way Property Address li Joseph Pellegrino Owner Owner's Name information is required for every Osterville MA 02655 6/17/15 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A;.B, C, D, or E checked 4 ® 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 i,• EE� ii Ii (I it 4' r' y t I Y. f ' i, ,r is i! of. fr S tt; r b t . t5ins•3113 j Title 5 Official Inspection Form:Subsurface Sewage Disposal System-page 17 of 17 i TOWN OF BARNSTABLE LOCATION O_S' f��- A44 SEWAGE VILLAGE ,// 'ASSESSOR'S MAP & LOT '601-7 INSTALLER'S NAME&PHONE NO:Gblfi�i��fi' (io�sT.va�e✓ //�-89?/ SEPTIC TANK CAPACITY /lbo G�9L LEACHING FACILITY: (type) 3,—Qo, .ez w4j (size)/J,e33.5 NO. OF BEDROOMS y BUII.DER OWNER PERMITDATE: /D /�� = COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet 3 Furnished by. /7ar�WI lack �irti.�rro,yy V6y 76, Poi I aooa-s�� D71 �0 SCJ, od No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: © — Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS 01ppYication for Migpozal 6petem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(1/)Abandon( ) Ie Complete System O Individual Components Location Address or Lot No. � Owner's Name,Address and Tel.No.�1� 5 Assessor's Map/Parcelw / ,+�e- Installer's Name,Address,and Tel.No. // Designer's Name,Address and Tel.No. jovwlt? Ggj�e_ �A , Type of Building: Dwelling No.of Bedrooms Lot Size 3 I��Z sq.ft. Garbage Grinder(/ Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures �1 Design Flow Zl gallons per day. Calculated daily flow �`Z gallons. Plan Date 14 Af Number of sheets l Revision Date Title Size of Septic Tank Type of S.A.S. ✓`VV Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue WYt B azd H t Signed �' ate Application Approved by ate Application Disapproved for the following reasons__61 Permit No. AQ0Q Sl,5— Date Issued t � 0 . �ooa _si5 D7/- QD No Fee Af Entered in computer: 4 � v THE COMMONWEALTH OF MASSACHUSETTS Yes L. f P:UB'LIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ,r r Zipplication for Miooml *pgtem Construction Permit �I Application for a Permit to Construct( . )Repair( )Upgrade(v)Abandon( ) U Complete System dividual Components I Location Address or Lot No. 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 l� sq.ft. Garbage Grinder(/ 37— Other Type of Building ipipllZ2_yNo.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 7 7 gallons. Plan Date Z,2 d 2 Number of sheets / Revision Date Title ,,� Y .J 42/7 D� 7/.2 fi 0 I-er Wa V Size of Septic Tank / 5 0/7 Type of S.A.S( Description of Soil 3 3• �X�Z J7 r� _ Nature of Repairs or Alterations(Answer when applicable) K -Ny Date last inspected: r' r.te-z -wa r Agreement: 'j 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 issue y thi B and He / Signed v ate ��1 Z rW Application Approved by ate Application Disapproved for the following reasons l r a. + Perinit No.' Date Issued ----------------------------------------- 'THE COMMONWEALTH OF MASSACHUSETTS �p Y BARNSTABLE, MASSACHUSETTS . Certificate of Compliance , ! THIS IS TO CERTIFY,that th On- ite Sewage Disposal System Constructed( )Repaired( )Upgraded( v)� Abandoned( )by., XeIr,7` O � _. e_f 1 at 77 has been constructed in accordance with the provisions of Title 5 and the for Disp sal System Construction Permit No l 001- S_/.S dated 1 D-3/'0 c)— Installer i Designer The issuance of tl}is permit shall not be construed as a guarantee that the system will function as designed. Date t I Ar D 3 Inspector 4al --------------------------------------- No. ca oo 2-' S I eJ Fee 150. 010 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mtgpozar *pztem Con.5tructton Permit Permission is hereby granted to Construct( )Repair( Upgrade Abandon System located at Ze2 q D VS �� lg� 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. �rir a Provided: Construction must be completed within three years of the date of this permit.. ry�� Date: l0-3/'a o2 Approved by i ' TOWN OF BARNSTABLE � SEWAGE LOCATION S/3A"r� -7 r �W�©�' � ASSESSOR'S MAP &LOT VILLAGE INSTALLER'S NAME&PHONE NO. fbo GAL SEPTIC TANK CAPACITY (size) { LEACHING FACILITY: (type)' A NO:OF BEDRObhSS y OWNE ''•! BUILDER � �,Ir 0 COMPLIANCE DATE: PERMIT DATE: Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ell and Leaching Facility (If any wells exist Feet private Water Supply W on site or within 200 feet aching leaching Facility lity(If any wetlands exist Feet Edge of Wetland and Le achin within 300 feet of leaching facility) Furnished by C ��sP•N i r id � I bb 2 d A7 6 R Proposed Plot Plan in Barnstabl-0 MA Address 208 OYSTER WAY Prepared For : PRISCILLA HOSTETTER Assessor's Map: 071 Lot: 007 Baxter Nye Engineering & Surveying Community Panel Number 250001 0756 J, Effective 07/16/14 Registered Professional F.I.R.M. Map Zones: X (un—shaded), X (shaded) Engineers and Land Surveyors Plan Reference: Land Court Plan 15354-99, 15354-3 78 North Street, 3rd Floor Certificate of Title: #206699 Hyannis, MA 02601 Phone: (508) 771-7502 Fox: (508)-771-7622 Owner: PRISCILLA HOSTETTER Job Number: 2016-107 Scale : 1" = 30' Date: DECEMBER 11, 2017 N/F PETER L. NAVINS, TRUSTEE o ONE NINETY OYSTER WAY I REALTY TRUST CERTIFICATE #169436 EX. STONE PARCEL 071-004-007 DRIVEWAY I Ch TO BE REMOVED n / EX• SEPT►C SYSTEM PER HEALTH DEPT. SKETCH N 83'53'54" E 213.99. ;: X V v I B SALVE i O L ;:11 DOIL ::.:.:::::::.:>:;;:;;;:;:;•;:::.; ::..::.:,.;-:;>:::;:;:;;;::;:..:....:..::::.:.:::.:::::. I ::>;12I;uVA`i'::=:.;;tom:: I - PORCH ><:: II U < 'EXISTING DWELLING — — o . ... . HR1 1 :a::2;;S' . / P ;;: I �. _ ............... - I : :< : a P ATIO PROPOSED u7 GARAGECo 1 n � n 1 W W c0 T -v _ �► 0 Y Q C 00 PAR EL 071007 0 0 31,402t SF �, L= 1MM >: .:::::.....: . 1 0. U% Z _ -V 101 0 1 rn LO w 1 1 CEI BROKEN x z FND PROP NE pOANKS — POOL o EQUIPMENT p O MENT �g•33'00„ E 213.`L �LOI N 1 o o CB/DH 1 M r FND _ N/F SCOTT J & KATHLEEN A. it a a o HARRINGTON _ J CERTIFICATE #183937 F v PARCEL 071-006 �w¢ 00 �r 1 z Q Notes: 1. A TITLE SEARCH HAS NOT BEEN PERFORMED FOR THIS SITE. THERE MAY BE RIGHTS BY OTHERS, EASEMENT, TAKINGS, MORTGAGES, RIGHT OF WAYS ETC. NOT DEPICTED. IF DETERMINED TO BE NECESSARY, A TITLE SEARCH J ' SHALL BE PERFORMED BY OTHERS AND SUPPLIED TO BAXTER NYE ENGINEERING & SURVEYING. 2. THE PROPERTY LINE INFORMATION SHOWN IS BASED ON CURRENT AVAILABLE RECORD INFORMATION CONSISTING OF PLANS AND DEEDS. THE EXISTING FEATURES SHOWN HEREON WERE OBTAINED FROM AN ON THE GROUND FIELD SURVEY PERFORMED BY BAXTER NYE ENGINEERING & SURVEYING ON JANUARY 4, 2017. I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE EXISTING STRUCTURES SHOWN HEREON IS LOCATED IN RELATION TO THE MONUMENTS SHOWN AND 1S NOT LOCATED WITHIN A SPECIAL 0'�s�0 .9� FLOOD HAZARD AREA. �s '_� zr! ' SHAivE '. THIS PLAN IS NOT TO BE RECORDED NOR IS IT TO BE USED TO ESTABLISH PROPERTY LINES. <: sr a Ir1ALLON e� 6;7 y r'- ����� , y`:. ,.,. c•f';ate,•�..,,�:3 REGISTERED PROFESSIONAL LAND SURVEYOR N BAXTER NYE ENGINEERING & SURVEYING DATE , Y��,.;;�,;W:;,;w• D:\2016\2016-107\CNIL\PLOT\2016-107 PP.dwg,12/11/2017 2:04:04 PM,1:1 NE - soe-azalzae 8 1 ESTAFnVe RlJrcD,OST EP.MMm 02 655 NOTES: _ - � . FFH :. �. ............ � : ......... . ®® ®® MIMI FRONT ELEVATION REAR ELEVATION LEFT ELEVATION 7 RIGHT ELEVATION `Q 4 SCALE:1/4' _ ,'-0' 5 �/ SCALE:'/4' = 1'-0' / SCALE:1/4' = 1'-0" LLi W J 24'-0" 24'-0 24-0" co O CV O = K'I AT occr: in I: I I I e:I RbraE wrr - 12 VP NEW I � I r' 2195 O 16'OL. /� I .I DROP wa�Ar vxa I s�e•ALRv�n�INs � � GARAGE -'41 I I�.:I Rm LEDAR 5XM6L6 DV + � mpg I I =.a501P50N rA. SET ISSUE DATES �j n 4 Fws /moire a UNFINISHED 40 _ ,TD UNFINISXED 5TORA6E 4 - GARAGE I''I ,`Dy JOMTTrn. dd/ _—I DA SUE rr GARAGE — n 5ECOND FLOOR n I:: '�- a•caNcri�TE al.Aa a•obe sNEATNvIb \`�_. :;. i .:;i PrtcN rorlARc Doorcz � .,-j 1>ta PAS'.La. 1 wm �Ev '. I%B 50FFlt I x. ].T69NG LL 16"OL. \\ LI W DA DE N I :�I I'.s_,I sRFarNwb rrlooD \\ L� GARAGE m . I qR 21Po •coNLRETE sue \`\ DROP yyALL AT DOOR DROP PiALL AT DOOR I.:. adAS' PITLM T`tt- DWR9 1 I I � I iti IO :ta+I0010V3 FOOTiNb I : .. 24'-0. GARAGE 1 FIRST FLOOR PLAN �.�� SECOND FLOOR PLAN FOUNDATION PLAN SCALE:1/4' = 1'-0' . DATE I]/= x,, (27 TW 1046 FINE ''[.w�L� A E A R.0 H I F.C:U R AL OF.5!GN R 508<2 1298 +-`_ -c www.FlnaUneArtilitecWrelBealgn.tom (3)TN�1046 � (2)TW'21046 8 WEST BAY ROAD.OSTERNUE.MA 02855 R.O.36 1/B'x96 T/B' R.O.961/B'x56 T/0' a 4 NOTES: - :__ GOJERED PERGOLA PORCH MIN � );s, i3.,t;` BUILT-IN BUI T-M - 1 -.� � � FW11606HR LGDE066 i s N R O.73"x80" MD NLGDE065 L NLGD6060 R r - - 4 • - ��� - — - T EXISTING WINDOW I I T REMANS x IKITCHEN y I E%ISTIREMAINS�w I I \El r F1-U5H 5TL t —F SUNROOM - - - , I LU r - 0 , C "+ •;,+, a - TING WINDOW I I - - 6ATH I * m ' wrl. EXIS LLJu, 3 -F�.'I _ - LU � SRBAA415- .. �'_ j 3 y 3 3HLV5 SHLVS - E`(5TIN6 YVNDOW � + B-0 f W V/ 1I REM.AMB O e 5 V O 3s �- T- /4' W T-1 / O r ^' LAUNDRY _ A V/ \V a J m O7W21046 EXISTING wNDOW 1/2 BATH REMAINS C • - - - TYY31046 BEDROOM#3 BEDROOM#D (Z AW251 24 'a.. R.O.]B 15'x35 VH" • LIVING J` p RENOVATION EJJSTNG WINDOW -- MASTER BEDROOM - _ SEf 4SSUE OAIES MTE BSUE T 1046 FOYER TY111046 1/6"x56 1/5, P LM REV SOS - ::- n a MTE oEscwvnoN ON zN 1 m y S mN Y 6 d d o d rc d rc FRONT PATIO FLOOR PLANS SECOND FLOOR PLAN FIRST FLOOR PLAN SCALE:114" = V-0' .SCALE:114" = T-0' S EUUOF2 Al fi 3 - MTE 110018 4 FINE LINE A.R::nl'r e,rTl;aal. Des:,r; P 50B�4 1296 vww.FlnollneNc�ItacWrelDesl9n.com 6 WEST BAY ROAD.OSTERVILLE.MA 02655 NOTES: I MEMBRANE WINDOW WELL 5/5'GDX UNDERLATMENT ® ® 5/B' SHEATHING T FOUNDATION APEREp SLEEPERS NO WINDOW OR Rx VENT P CLOSED CELL FOAM INSUL. 1 1 1 ---_-- — I FASTENER9AT ALL NO _ 1tAFTER/TOP PLATE z BOLTS I, �i J/NGTON5TW. `} 5/8 ANGIOR w / Q EMBEDDED T 1 I 1==1 12'FROM LORNERS WASHERS B'xXxt/4" p Q w n/ w u�c.Ess� canes cvACE I I VAPOR RETARDER I F N 3'C.ONGRETE DUST GAP I _ 0 LV w 10-6 GONGRETEWALL "L• LV 10'xib"CONTINUOUS ATCH EXISTING H F w I LOOR EIGHT ]xb STUD WALL INSUL. ' SHEATHING WC.SHM6LE5 O Lr 4'GSB T.G SUBFIOOR O EXISTING CRAWL SPACE - tOo o i1 O.G. v, RBO P.G.NSUL VAPOR RETARDER B'x40'GONGREfE WALL 04 1 O ]'CONCRETE DU5T GAP 10'xtb'C M.UOUS FOOTM6 //1 V O EXISTING FOUNDATION Section 1 SCALE:114•. - r-O' RENOVATION SET ISSUE DATES DA E ISSUE REVCi10r6 i DATE OESLPoPTION FOUNDATION/ SECTION WEFT 02OF2 7 FOUNDATIONA-2 SCALE:1/4" = 1'-0' GATE 11/19R018 TOP F-NDN, AT EL, 19.5' SYSTEM PROFILE TEST HOLE LOGS ACCESS COVER TO WITHIN 6. OF FIN. GRADE (NOT TO SCALE) ACCESS COVER (WATERTIGHT) TO ENGINEER AH OJALA, PE sR�ocE sT, /16.3. MINIMUM .75' OF COVER OVER PRECAST /� WITHIN 6' OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM 16.5' WITNESS; DAVID STANTON 2' DOUBLE WASHED PEASTON I °4 * RUN PIPE LEVEL DATE 10/3/D2 FOR FIRST 2' 3' MAX. _ < 5 MIN/INCH 9 PERC. RATE '� PROPOSED1500 13.83' } GALLON SEPTIC 1 CLASS i SOILS P# 10342 if 13,75' TANK (H- 10 ) GAS \ locus o A 13.2$' 6,8-t ���__-13.11 Cl CI Ca C� Cl L © r-BAFFLE13 0' 0 0 0 0 0 0 ED 0 1- 0 4' AROUND MIN o PHEASANT a < 2 7. SLOPE) t____6' CRUSHED STONE OR MECHANICAL 0 0 0 1 0 l� 0 � CI 4 PATr+ 2 C� C7 i� C� Cl C7 C� l� CI a E 16 V. COMPACTION. (15,221 I23) "tom 0 1 0..". 16.5' DEPTH OF FLOW = 4.^, .W, .7 ( � SLOPE) ( 1 ;: SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED STONE TEE SIZES, FILL INLET DEPTH = 10" 10„ OUTLET DEPTH = 14" LOCATION MAP NTS E F OUNDATION--- 10' SEPTIC TANK 3' D' BOX 13' LEACHING 5, FS ASSESSORS MAP 71 PARCEL 7 FACILITY 2011 10YR 6/1 * INVERT UNKNOWN. PROVIDE MIN. 2% B PITCH TO PROPOSED SEPTIC TANK LS 37" 10YR 5/6 6.0, 13.4' C MED/COS 2.5Y 7/6 126„ 6.0' I NO WATER ENCOUNTERED NOTES N 1 20. BENCH MARK - TOP OF CONC. BOUND t SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED ) 1. DATUM IS ASSUMED ELEVATION = 15.2' 20.0 <b °' 320.0 DESIGN FLOW: 4 BEDROOMS ( 110 GPD) = 440 GPD 2. MUNICIPAL WATER IS-EXISTING + 17,6 +"'1910 2 .G _ USE A -4AL GPD DESIGN FLOW ?. MINIIMUM PIPE PITCH TO BE 1/8` PER F'OiJT, Il + 14.6 16.0 24° Aft 213 99W GRAIL DRIVE SEPTIC TANK, 440 GPD ( 2 ) _ 880 4. D�SI6N LOADING FOR ALL PRECAST UNITS TO BE AASHO H-10 . - ,19.3 18.5 19.5 �+"1��"1 " 1 19.9 _ 1500 5. PIPE JOINTS TO BE MADE WATERTIGHT, 1, 1s.8 19.5 19.7 USE A GALLON SEPTIC TANK 6, CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS, 20" OAK 170 LEACHING: ENVIRONMENTAL CODE TITLE V. + 19,419.E it II I SIDES 2(33.5 + 12.83) 2 (.74) - 137 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT -' + 1 .5 TO BE USED FOR ANY OTHER PURPOSE. + 16.1 OD 0 1 Q 33.5 x 12.83 (.74) - 31$ EXISTING 4 BR k 19.6�19.5 0199 BOTTOM. S. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 6 20 DWELLING � 10 ` TOTAL: 615 S.F. 455 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT TF 19.0' 1E.79.5 1 USE (3) H-20 500 GAL. LEACHING CHAMBERS WITH INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED oECK _ FROM BOARD OF HEALTH.,� + 14.3 1 PATIO �6 \� 1� 19'8 4' STONE ALL AROUND 10. PUMP & REMOVE EXISTING CESSPOOL(S) Ad c7+ X CONCRETE 7 1 � X PATIO L E G TITLE v' POOL ac �' 5 SITE PLAN w x 100.0 PROPOSED SPOT ELEVATION OF _._ + 19.4 208 OYSTER WAY x t° 100x0 EXISTING SPOT ELEVATION 1 ' x� 17,5 0° IN .THE TOWN OF: i XrX ) 00 1---`X PROPOSED CONTOUR ( OSTERVILLE) BARNSTABLE 14.5 100 EXISTING CONTOUR LOT AREA PREPARED FOR: BORTOLOTTI CONSTRUCTION/SWAN 31,412t SQ. FT. 30 0 30 60 90 213 21 BOARD OF HEALTH APPROVED DATE MA SCALE: 1" ^ , �Q' DATE: OCTOBER 6, 2002 REV. 10/30/02 (MOVE SAS) off 508-362-4541 fox 508 362-9880 P�tH OF ,� tH Of. . qs down cape engineering, Inc, AR NE ��s o ARNE H. GG UOJALAa OJALA CIVIL ENGINEERS Na.2s3a8 e CIVIL ,, .4 . . LAND SURVEYORS �p� z �. �ss�o�6rSIER +02--326 939 vain st, yarmouth, mo: 02675 _--- - E H. OJA ., P.L.S. DATE