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0008 PICASSO PLACE - Health
8 Picasso Place.:': _ Osterville P A 146 107 I 4j y d , a w Iw _ I i ti a EI ql �j 9 7 ® Complete items 1,2,and 3. ,a si at,r ® Print your name and address on the reverse X --- ❑Agent so that we can return the card to you. %XAddressee 13 Attach this card to the back of the mailpiece, B Reb ad y(Printed N e) C. Dat of Delivery or on the front if space permits. L15 (� / 1. Article Addressed to: Is del ry address different from item 1? ❑Yes If YES,enter delivery address below: ❑No A Cie -E- A>, i i 3 Service Type ❑Priority Mail Express® II I oI�IDI I II III I II I I I I I Iil�i I II I09I I 1�1_r ' ❑Adult Signature ❑Registered Mail ❑Adult Signature Restricted Delivery ❑Registered Mail R Restricted ❑Certified Mail® Delivery 9590 9402 1933 6123 1782 86 ❑Certified Mail Restricted Delivery ❑Return Receipt for ❑Collect on Delivery Merchandise O Atticlo_Nurntisr_rTra»gfar frnm_serviceJahah 0 Collect on Delivery Restricted Delivery ❑Signature ConfirmationTM ,cured Mail ❑Signature Confirmation 7015 . 17'3 0 0 0 O 1 4 9 9 0 3 2;7 9 `'cured Mail Restricted Deily Restricted Delivery t"er$500) KS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt l LISPS TRACKING# First-Class Mail Postage&Fees Paid USPS Permit No.G-10 9590 9402 1933 6123 1782 86 United States •Sender:Please print your name,address,and ZIP+4®in this box• Postal Service Town of Barnstable ` Health Department 200 Main Street Hvannis,MA 02601 Ilriiiililiil�llli.IrIFiIIIlIif1�I,,rIoltllH IIjI {I I I�t Certified Mail#7015 1730 0001 4990 3219 Town of Barnstable Regulatory Services BAMSPABM MAS& `�$ Richard Scali, Director 16396 Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 2, 2018 • Aline &Adam Lepire 8 Picasso Place Osterville, MA 02655 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 8 Picasso Place, Osterville, MA was inspected on March 30, 2018 by Timothy B. O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint received by the Town of Barnstable. The following violations of the State Sanitary Code were observed: 105 CMR 410.450—Means of Egress. Observed a room within the basement with a bed in it. This room is without proper second means of egress as required by 780 CMR of the Massachusetts State Building Code and you do not have the septic capacity for a 4tn bedroom. Therefore the room may not be used for sleeping. You are directed to correct the violations listed above within twenty four (24) hours of your receipt of this notice by; removing all beds from basement. You are also ordered to cease and desist from using any part of basement as sleeping quarters. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER F THE BOARD OF HEALTH ��� iifas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Q:\Order letters\Housing violations\8 picasso pl 3-30-18 Citizen Web Request Page 1 of 3 h rt "�� ' q ,� fit�.: +�� ' --""'°-•....a. �. tv y.F a Logged In As: Citizen Request Management Thursday, March292018 TOWN\oconnelt Route to Users Search Requests Create Requests Request Information Request ID: 59384 Created: 3/26/2018 3:53:46 PM Status: Assigned To Staff Assigned To: - O'Connell,Timothy Health Office Anonymous: Yes Request Category: Chapter II : Housing Substandard edit Routine work: No Estimate: No edit Date scheduled: edit Estimated 4/9/2018 Change Estimated Mar April 2018 May Completion Completion Date: Date: Sun Mon Tue Wed Thu Fri Sat ,4 CS 25 26 27r28 29 30 31 12 3 5 6 7 8 9 10 12 13 14 15 16 17 19 20 21 22 23 24 1 L6 ,27128 1� e, 29 30 I 1 1 2 3 4 ' 5 Created By: Soto, Kathryn Priority: Medium edit Health Office Citation Numbers: edit Requestor Information Requestor Request DETAILS: LOCATION: 8 PICASSO PLACE Osterville, Ma 02655 f Request Parcel Map: 146 Block: IL07 _ Lot: Neighbor Number reports illegal Parcel Lookup basement - apartment that has been rented 6-7 years Email: Edit Requestor Information http://issgl2/internalwrs/WRequest.aspx?ID=59384 3/29/2018 . 1 f +: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel �� Application It Health Division Date Issued Conservation Division Application Fee - Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address C"5 6 Village Owner f 1 �w� ���(J r ' Address Telephone $ .:Permit-Request.. ©4 C o C'w ' ' n Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation CDC Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. LO Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kings)-Iighway:. ❑Ya ❑ No �d Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq. ) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑'Other Central Air: U Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ Existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size ` Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use ....,... ,r. II YOU WISH TO OPEN A 13U511VESS`? For Your Information: Business certificates (cost$40.00 for 4 years]. A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by.M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take�the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: Fill in please: APPLICANT'S YOUR NAME/S:. W/i'L I t%4,,/ BUSINESS YOUR HOME ADDRESS:_Q eZ fl /°/ T, ,1Z(:� _e�! q_42 o_?�1 1-2 5 k TELEPHONE #k Home Telephone Number NAME OF CORPORATION:_N W G/01vt:z �i�ro/(yi/fitter/7 ice// NAME OF NEW BUSINESS TYPE OF BUSINESS f Al� 15 THIS A HOME OCCUPATION. I YES N❑ ADDRESS OF BUSINESS Ezn6l �- MAP/PARCEL NUMBER �I D Assessing] When starting a new business there are several things you must do In order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the.information you may need. You MUST GO TO 200 Main-St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. -1. BUILDING GO ISSIO ER'5 OFF E This individ a i for e f p rmit requ rements that pertain to this type of busirp�Al T COMPLY WITH HOME OCCUPATION .0 hor d net ** RULES AND REGULATIONS. FAILURE TO MMENT 1 COMPLY MAY RESULT IN FINES. Of 2. BOAR ❑ Tj EA H This Ind vidual has.been informed of the permit requirements that pertain to this type of business, Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This Individual has been informed of.the licensing requirements that pertain to this type of business. Authorized Signature. COMMENTS: TOWN OF BARNSTABLE _ LOCATION _�c� t�ncnt Wood SEWAGE # �t.o 0� VILLAGE CcrtMMl®(J►IQ ASSESSOR'S MAP 'LO 33--�,�� INS fALLER'S NAME&PHONE NO. C0- 32 w Ld' X �rt k SO a YO a I . SEPTIC TANK CAPACITY _ "/YQ U q cL LEACHING"FACILITY: (type) 3066 (size) X X oZ NO.OF BEDROOMS BUILDER OR OWNER C-C PERMITDATE: ° 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) No Feet Edge of Wetland and Leaching Facility(If any wetlands exist . within 300 feet of leaching facility) /1/0 Feet Furnished by 7 J A. b A 3 33. � � 3 3 a•J� y A q 0. 3 L3 b �•c� g b 30 o YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. -it does not give you permission to operate.] You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed fonii to the Town Clerk's Office, 'I st A., 367 Main St., Hyannis, NIA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: Oglogll Z Fill in please: APPLICANT'S YOUR NAME/S: CA /(-L iAN J e (I j2�lz n BUSINESS YOUR HOME ADDRESS: ` en 3E/1 V%1 L f�A4B—[Z jr TELEPHONE # Home Telephone Number NAME OF CORPORATION: , L L' L Au/�t�Prw 7 NAME OF NEW BUSINESS TYPE OF BUSINESSA IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS r T a r4 , MAP/PARCEL NUMBER (Assessing) C326sS . When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE MUST COMPLY WITH HOME OCCUPATION This individual has informed f ny permit requirements that pertain to this type of business. RULES COMPLY ND WITH REGULATIONS. FAILURE TO Auth rized ature** COMPLY MAY RESULT N FINES. COMMENTS: w�. © u 0 �P 2. BOARD OF HEALTH This individual has een i r 'e permit requirements that pertain to this type of business. MUST"OMPLY WITH ALL Authorized Signature* COMMENTS: ' 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: oxs /No ov A1,a st-A-rSV Zs72- r72ti[Gtc- wi.N .4 137LG S �-LiNi)SGA-F1.JG S/4 Al I,r,1A-S �.4 KAJ �' p�'�/Y LrW Ay. {LSO NU�� � /�'Oi-rL�CsF/�� I��M� ��J V Tt1 rQ P S��rcai7a/2E bM �-� r'r�un� c ivy,. ��� ^JDi LoalG /.A/ TNT S�7La-ic.n j?-C ro sEz' v-iy->�T �.i�ts �Eia� s�ez�, TOWN OF BARNSTABLE Date:,6/ (o l Zz o TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: BUSINESS LOCATION: LA�a® P1RG� _.ey;LlZ Am 0INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: 12g - jQ,00 doll CONTACT PERSON: i.Zputs.1�� EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: j *,Iu 1)r CA fA: INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts(Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives(creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous(please list): Metal polishes �.� .2ad27 .0-0elx' r tj Li 7��S Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids T� (dry cleaners) C/ 1'4A/I' Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signatur6 Staff's Initials YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40_00 for 4 years]. A business certificate ONLY REGISTERS,YOUR NAME in town (which you must do by.M.G.L.-it does-not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office,-1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is v required by law_ - DATE: /� CJ Fill in please: .. APPLICANT'S YOUR NAME/S:_W i L L t.141 cT %L, //,L/ BUSINESS YOUR HOME ADDRESS. Q P// TELEPHONE #k Home Telephone Number x NAME OF CORPORATION:__�/ NAME OF NEW BUSINESS TYPE OF BUSINESS_ Oar., f ,v, d p i/l.e. IS THIS A HOME OCCUPATION? —,� E�vT ADDRESS OF BUSINESSYE5 NO �- MAP/PARCEL NUMBER _ [Assessing] When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the.information you may need.. You MUST GO TO 200 Main St. [corner of Yarmouth Rd. tY Main Street] .to make sure you have the appropriate permits and licenses required to legally operate your business in this town. - 1. BUILDING CO ISSID ER'S.OFF E This.indivld a in or, e f p rmit requirements that pertain to this type of busirMUST COMPLY WITH HOME OCCUPATION hor d ' net " RULES AND REGULATIONS. FAILURE TO MMENT I COMPLY MAY RESULT-•IN FINES. 2. BOAR ❑ EAL H' This individual has.been informed of th ermit requirements that pertain to this type of business, MU COM . r. HALL . HAZARDOUS MATERIALS•REGULATIONS Authorized Sign. 4 EI COMMENTS: / 3. CONSUMER AFFAIRS [LICENSING AUTHORITY) This individual has been informed of.the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: 2�1 LP W TOWN OF BARNSTABLE Dater/ TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: A/rf",.re jn/rd oy-la,�J,; BUSINESS LOCATION: d(% �'iG9rr© r INVENTORY MAILING ADDRESS: TOTAL AMOUNT- TELEPHONE NUMBER: S op.- CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: _Sd � (� ��� MSDS ON SITE? TYPE OF BUSINESS: INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers, Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous(please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signatu Staff's Initials r YOU WISH TO OPEN A BUSINESS? .For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. - it does not give you permission to operate.) You must first obtain the necessary signatures on this forrn.at 200 Main St., Hyannis. Take.the completed form to the Town Clerk's Office, 1 st FI., 367 Main St.; Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. f �<< DATE: ��Ola2o1; Fill in please: APPLICANT'S YOUR NAME/S Cf{/y71Z BUSINESS YOUR HOME ADDRESS: — j { TELEPHONE # Home Telephone Number NAME OF CORPORATION: /ZX V1/U NAME OF NEW BUSINESS TYPE OF BUSINESS L /A/ C� IS THIS A HOME OCCUPATION? YES NO ',� �2_ ADDRESS.OF BUSINESS - MAP/PARCEL NUMBER (Assessing) S When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the 'appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individual has een orrr� of the permit requirements that pertain to this type of business. MUST XMPLY'WITH ALL �- .. a V �iAnRD0US MATERIALS REGI.II.AT!tl.Iq Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual h informed of the licensing requirements that pertain to this type of business. nn Autho ize Signature* COMMENTS: 4V TOWN OF BARNSTABLE Date, /n/00r,3 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: BUSINESS LOCATION: INVENTORY MAILING ADDRESS: r.. � ��G�.S��O f l�f'�c� U��`�l�/LCc� / H a_21�5S TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: eifjViZ4 ref �L,1/,Gj2�y EMERGENCY CONTACT TELEPHONE NUMBER: Sc2P- MSDS ON SITE? TYPE OF BUSINESS: INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals(Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives(creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes e7'1 Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash Ll`ZiY.t A/ WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initial TOWN OF BARNSTABLE v LOCATION Z) "�Gla SSy ?�, f SEWAGE# 260 2 17 VILLAGE C vbT ee 1?=y.T_l( E- ASSESSOR'S MAP&PARCEL e!(o /o INSTALLER'S NAME&PHONE NO. G. &-Ps I W-o f Nc. &cB�SYg-2$"/(o SEPTIC TANK CAPACITY CXa l000 C,4( LEACHING FACILITY.(type) (Z) 5bo La I GL. (size) 30'X t I , NO.OF BEDROOMS OWNER XbAr - I-r,Pi 2 i-_ PERMIT DATE: -4--7-o-o COMPLIANCE DATE: !� v 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 leachm' ili ) Feet FURNISHED BY V I e � lJ 3 p .Dry cave NL7 e i�-- 2i -�P► _ �i e� s3 C- 24 O �m 21 14 �5` F 2fl' --z gr ,-a 31d No. I �' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Mioogal 6raem Cougtructiou Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. g ��C�4 15 5 C S jq-Gf— Owner's Name,Address,and Tel.No. A p.Wj,- Assessor's Map/Parcel lq(p//O:7- O Installer's Name,Address,and Tel.No. �, /3sT f/Efo D:^)C— Designer's Name,Address Ind Tel.No. 14AR �ft2L5T6p f/2 Cd5%/! vr- .4SSC5c Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3'3 o gpd Design flow provided 34os gpd Plan Date �' 20 Number of sheets 1 Revision Date Title Size of Septic Tank 4:kZ!5 t/yL. /vv o (art/ Type of S.A.S. Description of Soil Z 1 S6o Gn 1 L C _ i3e�lc Z'a 3� /(� 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 Environme 1 de d t to place the system in operation until a Certificate of Compliance has been issued by this and of eal Signed Date 7-a o D Application Approved by Date 7— Application Disapproved by: Date for the following reasons Permit No. G 0 Date Issued' � _•� - Via, � w x. No. �t' °4 k Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 'q PUBLIC HEALTH^DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes APPlication for Digpogal *pgtem Coworuction Permit 4- Application for a Permit to Construct O Repair O Upgrade O ''Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. 9 R A 5 5 D P14 I t Owner's Name,Address,and Tel.No. Gr Assessor's Map/Parcel /c/(0 S t Installer's Name,Address,and Tel.No. �, jJ 5/ L/G Z nJ C Designer's Name,Address nd Tel.No. / _1 K dii-Z STv/0Ak¢/1 57/I 4- !�f S / C,er,.ew Q p / (� #.. ,L. s Fri . t/., ,� f�!. ✓��� G Z 3 Go Type of Building: Dwelling No. of Bedrooms 3 Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building A- 4 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 e.;;, gpd Design flow provided 3(os gpd Plan Date - 2 y Number of sheets I Revision Date Title Size of Septic Tank 97 N(, /� l�rt/ Type of S.A.S. Description of Soil 7 b A i L.e, U. i7p. r,i 3e✓X // s� S Nature of Repairs or Alterations(Answer when applicable) k 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 Environme 1 ode ,d not to place the system in operation until a Certificate of Compliance has been issued by this Board of ealth. Q Signed ►` `� Date /—7 — � O `0� Application Approved by - Date 7- a U y Application Disapproved by: Date for the following reasons Permit No. G Daiellssued / - do- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that t Up e On-site Sewage Disposal System Constructed ( ) Repaired ( -�) graded ( ) Abandoned( )b � f J at has been constructed in accordance 7 �J with the provisions of Title 5 and the for Disposal System Construction Permit No. 9069 069 "0- r � a l � dated / l Installer Designer A #bedrooms '2'j Approved desDunct5io gpd The issuance of Q e�r it shall not be construed as a guarantee that the system wil `k des ed. 1CDate � ( InspectorV �s ----- -- ---- No ^ {IL/G1 — ---4 --- --- _ - Fee V� " THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS Tigpogar *pgtem Congtruction Permit Permission is hereby granted to Construct ( ) Rep 'r ) Upgrade ( ) Abandon ( ) System located at �'G� �j S o� � . 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 this permit. Date G r a Approved by v t� Town of Barnstable 'P# 12G, + OpIME r ti —V W Department of Regulatory Services BARNSTABLE, * Public Health :Division Date MASS. a mop 039. �0° 200 Main Street.Hyannis MA 02601 ATFD MAt a Date Scheduled Time Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed 13y�f�//�/STO!`��/�/� C,G PZ4, 1_5 Witnesse(I LOCATION & GENERAL INFORMATION Location Address Nantc AdAM �,,,g�� 1`E j 8 Pt'c Ass o P A ce Owner's osA-Cru`ile �rv�Ite Address g �i G PosSo Pigce, Os+ Assessor's Map/Parcei: l4(o�lQ1 a:neineer s Name Ch;i5+oj7he! Go-,4R AfJA A3Socia e5 NEW CONSTRUCTION REPAIR _ Telephone# f1 0 Land Use Asmz-,�"l Slopes(%)��� Sui1'ace Stones//4 f Distances from: Open Water Body�G�� It Possible Wet Area AV f( Drinking Water Well ft Drainage Way /Oat it It Other it SKETCH: (Street name;dimensions of lot.exact locations ol'tcst holes&perc rests.locate wetlands in proxit to holes)U, �t �.: > j x 7 =r ao a as n, I DFAT U �t5 i od /S Z,37 �/GA-SSv pl--✓�-cG Parent material(geologic) DclAt to Bedrock t_ Depth to Groundwater: Standing Water in Hole: Wei+pins li'om Pii Face Alcge:� Estimated Seasonal High Groundwater 1V,4 ` DETERMINATION FOR SEASONAL HIGH WATER TABLE \lethod Used: _;6/4-'r ,l4 P 5 Depth Observed standing in ohs.hole: in. Deptli to soil mottles: Depth to weeping from side ol'obs.hole: _in. (h-oun(hwttter Adjustment fl Index Well# Reading Date: Index Well level Ad.j. factin Ad,j.Groundwater Level PERCOLATION TEST Date 7/Z a e9Ti,», 10,&& Observation rt{ Hole# Time at 9" _ '54 i� Depth of Pere � O Mime at(i"' J f / Start Pre-soak Tintc(ii,, Iy,e> 1D.1O Time(97;-6':) ' End Pre-soak Rate iIMin./Inch J iue Suitahilih Assessment: Site Pass \ed 1' Site Failed: _ _ Additional I cstin_Needed(Y/N) _ Ori-inal: Public Heald,Division Observation Hole 1--hra -fo Be Completed on Back----------- *If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one (l) week prior to beginning. 't 0ASEPTICAPERCrORM.DOC w DEEP OBSERVATION HOLE LOG Hole # Depth from Soil Horizon Soil Texture Soil Color Soil Other i Surface(in.) (USDA) (Mm7sell) Mottling (Structure,Stones,B01.11ders. Consistencv.%Gravel d /bye �/6 /Vo -a i i DEEP OBSERVATION HOLE LOG Hole # Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. i Consistencv.°/,Gravel) ao-T I i i i i DEEP OBSERVATION HOLE LOG :Hole # Depth from Soil Horizon Soil Texture Soil Color Soil Other l Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistencv %)Gravel) i i i DEEP OBSERVATION HOLE LOG Hole # Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Gravel) Flood Insurance Rate Man: Above 500 year tlood boundary No_ Yes Within 500 year boundary No Yes Within 100 year Ilood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervt us material exist in all areas observed throughout the area proposed for the soil absorption system? It not,what Is the depth of naturally occurs ingQ pervt0us material: t Certification I certify that on (date) l have passed tt luator examination approved by the Department of En 0"mental Protection - �d that t �V150,�a was performed by me consistent with the required 4exand exp ri n d 5.017. SignatureCHRISTOPHER o TA 0 No.31305 co FGISTSUM ER� OQ Q:A.SEPT10PERCFORM.DOC Town of Barnstable �oFIME row Regulatory Services y�P tio, Thomas F. Geiler,Director w BARMNSTrABASS MASS.LE, : Public Health Division � M i63 9- Thomas McKean,Director FD MP 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: %- 2 0 - c3 q Sewage Permit# ZOC ei r Zl-7 Assessor's Map/Parcel / Installer &Designer Certification Form Designer: C4SSTo r?Ac,0- Cvs—r A- Installer: W6. a- six. .. // Address: („- Fa Hwy Address: Sex 3gctS u vs i YVV 62,5,S40 On ' - 2®-> G 1 &—i�o i 4cl 1N6.. was issued a permit to install a (date) (installer) septic system at e lPxLPSSC> y�fA&it based on a-design drawn by (address) 1 dated �}- Z e> (designer) /Ih certify that the septic system referenced above was installed substantially according to e design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e.' greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if required) was inspected and the soils were found sat OF A44,9 70 (Installer's Signatu CHRISTOPHER yGN COSTA 2i 0 No.31305 co 9eGl STE�`F�OQ, (Designer's Signature) (Af i g p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice forms\designercertification form.doc COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION�.m= -°< - ��C' F V JUL ` �13 TOwN L) Tt 4 )iAt' HEAL a TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 8 Picasso Place Osterville, MA 02655 Owner's Name: Grace Erdman Owner's Address: Same Date of Inspection: July 3, 2003 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Map: 146 . Mailing Address: P.O. Box 49 Parcel: 107 Osterville, MA 02655-0049 Lot: 46' Telephone Number: (508) 862-9400 - CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:_ ✓ Passes Conditionally Passes Needff urther Evaluation by the Local Approving Authority Fail Inspector's Signature: Date: July 6, 2003 The system inspector shall sub a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the.system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I r Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 8 Picasso Place Osterville, MA Owner: Grace Erdman Date of Inspection: July 3, 2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined(Y,N,ND) in the for.the following statements. If"not determined", please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND 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 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 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 8 Picasso Place Osterville, MA Owner: Grace Erdman_ Date of Inspection: July 3, 2003 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 indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 8 Picasso Place Osterville, AM Owner: Grace Erdman Date of Inspection: July 3, 2003 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ ✓ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_ _ ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone I 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.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 151000 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 lI 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 I Page 5 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 8 Picasso Place Osterville, MA Owner: Grace Erdman Date of Inspection: July 3, 2003 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant, or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ Were as built plans of the system obtained and'examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? ✓ Were all system components,excluding the SAS, located on site? ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions, depth of liquid, depth of sludge and depth of scum ? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 r Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 8 Picasso Place Osterville, MA Owner: Grace Erdman Date of Inspection: July 3, 2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.2.03 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: I Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system (yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped in 2002-per owner. Was system pumped as part of the inspection (yes or no): No If yes, volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes,attach previous inspection records, if any) Innovative/Alt6rnative 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: Sep. 6183-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 8 Picasso Place Osterville, M4 Owner: Grace Erdman Date of Inspection: July 3, 2003 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 18" 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: 1000 gal. Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or'baffle: 30" Scum thickness: 3" Distance from top of scum to top of outlet tee or baffle: 9" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There were no signs of leakage. Steel covers were to grade. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 I Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 8 Picasso Place Osterville, MA Owner: Grace Erdman Date of Inspection: July 3, 2003 TIGHT or HOLDING TANK: None (tank must be pumped at time'of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: Qallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) 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 level. No solids were present. The steel cover was to Qrade. PUMP CHAMBER: None (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 Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 8 Picasso Place Osterville, AM Owner: Grace Erdman Date of Inspection: July 3, 2003 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits, number: 1 -6'x 6'(1000 gal,) leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields, number, dimensions: overflow cesspool, number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil,condition of vegetation,etc.): The pit had approximately Y ofwater on the bottom. There were no signs of failure. The bottom to grade was approximately 9'6" CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth -top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 9 ?" Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 8 Picasso Place Osterville, kM Owner: Grace Erdman Date of Inspection: July 3, 2003 Map: 146 Parcel: 107 SKETCH OF SEWAGE DISPOSAL SYSTEM Lot: 46 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. n y 3 a I 3� a� a 3 y ac, 63 10 Page I 1 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE_DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 8 Picasso Place Osterville, AM Owner: Grace Erdman Date of Inspection: July,3, 2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 29 +/- . feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using the Barnstable topographic map and the Cape Cod Commission water contours map,the maps were showing approximately 29'+/-to groundwater at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. I1 TOWN OFF BARNSTABLE dam° LOCATION S i i e A r0 k'��1(SL ; SEWAGE # JJ VILLAGE D ST4./yr l l� ASSESSOR'S MAP & LOT l d 7 INSTALLER'S NAME&PHONE NO._ LAB 41 SEPTIC TANK CAPACITY M GAI LEACHING FACILITY: (type) V', 6 X G (size) /4L1i '1 NO. OF BEDROOMS /' BUILDER OR OWNER //•)U 9,1J/t4^ PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: MaximumAdjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ..L n XV -0, i0^ Fd�� A a .4�k 1 3;L Y 3 1$ 3- y a� 63 LOCATION SEWAGE PERMIT NO• VILLAGE INS kA6JER'S NA & ADDRESS 8UILOER OR OWNER R DATE PERMIT ISSUED D A T E COMPLIANCE ISSUED 1 ,1 v� �� -C !�J ` \ �(v �^ �� ��i +l �� }� IIj �� �' ��,_ 4�, � � , No...... _.`.._�/`. Fss........ .. ..... THE COMMONWEALTH OF MASSACHUSETTS+W BOARD OF HEALTH ................................OF...................................I................ :. Appliration for Uiopoottl Wark,5 Tonotrnrthin rumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -.•- A�'L .1.. d. '�� � - !�C........ .... . --------------------•• • -.-. � 5 b...... - ...---.....-- . Locati Add Lot No.�-.� . .�.Cne......�_.Q.......... .......,/� Add ess a .............••--••..........---_..........•...Owner`.! 5..........��.c�S. 4el Installer Address d Type of Building Z, Size Lot.... ..�1�).?Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbake Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) Cafeteria ( ) P4Other fixtures -_.................................................................................................................................................. w Design Flow................... .................gallons per person per day. Total daily flow.............. z1... ............gallons. WSeptic Tank—Liquid capacitv..�O()gallons Length_............. Width................ Diameter.........:...... Depth................ x Disposal Trench—No. ................(... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ~' Percolation Test Results Performed by..............................1........ .. ....._. rd7/ ..... Date...... ..._< Z..� a Test Pit No. IZ--• 4-._minutes per Inch Depth of Test Pit.....:.. Depth to ground water_.___-_-.. .. f14 Test Pit No. 2____ minutes per inch Depth of Test Pit.... �/�p p Depth to ground water........................ ---------------------------------------------------- ... O ->� ,� . Description of Soil.---------•--•----------------------------•-•...•-----..._.......•.-- { . ---..�....- ... x ------------- -=- -`r w VNature 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 iITIL- 5 of the State Sanitary Code— The undersigned further agrees not to place the syste in operation until a Certificate of Compliance has been issued bby��e board of Health Signed....................•• ... ......._............. ---------- .-•-•••••-•.............. Ptte Application Approved BY �....... %J` ................................. ",7... Application Disapproved for the following reasons:............•-----•--------.....-----•-•-•------•------------•---•--------....------------=-----------•-•------- ---••-•-•-•----••••-•-••••---•••----••-••-••-••••......••-•-•..............••-••-._.................-•---•...........-------•-••--•-•••••-•••-•-••••••••-•--•--....--••---•••••••-•-•---••-............. Date PermitNo......................................................... Issued.-•---•----------------•-------......---•----------_... Date No......9.: .4 1 _ Y= FEs....... ....� ..... THE COMMONWEALTH OF MASSACHUSETTSW BOARD OF HEALTH ........ ....."..............OF.�.............................._.....................------... Appliration for Biipoiittl Workii Tonstru.rtion Permit Application is hereby made for a Permit to CCo!nsstt°ruct ( ) or Repair ( ) an Individual Sewage Disposal System at: �/ . 7 d �i' 2 ' C S �C.e f ...................................... ... _ ............••-----•-••-•---........ •. --- ................. ...... . Locat' . Addr s ,. or Lot No. ............................................... L... ................................. .0.............a............ l Owner .. Add ess ........................................................... --s._.......: �Ls.T. .�l ..--•....•--............_..... ' 'C.,............................... Installer Address Type of Building 'Z Size Lot....I_. Sq. feet Dwelling—No. of Bedrooms.................!. ...................Expansion Attic ( ) Garbake Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q Other fixtures ................................................................................................................. ... W Design Flow.................... .................gallons per person per day. Total daily flow............... .... ...0_......_.gallons. WSeptic Tank—Liquid capacity._. ()gallons Length................ Width................ Diameter................ Depth................ xDisposal Trench—No. ................ ... Width.................... Total Length.................... Total leaching area------:.............sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching.area..................sq. ft. Z Other Distribution box ( ) Dosing tank Percolation Test Results Performed by....---__--__-•----.�.-_!:- -- .------. :�±✓�'..... Date...........*� t- x..t�._... Test Pit No. 14 S�._._minutes per inch Depth of Test Pit........ Depth to ground water...._.__.. ,�yy '''f} G4 Test Pit No. 2._'i 'minutes per inch Depth of Test Pit....f ..�"`�. Depth to ground water._._.... U`�`"� � ------------------------------•------•------------••------ " f ODescription of Soil-----•--••.............................................••--•........ r....------........ x /--- e,. ...r, V ...............•----•---•---......---•----•---•--•--....--•-•---•------•---•-•-- W U Nature 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 TITU 5 of the State Sanitary Code— The undersigned further agrees not t9,place the sy7?_ in operation until a Certificate of Compliance has been issued by t board of health Signed --- ---- ••--•••...----- .... ate Application Approved By............•-•:: � ...---....... ---•-•--•................. ............r-�-....... --:�••- Date Application Disapproved for the following reasons:-------•-------•----•----------•----..•.......-•-•--------------------------•-------....._: ........•-•-..... -------••-•---•------••---•--------------••--•--------------•--------•--•----------......-----.............--•----•----......--•------------•----...------------•-••-----=••-----•------•--••------•--... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trrtifiratr of Tompliatta ' by THIS IS TO CERTIFY,,T-•-l�t the Individual Sew e Disposal, ystem constructed or Repaired ( ) --- - - - ---- - Ins all at.-•-- •.---- S/ - 1 ----- -��-s--s--6..... ---�r. ------Q has been installed in accordance with the provisions of TIT F of The State Sanitary Code as described in the application for Disposal Works Construction Permit No............. ..... 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 ..............O F.......................... C f"i No.. .......'... ..... FEE......f..........:...... Dispooal Workii Tonotrnrtion Per t Permission is hereby granted----------------------------- '�'` ........ ....... ........................... _ to Construct � 't or Repair ( ) an Individual Sewage Disposal t f atNo.......................................................................................... ._.g --------------e • . ...----...... Street as shown on the aDnlica • n for Dis `Vorks Construction Permit No..................... Dated.......................................... Board of Health DATE.----{f . . --�-�- .... t FORM 1255 A. M. SULK'N, INC., BOSTON 1 n r r i 4 •. . > • t f � ` � s L-jtfav/vS/ar✓�C.QCM PIT','a (C� ( ' CN awl vi O ' s�r//C. • M1 J 0 0i V O 1 1� ip ti s't o r er'xa ! t J 44 7 Zvi I k l,t 5 -711 o' 'gym" I' i• r ' 4� i ; T�,# C' 1. Zoti� C t- r4f ' s T h MORS€ 3 9 No.10951 9 V s` o9o�F•G/57ES��`' FSSlONAL ENS s LEGEND ��"'' � : �. { °,, CERTIFIED PLOT PLAN EXISTING SPOT ELEVA'Y'tON)" OnO ,. �No� ar �� �" EXISTING CONTOUR --- 0 ROBERI: 4 '110 'L 0T F/(o Pl cgSSo r�LRC� LC rl ��16 Z S t FINISHED SPOT ELEVATION .t Q[ J ?.;;uRUCE =� °` osieAlV/Z-z FINISHED CONTOUR 0--- : {p ELORE y ` IN lh APPROVED , BOARD OF HEALTH. <§ucr� , DATE AGENT • SCALED % _yv DATES LDI�EOGE ENGINEERING ca IN CLIE'N�'G�EN.��. I CERTIFY THAT THE PROPOSED F_ EOFIN RE REOLSTEREl -` jOB.No-x19 6. BUILDING SHOWN ON THIS PLAN . LAND r CONFORMS TO THE ZONING LAWSENER OR:SY�°„ , .�.�-�.- OF BARNSTA9lE MASS. 712 MAIN STREET CH. BYE $ 3a 83 NYA NN L S, MA9S. " SHEET ' OF ` A E REO. LAND SURVEYOR ,i �f /�OII®I ' •:OTF = /f E/Ti5/G/T :N�ScRTIC TANK OR .:` !®IaY/•4/�11C E.4C.a/.VG p/T AR- MORE TH^;•/ /t 9EL0j';r 14A OEM A ?4 �O/.t.N E TER C'aNC t E:T,C �•CYE or �PYC PJPE .=:VALE BE OeOUGNT TO G�AOF. �i►,V JZC C*A CREBr� ' )60EAVy CAST /ROiY C YE ? ` ""AV_ .�rw , Siv.4� � 3 IN11is ` ' o • f• • • a .• s• • •�• 1 G'f /8�-siS� i •iPm P� SgpTiG` T.e�Il� w/ do • • • • , , ;VASHEOSAW STvNE ° EPTX s ti mob ` e a � e e a oe• 1 • • • 71- L e e. • • a o • • e • • • o.e a PRECAST s, Aar fi f.'I�°X' �.��� i/�d!/� - � ,5 u l.d s- 7� / . • • o o► a e • • o- m . O/7 O.$ £-vU/V. 6 07: J s rFT- o7I.G /• ET.4d cl( UL.t77®� •e�� �� �®' � E ABLE G ASO n. WA /. Y�F fs� Y_dSTJ�/m'� T _� /�'R -- -- D.+�S/c�J 'JT.ERf� 4 - se.� •� ;�• �" or�9EIVS1®AJ JIMAWSIOA0 GARd�1Gg DISJ®O SAL uilpl rrar� .�®� L 0C TCTAE. E3T/M4TED �LOrV 3�O _GAt IQIfY �SOI L TEST.*! SO/, TFST,it� ®!L T'E.1? / 'iY1MSEw9 CF L,P.4CXlNG 0/T3_f �"'L'rt�Y. Al' AA AA7-ee OR-JO TEST 7l Z-G���•. Slo -=Li'AGHIN6 'PeAt fo/T �g8.S .# fX �GTTQ/+9 7G — 2 RESULTS PV/TNESSED By �1/?4f= ✓Ac fa%; ! . t iG'/1/Nf3 P@�1Q P!T SQ. A7 6" Lv �! ^? P�RCdLATrO/y .LATE !._f'=�.5 7-3 rAL &d54CN/NG ARRA 247 SQ. f T_ ,*l `7-OP ' ?ESE.�'E LE.4CN/N6 ARE^ �� 50 .=T. -: � ,: •'iiw.�/.vCN t -2 ., F ?.� N :E ROB`RT � 2� •1 O \ -- - .Sc!-',/,�•�i PiC.g'<.'D- 7r BRUCE 4� �o AL�Rf1.� s ELORE F h i`�, y I LGC Alll :.� �Ff'r3i - yy1� T14 .� MCSRSE co ` No.10951�O �2 _ poF`°GissEPb��k ELOr?EDGE CO, ND 5uR`j FSS E� 7i Z MA in+ s r. , y yq,cr.v�s. ..v /ONAL IVD GRovNJ *-Y.4Td•.4 ENCOC,//VTLF CEO Q GRouvo pv�47 .AT• 6eLEV. LL/f;"T TE LOCATION c�-r 4Co VILLAGE- os-rc-QV LL ,.•.,�,. �,,,. DATE 0� IT- $� APPLICANT -CMP �ll�e 6�?�lhiT .Go�;A. FEE TELEPHONE NO• (Non-refundable ADDRESS G.E�aayII-L'e ' 1'71` 361f.. ENGINEER MLD"0&bF_ E�Ib I►.�EE2�•l� TELEPHONE NO. 1 1,14 DATE. SCHEDULED' JVL-e 1.(p 199% Applicant's signature ! SOIL Logy. SUB-DIVISION NAME " QEEM IE.e !. OSTS ILIE •--DATE O 3 TIME 9 30. EXPANSION AREA: YES ✓ NO J®H ICI R. . ELL1,1 ENGINEER 'l TOWN WATER✓ PRIVATE`WELL ,J®It W A GC Ra I BOARD OF HEALTH J I_M D Q l SGp L L EXCAVATOR SKETCH: (Street .name,etc. ,dimensions of lot, exact. location of test holes and percolation. tests, locate. wetlands in proximity to test holes) NOTES: j L,=T .r AT ISoo 1 5'2., -7 PERCOLATION RATE.: 2 M i_Jc_0 TEST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: LOArM �T. 2 2 3 3 4 ,r-7 4 5 5 . 6 d�^ 6 ME-0 7 s 18 � 'L' 8 9 9 10 10 11 11 12 12 13 o`rS w lee- 13 14 14 15 15 16 16 SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS_ LEACHING TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN BNTIREaY AX•P. ' Z 0 AN 2 RETURNED 3:0 BOARD OF HEALTH copy! RETAINED BY APPLICANT s r1 r r.w fi } NOTE: '.-, SCHEDULE OF ELEVATIONS 1. RISERS AND COVERS TO FINISH GRADE. SEWAGE SYSTEM PROFILE & DETAILS GENERAL NOTES . # r NOT TO SCALE #'ll 2. H-10 COMPONENTS AND SCHEDULE 40 PVC PIPE THROUGHOUT. 1 FIRST FLOOR = 1 102.64 ' a - .,r tb '!•y = 2 101.7 3. EXISTING SEPTIC TANK, D-BOX AND CHAMBERS ARE TO BE PUMPED DRY PRIOR TO 1. ALL CONSTRUCTION AND MATERIALS SHALL CONFORM TO MASS ENVIRONMENTAL 2 TOP OF FOUNDATION 1 102.64 �.'. 3 PIPE INV. AT FOUNDATION = 3 98.02 EXCAVATION. OBSERVATION PORTS CODE (310 CMR 15.00,TITLE 5), AND THE LOCAL BOARD OF HEALTH. ' 1 SET TO WITHIN 3" 2. THERE SHALL BE NO CHANGES MADE IN THIS PLAN WITHOUT THE WRITTEN r 4 INV. OF PIPE AT EXISTING SEPTIC TANK INLET = 4 97.81 4. EXISTING SYSTEM COMPONENTS MAY BE RE-USED IF COMPONENTS OF FINISH GRADE S=2% MINIMUM PERMISSION OF THE LOCAL BOARD OF HEALTH. x` ARE UNDAMAGED DURING EXCAVATION AND FOUND TO BE IN GOOD CONDITION. LQC"�.1►'a' r r 5 INV. OF PIPE AT EXISTING SEPTIC TANK OUTLET = 5 97.56 2 101.7t 3, ALL ERRORS OMISSIONS AND CHANGE OF CONDITIONS AT THE SITE SHALL 'fr . ., 6 INV. OF PIPE AT EXISTING D--BOX INLET = 6 97.47 ANY DAMAGED COMPONENTS MUST BE REPLACED. a . BE BROUGHT TO THE ATTENTION OF THE ENGINEER PRIOR TO PERFORMING THE 7 INV. OF PIPE AT EXISTING D-BOX OUTLET = 7 97.30 14 100.3 11 99.4t 6A INV. OF PIPE AT D-BOX INLET = 6A 96.78 4 97.81 RELATED WORK. 13 100.2 5 97.56 12 99.8 4. THIS PLAN HAS BEEN PREPARED SPECIFICALLY AS A SEPTIC SYSTEM DESIGN AND ' k h 7A INV. OF PIPE AT D-BOX OUTLET = 7A 96.61 IS NOT TO BE USED TO ESTABLISH PROPERTY LINES OR BUILDING SETBACKS. F : .,,: MIN BREAKOUT _ a .. • - 8 96.14 .•.,,,�,�;�. ��� a'�,.__��� .�;'� ;',._, � 10 96,97 BREA 8 INV. OF PIPE AT START OF LEACHING FIELD - �zf. # � aG °° y .,._ _ PROPERTY LINES AND BUILDING LOCATIONS ARE GRAPHIC ONLY, _. `� C 0 L , PROPERTY LINES , ... 3 i, ♦ .. �i z ^•. }. ..� .,61'Y r., ti. NF.'- �t. y :.et� , S'� .. �' .-."7_..> .: .�% :::-3i'�. }�?.S `�1'aa�A'-,� u'. ._.3'4. _ 9 94.14 . .. _. t� _} _ � . �� ,,� ,. t ..,. K , 3 -�:� . � .:;� , ..;;�- �_',, 15 NOT HAVING ,: - ^„. , .,:., •4=.. ,,.. a.,. ,� 9 BOTTOM OF LEACHING FIELD •ir�r> ,-¢ z .- ,, �. ;. .,., n ��. � ,-; �., .; _ �� �.�.,._.^ -.��} _ �3� �•x _ �^��.:�� s�T��_ BEEN VERIFIED. NO REPRESENTATION OR CERTIFICATION AS TO THE k; _. -._ F.yE -Mj- EX G �� �: . .�- �E OUTLET .=j s �-a���+ .; .. � s -.:.. ' _ 10 96.97 r _ '_ __ _b . » _ ,_= _ _,, . - ACCURACY OF THOSE SHOWN IS IMPLIED OR INTENDED. 10 TOP OF STONE _ _,.. r � _ L • [�- -� >. �,'.] -�3 BACK Flu. WITH . - ... s D BOX �sa--°°: ' •- r . . .-� ', t•� �-5 _ _ ME - � # ,s 3-. , ._.. :: e ., ,.. ,� . �� . •' � . 11 FINISHED GRADE OVER LEACHING FACILITY 11 . 99.4t :. , �-. , ° �_ -�€M- a':'' - ��� To _ _ � CLEAN Flu. _, , _ 5. ALL DISTURBED AREAS ARE TO BE LOAAED SEEDED AND MAINTAINED EXIST �-'t.; .. .r -: :: . .. ;q" �_ ,�_ REMAIN • � ,.�'':_� L.E/F.L,ER �� ay_s� a w, ar } -, 9 MIN. ` 12 FINISHED GRADE OVER D-BOX 12 99.8 ''' �€ s TO PREVENT EROSION. • ; t-offs A„ EXIST MIJV. S= : .••. 36 MAX.MAX LOCUS MAP NOT TO SCALE 13 FINISH GRADE OVER SEPTIC TANK - 13 100.2 y- apt L-10.5 ,_ - 0 1 :MIN. S=0.01 ;, _ ` 6. FOR PROPER PERFORMANCE, SEPTIC TANK SHOULD BE INSPECTED AT LEAST 14 FINISH GRADE AT FOUNDATION = 14 1 Q0.3 t � r o SCHD. 40 PVC TEES d. L=9.0 ,u« F L=26 �"q +=VAR Wj` ONCE A YEAR AND WHEN THE TOTAL DEPTH OF SCUM AND SOLIDS EXCEEDS tj 15 TOP OF CELLAR FLOOR = VARIABLE 15 94.2f . ; T_ _ .. r ' ;' ®® ® = ®® i A, ._. y _ + � 111-1 � �� ®® ® ® 1/3 THE LIQUID DEPTH OF THE TANK, THE TANK SHOULD BE PUMPED. 3 98.02 1 w ,{ r - , ' tj _� _ _ zi .. 7. THIS SYSTEM HAS BEEN DESIGNED FROM DATA REVIEWED 97.47 � �� ,-- ��;r-.�-��-��t ..�-� 3 ,i� f.�-�a � E D DA AND ACKNOWLEDGED GAS BAFFLE , . s .a a , w-� _._ � ,. -i ._._. � - BY THE MASS. D.E.P. AND THE LOCAL BOARD OF HEALTH; AND • , 3 ;: RECOMMEND ZABEL OUTLET FILTER, 7 97.30 6A 96.78 3- °- 4' of NATURALLY occuRRING 'd CONFORMS WITH THE REQUIREMENTS OF TITLE 5 OF THE MASS. SANITARY CODE. 8 96,14aERVIOUs MATERIAL ,. N NO GUARANTEE OF PERFORMANCE IS EXPRESSED OR IMPLIED. 15 94.2tt 7A 196.61. 7 •.' � � � -, 8. TEST HOLE INFORMATION SHOWN HEREON IS LIMITED TO SOIL CONDITIONS FOUND _.s:;-+•._...,: .j ` s EXISTING 1000 GALLONS 9 94.14 SEPTIC TANK TO BE KEPT IN s -x AT THAT PARTICULAR TEST HOLE LOCATIONS AND IS NOT CONSIDERED AN -4 :� ' . t fin_ T SERVICE IF IN GOOD ORDER INSTALL ON STABLE COMPACTED IMPLIED OR EXPRESSED WARRANTY OF SOIL CONDITIONS BEYOND LIMITS OF ,''••��: +._ ' ;% , ; USE (2) 500 GALLON GALLEYS WITH: • - � i � _ ° 6 MIN. CRUSHED STONE BASE SUCH TEST HOLES. 3/4 TO 1-1/2" DOUBLE WASHED STONE 36 ALONG SIDES; 60 BETWEEN; 48 EACH END. 9. ALL ORGANIC AND UNSUITABLE MATERIAL MUST BE REMOVED FROM THE AREA SEE NOTE 3 ABOVE PROFILE. TOTAL LENGTH = 30.0' TOTAL WIDTH = 11' DIRECTLY UNDER AND 5 FEET BEYOND THE PROPOSED LEACHING FACILITY. THIS AREA MUST BE BACK FILLED TO THE ELEVATIONS INDICATED ON THESE PLANS WITH ONSITEOF EXISTING COMPONENT NOTES.: GRAND ARCSANDwOR OTOHER GRA UDLAR !MATE IAL,4 FREED FROMNORGANICEAN OVERLAY NOTE: DESIGN DATA MATTER AND OTHER DELETERIOUS SUBSTANCES. MIXTURES AND LAYERS EXISTING 1,000 GALLON TANK TO REMAIN AND TO BE PUMPED, TEES INSPECTED. I CONCRETE BAFFLES, IF IN PLACE TO BE REPLACED WITH PVC TEES. THIS LOT LIES WITHIN A STATE DESIGNATED ZONE II 1. BUILDING TYPE: EXISTING 3 BEDROOM SHALL NOT BE USED. THE FILL MATERIAL SHALL CONFORM TO MA STATE THIS LOT LIES WITHIN A GROUNDWATER PROTECTION OVERLAY 2. DESIGN FLOW: 110 GPD PER BEDROOM = 110 x 3 = 330 GPD HEALTH CODE TITLE 5 - 310 CMR SECTION 15.225(3) AND SHALL HAVE EXISTING LEACHING PIT IS TO BE PUMPED DRY, CRUSHED AND THIS LOT DOES NOT LIE WITHIN ANY WELLHEAD PROTECTION OVERLAY PERCOLATION RATE OF BETWEEN TWO AND FIVE MIN. PER INCH, BEFORE AND FILLED WITH CLEAN FILL THIS LOT LIES WITHIN A ZONE OF CONTRIBUTION TO SALTWATER ESTUARIES 3. DESIGN PERCOLATION RATE: 5 min/inch AFTER PLACEMENT. 4. GARBAGE. DISPOSAL: NO If 5. SEPTIC TANK DESIGN REQUIREMENT: 200% DESIGN FLOW 10. ALL STONE MUST BE DOUBLE WASHED AND FREE FROM FINES AND ANY ,� Dag 10 146/ 330 X 2 = 660 GAL ORGANIC MATERIAL AND MUST HAVE LESS THAN 0.2 PERCENT MATERIAL 9� EXISTING 6 OAK CE1- . (USE 1,500 GAL. MIN. PER TITLE 5) FINER THAN A NUMBER 200 SIEVE. C� TO BE REMOVE PAR 6. TOTAL LEACH AREA REQUIRED: 11. THE DESIGNER HAS NOT BEEN RETAINED BY THE CLIENT TO CONSTRUCT OR i PROPOSED TIE IN TO 11TLE 5: 330 GPD / (0.74 GPD/SQ.FT.) = 446 SQ.FT. (CLASS I SOIL) SUPERVISE THE CONSTRUCTION OF THE SYSTEM. THE CONTRACTOR IS O A EXISTING PIPE RUN WITH ,I 7. TOTAL AREA PROVIDED: RESPONSIBLE FOR MAKING ARRANGEMENTS FOR INSPECTION OF INSTALLATION 6' NEW DISTRIBUTION BOX OF THE SYSTEM WITH THE LOCAL BOARD OF HEALTH. p� AND RE-DIRECT TO 98. 8 11' X 30' LEACHING TRENCH (SEE DETAIL) - - 12. THE GENERAL CONTRACTOR IS RESPONSIBLE FOR ALL HORIZONTAL AND �9 NEW S.A.S. EFFECTIVE DEPTH = 2:0'; LENGTH = 30.0% WIDTH -- 11.0' VERTICAL CONTROL OF ALL SYSTEM COMPONENTS. EXISTING D-BOX TO REMAIN \ SIDE WALL AREA (2x30){2) = 120 SQ.FT. 13. TIGHT JOINT PIPING TO CONSIST, OF POLYVINYL CHLORIDE (P.V.C.) r> EXISTING LEACHING PIT SCHEDULE 40, UNLESS OTHERWISE NOTED. EXISTING STONE WALL,, 0 .# a� BOTTOM AREAF 11.`Ox30.0 = 330.0 SQ.FT. 14. THE CONTRACTOR SHA NOTI Y THE DESIGN ENGINEER FOR CONSTRUCTION BORDERING CONCRETE PAT] -50• k � • t, -� END WALL AREA - (2x11)(2) - 44 SQ.FT. ESHALL F DE I ; INSPECTION AFTER EXCAVATION FOR THE LEACHING BED PRIOR TO THE BENCHMARK o- TOTAL AREA PROVIDED 120 + 330 + 44 494 SQ.FT. PLACEMENT OF STONE) AND ALSO AFTER PLACEMENT OF PIPE & STONE EXISTING 494 SQ.FT`. x 0.74~SQ.FT. GPD = 365.6 GPD PRIOR TO BACKFILLING. �O MANHOLE RIM :' 83 / 15. DESIGN ENGINEER SHALL CERTIFY CONSTRUCTION OF SYSTEM AND MATERIALS" TOTAL FLAW PROVIDED = 365 GPD INSTALLED. THE CONTRACTOR SHALL PROVIDE A SIEVE ANALYSIS OF THE FILL 99.90 �' MATERIAL REQUIRED. AN AS--BUILT PLAN SHALL BE SUBMITTED TO THE LOCAL 6�•.. 5� a N 1°-►�- 20.E ��''� �' �� NOTE: SYSTEM IS NOT DESIGNED FOR A GARBAGE GRINDER. BOARD OF HEALTH UPON COMPLETION. cr . PARCEL ID 146/108 16. NO RUBBER TIRE CONSTRUCTION MACHINERY SHALL DRIVE OVER THE PROPOSED 166•tr: 101.75 1�1.91 ----100 00 SOIL EVALUATORS L 0 G SEPTIC BED EXCAVATION DURING CONSTRUCTION. 03a6 s 10 01.86tlip- 17. DIG-SAFE AND ALL OTHER NECESSARY AUTHORITIES SHALL BE NOTIFIED FOR 0. 100.0 EXISTING Depth from Soil Soil Soil Soil Other THE PROPER LOCATION OF EXISTING UTILITIES PRIOR TO ANY EXCAVATION. EXISTING Elevation Surface Hor. Texture Color Mott. Relative ExIST. { CONCRETE 7 A SHED DECK PATIO .� 91 (Inches) (USDA) (Munsel) Factors 19 DEEP OBSERVATION HOLE #1 elev.99.4 Mx 11 EXIS 99. 8 0"-5" Ap L/S 1OYR 3/2 TING DWELLING #8 LOT 4.6 W F.FL.EL. 102.E � 98.40 5"-12" Ae L/S 10YR 6/1 0 0 97.40 12"-24" B L/S 1 OYR 5/6 15,009 S.F. zNL,j �, ��• > 4 „ , NOT WELL - - - - - 1 ( 89.40 24 -120 C COARSE 2.5Y 7/4 GRADED No a`,- w = �yh' 100.22 r SAND REVISION DATE DESCRIPTION BY APPR D in 100.57 00.92 � �'•s�ti qoA 0 DEEP OBSERVATION HOLE #2 (elev.99.4) . APPLICANT: U N 99.91 o� sl ADAM LEPIRE 99.98 0 -5 AP L/S 1 OYR 3/2 8 PICASSO PLACE °� 9.81 98.40 5"-12" A L/S 1OYR 6/1 • 79.4 Z6 99.62 ` �QL ► . » / OSTERVILLE, MA. 02655 0 152. �cF ° 97.40 12 -24 B L/S 1OYR 5/6 - --- - 24 �r� s 89.40 24"-120' C COARSE 2.5Y 7/4 NOT WELL PROJECT: /�42 60 ��00.03Z•1� SAND GRADED -�,� 00 98•03 WATER SHUTOFF SEWAGE DISPOSAL SYSTEM REPAIR DESIGN 8 PICASSO PLACE C� PERCOLATION RATE _ <2 MIN./INCH IN .34 DEPTH TO GROUNDWATER = NONE ENCOUNTERED OSTERVILLE (BARNSTABLE), MASSACHUSETTS OBSERVATIONS BY: DAVID W. STANTON DATE TESTED: 07/20/2009 SHEET NO.: 1 OF 1 DATE: 07/2%9 99.27 N 0 TE S SCALE: As Noted PRG FILE: PICASSO_8-LEPIRE 1. THIS LOT IS NOT IN A FLOOD HAZARD ZONE DESIGN BY.- DAVID FRENCH CHECKED BY- CHRISTOPHER COSTA, PLS LEGEND AS SHOWN ON FIRM FLOOD INSURANCE RATE MAP. 2. THIS LOT IS SERVICED BY TOWN WATER. PREPARED BY.• EXISTING PROPOSED 3. WATER SERVICE LINE SHALL BE LOCATED AND MARKED PRIOR TO ANY EXCAVATING AND 10' MIN. SETBACK - --� -^�.�• CONTOUR ELEVATION Q DISTANCE FROM SAID SERVICE TO THE SEP11C SYSTEM Christopher Costa & Associates, Inc. of Mq SHALL BE MAINTAINED. 50.5 50x5 SPOT GRADE ���P� SgcyG c 4. ALL WATER LINES SHALL BE SLEEVED WITHIN 4" PVC CIVIL ENGINEERING • LAND SURVEYING • ENVIRONMENTAL CONSULTING CHRIST P E N V (. SCH 40 PIPE FOR 10 ON EACH SIDE OF SOIL ABSORPTION SYSTEM. TEST PIT (TP) C0 A y N OF ® `V 5. EXISTING LEACHING PIT IS TO BE PUMPED DRY AND DISCONNECTED. P.O. Box 128 / 465 East Falmouth Hwy. 508.548.0350 FAX LAYOUT P L A Mo. ► P�� M�ss� Q , 6. GROUND ELEVATIONS ARE BASED ON AN "ON THE GROUND" East Falmouth, MA 02536 508.548.6424 PHONE I� 0 CONCRETE BOUND (CB) • o GRAPHIC SCALE ��� N. DOUGLAS �, �� INSTRUMENT SURVEY AND, ELEVATIONS BASED ON ASSUMED DATUM. DRAA'ING TITLE: SCHNE ► ��' 7. LOT COVERAGE CALCULATION: SPIKE (SPK) A SURv o m UTILITY POLE (UP) 2° o '0 2° 4° eo �' CIVIL38 �; b, LOT AREA = 15,009 S.F. SEPTIC REPAIR DESIGN PLAN ��a.se5aa EXISTING DWELLING DECK & SHED = 1 331 S.F. ( 9% ) *c LIGHT aF a� �- ' NO INCREASE IN EXISTING DESIGN FLOW ) ''►Fs� ��' TOTAL LOT COVERAGE = 1,331 S.F. ( 9% ) (� ►/ WATER GATE (WG) ( IN FEET ) ,�s 4►s 1 inch = 20 ft. �,Z.v- ' (�' �' WATER SERVICE (WS) ASSESSORS INFORMATION: PARCEL ID. 146 / 107