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Home My WebLink About0200 POND STREET - Health r200 Frond Street, . OsteNille A 118 040 o i I I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 200 Pond St 5 e Property Address Carstensen c Owner Owner's Name information is required for Osterville MA 5-10-18 ' every page. City/Town State Zip Code Date of Inspection rv„y 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: A. General Information /3v When filling out _ forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. D.A.BROWN INC Company Name VkA P.O. BOX 145 g� Company Address CENTERVILLE MA 02632 Haan Cityrrown State Zip Code 50842OA534 SI4297 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 5-10-18 Inspector's nature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system,or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 i i � °e Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 200 Pond St Property Address Carstensen Owner Owner's Name information is required for Osterville MA 5-10-18 every page. Citylrown 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 in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Main house and pool house each have there own system. Both systems met or exceeded the minimum passing requirements at time of inspection.The main house system is the oldest from 1998 and showed the most usage.There is an ejector pump in the basement of the main house. This property has been mostly vacant for some time.This report can not predict the future performance under the same or increased usage. This report is not to be used for bedroom determination. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined,"please,explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 C v Commonwealth of Massachusetts Title 5 Official ,Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 200 Pond St Property Address Carstensen Owner Owner's Name information is required for Osterville MA 5-10-18 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): . ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health):. ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is;not functioning in a manner which will protect public health, safety and the environment`. ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17- f � I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 200 Pond St Property Address Carstensen Owner Owner's Name information is required for Osterville MA 5-10-18 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool . ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 1 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary.Assessments 200 Pond St Property Address Carstensen Owner Owner's Name information is required for Osterville MA 5-10-18 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- El 10,000gpd. ❑ ® The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply# ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply.well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Offidal Inspection Forth:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts p Title 5 Official Inspection Form 1 a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '( 200 Pond St Property Address Carstensen Owner Owner's Name information is required for Osterville MA 5-10-18 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ 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: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 main 1 Number of bedrooms(actual): 4 pool DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330/110 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 200 Pond St Property Address Carstensen Owner Owner's Name information is required for Osterville MA 5-10-18 every page. City/Town State Zip Code Date of Inspection D. System Information Description: The main house consists of a 1000 gallon septic tank d-box and 4 Maximizers in a 35x9 ft area. The pool house has a 1500 gallon h-20 tank d-box and 1 500 gallon drywell. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage d Vacant 9 ( Y 9 (gP ))� Detail: Water usage has been minimal, property has been vacant for quite some time. Sump pump? ❑ Yes ❑ No Last date of occu anc : unknown P y Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 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 Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments rt 200 Pond St Property Address Carstensen Owner Owner's Name information is required for Osterville MA 5-10-18 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: unknown . Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ElYes ® No r• 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/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form. . Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 200 Pond St Property.Address Carstensen Owner Owner's Name information is required for Osterville MA 5-10-18 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: Main house 1998 pool house 2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑cast iron ❑40 PVC ❑other(explain): Distance from private water`supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass El polyethylene ❑other(explain) If tank is metal,list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No 1000 Main 1500 Pool Dimensions: Sludge depth: t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 9 of 17 6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y< 200 Pond St Property Address Carstensen Owner Owner's Name information is required for Osterville MA 5-10-18 every page. Citylrown 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 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 How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.). Both tanks were functioning properly at time of inspection. The Main house tank is older and showed more usage than the pool house tank. Grease Trap(locate on site plan): Depth below grade: feet I 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: Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form., Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '( 200 Pond St Property Address Carstensen Owner Owner's Name information is required for Osterville MA 5-10-18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tight.or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: 'gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No I t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 200 Pond St Property Address Carstensen Owner Owner's Name information is required for Osterville MA 5-10-18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0"on both 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 main house d-box was viewed by camera and the pool house was opened. Both were functioning as they should.The d box at the main house showed more signs of corrosion and usage than the pool house d-box. 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.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 200 Pond St Property Address Carstensen Owner Owner's Name information is Osterville MA- 5-10-18 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® 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.): 4 maximizers main house and 1 500 gallon chamber pool house. Cesspools(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 ❑ No t5ins•3(13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 L' Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r� 200 Pond St Property Address Carstensen Owner Owner's Name information is required for Osterville MA 5-10-18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): t5ins•3/13 rite 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 200 Pond St Property Address Carstensen Owner Owner's Name information is required for Osterville MA 5-10-18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately . a t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 200 Pond St - Property Address Carstensen Owner Owner's Name information is required for Osterville MA '5-10-18 every page. Citylrown State Zip Code` Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar - ® Shallow wells Estimated depth to high ground water: both are greater than 5 ft feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Property is much higher than pond at back of property. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 200 Pond St Property Address Carstensen Owner Owner's Name information is required for Osterville MA 5-10-18 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or.E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 F /`�► TOWN OF B,ARNSTABLE LOCATION i y SEWAGE �D VILLAGE DS �U� �IQ � ASSESSOR'S MAP&LOT b INSTALLER'S NAME&PHONE NO. g 4 SEPTIC TANK'CAPACITY � 6-PI �`�� LEACHING FACILITY: (type) Sw GA TW I II (size) 1��X 7 NO.OF BE ' BUILDER-OR OWNER ;44 IsUe 5�en1 d�I PERMIT DATE: 7 7 43 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 Feet within 300 feet of leaching facility) Furnished by u, rC�7lCATiON SEWAGE# L 1 i LACE O.TT�r�i// ASSESSOR'S MAP&LOT /i8 D4O max}' INSTALLER'S NAME&PHONE NO. gZ2CA/ 477 05 yg SEPTIC TANK CAPACITY- /000 LEACHING FACILrrY: (type) y (size). �S�X .'.NO OF BEDROOMS � BUILDER OR OWNER `PE1tIT17DATE: COMPLIANCE DATE: Z� _ Q$ ;St aration Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Pii_vaie Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wedand and Leaching Facility(If any wetlands exist :within 300 feet�o7f leaching facility),�yy Feet :Furnished by.�_�G�cr 1S �u1d Vk =a I 6 I L'Lr No. L 1 Fee 02 S THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for Bisposal �bpstrm Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(4""Q Complete System ❑Individual Components Location Address Lot No. (( � Owner's Name,Address,and Tel.No. C75 �'�t �►� S�- �c l 1 Assessor's Map/ParceT (') o Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 000, C, f � Type of Building: Dwelling No.of Bedrooms /" Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) M gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 Certificate of Compliance has been issued by this Board o Health. Signed Date Health. _� _( Application Approved by Date Application Disapproved by Date for the following reasons Permit No. C901 — ' Date Issued 5 —1 q --1 No. C901 Ll Fee J o2..5 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC.HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rpplication for M18108aY Opstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(ello Complete System ❑Individual Components Location Address o)Lot No. a co `Owner's Name,Address,and Tel.No. Assessor's Map/Parcel I&� 01-10 Installer's Name,Address,and Tel.No. 5_qC0_7/S"5 Designer's Name,Address,and Tel.No. �C?JCJC,S fC �/J l n� Type of Building: A/ Dwelling No.of Bedrooms !" Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures /{ Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil_ Nature of Repairs or Alterations(Answer when applicable) r . Date last inspected: e 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 Certificate-of Compliance has been issued by this Board of Health. Signei Date Application Approved by (wT ;). �j Date lj - C 4-1 _(� Application Disapproved by Date for the following reasons G � Permit No. got O 14-1 LI Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS T9-CAE-R-T�IFY,that the On-site Sewage Disposal system-Constructed( ) Repaired( ) Upgraded( ) Abandoned(lam by I G f 1 -(r .a)ro tJ r— at `YZb(\) _ has been constructed-in accordance- with the provisions of Title 5 and the for Disposal System Construction Permit No.a�� dated Installer Designer �1 #bedrooms Approved design flow -k gpd The issuance of this permit s-h+allpofdbe construed as a guarantee that the system will funcctio a�'es'gned. Date '^a!/ P ! Inspector ( �...----- ----------------- - - - -- -- -- - --- - --- ------------- - No. �) 0 j q /(J Fee ( THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS 3Disposal 6pstem Construction 'Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon(V) System located at '94!�o and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. 2 Date t , f 1( Approved b PP Y (\ V TOWN OF BARNSTABLE f4OCA.tON )UD PonlD S�- SEWAGE # 0) VILLAGE �5 '��l(� I�� ASSESSOR'S MAP & LOT 1-1b INSTALLER'S NAME&PHONE NO. .g I YI A<O A�5 Leu- ` ,a2 '.S 1? / SEPTIC TANK CAPACITY /SOa LEACHING FACILITY: (type) S�CTfk ��`�lt/2,� (size) & NO. OF BEDROOMS � I BLJILDER OR OWNER �� 6 �� 5e^J ^� PERMIT DATE: °I q COMPLIANCE DATE: g' (O-O 3 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 Furnished by -.:� >�` . ., _ � � � �� C� � � �_ � cZc M T � pp tom. � � � ��_ (�° � �� as-� � � M � .,. . � � s� Ell No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer • Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pphratton for Migozar *pgtem Con6trurtton Vertu Application for a Permit to Construct(✓j Repair( )Upgrade( )Abandon( ) l romplete System O Individual Components Location Address or Lot No. ZOO'PO INek S*. Owner's Name,Address and Tel.No. Os ervt�k,(tjA'. Suggnn-t CPgiWr%XY% Assessor's Map/Parcel t,00 -Poe%& Sk. 11 B - ON 0 Installer's Name,Address,and Tel.No. Desi ner's Name,Andress aid Tel.No. Su tjgr) Engtn�e('�n� 74er Pd 0 �0\ •47 a-3N Type of Building: Dwelling No.of Bedrooms Lot Size Garbage Grinder(Nd) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow Z 30 gallons per day. Calculated daily flow 110 gallons. Plan Date (o 15I t)3 Number of sheets Revision Date 711510-5 Title 5► e -Ply O�Pd ra�te�,en Size of Septic Tank 150 0 . Type of S.A.S. 1-5-M GAL. Chckn4w in a IZ:x vo.S' Fl6uQ Description of Soil O-S A La-j pr - 5a ndj f arm - " 3 L4ve,- - L, I -qq" e t L'-YR r - S1 I Log nn, Nature of Repairs or Alterations(Answer when applicable) Date last inspected: j2eS f Y��'h o,.� N �JiY►'w. r Agreement: P,vt`�'re ero e-p-r' y rP Go✓kck `f ireC e ivek 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 iss d by this Boar of Heat (� Signed Date / ��3 Application Approved by Date 7 03 Application Disapproved for the following reasons Permit No. 200 3— 3 2S Date Issued `7 7 6 3 ———— No. 2,003- Z - Fee t I b � - E�tered in computer:THE COMMONWEALTH OF'MASSACHUSETTS .; Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ` 2pprtcatton for Ofi6pozar *pgtem Construction Permit �r .1 Application for a Permit to Construct(v000 Repair( )Upgrade( )Abandon( ) O-Complete System ❑Individual Components Location Address or Lot No.Z CO Imo rN rA St• Owner's Name,Address and Tel.No. ` C.ARrV"\kq (Y�R, 1.:454r1r e �arS�enser �• Assessor'sMap/Parcel J Zoo Pond Sk. ►I B 0140 vsAer'J"4- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. S��IN�yn Erg��eer,�� JJ -7 tkr 4 e, R�. sker'J" 50 -4Z 3_;44 Type of Building: Dwelling No.of Bedrooms Lot Size i•S Z Rt, Garbage Grinder QVd) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design-Flow Z 30 gallons per day. Calculated daily flow 110 gallons. Plan Date-(. 1510 7> Number of sheets Revision Date 7 -5 0-5 j Title P�,r� �rQm� PIe.1 TmDr�VQmen j. Size of Septic Tank I SO 0 CAL. Type of S.A.S. 1-SDO 6AL•r C he rrlaer in n IZx �lD�7 FIGL� Description of Soil 0-5 A Lcr7 P,- - <AnA,r (nGr-, Lori Sw, t y Q I L ri e r - S 11- L a Qt Ls4_e e- - Cocose Sand SI`-lzo" C5 Dyer -F;nt 5"A SCC ?* 10. Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Q �j� hGl'✓w� �°r Agreement: 84111 're erolru,.r4%/ re-e-PrI . `f recQrve�. 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 iss ed by this Board of Healthl ' Signed Date Application Approved by 'Date Application Disapproved for the following reasons r i Permit No. 2-00 3- 3 2,5-1 Date Issued 7 7/0-,-3. THE COMMONWEALTKOF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(✓)Repaired ( )Upgraded( ) Abandoned( )by at ZOO rNIX 1_::1 has been constructe in a cordance i i with the provisions of Title 5 and the for Disposal System Construction Permit No.2 - 3 2 5- dated 7 G-� Installer Designer The issuance o this ermit shall not be construed as a guarantee that the system w' ,c on s si ne(d Date D D3 Inspector THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Otopo5al *p5tem Con!tructton Permit Permission is hereby granted to Construct(✓)Repair( )Upgrade( )Abandon( ) System located at 7_00 ?ond 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 us t be completed within three years of the date of this pe Date:_ 7 / v 3 Approved by .1 TOWN OF BARNSTABLE LOCATION �y� T d SEWAGE # VILLAGE �=�"��U t I� ASSESSOR'S MAP & LOT b INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 5�&A,l 1�{`�Nf2 j� (size) NO.OF BEDROOMS / ( BUILDER OR OWNER, I +- Sue eS-Yenl °^� PERMIT DATE: 7 43 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 Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by _ I r i I � *fy. Jul 11 03 03:56p hyannisport restoration 508 790 2338 p. l Doc a 929,681 r07 11-2003 12:54 Llo DEED FLESTFLICTION BARNSTPM-E LWV COURT REGISTRY WHEREAS, Warren Carstensen, Jr. and Susan K. Carstensen, Trustees of the "Carstensen-Pond Street Realty Trust", which was created by instrument dated March 16, 2000 and filed with the Barnstable County Land Court as Document No. 804,690, and situated at 200 Pond Street, Osterville, Massachusetts, 02655, is the owner of a certain parcel of land and buildings thereon located at 200 Pond Street, Osterville, Barnstable County, Massachusetts, by deed dated April 1, 2000, and filed as Certificate of Title No. t; 158236, at the Barnstable County Registry of Deeds Land Court. WHEREAS, Warren Carstensen, Jr, and Susan K. Carstensen, as Trustees of the "Carstensen-Pond Street Realty Trust", as owner of said lot have agreed with the 'Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a variance from the p State Environmental Code, 310 CMR 15.21 A and to obtaining a building permit for this y lot; y WHEREAS the Town of Barnstable Board of Health requires that said restriction be put on record in the Barnstable County registry of Deeds; a, 0 o NOW THEREFORE, Warren Carstensen, Jr. and Susan K. Carstensen, Trustees of the "Carstensen-Pond Street Realty Trust", do hereby place the following restriction on the above-referenced land in accordance with an agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title. U a Until such time as technology changes and the Barnstable Board of Health changes its regulations or otherwise grants permission, said premises located at 200 Pond Street, 0sterville, shall be limited to a house containing no more than four(4) bedrooms and the Trustees agree that this shall be a permanent deed restriction affecting said premises. We, Warren Carstensen, Jr. and Susan K. Carstensen, Trustees as aforesaid, hereby certify that we are the Trustees of said Trust and that said Trust has not been terminated, altered or amended except as may appear of record and that as Trustees, we have on this date, full power and authority to "enter into any arrangement for the use or occupation of the trust property, or any part or parts thereof, including without thereby limiting the generality of the foregoing leases, subleases, easements, licenses or concessions, even if the same extend beyond the possible duration of the trust." Jul 11 03 03: 56p hyannisport restoration 508 790 2338 p.2 We further certify that we are executing this instrument and will have performed acts recited herein pursuant to the powers granted to us by the teens of the said trust and at the express direction of all the beneficiaries Property Address: 200 Pond"Street, Osterville,Massachusetts For Grantor's title see Certificate of 'Title No. 158236 filed with Barnstable County Registry of Deeds Land Court. WITNESS our hands and seals this 9'h day of July 2003, Oklfh Warren Cart .nsen, r.,Trustee Susan K. Carstensen,Trustee COMMONWEALTH-OF MASSACHUSETTS Barnstable, ss July 9,2003 Personally appeared before me the above named WARREN CARSTENSEN, JR, and SUSAN K. CARSTENSEN, as Trustees of the "Carstensen-Pond Stre�lalaty Trust" and acknowledged the foregoing instrument to be their free act and deed' r-. Notary Pu c: 1Kathlyn Ne• e Snow• Commission Expires: July 1 ,2009 Town of Barnstable P 11 iD qV �p1HE Tp� ' Department of Regulatory Services 8AAN8rA8lE, : Public Health Division Date 2 3 MASS.s639. y 200 Main Street,Hyannis MA 02601 �0 Argo�y• Date Scheduled `L 0 3 Time Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: �/B/�/✓ �Q�/ T Witnessed By: &"L, .4I`��il y+F'�4fl 'tF A4},�iyr;' n'. '.:,.i fit n,fly'ir•.- M1Pf �F-, n i y � rob�ltiln9l y�-i�'",tk lrjr�' RI: t.x"n r'e� & f i 4 'S ' , �•�Fk n �� M� "'3��.' �.n...�rould ..4�i,w<d �v!nr°i'�•.as Frt� �,41F�ki'at'.�t.�, agar r4 '`issrt aaa,asw�w. . nl. � :�lwt.ry Location Address r Owner's Name Address Z OO /.70 IV Q S7 Ds-rE1z✓/LLL Assessor's Map/Parcel: (fig-O q0 Engineer's Name J �OYG c /�SSoGi�Tt y NEW CONSTRUCTION __kl REPAIR Telephone# SOB I Land Use rUn fir! Slopes(%) �7,0 Surface Stones A1,0 Distances from: Open Water Body 200 It Possible Wet Area 2 O O ft Drinking Water Well / ft Drainage Way S0 ft Property Line 149 ft Other It SYX4TCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) i°o 4/4 12, ?I 0 ` N • 2Z8 99 , S7��T Parent material(geologic) S�NA Depth to Bedrock Depth to Groundwater: Standing Water in Hole: /VO 6, � Weeping from Pit Face/I/O? 0b5971_V_r•D Estimated Seasonal High Groundwater /Va VJ f an 4 rr•T ( �r S p r � I�Ahs 1�1'i�9h is:�t',La ...� h•� ,�, �Y N"' ('7i> '"lGna :63ti"'Fi�a�,a� nae�A,r zx �s�.�,'i Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: index Well level Adj.factor Adj.Groundwater Level_ w, 'Al s y,fr- t�k$'�xTlt t- �s4Pf9JC „, rwll�it {�Naad$ �I :l ae nwa ci €?EF "�twL»vw� .e: W 4h,!:, Observation #/ r Time at 9" Hole# Depth of Perc Time at 6" Start Pre-soak Time® ` 9' Time(9"-6") End Pre-soak /0: Z 6411 Rate Min./Inch Z Site Suitability Assessment: Site Passed 1/ Site Failed: Additional Testing Needed(Y/N) , Original: Public Health Division Observation Hole Data To Be Completed on Back------ Q:I-IEALTI I/WP/PERCFORM J�4 1F 10-rm r r, a. } "wP,�,�,. q,>' : .1 �l{�t d Ik4km�G :IaNR�ir?�.A`xclit.n.!i•! !...'4 P::�Rx... t.l.ln:4l.AW '�ik .::R, .✓,'AYA! -,hAA r..:kAS�P?,7cd.tul r.n.,,.M.r 511ld4.�kt:6A5.::::ki:cx:.k+.!:..w.... IP''':I.:. 'I.:,l�fl..lY1.4NI.A�.d..mt: Depth from Soil Horizon Soil Texture Soil Colof Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel '=s'' A Lo�� sye j2- s i/ " s �y iv y2 T Z GLL-Y 7 M L.O/9 .S (J"XY,O/ZOO -574 o 7,s7w? c01-0 A16 nw��4kP ni xl sfkj VI N til'•ct t .,,I!.i I is i.:4a!S'� it I KA Gi£ +.wp:.:- —s{::P Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel x r,,n > t 1yt xY ;r fur rIh rlF°dF.�4Yrlti t plka wAr Ih ilF iM id �i oi.I'. M Li1Gt o- i� III F F ( i t. t !4 3 > k�Niik'b7kfd I ilw:: 'V I�k �Ik}"�!''�lljj I L"�C:.l�dnP MiSkll m r �I ILuSP IGhM N I,I;Il:hil f '�, i 14 �4F7k IAdPh :hArs..ktr. W .A. Ltl�. 'Pi' it,SN to tk'k6 bP:A71�.w•V!IY3YI II F/!:: .IIA4YLu Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel r T1. n ��ynz k�'�� ' �. � f>. 'f�'��.� ?. f ..'d � •�.r I ,��' 1 i r .'.� rB,PiF1:Tgl'�d'��I[tlfw iAlllbAud(rr�1t 11�t;,li:�y! Depth from Soil Horizon Soil Texture Soil Color • I Soil Other Surface(in.) (USDA) (Munsell) Mottling Structure,Stones,Boulders. Consistency,%Gravel Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No— Yes Within 100 year flood boundary No Yes Depth,of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? yE S If not,what is the depth of naturally occurring pervious material? Certification. I certify that on ,(date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. SignatureekCFFORM Date 2 �✓? Q:HEALTH/ M w 72 J q� ii Z, ?I --1 ------- I LY •� '"�F ,t 1 1 i � i I LL ZP- fv ,k CAD 44 i v sal , s� - /'N\ fJ - Q 0 I J ``X • r •J V - it l �- � _ _ {� �, '\ _� � �j _ , � Q. � . j � �� `� _ r.,�, L:L1 � � . �� ° v- .�.=.. J v � �� . _ �, � _ � � �- � �a�� j � � f . � � � l � � �� - .. t ,� r , � .-� ,. �� . . .� 1 � �� _ J �' --`� � �� .�_ � � 1 ��, . R � � �_ � '', �' ,' � � r L ,� c� ,f . , . � � .: � � v � - 1i � � � �� -.� �� ' �� • � �� - �� ' ��- I � � � r ` III ' � � y^.. \ J \�� I � � � � � � . . , �� _ I � � � �✓ `! r \�. ��'� J��\`` � a . V_ - —� �� .. - �/,� /� _ _ � �� \ �� . �d� '. T WN OF BARNSTABLE �; 6 L(;)CATION 00 P�� r` SEWAGE # VILLAGE O.T76,-r/lli; ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO:�� G � D� �s�r�®� `e, 03 9 SEPTIC TANK CAPACITY /000 a LEACHING FACII;ITY: (type) 41 '&.4x!!y!UT,'. .(size) - NC. OF BEDROOMS n B MDER OR OWNER PERmrrDATE: COMPLIANCE DATE:_. Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom'of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within.200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) a Feet Furnished by ' i / `�.,, �� _ c S � � � y ��b •hh �tti ,� . :� � ',( . No. _ !! •_~ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Migo$ar *p$tem Corigtruction VCrmit Application for a Permit to Construct(pair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. goo o; S j as Owner's Name,Address and Tel.No. �/.'! - (o j 09 Assessor's Map/Parcel a sere✓"Ma °�a� e_' 117110 0 y 1e Installer's Name,Address,and Tel.No. 4117— 0 9elf Designer's Name,Address and Tel.No. U�e 04,-~S &w, Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations Answer when applicable).ZMr 4// Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Uealth. Signed Date 'i'-2/— FS Application Approved by . - 1 6 Date y—Z/_fc?_ Application Disapproved for the following reasons Permit No. S�O Date Issued a ,P No. o / " Z - Fee -THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 01pprtcation for Mi000al *proem Construction Permit Application for a Permit to Construct(pair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. :�00 P01011 sr. Owner's Name,Address and Tel.No. Assessor's Map/Parcel 5 T ,� Oy,c, �'! _MO ,w Installer's Name,Address,and Tel.No. .9-7?. 0-7e/ Designer's Name,Address and Tel.No. ✓oS>rp� V e 494.-~S Type of Building: - Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of.Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil a" Nature of Repairs or Alterations(Answer when applicable) ahsrA411 �'dl9eoy/s�si�/=�3 ltiiT�i x Date last inspected: Agreement:, The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system r in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of ealth. Signed Date 7S Application Approved by Sk Date Application Disapproved for the following reasons -J ----- ----- q Permit No. Date Issued ---_ - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS "-(Certificate,of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( a:-" epaired ( )Upgraded( ) Abandoned( )by p at 6,0 Pa ez ha been constructed in accord ce with the provisions of Title 5 and the for Disposal System Construction Permit No. 9 ' ZA dated y' z �-97 "Installer ��T � L��rra$ Designer jos-clob l)s The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date I I\.c Inspector r Fee < THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTHzDIVISION - BARNSTABLES MASSACHUSETTS _ ig ogar*p5tem Con.5tructton Permit Permission is hereby granted-'to Construct( 4.4-Repair,r,( 1 Upgrade( )Abandon( ) System located at 2b0 P,7;6r sr 1 6jrl-y,t/i Ill.E i 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. ,/� o Date: y' Z ��'� Approved by �CXSI�� / '' . d`--'4 i 0/9197 Ue i�sed Foie the tt+i' 'ate of Failed . NOTICE: dorm Is '6 1? IC T , N O F.>. � k�,t Sto '11C5,Wsterh oniy CERTt CATION OF SKE rH AND APPLICATI N 0I2 A , t 0C"0S, -wSPOSAL �8f L fi t frNCfI PLANS) t � ya 4 d +fi T _Joy cP hereby cetttl�y{hat the application for cltspot3ai works 5 ;concerning the ' +.hZ ' ,construction permit stgfte' hY lire dated�.:. 2� meets ail of the . property located QSagd'dcf 4 j "fo116wing criteria: t ;Gl There Aid no wetiands locaied within`iO6 feei of the Earoposed leaching facility' Gl There A►e.no primate iYelisithiti 150 ieei bf the proposed septic system s; `✓� g_.. 1 - '.- There is w a.inctease iit flow, atid1di change m use ptoposed t•. „ ter' t t �:, ' ¢'There are no variattce5egUealed or needed x ) 1 t i ; •..# x �y��1_{ �Kki�'� aY,;pi '. '� Y,y �t ro z w h� pro osad ie�chin tacili Will Ue.located W thlh 230 feet of any wetlands,the bottoiti oFtlte � the ; < yi proposed-:leachit� actiit+.will pint�e located leas►ha fdilrieen(14)feet above the triaxlinttm adjusted' gg ; a gfobndwater table ele�rati�n, ' C, 'r.F c ya�'k t r l .s V t rkfv; Please cotitpletEe tthedri��dvirjng: r • '� 9 s � 4 Il i�=$ rd�.5�,'� i�'e'w{.. f tiR. y.',,r Yy"S��,F 1 � - }, z A)Top cif Ototirid 131evatioti(acciirding td the Engineering 17ivisibti(MA tnep) j B)Observed OtoittidwateW Fable giei►atih�i(aCedrdittg(d Health Division well map) br �t r .,c�,_: "� V'4' k t} 1 Ltd. .-1 AP iT SIGN Rr t�'� n � W;�k��+ts �B' �f! t -.. kt,�n'hskan... g l LICENSED SEp fi g 5 lVt tiVS�CALLi:i�1 �fl�l= 6*k OF 13AMS�°ASLE NillvtBi R _ y j, o f y f4 : h 3 y w trek" ' S - �Fy r a [Attact a sketch plait tit lh6 ptopo36d B�stetii Alsd'tf thi I[denaed tiietefiet potaesses a�eNified plot p[arii {� thi -41 s plan shouid be sulhtttted j ' 4 y 'r �"t h � - a• a e 140 , �ti q health folder:cart � �k?rr w ,;',p ran;. •'t 1 }„ 4, - h � r 6 �� .�` ", s � �_[�� ` �, • Q s :�. T WN OF BARNSTABLE LOCATION zo, Pdh sf" SEWAGE# YII:LAGE D-TTr_%"V/lei; ASSESSOR'S MAP&LOT //8 040 ;'INSTALLER'S NAME&PHONE NO. 6 ,�J Gy,/ Dc � ri►OS �l�9-O�S'9 SEPTIC TANK CAPACITY loop LEACHING FACILITY: (type) y 5 (size). �S'X °;NO.OF BEDROOMS 3 n B.UJ DER OR OWNER bl yr' �26�l S/C ':PERMTTDATE: COMPLIANCE DATE: '::Sepaation Distance Between the: -Maximum Adjusted Groundwater Table and Bottom of,Leaching Facility Feet "Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet ::Bdge:of Wetland and Leaching Facility(If any wetlands exist vuithin 300 feet of leaching faci ' ) Feet -.Furnished by k tiLm^s� s i Town of Barnstable P# R D q'(11 1 �Of IKE rp�'t, e Department of Regulatory.Services BARNMBLE, : Public Health Divisio RECEIVgate f-2 3 03 16,9. ,e� 200 Main Street,Hyannis MA 02601 A'Fp ,t. J U L 1 5 2003 Date Scheduled `J. 0 3 Time D TOWN CF C 4— Date DEPT, Soil Suitability Assessment for Sewage Disposal Performed By: Witnessed By: w r�, x}#, t_'�1, 2 .firsrtks �..M°u&n.Hc. A"mn3. :.p 3•-�„a3a,f.:� Location Address �� _ Owner's Name �S{ , Address 20p 1.70IVA S? AS'TEi2✓/L LE Assessor's Map/Parcel: l .D t�� Engineer's Name',.,pO�,G e- /�SS6Gf�l NEW CONSTRUCTION _� REPAIR Telephone# SOB` $ �✓�� 9¢ Land Use �DI2- t-S/b Slopes(%) %Jr�� Surface Stones AO Distances from: Open Water Body 200 ft Possible Wet Area 2 O D ft Drinking Water Well /S� ft Drainage Way -5-0 , ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) �6 i N 22� j-i¢NA Depth to Bedrock Ar/4 Parent material(geologic) '-/ Depth to Groundwater: Standing Water in Hole. /VO G° w` Weeping from Pit Face A/0 OIJr 5G72Vj5-b Estimated Seasonal High Groundwater d/ /VG y% s 7*r sni' F a ,*F�' �-P' 3 Ing 5. & pp nr,� Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: k. in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ _ kd r J'sr t r,a�o , E •�'+� r k �, a ..0,11 n Observation ! Time at 9" Hole# Depth of Perc 8 Time at 6" Start Pre-soak Time(a3 ' g' D Time(9"-6") End Pre-soak Rate Min./Inch '� 2 Site Suitability Assessment: Site Passed Y Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back---------- Q:HEALTH/WP/PERCFORM 3 ) P i w Ws A:efi Mpg; s.;....,m Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders., Consistency,%Gravel IVA 44= 5'i'� c 2 s4 v-,0 E 7,rY2 � N6 o ono' � r€g�a ,m.raa 1f. ....ur�...,..w ,�. �... ....�w�>r .. a w dws,e ny, Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) i a.} 3 a�'N. yii�. `' ,'3A, Depth from Soil Horizon Soil Texture Soil Color . ' Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel xa,'s, t r - �4:». sx �3 Da';: L, 2 � �ksuw�i11,�... .a..xiF ,m� Depth from Soil Horizon Soil Texture Soil Color i Soil Other Surface(in.) (USDA) (Munsell) I Mottling Structure,Stones,Boulders. Consistency,%Gravel Flood Insurance Rate Map: Above 500 year flood boundary .No_ Yes Within 500 year boundary No_ Yes Within 100 year flood boundary No_ Yes Depth,of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? y/--S If not,what is the depth of naturally occurring pervious material? Certification, I certify,that on 9S (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience/e described in 310 CMR 15.017. Signature Date Q:HEALT /P CFORM � S ,,•,. 2 �r'. t � "++'yam ,r �' .,� '� -`� " �.' v ..•—.�.�.K...,y..r 4'� a �S'y �. � �� r C { *wt G 1 r -.;+-..�.•�+r.-,- yam Wit ' r ��s S + _ r SS.Y � fi ='ty � o-�^' il: 9F3r x4.3.3 a. '1 t a ,.� n�,� •x'y.r'pr,.�.�,� Ifs"}s`� � r t"° ."w �.. ^ ,{ ++.. -...t� S S +f2' ... 'too r? aj.,' " dr�a.7.._.".' 'F'4"• � W �° '-..—w..-...t�,.�..r...., ."-..... �.. � _ ^�"s.,,,,,,,,.p:,,�.��`r 'pt 1`•� '� - '!ct#ir.:� �rNrt.._.„zT.�G ,syy"y;�� f},fi s`..r �Y1 :a }_`y.�+rr� ." + 1A *, '� rt �.. , t. S L'/1 4" s2kk�' S'`r<' " R�'S x :�t� #�} 4 tx .i. r •r.: 3I ,K't a ro+ tt { r• ty r e :..� . ' f 1. ` � rA �' � � ;•3 t� ,.. !' w.x� 4�{k �$* �.5 ��+t w vb $; � r � � �•+b�'i, � s s { •a 44 t z' C - t b9ra b aro} rtr % 'y tx>>>; uR i _..—_ . �i �t F -'C h iX. ..Sa�. 4.N: ♦F.7 CMG F.E.:N ty ;�r Sy sik'Tl. j� J�at� -:Ra =1 . '�1 i' r� �� i ,r.� � ,x > ,t' .y ,�,r „'•� � �.� =c } 4"�<-.^ �1 —VA : ' � 1 � "�7, � •� '' � t � �,�a�' 'xn � d'F;`max ��."�° ,� `t' x�sy t 2 x £� Y. "Amr CO '• '" i rem -�` ` '+ €,''v ,' 4W r 4' 5 :6 `�a t. �_ y �§' ?4.•t3 �`; r1 .�€".i.rro �.,,r;+ +y'Sa� ;,. �"{ ry., +'� •� 1 .': ��r . .� �, _ t .tS ;c'2 �' r g `' �'�� $ �''�� r r-' '� +,��'�a.9 �.=r3"""�+� ,�, �� i rt'roy � s' •�--,`� t�• y ro^ {': �>!; y* i{ . S• a"t 3 5 "- "' '� '�° } n a I•Z�` 4 f« ' i§ s..e+ `WT `g _ 1 "`.+ ! "� A �' .✓_. �oy,:i 2� }.'+ �„� ,}, t �.e f`r h;-. 4� i " '• 1 } t .J` 4t 4'SP w !(( ` ti ti Y/ S iK J _S l t I.Nz.{ �1- { w4i rti' t i spy ' . {'�l.� y 1'V.- '•+ �..' •,.j q-j � � ..�o-,..,..�•�,..�' yt ,a{•y� a« � x r,ro ro�{.�.�`tr�,w. S '�. � .•� .. .. �# � -� � it� �+ } �"'y )v SI { y `iV i 1 '•� �i `;,-r :W 1 Fa '" a r' d' a c S y/ } t. " i OC1 i Ilk Je �A j £ c 1Q, t 7�. I_ - F' //>� '' ` • t-. "r�.. '��1 a � r"fir S`� �s 3�. F .Jz _A P ^ . tit 411 _ I -� I E B 4 BA I a � ` i ; , I {; 1 ' L 0 C"A T ION SEWAGE PERMIT NO. VILLAGE i INSTA LLER'S NAME i ADDRESS R U I L D E R OR OWNER C4S t DATE PERMIT ISSUED DATE COMPLIANCE ISSUED C�„� , \ � � , ti` �. v.. • �� e"� J � "i '`�.. � �� + THE COMMONWEALTH OF MASSACHUSETTS_ :1 BOAR® E HEALTH l9GC f--- .--_-..---OF.... Appliration for Disposal Works Tonstrn.rtion 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair ( 41 an Individual Sewage Disposal System at.� -•- ................... - ._..... -- � tea:��r '2 U ®� .� ..... ........ ...--.-- . --- cation-Addte or Lot No. . � - . .. ....s. ?................. .......'------_..... .-•--.---------••---......................._...... caner, p r/ dress ---- .�,. ..�......._. �-.. t.. .................................... .......... -G--` i- :..................-'-'---------_-------------.... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type T e of Building ............... No. of ersons...._................__.___. Showers Ga YP g ------------- P ( ) — Cafeteria ( ) 04 Other fixtures -------------------------------- ----'-""---''-. . -------------'--------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------------------_ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box,{;" ) Dosing tank ( ) Percolation Test Results-; Performed by.........................................................................- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil........................................................................................................................................................................ x W ___ __ __ Nature of Repairs or Alterations— nsw r w en applicable-....� _ V_a U P1 0Ile s�'._.-... �� r - ------------------- --------------- f Agree ent: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 1 ITIL- 5 of the State Sanitary Code—The undersigned further agrees.not to place the system in operation until a Certificate of Compliance has been i s d 3ethe board of Ith. Signed... ...... •.. '---'---- ." --' ........ Date ApplicationApproved By-'...----'-- ---....... . '" ..................................... ...... 4.......................... Date Application Disapproved for the following reasons.-----•--------------------------------------------------------------------------•---------...---'-'--...----•--- Date PermitNo.......................................................... Issued....................................................... Date 4 N THE COMMONWEALTH OF MASSACHUSETT$; BOARD OF HEALTH " Ap'Ptiration for Diapas al Workii Cfnn itrurtiun rumit Application is hereby made for a Permit to Construct ( ) or Repair,( �a.n'`Individual Sewage Disposal System at: �'�( ') j` Location-Address or Lot No. ....._. �7r `•f 4••••-------- j i�a F '� Fr`?.............. ............................................. Owner Address - Addr ."•-•••.......................... !t v'%A/dd ess SQ�..er ........... ......_._.. ^ UType of Building !! Size Lot............................Sq. feet I—I Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder: ( ) a`4 Other—T e of Building .............. No. of ersons........_._.............___. Showers — YP g -------------- P ( ) Cafeteria ( ) d Other fixtures . W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. 1:4 Septic Tank—Liquid'capacity........____gallons Length................ Width................ Diameter................ Depth................ W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No..................... Diameter.................... Depth below. inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) NI .Percolation Test Results Performed bY-----•-----------•-----•••••--•------•--•.....................••......---- Date---•----------------......•-------..•--- W , Test Pit No. I...........:....minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ix .........-•-----------------------•--..........--------....-------•-• ------•••- 0 Description of Soil.......................-................................................................................................................................................ x W U Nature of Repairs or Altdrations—Answer when applicable--------_A�;3':rzt__�.......... i r...... .. 1517 !� �/ ........... ------------------------- Agreement: ~' '' The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with L provisions of TITLE4 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. S �.. �. Y.. v V .. _ Kl.. L '-----•--• -- . . ....................................... Application Approved BY Date" Application Disapproved for the following reason .---•-••--•---••--•------------•-----•-•-••--•---••-•-------•-•-------------.................................... •--•-••....................................•-•---.....-••-----•--••••-•------•••-•-----•--...•-----....•.--....-••------------•----------••-••----•-------••-•--•-------••-•-•----------•---•-•......... Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,: .`;�:>;........OF.. f . :irbv�......................... .(9rrtifir�i r oaf Toutpliana THIS S TO CERTIFY,AThat the Individual Sewage Disposal System constructed ( ) or Repaired ( ) b ,:.. ---•--•-•----------------------------•-------•--..............----•----••--•---........---------••---•--•------•••--...._ Installer at----------I�! r//k. �a ---------------•----•--•---------..... '" t E lr ..................................... has been installed in accordance with the provisions of TIyS, State Sanitary Code as described in the application for Disposal Works Construction Permit No.___...._._//............................. dated...............-..___.;_.-...................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................... lc, 2-6 - •--•-•.....-----.............•----•----_..... Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f 0; rr t �... ...............OF....!.. :% t. /J'< �v ? e FEE..{. i �r�a �t1 �r ° �na� rt- rrmit Permissionis hereby granted.............................................................................................................................................. to Constrpctd C))or%Repair ( 1)an Individual Sewage Disposal System atNo...............................li)-•--. s .. �f ..................................................... ��' rr � Grp 4Streel�!�/�.----• •�..r� , as shown on the application for Disposal Works Construction Permit-. ..................... Dated.._......___........_......_.v............ =------------------------.........-............................ ^ j, Z DATE...............................---------.� Board of Health _......... !--��-----••--- FORM 1255 A. M. SULKIN, INC., BOSTON F Finish Grade TEST - -�----- - _ - - - - -- _ HOLE 1 NOTES 1 r 7 a l + Z P# 10,479 is i Water. cipal 3'Mar r:� l j - -t t ORMED ASSOCIATES 1 Water Supply For This Lot Mun !: ! lj i i _ BY o 9"Min I — -- _....... ... F,lta • Compacted Fill � Fabric j PE a 04123103 � EL.30 2. Location of Utilities Shown on This Plan Are Approx.. A LAYER 5YR 3/2 At Least 72 Hours Prior to Any Excavation For This DARK REDDISH BROWN Project the Contractor Shall Make the Required 1/8"_1/2" 5„ : SANDY LOAM 29.58 , "�. >,. _ �& Pea stone + B LAYER 1oYR 7/2 Notification to Dig Safe(1-888-344-7233) LIGHT GRAY 3. The Contractor is Required to Secure Appropriate LOAMY SAND 29.08 Permits From Town Agencies For Construction 3' LIGHT GREENISH GRAY Defined by This Plan. 144" SILTY LOAM 26.33 4. Install Risers to Within 12" of x LEACHING C2 LAYER 7.5YR 8/6 Finished Grade. ` r CHAMBER 3/4"-1 1/2" REDDISH YELLOW 5. All Structures Buried Four Feet or More or Subject H-20 Double Washed 51° COARSE SAND 25-75 to Vehicular Traffic to be H-20 Loading. f - 3 'Stone C3 LAYER I OYR 8/2 VERY PALE BROWN 6. Septic System to be Installed in Accordance With_ s k FINE SAND 310 CMR 15.00 Latest Revision and the Town of 4'-10" l PERC TEST @ 58" Barnstable Board of Health Regulations. ' 120" LESS THAN 2 MINIIN 20.00 - 7. All Piping to be Sch. 40 PVC. I T NO GROUNDWATER ENCOUNTERED APPROX.GROUNTWATER @ EL.I CROSS SECTION OF CHAMBER 330 Calculation NOT TO SCALE s ;.. OF Total Lot Area= 1.52 Acres'. B Total Flow for Lot=440 GPD SULLIVA NO. 9t% (3 Bedrooms in House+ 1 Bedroom in Cabana) . Cif{L — < 1 330 , Ares —289 GPD/Acre GPD 152 c �O 440 G / Q y Design Data r, F.G.EL.31 FVG.EL.31 Single Family - 1 Bedroom With NO Garbage Grinder See Note 4(tYP Daily Flow=.) l 110 GPD Designed For 220 GPD(Min.Allowable Design) L.29.6 Septic Tank: 220 GPD x 200 %=440 GPD Top El.29.6 Use 1500 Gallon H-20 Septic Tank a 1500 Gallon Septic Tangy - r � . Leaching Area it � .,.. H-20 Flow Equilizets fi ^ Y d As Requiredt EL.2R 5 4�; f 220 GPD/0.74=297 SF Required ?`` , Sd i ewall=212'+ 16.5' 2= 114SF BocEl.26.6 Bottom Area= 12 x 16.5 198 SF - ?G - Bedding&"T"s 312 SF Total Provided lo' as Per Title 5 If Encountered Remove&Replace �. — � All Unsuitable Soils Within 5'of ; Min The Outer Perimeter of The System ` y Leaching Chamber Design DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Groundwater El.11 All Pipes to be Schedule 40. Use, NOT To SCALE Per T.o.B.Map 1-500 Gal. Leaching Chambers in a 121 x 16.5,Washed Stone Field as Shown., '. • f Title: Prepared By: Date:July 15,2003 SITE PLAN Prepared For. s PROPOSED IMPROVEMENTS Sullivan Engineering, Inc. i CapeSUrV Susanne Corstensen AT Po Box 65s I 7 Porker Rood 200 Pond Street Scale:Not To Scale 200 Pond Street Osterville, MA 02655 Osterville MA 02655 Osterville, MA 02655 ` 0 Barnstable (osterville), MOSS. (508)428-3344 (508)428-3115 fax (508)420-3994 (508)420-3995 fax project#:2ZO�• s PSUBPEDOOL com cap esurv®capecod.n e t N i 4 0� otv f v '. . k /p /� %�� 'tb . ' �•. ,tip =� �r �, BO �:, + / ASSESSORS REF.. x �, � L 4 5 , Map 118, Parcel 40 <p r A t OVERLAY DISTRICT: / , i ` ' • WP — Wellhead Protection District / As Shown on Plan Entitled Q r .• / "Revised Groundwater Protection ` • Overlay Districts" April 1993 s OWNER. S Location Map gGS~ Susanne Carstensen 6s+'� 200 Pone Street 1"=2,000E � ti� ``` \\\\ `\\\ •\a\ ) \ Osterville MA 02655 �` �\ % �r I \ to FLOOD ZONE: ZONE: S 6 I> I /� Zone B & C (see plan) RC Community Panel No. Area (min.) 43,560 SF #250001 0016 D Frontage (min) 20' \ O July 2, 1992 Width (min) 100 Setbacks: CDZ / / I Front 20' Side 10' 1''`• Ss�sr ` • '` N -Q�" Ql T / / y W/ Rear 10' !y ` St(!� - % / / oroge `�` I e ` � / / • I / �^CD eat Wdod o eck 00 fIP ;K Exisv ng Sept5ic�I N ° Bosediod Installers As-Byilt Cord \N, (Sew� 98-2iOver W/P \ \\ \ ♦ � � i t 1 � 3 o I / I I I I I I I I I I / / /� Shed 62 Over 'R ° / \�I ` \ / ! i lI // ' I I\\ ' Joshua s . .o l \\ � ► l I i IfI Io 23.8' Pond Q' Chain Lin� Bottom of Slope at E/osure O 4,4 V \ / / I 1 �� , I 1 I I 1 \ \ \ \ \ \ \\ Pond High Water Mark (Top of Inland Bank) 00.; IOK!tlCli �o Edge of Water 12/DEC/02) Setno \ \ \ \ 1 \ \ EI=11.0±' by USGS Quad C' is � Q,tros _30 ~ ` \ \ o \ \ \ \ \ \ 9 \ \\ \ \ TH-1 \ \ \` � \ �\ \ \ \ \ \ \ \ \ \ \� \ \ \\ \ •� \ \\ \ ° - '19gyp rod �°,Sexy\ \\ , \\ \\ \ \ \\ \ \\ \ \ � 'Find \Shy .ry 44.6 \ °�� 0` d ° ''' \\ O\ 33 t`f\e Lo i ss e \ th er/ skoc a O �r ofPETEn `� NO. 73 / CIVIL CBIC Fnd SSA•- �' Revision: Add Pool Cabana & Septic System Date: 07115103 Title: PREPARED BY. PREPARED FOR: Notes: ,�' Site Plan + O� „ CapeSury a7usanne Carstensen 1.) The property line information shown was ��- Proposed Improvement, Sullivan Engineering, Inc. 7 compiled from available record information. N PO Box 659 7 Parker Road 200 Pond Street /r �� Osterville, MA 02655 Osterville MA 02655 2.) The topographic information was obtained o 200 Pond Street (508)428-3344 (508)428-3115 fax (508) 420-3994 (508) 420-3995 fax Osterville, MA 02655 from an on the ground survey performed on T.. PSullPE®aol.com copesurv@copecod.net or between 201DEC102 and 31/DEC102, Bamstable Osterville �/� �+�+( ) �V�a.7s 3.) The datum used is Approximate MSL Draft: JOD Field: WHK/MDH 20 0 10 20 40 80 (mean sea level). Date: ./ rr Comp.: JOD Comp.: WHK MDH RRL June 5, 2003 I =20r Review: PS Drawing # C569 1