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0324 SEA VIEW AVENUE - Health
324 Sea View Avenue- a Osterville A= 138-004 i Ok a « u k a a �a n o f .ate ° m o . ° ° _ ,.off a �•� p� lE a "��4 '� ��,.�`a ��� � o ,`��`� a eiI ., e , .° Q. �. 1� o 6 T^ „phy�° r .. A"c fir„ p erF $r Y1 a u dry+.. ° ° d" a p �.�� ° °,�y m ro �n4 ^ ° o ° « n pn n ° ° 6 ° ^ F ° n y y e ° • ° ° o r �r ° e «�a ^ « A � a 9 , a " P ° ^ ° a b Town of Barnstable Inspectional Services s�ver,�sz� t Public Health Division MASS Thomas McKean$.Director 039. .� 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-004 r `e Installer& Designer Certification Form Date: (Z-ZC' Sewage Permit# Z021'611W Assessor's Map\Parcel /3�,Gay Designer: Installer: )"dVle C'OtiSG , ,, � Address: 70 .!�Q,vi S-Er�e�� _ Address: On was issued a permit to install a (date) ( st !t septic system at 32 `� lea '�,`e�-v, �i--e, LeL�, based on a design drawn by �c4h o' a (address) dated 2 7 Aa2L6 (designer) certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (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. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the to rms of the RA approval letters (if applicable) —-- f "OF S s S T �y W ND u nstaller's Signature) No` srss" ti A IT 5 (Designer's Signature) (Affix Desigi4„ ' Here) I, A PrV PLEASE RETURN TO BARNSTABLE P UED UNTIL BOTH TH SNFORM ANDAS- .OF COMPLIANCE WILL NOT BE ISS `BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. `THANK YOU. 'kVodWcptMEALTMSEWER connecASEPTICOesiper certification Form Rev 9.14-13.DOC I TU' T OF B�N�TABLE hr AUM rsc x ca4Acxcr eparstS Bstvicesegi�. tlmwaud;�vv ��btsto�je BMta�eo�Laa�Cng�acili�y: ....�•.. 01 e�t�a w3 wog t fUtY� ���4�'�fettand LeecbJ�g Ftt,V��y wdg exist iltldii190Q .p� C111$�` a} r Fro 4 CO-OT, 1 C`3 53 B-3 ,- ps- yy TOWN OF BARNSTABLE LOCATION 3'�-J SEWAGE# VILLAGE ASSESSOR'S AP&PARCEL INSTALLER'S NAME&PHONE NO. v SEPTIC TANK TANK CAPACITY LEACHING FACILITY: (type)(-J i (size) f& X 1, �X qb NO.OF BEDROOMS OWNER (AA-e i PERMIT DATE: 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 cf-yetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY r � IDI 3�y se Pam,e aj 4" . Fn lz�30 r � - IT I Z, I olf S DocuSign Envelope ID:ABFC7834-03B7-4C6A-B78C-C1C1C2FB85B5 Town of Barnstable Regulatory Services t Richard V.Scali,Director Public Health Division 11kaiSIStABIA MAW Thomas McKean,Director ° 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Homeowner Certification Form for Alternative Systems Property Address: 3Zy 5ek View AveNue 0SXE;tIJ LL. . _ Assessor's MaplParcel: I "may Property Owners Name: 64,\"7"et,, T. KAf+0;j. In accordance with Massachusetts DEP alternative system approval letters, the following certification information is required by the Owner of record.. The Owner of record must place an 'Y' in the applicable box next to each line certifying the information. Yes N1A. I have been provided a copy of the Title 5 UA technology Approval letters. (15 page Standard Conditions letter and the specific technology letter) O a I have been provided with the Owner's Manual I have been provided with the Operation and Maintenance Manual 0 8— For Systems installed under a Remedial Use Approval,I agree to fulfill my responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10) and the Approval 0 Q- For Systems installed under a Remedial Use Approval,I agree to fulfill my responsibilities to provide written notification of the Approval to any new Owner,as required by 310 CMR 15.287(5) 8' 0 If the design does not provide for the use of garbage grinders,the restriction is understood and accepted ET'- El. Whether or not covered by a warranty,I understand the requirement to repair,replace, modify or take any other action as required by the Department or the LAX if the Department or the LAA determines the System to be failing to protect public health and safety and the environment,as defined in 310 CUR 15.303 gocusiftl''i`3Ce4tK 4 agree to comply with all terms and conditions above. r Owners printed name F4448EFA8BBE42A... 1/12/2021 Property Owners Signature "Date Note This form must be submitted along- with the septic system disposal works permit, a` 'lication for all IAA. s stems includin new canstruchon r6ainNuk rades, with and without aregate tstone} and with conventional design criteria or credited desieu< criteria. Q:\SepticUA homeowner certification 2,doc 1 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for MispoBal *pstpm Construction Permit Application for a Permit to Construct(,<Repair( ) Upgrade( ) Abandon( ) �omplete System ❑Individual Components Location Address or Lot No. 3Z`\ S h V��-' fit'"`� Owner's Name,Address,and Tel.No. phi Kti�c�j o Assessor's Map/Parcel 138-OO�\ Ins ler's Name,Address,and Tel. o. :-"�-� I Desi ner's Name,Address,and Te.No. 19-e�L 1 ►-6 c)39� Sub\ fi c a \� ¢L�` ;s 0 J.S Sod-y z g- ti Type of Building: Dwelling No.of Bedrooms 77 Lot Size sq.ft. Garbage Grinder OU Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 770 gpd Design flow provided _7(2) gpd Plan Date \'X(trltiXr \1, "0?0 Number of sheets Z Revision Date Title 5ke_ \�(��, YrJQcbev� Size of Septic Tank \9 d U.) Type of S.A.S. ZO- C-\Vtc Qti5 k�x4o byccA Description of Soil 'Zb" \7�j 0-7" Cam 7-\Z OMr- �sl rcur\ryi S+\h� Pt 2Z l 2 her-, t OAIr l SRrn� 10`1��1(r ZZ— C MtD 5+M�7 ZS`1 rP ILI 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 Co d not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. . � Signed Datek-11 %-., - y � Application Approved by l Date / —J`f/—a Application Disapproved by Date for the following reasons Permit No. ?_0 O,o Date Issued y THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Comptiance THIS IS TO CERTIFY,that the Own-site Sewage Disposal system Constructed Repaired( ) Upgraded( ) Abandoned( )by I C 1✓��� %A 707--�_ jj at 3N 5e#Y Vtew VN-UF— has been constructed in accordance r , with the provisions of Title 5 and the for Disposal System Construction Permit No. 02/-066 dated I�'I Installer Designer #bedrooms Approved design flow �y gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector "a9• '•',�-.r4 ..:_'.`.. '« ..r,•• i - ".Ni`-F-w�7.* 3 T'?' 'rti r rsXx. �,{y} 1 v }.. .1,... y •irt' ' F f3.,.,b ,:.z -T No. Fee ��. � .�;•�"< x � � Entered in computer: THE COMMONWEALTH OF.MASSACHUSETTS Yes $� w PUBLIC HEALTH DIVISION TOWN OF-BAR`NSTABLE, MASSACHUSETTS f � 2pplication for Zisposal 6pstrm Constructtort ermit ,,,,,,Application for a Permit to Construct(.� Repair.( ) Upgrade( j Abandon( ), [-�Com�Clete System Individual Components,. �. Location Address^or Lot-No. 'Z"A �,,Vk'-' ' ���`'Q Owner's Name,Addresd,and Tel.No. "V- ham_ c Assessor's Map/Parcel r , Installer's Name;'Address,and Tel.Now r'"h •- Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms -7 Lot Size sq.ft. Garbage Grinder(N�j Other,,-*. Type of Building � No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.regdf d)` 7�V gpd Design flow provided _71�_ ss:.ap,, gpd Plan Date \k(,U 16r- Number of sheets - Revision Date . :.�.; Title a���. �`ra� �r��e� �''r�ruv�•r.►E�1 S ` _,,Size of Septic Tank \SV O (Z� l Type of S.A.S. ZQ k(oXtiu Description of Soil 7^12 OOh4- 1s1NC(wAr'11 SA),.) 10`l e 6 L a 11 n R fo ko&%-, 5NM-) to b St G �2..... C (nt 5'c,u0 ZIS) Ll ,a Nature of Repairs or Alterations(An wer when applicably t" r �r Date last inspected: 71 Agreement: The undersigned agrees to ensure the construction and rCiaintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Co 64M not to place the system in operation until a Certificate;of Compliance has been issued by this Board of Health.. Lf �J Signed -.-..^~-„" ,,,� Date Application Approved by L_ „+l / Vjt Date k f Application Disapproved by p Date t t for the following reasons c Permit No. 00fin Date Issued I `ti U THE COMMONWEALTH OF MASSACHUSETTS:': ti -n BA TABLE RNS , MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed(--'")" Repaired.( ) Upgraded( ) -- Abandoned(-_).by—' t at �fL'``•`°'jl`4\Vl�t,,: �"ut� Jw e : :`t ,,��,�has'been coii's4nioted in•'accordanoe''-1 .. "� '�"^ fi^-' N with the provisions of Title 5 and the for Disposal System Construction Permit No, 0 1-� dated Installer Designer .ry #bedrooms ?' Approved design flow 7 y gpd The issuance of this perm'tXshall;of bed construed as a guarantee that the system will fimctionya`s designed: Date Inspector .�.,•_ ^,,- ___-�_--==•No.•.-.:_��>�:'_�.���•---._1..-- ------•------------- ---•---- e•- --- ---- -- ---•-.__...__._.__.-•_____-.-.__.Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC,HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( i)' Repair( ) Upgrade( ) Abandon( ) System located at ,'�2�1 Stet. y�u' Ave ytiTC�Uktt-C" 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!' Date "" ' i - Approved by No. ca 0 01 O v � Fee 41rc) _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitatl0tt f"r '"osal *pstrm �Cuttst utiott permit Application for a Permit to Construct(' Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. -3 l4 �i`��J ` --�G VqA Owner's Name Address,and Tel.No. g cl� Assessor's Map/Parcel 3 0 Installer's Name,Address,and Tel.No..- C4, . ® j Designer's Name,A dress,and Tel.No. 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) �17 o gpd Design flow provided .1�� gpd g �� Plan Date L )T 0 Number of sheets �- Revision Date. Title Size of Septic Tank Sob d Type of S.A.S. " �t.�.�'�`�� !� Jr �` �ek Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and m ' ance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Enviro Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar f )ig e Date A- Application Approved by Date i Application Disapproved by Date for the following reasons Permit No. 1-y "— 6 Date Issued r l c 00 LIP No. s Fee THE COMMONWEALTH OF MASSACHiuSETTS Entered in computer: Yes ' PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 4ppf ration for ispbsaf *pstPm Coustrurtton 3offmtt A lication for a Permit to Construct Re air U rade1 Abandon pp O p ( ) pg ( ) ( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. Lo Assessor's Map/Parcel QSC �t � � A t � ��� Installer's Name,Address,and Tel.No. t,,t�,�GP.t® i` Designer's Name,Address,and Tel.No. tScatA� •... 6tv r�wr�rr'�...r► M`., -f;'���1 t, �•1'97 f'�';Ist7� �" �4 a �s Type of Building: Dwelling No.of Bed ooms Lot Size sq.ft. Garbage Grinder( ) r Other Type of Building*. No.of Persons Showers( ) Cafeteria( ) ' Other Fixtures Design Flow(min.required) T 7n gpd Design flow provided gpd Plan Date �.� �)•r, Number of sheets Revision Date Title Size of Septic Tank Ip ( Type of S.A.S. k_C) . �.�: 'C`l f r,-ea e�r SIC 01` 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 1 accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of ; C mpliance has lieen issued by thsjBoard of ealth �_' wr a SigneLd Date o4l a..'XJ I A L:� Application Approved by \ Date Application Disapproved by '" Date r 1 t for the following reasons Permit No. d-0 "'0 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance M THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( L) Repaired( ) Upgraded( ) Abandoned( )by i C f"f f A 0. s�g r..wA 45 at v has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated ~,Installer�. ..w--- Designer :Stil,t 4�sA . �ae jnz .R # 'bedroo s _ Approved design flow ud gpd The issuance of this permit'shall not be construed as a guarantee that the system"will function es'" ed. Date Inspector Inspector -- NO. � JD FeeQ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS rjtsp sal 6pstem Construction Permit -Permission is hereby granted to Construct( Repair( ) Upgrade( ) Abandon( ) System located at T,�f W1 ej-D 1 ' 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. ai Provided:Construction must be completed within three years of the date of this permit. ^ " s . Date r ,,,.gpproued•by�---- i Commonwealth of Massachusetts ��8—�� �Ot,,_Zvl Title 5 Official Inspection Forrn- Wl hI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •r `" 324 Sea View Ave t Property Address Dean McWilliams t Owner Owner's Name/information is Osterville V MA 02655 6-26-20. i c required for every - page. City/Town - State Zip Code Date of Inspection 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. A. Inspector Information S'F(4F 14(4441- 1 Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name ' P.O. Box 73 Company Address East Falmouth MA 02536 City/Town State Zip Code 508-495-0905 S13971 Telephone Number License Number B. Certification I certify that:l am a DEP approved system inspector in full compliance with Section 16.340 of Title 5 (310 CMR 15.000);I have personally inspected the sewage disposal system at theproperty address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation-by the,Local Approving Authority 4. ❑ Fails 6-26-20 Inspector's Signature bate The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 0 3 days of completing this Inspection. If the system 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form w: IMI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 324 Sea View Ave Property Address Dean McWilliams Owner Owner's Name information is Osterville MA 02655 6-26-20 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System�Passes: , ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. 2) System Conditionally Passes: ❑ One or more system components as described in the "Co nditionalPass" 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): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts - 1� fY Title 5 Official Inspection Form �.} Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r a 324 Sea View Ave Property Address Dean McWilliams Owner Owner's Name information is required for every Osterville MA 02655 6-26-20 page. CityrTown State Zip Code Date_ of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ; ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 "El•Y El ❑l 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 El ❑ ND (Explain below): 3) 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. " a. 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: I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 r Commonwealth of Massachusetts r, Title 5 Official Inspection Form w.� i,I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41, fir. . 324 Sea View Ave Property Address Dean McWilliams Owner Owner's Name information is required for every Osterville MA 02655 6-26-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts _ .. �Y Title 5 Official. Inspection Fora hr Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 324 Sea View Ave Property Address Dean McWilliams Owner Owner's Name information is t required for every Ostefville MA 02655 6-26-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) , 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number 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 water supply 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 2000 gpd- 10,000 gpd. ` -f ❑ ® 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. 5) Large Systems:To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts 3 Title 5 Official Inspection Form it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,fcl 324 Sea View Ave Property Address Dean McWilliams Owner Owner's Name information is required for every Osterville MA 02655 6-26-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: 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? ® 0 Wasthe 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)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official l.nspection Form —0 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 324 Sea View Ave Property Address Dean McWilliams rt Owner Owner's Name information is required for every Osterville MA 02655 6-26-20 • - page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: F Number of bedrooms (design): 4 Number of bedrooms (actual): 5 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: Number of current residents: 2 Does residence have a garbage grinder? - ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: , 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 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 6-2020 Date T t5insp.doc-rev.7/2 612 01 8 . Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 I Commonwealth of Massachusetts ` Title 5 official Inspection Form i� � 11�1 Subsurface Sewage Disposal System Form Not for Voluntary Assessments 324 Sea View Ave Property Address Dean McWilliams Owner Owner's Name information is required for every Osterville MA 02655 6-26-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? Y ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Owner----pumped 2yrs ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 324 Sea View Ave - Property Address Dean McWilliams Owner Owner's Name information is required for every Osterville MA 02655 6-26-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool a ❑ 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): Approximate age of all components, date installed (if known) and source of information: 1997 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 12"feet Material of construction: .r ® 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.): Good condition. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 s Commonwealth of Massachusetts Title 5 Official Inspection Form Q Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a >` 324 Sea View Ave Property Address Dean McWilliams Owner Owner's Name information is Osterville MA 02655 6-26-20 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 6"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ 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 Dimensions: 1500 gal Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts �. 1� Title 5 Official Inspection Form _ ,� ibl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments lri 324 Sea View Ave Property Address Dean McWilliams Owner Owner's Name information is Osterville , MA 02655 6-26-20 required for every - page. City/Town . State Zip Code Date of Inspection D. System Information (cont.) ;• 7. Grease Trap (locate on site plan): w Depth below grade: feet'. 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.):• _ _ . 8. 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 t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 324 Sea View Ave Property Address Dean McWilliams Owner Owner's Name information is required for every Osterville MA 02655 6-26-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) 41 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 9. Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 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.): Good condition with water at working level and no sign of back-up from field. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts r� 4. Title 5 Official Inspection Form I"f' I� wa ri Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 324 Sea View Ave Property Address Dean McWilliams Owner Owner's Name information is required for every Osterville MA 02655 6-26-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): , Pumps in working order: r ❑ 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. 11. Soil Absorption System (SAS) (locate on site plan,.excavation not,required): If SAS not located, explain why: Type: r ❑ leaching pits - r number' ® leaching chambers number: 8-Infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts r' Title 5 Official Inspection Form nl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 324 Sea View Ave Property Address Dean McWilliams Owner Owner's Name information is required for every Osterville MA 02655 6-26-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach field in good working order and empty at inspection with no sign of back-up into d-box or surrounding stone. 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 r Commonwealth of Massachusetts - a f Title 5 Official Inspection Form i,i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , } a 324 Sea View Ave Property Address Dean McWilliams Owner Owner's Name information is required for every Osterville MA 02655 6-26-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): 3 Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form wa hi Subsurface Sewage Disposal System Form-Not for Voluntary Assessments V 324 Sea View Ave Property Address Dean McWilliams Owner Owner's Name information is required for every Osterville MA 02655 6-26-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 8 tl a d i Irk t � 53 t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 III r Commonwealth of Massachusetts a r� ;w Title 5 Official Inspection Fora i�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 324 Sea View Ave Property Address Dean McWilliams Owner Owner's Name , information is required for every Osterville MA 02655 6-26-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.)_ - 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 1 et+ 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: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ICI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 324 Sea View Ave Property Address Dean McWilliams Owner Owner's Name information is required for every Osterville MA 02655 6-26-20 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5ins .doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 P P 9 p Y 9 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS. DEPARTMENT OF:ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM FORM . PART A CERTIFICATION Property Address: 324 Sea View Avenue Osterville, MA 02655 Owner's Name: Susan Tammev Owner's Address: ,v �Date of Inspection: _ July 14. 2008 ) Name.of Inspector: (Please Print) Jaynes M. Fond Company Name: Janes M. Ford , Mailing Address: P.O.Box 49 � Osterville,MA 02655-0049 ��._r Telephone Number: (508)862-9400 }. ". .T ru 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 C nditionally Passes ds Further Evaluation by the Local Approving Authority a is Inspector's Signature: Date: July 15, 2008 The system inspector shall subs t a copy of his 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 Conunents ""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 Page 2 of 11 cA OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION .(continued) Property Address: 324 Sea View Avenue Osterville, MA Owner's Name: Susan Tangnev Date of Inspection: July 14, 2008 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_detennined.(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 pipes)are replaced obstruction is removed ND explain: 2 'Page 3 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE IDISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 324 Sea View Avenue Osterville MA Owner's Name: Susan Tanyev Date of Inspection: July 14, 2008 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to detenmine 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 wateranalysis,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 I `Page 4 of I 1 r: OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 324 Sea View Avenue Osterville MA Owner's Name: Susan Tangnev Date of Inspection: July 14, 2008 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.'/2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ✓ 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 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 detennined 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 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above)* Yes No _ the system is within 400.feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 1I of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of I 1 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 324 Sea View Avenue Osterville MA Owner's Name: Susan Tanpnev ' Date of Inspection: Ju1v 14, 2008 . Check if the following have been done: You'must indicate" es"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 ]5.302(3)(b)]. 5 Page 6 of 11 OFFICIAL.INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 321 Sea View Avenue Osterville MA Owner's Name: _ Susan Tangney Date of Inspection: July 14, 2008 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203. (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 0 Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): n/a [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: Unknown COMMERCIAL/INDUSTRIAL . 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: Unknown 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/Alternative technology. Attach a.copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: installed on 2/24/95 Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 324 Sea View Avenue Osterville MA Owner's.Name: Susan Tangnev Date of Inspection: July 14, 2008 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron_40 PVC - other(explain): Distance from private water supply welt or suction line: Comments(on condition of joints, venting, evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 4" 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): certificate) (attach a copy of Dimensions: 1500 Qal. Sludge depth: 2" 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: 6". Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions detennined: 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 did not a . ear to be any signs of leaka e. 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: Commments(on pumping recommendations, inlet and outlet tee or.baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc): 7 ' Page 8 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE JDISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: .324 Sea View Avenue Osterville MA Owner's Name: Susan Tan-nev Date of Inspection: July 14, 2008 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: allons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alann 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 Continents(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 clean. No solids were present. PUMP CHAMBER: None (locate(in`site plan) ?umps in working order(yes or,no): Alanns in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 is Page 9 of I I OFF ICIAL ICIA L INSPECTIO N FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 324 Sea View Avenue Osterville MA Owner's Name: Susan Tann_nev Date of Inspection: July 14, 2008 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) 9 ) i If SAS not located explain why: Type leaching pits,number: ✓ leaching chambers,number: 8-.infiltrators ner as-built 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 infiltrators were dry and clean. There did not appear to be any signs offailur e A canter a was used for the inspection. 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 a Page 10 of 11 OFFICIAL,INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 324 Sea view Avenue Osterville MA Owner's Name: _Susan Tangnev Date of Inspection: July 14..2008 - SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. A CA . sa t3 3 - A% C 3_ SY - a 3 SQA V1&W AvC, 10_ Page I 1 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSIESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 324 Sea View Avenue Osterville MA Owner's Name: -Susan TanQnev Date of Inspection: July 14, 2008 SITE EXAM Slope Surface water Check cellar Shallow wells a Estimated depth to ground water 9+/ . feet Please indicate(check)all methods used to detennine 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 reaps t _ - Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable to o ra hic and water contours nta s the my Ls were showing qpproximatel 9'+/-to groundwater at this site. This report has been prepared only for the septic"system and components described herein. This septic system has been 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 septic system, the.inspection; this report and/or any components of the septic system which have not been located and inspected. • 11 _ Town of Barnstable GF tHE Tp� " Regulatory Services BARNSTABLF, ; Thomas F. Geiler,Director y MASS. �a $ '639. a Public Health Division Thomas McKean,Director 200 Main Street; Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. QASEPTIMisclaimer Private Septic Inspections.DOC TOWN OF BARNSTABLE c I-OCATION Say Seav,c�w A��• SEWAGE# l s- VILLAGE 0S1 br,1,( ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO.- SEPTIC TANK CAPACITY 1! S60 LEA CHING FACILITY:(�typpe) //1 tIFr4TbtJ (size) NO. OF BEDROOMS 7 .OWNER T-A/1 S luk 1 PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility f.-et Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) feet Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHED BY 1/1 S (l —7 1 g Al A O 1 C c3- SY 3 SBA VI`w AIA. ~. TOWN OF BARNSTABLE LOCATION 30 Sep U��tJ Ave, SEWAGE # VILLAGE ©SVt 2y'i A l(t- ASSESSOR'S MAP & LOT ®�U� INSTALLER'S NAME 6i PHONE NO. Gokoo,-, apvvs SEPTIC TANK CAPACITY /Soo 6,9 LEACHING FACILITY:(type) _r,J/-/T/�9�&0 (size) 8 NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER ��b9nf DATE PERMIT ISSUED: /? �9f� DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �,/ fr ' �, M AMANN" a� r f ASSESSORSLMAPN(03.::/No...•---•--••-•---•---... PARCEL NO: FIzs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Uiripoittl Workt5 Tomitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (!/) an Individual Sewage Disposal System at: ....-•••-3�`1...5 e....UcF ---------------------------•-'-------•----------------.....................•--••'•..........--- ._.... Location-Address / or Lot No. .........C Melt.... �IT�a��........................................... ......---------...----- p "T Owner .......................---...----•---------Address Installer Address Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms.--------------------------------------....Expansion Attic ( ) Garbage Grinder ( ) Other—Type Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' 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. I................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 V --------------•---•....---------------------------------------------••-•-----•--••-. .......................................................... ........................................................ ... ...................... ------------------------------------------------------------------------------------- }f V Nature of Repairs or Alterations Answer when ap liccaabl ,3r/ -- fT/Y1_� ________________________ e..�^ r ,-------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage .Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian has been iss �byard of health.. Signed .. ......... ... ......... .......... -----................................. .:.2.:9 ".... . /1 f� Dace Application Approved B �'� �...� -------------------- ---------------- /—:----- .. PP PP y --- ... / _......................... Dace Application Disapproved for the following reasons- -- ----------------------------------------------------------------------------------------------------------------------------- .. . ............. .. ........._................................. . ...........................-_....I.... ._...................._. . .......................... ........................................ 1Permit No. . .a Issued ------------- ...------ Dare ---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tertifiettte of Compliance THIS S TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (P ) by �0 ----- at ._.: ..� t.. .c ..-f '' � � ...,n,tali ... .... _-------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ....%S......._`V---._-------- dated ....-/..-.1--- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ,r� DATE......-------- v��� -... Inspect s //.- - 9- --' -------------- ------------------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _ yy TOWN OF BARNSTABLE °p FEE........................ �i��n��t1 urk� �It4��t� i1Qri ��ruti� Permission is hereby granted.......... 2 d ..��v� ------------------------------------ to Construct ( ),or Repair an Individual Sewage Disposal System atNo...3F�`.....15`R--=N...Q t e ) _-.L..—. 7 -` ------•-----. --- . . --- •------•---•--• --------------------------------•-----•--.._......... Street as shown on the application for Disposal Works Construction Permit No.95-..(-/y Dated..- % ... ..... - / —1 ^ F DATE.........-(--------•--/----------%----------.................................... Board of Health FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS // No......� ......... y dU Fss....`�....D............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apphratiun for Uiupu!ttl Workii Tnnitrurr#inn rrrmit Application is hereby made for a Permit to Construct ( ) or Repair (!/) an Individual Sewage Disposal System at: .........`��............................................... . � - —,7 Location-Address / or Lot No. �� t 1. ----------------------------------------- Owner Address r Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.. ......................: . . .Expansion Attic ( ) Garbage Grinder ( ) ---------------------------- No. of ersons.--__--_---_---__-_---_.-.._ Showers — Cafeteria p,, Other—Type of Building p ( ) ( ) a' 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. 3 Seepage Pit No...................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a 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 U -------------••-•-------• W �/`---•••------- ------------------------------------------------------------------------------------------ - 'f x Nature of Repairs or Alterations—Answer when applicable— S�f U P PPlicable f fig /��o ZZ,C.� . -- 0 .56A �-{-'--c� 1 �2u�1�2^-� �` (�`�� 3 1 �� e Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss ed by " Zard of health. 1�GG �1.>..........--� .��1r 5 ---- Signed .- _:...f } Date Application Approved By =. `- -ft " -'� -- ..�"..1.2.. f Date Application Disapproved for the following reasons- ---------------------- -------- ---------------------------------------------------------------------------------------------------- ----------------------------------------------------- ---------------------------------- ------------------ -------------------------------------------------------------------------------------------- ---------------------------------------- Permit No. ......... Issued .............. ..... .......--- Date PATRICK`AHEARN .. i' A.erll wr I • 100 Cmwwne.01h.4amue N'el'm Syuu� 2 - Suile U -1)N'iRln smn BONm..NA 03110 EJgliw MA U±319 -P:01)3M.1)10 _ P:.9Ue v.19.9113 F:01I.309._3)0 F:W8.919.g0e. ' t www p etriI,kahearn.cumr The Kaneb -- - Residence e IwvvLa 324 Sea View Ave. Osterville, Massachusetts f General Notes: --------------------------------------I H GENERAL CONTRACTOR SHAND ALL MAKE ALL SUB-CONTRREQUIR REQUIREMENTS OF IERS NOTES. OF THE 0.EOUIREMENIS OF THESE NOTES. Pool Cabana Cabana Bath ALL ORKSHALLBEPERFOM N COMPLIANCE WITH ALL APPLICABLE LOCAL W STATE AND NATIONAL BUILDING.LIFE SAFETY. ELECTRICAL AND PLUMBING CODES. GENERAL CONTRACTOR SHALL BE RESPONSIBLE FOR SECURING ALL PERMITS NECESSARY FOR COMPLETION CUNTRAR OF OUGHOUT ME EKISTNG BU RNFAD ___6_C_AS_ED0199NG G C ONTR HA LL AYOU DI T}O ________ IELDTHEENTSEWDRKTOPERFORMEDTO VERIFIDIMENSIONAL RELATIONSHIPS BEFORE I I I cas P fO N AND MALL VERIFY ------------------------- —STINGCOITIONSA LOCATONS INS RT BEFORE PROCEEDING WITH WORK LAC' GENERAL CONIRAROR SI W.L BE RESPONS®LE I I ' FOR'IRMEN SBETWEE OFEWORKOF DlMZNSIONAL REQUIRED TRADES IWEENTNEWORKOF REQUIRED TRADES ISUB-CONTRACr00.8. (Kids) ANY DISCREPANCIES FOUND IN THE PLANS. Pan a Famil / Room °PDP�AeRel ERaoenMnecussMnoa7 SPECIFICATONOFA PRODUCT'MATERIAL OR v ' ' ' I ' I , METHOD OF ASSEMBLY IS TO BE BROUGHT TO Tavem Room ' i ___________;_ ______________rt___________ THE ATTETR(ON OF THE GLTIERACfOMRACTR • ' i IMMEDIATELY. +,F I I --I I 4 ' y• I REGARDLESSOEFTED HE O0.NOT AN TIFM IS i I TO.mrR BLI16 ABOVG i. Pool Patio ' +-------------�------------------�-" ' - 9 jc_f M.L NT CONSHOTRA TO SHTED,THVIDESAAL I I I I I i i i I PANTRY NEMS R FCIRALLPROVIDEBAIDITEM IF OITIS OR I xi NECESSARYFOR THEPROPER ORSPE IFTED OR FUNCTION AND SUBCONTRACTORS ED. I I II I I Ax SUPPLIEM THE GE RCONTMRCTORO T I INFORM THE GENERAL CONTRACTOR OF THEIR -- — , , - REOLRR.WTUCHMA NO wORROFDTEO 11 II 1-�- F-r------ TRADES.WHICH MAY NOTBEINDICATED,PRIOR TABLE. TO SUBMITTAL OF FINAL BID FOR WORK. 8'-7 8'-7 Kitchen DMWNGS SHALL NOT BE SCALED FOR DIME'NSIONS.AND.—SUMS.DRAWINGS MAY HAW BEEN REPRODUCED AT A SCALE 1 I I I I I I I ' . ••'_____ ` N I I DIFFERENTTNAN ORIGINALLY DRAWN. _______ -_F 3R _--_ Drawing Copyright: C, PATRICK AHEARNARCHRER I.I.C.AND PATRICK COMM N LAW.KPRESSLY RESE 0 TIER " Z m I Open Air PROPERTYCRIGHT$NTHE Es DR�WINO RTHESE P_R.i i a O , - DaAWNGS ARE THE PROPERTYOF PATRICK Go I Covered Porch A ARN ARCHRER LLC,AND PATRICK AHEARN Z Z i PALA,AND SHALL NOT BE REPRODUCED IN ANY MANNER NOR SHALL THEY BE ASSIGNED FOR U AWING MPARYWITNOUTTED TEN USE -_- - - I OBTAINING THE PATRI�RECK AHEARN R d I PERMISSION OF PATRICK AN EARN ARCHITECT ` s ' I LLC.AND PATRICK AHEAAN FAL4. w h 2 I Living Room - Drawing Title: -------------------------' irst Floor n - ------------ - ---- --- F' Plan 11P ,2,-51' , .. Entry3 T _______________________ BWICS _________________________ 4-0 December 1,2020 I I , I r_ ISSUE DATES G D. O BIDDING: , (Adult) ■PERMIT: 12-01-2020 Covered EntryOfice/Libra x ❑CONSTRUCTION: I REVISIONS: ❑Dater 0 Date: O Dal e: O Date: n FIRST FLOOR PLAN ASP PLAC ❑Date: -- -- - -- -- s --1---- ----- - - - EEE� ws Rr I F t A- 1 . 1 PAT RICK AHEARN ' AROIIRIOf — Ieot:,,Nnn9ox"I�.A.m. -i-N— Ir 0 .- n W'„I.,SIIrrI BUteA1..MA 02116- F.AguA9un,M A e25J9 P'.01 i.26E.1T10 P:t08.9,10.9i 12 I F:011.2M.`11e F:IOR9)9.pOtl www,patriDkahearn.com The 1 Kaneb B } Residence 324 Sea View Ave. \ Osterville, Massachusetts �I General Notes: R GENERAL CONTMCTOR SHALL MAKE ALL SUBCONTRACTORS AND SUPPLIERS AWARE OF THE REOUIREME WS OF THESE NOTES. ALL WORK SNAIL.BE PERFORMED N COMPLIANCE WITHAL BUMOICABLE LO SAFETY. STATE AND NATIONAL BANG CO.LIFE SAFETI'. . FIECTRICAL.WD PLUMBING CODES. GENERAL CONTRACTOR SHALL BE RESPONSIBLE FOR SECURING ALL PERMITS NECESSARY FOR COAIDLETION OF WORK THROUGHOUT THE ________ _____T CONTRACTOUCU CENTS. - GENERAL CONRtACTOR SHALL LAYOUT N THE r BE BENCH - FIELD THE ENTIRE WORK TO BE PERFORMED TO 1--_ L_ ____ ______ ___ VE0.1F\'DIMENSIONAL RELATIONSHIPS BEFORE ______________ ____ ____________________ ______________ ____ ____ ." CONSTRUCTING AITYPART NOOTIO OCTIONS EQ, EO, P.Sitting BEFORE PROCEEDING WITH WORK, ATONS GENERAL CONTRACTOR I BE RESPONSIBLE e� Gallery i U P B tj m - REQURED TRA ESISU NONE ACTOR FA REDUIREDTRADBETWEE THEWCTORS His II � _ r� King ANYDIDIMEHSIONSPENCIES FOUND UNIN THE iON PLANS. RANY W.I.C.--__ -p xQ- --Y APPARENT ERROR IN WE CLASSIFYING OR S�-T BUILT-IN BUILT-IN1 �Y I SPECIFICATION OF A PRODUCT.MATERIAL OR METHODOFASSFhIDLY STOKE BROUGHTTO I II a ii - ------- 1 THE ATTNItON OF THE CiENEML CONTRACTOR B•-z,- Her W.I.C. T• ® ® IMMEDIATELY. ?-3,__________ ® ® WN N FMrED.ULFHE NOR SPE ffIEDIT IS - ----------------------- -- --- ® ® SUNCTCONT,( OFANFBCONTRWNNOENSSHALL 01 NECESSARY FOR THE PROPER INSTALLATION OR rt C TRFDMI i ttlee Laundry I; INFORM THE GENERAL CONTRACTOR OFIM THEIR L SruF. _ 9 REQOE S, CH M THE WORK ICATED. UP fLOSET I X TO SUBMI FTAL OFFNAL BID FORRTWORK PRIOR DRAWINGS SHALL NOT BE SCALED FOR 0 --- - OPN STAIR RAII. Bedroom#2 .-EBEONREMO UCE..DMWINGS MAY DRIER WASHER NAVE BEN REPRODUCED ATw SCALE M -1------I-I------I-- - E.T.R. DIFFERENT THANORIGINALLV DRAWN. !. JL—_J Stair Hall Drawing Copyright: PATRICK.-EARN ARCHITECT LLC.AND PATRICK AHEARN FAIR EXPRESSLY RESERYEME - DN COMMON LAW,COPY RIGHTS AND OTHER PROPERTY IN THESEOMWINGS.THESE DRAWING ARE THE PROPERTY OF PATRICK --- FALk N SHALL NO LLC.ANDPATRICK IN ANRN -- FAIA,AND SHALL NOT BE REPRODUCEDINAM' BUILT-INS -------- BOOKS MANNER NOR SHALL THEY BE ASSIUNED FOR USE OVERLOOK (LINEN) ____ _-__ ---CLOSET--- 'TO ANYT PARTYWTTHOUTFIRST BOOKS CLOSET _____ PE MISSIOBTAINON OF PAiME R CK®EAW RIN RCHITECT ' OPEN TO 4Gall. '-'-- LLC.AND PAMCK AHEARN FATA. ' BELox' Bath Drawing Title: y Second Floor Plan D g � EILI. ---- Bedroom#3 E.T.R. Queen December 1,2020 I ------____-- ISSUE DATES ---- - ---_- ❑BIDDING: Bedroom#4 ■PERMIT: 12-01-2020 E.T.R. _ ❑CONSTRUCTION: REVISIONS: ❑Dale:ln, ❑Date: Beth#3(New) O oat e: 9'-I ❑Dale: ❑Dale: _n SECOND FLOOR PLAN -----_ - --- - ------- -- _ I�J OENCHi ____ _______ ______ _ -0' I BENCH II'-II' --- ----------� I A- 1 .2 PATRICK AHEARN I' -- ARNIITtOI — 4 &ruort MA.2116 EIBeH IlNMA 0:514 P:617,iM.1710 . P:50tl V1Y.Y112 'F:S11.iNf.`31ti F:308.Y1Y.w0a ✓ w ww.patrickahearn.com The Kaneb I Residence lie,L324Se.aiew Ave. Massachusetts General Notes: GENERAL CONTRACTOR SHALL MAI:E ALL SUBGONTRACFORS AND SUPPLIERS AWARE OF _ THE REOUIR EMENT5 OF THESE NOTES. ALL WORK SHALL BE PERFORMED IN COMPLIANCE WITH ALL APPLICABLE LOCAL STATE AND NATIONAL B—G.LIFE SAFETY. ELE—CAL AN'D PLUMBING CODES, GENERAL CONTRACTOR SHALL BE RESPONSIBLE r_______________________ ____-------B.,I -__________j ____________ _ FOR SE CURING ALL PERMITS NECESSARY FOR COMPLETION OF WORK THROUGHOUT THE r----- --------------T CONTRACT IXKVMENTS. ExIS— /\,--�J,R�TII GENERAL CONTRACTOR SHALL LAYOUT IN ME CHIMNEY v 6J ' VELD THE DIMENSIONAL AL RELATIONSHIPS K TO IONSHI SBEFORE VERIFY DIMENSIONAL RELATIONSHIPS BEFORE T CONSTRUCTING ANY PART.AND SHALL VERIFY ' ALL EKISTMC EDING N$ANTI LDCATONS BEFORE PROCEEDING WITH WORK. Bath#5 i SLLT GENERALCONTRACTORSHwLLBERESPONS®LE FOR THE CO-ORDMTION OF DIMENSIONAL REQUIREMENTS BETWEEN THE WORK OF REQUIRED TRADES/SUB.CONTMCTORS. ANY DISCREPANCIES FOUND IN THE PLANS. •A/\'./\I DIMENSIONS,MSTMG CONDITIONS OR ANY TH APPARENT ERROR IN E CLASSIFYING OR - SPECIFICATION OF A PRODUCT.MATERIAL OR Mechanical METHOD OF A.S.SEMBLV IS TO BE BROUGHT TO 66-_ THE ATTENTION OF THE GENERAL CONTRACTOR I __------ I IMMEDIATELI', 2 5 T 3 5 -O - i'-li- REGARDLESS OF WHETHER OR NOT AN FIRM IS ' I SHOWN OR SPECI IED.ME GENERAL --------------------------- ------------------------------ -+ i j CONTRACTOR SHALL PROVIDE SAID ITEM IF IT IS NECESSARY FOR THE PROPER INSTALLATION OR I " � FUNCTION OF AN ITEM SHO WN OR SPECffEED. OPEN STAR RAIL 71- SUPPIMTHE SAND SURCONTMCI'CT SHALL I INFORM THE GENERAL CONTRACTOR H RMEM REQDIX.WMICH ATlIN WORK OFOTED. Open to Below IV TRADES.WINCH MAY NOT ID INDICATED,PRIOR TO SUBMITTAL OF FINAL BID FOR WORK.. Game Area DMWMOS SHALL NOT BE SCALED FOR OPEN STAUt RwIL - H VEBTON5ANDIORSTIES.DRAWING$MAY HAVEBEEN HANORIGIN ALA SCALE DIFFERENT THAN ORIGINALLY DRAWN. 30 j m Drawing Copyright: PATRICK AHEARN.ARCHITECI'LLC.AHD PATRICK 11 CONNAHEARNFLAWXOEXPRESSLY RESERVE AO THE _ -------------- - I I j - COMMON I0 COPY THESE DRAWINGS. PROPERTY RIGHTSE THESED OF PATRICK DRAWINGS ARE HI EC:PROPERTYA PATRICK wNP•SRN ARCHITECT LLf.AND PATRICK wiiESRN FANNE SHALL THERBE ASSIU EDFORU MANNER NOR SHALL THEY BE ASSIGNED FO0.USE i 3 TO ANY THIRD PARTY FIRST OBTAINING MEPATRICK AH WRITTEN � PERMISSION OF PATRICK AHEARN ARCHITECT LLC.AND PATRICK AHE.ARN FAIL. iSl I I I ' 1 , I , I m ' , I I I I I I I 1 L__________________T � Drawing Title: o Attic Floor Plan TV Area z --� ---- BD- December 1,2020 ` BEDS ISSUE DATES ur OBIDOING: ■PERMIT; 12A1-2020 ' ❑CONSTRUCTION: I 1 � 1 �____ Bunk Room I-------1 8 REVISIONS: BUNK 0Dal e:n, - BUNK BEDS BEDS ❑oat 0: O Dale: ❑Dale: nII 1I'I ❑Dale: "ATTIC FLOOR PLAN i� __--1 SCALE:1/4-=1'-0- 1L_____JI� ' - A- 1 .3 1 - 11, DIRECTIONS: ASSESSORS REF.: From Hyannis — Follow Main Street to the West End � Map 138, Parcel 004 " Rotary, Take third exit onto Scudder Ave. Turn right onto 3z `� Smith Street at the stop sign. Continue on to Croigville ' r Beach Road and left onto South Main Street. Continue over the bridge to Osterville, and left onto West Bay Road REFERENCES: * continue to Wianno Ave. and turn left and turn right onto Sea View Avenue #324 is on your right. • `" M Deed C223233 Plan LCP 2664—T s LCP 2664-26 Plan Book 243-113 ; Lot F1 LOCATION MAP: 1»=2,000f' ZONE: RF-1 ` Area (min.) 43,560 SF \\ Frontage (min) 20' Width (min) 125' Setbacks: Front 30' Side 15' BVW #12 Rear 15' OVERLAY DISTRICT \ 1 o euw #11 , j AP - Aquifer Protection District f�It , r 'G'Ub FLOOD ZONE: \ BVW #1 , �`� \ Zones AE Elev. 13 Community Panel No. #250001 0018 D 00 July 16, 2014 BVW #9 DRAINAGE / DRAWDOWN TO Brush BE PROVIDED Are/o PROPOSED i B #8 POOL EQUIPMENT PAD DISINFECTION TO BE OZONE i o \ OR APPROVED EQUAL 50'j BVW #6 : B o r, Lawn \ i100 � , 2' r � �ii //r o \ / / Z 1 Existing -- � It d i Garage 1 / r 6� \ / It 'ICb ❑ It 11 11 1 G� I 0l1 IF.Vo. 11 1 o i Tank O fi -f-o`t'Fa, '" lid 1\1 j � I Fen C j j A � 3 \� nground Pool C.15 �� O \ Pati n.FQ t j j G,, NJ , > ��\ Elev. 8.5 BVW #5 S 43 sill 9,4 O BVW Approximate Location of Existing Septic CVi � ,� ems\ � From Town BOH As —Built Card Z4 mac `:\` ��o\ TO BE REMOVED Sill 9.4 2YI w/f f/ate Z Dwelo9 10 10 pS ne rive i\ `� r r\ Walk -- MARK �1 I to \ ; �` `�Y 'r '""' 1 / o \ //Sill 9.Zz o f I N QQ�S I I f la Po Lawn f \ BVW i % , kp- r kS r' E�l(STING HAY BALES W/ SILT i _ '1 DRIVEWAY In d FENCING 1 TO BF REMOVED 1 r r TO BE PROVIDED ito up AS EROSION CONTROL N 1\ i 10 oJe` 1 t Q a a, cy 1.1 BVW #2 i / ;t r l i� 0 `` to TM O Lawn `� \ / I �a 8 BVWCb CD Lot F1 Q i � 5 5 SF m� QRQ G�' i n Lawn / Cb 1 I cn / I rn q' CB/dh 4s. / fnd t —4 o / 1 • 3 i ,�� � / fag up j BUFFER ZONE CALCULATIONS 0-50' Buffer: Remove Existing Drive = —2,733 sf ,- Proposed Drive = 1,798 sf CB/dh - Proposed Pool Equipment = 48 sf fnd "6. ' Net = -890 sf -' 50-100' Buffer: Remove Existing Drive 1,704 sf Remove Existing Pool = —1,440 sf Proposed Drive = 1,822 sf �+ Proposed Garage = 360 sf LEGEND: Proposed Porch = 30 sf CDT Cedar Tree Proposed Pool & Patio = 1,229 sf Net = +297 sf HT Holly Tree a DT Deciduous.Tree Mitigation Required: 4x(-890 sf) + 3x(+297 sf) _ —2,669 sf CT Coniferous Tree C70� Utility Pole —E— Electric SN OFA4A —G Gas s�X : h Wetland Flag Light Post o V El CB/DH ` 168 0 OHW— Overhead, Wires mot GrSTc�t� 25 Elevation Contour �S/0,44A TITLE.• .S_, PREPARED BY. PREPARED FOR: NOTES: `''/ � �'�� Enginccring 1) The structures shown were located on the ground by Qro osed Im rovements conventional survey methods on shown her I � �i ,J,p mil,Ili L 2) The property line information shown hereon was compiled. I� . ivan , from available record information. Record parcel is described r 1 At consuituig, 111c, Christopher KQneb on LCP 2664—T, but lot lines shown are depicted on Plan Book 243 Page 113. 324 Sea View Avenue 3) The datum used is NAVD 1988, a fixed mean sea level Bamstable (508)428-3344•P.O. Box 659.711 Main Street, Osterville, MA 02655 datum obtained by RTK GPS performed by Sullivan Engineering�OStervill ) Mass. seci@sullivanengin.com•wwwsulllvanengin.com )Consulting Inc. 4 Topographic information was collected usingboth Draft: CTR/ASL Field. WHKICTRIJOD 20 0 10 20 40 80 conventional survey method and RTK GPS on or between l 6/22/2020 and 711712020. DATE: December 17, 2020 1I,SCALE, =20I Review: CTR Comp./Review: CTR/JOD Pro jec t: Kan eb Project#• 4000016 PERC TEST:20-173 DESIGN DATA SEPTIC NOTES PERFORMED BY:JOHN ODEA,PE- SULLIVANENGINEERING Single Family 1.Location of Utilities Shown on This Plan Are Approx.At Least 72 Hours &CONSULTING,INC. Existing Dwelling Prior to Any Excavation For This Project the Contractor Shall Make SOIL EVALUATOR NO.2911 • ' 5 Bedroom 110 GPD the Required Notification to Dig Safe(1-888-344-7233)and contact WITNESSED BY.DONNALD DESMARAIS,R.S.-TOWN OF BARNSTABLE @ Daily Flow=550 GPD Sullivan Engineering&Consulting Inc.(508-428-3344). AUGUST 24,2020 Use Existing 1500 Gal Septic Tank 2.The Contractor is Required to Secure Appropriate Permits From Town SITE PASSED Proposed Carriage House Agencies For Construction Defined by This Plan. 3.Wherever Sewer Lines Must Cross Water Supply Lines Both Lines Shall TEST HOLE 1 EL.6.2 TEST HOLE-2 EL.6.2 2 Bedroom @ 110 GPD Be Constructed of Class 150 Pressure Pipe and Shall be Water Tested to Daily Flow=220 GPD Assure Watertightness. In General,Water Lines Shall be Constructed in ............... .LOAM LOAM................ Proposed 1500 Gal Septic Tank' Coordination With COMM Water,and Shall be in Accordance ' 7. .......... ..... 5.6 6' 5.7 No Garbarge Grinders With 248 CAM 1.00-700&310 CMR 15.00. o/A LAYER.lOYR 6f2......... O/A LAYER.fiOYR 612.......... 4.A Minimum of9"of Cover is Required for All Components.Total Daily Flow=770 GPD �h p° LIGHTBROV1XlSHBRAY....... LIGHT BROWNISHBRAY 5.All Structures Buried Three Feet or More or Subject " H J 12 FINE.LOA1b1I'SAND......... 5.2 12 FINELOAib1YSAPF.D. 5.2 LEACHING AREA to Vehicular Traffic to be H-20 Loading.It is the Engineees - B LAYER 10YR 516 B LAYER 10YR 516 Recommendation that H-20 Always be Used YELLOWISHBROWN YELLOWISHBROWN 4 Rows of Cultec Field Drain C4's 6.Install Watertight Risers and covers to Within 6"ofFinished Grade FINE LOAMY SAND FINE LOAMY SAND In Bed Configuration Over Proposed Septic Tank Inlet and Outlet,Pump Chamber Outlet 1 PERC TEST 4.7 25 GALLONS GONE IN 10 MIN 40 LF/Row @ 6.7 SF/LF=1,072 SF(793 GPD) and D Box,and to Grade Over Pump Chamber Net All covers are to be maximum 18"for concrete or 24"Cast Iron. 22" 4.4 24" PERC RATE<2 MINI N(LIAR=0.74) 4.2 7.Septic System to be Installed in Accordance With 310 CAM 15.00& C LAYER 2.5Y 6/4 C LAYER ZSY 614 248 CAR 1.00 7.00 Latest Revision and the Town ofBarmstable LIGHT YELLOWISH BROWN LIGHT YELLOWISHBROWN Board ofHealth Regulations. MED SAND MED SAND 8.All Piping to be Sch.40 PVC. 66" 0.7 66" 0.7 9.D-Box Shall Have a Minimum Inside Dimension of 12,and a Minimum BOUYANCY CALCULATIONS Sump of6". 96" -1.8 96" -1s 1,000 Gal H-20 Pump Chamber 10.The Separation Distance Between the Septic Tank Inlets and Dead Wight=17'250 LBS Outlets Shall be No Less than the Liquid Depth.Not Tees Shall Extend a Minimum of 10"Below the Flow Line.Outlet Tees Shall Extend 14" Uplift=2.97'x 9'x 5.25'x 62.4 LBS/CF=8,756 LBS Below the Flow Line,and shall be Equipped With a Gas Baffle and TEST HOLE-3 EL.6.2 TEST HOLE 4 EL.6.2 Department Approved EfTulent Filter. 1,500 Gal H-20 Septic Tank . LOAM .......LOAM..... Dead Weight=23,000 LBS 10 _. . 5.4 8 5.5 Uplift=2.5I'x ll'x 6'x 62.4LBS/CF=10,337LBS O/ArAYE>�.Iff 6�2......... oiA�LAM.10Yx612......... .............. .... ........ ..... .... ........... . LIGEIT BROWNISHBRAY. LIGHT BROWNISIT BRA.Y...:... ........ .. ..... 17". F)NEL.OAibIIX SAND.:.. 4.8 14".............. .FINE EOAhIY SA1�lD 5.0 - - B LAYER 10YR 516 B LAYER IOYR 516 YELLOWISHBROWN YELLOWISHBROWN FINE LOAMY SAND FINE LOAMY SAND PERC TEST 4.0 25 GALLONS GONE IN 8 MIN. 33" PERC RATE<2 MIN/IN(LTAR=0.74) 3.5 28" 3.9 C LAYER 2.5Y 6/4 C LAYER 2.5Y 6/4 LIGHT YELLOWISH BROWN LIGHT YELLOWISHBROWN MED SAND MED SAND 66" 0.7 66" 0.1 96" -1.8 96" 1.8 Locate Junction Box Outside of Tank - Pump Power & Float Control Cables Installed In Accordance With Federal, State & Local Bldg. & Elec. Codes Alarm To Be On Separate Service From Pumps 1/2„0 Goly. Pipe For Float Support JTonk To D-Boz 4"OSch24"0 Opening Above From S For Manhole Frame & Co ver PUMP COMPARTMENT PLAN VIEW DETAIL 12.0"[305 mm] OPTIONAL 4.0"[102 mm]DIA. NOT TO SCALE INSPECTION PORT MODEL R STARTERISTAND ALONE • Conduit Thru Chamber For SMALL RIB LARGE RIB Power & Float Cables 24"0 Manhole Finished From & Cover 9" Min. Grade Cover 48.0"[1219 mm] MODEL E END` - -� - - SMALL RIB LARGE RIB .. _. 4"0 Sch. 40 PVC AAAA From Septic Tank i Drill 1 8„0 Hole a1v Cha For Drain *MAY ALSO k USED AS AN INTERMEDIATE UNIT Emergency Storage Inv. 2.50 To D-Box TO EXTEND THE LENGTH OF A RUN. - Volume 526 Gal. cn Min. 2' Cover 102.0"[2590 mm] Alarm On El., -0.25 INSTALLED LENGTH=96.0"[2438 mm] Pump On El. -0.50 �, I 48.0"[1219 mm] 48.0"11219 mm] Off Pumps O EL -1.15 w oCb Pum 3.0"[78 mm] o -a 2"0 Sch. 40 PVC . . . S 31 1 * . . . . . . . . . a' Threaded Pipe 8.5"[218 mm] SMALL RIB LARGE RIB Bottom El. -2.25 INSTALLED LENGTH ADJUSTMENT=0.5(0.15 M)' ALL CONTACTOR FIELD DRAIN C-4WD UNITS ARE MARKED WITH A COLORED Secure Pipe at Top & STRIPE FORMED INTO THE PART ALONG THE LENGTH OF THE CHAMBER. Bottom of Chamber 1/4 H.P. Myers Pump Stable Compacted or Approved Equal* Base � *Prior to Ordering Pumps the Contractor CULTEC,Inc. THIS OMWINO.WM PREPMBDTO WMW THE DESIGN OK OM FORTHEPROMMSYSTS&IT Ong CHAMM &AWJS.r.-WWA0mIpmw.s.r.r ULTIMATE MISPONSIOUTY OF THE DESIGN ENdNE9T TO.ASSIJRETWITTHESTORMWATERSYSTO"MMEIW Must Confirm the Compatibility of the P.O.am= PH:(IIQ81 rM4416 Fur COMPLIAMWITH AU APPLICAMS LAWS AND ROXII ATIONS.ITSI THE DE.MPIONEERS REVOIAOLITY PROIWTNa PMECTNIN DATE DATE - STS Fed"RWA PH:(SW)4'MATEC. TO ENSURE THAT THE CULTEC PRODUCES AN DESIONED IN ACCOAMMINITHCIS.TL4'S WO M REOUROIHM Existing .Electrical .Service WOOMISK CT OM rX CULTEC INC.WES NW APPROVE KAM SOW OR SYSTEM DENSIA THE DE&[S"ENW61011 q RM ON101E DESHANED Or:DESWM DRAwNSY: DRA�E Y: _ CULTEC W"WAIErLAM %&Q ft- FOR All DESIGN Off. SCALE: SCALE SHEET NR SHEETS PUMP COMPARTMENT SECTION DETAIL NOT TO SCALE F.F El. 9,20 18.55 93.31 EL. 5.75 _A Installer To Con firm Prior EL. 5 2 To Any Work Existing EL. 4.95 1500 Gallon Septic Tank IN DEVELOPED PROFILE OP S. YES TI.FM_ _ NOT TO SCALE Provide Inspection Ports SLAB EL. 5.50 See note 10 F.G. El, 8.75 F.G. El. 7.7 Approved Filter See Note 6 (typ.) Soil for Strip Out Required 6.55 & Filling Shall Meet EL. 6.95 EL. 6.75 310 CMR 15.255 (3) H-20 i EL. 6. 0 EL. 5.75 EL. 3.25 1500 Gallon D-Box EL. 6.38 i Installer To E Septic Tank 1000 Gallon EL 5.95 Remove Unsuitable i Confirm Prior H-20 Required EL. 2.75 H-20 I - p- To Soils E Pump Chamber Splash Plate �------'----- ---------------- EL. 5.20 To Any Work Waterproofed/Sealed Waterproofed/Sealed & Flow w/ Two (2) Coats w/ Two (2) Coats Equilizers of Approved Sealant T of Approved Sealant As Required EL. -2.25 Ln To Be Installed On a e ornpac e ase Bedding,"T„s Inspection Port, High Groundwater as P�aTitle 5 EL. 0.72 NAV9 Per Test Monitoring Well 265'+/- To Nantucket Sound - DE VEL OPED PROFILE OF S Y.S., TEM Is E�` y NOT TO SCALE TITLE: PREPARED BY. PREPARED FOR: NOTES: Site Plan Proposed Improvements Engineering & At U111vall comulting, Inc. Christopher P. Kaneb 324 Sea Vle w A venue (508)428-3344•P.O. Box 659.711 Main Street, Osterville, MA 02655 Barnstable rosterville> Mass. seci@sullivanengin.com.www.suilivanongin.com Draft: CTR/ASL Field: WHK/CTR/JOD DATE December l7, 2020 1 a=20 SCALE: , , Review: CTR Comp./Review: CTR/JOD Project: Kon eb Project#.• 4000016 THE COMMONWEALTH OF MASSACHUSETTS ' BOAR® OF HEALTH TOWN OF BARNSTABLE ' Appliratiun for Disposal. Works Tonstrurtiun rumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: yv �abc.'GG tSf D/./li Location-Address a or Lot Np 44.1 Oct %///��/ ............................................................ --------- ..................... $e ....---.......... Ow r / A ress Installer Address Type of Building `ti Size Lot............................Sq. feet U Dwelling—No. of Bedrooms___.....__.:3-----------_---•-..___-___Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria Q, Other fixtures -------------------------------- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity Zd..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........................ a .•••------•••--•-•-••••••-•-----•-•--••------------••••---•-•----------------•--•--•----•------•-............................................................ O Description of Soil....................lf!t-. x --------------------------------------------------------------------------------------- V ----------------- --------------------------- ----- ----------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------•--------------------------------------------------....---...---- V Nature of Repairs or Alterations—Answer when applicable.... lZt.Atz ......T ................ ------------------------------------------------------------------------------•--------......................-•----------------.......------------------------......................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compl' ha been issued by the board of health. Signed--------- . .. �-5—7—�C7 .-----..... ---------------------------------- Date Application Approved B ....--...�6"'� �� Date Application Disapproved for the following reasons: ..---- .............. ----------------------------------------------------------............................ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- .................................... Dare Permit No. --------��-----------�-------------------------------- Issued ...../.lf...-------r --?.--C ----------- Date Z r'AI\Ik'!E3 IS F::'LJEI STOROGEE: RECORDS HEL-P -)4 FOR PARCEL NBR. 0( MAIN ACTION C Act ic)n 1-arif< Nbr, -1-ag N b r- I t,:..x.1. 1.e d Loc a t i on 257 C)101 so B Test Rem T e i: t A b a..n d c)n e d- 1::%`F.--wiciv(-:Pd Var-ianc-e FU e I R*: a s.;o n Car)ac i t y (."'c:)ris-;tr- Statu---:, L.eal-::--De t Ca t.h-D e t D F-I 1.c a 0 0 SS 1\1 N Addi t iona I fic.-Aa i I s ,SHORE.-LINE" COMM FIRE Action Tz-ank Nbr- T a g 1\1 L)t- I n�:-,t a 1 1.e d L.o c a t i c)n No t i f i c:a t i or) Oat.e T e s t Rem Test ----Abz.Ar-#cJoned---- Removed Var-iance F u e I Reason Capacity Constr- St.EAtLAS 1..-ea6.-.-Elet Cath-Det (2idditicinal Det.a.j. ).s Cancel. END OF DA*I-(-i • 1\1 I--X T IS C R E I:-:'N I-IMEIIJU AC I .I 0 1\1 FARCE.-I.- NBIR TANP". NBR it ---------- �:i rim,p,ssion will automatically appear on copies beneath. � PAPER REQUIRED: Just type (or write)on original. „(u rp� NO CARBON I Fold at(>)to fit 771 DU-O-VUE® Envelope PRODUCT 10G2�Inc.,Groton,Mass.01171.To Order PHONE TOLL FREE 1-800425-6180 CARL F. RIEDELL & SON, INC. ✓ 778 Main Street OSTERVILLE, MA 02655 LETTER (508) 428-6365 gate , Z" .. c.� } Subjec.t o�I l �j L Ta. t K 12 .Mov�L r ........................... ..... oe .. . .............. . ........ . . .. . ......... ......... . moo _ . ...... . .. SIGNED ❑ Please reply No reply necessary PRODUCT 18E2 Inc.,Groton,Mass.01/71.To Order PHONE TOLL FREE 1-800.225-M r SIiOItI•'.LIIM"TANK SMVICC, INC. Irnvironmental Contractor' 87 Pond Street Osterville, Massachusetts 02655 (508) 428-5529 or 428-03.3.4 Fax(508) 428-0180 Storage Tank Removal Receipt Date: Z1- SO, a -- TYPE: Oil Gas Other Owner: M(Z. G e M c L Address �a 9 S eA Osi�.ile , ( Ass. o�6sS Tank Size:— g000 Gr)'k10V Date Removed: ` -11c- 91 kck-5I FDID a: O-kcl 10 STS Tank a Dig Sure // �(�7 i J `� 6 L( STS Project a Tank Transported To: Shoreline Tank Service, Inc. 381 Old Falmouth Road, Unit 6 Marstons Mills, Ma. 02648 Inspector: G r A6��o x Commcnts: