Loading...
HomeMy WebLinkAbout0347 SEA VIEW AVENUE - Health 347 (Main) Sea View Avenue OsterviII6 P k 12134 i 0 J �kctuwcJ CFu� THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I M A�C(, I DATA i v TOWN OF BARNSTABLE MA��t I:OC:f ON t Se4V►LW AVe- SEWAGE # `"ILL;°GE 0STe/vII� ASSESSOR'S MAP & LOT/3-5'- 0a3 INSTALLER'S NAME&PHONE NO. aT- /o-X SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) /"0 641 NO. OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachi g facility) Feet Furnished by Si1S Y1 T For t� CAC L3 l3 Port 7 I&6 CI - - • C7 a, 13� ao I3 O 3 a� 13 6 306 TOWN OF BARNSTABLE Guf,ST' ,o,c ION SEWAGE # `49L.LAGE �S �f V 1 ASSESSOR'S MAP & LOT�38' Oa3 INSTALLER'S NAME&PHONE NO. L a' SEPTIC TANK CAPACITY I f/Uf3 UW LEACHING FACILITY: (type) PST (size) / NO. OF BEDROOMS BUILDER OR OWNER �2& a6e AU PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leach;ng facility- Feet Furnished by F0ecj f 30 a/S 3a, 38 3 TO _ OF B STABLE LOCATION ;e Q- SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER re-,Ck lk. � PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leac 'ng acili Feet Furnished by (/tl n���� 3'4 `j 347 Sea View Ave Page 1 of 1 Miorandi, Donna From: John Odea [John@sullivanengin.com] Sent: Monday, April 11, 2011 12:43 PM To: Miorandi, Donna Cc: 'Matthew Falconeiri' Subject: RE: 347 Sea View Ave Donna, As a follow up to our discussion today, and a previous discussion in January, we have been reviewing the information available on the existing septic systems, the existing dwellings, and the proposed modifications to the dwellings. Although the design number of bedrooms and the actual number of bedrooms for the main house has been listed as 3—the two existing 1,000 gallon leach pits have capacity for at least 6 bedrooms. Although the design number of bedrooms and the actual number of bedrooms for the guesthouse has,, been listed as 1 —the existing 1.,000 gallon leach pit has capacity for at least bedrooms. M Since the systems have passed inspection,and since the work proposed is not intended to exceed the,. capacity of the existing systems we believe the Title'-5 requirements.have been met. John O'Dea, PE Sullivan Engineering, Inc: (If you have a chance—please confirm that this meets your needs, so I can save the contractor'a trip tomorrow if there is an issue) From: Miorandi, Donna [mailto:Donna.Miorandi@town.barnstable.ma.us] Sent: Monday, April 11, 2011 10:26 AM - To: john@sullivanengin.com Subject: 347 Sea View Ave m; Hi John, Had a builder in here this morning for building permits on this property. The septic for the main house only shows that it is good for 3 bedrooms. We need one that states it is good for 4 (four) bedrooms and the guest house states that it is only good for one bedroom and it should`be good'enough.for three (3). The builder will get me floor plans for the guest house. The main house would be an increase in flow from a 3 to a 4 bedroom; Call ore-mail me back on this. <' Feel bad builder had to go back off Cape today and then'perhapscome back again tomorrow. ' Donna Miorandi 4/11/2011 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 347 Seaview Ave- Main House Property Address Travis Rhodes & Rachel Creutz Owner Owner's Name information is required for every Osterville MA 02655 . 1/25/11 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. Important:When filling out forms /A.Gener-al_..I.nformation f L on the computer' use only t�e-fab 1. Inspector: key to Eve your curs? not Darren Michaelis use he return Name of Inspector ke . ti Foresight Engineering Inc. ,ay Company Name 88 West Grove Street Suite#2 Company Address + Middleboro MA 02346 City/Town State Zip Code 508-245-2148 S13595 Telephone Number License Number 1 B.-Certification I certify that I have-personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ' ❑ Needs Further Evaluation by the Local Approving Authority 2/1/11 Inspector's Signatur Date The erny inspector shall submit aL of this inspection report to the Approving Authority(Board o ealth or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving.authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. v .I t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Dispos System•Page 1 of 17 Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 347 Seaview Ave-Main House Property Address Travis Rhodes & Rachel Creutz Owner Owner's Name information is required for every Osterville MA 02655 1/25/11 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: All components were located and inspected. I would recommend that the downspouts from the carport be redirected away from the septic tank cover as water was weeping in around the cast iron cover. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below):. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 347 Seaview Ave-Main House Property Address Travis Rhodes & Rachel Creutz Owner Owner's Name information is required for every Osterville MA 02655 1/25/11 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): I ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑' ND (Explain below): ❑ obstruction is removed ❑ 'Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 347 Seaview Ave- Main House Property Address Travis Rhodes& Rachel Creutz Owner Owner's Name information is required for every Osterville MA 02655 1/25/11 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and,the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable.to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool , ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 347 Seaview Ave- Main House Property Address Travis Rhodes & Rachel Creutz - Owner Owner's Name information is required for every Osterville MA 02655 1/25/11 page. Citylrown - State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a.DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. . ❑ ® The system fails. l have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection III Area-IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments G M , 347 Seaview Ave-Main House Property Address Travis Rhodes & Rachel Creutz Owner Owner's Name information is required for every Osterville MA 02655 1/25/11 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? El Was the facility owner(and occupants if different from owner) provided with --� ® information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example,a plan at the Board of Health. ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CUR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 347 Seaview Ave- Main House Property Address Travis Rhodes & Rachel Creutz Owner Owner's Name information is required for every Osterville MA 02655 1/25/11 page. Citylrown State Zip Code Date of Inspection D. System Information l Description: Single Family Dwelling Number of current residents: 0 Does residence have`a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection.required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d NA 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Summer HomeDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 347 Seaview Ave-Main House Property Address Travis Rhodes& Rachel Creutz Owner Owner's Name information is required for every Osterville MA 02655 1/25/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: None Available- Pumped in 2006 as part of inspection Was system pumped as part of the inspection? ❑ Yes ® 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval ❑ Other(describe): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 t Commonwealth of Massachusetts Title 5 Official .Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 347 Seaview Ave-Main House Property Address Travis Rhodes& Rachel Creutz Owner Owner's Name information is required for every Osterville MA 02655 1/25/11 page. CityTrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Unknown Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.5feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): no evidence of leakage, proper venting provided Septic Tank(locate on site plan): Depth below grade: 2 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 gallons Sludge depth: 1/2" t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 347 Seaview Ave-Main House Property Address Travis Rhodes & Rachel Creutz Owner Owner's Name information is Osterville MA 02655 1/25/11 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information.(cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 1/2 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Field 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.): Cast Iron cover at grade in stone driveway, Concrete baffles in place and functioning properly, no evidence of leakage or backup, normal liquid levels witnessed. Grease Trap(locate on site plan): 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 t5ins•09108 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 347 Seaview Ave- Main House Property Address Travis Rhodes & Rachel Creutz Owner Owner's Name information is required for every Osterville MA 02655 .1/25/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan)` Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow. gallons per day Alarm present: ❑ Yes ❑ No Alarm level.' Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments aM 347 Seaview Ave-Main House Property Address Travis Rhodes & Rachel Creutz Owner Owner's Name information is required for every Osterville MA 02655 1/25/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (coat.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No Dbox 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.):, Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 347 Seaview Ave- Main House Property Address Travis Rhodes & Rachel Creutz Owner Owner's Name information is required for every Osterville MA 02655 1/25/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: (2)6'x6' ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): both pits meet all passing criteria, Pit#1 has 4'of liquid depth with proper volume available, Pit#2 has no water and shows no evidence of inflow, the system is set up as a progressive failure with minor backup in the septic tank, Pit#2 will see inflow and Pit#1 will be in failure. I recommend that both pit covers be brought to grade for routine maintenance. Pits are the type of system that can last for lower than expected if maintained with annual or biannual pumping. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 347 Seaview Ave- Main House Property Address Travis Rhodes& Rachel Creutz Owner Owner's Name information is required for every Osterville MA 02655 V25/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of Vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w„ 347 Seaview Ave- Main House Property Address Travis Rhodes & Rachel Creutz Owner Owner's Name information is Osterville MA . 02655 1/25/14 required for every page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.Check.one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 347 Seaview Ave-Main House Property Address Travis Rhodes & Rachel Creutz Owner Owner's Name information is required for every Osterville MA 02655 1/25/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 11 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: 9/12/03 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 _ A percolation test was performed on 9/12/03 with groundwater determined to be 11' below grade. The bottom of both leach pits are 10' below grade with no evidence of groundwater inflow. The system is not within the water table and meets all minimum separtion requirements. Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 347 Seaview Ave- Main House Property Address Travis Rhodes & Rachel Creutz Owner Owner's Name information is required for every Osterville MA 02655 1/25/11 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 r d ✓I�1 A��t TOWN OF BARNSTABLE LOCATION SLY'7 Se4v/cw Rue- I .SEWAGE # � VII.L�`.GE 0 57 t w,I L� ASSESSOR'S MAP& LOT/3 8'— 0.)3 INSTALLER'S NAME&PHONE NO. L 07"— /a SEPTIC TANK CAPACITY. I S-tJ(5 LEACHING FACILITY: (type) [�" rr k(o� P �S /!/U� 3 (size)— GA1 N0.OF BEDROOMS nn BUILDER OR OWNER� � rJ�Pu4U�� PERMITDATE: 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) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaclug facility) Furnished by Feet Fa�� Fr�nZ' i I i CAS p PtrtT' p- - - • 13� ot13� ao 3 O 3 ao 13 c 6 6 3 y /� 30 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: 347 Sea View Avenue(Main House) Osterville, MA 02655 Owner's Name: Bob Breault 2��� I Owner's Address: �7 Date of Inspection: September 29, 2006 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT e I certify that I have personally inspected the sewage disposal system at this address and that the armation-r6portqe below is true,accurate and complete as of the time of the inspection. The inspection was perfotd based LE_my rpf training and experience in the proper function and maintenance of on site sewage disposal systec s I am a DEP f approved system inspector pursuant to Section 15.340 of Title 5 310 CMR 15.000 . The s 'in; PP Y. P P ( ) ✓ Passes _ Conditionally Passes cn Needs F her Evaluation by the Local Approving Au ority Fails Inspector's Signature: Date: October 2, 2006 The system inspector shall subm' a copy of this insp ction 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 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 347 Sea View Avenue(Main) Osterville, MA Owner: Bob Breault Date of Inspection: September 29, 2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced. obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART A CERTIFICATION (continued) Property Address: 347 Sea View Avenue(Main) Osterville. MA Owner: Bob Breault Date of Inspection: September 29, 2006 C. Further Evaluation is Required by the Board of Health: Conditions exist which require.,further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety:or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of atmnonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 - OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 347 Sea View Avenue(Main) Osterville, MA Owner: Bob Breault Date of Inspection: September 29, 2006 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or'ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ _ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply,or tributary to a surface Water supply. ✓ Any portion of a cesspool or privy is within a Zone 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 determined that one or more of the above failure criteria exist as_ described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what.will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 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 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 " OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 347 Sea View Avenue(Main) Osterville, MA Owner: Bob Breault Date of Inspection: September 29, 2006 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ _ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs.of break out? ✓ _ Were all system components,excluding the SAS, located on site? ✓ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes No ✓ Existing information. For'example,a plan at the Board of Health.. ✓ _ Detennined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 11 V , OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 347 Sea View Avenue(Main) Osterville, MA Owner: Bob Breault Date of Inspection: September 29, 2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: I Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Qpdf Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) . Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped in 2005 for maintenance-per owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Innovative/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: Date of installation unknown 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: 347 Sea View Avenue(Main) Osterville, MA Owner,: Bob Breault Date of Inspection: September 29, 2006 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 20" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate:of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500 a� l_ Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations;inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.). Tees were present. The liquid level was even with the outlet invert There did not appear to be any signs of leakage A steel outlet cover was to grade. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 347 Sea View Avenue(Main) Osterville. MA Owner: Bob Breault Date of Inspection: September 29, 2006 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working,order(yes or no): Date of last pumping: Comments(condition of alarm.and float switches,etc.): DISTRIBUTION BOX: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments (note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box, etc.): PUMP CHAMBER: None (locate on site plan) . Pumps in working order(yes or no): Alanns in working order(yes or no) Cormnents(note condition of pump chamber, condition of pumps and appurtenances,etc.): 8 f Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART SYSTEM INFORMATION(continued) Property Address: 347 Sea View Avenue(Main) Osterville, MA Owner: Bob Breault Date of Inspection: September 29, 2006 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 2-6'x 6'(1000 zaL) leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology Cominents (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): One pit 03)had S'ofliauid on the bottom. The bottom to Prade was 10' The cover was 8"below Qr ade The other leach pit 04)was div. The bottom to Prade was 10' The cover was 8"'below-grade There did not appear to be any signs offailure 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: Cormnents(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 347 Sea View Avenue(Main) Osterville, MA Owner: Bob Breault Date of Inspection: September 29, 2006 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. Frpnr O CAS p B po,r OP a. l3 a o A a p q 3 ao � 36 a y 3 y l6 b 30' a- r 1`0 Page 11 of I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 347 Sea View Avenue(Main) Osterville, MA Owner: Bob Breault Date of Inspection: September 29, 2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water I feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: ✓ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: , Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: A_Perc test was done on September 12, 2003, and water was located at 1 P below Qrade. 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 andlor any components of the septic system which have not been located and inspected. 11 f COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION VED U 2 Z003 TO eARN,STABLE .N DIEPT. TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP Property Address: 347 Seaview Avenue-Main House Osterville, AM 02655 PARCEL, Owner's Name: Bob Breault LOT Owner's Address: Date of Inspection: October 15, 2003 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5.(310 CMR 15.000). The system: ✓ Passes Conditionally Passes NeeM Further Evaluation by the Local Approving Authority Fail Inspector's Signature: Date: November 4, 2003 The system inspector shall subm�acopyof this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this,inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/1k000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:t 347 Seaview Avenue Osterville, AM Owner: Bob Breault Date of Inspection: October 15, 2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: 4 ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 3.10 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. t Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair, as approved.by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by;the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking.and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced' obstruction is removed distribution box is Leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 347 Seaview Avenue . Osterville, AM Owner: Bob Breault Date of Inspection: October 15, 2003 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 C.MR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health.(and Public Water Supplier,if any)determines that the system is functioning in a'manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 347 Seaview Avenue Osterville, MA Owner: Bob Breault Date of Inspection: October 15, 2003 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No _ ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow _ ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS, cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone I of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either`Yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D.above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST - Property Address: 347 Seaview Avenue Osterville, AM Owner: Bob Breault Date of Inspection: October 15, 2003 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant, of Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? ✓ Were all system"components, excluding the SAS, located on site? ✓ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions, depth of liquid,depth of sludge and depth,of scum ? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 r Page 6 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C - SYSTEM INFORMATION Property Address: 347 Seaview Avenue Osterville, MA' Owner: Bob Breault Date of Inspection: October 15, 2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 1 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system (yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied 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: Unavailable Was system pumped as part of the inspection (yes or no): If yes,volume pumped: Qallons--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: Unknown Were sewage odors detected when arriving at the site(yes or no): No 6. f Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 347 Seaview Avenue Osterville, MA Owner: Bob Breault Date of Inspection: October 15, 2003 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting, evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 20" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 6" Distance from top of scum to top of outlet tee or battle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage The tank was under a driveway. An extra cement pad was poured over the tank(per owner). The tank was checked and is approximately 6"+ thick to make it H-20. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of.leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 347 Seaview Avenue Osterville, AM Owner: Bob Breault Date of Inspection: October 15, 2003 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete metal fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in workingorder(yes or no): Date of last pumping: . Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box, etc.): PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 r Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 347 Seaview Avenue Osterville, AM Owner: Bob Breault Date of Inspection: October 15, 2003 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 2-6'x 6'(1000 gal.) leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number, dimensions: overflow cesspool, number: Innovative/alternative system_ 'Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): One pit(#I)had Y ofwater on the bottom. There did not appear to be any signs of failure. The bottom to grade was 10'. The cover was 20"below grade. The other leach pit(#2)was dry. There did not appear to be any signs of failure. The bottom to grade was 10. The cover was 32"below grade. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 347 Seaview Avenue Osterville, MA Owner: Bob Breault Date of Inspection: October 15, 2003 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties tout least,two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Frpe�' 0 CAS Q Q P°'r 0 - - � - 13 al3 ao � a O 3 ao ls6 a 3 /6� 306 y y 10 Page 11 of 1 1 - OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION (continued) Property Address: 347 SeaviewAvenue-Main House Osterville, MA Owner: Bob Breault Date of Inspection: October 15, 2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 11 feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked, date of design plan reviewed: ✓ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain:- Checked with local excavators, installers-.(attach documentation) , Accessed USGS database-explain: You must describe how you established the high ground water elevation: A perc test was done on September 12, 2003, and water was found at I1'below Qrade. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 A/ "' 1. 0 r TOWN OF BARNSTABLE 1 t)6 NN�.' Ve -(AG Ap O J UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS / ASSESSORS MAP N0. PARCEL N0. MA kckvl�s.,4 ADDRESS: -:?>141 evo VILLAGE' tNi '�� 1\eL n[s NAME' �nn .O(t�{I S CONTACT PERSON PHONE NUMBER 1-lo�c- ?�3 ysq l�tcarj ' LOCATION OF TANKS; CAPACITY: -TYPE- OF- FUEL- AGE: TYPE: LEAK OR CHEMICALS DETECTION - Y 1 a DATE OF PURCHASE OF EACH: 1. M 171 2. 3. 4. 5. DATE OF FIRE DEPARTMENT PERMIT: WO ReGorc(, - yor e TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS PLEASE PROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD. �. TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS f/ NAME ADDRESS �x / 4-Lc' VILLAGE LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: OR CHEMICAL ( E tZ As P N A<7 2,oacs 044S. 0 Z 1pucc o«0 7\3 R-t yE(Av" N - E , u 2N&2 G rcnr L o dc HeJS� (Give same information for any additional tanks on reverse side of card) DATE OF PURCHASE OF EACH: 1. 2. 3. 4. DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS ..�.. Ed a of Pavement t ASSESSORS RFF.: - MaP 138 Parcel 23 ... OVERLAYDISTRICT- f AP Aquifer P ,; - Protection ate District � -• "���' 9 N79 59 4. 2.00'j CB/dh 67.57 Fnd FLOOD ZONE.- Zone B, AE(el.12) & V17(e1.16) Community Panel No. : 7- #250001 0016 , — -— ._._.- _ _. �� _ Jul D y 2, 1992 3?Jdd3 — — — — i $ i And Via LOMAR r Case No. 96-01--009P -ti Dated May 1, - 1996 8_ r � I ZONE. - �� 1 _ r - 124:7• RF-1 Area (min.). 43,560 SF 87,120 SF (RPOD) ' --s_ Fronta a (min) 0' Im N width 2 LOCATION MAP: -_____ / PROP �a Frain) 125 v Scale: " _ 2 ' - _ _ os 1� vi -Setbdcks: 1 000 i r , ADD�nON / t+ Fron t 30' r I Side 15' 'r 14 Rear 15' , DIRECTIONS. ........................ � '��� ,�� 1 - From Hyannis take Route 28 towards Ostervi!le- �' 1 Take a left onto Osterville West Barnstable Road and follow to the end• Take a Jeff onto Main Street, and at the fork in the road in the Villa e I r el 1 o stay straight on Wianno Avenue and follow to the end / .- c v 3 z ^� Take a rightnto Sea Yew Avenue, and house is i-- — — -� Extst�g rn►°`� �� N w on the left, 34Z �0 j° pp o•1ti t�0o < I•``- '; � �,.-- r,\ opo ORGN p,0 C> . 0s) -� - 6� Lawn %20ne - J 1 GPgvo Pp,NG , Lawn CB o pp�oA�psE I /1/ °0 1 I ` Fnd Floor 9St Floor.Deck /o 150'Buffer t .�- \•' lCtf� . � �- I o I `'�� l� oket OARAOE PLAN5- / ELEVATIONS w II o J W REMOVE CLOSET a MAkE NEW DOOR Z OPENING O N I ®NRJ x 1 r�. mo•nowR y -wawa 9 >q CUPOLA DETAIL u 19 1/2"_,_Ox C) " l o - W wl w w - MODE EXIST.WINDOW REMOVE EXIST. NDO Pa ' r-TTll Fa �W ~ ❑- ❑ ❑ x < n•-a ^ Uuj , Q G a 5EGOND FLOOR PLAN F I R 5 T F L O O R P L A N 5CALE 1/ex_,,_ox 56ALE 1/4"=V-0 . . I I W In LU 1 1 I. 1 1xDCE0AR LAP 1xB CEDAR LAP 1 1 IxO CEDAR LAP W Q - RED CEDAR 5HIN6LE5 ON CEDAR BREATHERS ut O ICI RED CEDAR SHINGLES ON CEDAR BREATHERS ffiLU 1-W ® ® ® n ® ® ® ® Q O { n O d �J w I RED CEDAR SHINGLES ON CEDAR BREATHER5 RED CEOAR SHINGLES ON CEDAR BREATHERS - Q N I [UK BIN Iml [Ulu r zm 0 ® o e - g 4 N O NNS7ABLE 12 All `. : ! I, 17N AIT .. L. ON ON LINE OF OVERMANG_A SOYE _ _ _ ... . �. _ - _ — _ — . t - n. ON M _ _ pry _/•- .y+w �.r�•+ �r..��y,�.r y yy�yw+y �y_ _ _ �_ •• ..�y ,, . y�,_ T� � i7 "� 1 T,l 'I -I� i! • i�`� .". wwr r„Ste, BEAM ABOVE BEAM AI?!' O'VE BEAM ABOVE T f t I i -,1-Ilk �� I ti DECK DE,CK _ — - -- --- - - r :fir I . r}yv ; t e W.01 �- X 41 STL. 1 d 4* X 4• STL. I .. ... _ .. _ �. ' "_" ..-_-- L I f f f'4 t- -_ - - - TEE- d:OL. 1 u i TUBE COL. AElOVIa I 1 0 � O O STL !TEAM ABOVE �� 11 I ► 1 1 1 `y Vi 1 z - ` .4, i I 3 - 2 X 4 T-U P i ►� b f1 f II 1 qp�1 . qr 5_ s �C. C E I C:D�.. . I f 3/1' X 1/8' LYL P0 �' - ,�, I O R - - ---- ----ram - D( ING ROOMOH E I I l o -----j FAMILY ROOT i _ _ f dh I I T �r -- - - -_ -_1 IV L _ - - - - - xi i j r I SHE VES SHE VES t I ON _ F 7TV UP - L.- s-.�• -m-. -,ram• I I 7' _ - - - - - - - - - - -I-- - \, ! 1 ARCHITECTURAL DESIGN + • - -� i ►,1 1= - _ _ - ; f I TOP OF SLAB I �' t BULKHEAD INCORPORATED BELOW B`�TFf'" --- - �. L A U N Q R Y I 1 W j I I fit Route 9A EMO`� / RELOCATE 1- - - -- - - - , I ^ I r-2 l!102653 ; XIS_I'i G Bl1LKHt°AD - - - _ _ _I I 3 - -1 I _ ;PL/NN TE R 1 rip p i i <)rlersns MA 06W � 2 � 5 $ 5 W OD 11 7-1 V4' T-i0 3/1' _ — -- -_.. ice- .41 --- - - - I EQUAL w EQUAL X �'-tl9 v1• 7-1Q V1' TOP O {WALL z �1r - - _.a�—_._.._ t_ :,j X5 -5 I/1'R.D.;.XS'-5 Vti'R.0.3. xi'-S 1/�• . -----� _ _ _ __ , u , i0' I/�' +Z' " — _.EtJAI EQUAI — ' ' __-_ ._ TOP OF WALL ' t 3'-4' � G'-0' 1'-10 vY 1 10 I'>'► i y --- -- - -� _ '-- -r' TOP OF WALL \ +2.- .. t , IL TOP' Of WALL I I 4 4 _ , t • r i J ' ^t a RY Date Revisions Scale 1/4' •- 1'- 0" F 1 s ram- Date January 21. KUOU _ r y � 1 TOP OF WALL � Drawn RDE Job No 9911 _ • _ r-r FIRST FL00R I PLAN 02 '�• 5.6 0 ( I Registration •, i i Z I I � E I p._. �� PTIC 1 Lo I �- r QL " y A. 1 '{rr t •°Y r .:.+• ,?A "y,BYO <. .�. ti,h.. ' - { 'ccr—. _ ..:.�,..�.. Y' • M H 1 t' 6 fiM _. — —_ r r•1-. M`w.+Y1P — . .r.r...'j... _a••w—... — — — Its pitM. • . . 11riMK /'-10 vr t t r Al 1­ �..-- ---- --- 1 1 -. — —tr —_-- �) t 1 1 1' 11 II � + I II i I � a i 1 BATH 192 x , II II BEDROOM 92 — --- _-- � 1 11 t 1 —— — ' LOPE7 o -- - - -- - - -- -- _ I EXE?RC.'ISF — _J ,' \ ALIGN W/ TNIS 810E ` • UH ; 1. I 9 a , \ 1 t MASTER W 1 0 / \ - i i BEDROOM � _ \ \ -- ----- —'- Q� — CLOSET x 0 BELOW SgeLVES SHELVIkS I t 1 pill 111111111911111 IlIkk IL �Y BELO UP I t I ALIGN M/ THIB 810E ...., { ON x: I — I TEAM/SH RI i I) 1 If ~i1 r l I ! I a LINEN � NIT - T. I ,f I n !'QUILT—IN 2,10 yr 1 — ————-- I L "�i ARCHITECTURAL DESIGN { C 1 T INCORPORATED ZO 4 � _ J " 1 B CLOSET O S E T 82 Rt 6 Box 186 i SHELVES ——— Orleans, MA 02653 - _ - CRICK T i ELVBS AB- •� LINEN r' (508) 25b-0808 _. WIN V t 7 00 R OF BEL W I ROOF ELO f —__ _—_ t- v�• 1-3 yr 41- yr - ___ R.O. X 4'-1 ' R.O. X !'-{ 1' R.O. X !'-I 1' R.O. I 9'-1 3/1• r-10 3/4' 1'-31/r •_ Z 4 1 A. l r-o• r-o• Date Rovisiom j Scale 1/4' 1'-0' Date January 21, 2000 ODrawn RDE Job No 9911 �„J Q ' N SECOND FLOOR PLIrA1�T L.Z 0 Registration CL r� II1M �' iJG s. _s 1,