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0377 SEA VIEW AVENUE - Health
377 SEA VIEW AVENUE, OSTERVILLE A= 138 032 a /3g -o3oz Commonwealth of Massachusetts ' �s ,p Title 5 Official Inspection Form + I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 377 Sea View Ave Property Address Y P_a George Thibeault ;1a Owner Owner's Name f information is Osterville Ma 02655 11-28-18 ' ; required for every page. City/Town State Zip Code Date of Inspection ,.1 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. Inspector Information s/# f SI(p on the computer, Brett Hickey use only the tab key to move your Name of Inspector cursor-do not B&B Excavation ' use the return Company Name key. , 374 Route 130 us Company Address Sandwich Ma 02563 City/Town State Zip Code rxu (508)477-0653 ' S113747: Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property 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 . oNnmN a9roa W0ren NIGq Brett Hickey �^� ���a �� �NS 11-28-18 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 18 r } 1. "% c Commonwealth of Massachusetts ' �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 377 Sea View Ave u Property Address George Thibeault Owner Owners Name information is Osterville Ma 02655 11-28-18 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: .{ ` ❑■ 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: The system was in working order at the time of inspection. 2) System Conditionally Passes: t ❑ 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts �M Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 377 Sea View Ave L Property Address George Thibeault Owner Owner's Name information is Osterville Ma 02655 11-28-18 required for every page. City/Town 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 ❑ YT ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled'or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 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: l5insp.doc•rev.MUM 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 c Commonwealth of Massachusetts I , Title 5 Official Inspection Form f� 11 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 377 Sea View Ave �t fi Property Address George Thibeault Owner Owner's Name information is Osterville Ma 02655 11-28-18 required for every 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 El El clogged of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ El 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 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 377 Sea View Ave Property Address George Thibeault Owner Owner's Name information is required for every Osterville Ma 02655 11-28-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ o Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ a Liquid depth in cesspool is less than 6"below invert or available volume is less than '/day flow ❑ a Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Q' Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Q 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. ❑ Q Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ El 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.] ❑ El The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. - El 0 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 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 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 ' a t5insp.doc"rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System"Page 5 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 377 Sea View Ave Property Address George Thibeault Owner Owner's Name information is Osterville Ma 02655 11-28-18 required for every 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 0 ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ E Were any of the system components pumped out in the previous two weeks? ❑ El Has the system received normal flows in the previous two week period? ❑ 0 Have large volumes of water been introduced to the system recently or as part of this inspection? El ❑' Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ 0 Was the facility or dwelling inspected for signs of sewage back up? Q ❑ Was the site inspected for signs of break out? El ❑ Were all system components, excluding the SAS, located on site? 0 ❑ 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 w disposal s information on the proper maintenance of subsurface sewage d spo systems? f h it Absorption System SAS on the site has The size and location o the So p y (SAS) been determined based on: Q ❑ Existing information. For example, a plan at the Board of Health. ❑ El 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)] l5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments g � 377 Sea View Ave Property Address George Thibeault Owner Owner's Name information is Osterville Ma 02655 11-28-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 6 5 Number of bedrooms(design): Number of bedrooms(actual): • DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of be 660/gpd Description: { Number of current residents: Does residence have a garbage grinder? ❑ Yes [j],, No Does residence have a water treatment unit? ❑ Yes No a 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 F!] No Seasonal use? ❑ Yes [E No • Water meter readings, if available (last 2 years usage (gpd)): See below Detail: ` ***2016-10,000gallons 2017-15,000gallons*'* ` t • Sump pump? ❑ Yes 0 No 11-4-18 Last date of occupancy: ` Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 1 Commonwealth of Massachusetts Title 5 Official Inspection Form IQ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 377 Sea View Ave Property Address George Thibeault Owner Owner's Name information is Osterville Ma 02655 11-28-18 required for every page: City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA 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? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available:, Last date f occupancy/use:as a oDate Other(describe below): 3. Pumping Records: Source of information: Owner- last pumped 10 years ago Was system pumped as part of the inspection? ❑ Yes M No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts �9 p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 377 Sea View Ave u Property Address George Thibeault Owner Owner's Name information is Osterville Ma 02655 11-28-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: El 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): Approximate age of all components, date installed (if known)and source of information: 1996 per COC Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No 5. Building Sewer(locate on site plan): 31 Depth below grade: feet Material of construction: ' ❑ cast iron ❑■ 40 PVC ❑ other(explain): 'Town water Distance from private water supply well or suction line: feet Comments(on condition of joints, venting evidence of leakage, etc.): t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 377 Sea View Ave u— Property Address George Thibeault Owner Owner's Name information is Osterville Ma 02655 11-28-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 2' . Depth below grade: 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: 2000 gallons 511 Sludge depth: 35" Distance from top of sludge to bottom of outlet tee or baffle On Scum thickness NS Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle NS measured How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is not in need of pumping at this time but should be pumped every two years for maintenance. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ` 377 Sea View Ave Property Address George Thibeault Owner Owner's Name information is Osterville Ma 02655 11-28-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on�site plan): NA 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): NA Depth below grade: - Material of construction: " ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Of dal Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18' t c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 377 Sea View Ave Property Address George Thibeault Owner Owner's Name information is Osterville Ma 02655 11-28-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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): o„ 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.): The d-box was in working order at the time of inspection. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 c Commonwealth of Massachusetts i ,p Title 5 Official Inspection Form f ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 377 Sea View Ave v Property Address George Thibeault Owner Owner's Name information is required for every Osterville Ma 02655 11-28-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): r' Pumps in working order: ❑ Yes ❑• No' Alarms in working order: ❑ Yes No` Comments(note condition of pump chamber, condition of pumps and appurtenances„etc.): NA 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: ❑ leaching pits number: '0 leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: (2)fields 24 infiltrators 12k40'1' Q leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 <e',N Commonwealth of Massachusetts , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 377 Sea View Ave u Property Address George Thibeault Owner Owner's Name information is Osterville Ma 02655 11-28-18 required for every 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.): The leaching was in working order and was dry with no high staining at time of inspection. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): NA 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 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 377 Sea View Ave Property Address George Thibeault ` Owner Owner's Name information is Osterville Ma 02655 11-28-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): NA Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5insp.doc-rev.7/26/Ml8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 377 Sea View Ave Property Address George Thibeault Owner Owner's Name information is Osterville Ma 02655 11-28-18 required for every 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: W hand-sketch in the area below ❑ drawing attached separately Front of dwelling Garage A 3 2 1 Al-53'8" 131.38' A2-45' B2.46'6" A3.37'6" B3.53'4" t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts �d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 377 Sea View Ave ' V V Property Address George Thibeault Owner Owner's Name information is Osterville Ma 02655 11-28-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ' ❑■ Check Slope ❑■ Surface water W Check cellar ❑■ Shallow wells Estimated depth to high ground water: No GW @ 5' below SASfeet Please indicate all methods used to determine the high ground water elevation: F Obtained from system design plans on record If checked, date of design plan reviewed:, 9-24-96Date ❑ 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 plan on file with the Board of Health was used. 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 +s Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments lF' 377 Sea View Ave V Property Address George Thibeault Owner Owner's Name information is Osterville Ma 02655 11-28-18 required for every 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 Q■ 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 COMMONWEALTH OF MASSACHUSETTS ID EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS r DEPARTMENT OF ENVIRONMENTAL PRO. ECEIVED AUG 0 3 2001 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION.FORM-NOT FOR VOLUNTARY ASSESSMENTS ' SUBSURFACE SEWAGE DISPOSAL SYSTEM.FORM PART A CERTIFICATION Property Address:. ^ 77 Owner's Name: _ Owner's Address: Date of Inspection: 7f d 4I ; Name of Inspec or: please tint) r°� �� p,4v/1 '� Company Name ZC Mailing Address: C? ���� Telephone Number: -9/ 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 ins,pection.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: `IP Passes 'Conditionally Passes Needs.F her Evaluation by the Local Approving Authority ails - Inspector's Signature: �'` Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is.a shared`system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall.submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments i . ... ..•' .:� + �+ +. ice. �., `, ****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 i Page 2 of 1] I OFFICIAL INSPECTION FORM.-NOT FOR VOLUNTARY ASSESSMENTS i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A �I CERTIFICATION(continued) Property Address: 7 Owner: Date of Inspection: inspection Summary: Check A,B,C,D or E/ALWA S complete all of Section D A. ystem Passes: I have not found any information which.indicates* hat any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria nx evaluated are indicated below:. Comments: B. System Conditionally Passes: One or more system components as described in tl e"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. II 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.H.ealth. *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 wilt pass inspection if(with . approval of Board of Health): broken pipe(s)are re laced obstruction is remov:d distribution box is leYeled or-replaced .. ND explain: The system.required pumping more than 4 times a year due to broken or obstnicted pipe(s).The system will pass inspection if(with approval of the.Board of Health):. broken pipe(s)are replaced obstruction is removed i ND explain: . Page 3 of 1'1 i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS '4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ` CERTIFICATION(continued). Property Address: �7`. Owner: ; Date of Inspection: 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 witli 310 CMR 15.303(1)(G.).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 u 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a.tnanner.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 aseptic tank and SAS and the SAS is'withiti a'Zone,I of a'public water supply. _ The system has aseptic 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,feetbut 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: 7 CC �` Owner: Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to'each`of the-following for'AlI inspections: Yes N 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 V Static liquid level in the distribution box above outlet invert due town 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 viater 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.] (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 Systems: To be considered a.large'system he system must serve a facility with a-design flow of 10,000 gpd to15,000 gPd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to largesystems in addition to the criteria above) yes no the system i.s.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 I I �. OFFICIAL INSPECTION FORM[-NO1 FOR VOLUNTARY ASSESSMENTS SUBSURFACE+' SEWAGE DISPOSAL SYSTEM INSPECTION`FORM 'PART B CHECKLIST Property Address: r a", Owner: �� v ^ Date of Inspection: Check if the following have been done. You must indicate"yes"or"no"as to each of the following; Yes No Pumping.information.wasprovided by the:owner,occupant,or.Board of health l.'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 t/Have large..volumes.of water been introduced to die 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 owger).pro.vided 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 V"')✓xisting.infornikion.For example,'a plan.at the Board of Health: V — 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 Page of 1 l OFFICIAL INSPECTION-FORM—NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE`DISPOSAL SYSTEM INSPECTION.FORM PART C SYSTIJM INFORMATION s Property Address: 77 j Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):. Number of bedrooms'(actual):, DESIGN flow based on`310.CMR 15.203 (for example: 11.0 gpd x #of bedrooms): Number of current residents: Does residence have.a garbage grinder(yes-or no':i- ". Is laundry on a separate sewage system'(yes or no ;(if yes separate inspection required] Laundry system inspected(yes Seasonal use: (yes or no): Water meter.readings, if available(last 2 years usage(gpd# Sump pump(yes or no)• & Last date of.occupancy:�� T� p� = Z (/(✓ /2�tQ°t � �JZ�'1� CQMMERCIAL/INDUSTRIAL._/y 6— 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: OT14ER(describe): GENERAL INFORMATION Pumping Records a Source of information:. Vzuza� QA-Z�� Was system.pumped as part of the inspection(yes orn :: If yes, volume pumped: gallons--How was quantity pumped determined? Reason for pumping; . TYPE OF SYSTEM �ptic 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 froth system owner) _Tight tank _Attach a copy'of the DEP.approval _Other'(describe): pproximate a e of allcomponents,, date installed (if known)and source of information. Were sewage odors-detected when arriving at the site(yes or 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: % �( Owner r Date of Inspection: -75// QI „ BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron .40 PVC _other(explain): 3 } Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: (locate on siteplan)' Depth below.grade:UWLA Material of construction:_ oncrete metal_fiberglass Polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(atiach a copy of certificate) y Dimensions: X c.P• k 1• .t Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: ` Scum thickness: ri ` . ` Distance from top of scum to top of outlet tee or baffle: Distance from bottom.of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments(on pumping recommends ions; inlet and outlet tee or baffle condition,structural integrity, liquid levels a related to outlet invert,evidence of leakage, GREASE TRAvA�ocate of site plan) Depth below grade: Material of construction: concrete_metal_fiberglass_polyethylene other (explain): r' 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,uilet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage;etc.): 7 7 -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: -7 �- �� ` &y A Owner:. t� Date of Inspection: TIGHT or HOLDING TANK: 4,& tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: cbncrcte metal fiberglass.__. polyetth,lene oth'er(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:—Z(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:&&Aot ; Comments(note if.box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leak ge into or out of box, etc. • _ J PUMP CHAMBER: (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.): j` 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY.. ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-FORM PART C SYSTEM INFORMATION(continued) Property Address: -77 Y . lkIA Owner Date of Inspection: O 1 SOIL ABSORPTION SYSTEM (SAS):.__L_,,(rocate on site plan,excavation not required) If SAS not located explain why: Type leaching.pits,number:_ leaching chambers,number: , :Zleaching galleries,number: VU leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool;number: innovative/alternative system Type/name of teclmology: Comments(note condition of soil, signs of hydraulic failure,level bf ponding, damp soil; condition of vegetation, - et ): o U" 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(ves or. no) Comments(note condition of soil,signs of hydraulic failure, level of pond ing,"condition of vegetation,etc.): PRIV,yyj(L—(locate on site plan) Materials of construction:. Dimensions: Depth of solids: Continents(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): z. • 9 Page 10 of I I OFFICIAL INSPECTIOEN.FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFAC SEWAGE DISP SAL.SYSTEM INSPECTION'FORM PART� C SYSTEM INFORMATION(continued) i Property Address 77 . d / Owner: Date of Inspection: _ j SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system includir g ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feel-.-Locate w ere public water supply enters the building. 49 1 EI 10 f Page I I of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 377 /fir <(:CA y� Owner:�� d Date of Inspection: SITE EXAM Slope Surface water Check.cellar. Shallow wells Estimated depth to ground water.)v 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: I1 . 7 S 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property 371 Sea View Ave, Ost.erville owner' s name Jacque Solver' UIECEIVE® Date of Inspection 4/26/95 PART A AY 3 1995 ^- CHECKLIST HEALTH DEFT. rt OF SApstir 37ABLE Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. X None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. na As built plans have been obtained and examined. Note if they are not ` available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. The site was inspected for signs of breakout. x All system components, excluding the SAS, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. x The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. X The facility .owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. r � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential s number of bedrooms . 2 _ number of current�'residents yPS garbage grinder, yes" or no yP_S laundry connected to system, yes or no seasonal use, yes or no If nonresidential, calculated flow: Water meter readings, if available: NA Sprinkler system used. Fall 94 Last date of occupancy GENERAL INFORMATION Pumping records and source -of information: NA no System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping: Type of system x 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) Other (explain) Approximate age of all components. Date installed, if known. Source of information: 20 years+ per caretaker no Sewage odors detected when arriving at the site, yes or no • 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: x (locate on site plan) depth below grade: 16" material of construction: x concrete metal FRP other(explain) dimensions: 1 , OOO gallon 8 ' 6"x4 ' 10" 41, sludge depth 31 "distance from top of sludge to bottom of outlet tee or baffle e scum thickness na distance from top of scum to top of outlet tee or baffle na distance from bottom of scum to bottom of outlet tee or, baffle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, recommendations for repairs, etc. ) level with outlet invert Tamag tntn of nutlet end Repairs and cemented, appears structuaIly sound. DISTRIBUTION BOX: _ (locate on site plan) none depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc. ) Level box No solid carryover No leakage Good D Box PUMP CHAMBER: none (locate on site plan) pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs,etc. ) II 1 G` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) :Yes (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type leaching pits and number leaching chambers and number leaching galleries and number leaching trenches, number, length 1_1 _10'; 6 ' , 4 ' with gtopa leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) Coarse sandy No hydraulic failur-0 CESSPOOLS (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 (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,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, recommendations for maintenance or repairs,etc. ) " 11 SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' back of garage back door A UB bulkhead ° 4ft--- ° A B 30ft 33' Inlet 34' Leach trench 34' Outlet 39' --6ft 35' D. Box 50' DEPTH TO GROUNDWATER 7 ' depth to groundwater method of determination or approximation: monitoring well on property f 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined" , explain why not) N Backup of sewage into facility? N Discharge or ponding of effluent to the surface of the ground or surface waters? N Static liquid level in the distribution box above outlet invert? Liquid depth in cesspool <6" below invert or . available volume< 1/2 day flow? N_ Required pumping 4 times or more in the last year? number of times pumped r I N Septic tank is 'metal? cracked? structurally unsound?: substantial infiltration? substantial exfiltration? ,tank. failure imminent? Is any portion of the SAS, cesspool or privy: N below the high groundwater elevation? N within 50 feet of a surface water? N within 100 feet ,of .a surface water supply or tributarysto a surface water supply? , - N within a Zone I of a public well? N within 50 feet ofoa bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? N within 50 feet of a private water supply well? N less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysi for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. 13 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector Bruce Macallister-Gordan Bumpas Company Name Shoreline Construction Company Address 87 Pond Street Osterville.,. MA 02655 Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and manitenance of on-site sewage disposal systems. Cr4eck one: X_ I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15. 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have, determined that the system fails to protect public health and the environment as defined in 310 CMR 15. 303 . The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector ' s Signature Date 4/23/95 Original to system owner Copies to: Buyer (if applicable) Approving authority TOWN OF BARNSTABLE `.00P.TION ,. .5elt L eW ,Ve SEWAGE # VII,LAGE ©Sf�Y y d fe ASSESSOR'S MAP &LOT / 3Y—3- INSTALLER'S NAME&PHONE NO._�J-a A n R,. L2 y� �— �/S-1.5 SEPTIC TANK CAPACITY a©O O!!� LEACHING FACILITY: (type) (size) a ' /a yo X / NO.OF BEDROOMS to / BUILDER OR OWNER �r -�� U PERMTTDATE: y� COMPLIANCE 'DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 3 77 Seu t/,cw ,q✓e Os a o00 5 N�� JT 13 a- iaXyo'x 31 y 31 s� TOWN OF BARNSTABLE LOCAnl ON V Sz ol*r w mt.# VILLAGE 7,P)Q 11/11 E ASSESSOR'S MAP & LOT INSTALLER'S NAME`&,PHONE NO. -- ��,;,®v SEPTIC TANK CAPACITY /,DO6 (�1 LEACHING FACILITY:(type) �P/1�6, , %Fr��h/ (size) - '�� NO. OF BEDROOMS PRIVATE WELL OR'PUBLIC WATER IJ BUILDER OR OWNER 1 ti. 1 DATE PERMIT ISSUED rsz-,07<<1�i✓�rc%�u�! 1 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ���N�aag P Mc pvs s too- ga t t- TOWN OF BARNSTABLE LOCATION -5 1 1 SEWAGE # VILLAGE ',�C VII�..' ASSESSOR'S MAP LOT \58-0-57-- INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 1 SaC� Cl ' LEACHING FACILITY:(type) (size) 0C C) C NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER C C� BUILDER OR OWNER DATE PERMIT ISSUED: DATE COLIPLIANCE.ISSUED: VARIANCE GRANTED: Yes No � J IV Oh° No. 4� —`' Fee 100 ' 1HE COMMONWEALTH OF MASSACHUSETTS - '< PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Mi!5poal *pgtem C on5truction Verna Application is hereby made for a Permit to Construct or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 32.2. (oS3. b L•$¢. I# S-7-I SEA viEw Ave-nAuE JAcoves sc�vPrY OSr�Q��1LuE� M A. C� to SS L-C- ,LONLm FIMND5 - !310 LA HvLP'E d 3Z_L�isl v M Installer's Name,Address, and Tel.No. p Designer's Name,Address and Tel.No. /7•��lO . rS X Te A a- 4 N�(6 , 1 a.a �0a- 4'L8- ct .� .�) Type of Building: W Dwelling No.of Bedrooms co Garbage Grinder(Na ) a Other Type of Building N/A No.of Persons lo. Showers(w* Cafeteria Other Fixtures tiLo^4 Design Flow —sso I 1 o gallons per day. Calculated daily flow gallons. o Plan Date MAH S 101 q td Number of sheets 2 Revision Date 1-10 W G Title PaoPo-,ED is AL2QaTio�vS �1 3'1'� g45 A v1T= Av_Nvc A4A Fnl Description of Soil 0-i2 (A) L-cAM,1 Sfl-NO l2"-1ol ( N1) '5A 1.0 '1 1c"- 23" (P>Z) 5.�nrOy LOA" 0 23"-30" (M-6) ht0 i 3o"- S4" (G1) SRrvO ; 54''- (oo^ �c-� ) SANS (cc'- C.S' (e_-3) Sfr1vD - GQovr.o \14Pr7 Nature of Repairs or Alterations(Answer when applicable) 1-+/A Date last inspected: ►-4/A Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by t is o of Health. Signed Date 2 5'`4?4e1 Application Approved by /I Application Disapproved for the following reasons Permit No. l l� 19-3 Date Issued .S— ——————————————————————————————————————— THE COMMONWEALTH OF.MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS +J J Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed(✓)or repaired/replaced( )on > o by for D e , m e c tine-L_ flc t.c s a �+ 3-t-� -5-LA �s - '7 7 r. V, Gw -*ti -S`�G✓v� has been constructed in accor ance with the provisions of Title 5 and the for Disposal System Construction Permit No. /, /.�'�dated :S"- Use of this system is conditioned on compliance with the provisions set forth below: ———— No. (i� 3 Fee a THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS = 13 L ;Di9;poq;al *p.5tem Construction Permit Permission is hereby granted to D 12 AA+cH Ais L. to construct(✓Srepair( )an On-site Sewage,System located at #3-1� A 1-i+ + fi�+�+.0 . �s��+ c c j and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction ust e completed within two years of the date below. Date: (",�I i'; Approved'by 9� � No. / r"a• V/ f �. ..^IT- Fee 100 1 SHE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS OWlication for 33igpo5al *pgtem Con gtruction Permit Application is hereby made for a Permit to Construct(✓)or Repair( )an On-site Sewage Disposal System at: Location Addressor Lot No. Owner's Name,Address and Tel.No. S2.4, LS3. b1L•So 4% k! 3'i ► Se'A vic-w Av2N.S JflGGiv$3 :>divA-f * Al A, O��S� tE I-ON to iQNAS - I S IO LA Hv LPG O t ir,'E LG'�1 V M ' Installer's Name,Address,and Tel.No. �j Designer's Name,Address and Tel.No. Q /t, y�b 5s`9S GocS- 4119- q1S I Q OaTE•L'v�L.�.E= AA . O�LtoSS < Type of Building: - w Dwelling F No.of Bedrooms Garbage Grinder(moo ) Other Type of Building N IA No. of Persons Showers(we Cafeteria Cafeteria u Other Fixtures WC.1+c Design Flow I 10 gallons per day. Calculated daily flow gallons. Plan Date MA-4 S III a to Number of sheets Z- Revision Date +-+o Title PRr_.Po7co --m. A r A37! % A vOEw a��NVC (�s;�"2... �L$ >.� oSS Fr�� ✓ Description of Soil o -I2" (A) LC2.AAA-1 0 i'L Zo' ( rs�) y 4 { ��' _ 2�" ( gz) 5AN010 Lo-A" t Z� zr>" (f33)�nnio 0 30"- 54" (4 1 SANp "�J4-'' b0` �c�) -,,'\,D coo`- f-5, Nature of Repairs or Alterations(Answer when applicable) Date last inspected: I-+/A Agreement: ` The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by t 's o of Health. j Signed Date Application Approved by Application Disapproved for the following reasons Permit No.' Date Issued T ^�1 r�► Q No.-�--`--1-"--i-- Fee---------� --,5----..-- BOARD OF HEALTH TOWN OF BARNSTABLE Appiicat ion ifor V err Congtrutt ion permit Application is hereby made for a permit to Construct (V�, Alter ( ), or Repair ( )an individual Well at: a c I -d - -s e G s z_t e_ -c3Tc���'ll� --------------- ------------------------- ------=-----------------� --- --- - — -— Location — Address Assessors Map and Parcel ` ICC � - - - -- - �lw - V- --C�sTe� -1CP_- --------------- Owner Address 1l f l o�i`( I t e' po, /�oX �d a �v►as ..L ^4 oaf- Q.A - --- ----------------- ----- - ----------------------- - - -�'-- - - Installer — Driller Address Type of Building Dwelling--------------------------------------------------------------- Other - Type of Building ----------- No. of Persons------------------------------------------------------ Typeof Well---Y------------------------------------------------------------ Capacity-------------------------------------------------------------------------- Purpose of Well "-------------------------------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of ompb nce has been issued by the Board of Health. �w Signed�'k-.�-"-------------------------------------------- �-��--A?---------- date Application Approved By - - -— -- 1 -7 ----- date Application Disapproved for the following reasons:-----—-------------------------------------------------------------------------------- -- ------------------------------------------------------------------------------------------------------------------------------------------------------------- date Permit No. ------ _'l __ --------------------- Issued - -- -- - - - - -- ----------------------- date BOARD OF HEALTH TOWN OF BARNSTABLE C ertif irate ®f Compliance THIS IS TO RTrr, That the Individual Well Cjn structed ( 61, Altered ( ), or Repaired ( ) /by- -- — .�..rn/ -1-- 1 t ` - -- - --- ----------------------- I staller at 3 » Se�v «•�, tel o /1 has been installed in accordance with the provisions of the Town of Barnstable Board-o7f Health Private Well Protection Regulation as described in the application for Well Construction Permit No�-`,- -{-J--1�---Dated---------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- --- _--—_ -- - - ----- -- Inspector--------------------------------------------- ------------ p �I ------`'�{_.. .._-..- No.- - 1--1.-----`- . TOWN OF BARNBTA.: F. PC1�1 ' ion_*t V ftt o0tr ' t ion Akrmit Application is he eby"made'for a p. rmit to Construct v'f Alte ( ),,:or Repair ( ,,r)an individual Well at. K___cati _32- Location Address' F Asse$sors.4vlap.and,Parcel t o .. r/F M _ G`-_t ICL 4�, - - �, u i e `"' -G'€`� - = 'ILA ° --------- Owner — i Address ? ox Installer — Driller Address Type YP of Building Dwelling No of P f Other - Type of Building- -- ---- ersons - - - k TYPe of Well Capacity -- - -— 1 it Purpose of Well tr E o - o,} )� $ flgieement I S g 14 I • The. undersigned agrees:to install the aforedescribed individual well in accordance Sdrth the provisions of The w__._ o• e�B.arnstable-Bo- -of-Fea�lr-Pr-ivate W_e.11_Prot ction Regulation The undersigned,further agrees not to place-the well in operation until a Certificate of omplx nee has been issued`by tie Board of-'Idealth.-----�--- y Signed- -- -"-' - -- --- 1Gg e ¢ Application Approved By-- Gate Application Disapproved for the following reasons = M No. --- -�- --' -------------- Issued---".--- ------ -- --- ----------------- Permit '}. _-- rdate z ��'���►�� GL �d. C",t►o w Department of Environmental Management/Division of.Water Resources r`fsa► WELL COMPLETION REPORT WELL LOCATION q GEOGRAPHIC DESCRIPTION Address Q GI�I[9a.cJ 4 N S . E, W of , (feet) (circle). City/Town QS?"" Ut P A, Well owner r G GKfGtir( (road) Address �'j �'fc.ul2w a'� e. N S E W of A. (m(.in tenths) (circle) Board of Health permit obtained: yes 0 no ❑ el(ersect. w/ (road) WELL USE - WELL DATA.. t. Domestic ❑ Public❑ Industrial ❑` Total well+deptli �`? it.. ylonitoring Q Otfier f�/'e.h.a Depth to bedrock ft. Water bearing rock/tutconsolidated material: Method drilled-� Date drilled Description- Water•b'earing zones: CASING.. 1 From To Type Sc <<� p� e ) Length ft1Dia(.I.D.) , in. 2) From To 3► From To Length into bedrock ft. Gravel pack well: ilia Protective well seal: Screen; I dia. Grout.❑- Other Slot 0Z length-fromZT t; 3 STATIC WATER LEVEL(all wells) r Static waterlevel,beiow land surface :� ft. Date shif I WELL TEST(production wells) r Drawdown a fU�PEaftor pumpinig 3 14 min.at �S gpin How ,measured -Recovery It. after—hr. min. LOG of.FORMATIONS C>,OMMENTS • Materials From. .To ibriller D A ff I.A ej Firm D'A SCl c.ti,n c &A..e. J Coe*/3110 Address Po `',OX �hC� City/Town Supervising Driller RegA 777 Signature' of supervising registered well driller. II ifq»print rmfy .' Y t i :,e,:,., ...._. _ ... _,...,. �t'.;BOARD OF.•HEALTN(`,fTPY „ .,. _.,.. .,a.� Y ..,,;w,., _'., �.. ,...e�S { BOARD OF HEALTH Yr, TOWN OF BARNSTABLE 4, Certificatb9f Comp[iante -THIS IS TO C RT FY That the Individual Well Constructed Altered ( ) or Repaired ( ) 3 1)6taller at- has been installed in accordance with the provisions of the'Town of.Barnstable Board of Health Private Well Protection Regulation as described in the application for Well:Construction Permit No—W-9-7----t---y---Dated---------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. 1 . . DATE-------------------— -- — - - — - =- Inspector--------------------------------------------------------------------------- .nf�:4,_..r .c.. ......._�a..�.e�,��w:.wwe;.wa.s.���.iris++we:e�++w+s-;ww.+'r�•:..:�.ca?+..�rt..�e..ccafe�"i���wn.�-�es�z oe.:rx^�.. ,w�: -�s=is�.'k�• �, - � - BOARD OF HEALTH TOWN OF BARNSTABLE Vett Con5tructionPermit No. Fee--� ,}�-- Permission is hereby granted A. CGr^�"` l/-------------- to Construct ( "S, Alter.( ), or Repair ( )-an Individual Well:at LA. 0 f„-) �l Street is as shown on the application for a Well Construction Permit No.-----j-�-'-�--�----�--t�--------------------- Dated - -- ------------- -- ------- ---------- -- -------------- Board of Health"- DATE--- —------- -- --- —--- - ENVIROTECH LABORATORIES, INC. q—7 y MA Cer. No.: M-MA 063 M 449 Rte.130 Sandwich, MA 02563 (508) 888-6460 1800-339-6460 FAX(508) 888-6446 CLIENT: Dr. Ackland LOCATION: 377 Seaview Ave ADDRESS: 377 Seaview Ave Osterville MA 02655 Osterville MA 02655 COLLECTED BY: DA Scannell SAMPLE DATE: 5-14-97 SAMPLE TIME: 3:00 WATER SAMPLE TYPE: New Well/ Irrigation DATE RECEIVED: 5-14-97 LAB I.D. #: 97-5268 WELL SPECS.: 23'Deep RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Limits Coliform bacteria /100ml 0 0 9222 B pH pH units 6.5-8.5 5.61 4500 H+ Conductance umhos/cm 500 162 120.1 Sodium mg/L 28.0 14.2 200.7 Nitrate-N/Nitrite-N mg/L 10.0 0.92 4500-NO3 E Iron mg/L 0.3 3.15 200.7 Manganese mg/L 0.05 0.028 200.7 COMMENTS: Low pH indicates high corrosive characteristics. Iron level is not a health hazard, but may cause taste and staining problems. Filtering system should be considered. YES WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. �.. ' Date � 16/. — Ro ®Id J. Saari Laboratory Dir for <=less than >=greater than TNTC=too numerous to count ?,-� 1PPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS LOCATION LoT �:= �(1E�6�/ /4�( OPP '5 7' SC-A\J1Ew� AVE NO. L/D VILLIIGI; —p\,lk Z-, DATE 'Z-61-91 AP?LICYINT ,�AC-a;UES FEE /Ca 11ADDRESS 577 TELEPHONE NO. (Non-refUndabl( ENGINEER "1jA�C I�QC� TELEP NE DATE SCHEDULED o � sOe ..: oa . . . eOp . 00e . . . . . . e . . . . . (Applicant' s signature ASSESSOR'S hiAF' 0, 0:N0: l3a / '3 • • • • . . .. . . . . . 0 0 , . , .'. . . . . o . . . . ` SOIL LOG SUB-DIVISION NAME .A DATE 3 /G — `t'S TIME EXPANSION AREA: ----_ (�AUT�- -(• I�y� I,��, ENGINEER:'��' . TOWN WATER_.K PRIVATE WELL ^E_cw F NA-A-A'-r BOARD OF HEAL? J A•A 1--no EXCAVATOR SKETCH : (Street name, etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes ) -- NOTES : r Io Cnu�r Rau I�GB' M� Pl�vse co%! r \ V� . 1,0 ` O a ,.e.•.� �, 1 11i � ,6 � 9O' PERCOLATTION RATE: 4 (Nyk..S PeL 1t4c-4 TEST HOLE NO: ELEVATION: TEST HOLE N0: 1 a-► Lor4M ELEVATION: 2 1 3 �USOIL 2 4 3 3 - �' : (fin o No i� war 7'c4' . 5 5 '- "il-f-Qo.1b.r1 LLAy 6 "Y L L 1 W AEI1=01%JM 8 7 9 a(� 9 10; C-, ,-LJu 0 w A rE4- . 10 11 7.4/- ll 12 C la ,4M 3 �� /95 • 12 13 13 14 E. 14 . 15 l5 16 • SUITABLE FOR SUB-SURFACE SEWAGE: LEACHINGIFIELD' LEACHING PITS LEACHING TREN:CNE§ UNSUITADLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE : ENGINEEIRING PLANS MUST SHOW NUMBER- ASSIGNED -ON PERC TEST APPLICATION ORIGINAL: COMPLETED N ENT R 3 p COP:: RETAINED BY APPLICANT RNED O BOARD OF HEALTH APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS 51PpLeM;rur�kl. T YtEu�/ ��/ OPP 37Y SaA\J1CW AV5No DD AL'i'L,IC:•.I'll'S CC�uits 1 A1)DRES'; FEE TELEPHONE NO. Non-reftindablc +mil C_ TELEP 1 NE 9 '9� :?1-3D U L 1-3D 15 l-'- N /! li " " ' �APPcant' s signature �1sSLSS'JR's )AAVd j.,OT NUc ° 3 ' . . . . . . ' . . . SU13-DIVISION 17Al•1E SOIL LOG EXPANSION AREA: YES K NO DATE— '� I�5 A 5 ` TIME I4-n/1 1'OIrN P1 ,'i'ERPRIVATE FI'ELL ` (�AUT�2 ~� "'ic. ENGINEER:'?� ' 5UPPLEM BOARD E*,1-rAL w,,~�,, ss�o BOARD srto��,ll�►E - OF HE11L7 S1CI,i'Cli : (Street name etc. EXCAVATOR ,dimensions o� lot, exact location of test holes and Percolation , tests, locate wetlands in Proximity to test holes ) NOTES: �072: I '�° `1v'. pscJ- 3a4-yr :!4�cr rfC r t �r4.�1 Q/ .,. oe-m/17 N s / v wA I t Uf��iEfZ.,�AT1o1•/ CcV= RaN 1.7 ' 1 Pl¢�ac coal r,•�' \ 7 -04 n.r 6✓. / / �-+ ` .. I <<; T�'sT ) �� cry � ` .l /� q S Q 9 1` ,YJ �.�` L'`L)•„ �'� 1 �'(gST 10 1 • � � 6 � l � Y I 1�q A n J�It1�1 AAL-To ►�I 6 q C�t3s tfn�E�; A�JJ,>Z '�L�.>�. , FM' ' I �• � ' .. 5 'G�i=L�l h�E �G►.JS"!"Q�' y v� i�' n.r s, \ I .o .�RCOLATION RATE: 4 ,1,,,,_, hk-acN CA-- Ne-fz a "ST POLE NO: ELEVATION: lo• 1 TEST HOLE N0: 4 ELEVATION: lo.g 2 2 3 3 I I-T'r S A 5 .,5 i 6 Me-AIvn., �N Men SAN4) 3'S . - � i3 „ Mt�7 Iwm NOV�f�?eY' 8 8 S/YIJI� 9 I 15 6pA LL.O H S 114 9 10 10 1 I�1 MIN ?•p S£t 1 11 11 wr¢ 9 1 12 IJOle 1 ,ffaLC E><CAuA 1E0 2 r 13 TO CIP- • 146 WA its Ac-TtA 3 1 0.5 r H• r*4- 14 l�2t - I MsrAL,_ 4' PVC A AE 9. 1 S c t�f--Pi?I -ra N "_QoVW0 WA-T♦;¢.. : ('�c,'in., 4 15 3' Pc�Po¢A�o wRnPA�D 5 t• 1s 16 111 P1'veL C�oT}I C,tp O H W vo tii File GtlhOC 6 7-1 IITABLE FOR SUB-SURFAC a �7�'CHING FIELD LEACHING PITS LEACHING TRENCHES . 1SUITABLE FOR SUB-SURFACE SEWAGE. REASONS: )TE : ENGINEEIRING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION .IGINAL: COMPLETED IN ENTIRETY BY P . E. AND ETURNED TO BOARD OF HEALTH )PY: RETAINED BY, APPLICANT ..., _. . � ,..___..,...._........_......_.. .. .,._...._-,..._..._... _.-_......._ i�---- .....__ ..- Err -__ .ran ..�...� :. ...r.... o� d '• AMR '� , •. o off. ... oG, to LOCATOON MAP COTUIT QUADRANGLE SCALE: 1:258000 ASSESSORS MAP 138 PARCEL 32 o� ZONES: °P AQUIFER PROTEC11ON OVERLAY DISTRICT ZONING DISTRICT: RF - 1 MINIMUMS AREA - 43.560 S. F. FRONTAGE = 20' WIDTH 125' S+ FRONT SETBACK = 30' SIDE SETBACK 15' SETBACKREAR 1 S00, BUILDING HEIGHT = 30' (OR 2.5 STORIES IF LESS) Ca?�264' FLOOD ZONES AS NOTED FIRM COMMUNITY PANEL No. TI3M 0 HYDRANT #107 REVISED001 JJULY02. 1992 EL 0 SPINDLE - 11.06' N"j59'0" E AUBREY CONSULTING, INC.. 14 POLE 3Q !�^ 17g 3 ' LOMR REQUEST Ca DECEMBER 1995 185 C,a'�2s. 8 ; �-- ° 00• l°'$33.s�1• "'---- V E N 71 130.40• 210• ' ~ ____--_ S 79g9'49" W �A0' '"� ,,, EDGE OF PAVEMENT I-c 178.08' POLE 35S R-122540' ' 110 L-321.03' 10 " " �t� PRtRI 09ED V �..- 1 ' u► t 10 tr o 10 12. cr00p � rn N ,a B RE A L 121 u`, k/ tN JR r 00 ly �•• 1748 T o ` 1... C• Pi w � ? 11 3p,5' PR0O9ZP NEW CONSTRUCTION Av 16.5' 6 A4 � - FOUND © 7.8 FEEL~ �1 ' -12 16 ZONE N V E 14- 2 PROPOSED FLOOD ZONE BOUNDARY 14 SEE AUBREY CONSULTING, INC. o` 12 ,— 8 LOMR REQUEST FOR J CQ ES SOLVAY LO to cn w EXISTING SINGLE FAMILY DWELLING PROPOSED SITE ALTERATIONS o /14 - �- BARNSTABLE, MASSACHUSETTS PROPOSED FLOOD ZONE BOUNDARY p E ,/ ' -- ° 4 SEE AUBREY CONSULTING, INC. Z �(0-14 12) _ �� , i f _ -' 2 DECEMBER 1995 AT LOMR REQUEST FOR JACQUES SOLVAY \ , ./ -,,- —�- EXISTING SINGLE FAMILY DWELLING E � ���� 377 SEA VIEW AVENUE BARNSTABLE, MASSACHUSETTS Z OCHE 1B) 124'! �/ J - ��.I'�r MEAN HIGH WATER 10-27-95 N� 10 OSTERVILLE MASS. SupmP DECEMBER 1995 --.•.-- -._ --� ' • 2p� g NO.29r4 FOR CIVIL, DR. MICHAEL ACKLAND 4 / CB WITH DRILLHOLE / P�• 174$ El V $vALE: 1" ,Q 40' MAY 8 1996 FLOOD ZONE LINES DIGITIZED FROM FIRM COMMUNITY PANEL No. 250001 0016D (REV: JULY 2, 1992) USING PARCELS U01 13 SAXTER & NYE, INC. ' BARNSTABLE GIS SHEETS ORIENTED TO FIELD LOCATION OF EXISTING BUILDING ON LOCUS. p {eel t 812 MAIN STREET „��> �4+ LOCATION OF EXISTING SEPTIC SYSTEM IS APPROXIMATE AND IS BASED ON DEP INSPECTION BY G. BUMPUS 4/26 •95 55, 5995 °re OSTERV08)-+i28-9131 MASS., 02655 „ • ' LOCATION FROM BUMPUS SWING 71ES It Y� N EXISTING CONTOUR 16 N N ID PROPOSED FINISH CONTOUR S 0 �l PROPOSED FINISH GRADE 14.5 GRAPHIC SCALE PROPOSED STONE RETAINING WALL 0 0 0 0 0 PIN FLAG AT TOE OF SLOPE (BY BAXTER & NYE, INC.) LOCATION DATE: 05-07-96 BASE OF EXISTING JAPANESE PINE ® ( IN FEET ) I Inch s 000 tL 1=ET 2 o F 2 95172 (STUDY06.DWG)