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HomeMy WebLinkAbout0941 SEA VIEW AVENUE - Health 941 Sea View Avenue Osterville y V o .- ...tea ,, a.. n .• gyp' 'e R ., � .: .. � :y;a c _, ru: Town of Barnstable �f . Regulatory Services. Richard V.Scali,Interim Director • BARMABM „ MAW 39.A Public health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form 24%3 Date: MA-16-1 ZoA Sewage Permit# S S Assessor's Map\Parcel 050 004, lk"wus."1S6YmTo►y Jr.. Designer:Suu.%,vgM Installer: 'Vux 6%)jZX Cou►s- _rto#.{ Address: '7?Aier rw , Coop Address: 70 SM ZS %-A Dsrtt2Yiuz MA 'DuuB�e� � 02331 c,�t�gNu�.t 3oYK'�nl t�2 On 1Z1%&1Zb13 -PDX604Lt Catesk1We-n0►awas issued a permit to install a (date) ,/ (installer) septic system at 9 � Y l CW AVE 0.0-tEa/l LSE based on a design drawn by (address) �j ut�wq,M1 1�u►E 11a(� �r•1 c. dated 1'7 1613 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. .Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major.changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was cons t ce with the terms of the IAA approval letter's(if applicable) nstalIer S' e) CML esi er's Signature (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTI>F'ICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic\Designer Certification Form Rev 8-14-13.doc PSI al G -T a 3 { � . 1 j .. .�: : . , .. . ..'..,J .. -il®wn o.t B I Astable P# o'�rt ]y r ` ' op;rtnopt of Regq!atbry services ,­..A�;���­-:,.1.,.�,�.t.�__�1./, , ': ;"� VM F .,u:r,a„B I : 'ulbhc I3ealth Division mite f61g . 200 Main Street,Hyannis MA 02601 ` ' '` �.9-,',...:'-.-'I�.�­I_�'.::—,I�,...�I�,._.;­1-t_--­�.I."_�-,:�I�-�:.,��S.�.-j."-�W,,:1II_�,,.�-.�.,.I��:..I-,".,---'-��-4,.z>:_�.t,:,9­�,,."1..:-�,,.'_� �.".-:.,....,."�.�i,4t*,.�_1,.�,:'�,�,i*�UI...-.W.�.I'�_.-.i��-�_,,�'o­.�­::;,,�I,:�,-I�:�.::��.--��t.,,,,�-':;�I:,.,0'����,Y�.,,­,.��`..�.Y,�"'':..,,-,�.:-:�',,._-�:5��-.I�`-�.'I-:-��,1-�'.��.9�,,.,._:?���"­.:,,,,_-�,-,.`-,,.�.-,1:.--.-_9 9 .��,`_..;X91',:".­�"�.�I_,;"�:-­I,_�1"'�Z"�:..-....-�:-.�1�.�.,!,:1.-..-1._:-.',':,�,"-..�,i.:-,-.,�:.-t.:,_-_,_i.!.I":,,_�:�::,:.:.:..-�­I,��,:.',".,',N.-!�'.,..,I�..'_,��,-,'_,�,�-...�,,`.�.;,.��,j",.,�?��-".,�_:;:;"`-.-�_:0,.',i%,�.,:,.i`-�q,.'�.`.��;.-1'4-��...�,..5:-��::...IF_:,-:--­�'.j-'-"..-.q_�I�.,'�,"1.t t..-:.,_...�.�-.,,r..::1.t..,I�'_:'_.:,I�-,.0:,,,,.,'._-'�,,,��*1,-�..-1.-,,_".��.,-._`­:.,��.W�,,_:,"_-1��'��:��--'.,*T:,.,-_-_-I�;­�-.,;:t:_-I,­�,:..,-�,-.-.,'.­�.:..�T9 I,-I­,,`,,1�,,t-..-,:�,41 ,�.-:�1-,­-,.:,,­.��,-,--:.:.,,,.I�-��-�_,_.,�,,_,,��_��,,�.,�.,:-.._,-�1..-_-��i�1:,�,;:�,%,�;,,,-.".;-.._:�'--:_-�:,.i'�-,:,,,".­:f.I,,.-,:.�-,_�.t".,:_-,,_���_��,.--",i�,:.,WIV...,t:n-,.S1'.�,�:,..,_,.:,-5�..:-.,,:,"::.,..,.�­:�.-,..,-:4:����,1,,I,ti"�:�::�:����:',�-.1�-'�.�I,.,:;,----,�;-,.,,"��t-_�,,�..-.��..!"..,�.-.t,,�.�,.."._�.t�,��,�::"�._.�..,�,.,i�9.-­.�-.­:1.�,,,,.�-,�.,.-...,:��k,-!�.-�:�:!.'�.:.-.'�-,:�..­j�.,;,:��:t-�',,1"_.'.:,&1�,-'":.s,-i..,",-�s��,-,..*;,-,":'",..,,.�,_�,..-,',',,,,­,.,_,�,,._II,".�,-t.i.:.,_:-_v,,,J,'-,,.-n'1,,.­J.,I1.-:V:,`��..;.,"_I­,.i"*".�f_��"',I%'����.7—_.,'.,:-,;...I:,.,.��.�,.�r.-..�1 I:�:��.,-�`n,,'..1,-.-,..!",.",-.,;-y��_,-,�'�.,.W.�.�,`:"',l.­'.�.t:,,-",-"t-���'r�.I.9�-I,­-�__.9!t�:-.,.-,_".'�9.,�"-t`".o-�-.,.::�:�j�.�_..:,��,..�`._�t�!_,�.,,.,-.:,�,.�_':..--'.,�.,�.,..��_�,0�'__'­0..1':�t",,.',_�:�-'a:."-:,��I.�:-.�_�-�:���,I-I-,..1 L A,�*�:-,.:9 I.j.Q__.,,�-,-,I.0-�'.,�._�.','t:--:�._,-:-�:�t�A-.--.,'�..�N.,�,_-�,I.,-x..1,,�"�,._-."'_-:,!,��t_...�--I.-�.o�O,*.��,!.�n,`I,--�.-I.-..z,�1.:,,­�i`­_:71,�*,�:�--­'.,�.-",z,.-!�..�it�,,.1 I�.�.f,-,,..,-, -,,�'�-.:.'-.-,..A Ii,�,��_e"..`,.,.­.,'-,,'�.,.:,,;-.�-.t��"..t,`,",r,1,,M."�*���.:,�!'.'�,.,1,,-...-,-,9,."*--,-.�,!.O:.,'.'15­�,��'.....:"Q.��"t,;...,.,,.,,t...,,-,.,''�,�0,I,.:�,-,,-�,..- �:..,:.A�'-,,�.1."mt,"..�,.�M.-,��..._i,.�;z_�_".�:-'�,_:f;-_.­_-�'��""1!-,9?.'_-,_.,-,n,:";�'­.,,I`�_,-�1.�,,.,­4?,:"�,,-_-`--:.,�,--.'�.-n,.�-"..*_:I.�:,..-�.,"...3,.l;9-��.",�.�0:1,I...-Z!"7-,.1��ii:.l,,�..-,��,ijM'�..�-/�.lY�.i;j..-,Q,.���­I.I,.:�,�,_:AI...,,,�47,0�.�;��Ji,,���''��It!:'�,1I".�.::,`,,,..,�.i,iI'11_,-i1.*,,,.I.,L::,,1-n,���:,�1il,,I I'i1.�i..,,I,­;,�V-V�i1,�,,:,-�,,M:..,,-Z".,I�-z—yI''A .,�!!"�.-�:-�ei�,��.�:,t''�_i,:'.ti l�",,_�-­':z.f,C-W�..�-,,�,��t�-�".���,..-,:,.��­�'I,,"�I.,,::.,I.�..,,..�',-_t,t,1K_*.t.'�'�__ �_UA._-,:,"):-_�..W,E7�-�.;�.,.��,..."-, -,,�::,,��.1L.A,tI.7 ,,;,�".,:i.,t!%1tS.,..,Yp-,"_�-_­�,Q.I-.-������._--.,:-�..-,',-::I��,--.­"""�.�,":.---..i 6,�'t.��1. 1':..,.,,-.,,��.,�,'M..o'.­:..,',.:�.. fEt) ..�l .1 t:�1'��_-�_..:t M���T'�..:_,�,,.--t1..t.,,[�..1,9-.'"Z�,:,E��,,­,",,1:'T.�-�.-"�����_' , .,"­__,�,.��-�-,.�'..,.,;�-..����.,'.-,,,.��1� Date 5cteduled I ¢`:: .. i < ". - . , Fee` d P � �:,1t,:"..o�,*I�,.,at,,I.,�,,,:.:0.,��,,-,4,�.����-?o1:I���.�,,��"I,,_,,_,:.,�,.p,*.­.�_;.t..p�,,'t',9_.�.g1-,,�,, ►foil ► { itabilrlPyi Assessment for Se e tDis o l j/ ' . n ,,.9­,:..�.t�A- o. i. Performed[iy St>L L\v t4, ' / .l�Liv G`GZ LcLA �I t ( y Wihiessed By CATIN'Ict'GENBRAL _ INCOItMATION Location Address 9 Fes'V t V 1= Owner s IVeme. � S C e i wJ ��! l LLC, + Address d�Ge.cor.l.7'I t ` � '� a Asscssor's Map/Parcel �'�j(p Engineer's Name Ei�/��.Gy y�,'�n�r�y��f NEW CONSTRUCTIDN REPAIR ;' Telephone# �� Z F„?��yy,_ Land Usd E15 ..... lflL I Slopes(Sb) 11CUt�L- Surface Stones= Distances from Open Water D y 1-$ Possible Wet Area `2C�R Drinking Water Well �A-eft . _ tI '. Drainage way ft Property Line ft Other n1 1�1Qc _ft SIM{ II� '��� :j,+ I Y a ,TCI�.(Street name,dr pensions of loll exact tocalidns of test holes&perc tests,locate wetlands 3n proxiiiuty to,ho]es) + I .-. 1 I� [ ' C u Irk x 1 6. , US :,r I"- I n I t "�;t 11 C 1a $ + t _6`/ I ' ', .s i_� - IL. �'a r tr i to- r 4 ' t .s . m o - a c r t A Y / I F t� ­1 4 I s i fL- ' � rk ,L '' N O tf1 S, t X C L� a L �1 A_.a . �) t - o rr m - i _ i Z X3-. ' 1 ! �. ,P Parent tnatedhl(geologic) <l AS 64 ' r Deptit tp 13edipeft ` A ' Depth toOroundwater Standhi +atermHole jo'P1'� WeepingfiplttPltFnee , e ) t i II u Y ­�;�.�:'-�.,,-..t,,.:A...�..'­1­-�.,I_�:,.�,!-:-,.",:.,­.,:,,,.!,,:,,��_.,,,­.4..`--I1.1,;�;,�i._-.�11�.,.I.:W",_,.�__:.jT-:Z.9,1`I-,.,,,9.:I,-,ist-.,-,.,.'t*_,:-��,-,t!,.-_��..`..,---�0,�,:-�.--__�"­�V.".,'.�.,;t­,,-..7,—,41_".­,i�`":?,�4�i�,--,,',�;,:.'`9 Q�*_��--,!-,If,9,�'n�,,!�Ii.,�'�,,1�,�"��.���:-.tI,.,'._,j f.',',,:,-�".,-q9L­,,�I�,E,:'_i0::_,.t.�'�,-,.".._.-_­,-I,.�3,.­.-,1...:'_1.Li4'�9 9,..,._-,,:-;%�­,",-,�.�.�,.m-,�,t'',,,_­_�-��-_��.,-.I-,,_.�,:�..��'�1-_1,"'__�o:,_.4�.....-.-'�-`-_�,.I�:.��t-�­,I1 I­�'�_"'�,C.�S.7_,,.I:-��.,,,-I,:.�,I,.1:.'_:v".,,,,�,,s',,01��',�t'.1-�_��-.,...�� ,.-'.'1::-�.��_,_":.,,..";_.,it-,�__�:I­;,.W­�':j,,���,,.I,,i.:­�,,.,`.,..�..t-�.'�.,'..�t-.f.,.-�;...,I—I,�,:'.!.'-,",-a.P4,.�',,.:.*.-.,,A�1�����A.:.�-,.!�.�..,---;,�It,..1!;--_,:,-_4-._,"'�.,,�:A.--,%-�*...�'.��,.,.:--"'.-�,.-., $strmated Seasonal High Otoundwllter �: �� ,� t DETBIIIVIINTAI'I �t®I�_SI';ASQNAI. GH WATEX.TABL ..4­1:.�.,,-.-1,74,4�'�i�,,.__�t.,,,:�0.�,.,;,,:-:-;­x":--,_­n�t.,��t,o-:I..*0"�,,,.,;-""­-t�,,,.-,;�:..�.�;"*�"q..�-o-.V.,�!I-.:,,A�';;.1�r I:,..,-.��1.!'-i.c..tK,��-.*,,,_z,��.�.:_�,.:._-'i..�,..,��-�;,-�:`:--���,',..�,�1-,:..­,-.,_.�..:��.�?._.�...-�.i_ 1Nethod Used E',� I , Depth Qbservedl standing to obs holei�I lu Depth Ip Sgll lttpttley ^.,,in Depth to.tiveepmg frog slide of bbs hol In Ort%itttdwatpr:�dJu�thlent e..... .� .:_ ..it Index Well# ReadingIp ter Index Well level AdJ fhctor, ,q„4 �r1J�tlrbMilwaterLevel I' ,RCOL{ATION'll'�ST Dke j2,.._..�7 ���u„� icy Observation -i Bole# Y jhobatW, , . .,..,.`, Depth of : ., �' _ Tlllte at'G' v F J I1 Start Pre soak Time @ i ©` i rota(9''G") 8nd Pre soak �y!.i0 >V'pe Rate Min flncit _ 'ZNIr h �.2�} "7 r Site Su it abiitty.Assessment Srtd Pnssed Site Failed AIwbnul Testing Needed(YM) Ongmat Public Health Dry siou 661 va m Hole Data To Be Completed on Back --- - . ''_",, .percolation tegt as to:lie�cotatlli<cte :tivltll u 100'.of`vetiand,you must first notify the . I3arilstable Conse>rvat>iola Djvisiot tit least one (1) week j rl!dr, to beguwog Q\0p,rIC�PERCFORM.DUC G l-F�[_ g51 .. -. 1. S �:._--i,,��.-..-1."i.,.I1-i.�'.",."i...I:,,".-�,.t�'-I.1'�:,.,1-�"iit'.I.,�:.�-:�.��-I!."",,,'r--...�:,:�..�.,.�.t, DE rP OBSERYA T'IO Depth from Sail Howzor.: HOLM ..... —,."I...::,;j:,,I.�ie�.'.I�-.�'j'...!:I�tI-'-.'1....1�';.,.,i,�,,'�.i i:,&&I�,j�"1�.,�1,,:i.,:I-.:,I.�.-,,,'"1,..,-�1 I I�,I;t;19i-�I,�f1-I�:�,.I..,!.:1..t�1 9.',.'1.'!q.1�:i%%I.,..t.'.I:�.,�,.z_':1 i.',,,�1..I;.',!1::..1-.I'"�.�:--.,,,9����..I,V;;,i 1;,":..-J.r f�1.,�-I j�I�-I,,,,"4��..�.I.-..,/r.._!,.,"�,�"...,-fi,,*:1,:-.I%.�t��.7'!I.7.--*',,!i...�-.:�6iI,1;.I,-'�I 6�.''"1..t 1.-��,_-i:-,"'..,:��ii1',!4- Surface(tn) 5ot1 feature LOG Hole# 1;; (IISDAj; Sdil Color Soil —"-- /r �I (Mansell) Moulin Other (f '8 , j 8 (Structure,Stones;Boulders.: L` Si..,1 •� O 3 ortsrstcn era el 8' !6 � 1. �'/� .'Ja X . C i'I 1I I � � I 1 f I , f - I —��, SEEP' , Depth from S ..), — IGtiN:I pLE Surface(tn.) SoII Hori n 5otl 7etttt}re .: LO(ryr Hble# 2, Soil Color ---- (USDA) (Mansell);` Soii Other O ' ' Mottling (Structure,Stones,Boulders ,,. S9 ,`P4„r'` 0" 3 2 onsrs en Y. S !2 f !! - 2 f^i'r`�� (�� h 1cs 2 3 2 ' , lo:rk' i' --- J � C rr is L. �a� I ,:I' V 1 --�— - - - 1J DEEP O > E , Depth from t RYAiC.. 110, Surface to .1 Hortzti l , Soil7`rsature LOG I HOIC.# 3.' ( ) Soil Color (U,iI)q)1 (Mansell) Solt 011ter a Mottling (5tnicturc,Stones,Boulders C i to el) 2y )6 << -: I* -_ __ , . .f7. .f *. ! < , .-e --_—__ I' s --_-_ i 1 1 :"1 , r: ... .-. I :.I '1 1 - . - 1�r I -i i.. - 1 .. DEEP®; 1CIIVA"hION HOLE LOG a Depth frorn Sotl Hortzor : HOIe#: Y Surface(tn) •: Soil�exture Soil Color '-"' ' .. oll. (U;D M. Ot A). (Mansell her _z ) Mottling (structure,Stones,Boulders ' �, ` o st n 6 l 1 , z? J=� Z. ? . I LQa � a-- -/Iz i ', . stiff Co 'f R 6 ' I --= ;, f II -- J , I4i Tloud'Itlsurttnce Rnte a ; , -?-_— 1 1 'i '{ Lli 11 Above SOU year floo b n i t oM' lVo I Yes Witlt[n 500 year boa I ry 1 No .:j Yes . I 11- Wrthtn 100 ear flo 9. 9. Y f Boundary No yeS De t11 of Naturall Oc ' >!rili 'Pervlo '�'Mht�t lal Does at least four feet of'' tr11y occu ''ing perylous meter#al exist to all aleas'nbservetl thrau area proposed for..the soil ghout:.the ,of Iton s �, P' y�Eem� �S'; If not, what is the depth o aurally occ'drrtn ervio -' , K s I ;,;. ., t. matorial7 CerliGca., II 1. ,tto .Il , I I certify that on `/.2 / (date}1 have passed the sml evaluator exarrunahon'approved by the Department of Envti`onment i Protection and that the above . analysts was performed by-tna consistent with '.. L the required t.b ., exile tt5e and exile fence described;m 10 CMR 15 017 Signature ' - Date -j :l1 /3 . I. { - . Q:�SBPTIcvp-RCI^ORM DOC ' . e . f . „. TOWN OF BARNSTABLE LOCATION 9 v V;-8Lo au4-, SEWAGE# �-3 VILLAGE 6,) /(it'//-E- ASSESSOR'S MAP&PARCEL �]06 INSTALLER'S NAME&PHONE NO. nu Jam,f 1yu t ll --I )-M'-Odoy SEPTIC TANK CAPACITY �p p Q ,� P�y►,�. a y a //O,,4 LEACHING FACILITY:(type) (size) S®0 lam/Ur NO.OF BEDROOMS OWNER q y IG PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of'Leaching Facility Feet PrivateWatertSupply 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 05Il -, �^ T 3�1.0 Li 5Wit`, � a 0 o � CoveceA Dew No. (3 Fee ' /,q THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes NpliLAtion for !Disposal 6pstem Construction Vrrmit Application for a Permit to Construct(Repair( ) Upgrade( ) Abandon([,<E Complete System ❑Individual Components. Location Address or Lot No. `rill Sek-V.-ew /H''e Owner's Name,Address,and Tel.No. 054"(",it 02455- g Obi Beacon. S4, LGc Assessor's Map/Parcel p 540kv 0-411 If Installer's Name,Address,and ell. o. 7 3'1—60049 Designer's Name,Address,and Tel.No. VL 4�04 n EtK eer,, 1'✓�,e_v"4 l r�, CPd`a��e o�{ji.+r✓f 7 F'a-rker Ke7 l os we l AA d266 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(f- Other . Type of Building �QS'r No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.re uirt O X gpd Design flow provided I'YO-7.72Y gpd Plan Date 1� 2� Zo/2 Number of sheets f' Revision Date 7 3 Title P(I m m s- o = lw v1tre q 45 Size of Septic Tank �aoD �11or► 2 Cs D, Type of S.A.S. 12- SO0Gal LtaC4,n A�x1er/ s�fva� Description of Soil "TE'S-/ lac e 1- �'�� ./� Z-? ec l�` 3� ;f q u e,P �r 4 E1/4 jf l0h? V/,, A./.fiwt S.av( l6 8 40e� �at��Pj-'S as tote ill; P�'��•, Sa Nature o Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si Date 4+ ®! Application Approved by Date Application Disapproved by Date for the following reasons Permit No. U (�� j _ Date Issued ,� ---------------- 'No. (� tp 1. 3n Fee r THE COMMONWEALTH OF MASSACHUSETTS Entered m computer: l PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for 33isplosal 6pstem Construction Permit Application for a Permit to Construct(Repair( ) Upgrade( ) Abandon(0'0' ETComplete System ❑Individual Components Location Address or Lot No. ` �� 5 ew �'�^' /{� Owner's Name,Address,and Tel.No. `�`// ��'�U,-e r e oSferc,.(j.e Nt� oZG55' 3b/ gPncon 54, LGC Assessor's Map/Parcel :40ft /► ©2.r�9 Installer's Name,Address,and Tel. o. 7 3 -6©OCJ Designer's Name,Address,and Tel.No.Y A wa n 1:t�* Cr n� 7 /,er /lom- ✓-e c9sfLo(v,41e A,4 0260- Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(Lr i Other Type of Building e$ No.of Persons Showers( ) Cafeteria( ) Other Fixtures r Design Flow(min.require ) x!.5= !3 2 O gpd Design flow provided /17107,7 Z y gpd Plan Date P/2 0/ Zorz Number of sheets ! Revision Date i f-7 �-5 Title �f v�C)5•�oP � /elPfa f S ,. Size of Septic Tank /�� Cr'llovi 2 C&*P. Type of S.A.S. l2- Description of Soil -re S/ fqe 1- Q"'�� /� �4 Pr /Q t'R 3/ 5 ti Cyr q�.c /C � e,. tot/I y� i7P�,c,�, Sperm( /ro— �i 8 e� io��P� Ei Nature of Repairs or Alterations(Answer when applicable) J � Date last inspected: 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 Certificate of Compliance has been issued by this Board of Health. qq ;!i�F7 DateApplication Approved by Date /2 rF. Application Disapproved by Date for the following reasons Permit No. a U ( -.P 3 Date Issued—tI I&I ------------------------------------ -;;�----- --------------------------------------------------- r TIC Z COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY that the/On-situ Sewage Disposal snysstem on eructed((�j� Repaired( ) Upgraded( ) Abandoned( )by ��T/1/ at 9�9 / Se. Vi e cJ, Le- has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.20(3-9; dated 5� P Installer , Designer #bedrooms 0 1,,116�-( 4 f C 6/'r ;,oAr Approved design-Blow /G/�7. `� gpd The issuance of this p unit shall n/obe construed as a guarantee that the system wl nctl asfd)esilg/ned. (/ b Date `� , Inspector V -- --------- No. C�� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction permit Permission is hereby granted to Construct(L Repair( ) Upgrade( ) Abandon System located at / & SPe{ V 4 ,{(%j /` y(! and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date I / Approved by (� THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A , m / �C(�'J IL DATA TOWN OF BARNSTABLE CATION VILLAGE wrt), p ASSESSOR'S MAP&PARCEL 'S NAME&PHONE NO. R(,%C-1c VC,0 SEPTIC TANK CAPACITY JOW IC)-) LEACHING FACILITY:(type) /6 3:/1•4 t IN-cTOrS (size) NO.OF BEDROOMS `7 . n I OWNER L�cJrUY C� Vt'� PERMIT DATE: TES 11 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY s J J f f f F'f F f i J J f J f J F f4J`f} _ tJ\f\J\i\f\i4J\F4f4f\Jtf4J\f\F\J4f\i4f\f4f\ \�\f\f\r if4f\f\+t J4Jtf4f4J\ tF4Jtf\ftf\Jt F4f\F4 �7 4 4 \ 1 t \ 4 t t 4 51 15 98 69 ............... :.. . .. .... ................. TOWN OF BARNSTABLE rbCATI�CN qV�1Ig1JS�1� (� CT6�S-� E# �'✓I S� VILLAGE O -e(011W ASSESSOR'S MAP&PARCEL q INSTALLER'S NAME&PHONE NO��fr(-,C,IL(3C0AA SEPTIC TANK CAPACITY �'500 �'J LEACHING FACILITY: (type) ��U�ul (� (size) J NO.OF BEDROOMS OWNER L\c rc. (MC+�n PERMIT 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 leaching facility) Feet FURNISHED BY • ! f f f FyF�f r' f F f F f 1 .'ftf\f ?t/ly�tf\1t/1uy't ftft f.,f \ \ftfT �L/ ft t. t f F f . \f\f•f\f\1•J•J\J•?4?,1ftftJ f f f 1 J f J f f f ! f 17 2 r TOWN OF BARNSTABLE (,,, Of 101 71031 LtJCA 'ION � �F�UtecrJ Ay e. "6A2f4GC SEWAGE # o�00a-S,3Y V'iLLAGE +e!��.�'e ASSESSOR'S MAP & LOT 049b tINS ftLLER'S NAME&PHONE NO. � ���`� �� L{�� SEPTIC TANK CAPACITY J5'00 G-1164- : Dab ynA) meilT h4-a 0 LEACHING FACILITY: (type) 50 C4110R T( (size) /off /0 a)( 6-OS K NO.OF BEDROOMS BUILDER OR OWNER /CiCtfA Co/M,4/1 PERMIT DATE: VOU, 13 CQ COMPLIANCE DATE: --tea Separation Distance Between the: Maximum Adjusted Groundwater,Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by oA qd c P.LI w All CoM��nc.�fsj o rcxt . TOWN OF BARNSTABLE N, �At SEWAGE# EWGE# —✓t�� VILLAGE ASSESSOR'S MAP&PARCEL NAME&PHONE NO. r�LC n1c I L =►'7�Z� SEPTIC TANK CAPACITY 0000 LEACHING FACILITY:(type) 1C9� (size) NO.OF BEDROOMS 7 OWNER PERMIT DATE: C6W=idEE DATE_r5R 101,90C /0 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 existwithin 300 feet of leaching Feet FURNISHED BY w r, I J J J f J f r .51 15 :... :.....: = ::. 98 . . 69 D ri v vii a"y . :: ... . :.. ... f .... t t�r TOWN OF BArSTABLE y LOCATION -1' �C_ i e� Fd y Q- S'WAC,E# ''�S VILLAGE v i�� -ASSESSOR'S MAPP&PiA�RCEL lfd'S�*R'S NAME&PHONE NO. r�`�-'�� �J(��1�'-'�`� L`� SEPTIC TANK CAPACITY JSbO LEACHING FACILITY:(type),, br', S CAM S (size) 5-60 NO.OF BEDS pOMS `'1 OWNER .F PERMIT DATE: 0 PL E 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 leaching aci Feet FURNISHED BY •:.•:•:•::•:°:•. > fr. J ! ff f r Jf f f':: ■rSl r: urWG}Y 17 2 51 Y s • r 'No. t f T t ; Fee � �, 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for ligpogaf *pMem Cow6truction Permit Application for a Permit to Construct( )Repair Upgrade Abandon( ) E tomplete System ❑Individual Components Location Address or Lot No.9N1 SEAV IE W AVE. Owner's Name,Address and Tel.No. 0STERVILLE RK.NAtRD COWMAN Assessor's Map/Parcel SZOS C►{AMSERLIN AVE. 090-00(o LHEVY L066, MD Z081S Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. SOL IVAN 1EN6WEL-R,lg6 .2rC-- Q U� ACr( /), 7PA'RKER RD. P•0,20X U51 Jf to OSVE'RJ,u-I✓ 50 yZ8-33yy Type of Building: Dwelling No.of Bedrooms q Lot Size 2-lo4 suttES-sq-#'t. Garbage Grinder(✓) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow + gallons per day. Calculated daily flow 414 0 gallons. Plan Date NOYEM►�ER I 2ooZ Number of sheets Z Revision Date Title Pk0�05E1> Se'FTIC UPGKA-DE' Size of Septic Tank 1500 &AL Type of S.A.S. 5-500 CAA(.. CttAMSERS IN Description of Soil O-Zg' A LAYER LO&KY SANI> ZB-y4" B CAYEP. WARbE SAND !tHGt CI LOWER �A�SE 50.ND 46-IZS CZ LAYER MED_ SAND NO WASE� Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss by this B=of Signed Date 11-13 -Oa Application Approved by Date ,.Z Application Disapproved foAbe following reasons Permit No. Date Issued /I /7-v 7 Nb. .. Fee I OC7t 0•f� __ _ THE COMMONWEALTH OF MASSACH ETTS Entered in computer. +` Yes ,PU LIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 01ppYfcation for MRt.paal *pgtem Congtructiott permit Application for a Permit to Corisiruet Repair Upgrade Abandon( ) El"Complete System ❑Individual`Components Location Address or Lot No.9�11 SEAVfE W AVE, Owner's Name,Address and Tel.No,., OSTERVILLE R%UAPAD-Gat,MAN Assessor's Map/Parcel, 5ZOS tc'KAM6ERLIA/AVE, r { �90,-001P' ' otavy Loss—,MD zo81S Installer's Name,Address,and Tel.No. 1 ek ner's Name,Address'and Tel No. ' Sic- IVAM`ENbWFER1t16 d!C• �n ) 7'PAIRKIFR RA P'A,"e'130X u5`J 50g•4Za-334y Type,of Building: Dwelling No.of Bedrooms y Lot SizeZ.loy,AGRES 1q-ft. Garbage Grinder(-,") Other h Type of Building No.of Persons k yp g &� 7 • Showers( ) Cafeteria( ) j Other Fixtures i Design Flow ggOt gallons per.day. Calculated daily ly flow y140 gallons. 4 Plan Date MbVEAFER 1, ZOCZ,. Number of sheets Z E Revision Date Title pk0P05Eb SEP" TkC Q?6KA1>E k t Size of Septic Tank 1500 UAC Type of S.A.S. 5-500-GAL. C AMBEAS. W 1Z�-10"a�p'•�" F1EL> , '\Description of Soil O-Za' A LAVER LoAKY SAND Z43.44" Z CAitk CoARS'E sAVb W-W Cl CANER LoW_sE S;kfJ1> 46-IZs" CZ LMEK WED. SAND NO WATEP. Nature of Repairs or Alterations(Answer when applicable) •-......_Date last inspected. Agreement: ( . The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi; ' Cate of Compliance has been iss by this Bo d of "t . Signed / 13 r'0-1 Date if Application Approved by _ Date ' Application Disapproved for a following reasons i Permit No.��t Date Issued // / ?-a i ————————————----------- —————— — --- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance i THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( ✓)Upgraded(✓ ) I Abandoned( )b at QS)1f'V//cam has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.—u o Q?V dated Installer Designer " . The issuance of this permit shall not be construed as a guarantee that the'syste�rl ill function as de.igned. n ( Date Inspector / r 1 i No.00VtD_53 ---------------------------Fee 00, �d THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS liopooal *p.5tem Conotruction Permit Permission is hereby granted to Construct( )Repair Upgrade(✓)Abandon( ) i System located at 9''il/ SP1 ;o at o /MVP • A /'✓/V e_ and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this rITit. r . O Date: ! a Approved by TOWN OF BARNSTABLE v LOCATION �y e-AUceLJ U e-. 6 Af2(46 IF SEWAGE# 6200a2-53Y VILLAGE ens��le ASSESSOR'S MAP & LOT 616 Job INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY J6e4 G,q/1bz -- Cb/fnAAE'"e'4T 0 LEACHING FACILITY: (type) 6400 C41104 A'�,FAiyt�7 C�� (size) /off%a�X $"0�6 A j NO. OF BEDROOMS BUILDER OR OWNER /(iCt�{A G!/; A17 PERMIT DATE: A1011, .13 "CQ COMPLIANCE DATE: )I-�0 U'; 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 i 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 i Furnished by I ti ; GQ^ACZ Ilk ao � sod 6 • �qJ�v.i.��at '9II COM/4�nc.c/s- ��8 AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION V.CAU mAZA Vt $yAE p Tn5p VILLAGE "F ru,1 ASSESSOR'S MAP&PARCEL Il 'S NAME&PHONE ,,NO. o r,GIC 0�OnA•l SEPTIC TANK CAPACITY AOCO )^ LEACHING FACILITY:(type) NO.OF BEDROOMS OWNER K'GHyr �C�'MC A PERMIT DATE: C ATE:7;4P Il 1-1 lI 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 Of any wetlands exist within i 300 feet of leaching facility) Feet FURNISHED BY " 51 15 i se 7169 http://issgl2/intranet/propdata/prebuilt.aspx?mappar=090006&seq=4 9/17/2013 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form =Not for Voluntary Assessments 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 November 17, 2011 every page. Citylrown _ State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. ' Important: A. General Information • When filling out • 14, forms on the _._ . . .. . . ...... r t computer,use 1. Inspector: only the tab key L{/ '✓✓ t to iilove you ratricc v. tLonnei - cursor-do not Name of Inspector ; use the return key. Septic Inspection Services Co. Company Name 189 Cammett Road Company Address -; Marstons Mills MA 02648 ,enen City/Town State Zip Code 508-428-1779 SI 12855 Telephone Number _ License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority November 17, 2011 Job# 11-207 pector'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. ****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. ' 11-207 Colman 941 Seaview H.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 a Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 November 17, 2011 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Tank is not in need of pumping at this time, leaching system shows no signs of surcharge. 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 I' ❑ obstruction is removed 11-207 Colman 9411 Seaview H.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 November 17, 2011 every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced Nib 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: 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. 11-207 Colman 941 Seaview Kdoc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 November 17, 2011 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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_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. 11-207 Colman 941 Seaview Rdoc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 r r . Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System form - Not for Voluntary Assessments 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 November 17, 2011 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 11-207 Colman 941 Seaview Kdoc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is required for Osteryille MA 02655 November 17, 2011 every 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? ® ❑ 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 Ab3orption 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)] 11-207 Colman 941 Seaview Kdoc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments LM 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is Osterville MA 02655 November 17 2011 required for - , every page. Citylrown ` State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 7 Number of bedrooms (actual): 7 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 70 Number of current residents: 2 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 0 No Water meter readings, if available last 2 ears usage d N/A Irrigation g ( y g (gpd))-. system. Sump pump? ❑ Yes ® No Last date of occupancy: CurrentlyOccupied. 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: Last date of occupancy/use: Date Other(describe): 11-207 Colman 941 Seaview Kdoc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 -<�\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 November 17, 2011 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of Information: None 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Compliance date: 12/9/94 Were sewage odors detected when arriving at the site? ❑ Yes ® No 11-207 Colman 941 Seaview Kdoc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 November 17, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 1 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ 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 gal. Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 2" Distance from top of 6"'Scum to top of outlet tee or baffle . Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Measured 11-207 Colman 941 Seaview Kdoc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts 01. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 November 17, 2011 every page. City/Town 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.): Liquid level was found at bottom of outlet invert tees are intact and clear. Tank is structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): I 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 rerommendat6is, 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): 11-267 Colman 941 Seaview Kdoc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 November 17, 2011 every page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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 Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 01. 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.): No solids or high stains present. Liquid level was at bottom of outlet pipes. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 11-207 Colman 941 Seaview Rdoc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 November 17, 2011 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 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: Type: ❑ leaching pits number: ® leaching chambers number: 18 Infiltrators. ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ Teaching 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.): SAS shows no signs of surcharge, soils were probed with no signs of saturation. M 11-207 Colman 941 Seaview Kdoc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 November 17, 2011 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): 11-207 Colman 9411 Seaview Kdoc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form Not for Voluntary Assessments 941 Seaview Ave.—(Main House)--- - -------- ___.-_---------.-_-- Property Address Richard Colman Owner Owner's Name informationis requiredairedfor Osterville MA 02655 November 17, 2011 for -----------------------___..__.._._..__------ -------- ------- — every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 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. \ \ \ \ \ \ \ \ \ \ 51 15 98 :. : .. :. : ... 69 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 . November 17, 2011 every page. Cityfrown State Zip Code Date of Inspection D. System Information (Cont.) Site Exam: ® Check Slope ® Surface.water ® Check cellar ® Shallow wells Estimated depth to ground water: 15+ feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Ocean at rear of property is approx. 15 feet lower than area of SAS 11-207 Colman 941 Seaview Rdoc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 ^ � Commonwealth of Massachusetts T Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 941 Seaview Ave. (Main House) Property Address' Richard Colman Owner Owner's Name information is Osterville MA 02655 -October 20, 2009 required for every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Impotent: A. General Information When filling out forms the computer, r,use 1. Inspector: / J only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name 189 Cammett Road Company Address Marstons Mills MA 02648 Bmn CityfTown State Zip Code 508-428-1779 --Y SI 12855 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was,performed based on my training and experience in the proper function and maintenance of on site a seAge disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of N Title�5(310 CMR 15.000). The system: " Passes ❑ Conditionally Passes ❑ Fails Needs Further Evaluation by the Local Approving Authority Cy­ ' -- October 20, 2009 In ector'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. ****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. 09-212 Colman.doc-08/06 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 1 of 15 Commonwealth of Massachusetts u - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 October 20, 2009 every page. Cityrrown 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: Tank is not in need of pumping at this time leaching system shows no signs of surcharge. 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: ❑ i 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 09-212 Colman.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 October 20, 2009 every page. City(rown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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: 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 i oard 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. 09-212 Colman.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M rt 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 October 20, 2009 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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_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. 09-212 Colman.doc-08106. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts v. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ..'' 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is Osterville MA 02655 October 20, 2009 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (contj D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,.therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 09-212 Colman.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form , Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 't 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 October 20, 2009 every 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? ® El available 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, L dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 09-212 Colmen.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 October 20, 2009 every page. Cityfrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 770 Number of current residents: 2 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 0 No Water meter readings, if available (last 2 years usage (gpd)): N/A Irrigationsystem. Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied. 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: Last date of occupancy/use: Date Other(describe): 09-212 Calman.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 October 20 2009 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: None 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Compliance date: 12/9/94 Were sewage odors detected when arriving at the site? ❑ Yes ® No I 09-212 Colman.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is Osterville MA 02655 October 20 2009 required for , every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 1 . Depth below grade: feet Material of construction: ❑cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ 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 gal. Sludge depth: 3 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 Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Measured 09-212 Colman.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 October 20, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level was found at bottom of outlet invert, tees are intact and clear. Tank is structurally sound. K. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene e ❑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.): 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): 09-212 Colman.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 October 20 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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 Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0° Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No solids or high stains present. Pump Chamber(locate on site plan): Pumps in working order:' ❑ Yes ❑ No Alarms in working order:_ ❑ Yes ❑ No 09-212 Colmen.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 October 20, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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: Type: ❑ leaching pits number: ® leaching chambers number: 18 Infiltrators. ❑ 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.): SAS shows no signs of surcharge, soils were probed with no signs of saturation. 09-212 Colman.doc-06l06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts : Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 October 20, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert , Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): m 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.): - 09-212 Colman.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 I . I Commonwealth of Massachusetts - r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is Ostervllle required for _ MA 02655 October 20, 2009 eve ry page. Cit frown State Zip Code Date of Inspection D. System Information (cont.) 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. ♦ , ♦. / /r�r,`/•/ r / rY�'r-(r r r r r / r r / r r / , , 51 15 98 69 D Irifrtr . r Commonwealth of Massachusetts u - Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments " 941 Seaview Ave. (Main House) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 October 20, 2009 every 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 ground water: 15+ feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with focal 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: Ocean at rear of property is approx. 15 feet lower than area of SAS 09-212 Colman.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments. 941 Seaview Ave. (Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is Osterville MA 02655•• November 17, 2011 required for every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. -- Important: A. General Information- Men filling out forms on the I computer,use 1. Inspector: c^!y the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key._ Septic Inspection Services Co. Company Name - 189 Cammett Road Company Address .. Marstons Mills MA 02648 City/Town State Zip Code 508-428-1779 - S112855, Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system,at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of,on site---.' sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails I Needs Further Evaluation by th : Local ,Anprnvina Authority i` _ November 17, 2011 Job# 11-206 Ins-ector's ignature Date V Y ' The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. d� 11 11-206 Colman 941 Seaview C.doc•08/06 Title 5 Official Inspection Form Subsurff a Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 941 Seaview Ave. (Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is Osterville MA 02655 November 17, 2011 required for every page. Cityrrown 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: Tank is not in need of pumping at this time leaching chambers have no standing water. 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 Ceitir`ica 2' 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 11-206 Colman 941 Seaview C.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 941 Seaview Ave. (Cottage/Garage) _ Property Address Richard Colman Owner Owner's Name information is Cisterville MA 02655 November 17, 2011 required for Date of Inspection every page. Cityrrown State Zip Code p B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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 p system will ass inspection if(with approval of the Board of Health): Y ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: 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 to accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a'manner wiiiel-i wili protect pub=. c 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. 11-206 Colman 941 Seaview C.doc•06/106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 941 Seaview Ave. (Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 November 17, 2011 every page. CityfTown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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_day flow El ® ' 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 'i tributary to a surface water supply. 11-206 Colman 941 Seaview C.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 941 Seaview Ave. (Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is Osterville MA 02655 November 17, 2011 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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. I have determined that one or more of the above failure criteria exist as described in 310 CM 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 ques±ions in Section,D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 11-206 Colman 941 Seaview C.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 941 Seaview Ave (Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is Osterville MA 02655 November 17, 2011 required for every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® . Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® El information on the proper maintenance of subsurface sewage disposal systems? The size and location-of the Soil Absorption System (SAS)on the site,ha`s been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® El approximation 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)] 11.206 Colman 941 Seaview C.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w. 941 Seaview Ave. (Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 November 17, 2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 40 0 Number of current residents: 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 years usage (gpd)): N/A Irrigationsystem. Sump pump? - ❑ Yes ® No -Last date of occupancy: Unknown 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: Last date of occupancy/use: y Date Other(describe): 11-206 Colman 9411 Seaview C.doc•08/06 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 941 Seaview Ave. (Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 November 17, 2011 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: None 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 J ❑ 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: Compliance date: 11/20/02 Were sewage odors detected when arriving at the site? ❑ Yes ® No 11-206 Colman 941 Seaview C.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 941 Seaview Ave (Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is Cisterville MA 02655 November 17, 2011 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 1' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ 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 10.5' long x 5.8'wide- 1500 gal. Dimensions: 0" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 0" Scum thickness Distance from too of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle M How were dimensions determined? Measured 11-206 Colman 941 Seaview C.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 941 Seaview Ave. (Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 November 17, 2011 every page. City/Town 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.): Liquid level was found at bottom of outlet invert, tees are intact and clear. Tank had liquid only, no solids. 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 Comments (on pumping recommendations, inlet and outlet`ee 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): 11.206 Colman 941 Seaview C.doc•08106 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 10 of 15 .w r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 941 Seaview Ave. (Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is Osterville MA 02655 November 17, 2011 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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 Distribution Box (if present must be opened) (locate on site plan): 0.1 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.): No solids or high stains present. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order- ❑' Yes ❑ No 11-206 Colman 941 Seaview C.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 941 Seaview Ave. (Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 November 17, 2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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.- Type: ❑ leaching pits number: ® leaching chambers number: Five 500 gal drywells. i ❑ 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.): Leaching chambers have no standing water or sidewall stains. 11-206 Colman 941 Seaview C.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 941 Seaview Ave. (Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 November 17, 2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert — Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): I 11-206 Colman 941 Seaview C.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 r Commonwealth of Massachusetts - - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 941 Seaview Ave. (Cottage/Garage)_ Property Address — — — Richard Colman Owner ----- — — -- — — --—-- Owner's Name — information is required for Osterville — _ ______ _ _ _ MA 02655 November 17, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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. 17 2 2 51 if �nn W t ut �i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4M 941 Seaview Ave (Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 November 1.7, 2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells 15+ feet Estimated depth to ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Ocean at rear of property is approx. 15 feet lower than area of SAS 11-206 Colman 941 Seaview C.doc-0a106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 `./" (�(/ -- �c�; , ��v I J � �l�i�. . ` / v l (��/�'� � a i i f �_ _____. Commonwealth of Massachusetts, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 941 Seaview Ave. (Cottage/Garage) Property Address Richard Colman Owner Owner's.Name information is required for Osterville - MA i '02655" October 20 2009` every page.. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Impodant:When filling out A. General Information When forms on the computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name 189 Cammett Road Company Address Marstons Mills MA 02648 City/town State Zip Code 508-428-1779 .__ SI 12855 Telephone Number License Number CV . c)B. Ceitificatiom CO I certify that I have personally inspected the sewage disposal system at this address and that the c information reported below is true, accurate and complete as of the time of the inspection. The inspection ► as performed based on my training and experience in the proper function and maintenance of on site 'Lj-- —sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of a Title 5(31..6-"0MR 15.000). The system: 0 e H-- ® Passes ❑ Conditionally Passes ❑ Fails eeds Further u tion by the Local Approving Authority October 20, 2009 I pector's l natu Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. U 09-213 Colman.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage posal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 941 Seaview Ave. (Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is Osterville MA 02655 October 20, 2009 required for every page. Cityrrown 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: Tank is not in need of pumping at this time, leaching chambers have no standing water. 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 09-213 Colman.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -,Not for Voluntary Assessments 941 Seaview Ave. (Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 October 20, 2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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: 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 passunless Board"of I1ea;th 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. 09-213 Colman.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 941 Seaview Ave. (Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 October 20, 2009 every page. City/town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 we!!**.- 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 forsall inspections: Yes No El ® 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_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. 09-213 Colman.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts : Title 5 Official Inspection Fora, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 941 Seaview Ave. (Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 October 20, 2009 every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. ' Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large M 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. 09-213 Colman.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 -C\• Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 941 Seaview Ave. (Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 October 20, 2009 every 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? ® ❑ 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)) 09-213 Colman.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 15 F Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 941 Seaview Ave. (Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is Osterville MA 02655 October 20 2009 required for , every page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ® Yes ❑ No N/AWater meter readings, if available last 2 ears usage d system. Irrigation 9 ( Y 9 (9P ))� system. it Sump Pump? ❑ Yes ® No Last date of occupancy: UnknownDate , Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203): •Gaibns 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: Last date of occupancy/use: Date Other(describe): 09-213 Colman.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r� 941 Seaview Ave. (Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 October 20, 2009 every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: None 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 fYom 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: Compliance date: 11/20/02 Were sewage odors detected when arriving at the site? ❑ Yes ® No 09-213 Colman.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 r �. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 941 Seaview Ave. (Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is / required for Osterville MA 02655 October 20, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: feet . Material of construction: _ ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ 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: 10.5' long x 5.8'wide- 1500 gal. Sludge depth: 0" Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 011 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle I How were dimensions determined? Measured 09-213 Colman.doc•08/06 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 9 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 941 Seaview Ave. (Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is required for Osteryille MA 02655 October 20, 2009 every page. 'Citylrown 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.): Liquid level was found at bottom of outlet invert, tees are intact and clear. Tank had liquid only, no solids. 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): h 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): 09-213 Colman.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 941 Seaview Ave. (Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 October 20 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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 Distribution Box(if present must be opened) (locate on site plan): 0,1 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.): No solids or high stains present. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 09-213 Colman.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 941 Seaview Ave. (Cottage /Garage) Property Address Richard Colman Owner Owner's Name information is Osterville required for MA 02655 October 20, 2009 every page. Citylfown State Zip Code Date of Inspection D. System Information (cont.) 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: k Type: ❑ leaching pits number: ® leaching chambers number: Five 500 galdrywells. - ❑ 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.): Leaching chambers have no standing water or sidewall stains. f 09-213 Colman.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '~ 941 Seaview Ave. (Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 October 20, 2009 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): 09-213 Colman.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 rCommonwealth of Massachusetts usetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 941 Seaview Ave.__.(Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is Osterville required for MA 02655 October 20, 2009 every page. CitylTown State Zip Code Date of Inspection D. System Information (cost.) 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. % / , / / !%.% / !%/%.%. Qriutntay , / J / , / , / / , / „ ! „ %! 2 17 2 51 r Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 941 Seaview Ave. (Cottage/Garage) Property Address Richard Colman Owner Owner's Name information is required for Osterville MA 02655 October,20, 2009 every 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 ground water: 15+feet _ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) r - ❑ 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: Ocean at rear of property is approx. 15 feet lower than area of SAS 09-213 Colman.doc•08106 Title 5 Official Inspection For m:Subsurface Sewage Disposal System•Page 15 of 15 TOWN OF BARNSTABLE 7INSTALLER'S N (// �r SEWAGE #P�✓i(Q� ASSESSOR'S MAP & LOT 0 NAME & PHONE NO.ANK`CAPACITY C LEACHING FACILITY:(type) /0` /�/ j,� 0✓ (size) / Al NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER7X4f— BUILDER OR OWNER DATE PERMIT ISSUED:AP4 a' DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No q - v �� -Y THE COMMONWEALTH OF MASSACHUSETT-S— BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diopoottl Nimbi Tomitrnrtion run it Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: ..... �2 1....5�A.u! w.tivE..----os &&1 -----------------------------------------------------------------•---------••---...........••--'- oft ./ Add ress �/ --.Y.�.�,e..----- � No:/'Y1 gC l0.U!/1.L--....-•--•-••-- )Ci!JA_._ 5�. '1.'�yV-------------------------- /..................��/ /�A ta, /� q 1i1.� aIiL/I�N 1..1�!. of�� � AV ..!!..1.rV�/f r... ®J (5. .�.1.1�..... Installer Address d je of Building J Size Lot............................Sq. feet U Dwelling— No. of Bedrooms.._._..._l.................. . . Expansion Attic ( ) Garbage Grinder ( ) ----- -- aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) 0.t Oth r fixtures --------------- ------------- W Design Flow----- - ---------------------_--_--gallons per person per day. Total daily flow----. .............................gallons. WSeptic Tank—Liquid capacity), gallons Length---------------- Widtl},d-s--------- Diameter................ Depth................ x Disposal Trench—No. .................... Width_.IIV............ Total Length---- ' ........... Total leaching area....................sq. ft. 3 Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.................................................................... ----- Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ rz Test Pit No. 2................minutes per inch Depth of Test Pit...----------------- Depth to ground water........................ 9 -----•----•'--------------'----•--•-'----'-'........'-'-"-•------•----------------'•--._...--------......................................................... 0 Description of Soil......................................................................................................................................................................... x V ...-----•-••-•-'-••----••-•-•---'------------------------------•-'•---"--'------'--••------------------•--•--•-•-•--'------••-----------------•--•-•-••-------'-------------------••---•----------•-'-- W ••---•-•-•-•-------------------------------••---••--- ---------..............-------------------------------------------------------- /�- -------------= �, U Nature of Repairs��o��Alterations—eAns� r�en applicable.-.-4a-..1.9----I- 1�✓� q�Q -..u?.`.�!�?........................ --------••-'......--'- -...... S ......G-£------..................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees.not to place the system in operation until a Certificate of Compliance has been issued by the b(oarrdd off health. Signed ...... .. ......... ............ .. 1 " "........... /� o� e..- -1 ... Application Approved By .......... 'A:......... ..----------L%. Dace \ Application Disapproved for the following reasons: .................... .----------------------------------------------------------------------------------- Permit No. W Issued -.,./ .=' . e Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of C antyliance 9 THI S TO CERTIFY;,T at the Individual Sewage Disposal System constructed ( ) or Repaired (� ) by ............. . .......... ... ----- �1.CA/ 'a�`�--... . .... -- ---------------------------------------- ---------------------- ----_------------------------------- at .. m....5 '. U l o' (��C----------..tom-�:...�' � v 1--�. �------------- _----------------------------------------------------------------------------- .. has been installed in accordance with the provisions of TITI.E of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ��... ..: ..���&qS . dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON-S& A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. - � '>" '"' '� - Inspector - `'+ .�_: -- -------4...'� ---- ` DATE..... i ----------------------------- ------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Permission is hereby granted.... .?!� ?.'• {t�------------------------------------------------- ...... to Construct or Rr pair (X) Individual Sewage Disposal System atNo.g (. A ......0 .. (IZ_UI............................l -l- --------------- ------------------------------------- ----�J-----.-...........�,/ Street 1/-IN ! ,��"'. as shown on the application for Disposal Works Construction Permtt .o/__ _________ Dated..____...;:_.__.....__...._................ ----- -5-.5�- .............. --------------------------- /� ` Board of Health DATE-------- ..................... l FORM 36508 HOBBS 6 WARREN,INC.,PUBLISHERS f. A ---,r �, _ h No. -- . Q dU Fria...✓ :...�'�-� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Bi_npuuttl Works Towitrurtiun rrrniit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: . .... UI LOj....F_�_.0E....--OS.s��� ll�� &- Location-Address o Lot No. r►.�,h .....e�.(.rn q .............................................. yi -s A�, _ ... v --- ..........------------ nOwner ddre Jam_!`�.P S .......................................w %iV O5 � . 1 ---- ..-•-•---• --- --------------------------------- �? y ------. Installer Address d ype of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.__._.___!__________________ __ Expansion Attic ( ) Garbage Grinder ( ) --------------- No. of persons---------------------------- Showers —per,, Other—Type of Building _____________ p � ( ) Cafeteria ( ) a' Other fixtures ------------------------------------------------------ W Design Flow...../a.O_________________________gallons per person per day. Total daily flow.....//55...................._........gallons. WSeptic Tank—Liquid capacity;�900.galIons �,ength--------------- WidtlL_i--------- Diameter.---. ___-_- Depth................ x Disposal Trench—No __________________ Width_.Ay-----_-__--- Total Length...__�__C-7........... Total leaching area....................sq. ft. Seepage Pit No...................... Diameter...........--------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0-4 Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water-.__-.------__----_._._. f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+ -----------------------------------------------------------•------------------------._......._------......................................................... ODescription of Soil........................................................................................................................................................................ x U --------•---------------------------------------••--•----•-----•-------------------•---•-......------------------....--------------------------...•---------------------.............------.....-------- W -------------- ---------------------------------------------------------------------------------------------------------------------- -_ .,.-;- U Nature of Repairs or Alterations—Anse�'jer when applicable.-__k sa..._L_>�?.._.I W S?.b7R Aas_..u?!�. ........................ Agreement: The undersigned agrees to install the aforedescribed Individual.Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued bythe board of health. Signed .---(� ` '�` .. -...IJ..I �v`-� .................. Application Approved By ------ ..._eC —.._ G " ! ........ ......................................... ........................................ Dare Application Disapproved for the following reasonr: ---------------------------------------/............................................................................................. ........................................................... ..... ....- ....................................... Permit No. /'........... ..................... Issued ...^. ....":. ...... Dare TOWN OF BARNSTABLE UNDERGROUND FUEL AND -CHEMICAL STORAGE SYSTEMS VA � ASSESSORS MAP N0. PARCEL N0. 9�I 'ADDRESS; I Ye/U e- VILLAGE% `7D ' .�✓ � CONTACT PERSON q-(Z � ; �?��- PHONE NUMBER LOCATION OF TANKS; CAPACITY: TYPE OF' FUEL. AGE: TYPE: LEAK OR' CHEMICAL::— = - nt??'ECTI01�h__. ~ - SYSTEM' DATE OF PURCHASE OF EACH: 1. 2. 3. 4. 5. _ DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS PLEASE PROVIDE A-SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD. r .. . r,- _ 't �a _. a5 _ _ �'-� .. ... _ - e .. -. �� ' t • / > ` � �t '. i::. .., � �' ��f � •,. �� ��: � i��� . � �� � ��� . . A • 1 . �;�� �., �.__ ��. 4 JUN 13 '91 ,15:49 CENT.dST.FIRE DEPT. P.2/2 'FORM F.P. 292 (rev.9/90) Department of Public Safety Division of Fire Prevention and Regulation AMCAT"FOft PEAW, AW PEAW, FOR REMOVAL. ADD TRMSPORTATION TO APPROVED TANK YARD Permit �! [late ZIQ City,Town or District DIG SAFE DUMBER Fee Paid: �. � start: dat u In accordance with the provisions of Chapter r 148, Sea. 38A, 527 CHR 9.00 application is hereby made by.- }qj, ,P_p,j Tn 31 K. _ -,Street Addr ess & City or To ,�,.��. __, - �, � __..�..... �... ..�: �.;__ .�_� .-,.,, , _ .- - - w, .. ,. ,.��-.:,• a ., .. .��; . :---.T...:, signature of applicant ,Applicants name printed: , For permission to remove and transport one underground storage tank from. owner: A.j. el ,nn oC, ,Zc, Street Address: Ci S U 5 Firm transporting waste-.— - �.._ State Lid Hazardous waste manifest ��`�' c��Cr.U_i�� � T E.P.A. #_ � �16 Approved tank yards, -C r c !ifL 0 Tank yard Addresst Type of inert gas: ill, tank #: Tank capacity: -,�:,-C>� substance last storedso� Date of issues _ date of expiration; `>y�C cad 19�c/ Signature/Title of officer granting permit: JW KEEP ORIGINAL AS, APPLICATION AND ISSUE DUPLICATE AS PERMIT J , J _ s b ASSESSORS MAP NO•,& 9'40 No.-- PARCEL NO: 9a q - BOARD OF HEALTH TOWN OF BARNSTABLE 0[pplicat ion,for V ell Con0ruct ion Permit Application is hereby made for a permit to Construct ( 9, Alter ( ), or Repair ( )an individual Well at: 9((------Se-`----�_o e w------ -4`7- - - -- - -- - - -------------------------------------------------------------------------------------- //�� / ( Location — Address Assessors Map and Parcel /!!G 4 CL c` Q ^,u ------------------------------------ y/=—S `��'t E—` —C�c'_e --------------------------------------- Owner Address �_ll Qrs_�L / o ,/�j c,� l G o r►.t �s G/ - li 03 G cif Installer — Driller Address Type of Building Dwelling---------------------------------------------------------------- Other - Type of Building--------------------------------- No. of Persons--------------------------------------------------- �r Typeof Well- - -- ----- - -------------------------- 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 Compliance has been issued by the Board of Health. Signed-1c� -'�- -- - -- --- - /W% 7 f - -- date Application Approved ----_____`"------� date Application Disapproved for the following reasons:--------------------------------------------------_-________________-____ -__------------------------------------------------------------------------------------------------------------------------ "� date r �-- -------- t Permit No. -- -------- =- -- -------- Issued---------�--- - ------___f�___� date BOARD OF HEALTH TOWN OF BARNSTABLE o Certif sate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ('), Altered ( ), or Repaired ( ) ----------------�A_S__c Uti. �� - - ------------------------------- Installer at g 11_- S �u �'e"'--4� ------- 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 No4/� aDated °`� � THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------- -— Inspector---------------------------------------------- ,� L Fee-- --------- -- .__.. BOARD OF HEALTH ,. = . TOW ARNBTABL ', 4� p[uation AeIt Congtrutt ion Permit Application is hereby made for alpermit)to Construct ( L)Ater ( l&r-Repay(" )an individual Well at: y �j((l Seµ t e, G a C ,-- '= -- — A$`'- P-- ------------- --------------------- y - _ - Location Address f t ssessors Ma and Parcel i - -`;- :�--'--- r G��-/�-- — � s�-N -----`-+ --- ------- ��`--�-i� cam,----`�--`-�`� 1 --- - _--- --- - t � -- Own'r f Address - = //� /�j �( 1 QNN�LI P 1 LL' ___ D - �Y"___�� GS M`___Ov Installer —�Driller r 0 )��T 4 4ddressi TYPe of 18uilding.: � Dwelling-_-- ------ �-=-- f---------------------- her - Type of Building - ------------------------ No, of Persons------- -- ----------------------------------- Typeof Well 2Y --------- - -- Capacity-------------------------------------------------------------------- Purpose of Well -= -----'-'------------------------------------------ t 7 } 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 operationuntil a Certificate .of Compliance has been issued by the Board of Health. Signed -- --- — -` a�1-�--- -- date p- r�r Application Approved By _ --- �` pJ)c `--� - - ,. � date Applica-Cio�rsappr—Dyed-forte o owing reasons:-- --------------------------------------------------------------------------- -- --------------- --------------------------------------------------------------------------------------------- date Permit No. __ "-7 `-' �------------ Issued-------- `� -�- - -------------------- date a x �O 5��TtC t e -1 v 'e Deriartment of Environmental•Manademet>�t/Division of Water Resources WELL COMPLETION REPORT , WELL LOCATIO GEOGRAPHIC DESCRIPTION -Address CO �w 4+> n N S E W of J C Ge U t e v C4 (reed (circle► . -City/Town /�/�.aGl. . Well owner �O/M n N. R.G,t t /tk o/w•e! (road/ �. Address per-/Box, Ala N S E W. of &S (nil.in tenths) (clrclel Board of Health permit obtained: yes L'J no )lt(ersect. w/ (road) WELL USE WELL DATA / Domestic ❑ Public❑ Industrial ❑ Total well depth Monitoring❑ Oiher//l.l G. to Depth to bedrock - - ft. Water-bearing i ek/unconsolidated material: Method-drilled G•lt Gr Date chilled Description. Water-bearing zones: CASING . f) From To Typa. . SGM Ya G t, 2) From To Length ft. Dllal.1.D.) in. r* s 3) From To Length into bedroc Gravel,pack well: dia Protective well seal Screen: a Grout. / e SlockLSL length, from 2 to-''y FI STATIC,W TER LEVEL(all wells) Static'water level,below land sulface �� ft. Date WELL TEST(production wells) Drawdown3 f . after pumping !�"r.� min.at J� 9pm How measured, Recovery--;—. ft. after—hr. min. LOG of FORMATIONS C MMENTS : Materials From To ��`f �� J CGt N•v � � Su« (j J �riller e / I4 c F' f SCG[�Vr\ .( k r a�G a .�• '`� '�9 G I /lam`'• i'••(4. ��G Y 'f�l City/Town ra Supervising;Driller RegA T -.y i �Signature,al ruparvising registered well driller Y P/sssr Pnnr firmly ' BOARD'.AF.HAL'TH,,GQPY�., BOARD OF HEALTH TOWN OF BARNSTABLE i; Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( �), Altered ( ), or Repaired ( ) SCGvrc /� r i by-------- --_�� --- - - --———- -J / - -------------------------------------------------------------------------------------- � 4 tJ Installer R �} at I ��� J Z J_P.J —� Q,----LS 1 v/. � ( _ 14— ---------------------------— — 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!' l ated,4v- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL i SYSTEM WILL FUNCTION SATISFACTORY. DATE------- ------- — - ------ -- Inspector---------------------------------------------------------------------------- g `r I BOARD OF HEALTH TOWN OF BARNSTABLE lVell Con5truct ion Permit No. Fee- ---=_— `-`� ` '� �� Permission is hereby granted- - Cu v..1_ ____-___- to Construct (1-1, Alter ( ), or Repair ( ) an Individual Well at- �j/ No. ----g]--=----- Cu_vL P,a --� ---------�e'e l- _ -J ` ' ---------------------------------------------------------- Street as shown on the application for a Well Construction Permit No.- 1�" f- -�-�� ---- -- - - Dated - ------------- ------------------------`-!;�--- -- --- -- ----------------- .. _..� -u - _ Board of Health DATE - -- - ----ZZ-- -- — - ------ r Lim 941 e a Vi w _ Design eAve Studio Inc 1666 WASHINGTON ST.93 8.t-MA.02118 'MMV.IMCEy1tli5TUd0 WM Renovation Addition L rl UJw Lij W 11111d IIGie'Pi 111 WIW i� O NNI n i t ..,..._may., `1 . TITLE COVER FOR. 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Pt1C L 28b I I I a r I I Oi 120 bottles Ve I 1 30 bottles dec 3 ��, • ? i� I °i,7 IIILp bottles £ 1 �N TREADMILL _ 15 rows.d6cbrati oralivJ 1 00, 7.75x79.5 I I 1 I 4• A7 bbad -beam I I I W I I ! I cp0" above �Z I I I i i I I 1 60X60 TABLE I I 30 bottles 30 bottles a o1 I 'I I i WINE CELLAR � TEMPERATURE CONTROLLE _ .yrr,3i.ze.,w,,.rir,:rris;-rii�r<rrv.ri.y ivoY� GYM i i I bRICI(TILE FLOOR -NEW FOUNDATION — 10'-0"+ FIN.CLG I I I I 415 bottles— vertical CORK FLOORING I I I I 2400 bottles—horizontal C' 8 s eqwlnd.wj I I i I �l - FUTURE EXPANSION OF WI ROOM - - cl - N WALL • 3Ob 2-FURRING OCATEb —enlarge op8nln JR HANDBO BOg S O O O Q > — UP s EEzE STAIR HAL w H NEW FLOOR WATER HEATER //1 O UNE OF ' ,I BOi v LJ J �ULD.ARNDIDING AO 36X80 DR STORAGE •I I •I � EXISTING STAIR GROOMED CONIC. - NEW OPENIN • Fj}OU IN FOR COOLING EXISTING F OAI WALL=}' `I $IN +D ASHER - EXISTING BASEMENT -�L' !• PANTRY EXISTING EXIST Fcn�r+DATI Qft� s, 1 E W— 1 - WALL—PR041DE F tAO INSULATION 5• 1- r-r---- I I. 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GUEST SUIT odified exising stair EXISTING DECK U) TO REMAIN do L — — — — — — — — - OPENBELOW HALLWAYSTAIR HAL I 0 EX BA�l*A ------------------- EX. BA REMA N Jlinen ---- --- O EX. BAT TO REM AW— ROOF OVER ADDITION BELOW EX. BED RM 2 EX. BED RM 1 TO REMAIN TO REMAIN TITLE: PROPOSED PLAN FOR PROPOSED SECOND FLOOR I /ff NEW WALL DATE: 8-30-2013 REVISED: SCALE. 1/8" 1' A-3 Lim Design Studio Inc 1666 WASHINGTON ST.b3 Boston,MA.02118 —,UMOESIGrvSTUOIO.COM WARDROBE W 301 NEW AC REGISTER DNLl Q W LLJ J J --- LLJ L/� � C/'��J p r TITLE: PROPOSED PLAN �1 PROPOSED ATTIC �� �� � - t� .� NEW WALL FOR: DATE: 8-30-2013 REVISED: SCALE: 1/8"=1' A-4 MAP 90 Z 6 _ W # 941 - L❑T SIZE 2,64 ACRES Q W Z5c Q W 1 E ❑ G,I,S. Overall Site' Plan Scale: V _ 60' EXISTING STONE DRIVE o p _N PROPOSED 5EPTIC 51SIEM O O O IC;MIN. IL.3 (5EE SHEET Z oFZ) MIN. x14.3 O EXISTING GARAC�E� �OF EXI$TMG, SYSTEM GUESTVTbUSE _. TO be ReMOVED OR ABANDONED �F.F. ELEY. 12.4G) xIz'I SULLIVA;� K() 29733;I`dI L � x 12.3 v Plan View Scale: I " = 20' Title Prepared By. Prepared For: s Proposed Septic Upgrade a Date: November 1,2002 c At Sullivan Engineering, Inc. PO Box 65.9 I Richard Colman .0- 941 Seaview Avenue 0stervu►e, MA 026s5 52 Project#:05 Chamberlin Ave. Scale:As Noted Barnstable (Osterville), MASS. (508)428-3344 (508)428-31'15 fax Chevy Chase, NID 20815 ° Z O S PSuIIPEOt�ol.cm Z N �I , v FinislYC3!ade ' r m NOTES ----�„ TEST HOLE - 1 1. Water Supply For This Lot is Municipal Water. 9"MMi�it - .. ..-`'-' . .� ..,. 4�- --" � . .;-:= ._ . .�_, _- .:: Filter , Compacted Fill Fabric FESCUE LAWN 2. Location of Utilities Shown on This Plan Are Approx. �k 1 A LAYER lOYR 3/4 At Least 72 Hours Prior to Any Excavation For This a' f h z" �a •: 1/8"-iiz DARK YELLOWISH BROWN q Project the Contractor Shall Make the Required L a } tips - L Pea Stone LOAMY SAND 11.67 Notification to Dig Safe (1-888-344-7233) B LAYER lOYR 5/6 3. The Contractor is Required to Secure Appropriate A ;P YELLOWISH BROWN Permits From Town Agencies For Construction 3' 4411 COARSE SAND 10.33 Defined by This Plan. C 1 LAYER 2.5Y 6/6 ' " LEACHING r1 4. Install Risers to,Within 12" of CHAMBER 3i4^-1 l z" ` OLIVE YELLOW 2 G� , H-20 Double washed 4E i' Finished Grade. � f � ' COARSE SAND 10,17 �tr e 5 Scene C2 LAYER 2.5Y 6/6 . All Structures Buried Four Feet or More or Subject OLIVE YELLOW to Vehicular Traffic to be H-20 Loading. 4'-10" 125 MED. SAND 3.58" 6.,Septic System to be Installed in Accordance With t NO GROUNDWATER ENCOUNTERED 310 CMR 15.00 Latest Revision and the Town of lr-lo° APPROX.GROUNTwATER@ EL.zs Barnstable Board of Health Regulations. - 7. All Piping to be Sch. 40 PVC: CROSS SECTION OF CHAMBER Gal. 2 `ompartments. NOT TO SCALE _ � � 8 Septic Tank Shall be a 1500 The First Compartment Shall Havea o ume of Not Less Than 880 Gal. And the Second of Not Less Than 440 Gal. z , - Design Data RG L.14 F G EL 14 Single Family -4 Bedroom F With Garbage Grinder See Note 4(typ.) Daily Flow= 110 x 4=440 GPD -L.11.3 Septic Tank: 440 GPD x 200%= 880 GPD 1,�o,>EEtrs.t.NG�,rzL � Use 1500 Gallon H-20 Septic Tank i Top El.u o (See Note 8) 1500 Gallon r - 2-Compartment 4 M 4 Septic Tank Leaching Area p z tt x ems,* H-20 0 Flow Squired �� # � F: 440 GPD/0.74=595 SF+56%= 892 Required As Required EL lC sY suss Sidewall 2(12'=10" +50'-6")2 253 SF - Bot El.8.0. `" *Bottom Area= 12'-10"x 50'-6"=648 SF.` Bedding&"T"s' 901 SF Total Provided 1� —I as Per Title 5. If Encotmtered Remove&.Replace min. All Unsuitable Soils Within 5'of ' P Min. The Outer Perimeter of The System PMRa Leaching Chamber Design Slslwl.:v.A 0.29733 t DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEl�'I_ Groundwater E1,2.5 All Pipes to be Schedule 40. Use Gll+�ll.� rroT To SCALE PerT.o.B.Map 5-500 Gal. Leaching Chambers in a 12'-10" x 50'-6"Washed Stone Field as Shown. Title: Prepared By. Prepared For: Date: November 1,2002 s ly Proposed Septic Upgrade Sullivan Engineering, Inc. Richard Colman At PO Box 659 5205 Chamberlin Ave. Scale:As Noted �, 941 Seaview Avenue 0stervllle, Ma 02653 Chevy Chase, MD 20815 N Barnstable (Osterville), MASS. (508)428-3344 (508)428-31}5 fax project#:22051 PSWIPEVhol.Com N' y , LIM DESIGN STUDIO 1666 WASHINGTON ST.#3 Boston.MA.02118 W WW.UWDESIGNSTUDIO.COM 5'-2 " O p p O 44x62x95 as CABLE MOTION OISPLA '" `Li ik Y UPTICAL ;' i i �`� r i 20 bottles I r 30 bottles TR MILL ,� i ; `` { i 3_3!4 15 rows.declyrotive decorati 37x x62.25 2x80x6 i �.r » beats beam �; i i opoo above t TAS'} ARE I i i WINE CELLAR. 30 bottles W I 1 'V ciTEMPERATURE CONTROLLE /� GYM i i i i BRICK TILE FLOOR *NEW FOUNDATION - 10'-0"+ FIN.CLG benches/ro s CORK FLOORING 6 s s `• . i i i i sl t,;j st O 49x87x93 REPLACE EXISTING FOUNDATION BU 'I 30b TV WALL Ad la It 2" FURRING f �. ....I Lj enlarged window ing t 11 open O LOCATED BO BO I BO R HAND � bi ger op Ing O 0 O 5. _ Q Lu r -- up EEZ£R� � STAIR HAL � NEW FLOOR WATER HEATER LINE OF MUDROOM STAIR ^�, EXISTING STAIR > &LANDING ABOVE I ' I Z �. 3 X80 DR I i STORAGE j NEW OPENING @ EXISTIN� n BROOMEO CONC. s - IOU -IN FOR` s !WALL- T— a FOUNDATION _ » coo 1 §IN +D HWASHER FOR SO' DOOR EXISTING BASEMENT i " = PANTRY i EXISTING FOUNDATION i 't ___----- � E I IUN - 6- 1 \ WALL - PROVIDE RIGID�INSULJ,RION 1 i I I----- -------------- RIGID INSULATION IN X4 FURRING - TYF 0 FOUND ON W 0 O cnvrE O EXISTING CONC. FOUNDATION WALL e JA LOCATED DOOR UNE OF MUDROOM STAIR 'I CRAWL SP - IUNG ABOVE n OIL TAN 1 n a e n c>� NEW WALL TITLE: PROPOSED PROPOSED BASEMENT PLAN FOR: DATE: NOV 8-30-2013 1/4°-1'0° � � _ � A- 1 a` 1 O ! o L[Ma.. 1 DESIGN ! 1 1 t STUDIO 1 t 1 ! 16M WASHINGTON ST.#3 ! ! Boston,MA.02118 WWW.UMDESIGNSM0.00M 1 1 1 1 1 00' SH RE INE SETBACK / I L DIRECT ACCES$ TO POOL - OPTIONAL LANDSCAPE EQ -0 - ------------------------- ------ ------------------------ [__------------------------- [---__--- ----_� ____ STORAGE - b ues one counEer{op �,� � • i I NEW COLUMN BELOW PERGOLA-1 BY LANDSCAPE ARCHITECT , t -10" _ _ MATCH EXISTING ' s" I NEW DEgK ' as grill I 1, she, sAME'1�,FkRIAL COVERED DECK I 6'6" TALL WALL , t 1, TALL WAl RINSTAS ON I , < 2'-.8~ fold-out drying rock O � � 1 � � G 4'- t 1 _ r LV 47- tos J - \ J 1 � +_ ' SINK bin-t in w for q Kim's s re >. t ON b n4F t o t Yl t 3�ffi existingopening btwn kitchen dinin � � 1 1 cn. . 3 3 11 P 9 / 9 tt tt AODD(�Ot ® EXISTING CASED OPENING Ell itrl AUNOR I I t t NEW DECORATIVE BEAM AB0 _! 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STO 0 ; tt----------- t ' 103 48' ron a Pu ou ros ----------- 9 +recycie microwa Oi i KITCHEN e _ tosEXIST L 1 t B I M WD.FLR I . ( io io TILE i t t t t t 1 D.W. I SINK 1 D. 1 t ----� , t t —I--?--� d ._ 0 g 19-10 C A 8 �r ----- EXIST,ENTRY DOOR t DER W/ SHOWER WALL/F W-3" I. 15'-3" TITLE: MODIFY EXISTING DRIVEWA PORTICO PROPOSED PLAN 1 EXISTING 1 I PROPOSED FIRST FLOOR NEW WALL 1. t -------- -------------------------------------� FOR: DATE: 10-21-2013 MODIFY EXIST. DRIVEWAY SCALE: 114°-1'-U' A-2 LIM DESIGN STUDIO 1666 WASHINGTON ST.#3 Boston.MA.02118 W WW.UMDESK NMDIO.COM I ----------------EXISTING WINOOVYS --———————-——————————— ------t 4. a TO REMAIN a . to i ter ---� i 36x72 tub i I L--- EX. BED RM W' 1 ' DECK BELOW 5s s war ® i I CL i i OUTLETS TO BE IN THE INE .................. .... Cdll m 10" _ - {° MASTER . ROOF OVER ADDITION BELOt 1 117 11 ---- - Q '_ �(� SEATING AREA It �'� I < W . o a w ---- ; ; I 1 g -- - , --- -- - - -- --------- --------- I .ate.. ' I ' ------ _I J �7 - ------------------- URE& AREA OF WOR_---- - i ____——— — ---- — -- W dn 0 17) EX. GUEST SUI rriodi red axis tng stair UP i rm812:= ; i I i IN 1-7 1EXISTING DEC TO REMAIN d^ 1— — —iJ V HALLWAY oaeN BELOW STAIR HAL N STA[Ll EX. BA ------------------------------------1 TO REMA N -linen -------------- ----------- 3-------!L O EX. BAT STNG TO REM Fl ROOF OVER ADDITION BELO EX. BED EX. BED R . TO REMAIN TO REMAIN TITLE: PROPOSED PLAN 1 PROPOSED SECOND FLOOR FOR: NEW WALL DATE: 10-21-2013 SCALE: 1/411=1I-015 X-3 LI M DESIGN STUDIO 1686 WASHINGTON ST.#3 Boston,MA.02118 www.uwmr-imtmo.com ■ W sot STORAGE -------------------- I3T---------------------------- f� c DN HOME OFF W u EXIST SEATING .�jtr7 •►� cc W STORAGE LL1 U5 -=-----------------EXs�--------------------------- U) 0 r F1 TITLE: 1 PROPOSED ATTIC PROPOSED - NEW WALL PLAN FOR: DATE: 8-22-2013 SCALE: 1/4"=V-0" • A-4 DIRECTIONS: p From Hyannis rotery, take Scudder Ave. „ to the stop sign and take a right onto a° k Smith St. and continue to Croigville Beach Rd. Turn Left onto South Main Street and a Seft onto Parker Rd. Turn Right Onto Sea Veiw Ave. Property is on the Left # 941. 1 . A " LOCATION MAP: . Scale: 1" = 2000't _Hydrant # 79 A V e • h n BM Elev. 13.76 Seaview 3' Hag Co . wall c -�- 6.1 a 20-00 ASSESSORS REF.: Map 090, Parcel 6 58.8 OVERLAY DISTRICT: � Electric Meter AP - Aquifer Protection District \ RPOD - Resource Protection Overlay District � a �5,5 FLOOD ZONE: \ 1 Is Zone B, A 14(EL 12) & V17(EL 16) 1 \ / \ Community Panel o 0018D 1 ` July 2, 1992 T ce Court F e ! Tenn' Court ZONE., RF-1 Area (min.) 87,120 SF (RPOD) Frontage (min) 20' Width (min) 125' ISetbacks: Fron t 30' Side 15' Rear 15' N N3 . III i 7 MITIGATION AREA: Septic Permit # O 2002-534 O AM Components H-20 Disturbed Area: 0-50' Buffer 135.42 s.f. 0 50-100' Buffer 1115.57 s.f. a a a Mitigation Required: 135.42x4=541.68 s.f. \ rash Shed 1115.57x3=3346.71 s.f. \` O o L n \1Am G Total. 541.68+3346.71=3888.39 s.f. Bulked/Utility Shed Mitigation Provided: Garage/ c, 3900 s.f. Gue;/t 2 Stye m Elev w�f V \ri r Dwelling � � � `• Lawn Brick 2 Patio GEND L . r000 carton -•� \ E • leaching Catch Basin --` d TYP• Septic Permit #f 94-641 0 LCB Land Court Bound 13 CB/DH Concrete Bound w/drillhole f ! a SB/DH Stone Bound w/drillhole -- Hydrant --- Elevation Contour / 1 Pianrin Bed Light Post Lawn $ Utility Pole f Holly 1 Cedar Pine Brick <t Deciduous Planting Bed ,- St 3 Air Conditioning Units 2l�� Pr os/ Addition 0 t ( Covered Deck 25.4f #941 2 1/ Sty w/f Zc' EXistin Dwelling FF Erev.r �- -� 16.73 21.7' Patio Elev. 16.20 ✓�_ INS 12.82 .74 Steps Proposed Patio a 1329- �— 1 Lo Proµ�e�! Dry WeB Proposed id�Pao Draw _____ Pool Equipment Down & Drainogs• Proposed Pool Elev. 14.95 l \ Lawn , Pr`opose�Sato Lawn Wall & Fence B Top of wall Elev. 15.06_�.- ZONE of wall lev 12 61 _____ FEMA Zone— —. — A14(EL12) !:�CCC ::: .: ..... ........... ......................... ........... .......... �0. I A14(EL12 .::.T0:3t.Edge: F � _ -,OIL . - 12 1 .J l -1�'" EMA Zone V17(EL16) `Vegitation geoQ It c�hn Veg tatlon � � sha,,`r 10 •� B ch ti •—__._a— _ � ��. �. och r —> PETERSULUVAN o. 21733 N �i3 Nantucket Sound No. AU Add Tennis Court and Change Detail on 9/Sep t11 Revision: East Side of Property. Revision: Update Topo and Add Trees 10/July/1 TITLE. PREPARED BY. PREPARED FOR: Notes/Revision: Proposed Improvments Sullivan Eng'neering, Inc. 941 Sea View, LLC 1.) The property line information shown was ? PO Box 59 381 Beacon Street compiled from available record information. 941 Sea View Ave Osterville, MA 02655 Boston, MA 02119 2.) The topographic information was obtained Barnstable, (Osterville) Mass. (508)428-3344 (508) 28-9617 fox from on on the ground survey performed on or between 3/DEC/12 & 1/JULY/13. 0 Draft: JOD Field: MDH/WHL/MLL 30 0 15 30 60 120 3.) The datum used is NGVD '29, a fixed mean � DATE' January 24, 2012 SCALE: , » = 30' Review: PS omp./Review: MDH/RRL sea level datum. Project: ' Z9-- ro jec t: C284.5 SHEET 2 OF 2 BREAK OUT CALCULATIONS SYSTEM #1 EXISTING SLOPE = 0 SYSTEM #2 , DESIGN DATA DESIGN DATA SINGLE FAMILY- 7 BEDROOMS APARTMENT OVER GARAGE WITH GARBAGE GRINDER SINGLE FAMILY- 4 BEDROOM DAILY FLOW = 110 X 7 = 770 G.P.D. WITH GARBAGE GRINDER SEPTIC TANK = 770 X 150% =1155 G.P.D. DAILY FLOW = 110 X 4 = 440 G.P.D. x 14. SEPTIC TANK = 770 X 2 = 1540 GALS. LEACH FIELD = 440 X 150% = 660 G.P.D. USE 2000 GAL.SEPTIC TANK SEPTIC TANK = 440 X 200% 880 GALS. 1 � x 15.4 USE 1500 GAL. SEPTIC TANK 38' DISPOSAL DISPOSAL AREAo r �, USE 12 4'X 8' FLOWDIFFUSORS USE 6 4'X 8' FLOWDIFFUSORS WITH 4' OF STONE ON THE SIDES AND 3' ON BOTH ENDS WITH 3' OF STONE ON THE ENDS AND 4' ON EACH SIDE c x 14.3 1 SIDEWALL AREA = 2 16-+54 1 X2.5 = 350 GAL./DAY SIDEWALL AREA = 2(30+16)2.5 = 230 GAL./DAY 1 Y 3 0 - - o :o BOTTOM AREA - (16X54)1.0 - 864 GAS./DAY BOTTOM AREA - (30X16).,0 - 480 GAL. DA � o TOTAL DESIGN 1214 GAL./DAY TOTAL DESIGN 710 GAL-/DAY oOq ' 1 REQUIRED GAL./DAY = 1155 REQUIRED GALJDAY 660 ;n m DIST. r' BOX PERCOLATION RATE' PERCOLATION RATE: o ' x 14.4 1 INCH IN 2 MINUTES OR LESS, 1 INCH IN 2 MINUTES OR LESS. Z 1461- x NOTE: ALL COMPONENTS TO BE H-20 �--- 14 EXISTING �-GX 1500 GAL• CESSPOOLES N SEPTiC TANK ' TO BE FILLED 5.66 X 10,5 wv x 14.8 13. 4L1 \ CONSTRUCTION BID ALTERNATE' CONSTRUCTION BID ALTERNATE �.?' 13 12.4 Il�II�lIRATOIi USX MOH CdI'ACT'Y'' IISFILTRATOR - USE ffiG�f C�iPAGITY 13.4 - `-._ x Li USE 18 (3'X 16,) CHAMBERS USE 10 (3'X 6') CHAMBERS N � � � c �,� o USE A 14' X 60' WASHED STONE FIELD USE A 14' X 34 WASHED STONE FIELD <- o � °I \ in � E OJ SIDEWALL AREA 2(14+60)2.5 = 370 GAL./DAY SIDEWALL AREA = 2(34+14)2.5 = 240 GAL./DAY Q II 11 > °I \ �,_ w:- / �n R ,� r�.t\___ A,,-, .[,C*A _ (•�-tY1 l� O 4 C / Y _, > � J E N M AREA 60x!4 1.0 - 310 G"L, ur, r wTTOM � :.- 7� �,L. DA . 4 � � � ! BOTTOM ( 1 TOTAL DESIGN = 1210 GAL-/DAY TOTAL DESIGN = 716 GAL./DAYuj w 2.4 REQUIRED GAL./DAY = 1155 REQUIRED GAL-/DAY = 660 �- z i.L. t 22I 2 128 PERCOLATION RATE: PERCOLATION RATE: / x 1 INCH IN 2 MINUTES OR LESS. 1 INCH IN 2 MINUTES OR LESS. x lZ,y No 11.8 12.3 / \ 11.3 40.8 INFILTRATOR SECTION TYP. 68/695c _. S.B. 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AR ED env AAooAeA AOAAAeAA a a A n. eAn&nnLA&LALb vvv av PR ,c ,furtn 11,8� eennnAnnnnnnnnannnnAALapace.ace44AAAeAAeAA444AyeoeeeAC.pAAG\ t\AAe - - vvv v div Q OP�O�: epAAAeeeebenegeeeeeeL\AAAAnnAAeA�eAeeeAAN&LeAeAAALAALeLb Ovvvv000VDODVOODvvv vv / vv / ovv / • �0 Ch a3.41NVER A AAAAAAAA,A AAAA&&AAAA AI eA&AAA AA AAAA A A&Ice,&&WA eoeAeAea AaL\ec\AAA d I- vvvvvav vovvvvovavvvobo cc'77 cc7�v co Vth Porch A A A A AAA AAA A An A A A AAA&L\AAAAA&Aa,A&A A A A A AA A A.ALpAn&&nLneLAL� v b v v v b b b v v b vb v v by vv / a AAAAAAA&AAAA AAAAA AAAaL-eAeApAnAAAAAA&A&AA eaAt.,A AAAAfdeAL\ \neA 3' 3 3' 3' T EI EV y 12.20 INFER _ 13.4 11.3 x 12.2 ELOWDIFFUSER . SECTION SYSTEM, ,&OWDIFFUSER SECTION Y F BANK 13.0 13,0 TOP 0 _._. 4' 4' 4' 4. 4' 4, 4� x 11.4 A-14 ZONE" ( - 12 12 12" 1. ad Aa 'ace ada deC d4C dde a4e J.°. a °° dd� a C 1nA 4d did Qda Qe 44 AAd 44d _ _ d apZ add d da.B gpdCM p4 q d�d dd A�°aCddad C4 ddd4 dC,Add Q44,1 le A4Qa d4a.44d Q.A°a:. - O 18" p.LAN. aa�°ead`ded°dd° Q Qada°4cde4dda44A popa�Qad6AaQa desk';a aad� - _. SCALE: V = 20' ELEVATIONS ARE BASED ON N.G.V.D. 100 YEAR FLOOD ELEVATION 12.0' - 4 � F.F. ELEV. - 12.46' TEST HOLE COVERS LOCATED TO WITHIN -. 12" OF F.G. SEPTEMBER 22,1994 P. SULLIVAN BAXTER & NYE :INC, F.G.=13.8' F.G.= 14.0 PIT #2 ELEV. 14.2 PIPE SANDY INV,- 8.4 INV. = 9.29' LOAM & SUB SOIL_ T 4» DIAMETER 1500 GAL. INV. _ 8.2 0 P.V.C. WV. = 9.0' -2 _ 4 DIST. TOP ELEV. 8.7 SCHEDULE - BOX SEPTIC TANK BASEMENT FLOOR ELEV. = 4.96' INV. _$,$ PIPE INV. - 8.6 ' 10.00' o INFILTRATORS OR v v v v v v v v P ,f MIN vvvv`vv vvvv FD 4 X 8-S vvvvvv vvvv 2, PEASTONE MEDIUM WHITE SAND 3 4" TO 1 1 2" EL = 7.2 SET D. BOX ON 6" DEEP WSHEC. _SCONE _CRUSHED S N A _ - 2" PEASTONE SYSTEM PROFIlir-AUl r _ W TER V 12 WATER EL. 2.2 A E OBSERVED I�0 SCALE EL. = 2.2 F.F. ELEV: - 17.12" TEST HOIZ b COVERS LOCATED TO WITHIN SEPTEMBER 22,1994 12" OF F.G. P. SULLIVAN : BAXTER & NYE INC. F.G.=�3.8 . _ 13.0' F.G.= - INV. = 13.6' PIT #1- s .; n ELEV_ 12.85 INV. =8.0 PIPE SANDY F.G.= 12.0' T 4" DIAMETER 2000 GAL. LOAM & SUB SOIL wv: =10.2 INV. = 10.8' -3 = LE 40 P.V.C. DIST. V INV. 10.6' TOP ELEV. 8.5 scHEDu vox IN =10.4 -4 PERK TEST PIPE �r;.:... .::. SEPTIC TANK BASEMENT FLOOR ELEV. 9.20' o vvvvvv vv v INFILTRATORS OR FD 4 X 8-S, v v v v v v v a v v 2"' PEASTONE . .... EL �: 7.0' 3/4 TO 1 1/2,. SET D. BOX ON 6`' DEEP WASHED STONE 00 CRUSHED STONE BASE. MEDIUM WHITE 2" PEASTONE co pf SAND M OF SYSTEM # ti PROFILEpm Z yYM4.tAM Gv,. 5UUIVA#1 ROGERS & MARNEY 11.53 WATER EL. 1 .32` WATER OBSERVED N Y E �' No.29733 EL. = 1.32 ,f,t ,> iss��o NO SCALE ���s� COLMAN PROPERTY _ � ,�. SEAVIEW AVE UNAl #94109A-21 G