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HomeMy WebLinkAbout0986 SEA VIEW AVENUE - Health 986:S�ati e ✓'A�enue �' ke4 i i� e d J Q Y stervll�e ., d�•R t k '�4�•y; A`E091 0Q2 I fa C p ,•� t: , M � �- �,?.i t ,� t� , S M E A No.2-153LGN UPC 12134 HASTINGS,MN I 'I Lf 3 I� 2 o�z Ina 4dJ Si � �� �J��i✓� 1"� C� '-�lc`K 0 l� V C c ffe-J si-s, A owC-vgr2 �'h�5 �'�br , s b c�•k,J w'�^ c 2 ,^j 2 A cde a" �s tser c'n9 etc,\ r'I CJ IG J r t;n I'd�St , Y7 ll atits i i i ill ` f it Bit � �66, � ► �� t�- ry,)tiS 0c� 3l� 20/t- j m2,6. �'f'dJ Yi 1`e,l'S�r �J��i✓cn � �� .L J��Jx�"=� �TG i1 10 this Z %71- �I c��� �° Iaf,�1 •�I Ir� t91G�. rl b� M a; ti`d✓st . �o! �.oa�s I i " I � I I i; I ' I f I I I i i � i �� i TOWN OF BARNSTABLE LOCATION ( 1 cW#I Ems' riV� SEWAGE# VILLAGE O tc���LF_M,� ASSESSOR'S MAP&PARCEL AP0 1 �Ltot INSTALLER'S NAME&PHONE NO. JOO, 8Z3 SEPTIC TANK CAPACITY Sam LEACHING FACILITY: (type) �NAL'I1L_ (size NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility k[A Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) J Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 01 300 feet of leaching facility) Feet FURNISHED BY `. F86 5j5?W VAJ MCM-F Cqlco2- MA vL� l4 to Q 2S it r 000 ri A 32 5- �� A' h� z3 6 ol i, u �6« A 6t . TOWN OF B��A11 RNSTABLE LOCATION ��5� ►l�� SEWAGE# VILLAGE Q� V1 11-e ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO.R&a-q�-12�a la\3 SEPTIC TANK CAPACITY ,5G() LEACHING FACILITY.I(type) rt.3 5 I L'fC>7% (size) NO. OF BEDROOMS t OWNER W t1 kj A KM C A"sue PERMIT DATE: COMPLIANCE DATE: o� a 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) p� Feet FURNISHED BY ,�*`.-4r A �Icw LA io 5 3 yo Li� 3 3l i ;0�o v �f®3 No. Fee U THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for deposal 6pstent Construction Vermit >*,y Application for a Permit to Construct( ) Repair(, Upgrade(—I—Abandon �( ) ❑Complete System 'Individual Compone'nts Location Address or Lot No. 9 S& Sp4 V� A� O 's Name,Address,and Tel.No. cx A�Assessor's Map/Parcel D _pu Ge ( L —FLL9t Installer's Name,Address,and Tel.No. Desi ner's Name,Address,and Tel.No. i ;�i Nit 'v S�GIo:✓� � Zu ��i3 0�- - Type of Building: Dwelling No.of Bedrooms 7 (ffij�Am� Lot Size WT AM%:7% -sT.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) t1 gpd Design flow provided N gpd Plan Date �(�'',Z�zoty Number of sheets Z. Revision Date I Z-L)4I t'c L y Title � ►y1p��x,C Size of Septic Tank Type of S.A.S. Description of Soil Nature of R it or Alterations(Answer n 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 Enviro ental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board Hea Signed Date� � '� C_7L Application Approved by A9 A Date 1 2 m f Application Disapproved by Date for the following reasons Permit No. 70 d "l 6 Date Issued 2 — J �.a•-.`'�...r-y ..J,lJfrt.t.....s`rr r'f""yyyt -✓ - YVF t •qff r:. tr "^1^ "-.Y."'...d � t_y. i c„ ��,F}R� b SS�. � J�+ FiG'� �T•fCAy,'dA'..'��•'dM�' "1�"p/p'•n�ky' M1t �"L�`'"a"k i.' _ancrx� ..1„ k 1 Fee /LIJ . + /tHE COMMONWEAL OF MASSACHUSETTS Entered in 6'p'uter y {. � . PUBLIC HEALTH DIVISION,lb i'N OF•BARNSTABLE, MASSACHUSETTS }. a plit'Ation,for Mispo8AY ,pstem Cons CULtIotC PQCtYCit - Application for a Permit to Construct( ) Repair(,,)*.,, Upgrade(u:) Abandon( ) ❑Complete System ©-I'ndividual Components Location Addressor Lot No. �(. A VKw Owner's Name,Address;and Tel.No.. L' LTI Assessor's Map/Parcel ©y e_e a installer's-Name,Address;and Tel.No. Designer's Name,Address,and Tel.No: :., 5v����RJM�. ��151�4.f•q "� C4tSv,1\� 1 Type of Building: Dwelling. No.of Bedrooms 7 Lot Size �, /k�y sq-ft. Garbage Grinder Other Type of Building No.of Persons Showers( , ):"Cafeteria t Other Fixtures : Design Flow(min.required) b gpd Design flow provided. N gpd r Plan"a Date � 1-561 7,31 q Number of sheets Z_ s ``Revision Date l 2-/I LI u . , Title f�c l�l cn lLkiSCw7 3w10.�.er+.�. C 4;,;r Size of Septic Tank Type of S.A.S. x Description'of Soil Nature of Repair 'or Alterations(Answer en applicable) ��1:t `?L yrnn 3 t Date last inspected: ,Agreement The,undersiggedegreeslo ensure the construction and maintenance of the afore described on-site sewage.disposal�system in r r . accordance with the provisions of Title'5 of the Environmental Code and not to place the system in operation until a'tertificate of Compliance has.been issued by tht Boarder Healthy . ft+ r q? r Sign'd l r£ Date Application Approved t,! Date /a % •fit, Application Disapproved by , !" tEr) Date for{he following reasons , f qya Noy n' q gp • 16. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS r (tPrtifILAte of Com' fiance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded(_):. Abandoned at- ( r Vlexi - has been constructed in accordance , with the provisions of Title 5 and the for Disposal System Construction Permit No. v*-10* a3 dated I� " Installer 0 01 Designer . #bedrooms 7 Approved design flow P47— gpd The issuance of this permit hall not be construed as a guarantee that the system will funcctio,ras mess geed. Date "�/'f "/' Inspector -- - - -- No. 20;0 Fee d100 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH-"DIVISION-BARNSTABLE, MASSACHUSETTS ;A'ZisPJ 8'r *, psttm Cone-tCUCtion Permit Permission is hereby granted to Construct•( ) Repair(-I-) Upgrade(� ) Abandon( ) System located at t �(, (e pC Lj1Fj_,J Ate" 11 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 thisipermit. -�. Date Approved by ` } Ta vn of Barnstable Inspectional Services •. A" Public Health Division Thomas McKean, Director °i 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Sewvage Permit# ZOW Lg 4 __Assessor's MapWarcel 44L Designer: Su`(fY04 Installer: `I 1V*1* ° 0� Address: Ill Address: Z W 1414 On�''Z > was issued a permit to install a (date) (installer) septic system at Q86 a �.�"�+� A_,e based on a design drawn by (address) dated 112 I/ZAZ e esigner) 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. p,,y1p G.44m ACr d - 7"qh /-- cam,l�/ I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of e M a pro al letters (if applicable) �aLty�OF kASS9 � c = CHARLES T. ROWLAND � r s Signature) o CIVIL No. 52699 \oP `PFGISTER� E� OFFS �lV�� esigner's Signature) (Affi Stamp Here) PLEASE_RETURN.TO BARNSTABLE PUBLIC-HEALTH DIVISION. CERTIFICATE OF COMPLIANCE 'WILL NOT BE ISSUED 'UNTIL BOTH THIS.-FORM AND_AS- BUILT CARD.ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK'YOU.. kho6deptMEALTUSEwER connecASEPTIMesigner Certification Form Rev&14-13.DOC No. �_Cj �X Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes RpPliCation for Misp08al 6pStrm Construction 3permit Application for a Permit to Construct( ) Repair('fj Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components m Location dd ess or Lot No. qw�A�j�y`� ��� O er' Name,Address,and Tel.No. �C1/ Rye T/Rtij-A QqU 1-S Asses or's Map/Parcel dQ� I tall r Name,Address,and Tel.No. J Designer's Name Address,and Tel.No. iCP4O\Ail Type o Building: y� Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures IV if Ir Design Flow(min.required) gpd Design flow provided IV gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs orAlterations(Answer when applicable) O` Lr_ Sind �— p Lv k C o N N-4LL T t ).ZUJ C)v-TLe;.i- hP-e. F<or� ovSC -rn 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 d not to pia a the system in operation until a Certificate of Compliance has been issued by this Board of Health Signed Date fo ao Application Approved by Date C) Application Disapproved by Date for the following reasons Permit No. go xo Date Issued s N . Fee o: THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF`BARNSTABLE, MASSACHUSETTS Yes d • ` , 2prication for 30isposar bpstem Construction 3permit .Application for a Permit to Construct( ) Repair(V Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. � I t.1� �� O er's Name,Address,and Tel.No. Assessors Map/Parcel Installer's Name,Address,and Tel.No. J 4 Designer's Name,Address,and Tel.No. Type of Building: Dwellin No.of Bedrooms _� g /l Lot Size '" sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixturest may- Design Flow(min.required) gpd Design flow provided T [ gpd Plan Date Number of sheets s Revision Date Title f Size of Septic Tank Y Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) RR.9114t—e. C_, ) �Q IS 11-6 A)CW 4p:,t� C<)t i tj p-.Cs 1 @.QJIa mil.► + �..�1 1� C L� t��3 a� C C�yS�, v, v 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 aftd not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health., ` r r , Signed pp4 {� (a( % Dates 1 t c 0 d_() - Application Approved by Application Disapproved by 'I Date for the following reasons Permit No. �,C)-Q .F Date Issued ' THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance f'f THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( i) Abandoned( )by �� ?Q r (� t a• [ .. e at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.a y'c) `f�,/dated Installer R/) y- 0V / C 0 M TN)C Designer �/� #,bedrooms ( �.; Approved design flow Al gpd „. ; l The issuance of this perms shall nol be construed as a guarantee that the system willafuncti-n as Date Inspector . ------- ii----- --- --- -------. - --- -- - - No. do 1 y Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS C� . — Misposal 6pstetn Construction 3permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ,1) System located at q S6 e i1jeL,) Alf a�r'�"[:. r#/m { 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 `ccc Date �p Approved by Z ; 4 i t 6/30/2019 j Assessing As-Built Cards /114Aln Hoist ((�� TOWN OF BARNSTABLE LOCATION_ 2G StAVU) AV# . SEWAGE:Y VILLAGE D,Sr11rV,�l _ASSESSOR'S NW&PARCEL INSTALLER'S NAME&PHONE NO. ' SEPTIC TANK CAPACITY p1 LEACHL14G FACILITY: � (h'Pe) �a T� t r r � ,(size) NO,OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE . Separation Distance Between the: I , Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility r Feet Private Water Supply Well and Leaching Facility Of any wells exist on, site or within 200 feet of leaching facility) Edge of Wetland and Leachi Facility —P ng ty Of any wetlands exist within � t 300 feet of leaching facility) Feet FURNISHED BY-JC;-aDe[,T_LQ1— — f I P l} — �• A i 01 A a S r3y� IT ace as `i 0 3yoy3 I � • �, • , -s tis 3'l s 4 z https://townofbarnstable.us/Departments/Assessing/Pror)ertv Values/HMrii�nlavacn9mannar-flq�nn9A.�o�—!n w 6/30/2019 Assessing As-Built Cards MAtn I�Ws� (� TOWN.OF BARNSTABLE �l a G LOCATION StA �( VI W VP_, _SEWAGE# VU_LAGE 05rt ,rV L4 —_ _ ASSESSOR'S MAP&PARCEL Oq I �0 _ INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY.(type)Ja (size) _s`rat� NO,OFBEDROOMS 1 + OWNER V�1 S PERMIT DATE: COMPLIANCE DATE Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom orLeaching Facility Feet Private Water SupPly Well and Leaching Facility Of any wells exist on site or within 200 feet of leaching facility) Edge of Wetland and Leachl Facility _Feet ng ty of any wetlands exist within 300 feet of leaching facility) Feet FURrnsHED BY Tnt T ' For c� r (p la-_ i h S 1 3y S t 3 yo 93 • � � c, ra s c,y • A https://townofbarnstable.us/Departments/Assessing/Pror)ertv ValuPI/HMrli-nlaVACri?mannnr_nainnoR.00n—A 6/30/2019 Assessing As-Built Cards /►'1AIA Wst TOWN OF BARNSTABLE LOCATION Cleo St4VMW AA. _SEWAGE it VILLAGE 0'MY -_ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO.` SEPTIC TANK CAPACITY t LEACHING FACILITY.(type) la Tn t r f (size) s�s'ran� NO,OF BEDRO,OaMS t OWNER PERMIT DATE: COMPLUNCE DATE: ' Separation Distance Between the: I Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Fcel Private Water Supply Welland Leaching Facility Of any wells exist on site or within 200 feet of leaching facility) I Facility t Feet Edge of Wetland and Leaching ; ry(If any wetlands exist within � 300 feet of leaching facility) Feet FURMsHED By I c�mCr p p . . A a S o >1 34 18 i y o 3 yo 93 L 0 S ys 3� https://towhofbarnstable.us/Departments/Assessinq/PrODertv Values/HMrii.-nlavacn?mannmr=nQll 0')R- —n Commonwealth of Massachusetts 9 Title 5 Official Inspection Form \ A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 986 Sea View Ave Main house v� Pro;. ...,jje-pp.��— �� Owner Uwner's Name, information is Osterville required for every Ma 02655 6/18/19 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: -- Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date - Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert In driveway and needs to be replaced with an H2O distribution box 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 12 of 18 f °F IKET Town of Barnstable Barnstable "-AfiaficaCity i Inspectional Services 9AftNfiTABC,£• `b� ,�' Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO PAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4987 7534 July 25, 2019 CAREY, C WILLIAM TR 986 SEA VIEW AVE OSTERVILLE, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 986 Sea View Avenue Main House, Osterville, MA was inspected on 06/18/2019 by Michael DiBuono, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • H-1.0 distribution box is in driveway. This needs_ to be replaced with an H-20 component. You are ordered to repair or replace the septic system within two (2) years from the date you receive this notification. - Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF TH BOARD OF HEALTH LL Thomas McKean, R.S., C Agent of the Board of Health Q:\SEP'illC.\Title V Inspection Report Letters Mail inb\Conditionally Passes Letters\986 Sea View Avenuc Main House Osterville.doc I Town of Barnstable BARNSTABM '�A b 9 ,.� Inspectional Services Department TFD MA'S� Public Health Division. 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 PAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 3.10 CMR 15.000) An "x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ ISingle Cesspool AMy "conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER ! \d (� G t ;Vt Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc c; 09/—00 a- Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 986 Sea View Ave Main house Property Address t • CAREY, C WILLIAM TR ' Owner Owner's Name information is x required for every Osterville Ma 02655 6/18/19 ^ 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. Please see completeness checklist at the end of the form. Important:forms A. Inspector Information filling out forms Slm 31(.f on the computer, use only the tab Michael DiBuono key to move your Name of Inspector cursor-do not DiBuono Sewer And Drain use the return key. Company Name 35 Content Lane Company Address Cotuit. Ma 02635 City/Town State Zip Code 508-364-9587 S113522 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage�disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ® Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails A 6-30-19 I spector's Signature Date The system in shall submit a copy of this inspection report to the Approving Authority(Board . of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DER The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 986 Sea View Ave Main house Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4-and 6. 1) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System contains a 2000 Gallon septic tank as well as a 1000 gallon pump chamber a concrete distribution box and 12 Infultrators. 2) System Conditionally Passes: ® One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ' ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 986 Sea View Ave Main house Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. CityrFown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ® Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ® distribution box is leveled or replaced ® Y ❑ N ❑ ND (Explain below): replace distribution box with H2O distribution box ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which.require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 I Commonwealth of Massachusetts ip Title 5 Official Inspection Form IQ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 986 Sea View Ave Main house U Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 986 Sea View Ave Main house Property Address a CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary-(cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No } ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence .of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system'is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 986 Sea View Ave Main house Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner,occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? El E 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)] 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 986 Sea View Ave Main house Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 7 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 770 Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ® Yes ❑ No Water meter readings, if available last 2 ears usage 222 Gpd 9 ( Y 9 {gpd)): Detail: Sump pump? l ❑ Yes ❑ No Last date of occupancy: Date t5insp.doc•rev.7/26/2018 ; Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts MET, Title 5 Official Inspection Form _ la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u% 986 Sea View Ave Main house Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: a Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): k Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Not Provided Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined?. Reason for pumping: t5insp.doc•rev.7/26/2016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 986 Sea View Ave Main house Property Address CAREY, C WILLIAM TR Owner Owners Name information is required for every Osteryllle Ma 02655 6/18/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1993 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2 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.): System is vented at the roof line t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 986 Sea View Ave Main house Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) .6. Septic Tank (locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 2000 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 2000 Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffle 2411 3" Scum thickness 4�� Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 30" How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form l Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V � 986 Sea View Ave Main house Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. 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.): 8. Tight or Holding Tank(tank must be pumped at time of.inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form l Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 986 Sea View Ave Main house Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. CityT town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: i Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert In driveway and needs to be replaced with an H2O distribution box 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.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form _ I� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 986 Sea View Ave Main house Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ® Yes . ❑ No* Alarms in working order: ® Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Functioning as designed If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 12 I nfultrators Type: ❑ leaching pits number: ❑ leaching chambers number: , '® leaching galleries number: 12 ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection .Form �p Subsurface Sewage Dis osal System Form - Not for Voluntary Assessments 9 p Y rY 986 Sea View Ave Main house Property Address _ CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 ' page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No ponding or break out. System is functioning as designed 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site`plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer - Depth of scum layer y Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition,of vegetation, etc.): ° t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 i Commonwealth of Massachusetts p Title 5 Official Inspection Form 1.1. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 986 Sea View Ave Main ho use Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. Cityrrown State Zip Code Date of Inspection' D. System Information (cont.) 13. Privy (locate on site plan): ro Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): • .. 4 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 986 Sea View Ave Main house Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a � 986 Sea View Ave Main house Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 1 feeett 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: 10/14/1993 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: Test hole data on plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form l Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 986 Sea View Ave.Main house Property Address CAREY, C WILLIAM TR Owner Owner's Name information is Osterville Ma 02655 6/18/19 required for every ' page. City/Town State Zip.Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of:; ❑ A. Inspector Information: Complete all fields in this section. ❑ B. Certification: Signed & Dated and 1, 2, 3, or,4 chIecked ❑ C. inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ❑ D. System Information: A For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 r— 6/30/2019 Assessing As-Built Cards /Y)Aln 14 Wst- TOWN OF BARNSTABLE LOCATION R26 SLAY MW AA. SEWAGE# VILLAGE OSr6rV ASSESSOR'S MAP&PARCEL OC(I"002l,— INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) Ia T^ r / (size) a. -MAL- NO.OF BEDROOMS 3 +. �y OWNER Cgr . PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet.of leaching facility) Feet FURNISElED BY T/1S T' � 11 P l a i i - I i Fro,tr .p A O O i S o 3y I8 0 3 ya y3 c y 3 y SI Z https://townofbarnstable.us/Departments/Assessing/Property_Values/HMdisplay.asp?mappar=091002&seq=4 1/2 L I Commonwealth of Massachusetts �91 00� :. Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 986 Sea View Ave Cottage Property Address _ CAREY, C WILLIAM TR f,. Owner Owner's Name/ UJ information is osterville V Ma 02655 6/18/19 ��`±' required for every ��+ page. Cityrrown State Zip Code Date of Inspection W Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information b'! q � � /q a---- on the computer, use only the tab Michael DiBuono key to move your Name of Inspector cursor-do not DiBuono Sewer And Drain use the return Company Name key, . 35 Content Lane Company Address Cotuit Ma 02635 Citylrown State Zip Code gym, 508-364-9587 S113522 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 6-30-19 In 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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. . Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 f r Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 986 Sea View Ave Cottage Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. City[Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System contains a 1000 Gallon septic tank as well as a concrete distribution;box and 5 Infultrators. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): l5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts l Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 986 Sea View Ave Cottage Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water'level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven,distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N F1,ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form /a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4Ki u 986 Sea View Ave Cottage Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *` This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 - Commonwealth of Massachusetts ip Title 5 Official Inspection Form �a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 986 Sea View Ave Cottage Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® 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: ❑ N Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis = and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 V 986 Sea View Ave Cottage Property Address CAREY, C WILLIAM•TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. CityrTown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection?' ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 986 Sea View Ave Cottage Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 - page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual). 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ®, No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d 112 Gpd 9 ( Y 9 (gp ))� Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 986 Sea View Ave Cottage Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Not Provided Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 986 Sea View Ave Cottage Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1993 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2 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.): System is vented at the roof line t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 986 Sea View Ave Cottage Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate'on site plan): Depth below grade: 1.5 feet Material of construction: ' ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No - Dimensions: 1000 Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 311 Distance from top of scum to top of outlet tee or baffle 411 Distance from bottom of scum to bottom of outlet tee or baffle 30" How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 e Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 986 Sea View Ave Cottage Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. 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.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal El fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 986 Sea View Ave Cottage Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: El Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Level and at Normal level 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 f Commonwealth of Massachusetts 6F Title 5 Official Inspection Form I� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 986 Sea View Ave Cottage Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma . 02655 6/18/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 5 Infultrators Type. ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 5 ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �_ la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 986 Sea View Ave Cottage Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Ostervllle Ma 02655 6/18/19 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No ponding or break out. System is functioning as designed 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form le Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 986 Sea View Ave Cottage Property Address CAREY, C WILLIAM TR - Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 a Commonwealth of Massachusetts ,p Title 5 Official Inspection Form (�c o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 986 Sea View Ave Cottage Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts p, Title 5 Official Inspection Form 1�I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 986 Sea View Ave Cottage Property Address CAREY, C WILLIAM TR Owner Owner's Name information is required for every Osterville Ma 02655 6/18/19 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10+' 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: 10/14/1993 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: Test hole data on plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp`doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 986 Sea View Ave Cottage Property Address CAREY, C WILLIAM TR Owner Owner's Name - information is Osterville Ma 02655 6/18/19 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ❑ A. Inspector Information: Complete all fields in this section. ❑ B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ❑ C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist)completed ❑ D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included 3 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 6/30/2019 Assessing As-Built Cards 6utlr 140vn TOWN OFBARNSTABLE LOCATION_ 5tAU(LW AV SEWAGE# VILLAGE oSr,, vjj4 ASSESSOR'S MAP&PARCEL 00 a— INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY / LEACHING FACILITY;(type) NO.OF BEDROOMS�— : .e OWNER CA I - PERMIT DATE; COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility _Feet Private Water Supply Well and Leaching Facility of 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 Tn Lrle­ Fo i' ( I t y 0 o- A 3 10 yl C - 3 I - I - i https://townofbarnstable.us/Departments/Assessing/Property_Values/H Mdisplay.asp?mappar=091002&seq=5 1/2 COMMONWEALTH:OF MASSACHUSETTS. EXECUTIVE OFFICE.OF ENVIRONMENTAL AFFAIRS' DEPARTMENT OF ENVIRONMENTAL PROTECTION .: TITLE 5 OFFICIAL INSPECTION,FORM.-NOT FOR VOLUNTARY,ASSESSMENTS m SUBSURFACE:SEWAGE DISPOSAL SYSTEMFORM PART�A .CERTIFICATION,. r ' Guest House . Property.Address: 986 Seaview Avenue Ostenille;MA 02655 Owner's Name: Willaairi Carey �. O Owner's Address: Date of Inspection: Janarar-v 18, 2012 Name of Inspector: (Please Print) Jaines M. Fond Company Name: JamesM Ford Mailing Address: P.O. Box 49.1 Osterville,MA 026554049 Teleplione.Number (508) 862-9400 CERTIFICATION STATEMENT I.certify that I have personally inspected.the sewage disposal system at this.address and' .� that the information repirted below is true;-accurate and complete as`of the time of the itspection. The inspection was performed based on"i-Ay f' training.and experience:in the proper,function and maintenance of oh site sewage disposal.systems. I am a DW. approved system inspector pursuant to.Section 15.340 of Title 5(310 CMR 15.000):'The system: . 3 t Pusses . = ° Conditionally Passes.. Needs Further Evaluation by the Local Approving Authority,. Fails Inspector's Signature: Date:, February 15, 2012 The system.inspector shall Su Lit a:copyof this inspection report toahe 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. : *There Was another system that the owner washaving problems witli.I could not locate Notes and Comments That system.After the inspection was done the pipes.were cut and re-routed and hooked up to this system describe.in this report.' Thi re s ort'onl describes conditions o drtion at h i s the time of in s echon and under P.. y p der 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. 1 Title'5 Inspection Fonn 6/15/2000 "° page 1 sy Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM` PART A CERTIFICATION (continued) Property Address:' 986 Seavieiv Avenue Osterville.MA Owner: William Carey Date of Inspection: January 18,2012 Inspection Summary: Check A,B,C,D or f 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 31.0 CMR 15.303.or in.310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes:A One or inore system components as described in the"Conditional Pass" section need to be replaced or . .:: repaired: The system,upon completion of the replacement of 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 b . explain. : l 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 enfiltration or tank failure is imminent. SysterniVillpass`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.anddf a Certificate of Compliance indicating that the tank is less than 20 years old is available: . ND explain: 4 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,iiispection.if;(with'. approval of Board of Health)' broken pipe(s)are replaced' obstruction is removed distribution:box is leveled:or replaced .r . ND explain The system required pumping more,than 4..times a year due'tobrokenor obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced Obstruction is xemoved ND'explain: 2 Page 3 of 11 OFFICIAL INSPECTION:FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL-SYSTEM INSPECTION FORM PART A CERTIFICATION .(continued) Property Address: 986 Seaview Avenue , Osterville,MA Owner: William Carey . Date of Inspection: January 18, 2012'` = C. Further Evaluation Js 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 (i)(b)jhat the system is not functioning in a mariner which will protect public health,safety and the environment: Cesspool or privy is within 5.0 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 septictank'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.arid the SAS is within a Zone l::of a public water supply The,system has a septic tank and SAS and the SAS is within 50 feet of a private water:supply.well. . The system has a septic tank and SAS and the SAS;is less than 100.feet but 50 feet or more from a private.water supply well**. Method used to determine distance **This system passes-,if the well water analysis,performed at`a DEP certified laboratory, for coliform'- e bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 pP m provided that.no other, failure criteria are:triggered.,A copy of the analysis must be attached'to this form.' t . 3. Other: 3 : Page 4 of 11 OFFICIAL INSPECTION-FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE,DISPOSAL SYSTEM INSPECTION FORM PART A 'CERTIFICATION (continued) Property Address: .986 Seavieiw Avenue Osterville,MA Owner: Williain Carey Date of.Inspection: January 18, 2012 ' D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections Yes No Backup of sewageJnto facilityor system component due to overloaded or clogged SAS or-cesspoolr' 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 lan overloaded or clogged SAS or cesspool �. - ✓ Liquid depth in.cesspool is less than V below invert or available volume.is-less than%day flow ✓ .: Required pumping inore than 4 times'in the last year NOT due.to clogged or obstructed pipe(s). Number of times pumped—. ✓ Any portion of the SAS,cesspool or.privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary,to a surface' water supply. Any portion of a cesspool or privy is within a Zone l of a public well. ✓ Any portion of a cesspool or privy is within 50 feet'of a private water supply well. r ✓ Any,portion of a cesspool.or'privy is less than 100 feet but seater than 50 feet f g rom a private water ` supply well,with no acceptable water quality analysis.-[This system passes if the well water analysis; performed at a DEP certified laboratory;for:coliform.bacteria and volatile organic compounds indicates that the well is:free from pollution from thatfacility and.the presence.of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no otlier failure criteria are triggered. A copy of the analysis must be attached.to this form.] No (Yes/No)The system fails.-I have determined that'one or more of the above.failure criteria exist as described in 310 CMR 15.303 therefore the systern fails. The system owner should contact the Board,of Health to determine what will be necessary to-correct the'failure. E. Large Systenic To.be considered a.large system the system must serve a facility with a design flow of 10;000 gpd to 15,000 gpd You must indicate either`°yes"-or"no"to.each of the following: . (The following criteria apply to large systems in addition to the criteria above) ., 4 Yes No the system is_within 400 feet of a surface drinking wafer supply the system is within 200 feet of a tributary to a surface, 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 s}ipply 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 8ectionD shall upgrade the system in accordance with 310 CMP 15.304. The system owner should contact the appropriate regional office of the Department. I ,i . Page 5 of 11 s OFFICIAL INSPECTION FORM -, NOT FOR:VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM` PART B ..-CHECKLIST Property Address: 986`Seaview Avenue Osterville,MA Owner: , William_Carev Date of Inspection: Jmivary 18, 2012 Check if the following have been`done: You must indicate"yes"or"no"as to each of the following Yes, No f ✓ Pumping information.wa&iprovided by the.owner,occupant,or Board of Health" ✓ Were any of the system'coniponents 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.A6 the system recently or as part of this inspection 7 ✓ 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.mardioles uncovered;opened;:and the inferior 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'tI 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: c - Yes No 4 ✓ Existing information. For example,a plan at.the Board of Health. ✓ — Determined in the field(if any of the failure criteria related to Part-C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] '. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM`. PART C SYSTEM INFORMATION ` Property Address: 986 Seaview Avenue Osterville, MA Owner: William Carey Date of Inspection: January 18, 2012 , FLOW CONDITIONS RESIDENTIAL Number of.bedrooms(design): 4+ Number of bedrooms(actual): ' 2 DESIGN flow based on 310 CMR15:203 (for..example: 110 gpd x#of bedrooms): 220 Number of current residents: 1 Does residence have a garbage grinder(yes or no): N/a - Is laundry on a separate sewage system(yes'or no): N/a [if yes separate inspection required] Laundry system inspected(yes or no): ;no'! k Seasonal use(yes or no): ' no . Water meter readings,if available(last 2 years usage(gpd)): Unavailable.ry Sump Pump(yes or no):- No Last date:of.occupancy: Currently COMMERCIAL/INDUSTRIAL Type of establislmient: Design flow(based on 310 CMR 15.203): gpd u Basis of design flow'(seats%persons/sq/ft etc,): a . Grease trap present(yes or no): , Industrial waste holding tank present(yes or no) Non-sanitary waste (Y discharged to the Title,5'sY stem , es or no ): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERALS INFORMATION Pumping'Records04 Source of information: Unavailable Was system pumped as part of the inspection(yes or no):' No If yes,volume pumped: gallons--How was Yp P quantity um ed determined? Reason for pumping.; j TYPE OF SYSTEM- Septic tank,distribution box,soil absorption.system ; y Single cesspool Overflow cesspool Privy Y ) ( _ Shared system(yes or no if yes;attach previous inspection records,if any) _ Innovative/Altemative.technology.- Attach a copy of the current operation and maintenance'contract.(to:be' obtained from system owner). ., . Tight Tank Attach,a copy of the DEP approval Other(describe): Approximate age of all components;date installed(if known)and source of information: Date of installation 10126193 per as-built card Were sewage odors'detected,when arriving at the site(yes or no): No . s 6 i Page 7 of I 1 r , OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 986 Seaview Avenue Osterville,iLM Owner: PVilliani Carey Date of Inspection. January 18, 2012: BUILDING SEWER(locate on site plan) ' Depth below grade: Materials of construction: _cast iron- 40 PVC other(explain): Distance from private water supply.well or suction line:" Comments(on condition of joints,venting,evidence'of leakage,etc.): SEPTI C T .ANK: ✓ :(locate o ate n _ ( o site plan). Depth below grade: :24" a Material of construction: ✓ concrete=_metal _fiberglass _polyethylene other ex lam ( p ) , If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no), (attach a copy of. certificate) Dimensions: 1000 gal: Sludge depth: 2„ , Di tan s ce.from to of sl udge d e to bottom of outlet� baffle: .. , ttee or p .g 30 '.Scum thickness:. 1 Distance from to of scum to to p of ou tlet tlet tee o baffle p 6 p Distance from bottom.of scum to bottom of outlet tee:or baffle: 10" How were dimensions-determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural.integrity;' iquid levels' as related to outlet invert,evidence of leakage,etc)., The tees ivere present. The hauid level was even with the outlet invert. GREASE TRAP: None-(locate on site plan) .•_ Depth below grade: Material of construction: _concrete :_metal fiberglass _polyethylene _other ' (explain). . Dimensions: Scum thickness:.. Distance from-lop of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or:baffler Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or,baffle condition, t s ructu ral integrity, as related to outlet invert,evidence of leakage;etc) ' g itY liquid levels q, - q I I - Page 8 of 11 r OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGEmDISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 986 Seavielu Avenue Osten)ille, MA Owner: William Carey Date of Inspection: Januan 18: 2612 TIGHT or HOLDING TANK : None (tank must be'pumped at time of inspection) (locate on site plan) Depth below grade:' Material of construction: _concrete _metal _fiberglass _polyethylenes.':. other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day , Alarm present(yes or no): Alarm level: Alann in working order(yes or no): Date of last pumping:. Comments"(condition of alann and float switche's,'etc.): DISTRIBUTION BO X: (1 f resent ent must.be opened) ed (loca to onsit e plan -, , Depth of liquid.level above outlet invert: Even Comments(note if box is level and distribution to outlets equal;anyevidence o f solids carryover,any evidence of leakage into or out of box;etc.):: PUMP CHAMBER:. None (locate on site plan) Pumps in.working order(yes or no) Alarms in working order,(yes or no) Comments(note_condition of pump chamber,condition of pumps and appurtenances,etc.) + n 8 Page 9 of 11 _ OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART. C SYSTEM INFORMATION (continued) Property Address: 986 Seaview Avenue Oster-yille.MA Owner: William Carey Date of Inspection: January 18, 2012' SOIL ABSORPTION SYSTEM (SAS): ✓. (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:' ✓ leaching chambers,number: '_6Infiltrators with 3'stone leaching galleries;number: leaching trenches,number,:length: • • ' leaching fields;number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name.of technology: ` Continents(note.condition of soil .signs of hydraulic,failure,level of.ponding,damp soil condition of vegetation,etc.); I dug down and hand probed the sire of the surrounding stone"Which iws 3` 77iei•e did not appear to be any sirens of failure The bottoih to grade ivas approximately 6.3' - CESSPOOLS: Noiie (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration Depth top of liquid.to inlet invert: Depth of solids layer: Depth of scum layer:. Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no); Continents .(note condition of soil,signs.of hydraulic failure,level of ponding,condition of vegetation,-etc) PRIVY: None-(locate on site plan)" Materials of construction: Dimensions: Depth of solids Comments(note condition`of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): f .9 Page 10 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECT"ION FORM PART-C p SYSTEM.INFORMATION;(continued) Property Address: 986 Seaview Aveiztie Ostei.-ville,MA Owner: William Caren Date of Inspection:, January 18. 2'012 SKETCH OF SEWAGE DISPOSAL SYSTEM , Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks.o"r benchmarks. Locate all wells within:100 feet. :Locate where,public water supply enters the building:'. y0 8A661 i. 3y a r t 3 - µ 10 J� Page_II of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION.(continued) Property Address: 986 Seaview Avenue Osterville.MA . Owner: William Carey Date of Inspection: January 18, 2012 a SITE EXAM , Slope Surface water Check cellar Shallow wells e Estimated.depth to ground water 10+/2 feet Please.indicate (check).all methods used.to'determine the high.ground water elevation': Obtained,from system design plans on record- If checked, date.of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-'explain. : To o ra hic and water contours mays p p Q U _ Checked with local excavators,installers-(attach documentation Accessed USGS.database-ex lain: p t You Must describe how you:established the high groundwater elevation: ; Usin-z Barnstable topographic and ivater contours naps;the»haws we're showin�qpproxitnate/v 10 +/--to Qroiind ivater at this _ .. site. i This report has beeri prepared only for the.septic system acid components described herein.: This septic system has been inspected and passed as of,the date of inspection. This report is iiot a ivarrawy or guarantee that the'system will function properly in the fiatu•e.'There have.been no warranties oi-giiar•antees, either:expr•essed written or,implied - relating to the septic system;the;iiispection, this report acid/or any conrponents.of the septic system which liaise not been located and inspected. 17 ,k i No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:_ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 21ppliLation for MispoSal bparm Construction Permit Application for a Permit to Construct( ) Repair(,,<,Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. C;st_ 1'CCA" *UC. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Q!� Og 0.�, 1P It L, (�✓.d/i�c S /�.S h Installl/ller's Name,Address,and Tel.No.TbF 3 4 Y f Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) Mrgpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �Lz' � S'f�` ® Y 1` (/v /, kL-1 /74 Zee Date last inspected: f 1 1 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 place the system in operation until a Certificate of Compliance has been issued by this Board of Signed Date Application Approved by Date -� Application Disapproved by Date for the following reasons Permit No. n �CJ i l� Date Issued o— —o No. Fee v` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Misposal *pstem Construction 3permit Application for a Permit to Construct( ) Repair({Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ( �� �'t� v�„ O�w•�ner's Name,Address,and Tel.No. Assessor's Map/Parcel f tJa��� p— y Installlller's Name,Address,and Tel.No.,TOV �G y !,' F*7 Designer's Name,Address,and Tel.No. �ls�^o a..� �c<i n Type of Building: Dwelling, No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min required) gpd Design flow provided � A gpd Plan Date t1 Number of sheets Revision Date/ r Title Size of Septic Tank Type of S.A.S. Description of Soil ti t Nature of Repairs or Alterations(Answer when applicable) C r f .hc, Rhl -2y 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 nDtto place the system in operation until a Certificate of Compliance has been issued by this Board of He Signed -Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. i Date Issued 4,0V --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS /\ BARNSTABLE,MASSACHUSETTS � Certificate of Compliance I HIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( "� Upgraded( ) Abandso�ned( )by�j`Q�,. avt to e1 riw� f6/l e� at / 0?4 V;C LAI A—., has been constructed in accordance � with the provisions of Title 5 and the for Disposal System Construction Permit Nal.O dated /at Installer M 4,1,h G p O J1,—i A.-_a Designer #bedrooms 9 Approved design flow and The issuance of this permit sh ll got beacoristr}ued as a guarantee that the system will fun7L_ desigfied. Date , � 1 �� Inspector - I' No. �L I ' Fee _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(y/� Upgrade( ) Abandon( ) System located atte,) �ec� 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 L 114 — Approved by r Page 1 of 1 Crocker, Sharon From: Peter Sullivan [peter@sullivanengin.com] Sent: Thursday, April 21, 2011 9:38 AM To: McKean, Thomas Cc: sullivanengin.com; er, Sharon; paula@sullivanengin.com Subjec RE: 986 A Seaview Ave. Hi Tom I will not be available for the May hearing so please schedule me for the June 14th Board hearing so I can discuss this matter with the Board. Thank you Peter From: Peter Sullivan [mailto:peter@sullivanengin.com]'< ,Sent: Thursday, April 14, 2011 2:25 PM To:-.'McKean, Thomas' Subject: RE:.986 A Seaview Ave. Hi Tom ('understand from John O'Dea you expected me at your Tuesday Board meeting. I was somewhat surprised since you left me the phone message on April 6th.(below)as to how to proceed and the item was listed as withdrawn on the Boards agenda (copy attached). So is there something else I need to do? Peter From: Peter Sullivan [mailto:peter@sullivanengin.com] Sent: Wednesday, April 06, 2011 12:34 PM To: 'McKean, Thomas' Subject: 986 A Seaview Ave. Hi Tom Fgot your phone message regarding 986 A Seaview and yes it does make sense.for me to do a septic inspection and provide a flow calculation based on the inspection. Then you can assign the appropriate bedroom count. Thank you Peter g4 14/25/2011' Crocker, Sharon From: McKean, Thomas o)-Q I Sent: Friday, May 06, 2011 9:04 AM To: Crocker, Sharon Cc: Stanton, David. . Subject: RE: 9WSea View Ave;i3Ost Po§tponed- n talked to Dr. Miller yesterday and he had the following comments: - There is a discrepancy between Peter Sullivan's letter and the permit and as-built in.regards to the number of infiltrators (are there 5 infiltrators there?) , -The existing septic tank is only 1,000 gallons.. ' w QUESTION: Why was the SAS constructedifor:four bedrooms if the permit wasfor only two? -----Original Message----- From: Crocker,Sharon Sent: Friday, May 06,2011 8:40 AM To: McKean,Thomas;Sue Rask(srask@barnstablecounty.org);Jimmy Sawayanagi ; Wayne Miller, M.D.; Paul 1.Canniff, D.M.D. Subject: 986 Sea View Ave,Ost -Postponed Peter Sullivan notified me that he is out of the office and requested to postpone'until'June 14 meeting- Sharon 1 Excerpt from Board of Health Meeting Minutes on 6/14/2011: B. Peter Sullivan, Sullivan Engineering representing C. William Carey, owner - 986 Sea View Avenue, #A, Osterville; Map/ Parcel 091-002, 2.72 acre parcel, proposal to grandfather four bedroom without installing new septic system. Peter Sullivan presented the history of the property. Since the initial permit, the area has fallen under the salt-water estuary limitations. Mr. Sullivan.suggests performing a 16-page septic inspection of the property to validate the`system's design handles a four-bedroom. Upon a motion duly made by Dr. Canniff, seconded by Mr. Sawayanagi, the Board voted to approve the parcel as having a four bedroom approval with the following condition: 1) A full 16-page septic inspection report will be done on the property and it must validate that the system's design is built.to handle a four-bedroom capacity. (Unanimously, voted in favor.) f 4 E Town of Barnstable Barnstable �bt tt+e r04; ti by Board of Health �;�a� (l�nAnNSTAa`E,l:,f 200 Main Street, Hyannis MA 02601 �1ASS. Q ,. oo �a�q. 2007 ArfD MA, Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M:D: Junichi Sawayanagi October 31, 2012 Mr. Peter Sullivan Sullivan Engineering PO Box 659 Osterville,MA 02655 RE: 986 Sea View Avenue, Osterville Map /Parcel 091 —002 Dear Mr. Sullivan; This is to notify you on behalf of your client, William Carey, owner of 986 Sea Uiew Avenue, Osterville, that the Board of Health has reviewed the files in April 2012.. - The file documentation shows Unit A-Guest House,is approved for four bedroom as it (1) has capacity for four bedrooms as documented in the septic system inspection dated 2/15/12, and(2) it passed inspection. Since ly, Wayn.' iller, M.D. I Chai an,Board of Health t Q:\WPFILES\986 Sea View Ave Ost Guest Hse 4 bd Apr 2012.doc y Excerpt from the Board of Health Meeting Minutes 4/26/12: I. Variances — Septic (Cont.) Peter Sullivan, Sullivan Engineering, representing C. William Carey, owner— 986 Sea View Avenue, #A, Osterville; Map/Parcel 091-002, 2.72 acre parcel, proposal to grandfather the four bedroom house without installing new septic system (continued from June 2011): i The Board reviewed the prior minutes pertaining to this property. The Board reviewed that the 16 page inspection report showed the septic system was designed to handle four bedrooms in the guesthouse and did not have any issue with the house referred to as Unit#A to be a four bedroom. The Board was aware there is another house on the property —the other house was not discussed at this meeting. Upon a motion duly made by Mr. Sawayanagi, seconded by Dr. Canniff, the Board voted to approve the existing septic system as a grandfathered four- bedroom system for Unit #A at 986 Sea View.Ave, Osterville. (Unanimous, voted in favor.) v _ Sullivan Engineering Inc. 7 Parker Road,P.O. Box 659 Osterville,MA 02655 Peter Sullivan P.E.Mass Registration No.29733 phone 508-428-3344 - fax 508-428-9617 peter@sullivaneng_m.com February 16,2012 Thomas McKean,Director = Health Division Town of Barnstable .� 200 Main Street Hyannis MA.02601 •, ,. • RE: Septic Capacity/Daily Flow C. William Cane 986&986 A.SeasView,Qve, Ostervilln e 4'_ Dear Mr.McKean, As per the Board's direction at your.June 14t'public hearing,the owner has had the septic systems for both dwellings inspected by a certified Title 5 inspector. The completed 11 page inspection reports are attached. In addition to the standard inspection criteria,we had the inspector confirm the geometry of the leaching fields.With this geometry, a design flow capacity can be calculated for each system. Based on the physical inspection of the leaching fields,we determined the following consistent with the regulations in place at the time of installation: 986 Sea View: Two, 40' long x 7' wide leaching galleys with 6 infiltrators each (Main House) Total design flow capacity=1030 GPD This flow equates to 9 bedrooms 986-A Sea View: One,40' long x 9' wide leaching galley with 6 infiltrators (Guest House) Total design flow capacity=605 GPD This flow satisfies 4 bedroom design In conclusion, based on the above inspection and analysis, and,consistent with the Board's direction,the approved capacity of the two dwellings are respectfully 990 GPD (9 bedrooms) for the main house and 440 GPD (4 bedrooms) for the guest house. ry truly your s ��= �,�'�'E'.YK" -*...7I rff� ^ < , eter 89,11,11Sullivan PE v.z R J Sullivan Engineering,Inc. Nc. 29i33b �. 4A� Members of American Society of Civil Engineers and Boston Society of Civil Engineers Section . Sullivan Engineering Inc. 7 Parker Road,P.O. Box 659 Osterville, MA 02655 Peter Sullivan P.E.Mass Registration No.29733 phone 508428-3344 fax 508-428-9617 peter@sullivanengm.com February 16,2012 , Thomas McKean,Director Health Division Town of Barnstable sr- / 200 Main Street _ Hyannis MA,02601 ctl RE: Septic Capacity/Daily Flow C. William.Carey,-986& 986 A Sea View Ave,Osterville Dear Mr.McKean, As per the Board's direction at your June 14th public hearing,the owner has had the septic i systems for both dwellings inspected by a certified Title 5 inspector. The completed I I page inspection reports are attached. In addition to the standard inspection criteria,we had the inspector confirm the geometry of the leaching fields. With this,geometry,a design flow capacity can be calculated for each system.Based on the physical inspection of the leaching fields,we determined the.following consistent with the regulations in place at the time of installation: - 986 Sea View: Two, 40' long x 7' wide leaching galleys with 6 infiltrators each (Main House) Total design flow capacity=1030 GPD This flow equates to 9 bedrooms 986-A Sea View: One,40' long x 9' wide leaching galley with 6 infiltrators (Guest House) Total design flow capacity=605 GPD This flow satisfies 4 bedroom design In conclusion, based on the above inspection and analysis, and consistent with the Board's direction,the approved capacity of the two dwellings are respectfully 990 GPD (9 bedrooms) for the main house and 440 GPD (4 bedrooms)for the guest house. T ry truly Your i'j r� �,�' F��"3`d 'Peter Sullivan PE Sullivan Engineering, Inc. Members of American Society of Civil.Engineers and Boston Society of Civil Engineers Section 5 � f COMMONWEALTH. OF,MASSACHUSETTS" EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS. DEPARTMENT OF ENVIRONMENTAL PROTECTION _70. TITLE 5 ". OFFICIAL INSPECTION:FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE-DISPOSAL SYSTEM FORM . ART.A - CE RTIFICATION t Main House Property.Address: :06 Seaview Avenue Osterville:MA 02655 Owner's Namec ' William'Carev Owner's Address: Date of Inspection: Janugdy 18, 2012 Name.:of Inspector:',(Please-Print) James M Ford Company'N.ame;... James M. Ford Mailing Address: P.O:Box 49 Osterville MA 02655-0049 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected.the sewage,disposal system at this address and that the information reported below is.true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and.experience in the proper function and maintenance of on:site sewage disposal"systems. I am'a DEP approved system'inspector pursuant to Section 15.340 of Title 5:(310.CMR 15.000). The system:` ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority. Fails Inspector's Signature: Date Februaw 15:2012. The system inspector shall sub t a copy of this inspection report to the Approving Authority'(Board of Health or DEP)within 3.0 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner,shall submit the report to the appropriate regional office of the DEP.. The original should be sent to the system owner and copies sent to the buyer,.if applicable,"and the,approving authority:" • Notes and Comments. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Fonn 6/I5/2000 page 1 r Page 2 of 11 ` OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART A CERTIFICATION (continued) Property Address: 986 Seaview Avenue Osterville,MA. Owner: William Carey Date of Inspection: January 18, 2012 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 15.30.3 or in 310 CMR 15.30.4 exist..Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or.not determined(Y;N,ND)in the . for the following statements. If"riot 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 thari.20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution"box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): - broken pipe(s)are replaced obstruction is removed distribution:box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health):' broken'pipe(s)are replaced obstruction is removed ND explain: 2 f Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 986 Seaview Avenue Osterville,MA Owner: William Caret/ Date of Inspection: January 18, 2012 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 systernas 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 3AS.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 i.of a public water supply. The system has aseptic tank and SAS and the SAS is within"50 feet of a private water supply well. _ The system has a'septic tank and SAS and the.SAS is less than 100 feet but 50 feet or tore from a private water supply well*.*. Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution,from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to:orless.than 5 ppm,provided that no other failure,criteria are triggered:.A copy of the analysis must be attached to this forma 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION'FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: .986 Seaview Avenue - Osterville.MA . Owner: William Carey Date of Inspection: January 18, 2012 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged.SAS or cesspool ✓ Discharge or.ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ti ✓ Static liquid level in the distribution box above outlet invert due to.an;overloaded or clogged SAS or cesspool ✓ ,Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged,or obstructed pipe(s):.Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. J Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface ' water supply. _ ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well: Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water.analysis, . performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm;provided that no other failure criteria are triggered. A copy of the analysis,must be attached to this form.] No (Yes/No)The system fails. I have determined that one or-more of the above.failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will'be necessary to correct the failure, E. Large System: To be considered a large'system the system must serve a facility with a design flow of 10,000-gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the.following: (The following.criteria apply to large systems in addition to the criteria above)., Yes No the.system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the'system is located in.a nitrogen sensitive area(Interim:Wellhead Protection Area:-IWPA)or a:mapped Zone Il 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 s:.. "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance-with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department: 4 0 Page 5 of 1.1 OFFICIAL.INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART B CHECKLIST - I Property Address: 986 Seaview Avenue Osto-ville,MA Owner: William Carey Date of Inspection: January 18, 2012 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? ✓ - Wasthe site inspected for signs of break out? ✓ .Were all system components,excluding the SAS,located on site? ✓ Were the septic tank manholes uncovered,opened,and.the interior of the tank"inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ _ ,Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No .. Existing information. For example,a plan at the Board of Health. ✓ . _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. r Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 986 Seaview Avenue Osterville.MA Owner: William Carey Date of Inspection: January 18, 2012 FLOW CONDITIONS RESIDENTIAL 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).: 770 Number of current.residents: 2 Does residence have a garbage grinder.(yes or no): N/a Is.laundry on a separate sewage system(yes or no): N/a [if yes"separate inspection required] Laundry system inspected(yes or no): no Seasonal use(yes or no): no Water meter readings,if available(last 2 years usage(gpd)).: Unavailable Sump Pump(yes or no): No Last date of occupancy: Curmntly COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): _gpd Basis of design flow(seats/persons/sq/ft etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: . Unavailable Was system pumped as part of the inspection:(yes.or no): Yes If yes,volume pumped: gallons--:How was quantity pumped determined? Reason for pumping: Maintenance : TYPE OF SYSTEM. Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool_ Privy .Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Date of installation 1112193 per as-built card . Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 986 Seaview Avenue Osterville.MA Owner: William Carey Date of Inspection: January 18, 2012 BUILDING SEWER(locate on site plan) . Depth below grade: Materials of construction: cast iron_40 PVC other(explain): Distance from private water supply well or suction line; Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 36" . Material of construction: ✓ :concrete- _metal. fiberglass ^polyethylene _other(explain) If tank is metal.list age: Is age confirmed by a Certificate of Compliance.(yes or no): (attach a copy of certificate) • Dimensions 2000 gal. Sludge depth: 2„ Distance from top of sludge'to bottom of outlet tee or baffle: . .30": Scum thickness: 4" Distance from top of scum to top of outlet tee or baffler 6' Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition;structural infegrity,.liquid levels as related to outlet invert;evidence of leakage,etc.). The tees were present. The liquid level was above the outlet invert do to a bad pump The tank was pumped after the inspection and the pump was fixed at a later date. The inlet cover was to grade GREASE' TRAP: None (locate on site plan) Depth below grade: Material of construction: concrete metal._fiberglass _polyethylene _other (explain):' Dimensions: Scum thickness:. Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels" as related to outlet invert,evidence of leakage;etc.): 7 i Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued)" Property Address: 986 Seaview Avenue Osterville,MA I Owner: William Carey Date of Inspection: January 18, 2012 TIGHT or HOLDING TANK: None (tank must.be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete._metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day . Alarm present(yes or no).` Alarm level: Alarm in working order(yes,or no): Date of last pumping: Comments(condition of alarm and float switches,etc.):.. DISTRIBUTION BOX: ✓ (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: ✓ (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): At the time ofimpection the pump ivas not working The pump chamber was pumped and a new pump was installed at a later date 8 I Page 9 of 11 OFFICIAL INSPECTION'FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C . SYSTEM INFORMATION (continued) . Property Address: 986 Seaview Avenue Osterville,MA Owner: William Carey Date of Inspection: January 18.2012 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: ✓ leaching chambers,number: 121nfiltrators with 2'stone. 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.)::: I_duQ down and measured the size of the surrounding stone Which ivas 2' 77ze stone was dry and clean There did not appear to be any signs of failure. Vie bottom to grade was approximateh 4.3'.. CESSPOOLS: None (cesspool'must be pumped as part-,of inspection)(locate on site plan) Number and configuration: Depth-top.of liquid to inlet invert: Depth cf solids layer: Depth of scum layer: Dimensions of cesspool: Materiais of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc;):. PRIVY: None (locate on site plan) Materials of construction: : Dimensions: Depth of solids: i Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,-etc.): 9 Pa9e.10 of 11. OFFICIAL INSPECTION FORM'-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE"SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PA RT.C SYSTEM INFORMATION(continued) Property Address: 986 Seaview Avenue Osterville.MA _. Owner: William Carey, Date of Inspection. January,1 , 2012 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.eniers the building' C' 'Q . O . o a ace as 3 yo y . t c� s ys 31 . 10 Page 11 of 11. OFFICIAL INSPECTION FORM.-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM,INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 986 Seaview Avenue Osterville.MA Owner: William Carey Date of Inspection: January 18, 2012 SITE EXAM Slope . Surface water Check cellar Shallow wells Estimated depth.to ground water 10+/- feet Please.indicate (check) all:methods used to determine the high ground.water elevation:. Obtained from.system design plans on record-If checked; date of design plan reviewed: Observed site(abutting_property/observation hole within.150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours inaps Checked with local excavators,'installers-(attach documentation) Accessed USGS.database-explain; You must describe how you established the high groundwater elevation: . Using Barnstable totioQrayhic and water contours maps.the maps were showing approximately 10 +/to ground Water at this Site. This report has been prepared only for the septic system and components described herein. This septic system has been' inspected andpassed as of the date of inspection.-This report is not a warranty or guarantee that:the system.will firizction.properly inn the fixture. There have been.)to warranties or guarantees, either expressed, written or'iniplied, relating to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 .. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION �oq TITLE 5 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART.A CERTIFICATION Guest House Property Address: 986 Seaview Avenue Osterville,MA 02655 Owner's Name:: William Carey Owner's Address: Date of Inspection:. Januaiv 18, 2012 Name of Inspector: (Please Print) James M:Ford Company Name: James M. Ford Mailing Address: P.O.Box 49 Osterville,MA .02655--0049 Telephone Number:. (508) 862-9400. CERTIFICATION STATEMENT I.certify that I'haye 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 15.00.0). The system: . ✓. Passes Conditionally Passes;.- Needs Further Evaluation by the Local Approving Authority Fails Inspector's. Signature: Date: Februaw 15, 2012 The system inspector shall.su it 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 10,000. gpd or greater,the inspector,and the system owner shall subinit 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. *There Was another system that the owner was havingproblems with.I could notlocate . Notes and Comments' That.system.After the inspection was.done the pipes 'Were cut.and re-routed and hooked up to this system describe in this report. This report only describes,conditions at the time of inspection and under the conditions of use at that . . time. This.inspection.does not Address..ltow the system will perform in the future under:the same or different conditions of use. Title 5 Inspection Fonn .6/15/2000 page.] I - Page 2 of 11 OFFICIAL INSPECTION FORM-' NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-FORM PART A CERTIFICATION (continued)` Property Address: 986 Seavieiv Avenue Osterville.MA Owner: TVilliain Carey Date of Inspection: Jaimary 18,2012 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. .System Passes: J I have not found any.information which indicates that any of the,failure criteria described in 310 CMR . .15.303 or in 310 CMR 15.304 exist. Any failure criteria not.evaluated are indicated below, Comments: B. System Conditionally.Passes:. One or more system components as"described in the"Conditional Pass' section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.. Answer yes,no or not determined(Y,N,N .)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 ornot)is structurally unsound,exhibits substantial infiltration or ezfiltration 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 cut.or high static water level in the distribution box due'ao 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 - distributionbox is.leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): > . broken pipe(s)are replaced obstruction is removed ND explain: - 2 f Page 3 of .l 1 OFFICIAL INSPECTION FORM= NOT.FOR VOLUNTARY ASSESSMENT_S SUBSURFACE SEWAGE:DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 986 Seaview Avenue - Osterwille.MA Owner; William Caren Date of Inspection: January 18,2012 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 environments Cesspool or privy is within 50 feet of a surface water. Cesspool or privy:is within"50.feet of a bordering vegetated-wetland.or asalt marsh 2. System will fail unless the Board of Healtlt.(and Public Water.Supplier,if any)determines thaYthe 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 kpply. The system has a septic tank and SAS and the SAS is within 50..feet of,a private water supply well:. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,. for.coliform_ bacteria.and volatile organic compounds indicates that the well is free from.pollution from-that facility acid the presence of ammonia nitrogen'and'nitrate nitrogen is equal to.or less than 5.ppm;'provided.that no other failure criteria are triggered.. A copy of the analysis must,be attached'to'this form. 3. Other: . ,. 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued)' Property Address: 986 Seaview Avenue Oster ville;MA Owner: William Carey Date of Inspection: January 18, 2012 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the.following for all inspections: Yes No Backup of..sewage into facility or:system component due to overloaded or clogged SAS.or cesspool . ✓ Discharge or"ponding of efflueni 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 Tess than%z day flow ✓ Required-pumping more.than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times..pumped_. ✓ Any portion of the SAS,cesspool or privy is below high:ground water elevation Any portion of cesspool or privy is within 100 feet of a,surface water supply oraributary to a surface 'water supply:. ✓ Any portion of a cesspool or pnvy is within a Zone 1 of a public well:, ✓ Any-portion of a cesspool orprivy is within 50 feef of a private water supply well; ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet,from a private water supply well:with no acceptable water-quality analysis;[This.system passes if the well water analysis, ` performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and;thepresence of ambionia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other,failure_criteria are triggered. A copy of the analysis must be..attached.to this form.]; No (yes/No)The system fails. I have determined that.one or more of the above failure criteria exist as described in 310 CMR 15.363,therefore the system fails.,The system owner-should contact the Board of Health to determine what,will"be"necessary to correct the failure: E. Large System To be considered a large system the system must.serve a'facility with.a design flow of 1,0,060 gpd to 15,000 gpd You must:indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above). Yes No _ the system is within 400 feet-of a surface,drinking water supply. _ the system is within 200 feet of a tributary to a surface:drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or,a mapped Zone II of a public water supply:well If you have answered"yes"to any question in Section E the:system is considered a significant threat,or answered.' "yes"in Section D above the large system has failed..The owner or operator of any large system considered.a significant threat under Section E.or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department: Page 5 of I.I. OFFICIAL INSPECTION FORM-'NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 986 Seaview Avenue Osterville,MAC. Owner: Willimn Carey, Date of Inspection: January 18, 2012 Check if the following have been.done: You rust 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,h..systes. A^ ' 'lows uii.,prf.Lious two week pc'i16d? - -. - 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'Arid location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No <a Existing information. For example,a plain at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. r 5 Page 6 of 11 OFFICIAL;INSPECTION FORM.-'NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE,DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 986 Seaview Avenue Osterville.MA Owner: William Carey, Date of Inspection: January 18, 2012 FLOW CONDITIONS RESIDENTIAL Number of.bedrooms(design): 4+ 'Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example:i 10 gpd x#of bedrooms): :220 Number of current residents:. 1 Does.residence.have.a garbage grinder(yes or no): Nfa Is laundry,on a.separate.sewage system(yes or no).: N/a [if yes separate inspection required] Laundry system inspected(yes or no): no Seasonal use(yes or no): no Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date'of occupancy: Cuitenth COMMERCIAL/INDUSTRIAL Type of establishment:. Design.flow(based on 310'CMR 15.203): . gpd, Basis of design flow(seats/persons/sq/ft etc:)': Grease.trap present(yes or no): Industrial waste.holding tank present(yes o -r no) Non-sanitary waste discharged to the Title 5 system(yes.or no): Water,meter,readings,if available: Last date of.occupancy/use: OTHER(describe):. GENERAL INFORMATION Pumping .Records. Source of information: Unavailable Was system pumped as part of the inspection(yes or no): No If;yes,volume pumped: gallons--How was.quantity pumped determine,d? .Reason for pumping: TYPE OF 'SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool . Overflow cesspool Privy,, Shared system(yes.or no) (if yes,attach previous inspection records;if any) Innovative/Alternative technology; Attach a copy of the current operation and maintenance contract(to be. obtained from system owner) Tight Tank Attach a copy of.the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: . Date of installation 10126193 per as-built card Were sewage.odors detected when arrivinig at the site(yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 986 Seaview Avenue Osterville.MA , Owner: William Carey Date of Inspection: _ January 18, 2012 BUILDING SEWER(locate on site plan) Depth below grade:. Materials of construction: _cast iron _40 PVC r other(explain): Distance from private water supply well or suction.line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ .;(locate on site plan) Depth`oelow grade: .24" Material of construction: ✓ concrete. metal _fiberglass _polyethylene _other,(explain) If tank is metal.list age: Is age confirmed by a Certificate of Com liance(y o es or n certificate) l? ) (attach a copy of Dimensions: 1000 kal. . Sludge depth: 2 Distance from top of sludge to bottom of outlet tee or baffle: 30". Scum thickness:. 1, . - Distance from top of scum to.top of outlet te'e or baffle: ` 6" ' Distance from bottom of scum to bottom of outlet tee.or baffler 10" How were dimensions determined: Measur tz stick Comments(on pumping recommendations;inlet,and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.).. The tees ivere vresenr The lioid level lvas even with the outlet invert GREASE TRAP: Norte (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass _polyethylene _other (explain): . . Dimensions: Scum thickness: Distance fro r In' top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping:, Comments(on pumping recommendations,inlet and outlet tee or baffle.condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): r Page 8 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 986 Seaview Avenue Ostewille:MA Owner: William Carey Date of Inspection: January M, 2012 TIGHT or HOLDING.TANK: None (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete -imetal _fiberglass _polyethylene ._other(explain). Dimensions: Capacity: gallons Design F1ow: gallons/day Alarm present(yes or no): Alann level: Alarm in working older(yes.or no): ` Date of last pumping: Comments.(condition of alarm and float switches,etc.):' DISTRIBUTION BOX: ✓ (if present must be opened) (locate on'site plan) Depth of liquid level above outlet.invert: Even Comments(note if box is level and distribution to outlets'equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc:): . PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no):. . Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 ; Page 9 of 11 ' OFFICIAL INSPECTION FORM'-NOT FOR,VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE`DISPOSAL SYSTEM INSPECTION FORM .PART C SYSTEM.INFO.RIVIATION (continued) Property Address: 986 Seaview Avenue - Osterville.MA Owner: Williain Care), Date of Inspection: January 18, 2012 SOIL ABSORPTION SYSTEM(SAS) ✓ (locate on site plan,,excavation not required) If SAS not located explain why: Tvne leaching pits,number: t. ✓ leaching chambers,.number: 6 Infiltrators with 3`stone. - 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.): I dug down and hand yrobed the size of the sui•roundine stone. Which'was 3'. 77iere.did not atiyear to be any signs of failure. 77ze bottoriz to grade ivas.avyroxiinately 6.3' CESSPOOLS:. None (cesspool must be pumped:as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to.inlet invert.. Depth of solids'layer: Depth of.scum layer: . Dimensions of cesspool:' Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs;of hydraulic failure,level of ponding,condition of vegetation,etc.): e E PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids:. Continents(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation;etc.): 9 I - , Page 10 of 11` . OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE:SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C . SYSTEM INFORMATION:(continued) Property Address: 986 SeaviewAvenue Osterville,MA' Owner: William Caret/ y Date of Inspection: January 18, 2012. SKETCROF SEWAGE DISPOSAL SYSTEM Provide a sketch;of the sewage,disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.'Locate where.public water supply,enters the building, a A , . � pa► a 1 O O 10 Page 11 of 11 4 , OFFICIAL INSPECTIONFORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 986 Seaview Avenue Osterville:MA .. , Owner: William Carey Date of Inspection: January 18:2012 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water. 10+/- feet. Please indicate.(check) all methods used to determine the high ground water elevation: Obtained,from systein design plans on.record'.- If checked, date of design plan reviewed Observed site(abutting property/observation hold within 150 feet of SAS) ✓' . Checked with local Board'of Health-explain:" Topo&aphic and ivater.contotirs maps . Checked with"local"excavators;installers-"(attach`documentation) Accessed USGS"database-explain: You must describe how you established the High ground water elevation:. Usinz Barnstable topokraphic and water contours maps the naps were showing ayproximately 10 to ground water at this site. `. . ; This report has Neen prepared only for the septic system and comporiews described herein.'This septic system has been inspected and passed as of ther date of inspection. This report is not a warranty or guarantee that the systeni will function properly in the future. There have,been no warranties or gitar'antees,either•expressed, written or iiitplied, relating to the septic systeni, the inspection, this report and/or any components of the septic systeni which have not ' been located and.inspected 11 fJl r ` EXCERPT FROM THE BOARD OF HEALTH MEETING MINUTES-6/14/2011:" B. Peter Sullivan, Sullivan Engineering.representing_C. William Carey, owner=..986Sea View Avenue, K—Osterv-ille; Map/ Parcel 091-002, 2.72 acre parcel, proposal to grandfather four bedroom without installing new septic system. Peter Sullivan presented the history of the property. Since the initial permit, the area has fallen under the salt-water estuary limitations. Mr. Sullivan suggests performing a 16-page septic inspection of the property to validate the system's design handles a four-bedroom. f Upon a motion duly made by Dr. Canniff, seconded by Mr-: Sawayanagi, the Board voted to approve the parcel as having a four bedroom approval with the following condition: 1i)-A full'1-6=page-septic'inspection report will be done"on the,property- and it must validate that the system's design is built to handle a four-bedroom capacity. (Unanimously, voted in favor.) MAin 14 cost. TOWN OF BARNSTABLE LOCATION —1 O( SeAMW AVQ,. SEWAGE# VILLAGE O.rt�rVtl� ASSESSOR'S MAP&PARCEL Oq I " O 02-- INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY i LEACHING FACILITY: (type) [a- Tit t fA /S (size) p� S'r3AJ_ NO.OF BEDROOMS + OWNER C Ct PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) f Feet FURNISHED BY nS R e,4,'Ar N1 '7 FO r G i a A O O A a c S ° 1 34 18 a ace aS O 3 40 93 ° y 3 q 5-1 S3 �° s ys 31 t Y Gut,;' 14wn TOWN OF BARNSTABLE LOCATION n(D StQVlLW AV, SEWAGE# VILLAGE OSIG(yllt, ASSESSOR'S MAP&PARCELa-- INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) fA (I (size) *3'.STQ/1-k NO.OF BEDROOMS Q- OWNER CA(!:q PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY AT M Or c y o ��k JA a � t3(La Ial o O 3 10 yl C 3 COMMONWEALTH OF. NfASSACHUSETTS . . . `:EXECUTIVE OFFICE OF ENVIRONMENTAL.AFFAIRS =DEPARTMENT OF EN { I' TITLE 5' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY'ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION 1VIain House i i Property Address: 986 Sedview Avenue Osterville,MA.02655 Owner's Name: Willianr`Carev Owner's Address : .. Date of Inspection: . Janua618, 2012 .' Name of Inspector: (Please Print) James M Ford Company Name: James M For^rl Mailing Address: A Box 49` Osterville,`MA 026554049 a Telephone Number;. (508)8624400 CERTIFICATION STATEMENT" r I certify that I have personally inspected the sewage disposal system at this address arid.that the mformahon ieported'. below is.true, accurate and.complete as of the time of the inspection: The inspection was performed based g piny ` training and experience in the proper function and 'maintenance-of on site sewage disposal systems -I am ai4aEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMRt15.000). Thetis stem: " Passes as n 1 t ` :Conditio'nally Passes C0 Needs Further Evaluation.by,the Local Approving Authority Fails a 4As; Inspector's Signature: Date FeUr uarCQ v Ir5 '2012 rn The system inspector shall su it a'copy of this,mspection report to tlie.'Approvmg Authority(Board of Health or- DEP)within 30 days of completing this inspection. If the system is a shared system..or has a design flow'of 10,000 gpd or greater,the inspector and the system owner.shall`submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner.and,copies sent to the buyer„if applicable,and the approving authority. Notes and Comments ****This report only describes.conditions at the tiiiie of inspectioj a' under the conditions of use at that " 7 time.: This inspection does not address how the system will perform in the future under the same or different. ' conditions of use.. i . Title 5 lnspection Fonn page 1 s Page 2 of 11 OFFICIAL_INSPECTION FORM= NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM d PART A CERTIFICATI.ON (continued). Property Address: 986 SeaviervAveizxze Oster-ville MA Owner: _William Carev Date of Inspection: January 18 2012- 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 3-10 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria pot evaluated are indicated below.. Comments: B., System ConditionallyT.asses: One or more system components as described in the"Conditional Pass" section need to' be replaced,or repaired. The.systerri,upon completion of the'replacement or repair,as approved by the Board of He"altli,:will,pas s. ' Answer yes,no or.not determined(Y,N,ND) in the. for the following statements:. If"riot 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.witli a complying septic tank as approved by the Board of Health *A metal septic tank will.pass inspection if it is structurally sound,riot leaking anifCeifcate•ofmdrt l 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 pipes)are replaced '. obstructioii is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or,obstructed pipe(s). 'The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced ". obstruction is removed ND explain: Page 3 of 11 �. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE D.ISP.OSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued] Property Address: 986.Seaview Avenue Osterville MA $ Owner: William Cares? Date of inspection: Ja ivai 1 2 8 012 C. Further Evaluation is Require&by-the Board of Health Conditions.exist which require further evaluation by.the Board of Health in order to determine if the'system is railing to protect public health,safety or the enviromnent. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303 (1)(b):thanthe system is not functioning in a manner which will protect public health,safety and.tlie'environment':. Cesspool or privy is within 50 feet'of a surface water M Cesspool or privy is within.�50 feet of a bordering vegetated wetland.or_a salt marsh 2. System will fail unless the.Boar id of Health (and Public,Watel Supplier,if any)determines that the system is fwictioning in a mafiner that protects'tlie'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'withina Zone I.of a public water supply. The system has aseptic tank,and SAS and the SAS is within 50 feet of a private water supply_well The system has aseptic 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 **Thin system passes if the well water analysis;performed'at a DEP certified laboratory forµcoliform bacteria and volatile organic compounds indicates that the well is free,from pollution.from that facility and the presence of ammonia i nitrogen and nitrate nitrogen g g s equal to or less than 5 q. . ppm,provided that no'other failure criteria are triggered. A copy of the'analysis in be attached to this form. 3.. .. Other:. . 3 -s Page 4 of 11 - FFICIAL INSPECTION FORM-SNOT FOR VOLU NTARY.ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION -(continued) Property Address: 986 Seaview Avenue Oste— �v——ille MA :.• s Owner: _William Carey , Date of Inspection: Janum 18 2012 D. System Failure Criteria applicable to all systems: You must indicate either `yes or' o".to each of the following for-aIl inspections: . - ." n Yes No . ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or podding of effluent to the surface of the ground or surface waters due to all overloaded or clogged SAS or cesspool. r, ✓' Static liquid level in the distribution box above outlet.invert due to.an cesspool overloaded or clogged SAS or n ✓ Liquid depth in cesspool is less than 6,"below invert or available volume is less than 1/2day flow ' ✓. Required"pumping more than 4 times in the last year of tu NOT due to clogged or.obstructed pipe(s). Number nes pumped . — `. ✓ Any portion of the SAS;cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is.within 100 feet of a surface water.supply,or tributary to a:surface`. water supply. ✓ Any portion of a cess pool,of pri vy vy is within a.Zone f.of a public well. , ✓ Any portion of a cesspool or privy is within 50 feet of a p"rivate-water supply well..' ✓ ' Any portion of a cesspool`or privy is less than 100 feet but,gre. than SO.feet from a'private water supply well with no acceptable Water quality analysis. [This system passes if the well water analysis,, performed at a DEP certified laboratory;for coliform bacteria and..volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided tliatno other failure.criteria are triggered. A copy of the.analysis must be attached to this form'.] No (Yes/No)The system fails. I have determined that one or more of the above failure f criteria 'exist as described in 310 CMR 15.303,therefore the system-fails; The system owner should contact.the Board of Health to determine what will be necessary to correct the failure.. . E. Large System: To be considered a large system the system must serve a facility with a design flow: gpd• of 10,000'gpd to 151000 You must indicate either"yes or"no"to each of the following:. (The following.criteria apply to large systems in addition.to`the criteria above) Yes No y' the system is.within400 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)Ora mapped Zone lI.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 significant threat udder Section E or failed udder Section D shall upgrade the system in accordance with 310 GIVIR 15.304. The system owner should contact the appropriate regional office of the Department.' 4 5 Page 5 of 1.1 OFFICIAL INSPECTION FORM=NOTFOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO NFORM PART B CHECKLIST; Property Address: 986 Seaviery Avenue Osterville MA Owner: William'Carey. Date of Inspection: Januaw 18 2012 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? r . ✓ Were as built plans of the system obtaine&and examined 1.(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 ofbreak out Were all system components,excluding the SAS,'located on`site Were the septic tank manhole's 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 onahe proper maintenance of subsurface sewage disposalaystems The size and,location of the Soil Absorption System(SAS)on the'site has.been determined based'on: Yes No ry Existing information.`For example,a plan at the Board of Health.. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR.15.302(3)(b)]. •> y • z 5 . Page 6 of 11 OFFICIAL INSPECTION.FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ;SYSTEM INFORMATION Property Address: 986 Seaview Avenue Osterville MA Owner: YVilliant Carev ' Date of Inspection: January 18 2012 FLOW COND ITIONS RESIDENTIAL Number of bedrooms(design): 7+ r_ Number.of bedroonls.(actual): 7 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 or no): :'N/a 'Is,laundry on.a separate sewage system(yes or no): N/a [if yes separate inspection required] Laundry system inspected(yes or no): no.`•Seasonal use(yes or no):. no Water meter readings,if.available(last 2 years usage(gpd)). Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently COMMERCIAE/INDUSTRIAL 3 . Type of.establislunent: Design flow(based on 310 CMR 15.203): gpd " Basis of design flow(seats/persons1sq/ft etc.); Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system,(yes or no): Water meter readings,if available: Last date of.occupancy/use:, OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable. Was systempumped as part of the inspection.(yes or.no): Yes If yes,volume pumped: gallons--;How was quantity pumped detennined? Reason for pumping: Maintenance 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 andinaintenance contract(to be obtained from system owner) : Tight Tank. Attach a copy o.f the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of info rmatioi% Date of installation 1112193 126-as-built card Were sewage odors detected.when arriving at the'site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION'FORM -:'NOT`FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C { SYSTEM INFORMATION (continued) Property Address: 986 Seaviei, Avenue Osterville MA ' Owner: William Carey Date of Inspection: _ January 18 2012 BUILDING SEWER(locate On.site plan) Depth below grade: . r t Materials of construction: -cast iron ` 40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition ofjoints,venting,`evidence of leakage;etc.): E. SEPTIC"TANK: ✓ (locate on site plan). Depth below grade,: '36" Material of construction: ✓ .concrete'. metal _fiberglass _polyethylene:: _other(explain) If tank is metal list age:' Is age confirmed by a Certificate of Comphance,(yes orno). (attach a copy of ` certificate) Dimensions: 2000 gal. Y Sludge depth: 2„ Distance from top of sludge to bottom of outlet tee or baffle:,,' '30" Scum thickness: 4 Distance from top of scum to top of outlet tee or baffle: "6" Distance.fi-om bottom of scum to bottom of outlet tee or baffle: 1.0" How were.dimensions determined: MeaSMrinP sticlt Cotmiients(on pumping recommendations,inlet and outlet tee or baffle condition structural.integrity .liquid levels - as related to outlet invert;evidence.of leakage,etc.). The tees were present The liquid level ivas above the outlet in el t do to a bad yuriry" The tank was n=12ed diter the`insvection and the vrmiv was fried w a later date. The inlet cover was to grade GREASE TRAP: None (locate.on site plan) Depth below grade Material.of construction: concrete _metal _fiberglass _polyethylene _other' (explain): Dimensions: Scum thickness: ; Distance froin top of scum to top of outlet tee.or baffle: Distance from bottom of scum to:bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,;liquid levels as related to outlet invert,evidence of leakage,etc): t , . . Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE,SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION.(continued) Property Address: 986 Seaview Avenue Osterville MA Owner: William Carey Date of Inspection: Janiiarvl8, 2012 TIGHT or HOLDING TANK: None (tank must.be pumped at time of inspection) (locate on site plan) Depth below grader Material of.construction: concrete _metal fiberglass -_polyethylene other'(explain) Dimensions: Capacity: . gallons l t Design Flow: gallons/day, Alarm present(yes or.no): Alarm level: Alarm in working Order,(yes or iio) Date of last pumping: Comments(condition of alarm and float switches,etc.):-.: < DISTRIBUTION.BOX: ✓ (if present must be opened) (locate on site plan). Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution`to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: ✓ (locate on site plan) , Pumps in working order(yes or no): Alarms in working order(yes or no) Cornrnents(note condition of pump cliamber,,condition of pumps and appurtenances,etc.): At the time ofinsvection the punin was riot working The prim)chamber ryas puniyed and a new puniy was installed at a later date , p Page 9 of 11 OFFICIAL INSPECTION FORM=NOT FO R R VO LUNTARY LUNTARY ASSESS_ METS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ; SYSTEM INFORMATION (continued) Property Address: 986 Seaview Avenue Osterville MA Owner: William Carev Date of Inspection: Janitary.18 2012 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation_not required) If-SAS not located explain why: Type leaching pits,number: ✓ leaching chambers,number: 12lnfiltrators with 2'stone 7. leaching galleries,number: leaching trenches,:number,length: leaching fields,number,dimensions: overflow cesspool,number: x Innovative/alternative system ;,Type/name of technolo gY� Continents(note conditioirof soil,signs of hydraulic.failure,level of ponding,damp soil,condition of vegetation,etc.): I dug down and measured the size of the surrounding stone. W/nc/r was 2'. T/re stone`was dill dnd"clean. There did not a eai to be any sign of failure. The bottom to evade ivas oy oximate6 4 3' CESSPOOLS: Norte (cesspool must be punped as.part of inspection)(locate ori'site plan) Number and configuration: Depth_top of liquid to inlet invert , Depth of solids layer: Depth of scum layer: Dimensions of cesspool: ' Materials of construction: Indication of groundwater inflow(yes or.no): Comments (note condition of soil of Hydraulic failure,-level of ponding,condition of vegetation;etc): PRIVY: None (locate on site plan) . Materials of.construction: Dimensions: , Depth of solids: Connnents(note condition of soil,signs of hydraulic failure,level ofponding,condition.of vegetation;'etc.). } • 9 - , Page 10 of 11 f OFFICIAL INSPECTION FORM'-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 986 Seaview Avenue Osterville MA Owner: William Carey , Date of.Inspection: Jaiivaw 18, 2012 v SKETCH OF SEWAGE..DISPOSAL SYSTEM `" Provide a sketch,of'the sewage disposal system including ties to at least two permanent reference landmarks'or. benclunarks.:'Locate all wells.within,100 feet..Locate where public.water supplyenters the building.- f t _ - Ark --- � a A O , o " as C , 10 • Page 11 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: ._ 986Seaview-Aventie ' Osterville MA" Owner: William Carev Date of Inspection: Jantiai-v 18, 2012 SITE EXAM Slope Surface water , Check cellar Shallow wells: Estimated depth,to ground water f'10+/- feet Please.indicate(check)all methods used to determine the high ground water elevation. Obtained from system design plans on record If checked,'date of design plan reviewed. Observed site(abutting property/observation Bole within_150 feet of SAS) Checked.with local Board of Health-explain: TovoQraUhic and water cot2t6urs maps Checked with local excavators,installers=(attach documentation) Accessed USGS database-explain:' You must describe how.you established the high,ground water elevation Using Barnstable topographic and water c6ntours neaps the''nians wet•e showing approxitnately 10 +/ to Qt ound water at this site. t s r T171 7 - s e of this been r e r p p pa ecl only fa the septrc system and compoi7ents described herein Tlns septic system has been inspected acid passed as of tl7e date of inspection. This reoi t is itot a vvarranty'ot guarantee that the system will fiii7ction properly in the fiittae.'There have been 7o vvarratities orguara.ntees;either expressed, vvrittet7.or.implied, relating to the septic system, the inspection, this report andlor ally components of the septic systeni.;ivhicl7'hkve not been located and inspected. , e. •.11 , f A<J, 1 ` No. _OCl Fee l'v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zpprication for Migogal bpotem Construction Permit Application for a Permit to Construct OO Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.Q 816 5 Q AV I E-Al AV 1= Owner's Name,Address and Tel.No. 0STEM1/1L.Lt, MR Vitt-Liam CArzay Assessor's Map/Parcel ►O Po s 7 OFF 1 C er -sat. S 4 1'r6 9740 M q I P oa2 G05-rom MA Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.50$-419- a 3 4 y S U LLI VAIN 6NG�N6EFRt 1vF I NG 7 r-,ARtc.GR. RR 0S7GR1/ILLL: 41.4, Type of Building: Dwelling No.of Bedrooms L— Lot Size 2.72 A sq,ar Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design'Flow L•14 D gallons per day. Calculated daily flow 4 V 1 gallons. Plan Date S E PT. 3 Og 200 q Number of sheets Revision Date Title S 1'rFs 'PLgly - PRcaPoSE D C A2qG6 Size of Septic Tank 1500 GALLONS Type of S.A.S. 12'x3U' L_gAclii!✓G CAAM13E2 Description of Soil D-q�L L_AW N/ORG.APwr- O- I q'..-22 t-A- 8RN, COARSE SAND. IOY2 S/3 -2--1"- 4(," =-I3— t32�+ COARSE SAND -7 S Y2 t4/N , L!!." 88"-- G- Stmw_tr. laity GoARSO SA140 '�•IsyR S�$� GrouNcwATc2 an 98" 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 issued by this Board of Health. Signe Date Application Approved by Date Application Disapproved for the following reasons Permit No. o'D4370 Date Issued B- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(X)Repaired( )Upgraded( ) Abandoned( )by at 98l7 SEAv1Cw AVE t3s"TrER✓tLL6. AIA has been constructed �*n accordance with the provisions of Title 5 and the for Disposal System Construction Permit Nor�Lw�l (02' dated o Installer Designer$ULLIVA/y E/VGII &eq_1/V4 1/VG. . The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector _ -----No. - --- --_ ---------------------------- --Fe / O e ��q----- ---I THE COMMONWEALTH OF MASSACHUSETTS (J PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 'Wi5po5al *p5tem Construction Permit Permission is hereby granted to Construct(x)Repair( )Upgrade( )Abandon( ) System located at CI OG, SEW✓I Ew AV6 4,757-=21/W[_tE M _ 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: Constructiod must b q completed within three years of the dat of this pe i . Date:_ Approved by Wes, b....•:y.�, - ` -",^r..,.,, J..,,^iy.. T t.' t .,.f{•.. ` . -. ^f i. " ., ;I.r.x .�• ,,t .. ,n r .,:,..:. +r:.. *^•...".,,. ... _ No. • THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppricatiou for Migogal *Proem Conztruction permit t Application'for a Permit to Construct(x)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual'Components _ _ Location Address or Lot No. 6 t Owner's Na e Add e s d Te.No. CO STG RVII-.I.,15 W, m►� 1L_1.11 1►� ��I Assessor's Map/Parcel _ 10 Po s-r o F F i c C 5 ct. S 4#T E 9 7 D M C1 I vaZ C30 toN , MA Installer's Name,Address,and Tel.No. Designer's VN�aNme�,C,11164T�1 v I rvC_ 5 7 l�A2�c�R Rn. x r. Type of Building: Dwelling No.of Bedrooms Lot Size Z A c Garbage Grinder( )� Other Type of Building No.of Persons Showers( ) Cafeteria( ) tif F Other Fixtures Design Flow H 4 O gallons per day. Cal ulated daily flow `4 1' ( " , /1 gallons. Plan Date S C PT. 3 G 2-co o`f Number of sheets Revision Date x - Title S I TE P LP v - PR o P0-5 L 0 C-A 12/96-E Size of Septic Tank 1 500 Type of S.A.S. 1zx 3� �.c/�ct1 rwy tIM13t IL O_q t-Awntfc)r2c-F�N+cr- O- 9 - 2-Z Z- A- SRN. GoARSE 5AtvD. . Description of Soil 1 01 Q 513 J 2_2 - +- b _- C3 7 BQta Ca^RsL= SAND -7.6 Y2 q 1-1 1, - F'8 -- C.- SttzohJC. t3p_ly Cvla(Zse SA14D CrouNhwATL•R a) SO' 14, 4 M1 # Nature of Repairs or Alterations(Answer when applicable] r -: Date last inspected: " Agreement: Ni i The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Sign Date Application Approved by Date Application Disapproved for the following reasons Permit No. c Date Issued Q L THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS _ Certificate of Compliance,, THIS IS TO CERTIFY that the On-site Sewage Disposal System Constructed X Repaired Upgraded r > g P Y (�r ) P ( ) Pg ( ;) Abandoned( )by `�8l� SEAvILw Vt USIERVt(_LE A r at h fa n constructed_ ,n a�,cgrdagce with the provisions of Title 5 and the for Disposal System Construction Permit No. dated 8/�1S Installer -~ Designer S U L L I VA N EIVGI IV C-- 12 111/y I NC The issuance of this per„it shall not be construed as" s a guarantee that the system,will;function as deigned, Date Inspector No. �—�-' tOg—.------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS _., liq;paal *Pztem Construction Vermit , Permission is hereby ranted o Construct(X)Repair( )Upggrade( )Abandon 6/9VIeW A\✓r✓ U57"CR�/ILL System-located at i and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: ConstruFtitu�7bg'co leted within three years of the dat ofthis pe r Date:_. Approved by n . J. F j. s I 34' LIVING. � RooNt '15ATH- K�Tc HEW I.00M _LlBATNC20o M ri pED.Roo ivy` GARC'C'A1GER5 .DvVE►_l-t.NC� r 7rCo. SGAA1_M ~ . 9®b .SEAV E.w.:AvF-. Y i Messy .,;, -r' Page 1 of 2 Crocker, Sharon ✓ - From: Peter Sullivan [peter@sullivanengin.com] Sent: Thursday, March 31, 2011 6:12 PM - To: Crocker, Sharon Subject: FW:'986-A Seaview Ave. Osterville Hi Sharon As discussed here is a summary of the question at hand. ` Peter From: Peter Sullivan [mai Ito:peter@sullivanengin.com] Sent: Wednesday, March 23, 2011 5:21 PM To: 'McKean, Thomas' Cc: 'Stanton, David' Subject: RE: 986-A Seaview Ave. Osterville Tom You are correct; the permit has been extended the 2 years. However the problem is that the owner presently does not plan to build the addition and does not want to install the 2008 septic in order to guarantee the 4 bedrooms. Peter From: McKean, Thomas [mailto:Thomas.McKean @town.barnstable.ma.us] Sent: Wednesday, March 23, 2011 4:58 PM To: peter@sullivanengin.com Cc: Stanton, David; thayes@town.dennis.ma.us Subject: RE: 986-A Seaview Ave. Osterville I'don't wish to complicate this any further; but was this four bedroom disposal works construction permit secured during the qualifying period of the Permit Extension Act- so that it was in effect or existence during the qualifying period beginning on August 15 2008? I believe the answer is yes. If the answer is yes, this 2008 permit would be automatically extended for two additional years as authorized by Section 173 of the Acts of 2010 (Permit Extension Act). Does the applicant intend to construct the addition before the new extended deadline in 2013? -----Original Message----- From: Peter Sullivan [mailto:peter@sullivanengin.com] Sent: Wednesday, March 23, 2011 2:52 PM To: McKean, Thomas; Stanton, David Cc: 'John O'Dea' Subject: 986-A Seaview Ave. Osterville RE: 986-A Seaview Ave. Osterville T m 0 Could you put me on the agenda to talk to the Board about 986-A, Seaview Ave.? I reviewed this one with you and Dave and you felt it best to have the Board give a decision. What we have is.an old permit 93-550 which indicates 2 bedrooms on the application but the installed system has capacity for at least 4 bedrooms (6 infiltrators packed in stone). The owner was planning an addition in 2008 and we secured a newer permit to upgrade since the proposed addition was on top of the 1993 system. The 2008 system design (Permit 2008-068) is essentially the same as what is in the ground however the new application states 4 bedroom design flow. The present plan is to not build the addition or to build so as not to interfere with the present septic system. What the owner would like is to not install the 2008 system yet retain the 4 bedroom �4/5/2011 Messages Page 2 of 2 : �• capacity for the property. The 1993 system works fine and appears to be in compliance with present regulations and has capacity for the four bedrooms. Since the Estuaries Regulation has come in to effect it can be argued that the property/dwelling has 4 bedroom capacity since it is"permitted What do you think? Please let me know. Thank you, Peter Peter Sullivan PE Sullivan Engineering, Inc. M t 4/5/2011 - w�z Message Page 2 of 2 -----Original Message----- From: McKean, Thomas Sent: Friday, March 25, 2011 9:10 AM To: Weil, Ruth; Houghton, David Subject: Fw: 986-A Seaview Ave. Osterville Hi Ruth and/or David, This appears to be a legal question:See below-can someone grandfather the number of bedrooms on a disposal works construction permit application that was appproved by the Health Division in 2008 if the applicant did not and does not act on the permit(does not install the septic system)? From: Peter Sullivan <peter@sullivanengin.com> To: McKean, Thomas; Stanton, David Cc: 'John O'Dea' <john@sullivanengin.com> Sent: Wed Mar 23 14:51:33 2011 Subject: 9867X Seaview Ave. Osterville RE: 986-A Seaview Ave. Osterville Tom. A Could you put me on the agenda to talk to the Board about 986-A, Seaview Ave.? I reviewed this one with you and Dave and you felt it best to have the Board give a'decision. What we have is an old permit 93-550 which indicates 2 bedrooms on the application but the installed system has capacity for at least 4 bedrooms (6 infiltrators packed in stone). The owner was planning an addition in 2008 and we secured a newer permit to upgrade since.the proposed addition was on top of the 1993 system. The 2008 system design (Permit 2008-068) is essentially the same as what is in the ground however the new application states 4 bedroom design flow. The present plan is to not build the addition or to build sous not to interfere with the present septic system. ' What the owner would like,is to not install the 2008 system yet retain the 4 bedroom . capacity for the property. The 1993 system works fine and appears to be in compliance with present' regulations and has capacity for the four bedrooms. Since the Estuaries Regulation has come in to effect it can be argued that the property/dwelling has 4 bedroom capacity since it is"permitted". What do you think? Please let me know. Thank you, Peter Peter Sullivan PE Sullivan Engineering, Inc. 4/5/2011 t of.r� Town of Barnstable c# �� o* Department of Regulatory Services t 6AarrerA9[t1 3 Public Health Division Date MA88 200 Main Street,Hyannis MA 02601 I rfD Mtd� Date.Schedu)ed 4 D Tune Fee Pd. 'Soil Suitability ssessm nt for.Sewage A Disposal . Performed III';' :Il%VQ !� rl� lu2 r1'- WiutessedDy:�aPkk ?, Mtti�Aw'�=,25 i LOCATION': GENERAL INFORMATION Location Address Owner's Name �'r✓j%/tl Address �I .S� / Cn ineer's Name a!/J"( Len Assessor's Map/Parcel: h � g �: NEW CONSTRUCTION REPAIR t.Telephone M Qd^-yo?Id% 3 3 V Lf Land Use �e51(�Q(�f�` � Slopes.(%) 3-.5`d Surface Stones !"Orly t4 , t �4- Distances from: Open Water Body LSO A 'Possible Wet Area•2 06 it Drinking Water Well ,S0 It - DrainageWay 1 Property Line. SS R Other { 51�,1_,TCI'I.,(street name,dimensions of ion,e:teet locations of test holes&pert tests,locale wetlands in pmxtmiry to holes)_ 4 • � f f3�y�, ti ' R ry�r•� � Z SEA YIEW A4ENU6 '- `_-.�-a�,,.�,�,.-•--sue-►-..- _�. r"�..�..-=t-�' _ - - - - '- -- l T Depth to Bedrock Parent material(geologic) .. - Depth to Groundwater: Standing Water in Hole I O Weeping from.Pit Face Estimated Seasonal Iiigh Groundwater GL 1. DETERMINATION TOR SEASONAL kIIGII 'WATER TABLE Method Us � R MID Itr, Depth Observed standing M.hole• In, Deptlr to soil mottles R Depth to weeping from side of obs hole:: in. .Groundwater Adjustment Index Well N Reading Date: Index Well level Adj.factor Adj Oroundwntct Level PERCOLATION TESTDate2 Time l _ Observation . Time at 9" Hole H . Z Depth of Pere Time at 6" Start Pre-soak Time Q .t AN Time(9 -ti'.') End Pre-soak ` . Rate Min./Inch L wt, i , Site Suitability Assessment: Site Passed : site Tailed: Additional Testing Needed(YM) Original: Public Health Division Observation Hole.Data To Be Completed on Back-- ---- S ***If percolation test is to be.conducted within 100' of tivetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. J w Q 1IEALTIMP/PERCTORM I,E,P OBSERVATION HOLE LOG Hole It Depth fiuln Soil 11011zoll Soil Texluro Soil Culi!r Soil Olhcr Surthct,(In.) (USDA) (Muosoll) ; Mottling (Situcluro,Slunes,lluuldeis. -- -_ _- _ Cnnelerenav °e(lraycll 0-4 l atAvv� 4—t1`, / awe 10V?i W-715. C 5 q I oy 1 Z2 ' 7t TN \� ww AL DEEP OBSERVATION"IIOLIJ LOG . IIole# Z' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) I (Munsell) Mottling (Structure,Stones,Douldcts. Consistency.%Gravcl) ,1 5hPjI �S-lit Lo t(Sy k 1.k.� ,,,, DE,IJP OBSERVATION HOLE LOG. Mole# Dcpth from Soil Horizon Soil Teztute Soil Color Soil fluter Surface(in.) (USDA) I (Munsell) Moulhig (Structure,Stones,Douldcis. . Consistency.%Gt. cl . _ • I j DEEPOBSE,RVATIM HOLE LOG Mule# Depth from Soil tlorimn SoRTWurcl Soil Color Soil Other . Surface(in.) (()SDA i (Munsell). Mottling (Structure,Stories,pouldcrs. Consistency,%Graven i Flood Insurance Rate Man: Above 500 year flood boundary`:No Within 500 year boundary. No_` Ycs � WiUiin 100 year flood boundary No Yes .¢ Depth of Naturally Occurring Pervious Material Does.at least four feet of naturally occurring pervious material exist urtill areas observed throughout the area proposed for the soil absorption system? If not,what is We depth of naturally occurring pervious.materials . Certikatiun I certify hat on ll O _(date)t have passed tide soil evaluator examination approved by.the . Department of Cnvirotune.ntal Protection and that the above analysis was performed by,me cons'lsteut with tho required training,ex cA. o and experience described in 310 CMR 1.5.017. Signature Date Q:1IEA1 TI-IMPIPERCrott.M Message Page 1 of 1 Miorandi, Donna From: Paula Sullivan [paula@sullivanengin.com], Sent: Thursday, February 07, 2008 9:47 AM To: Miorandi, Donna Subject: RE: permit How stupid can I be. The address is 986 Sea View Ave., Osterville Map 091 Parcel 002 Thanks. From: Miorandi, Donna [mailto:Donna.Miorandi@town.barnstable.ma.us] Sent: Thursday, February 07, 2008 8:25 AM To: paula@sullivanengin.com Subject: RE: permit Hi Paula, What's the address???? Donna -----Original Message----- From: Paula Sullivan [mailto:paula@sullivanengin.com] Sent: Wednesday, February 06, 2008 5:25 PM To: Miorandi, Donna Subject: permit Hi Donna, We did a perc in Sept 2004 and then a design for a 4 brm septic for a 2 brm proposed garage addition which would include upgrading the exiting 2 brm carriage house. We cannot find anything in the folder that shows we pulled a permit. Do you.have any records in your files? Please advise. Looks like this one may have slid through the cracks and now they want to do the project..Any information would be appreciated. Thanks (they also have a main house with a separate system for 7 bedrooms). Please call to discuss if you need to. Paula for Peter 2/7/2008 d r TOWN OF BARN-STABLE LOCATION 9 ?v/ SS,4111E W 411 SEWAGE #�. VILLAGE ,s�� LyG _� ASSESSOR'S MAP & LOT_ 9I -ab� INSTALLER'S NAME & PRONE NOe , P /V1.�c®Avt le, fi SoAl SEPTIC TANK CAPACITY jt. 00� LEACHING FACILITY:(type) /,Z NO, OF BEDROOMS 6' PRIVATE WELL OR PUBLIC WATER- BUILDER OR OWNER- DATE PERMIT ISSUED: d '� DATE COIIPLIANCE ISSUF.D�_ VARIANCE GRANTED: Yes No ¢� V I Sri f� ' f„ TOWN OF BARNSTABLE LOCATION 9 flt5 AV12-- w Ay SEWAGE-# Z 'S60 q VILLAGE 0STeR !/�G�E- ASSESSOR'S MAP.& LOT-ow INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) sue) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER I BUILDER O OWNER N UCH ® W k DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No r _ _ - - - i ` - - � ..� ,,3a �. `�® \'�� 3�7 �. . ��� � � � i � �o . . ,, � � a � . � � — — —- APPROVED r ble Consety ion Depa ent THE COMMONWEALTH O MAS ACH SETTS BOARD OF HEALTH Signed Date TOWN OF BARNSTABLE Appliration fur Diripimal Mork,i Tomitrnrtinn Frrmit Application is hereby made for a Permit to Construct ( ) or Repair R an Individual Sewage Disposal System at: 986 Seaview Ave Osterville .................................................................................................. •-•-•-••--•-•••--•........••---•--•-•-••---....._......_......---•---------•-•----..........----•- C .W.Car ey Location-Address or Lot No. O�cner Ad W J.P.Macomber Jr. Address IustalIer Address d Type of Building Size Lot............................Sq. feet DwellingX- No. of Bedrooms.--_--_---_---------------------------__-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ---------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.....-------gallons Length................ Width---------------- Diameter................ Depth................ x Disposal Trench-- No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gr4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ............................................................-................................................................................................ 0 Description of Soil..... and-.. ..ar.a el-•••••-•-••....•••---•-•-•••-••-•--•--•........•----------•••---••-•---••••...---••-•---•---••••......-•••-•-•-••---......... x .-------------•----•------------------------------------------------•--------------------......--------------------------------...------------------------------------------------...................-•-- w -• ---•-•-•------------------------------------•--........-------------•--------------•-------•-----------------------------------••----------------•-••-----•-......_......................•-•-••••... UNature of Repairs or Alterations—Answer when applicable----1_5.QQ_._ :a lQn_._t.an$,1-da.s.f;xJ.but- 044.... boxand 12 infiltrators---packed.-. •r'---.�.t.one.._._Omi �-_-ae.szpaals._.........................:..........--•-••-••----•-•-•• _ .......... 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 Complianc has bee ss d by t e board o he . Signed ...... .- - ------/e"... '------...... ..8/5/93.............. Dace Application Approved By ............ - .............. ��.`.Date.-. Application Disapproved for the following reasons: ..... .......................... ........................... ................. ......................... ................... .................. �..r........................ . . ........................................................ - . ........ .................................. ............................. ......... Permit No. < ..5.3...... 1................_........... Issued ...................................................... Da. ........ ....... /� Dale . t E COMMONWEALTH OF MAS AC4HU �TH BOARD OFHEALTH TS . TOWN OF BARNSTABLE Cl i Appliration for Diripniul Works Towitrurtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair R an Individual Sewage Disposal System at: 986 Seaview Ave Ostervl.11e --•--------------------------------------------•--..._..------------------------........----..-... ------•------------•------........----•--•----......•-•-..-........------------........-...--•••-. Location-Address or Lot No. C ,W .Caren ........................................................... J.P.Macomber Jr. Owner � Address I list al ler .... � Address UType of Building Size Lot............................Sq. feet r, DwellingX No. of Bedrooms............ ..__._.__...n................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons--.._____---_-__--_-_-__---- Showers ( ) — Cafeteria ( ) dOther fixtures --------------------------•--------------------------.-----...------------------------. ---•-----•.........--------•--....:.. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity_.____.....gallons Length---------------- Width................ Diameter................ Depth................ W x Disposal Trench—No. .................... Width--------------{.__.(Total Length.................... Total leaching area-----...............sq. ft. 3 Seepage Pit No-------_------------ Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------- '-----%..._.._...-^-------------••---.....----•---------•• Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gx, Test Pit No. 2................minutes per inch Depth-of Test Pit.................... Depth to ground water........................ a ......---•----^-----------^----^•............................•-••••••---------...••-- Description of Soil....Sand... ............................................ V .....••••-----•-•-------•-------------•-•--...............•---._.........--•--------•---••••••--•--•--•------------------------------•--•--------•-••--••-•••------............-•---•---••-•........---- UW •--------------------- •-----------------------------------------------------------------------------....-----------.....------------------------......•-•---------.....................-.......... Nature of Repairs or Alterations—Answer when applicable....15D0...,._8_1_1on_,_t:a_n,. ;•r ,+-;-yn•--. boxand...12...infiltrators_._nac�kQc�--. .�....;3tan Qm�t- r.e_sn�r�1-G..y -------•------••----------------•--•-•--• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmen.ffl Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee iss•ed by the board 4 health. Signed ------ .. /. f `�� 8 .............................. — Date Application Approved By ............... �-may ....-------------- ------- ... - �-----------------...-------'--`--- Date Application Disapproved for the following reasons. ...................................... . .......... .......... .................................... ....................... .................... ..... ............................................ . . ..... ............................. ......-- .--. . . ...... .. ....... .... ........................................ C• Dace Permit No. ......../-_3........�,2��.............................. Issued,...-..' ........................ <✓ �, Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARl.�NSTABLE (gjer i�irzttr of Compliunre THdIS�SNTlaeOEmb IFY,0T at the Individual Sewage Disposal System constructed ( ) or Repaired (XXX) by ............................................................................................................... ......._.....-- ............................... Installer ac ..... ...98E....Seavi_ew...Ave....0.steridliQ..._------- --------------_...---------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ........... dated .---...................._............_...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. IDATE.................. ..-. .'.../..�� ........_----.............................. Inspector .....__... ���...,.. - .................... ---- -----_�_---- - -_ _-_,.-------------------------------_-.,--------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �j TOWN OF BARNSTABLE �No. / >.-..�.,2� FEE......3�..20 ._ Dispofial Norkii Tonotrurttion "omit Permission is hereby granted..J-P,Xa4nom e r-jx ----------------------------------•-----------------------•----------•--......---......---.... to Construct ( ) or Repair KX) an Individual Sewage Disposal System .....................................•--------._......•---.._.......--•---..................•- street as shown on the application for Disposal Works Construction Permit No.-73-�6).. Dated........................................... -----------------------•----..�..:--------....................................................... - /1 y _ Board of Health DATE..................�•------�---•-r-------�--�- ---------------------------- FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS �. No...� __: .JTO FFs... ...3�.�.. ��.. APPROVED THE COMMONWEALTH OF MASSACHUSETTS rust Ie C nservati Depa1�_ �TOWN BOARD OF HEALTH /7 l OF BARNSTABLE �T_ lgned Data Appliration for Uiripoinl 19ork,6 Tontitrurtiinn Famit Application is hereby made for a Permit to Construct ( ) or Repair )(X)o an Individual Sewage Disposal System at: 286A Seavievr Ave Osterville .....--•................ ............ ...............I...................................... ............. Location-Address or Lot No. C.W.Carey Owner Address W J.P.Nlacomber Jr. Installer Address UType of Buildin Size Lot............................Sq. feet Dwelling yNo. of Bedrooms.............. .......................-----Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures _________________________________ W Design Flow............................................gallons per person per day. Total daily flow_-------------------............_..........gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter................ Depth................ x Disposal Trench— No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by ---------------- Date........................................ � Test Pit No. 1................minutes per inc[I Depth of Test Pit-------------------- Depth to ground water..___....._._........... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---------------------------------------•--•---------------•----•--•------------•-------------..•---......................................................... 0 Description of Soil Sand-•-........... ... ........................--- ravel ................•---•---•------------.--------------- V ------------------•------------•---•--...........-------------------------------------------•--------------- -----------------•----.------•---- -----------------...........-•--...... W --- -----------------------------------------------------------------------------------------------------------------------1---10-0-0---- U Nature o Re airs or Alterations—Answer when applicable...Omi..t cesspool. 1-1000 tank 1 --------------------------•---................. distriK ion box a.-nd infiltrators packed in stone . ........................................ ----•--------------------.................. 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 Comphain e has bee iss by t e board heath. Signe ... kk� ....�................ .��5/93..........._'-- - Dace ........... Application Approved By ............. .e ^= .................................................-........................... ...... -�Se Da, Application Disapproved for the followi g reasons: ................................................................ ..................................................................... ............................ ................ ... ....... ........................ . ...................... ............................ . .. .... -------------------------------------- Dme PermitNo. ................................... . ................... Issued .............. . .........................----.................. Dace THE COMMONWEALTH OF MASS CHUSE17S BOARD OF HEALTH TOWN OF BARNSTABLE (gerti rate of V�!�.�T ont lianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX) by J.P.Macomber Jr. ----------------------------------------- ----------.------- _............._.... ...... Iasr,Jicr at ....986A...Seaview...Ave....Os.te.rvi.11e........--------------- has been installed in accordance with the provisions of TITLE 5 qof The State Environmental Code as described in the application for Disposal Works Construction Permit No. ._.._.l.. ..--- .).._.... dated -------._.---------............... ......__. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON UE AS A GUARANT E THAT THE SYSTEM WILL FUNCT19N ISFACTORY. DATE....._._._........../0,/*,!��J�7�/��­�`-1 ' - Inspector .... ......r!V/��/ ........._......._. - -------------------- '-------------_-a-------------__ -------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE $ 3�.,�� No...� ..,..5. .lJ FEE.................:..... Raplioat Vorb Tonotrurtion Vamit Permission is hereby granted -J--- ----- - ----- ----------------- P.Macomber Jr. to Construct ( ) or Repair (XX) an Individual Sewage Disposal System at No...9Df A--Seavzemu Ame---Da t exy le-----------------------------------------------.-------------------------------- ............................ Street : as shown on the application for Disposal Works Construction Permit No.�-.�h�___ Dated___.._k5.-..-/. �...�...... 0 ---------------------------------------------------- (`1 Board of Health DATE....................).0--.... .. ......................... V FORM 36508 HOBBS&WARREN.INC..PUBLISHERS THE COMMONWEALTH .OF•'MASSA�CHUSETTSe �fJ� � BOAR® OF HEALTH TOWN OF BARNSTABLE' v Apphratioll for Diri niul Works Tvfwtrurfioo� rrmit Application is hereby made for a Permit to const uct ( ) or Repair�(X)Da Individuals Sewage Disposal System at: ...Wit►" 986A Seaview Ave Osterville ..............................•-•---.........---.....-------•--_-----....-••---.......------------• ----••-•-•--•-••-------•......----•-•--.._._........._._......._._...--•-------------...._.---•-- Location-Address or Lot No. r` r Owner Address r W J.P.Macomber Jr. ' Installer �:. Address ' UType of Building Size Lot...........:..............Sq. feet .. Dwelling No. of Bedrooms--------_____2•--_-_-_----_-_--___---_-.-Lspansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons......................... Showers ( ) — Cafeteria ( ) a Other fixtures ..................................... . W Design Flow............................................gallons per person per day. Total daily flow................................._...........gallons. 1:4 Septic Tank—Liquid capacity...._......gallons Length................ Width---------------- Diameter---..--.---_-___fDeptli................ Disposal Trench—No. .................... Width..................t_ Total Length.................._. Total leaching area''- -...............sq. ft. Seepage Pit No............ ....... Diameter-----------------:__ Depth below inlet.................... Total leaching area.._......::.......sq. ft. Z Other Distribution box ( ) •= .Dosing tank ( ° ) aPercolation Test Results Performed by.......................................................................... Date........................................ 14 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fZq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W -•--•----••.........-••------••.............................................................................. 0 Description of Soil.......Sand & gravel x - - - W V Nature of,Re airs or Alterations—Answer when applicable._.Om it cesspool. i-1000 tank 1 . . -•••••-••-•----•--•.............. distribution box and 5 infiltrators packed in stone. 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 board of health. -Signed /t ._ -...... .. ............... -- Date ApplicationApproved By ................ ......,yeti ��.....................l.... - ........................................ ......�.�.—../.Y_-%3 Dare Application Disapproved for the followi g rearonr: '.....................................................................................:'........... + / yf Dare - PermitNo. ........................... ..... . . ... Issued ...................................................---.............. Dace i - z .Y nLL 11 HIM ' 41 RINI"T P R UA E55 .I - i � I I, I • p/{T /4GGF SG lJr'1 V• , 3 - - - 5 -� -:r j 7 x17 f _ -7X f7 � x 17. - VATE , - ESIIDENCE 986 Sea View Ave. Osterville, MA 02655 LI ry SUNRE AR COURTY( D - G•CHARLES GAOBOIS•`Ia,, T Do.O••M•,�wovo,mm Y? s w L TOM GP1lIGAN �.S �t a'M' 4n1mM0.•mmn' 1 I-- i oaoiii 'reaioim7/igoii2- ixo _.a c•ALL CONSTRUCTION TO COMPLY WTH - MASSACHUSETTS STATE BUILDING - CODE.BTH EDITION. y _ - CONTRACTOR TO VERIFY ALL _ - - DIMENSIONS INFIELD.IF EXISTING CONDITIONS REFLECT SIGNIFICANT NON CONFORMANCE TO DRAWINGS, {: CONTRACTOR M IIAATEOY TO NOTIFY ARCHITECT ' O _ LIGHT.BHADEIBUND•DIFFUSER ANDTHER DISTANCES ASSOCIATED MH ELEMENTS HEREIN ARE PROVIDED OR ESTIMATING PURPOSES ONLY. 10T , 108 E n,. - ALL AS-BUILT CONDITIONS MUST BE E%i$TING . VERIFIED BY CONTRACTOR PRIOR TO EXISTING PLANTER BED PRODUCT PROCUREMENT. - TERRACE -. .,.,. _ _ ON�SKAEACH SHEET. (STONE) VERIFYRESULTANTCHANGES TOIN ON EACH SHEET.CONTRACTOR TO FN�IIY ASSOCIATED DRAWINGS. ANfR MG RM. q � ®� 9 _ EXISTING PLANTER BED i n rK HIS ElW31 u n_ �[JYcI, y I GD„RM GIR ._ r , DEN XB , s I ®•� / NTH AHILY F / 11P r / BITTING RM. ® FOYER ® 110 S 1 101 ❑ 0Ll viol/.. - LA"a NB I I — =aonu �oPA P�a�ErEE=ON.'— PT RM _ IF rHE aM lR""I'D'MEGG„G I i PAN-S ova`' BARE TO IF 11OUGHl TO EEFURE�E-DAB N1111 ED GS D- i rm ETD 'B y OHA DESIGN DEO GOLLABORIT vE AEE R G aP v _ o - Y I to I FIRST FLOOR PLAN EXISTING — I PRIVATE RESIDENCE 986 Sea View Ave. Ostervilla' MA 02655 os rc ' u•CNARIES GADp01S•s r e r.---I rFxcOxsiAUC,rox ' - sw, - Pomr 55n. uamuwpnwa„Sz k�m,pw.m,me siw.n,vutimmn rTa ey oGANIE a •.r. z�5um�ia59 ENc+xFExx,G —y KW k5l I PP I ALLCONSTRUCTIONTOCOMPLYtNTH MA CODE.8HEDITISSTATE BUILDING LOGE.BTH EDITION. CONTRACTOR TO VERIFY ALL Y. DIMENSIONS m 4 p CONDONS REFLECT SIGNIFICANT ITI CANT xsw.wlEn I F 1 NONCONFORMANCETIT pC xswnxrE nuo CONTRACTOR TO NOtIFY ARCHIT ARCHITECT IMM LIGHT LIGHT,SISTAN ESASSFFUSERANO OTHE,t,• r t b R. i ALL ASBUITELEMENTSHECG PURPOSESDITIONS OEINAREPROMDENLY, FOB "v ROVE IFIEDBY DICT PROCUREMENT. PRIOR TO RATTRY ON EA ANOTATIONS FOR REFERENCE EACRIFYH SHEET.COW RALtOR TO { 1 E ASSOCIATED DRAWNGS.--- y c k`�m5+ce�'im j e ro @j ,,,v GUEsr d1` 1W a-US&IDFro - , G r , t - S� IF '— . w . - -, i / .� 1f0 � 9 �� s ttP i� Q� ❑ Fwar cant Rupp 1 q Exi0.r1� TO, . ,' p N , 2: _--irri�iciiiooii ioa� ri Tin. i.iiioioe ,. ,i i �� � "` �Q 'y eencx - cwr,u - O Q y Q QI •.,K i EHmrHUL 9 scx:xo PGE,s m 1' 115 rvmum L coxwrxvm O oEw.PHE u Pnar ®❑ RESExTEDTHEREFYAa-ED i _ —--I — RaPEH of E T x ❑® �-- �,,�„�,,,,9 1 ,%. a R.T VEFcr RN oL w11 1 Fc .,,rwuwFocEo.ram o N .. �Mas ory or1111 a ix,nrAT.,x"� ._,. s es O OF DECRE u,aESox THE ,., H N LnRicEoa eH �° i Saiscon�ceozw ETO y; E aHl_UG USED—TO oP.»,xcs .R (Cu:vGH w.R OEs cx C—AlOT 1E CONSTRUCTION NOTES GENERAL FL01 SCOPE NOTES unGnTS PESERveo K.,o,,..,,,.r,..r.r...m....�,a...m®.�,w,•M,.,�,. ,...�..>.�...,.,... .,..M>,,. ....,.,..u.mK..r�.,,.,.,.rw�..... am.rrmxx w.vF.w,,.,o .,rz.w.reoou.,H.rhUEl 155- - —� .n, ..r,.,,r,.a,...,.a,,.<,>�.....m µMa.... ,.......a.�ro,,,.ar�...,r.m..ur. �n..rn..,.,..,..w,�,.,.,,,a,.,...�.•..nm,r..n�...,.. uc..o.e.r a , RRERc — ry.'' t o...,® ,..�ar.n.�.m�m,-.�.......� ..mv.,�r..r..w,e,.�,s.a.nw.�...Ya.,,.a,o w�^w,.a�.,,�pw•w,`.a..r..,.�..r u,Evs xcmw,uen nxsnzwr.vxsrou nF>umso .� . I --_ �#;. � I a•^.^.,...a.,..��r Wn��N.,....m,��L��,a.K,.,....r.�,.,.a..,r....,r.r...,..w.....,.m<.....m�m,a,.A,,,,,<..r� J n,.r..,r.n. -- a�V+; ...m."�w..ma.,�,a....n.�m,.r.,.a.r.,.m,...,u„�...�.,�..,.„.��,a......,..r..,......r...>,,...r...r�,..,rmm.....,r..,.,.,,..rt,. ..a..r.. .....,rma, .,,...,.r....,m.....m,w.4...-�..,,,r:..,....o•..a. ENERGY CODE INFO. FIRST FLOOR PLAN r—, PROPOSED i Locate Junction Box Outside of Tank 4� DESIGNDATA SEPTIC NOTES Pump Power & Float Control 1.Location of Utilities Shown on This Plan Are Approx.At Least 72 Hours 7.Septic System to be Installed in Accordance With 310 CAIR 15.00& f Cables Installed /n Accordance Single Family Prior to Any Excavation For This Project the Contractor Shall Make 248 CAIR 1.00-7.00 Latest Revision and the Town ofBarvstable With Federal, State & Local -7 Bedroom Qa 110 GPD the Required Notification to Di Safe 1-888-344-7233 and contact Board ofHealth Regulations. Bldg. & Elec. Codes g ( ) Alarm To Be On Separate No Garbage Grinder 8,All Piping to be Sch.40 PVC. P Sullivan Engineering&Consulting Inc.(508�28-3344). Service From Pumps 9.D-Box Shall Have a Minimum Inside Dimension of 12,and a Minimum 2. The Contractor is Required to Secure Appropriate Permits From Town 1/2"m Gal v. Pipe BOUYANCYCALC Agencies For nso h�rctionDefinedbyThisPlaa. Sump of6". „I' For Float Support 1500 GAL H-20 Pump Chamber 3.Wherever Sewer Lines Must Cross Water Supply Lines Both Lines Shall 10. Septic Tank Shall be a 2,500 Gallon,with 2 Compartment Dead Weight 23,000 LBS Be Constructed of Class 150 Pressure Pipe and Shall be Water Tested to The First Compartment Shall Have a Volumce of Not Less than 5' Q To D—Box Uplift=6xI I'x2.25'X 62.4 LBSICF Assure Watertightness. In General,Water Lines Shall be Constructed in 1,540 Gallons and the Second er Not Less than 770 Gallons. =9,266 LBS Coordination With COMM Water,and Shall be in Accordance The Compartments Shall be Interconnected by a Minimum 4"0 Vented Inverted U-Shaped Pipe with a Gas Baffle on the Outlet • With 248 CMIZ 1.00-7.00&310 CMIt 15.00. C 4"0 Sch. 40 PVC 24"0 Opening in 11.The Separation Distance Between the Septic Tank Inlets and From Se tic Tank P 9 Above VARIANCES 4.AMinimumof9"ofCoverisRequiredforADComponents. P For Manhole Outlets Shall be No Less than the Liquid Depth.Inlet Tees Shall Extend Comportment Town of Barnstable Ch 360-1 5.All Structures Buried Three Feet or More or SubjectFrame & Co ver to Vehicular TraflSc io be H-20 It is the eves a Minimum of 10"Below the Flow Line.Outlet Tees Shall Extend 14" 100'Required to Tank&Pump Chamber Loading. Engm Below the Flow , Equipped an 80'Provided Recommendation that H-20 Always be Used. Line and Shall be Euied With a Gas Bad - 6.Install Watertight Risers and Covers to Within 6"ofFinished Grade Department Approved Filter. Over Septic Tank Inlet and Outlet,D-Box,and One Leaching Chamber, 12.All joints connecting pipes to f6undation,tank,d-box and SAS are to be and to Grade Over Pump. Sealed with hydraulic cement. All covets are to be maximum 18"for concrete or 24"Cast Iron. PUMP COMPA R TMEN T PLAN DETAIL NOT TO SCALE See note 10 See Note 6 (typ.) Conduit Thru Chamber For 24"0 Manhole FF EL. 11.20 Power & Float Cables Frame & Cover Approved Filter Required Finished 9" Min. F.G. EL. 9 Grade Cover FMI • _ Flow Equilizers I I I I FMIAs Required 4"0 Sch. is PVC EL. 7.70 H-20 From Septic Tank Installer To D—Box Compartment - Galy. Chaff Drill 1 8"0 Hole PROPOSED For Drain Con firm Prior L. 6.50 PROPOSED To An Work 2500 Gallon EL 6.25 1500 Gallon H-20 ( Inv. 4.50 y Septic Tank EL. 6.00 REPLACE Emergency Storage To 2' Box P Pump Chamber Match Existing Volume 998 Gal. H-20 Required Min. 2' Cover See Note 10 & 11 Waterproof/Seal with 2 lnvet Elevations Coats of Approved Alarm On El. 1.83 Sealant EL. 1.25 Pump On El. 1.50 r, Pump Pumps Off El. 1.00 o To Be Installed On 1Do 2"0 Sch. 40 PVC Tanks to Be Stable Compacted Bose Bedding,"T"s, - CL Waterproof�Seol with 2 Inspection Port, Threaded Pipe Coats of Approved & Boffels Check Sealant as Per Title 5 Top of Conc. El. 0.25 Bottom El. —0.25 LOPED PROFILE OF SYSTEM Secure Pipe at Top' C IL to Bottom of Chamber 48168 NOT TO SCALE 1/4 H.P. Myers Pump Stable Com acted A�p,�. or Approved Equal* Base FGISTE�� S/OpdF.t 4_��� *Prior Muost to Ordering thePumps the Compatibility f the Contractor �. . . Existing Electrical Service REV.: Replace Septic Tank 10112112021 IV TITLE: PREPARED BY. PREPARED FOR: Septic Details PUMP COMPARTMENT At Engineering& Robert & Rita Davis 986Sea View Ave Sullivan !COnsulting,Inc 22 Liberty Drive y SECTION DETAIL Barnstable (osrely iw Mass. (508)428-3344•P.O.Box 859.711 Main Straet,Oatemille,MA 02655 Boston MA 02112 aecl@sullivanengin.eom.wField. lNanMIKIcom l{ NOT TO SCALE Dro/t: C7R Field: WHK/C7R/JOD/EM DATE• SCALE: Review: cTR Comp./Review. CTR/JOD _ '{ December 14, 2020 Project. Davis I Pro'ct. 3B00f0 i I i Locate Junction Box Outside of Tank DESIGN DATA SEPTIC NOTES I Pump Power & Float Control 1 Location of Utilities Shown on This Plan Are Approx.At Least 72 Hours 7.Septic System to be Installed in Accordance With 310 CMR 15.00& Cables Installed In Accordance . Single Family 248 CAM 1.00-7.00 Latest Revision and the Town ofBarnstable With Federal, State & Local Prior to Any Excavation For This Project the Contractor Shall Make I Bldg. & Elec. Codes -7 Bedroom Qa GriI 10nder r the Required Notification to Dig Safe(1-888-344-7233)and contact Board Piping to a Regulations. Alarm To Be On Separate No Garbage Grinder S.All Piping to be Sch.40PVC. Service From Pumps Sullivan Engineering&Consulting Inc.(508-428-3344). P 2.The Contractor is Required to Secure Appropriate Permits From Town 9.D-Box Shall Have a Minimum Inside Dimension of 12,and a Minimum / P BOUYANCY CALL Sump of6. Fo?Float al Support Agencies For Construction Defined by This Plan. 1500 GAL H-20 Pump Chamber 3. Wherever Sewer Lines Must Cross Water Supply Lines Both Lines Shall 10.The Separation Distance Between the Septic Tank Inlets and Dead Weight 23,000 LBS Be Constructed of Class 150 Pressure Pipe and Shall be Water Tested to Outlets Shall be No Less than the Liquid Depth.Inlet Tees Shall Extend 5' Q To D-Box Uplift=6'xl I'x2.25'X 62.4 LBS/CF Assure Watertightness. In General,Water Lines Shall be Constructed in a Minimum of 10"Below the Flow Line.Outlet Tees Shall Extend 14" =9,266 LBS Coordination With COMM Water,and Shall be in Accordance Below the Flow Line,and Shall be Equipped With a Gas Baffle and With 248 CAR 1.00-7.00&310 C11Bi 15.00. Department Approved Filter. )4"0 Sch. 40 PVCVARIANCES 4.A Minimum of9"of Cover is Required for All Components. 11.Alljoints connecting pipes to foundation,tank,d-box and SAS are to be m Sep tic Tank 24 0 Opening Above ManholeFor Town of Barnstable Ch 360-1 5.All Structures Buried Three Feet or More or Subject Sealed with hydraulic cement Compartment Frame & Cover 100'Required to Pump Chamber to Vehicular Traffic to be H-20 Loading.It is the Engineer's 82.5'Provided Recommendation that H-20 Always be Used. 6.Install Watertight Risers and Covers to Within 6"ofFinished Grade Over Septic Tank Inlet and Outlet;D Box,and One Leaching Chamber, and to Grade Over Pump. PUMP COMPARTMENT All covers are to be maximum 18"for concrete or 24"Cast Iron. PLAN DETAIL NOT TO SCALE See Note 6 (typ.) Conduit Thru Chamber For 24"0 Manhole See note 10 Power & Float Cables FF EL. 11.20 Approved Filter, Finished Frame & Cover g Min. Required Grade Cover F.G. EL. 9 Flow Equilizers As Required - 4"0 Sch. 40 PVC EL. 6.00 - H-20 From Septic Tank Installer To EXISTING D-Box Compartment Galy. Chaff Drill 1 8"0 Hole Confirm Prior EL. 5.47 2000 Gallon PROPOSED For Drain To Any Work Septic Tank EL. 5.22 1500 Gallon H-20 REPLACE Emergency Storage Inv. 4.50 To D-Box P EL. 4.50 Min. 2' Cover Pump Chamber Match Existing Volume 998 Gal. N H-20 Required g (See Note 5) Waterproof/Seal with 2 In vet Elevations Alarm On El. 1.83 z C Coats of Approved m CD Sealant c EL. -0.25 -Pump On. El. 1.50 I pump Pumps Off El.. 1.00 °o To Be Installed On 2"0 Sch. '40 PVC Stable Compac e ose Bedding,"T"s, a Threaded Pipe Inspection Port, & Boffels Top of Conc. El. 0.25 Check Valve as Per Title 5 Bottom El. -0.25 DEVELOPED PROFILE OF S YS TEM �PL�N OF 49gss� Secure Pipe q t Tap 8c �� c, Bottom of Chamber NOT TO SCALE o �oD' / y P Stable Compacted � s 1 4 H.P. Myers Pum Base C 4-k or Approved Equal* VIL Cnn U h o.48168 *Prior to Ordering Pumps the Contractor 9FGISTE. ��2 Must Confirm the Compatibility of the 4,c ., Existing Electrical Service nnE. Septic Details PREPARED BY., PREPARED FOR: PUMP COMPARTMENT P At Engineering& Robert & Rito Davis 986 Sea View Ave Sulli van cowltingj.. 22 Liberty Drive SECTION DETAIL Barnstable mBr miw Mass. Boston MA 02112 (508)428844 3 .P.O.Box 859.7N Main Street,Oeterville,MA 02855 secs@sullivanengin.com.w .aulOvanengin.com - Draft: C77 meld: WHK/CTR/JOD/EM NOT TO SCALE DA7E' December 74, 2020 SCALE Review: Cni Comp./Redew. CTR/JOD Project: Dods Project# 390010 { f DIRECTIONS: ASSESSORS REF.: r ZONE Map 091 Parcel 002 From Hyannis - Follow Main Street to the West ' RF-1 End Rotary, Take third exit onto Scudder Ave. # Turn right onto smith street at the stop sign. OVERLAY DISTRICT. Area (min.) 87,120 SF (RPOD) Continue on to Craigvilie Beach Road and left AP - Aquifer Protection District , . Frontage (min) 20 onto South Main . Street.. Continue over the Width (min) ' ( ) 125' bridge to Osterville, and left onto East Bay FLOOD ZONE: Setbacks: Road, :-left onto Wianno Avenue, and contrinue , Front 30' right onto Sea View Avenue. Zones VE Elev. 14, , Side 15 #986 is on the & AE El e v. 12,right. Community Panel No. t Rear 15 #250001 0018 D . , r' July 16, 2014 REFERENCES: Deed: C179425 Plan: LCP 2664-125 (Record) Book 463/62 (Record) LCP 264-30 LOCATION MAP: LCP 2664-N / , ' ,/ ,- r ' ~✓ ~ \ Scale: 1" 2000'f / I / ✓ /' — _ __. . �_: _... .__ _ T _ '` Ij A3-2713 08032 (Ti¢offs) / Existing F/aat Dredge 2738 & SE3 3283/ / DEP Lic No 4424 ° din It ----C Water L,ne Beach � 11 i _ _ ``" --_. •� \ \ I I Timb-er-Butkheed.: It ! - It Py `^ oW0 (NOT 'P q� 11 �1 ADDI � I �I �1 ;0%% ANANr INQYUDED q SED -- .„,, (ego src 1 I �, 1 / 1 „�;,-.- '"• MA �ncAnON�'RA ,Qv>� ro i 1 i { 1 ` / / � '' �- M MEy CONO.RE� �`H/C�l / W " " \,'`" `' -• . ,� \ •'" "`` _ } / Beach S Q ON, AR STOvAr Gross C C r nOyy O EP j RA/ WqY°O o v �eQ� I STAB C c 4 Z — ,� Pq \\(,cjto 1£pS Cabana 1 { 1 / / roe no \ ,, oo '� PRopp Ikg •... l �--.•- " SE3-176� 1 / / to 1 f SF) �` `WqW SEp / } SE3-273� E�d a of Cos al Dune / o WQ I \ \Ip AY TO j Rack " " - / { { 1 / Per SE3 3697 / " " " " each t R�i1 ° + _ j° I i ( ' / — / " " " Bar - l <f -'Ai / ! {� i} t m { / / /� / K " " " TOS EG S7RUC �; 7) \ l Gardens \ ; } "" " P A.a�H�E qe W CED \ \ I I I PRO yDE 1 l L 7 ROPo l / A. -^E Zone OR WAD,7A S / 50.0 " © of 5 &_257A l P I 16 / ! . } l/M/T F I 1 " " " Lot Area i.5 Acres <Z; A770 „�- q1E E� 14 fMPR�? S r " " Per Record Plan O�cD P I 11.3 �MpRO� Ar ro ( PR�oo Sill <fs c A// - 1(f WgSE j.S© �/ Walk ~ �f � f ' G� " PRop ENTS / 79 - / DER P oy { ! "" " Minc,°n s � !, \"t o 7?A� F 0. ........... - ' - ... ..: l7eNc { I "� " t � ` I �d9e J sp A 170 1 vd R�dgg EX/ L — p gh { ; C+ss � I;' .3?. tN�ti wA �yll' 2 ro e� D.. E v 1 t .3a, PR eE P004 r .SEp SEDOL�D t { } I ! 1 t � 1 l � 1 t " �C.��� / , '•'.••f'3oo'\ sx� :�' �1�� o #986. : ,4,u •/ !: I t ` 1 i t i � " Q �� i •.•• ` �� � ...:• , /� 0 2 Sty Bld. l \ ` Ws B t 1 } .� ��� � ;' f eptic As Per a�/ t 1} ` I 1 8 4, , / y l�t o M O �' Tie Card ,V o ,,( 1 i t - k 4R �7 eAECOy fyS �°RO jDE rj NV r 5�\\ Silt11.2 / ! j I , i 1 i I �d92 PROPOS b / � j SE3-1769 t ! t i t t lag PRO ( ZS_ CC ED DEP is No. 2 20 1 1 1 1 " " 1e (ld \ �'EBU/ pNY A ftr t I l do pA D q N cD As Garden 100 / j " RESTOR ` V (36 1 0 `�1 / I jl 3 I " ! ti I� 0,11 5 b ) cb/dh� \ ROp� f I in p fnd l \ P A. 0 100' Beach Grass o " �` f JAVA 1 c l dh 11 1 / \ fn } \ fI " "�" ± Lot 258` & 258A ' T '�, \� � i " / ° Lot Area 1.0 Acres L { ' o Per Record Plan 170'1 \ ` • /�1 I 11 ' f rl � " .✓' " �'-w" " " v u ~f r^' �` / !/ �. �� � t�{ I ,,r • / , � Se i / 9 Tan 1 It o ' I r j � / n�re � 11 i j( •., J.,• _ _ �r� \1 �fj' j " _ I Mr 4DoFD #986 ` t 1 Sty Bld: Pa io 0 Buffer Zone Calculations Driveway Reconfiguration = -18 SA - ' s x 11.8 '4 86' Walkway to Relocated Rinse Station +16 SF ' �o. Walkway & Steps to Pier = +118 SF\ LEGEND: Beach Bar Patio Reduction = -100 SF. f `� Total = +16 SF ^ CDT Cedar Tree HT Holly Tree 50-100 : / �+� • 1 e �'o/� e' 4 Driveway Reconfigoration = +600 SF/ DT Deciduous Tree AH OF Remove. Walk & Walls = -130 SF �Pn�gss� Proposed Dining Patio = +402 SF CT'Coniferous Tree cy Proposed Pool & Patio +579 o Jot�N C. p e o , Proposed Walkways = +195 SF 411 c-Cj_, utility Pole o ML � Proposed Shed = +100 SF —E— Electric o.4s168 Total = 1,746 SF ¢� ' —G— Gas C8TV �ck`� D wetland Flag �FsstoNAt Mitigation Required: j Light Post 16 SF x 4 + 1,746 SF x 3 = 5,302 SF M CB/DH Mitigation Provided: 1� y OHW Overhead Wires 5,325 SF 25 Elevation Contour 1 \ Mitigation Plants: _ Replace Septic Tank 0112112021 Beach Grass - 12" O.C. Max (8,000 Culmsf) Pasture Rose - 3 Gal 104 Replace Pump Chamber 12/14/2020 ( ) Add irrigation Well 10/2/2020 Sweet Pepperbush - 3 Gal (11)Bayberry - 3 Gal (6) Add Pool Fence Over Approved Pool Walls 9/3/2020 Beach Plum - 3 Gal (6) Add Pool & Raise Beach Bar 0512012020 REV.: Adjust Mitigation Plantings & Notes 1012212019 T/TLE: Site Plan PREPARED BY. PREPARED FOR: NOTES: Proposed Improvements • E11 111VV1111 & 1) The property line information shown was compiled from g g Robert & Rita Davis available record information. This plan is for permitting At Liberty Drive purposes only and should not be used for legal lot ivall 22 Consulting, Inc. y description or recording. 986 Sea View Ave Boston MA 02112 2) The topographic information was obtained from an on (508)428-33"•P.O. Box 659.711 Main Street, Osterville, MA 02655 the ground survey performed on or between May 31, 2019 V Barnstable (Osterville) Mass. seci@suilivanengin.com•www.suilivanongin.com and 61312019 using conventional survey method and RTK 0 Draft: CTR Field: WHK/CTR/JOD/EM 20 GPS. ri 0 10 20 40 100 3) The datum used is NA VD 88 based on RTK GPS DATE: S eptember 30, 2019 1 20 SCALE: Review: CTR Comp./Review: CTR/JOD provided by Sullivan Engineering & Consulting, Inc.= Project: Davis Project#• 390010 Q LAWN/ORGC.NfGS I`i 4•rOb\` � r f" A SaowN Gofi.RSM SAND $# i •. i} ►, '� E ST 22 Sr24WfV co,y.R&E.SAND ~` ,�� ;�_• ,a` �I. -t-Ran►a aaawK coAtxsc LOCUS W+ GLASS 1 MAT'C.R1At► W%QLIt30WA'rB1k\N46\1% OeSIL IMAT Be81t:h "rra r ` PaRG.-resT 9D 5'01' t400N A'C HL6H5_r0fA►M'riDE OM A ., s.• Luss -rMAN ?_mimp NCH FULL..MOON, Light 1 /^�$ BY% 5.1ILLIVAN t3NGfNC:ERiNG INC• Ib/ EACH �.7A'rE.: 8t>3.PT.2.`f-24/J4 p WITNRSS' F7,s"rAISToW,"ro.S.,,13.0.!•1. p1Mrtc,tdo; to,2.911 .. �.. T.H,-2 C.t•.,tl.C.> . � � o F'ERG. 1at2.�1 LOCUS PLAN ,y I57.Tr M QS' HofJgg y lb MOUS4 y�f f7.., L-AOAM S� b LOAM DEP'rld Q''( PY�$ �" _ Scale: I =2000 -.> VILRY DA94KCrIAXY. `SAVOY VIRRY P4114K crFLAN $4.WOV i ESS`THAN ?_M%N/1►4 .14 O-C�\P� 11,E i°` %.X21A► toylxz/t A LOAM t4YtR.-6/1 BjY C>Mt1 'O'deEh Assessors Map91 LOU- O\,- , ,... " 0 09 C+RAY I.oAMY 5ANP 10 GRAY LOAMY SAhtL? 3r.11.LIVA1.tlrni¢tat�tta� IP1AG, Parcel 2 zrJ i 0aPQ ts" toYR 4/1 v,;t-rlvssaA.c"�nta+�lw>;st,�:a.e.,so*t Zoning : RF-I GR'K YMVISN OROwN !.B 0R'K Y�L'tsi4 epowt+1 law , Setbacks Q d oQ.tJl 5AtAwy %-t>AM t©YR 3/4 SANDY "OAM 14YR �/K J IdQe �4 Front 30r N fa rA �� Be SAND H1oYR 5/.0. �� `3ANC Na �N jfs � Side 1 5 <ON / "%t•t. Rear 15 ox� I r cMpf'` O-. 1,"c, .L:►sN BR(^I sd "t..`C.vEl:ibt► Rty U�oc,a-Awo �, MGO sAtdta 2„AsY �/y C Z f psoQ I Lae N► sa sAn40 z.,sv G Groundwater Protection Zone AP o ( !, ! `' GRout pwATER t20"�$L.t.4� CI-AaS '1 titATRtAL "� GPzouftPWA-rr,-.RQ t'Lt7 O.L. 1,0) #as 5-ri, f C.sv -rw.n �• � , 1 NOTES i 1. Woter'Supply For This Lot is Municipal Water. DESIGN DATA %_01reA�' (d eradi 2.Location of Utilities Shown on This Plan Are Approx. Exist.Dweliing- 2Bedroom ` At.Leost 72 Hours Prior to Any Excavation For This With no Garbage Grinder FIQ.► Project The Contractor Shall Make The Required Prop.Garage/Guest House-2 Bedroom Foerio Conwed Fill Notification to DIG SAFE-1-888-344-.723a With no Garbage Grinder Q 3.The Contractor is Required to Secure Appropriate Daily Flow=110 x 4=440 gpd �4 1 s Permits From Town Agencies For Construction-. Septic Tank'. 440 gpd x 200%=880 gpd kN z Defined by This Plan. Use a 1500 Gal Ion*Septic Tank ` 4 ( �q S�rNa =d N 4 tristall Risers as Required to Within 6"of Finished p , 'Rt7p t'i?- t"a� � I + ceomeH 3i4"-11�z"Doom• Grade. LEACHING AREA WNW � 440 gpd/0.74=595s.f.Required �`+�Nc�-c'R 5.AllStructuresBuriedMoreThanThree(31Feetor PRoP. ttA�+s/ \ ��� Q, o Sidewali t 2(t2+36�2= 192 s.f. I + ro._.I SubjecttoVehiculgrTrafficistobeH-20Loadfng. ,/ GLl.titsT WCissr� � a Ao Bottom Area:12 x 36= 432 s.f. ( O '� 4 i:,_0« 6.Septic System to be Installed in Accordance With 624 s.f. Total Provided / t \ E*X18T.SEPTf¢,gY4 M Fa `Q ��s ` 310 CMR 15.00 Latest Revision And The"Town of LEACHING CHAMBER DESIGN �+ q3-'-fS4 SY GAiap I2" t2 !. Q CROSS SECTION OF CHAMBER Barnstable Board of Health Regulations. All Piping to be Schedule 40.Use 4- WOT TO SCALE 7 Ati Piping t°be Sch.40 PVC., - 500 Gal tbn Leaching Cbam6ers:inu �, �� �► 0 12'x 36"Washed Stone Field as Shown. 0 8.Depth of Inlet Tee Below Flow Line: I 0 "Min. ► Depth of Outlet Tee Below Flow Line, 4 Min. R w 1 With Gas Baffle. a �K, �b cw��44Mpc Tq oRiy� rONe �° is > F:G.10.0 Vent F,G.10.0' . LoTAREA s $6 0 �tN��gk� Sip 8.0 8.0 t o- "" f• ( 1500 Gallon Top El.9 O .S 3 T.8 Septic Tank 7.6 H-20 7.4 7 Bot.El.6.0 Dilmetions to the Site: From Hyannistake Route 28 toward 5/ Bedding Bottom of T.H.a Ground- Osterville. At a set of traffic.lights, take a Per Title 5 water EL 1.0 left onto Oeterville West Barnstable Road and follow to the end. Take a left onto DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM( Not to Scole If Encounted Remove a Replace A 11 Main Street and follow into the Village of PLAN VIEW Unsuitable Soils Within 5'of The Outer Osterviile. At the fork In the road'stay to 3 ( Perimeter of The System. Scold : i = 40� the right (Wianno Avenue) and follow to the end of the road. Take a right onto 1'.":TOPOW2APNiG IWrORMATION Existin� TA.KL3N FROMTO.Q. Gzs 9 UtilitiesinAreaofNew Sea View Ave. and the house is the last N4AP Construction to be Relocated. .,\ house on the right. 2. 'f=uii PROPcRTY 4.�Nt3 INF'ORMATtON AsL6 LAND GouRT CEFCr1F1C,bT 1`t2Z1Ip 3, -rwF- Si-ra 1fo L.aaATED wrrHlN k FILMA$=LOCO ZONE A-IN♦:L,IZ,.Q NOVD �o o SUL! VAN CViL Ado '��,•�., �.;�e��0 ��,� __..� SITE PLAN PROPOSED GARAGE AT 986 SEAVIEW AVENUE OSTERVILLE , MASS. FOR C.WILLIAM CAREY SCALE' AS SHOWN DATE' SEPT y 30,2004 SULLIVAN ENGINEERING INC. OSTERVILLE, MASS. 2.00 { col) CONSTRUCTION NOTES I > N V N W 1.DO NOT SCALE DRAWINGS.ALL DIMENSIONS ARE TAKEN FROM FACE OF MASONRY OR ROUGH O fO Lo FRAMING.CONTRACTOR TO VERIFY ALL DIMENSIONS IN THE FIELD PRIOR TO CONSTRUCTION AND * O tS1 d 0 c m > NOTIFY ARCHITECT OF ANY DISCREPANCIES. `' O1 C"0 d O E¢r�m 2.CONTRACTOR SHALL INSURE ALL WORK IS IN CONFORMANCE WITH ALL APPLICABLE BUILDING CODES.WORK SHALL BE COMPLETED IN STRICT ACCORDANCE WITH THE LATEST EDITIONS OF THE N m 'D MASS.UNIFORM FIRE PREVENTION AND BUILDING CODE,MASS.ENERGY CONSERVATION CODE, W c w v MASS.PLUMBING CODE,NATIONAL ELECTRIC CODE,AND ALL OTHER FEDERAL,STATE AND LOCAL o AGENCY REGULATIONS HAVING JURISDICTION OVER THIS PROJECT.IN THE EVENT OF ANY m = m m vm avv DISCREPANCIES BETWEEN AGENCY REQUIREMENTS.THE CONTRACTOR SHALL OBSERVE THE = O MORE STRINGENT OF REQUIREMENTS. 1 (� 3.ALL WORK SHALL COMPLY WITH THE STANDARDS OF THE NATIONAL BOARD OF FIRE EX UNDERWRITERS(NBFU),INDUSTRIAL RISK INSURANCE UNDERWRITERS(IRI),FACTORY MUTUAL O O (F",OR THE APPLICABLE RATING BUREAU.THE NATIONAL ELECTRIC CODE(NEC),THE AMERICAN GAS ASSOCIATION(AGA),AND THE AMERICAN SOCIETY OF HEATING AND AIR CONDITIONING ENGINEERS(ASHAE),OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION(OSHA),APPLICABLE EX C aA STATE AND CITY BUILDING CODES AND THE REQUIREMENTS OF ALL PUBLIC UTILITY COMPANIES M N SERVING THE PROJECT SITE. Q 0 4.CONTRACTOR(AND HIS SUBCONTRACTORS)SHALL BE LICENSED BY THE STATE IN WHICH THE PROJECT IS LOCATED AND APPROVED IN ADVANCE BY THE OWNER. 5.CONTRACTOR SHALL FILE ALL APPLICATIONS,PAY FOR ALL NECESSARY PERMITS AND SECURE CERTIFICATES OF OCCUPANCY FOR THE PROJECT. 6.ALL WORK IS TO BE COORDINATED WITH THE OWNER.THE CONTRACTOR IS TO MEET WITH THE OWNER PRIOR TO STARTING CONSTRUCTION.THE CONTRACTOR WILL PRESENT THE BUILDING PERMIT AND INSURANCE CERTIFICATES TO THE OWNER PRIOR TO STARTING CONSTRUCTION EX 7.CONTRACTOR SHALL PROVIDE ANY NECESSARY MEASURES TO PROTECT THE WORKERS AND OTHER PERSONS DURING CONSTRUCTION. ( LIVING RM. BEDROOM 02 8.CHECK WITH THE OWNER FOR COORDINATION OF THE WORK UNDER THIS CONTRACT WITH / \c" '3� 306 WORK OF OTHER TRADES.OWNER'S REGULATIONS GOVERN ALL ASPECTS OF OUTSIDE CONTRACTORS WORKING ON THE PROPERTY. 9.CONTRACTOR SHALL KEEP THE JOB FREE OF DEBRIS AND MAKE FINAL CLEANUP TO THE SATISFACTION OF THE OWNER.CONTRACTOR SHALL BE RESPONSIBLE FOR REMOVAL OF ALL CONSTRUCTION DEBRIS FROM PROJECT SITE AND SHALL PROVIDE DUMPSTERS ETC.AS REQUIRED. ( � REMOVE ALL DEBRIS ON A DAILY BASIS. 10.CONTRACTOR SHALL BE RESPONSIBLE FOR THE PROTECTION OF ALL EXISTING BUILDINGS AND O OTHER INSTALLATIONS THAT ARE TO REMAIN INTACT WHILE PERFORMING THE SPECIFIED WORK. 1 1 PROVIDE AND MAINTAIN FIRE EXTINGUISHERS ON PROJECT SITE DURING CONSTRUCTION. W L 11.UNLESS INDICATED OTHERWISE,ALL MATERIAL FURNISHED AND INCORPORATED INTO THE U ^' L J WORK SHALL BE NEW,UNUSED AND OF QUALITY STANDARD TO THE INDUSTRY FOR FIRST CLASS liW WORK OF SIMILAR NATURE AND CHARACTER.INSTALL ALL MATERIALS TO THE MANUFACTURER'S Z 2ECOMMENDATIONS AND BEST STANDARD OF THE TRADES INVOLVED. EX > > ?.CONTRACTOR SHALL FIELD VERIFY ALL DIMENSIONS IN FIELD PRIOR CONSTRUCTION.NOTIFY KITCHEN W O ?CHITECT OF ANY DISCREPANCIES ON DRAWINGS. 302 C Q z C THE CONTRACTOR AND ALL SUBCONTRACTORS MUST VISIT THE SITE TO VERIFY EXISTING DITIONS PRIOR TO ANY WORK.EXISTING CONCEALED CONDITIONS AND CONNECTIONS ARE ! EX D UPON INFORMATION TAKEN FROM LIMITED FIELD INVESTIGATIONS.CONTRACTOR SHALL ® W Q) 'REQUIRED ADJUSTMENTS TO SYSTEM COMPONENTS AS NECESSITATED BY ACTUAL FIELD N DNS AT NO ADDITIONAL COST TO OWNER OR ARCHITECT.REPORT ANY DISCREPANCIES } W LITHE DRAWINGS AND ACTUAL FIELD CONDITIONS TO THE ARCHITECT BEFORE ICTION BEGINS. OTHERWISE INDICATED ALL INTERIOR FINISHES SHALL BE AS DIRECTED BY THE I EX cuW S FINISH DRAWINGS(900 SERIES) ( I I r 1 1 I (D `OR TO OBTAIN AND PROVIDE OWNER WITH COLOR SAMPLES FOR PROPER COLOR • ■ JD FINAL APPROVAL OF ALL FINISHES PRIOR TO INSTALLATION. EX y ( I I EX V//W� J •> ASHES SHALL BE CLASS C(SURFACE FLAME SPREAD RATING OF 76200)MINIMUM IN i I I EX EX I t O '^ *H GENERALLY ACCEPTED STANDARDS.CARPETING SHALL BE CLASS 2 WITH A RADIANT FLUX OF.22WATTS PER SQUARE CENTIMETER. I I EX _ CO ARD WORK SHALL BE DONE IN ACCORDANCE WITH THE DRYWALL I n/ (n IDBOOK,LATEST EDITION,PREPARED BY UNITED STATES GYPSUM.ALL JOINTS LJ� TAPED AND FINISHED IN ACCORDANCE WITH MANUFACTURER'S INSTALLATION L — J 31Y RANGE BATH 02 CL v�/�J O EX EX IM BOARD AND WOOD CONSTRUCTION PROVIDE TWO(2)FINISH COATS OF 305 W ,/ER SINGLE COAT OF COMPATIBLE PRIMER,PROMAR 200 SERIES BY EX LAND,OHIO OR APPROVED EQUAL.ALL PAINT BY SINGLE 612 D 6-8" T-F T-6" ® ® ® ® C•^l W LOCATIONS AND SIZES FOR REPLACEMENT SCOPE.ANY v T WITH NEW CONSTRUCTION ASSEMBLIES SHALL BE BROUGHT TO iN WRITING,IMMEDIATELY. .CTOR SHALL INDEMNIFY AND HOLD HARMLESS THEARCHITECT/ .T CLAIMS,DAMAGES,LOSSES AND EXPENSES ARISING OUT OF OR a� ORMANCE OF THE WORK,PROVIDED THAT SUCH CLAIM,DAMAGE,LOSS c0 3LE TO BODILY INJURY,SICKNESS,DISEASE OR DEATH,OR TO INJURY TO BLE PROPERTY,BUT ONLY TO THE EXTENT CAUSED BY THE NEGLIGENT CONTRACTOR,A SUBCONTRACTOR,OR ANYONE DIRECTLY OR EX OR ANYONE FOR WHOSE ACTS THEY MAY BE LIABLE. aEaoaveo (9 G.A 3036 h 50 :— tL' � J 303A ch V o F W z_= a J BATH 01 a0=ozwg aXo 3 303 ® — — — z z0Www� o ~ C14 rn =°°°Waa=oz oFm Z�z gaz mow a,- �oa awoz mw a mN g 304AIa a\LL TO BE DEMOLISHED oawmww NU wmm o °m ]STING WALL TO REMAIN ° 3046 ati¢zm��wa 2¢im°�aiiif,-.awo au1.ow¢ zzo o�moxr-�am ww m C�EWWALL a 08 -g =mN owE9,-7%" wz0°oLL> xowm z O 36 o� zwduwa }m zoo �o oN� Sr Ua Drawing Information: zo EX V EX PROJECT NUMBER: 2 0 1 9- 1 5 BEDROOM 01 x DRAWN BY: J R K 304 CHECKED BY: D H R DATE: 10/29/19 EX SCALE: 1 /4" = 1 '-O" SHEET REFERENCE: -- ENERGY CODE INFO. �� � TITLE: FIRS T OWING ARE ENERGY CODE REQUIREMENTS BASED ON THE 2015IECC. REFER DIRECTLY TO THE )VERNING AGENCY TO ENSURE THE R-VALUES BELOW ARE SUFFICIENT PRIOR TO INITIATING AN -RS R_VALUES: W NEW ATION:0.32 CEILING/ROOF-R49 FLOOR S:0.32 WALLS-R20 � _0 © 0. /GLAZING:0.27 FLOORS-R30 NEW ' C /� 0.30 BASEMENT WALLS-R15(CONT.)OR R19(IN STUD CAVITIES) e ,v C v V CRAWLSPACE WALLS-R15(CONT.)OR R19(IN STUD CAVITIES) SLAB:R10 TO 24"DEPTH NOTE: 20151ECC TABLE R402.1.2 FOR FURTHER INFORMATION IF NECESSARY. -DIMENSIONS ARE TO FINISH WALL FACE/SURFACES U.O.N.; SHEET NUMBER: or Y A10 2