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0850 SEA VIEW AVENUE - Health
850 Seaview Avenue �y ,Ostervid(e _ r o No.. ©& Fee — THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 7> Rpplitation for Disposal 6pstem !Construction Permit CIO Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System individual Components ` �-5 Location Address or Lot No. e— '> 13 O S1Lx�E f J-A V7 owner's Name,Address,and Tel.No. Assessor's Map/Parcel ! v OZ`�Q: R �Z�D i- GiArl, ` H-G �. Installer's Name,Address, el.No. Designer's Name,Address,and Tel.No. f SaC3-v'tY � -v�tab f Type of Building: k \,1 i GC_ 'Tv Dwelling No.of Bedrooms 4 Lot Size ��'�1 sq.ft. Garbage Grinder( ) �A � Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 1/1 Design Flow(min.required) gpd Design flow provided S G� gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank f S; i S!'� Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) : -�T4 _QL,3 ;(a C�d'rf�1� 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 ntal C e of to place the system in operation until a Certificate of Compliance has been issued by this Board of e .h. S_ 11_16. S Date Application Approved by Date Application Disapproved by Date for the following reasons � c Permit No. o Date Issued ---- --------- xNo. /a(DILJ'� / Fee 4S� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 3 PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 3L 2pplitation for R14posal bpstetn Construction Permit ra Application for a Permit to Construct( )" Repair Upgrade) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel U Z�¢v��Lt.l� ('�90 GI-112tS?� 4'���i�ta�Fl♦LT �-� . — 1� Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 5 e of Building• '4'p b• I Dwelling No.of Bedrooms -X Lot Size _� _ C sq.ft. Garbage Grinder( ) �'A^�k Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures iv Design Flow(min.required) gpd Design flow provided -� a�, qi 8W7 gpd Plan Date Number of sheets Revision Date Title i Size of Septic Tank �X t G,•t I �j'(,b Type of S.A.S. Description of Soil A- Nature of Repairs or Alterations(Answer when applicable) `,DT4 Q Q t o o �r� cp ��c � r t� ccc l�� Date last_insp ted: k 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 E iro ntal C e and^not to place the system in operation until a Certificate of i Compliance has been issued by this Board of ea th. Si ed�''" ' �,� Date Application Approved by ' Date i` Application Disapproved by �-/ Date for the following reasons Ar Permit No. 0 0 �� Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliante THIS S TO CERTIFY,that thet wage Disposal system Constructed( ) Repaired�o< "Upgraded( ) Abandoned( )by -at - `3Pa 01-,ek.) At--Q 10 has been constructed in accordance with the provisions o Tittle 5 and the for Disposal System Construction Permit No.e �l�' dated Installer MQ.�I C? Designer #.bedrooms Approved design flow gpd The issuance of this permit shall not be/con/strued as a guarantee that the system wi•1.1'fun tic o as d'estgned. /�,,..... -Date �//'2/ / Inspector No. Fee THE COMMONWEALTH OF MASSACHUSETTS ` ` PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS 1 Misposai *pstem Construttiou Permit Permission is hereby granted to Construct( ) Repair<) Upgrade( .•) Abandon( ) System located at <1_19_w/PCl) i -P 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 comp e e within three years of the date of this permit. --.. V�) Date _7� "� Approved by Sep 14 2016 10:34 Jim The Inspector Man 5085349919 page 19 do/- Da3 Commonwealth of Massachusetts / Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form - Not for Voluntary,Assessments r 850 Sea View Ave. Property Address cr) Frank Saul Owner Owner's Name �7 information is Osteryille MA 02655 9-13-16 required for every page. CitylTown 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 forma Important:When A. General Information filling out formson the computer, %`�U11Utllllp/U��, ` use only the tab ��`\`\` IN OF 44,1 key to move your 1. Inspector: o= .' cursor-do not James D.Sears j:' JA M ES use the return , Name of Inspector s ; S' .0z _ key. Capewide Enterprises,LLC s*T°�--�Q.4` Company Name l�•..,RTIf%� y 153 Commercial Street 'fyF rfr ��`�� Company Address Mashpee _ _ MA 02649 City/Town State Zip Code 508-477-8877 S1623 Telephone Number Llcense Number B. Certification. >$ f I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 9-14-16 nspector'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 should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. '***This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform,in the future under the same or different conditions of use. t5ins.doc•rev.5115 Tltle 5 official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Sep 14 2016 10:34 Jim The Inspector Mari 5085349919 = page 20 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 850 Sea View Ave. Property Address Frank Saul Owner Owner's Name information is required for every Osterville MA 02655 9-13-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure.criteria described . in 310 CMR 16-303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments; Both covers on tank should be raised and replaced for maint pumping. The system is a 2500 Gal.H-20 Tank D Box and 10 chamber's. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", .no" or"not determined" (Y, N, ND) for the following statements. If".not determined,"please explain. The septic tank is metal and over 20 years old' or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 x Sep 14 2016 10:35 Jim The Inspector Man 5085349919 page 21 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form = Not for Voluntary Assessments ; 850 Sea View Ave. Property Address Frank Saul Owner Owner's Name information is required for every Osterville. MA 02655 9-13-16 page. CltylTown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or-uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ -Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced` ❑ Y ❑ N ❑ ND.(Explain below): ❑ The system required pumping more than 4 times a year due to broken or.obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed' ❑ Y ❑ N ❑ ND(Explain below):_ C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in,order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines'in accordance:with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water Ll Cesspool or privy is within 50 feet of a bordering vegetated wetland.or a salt marsh 15ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal system Page 3 of 17 Sep 14 2016 10:35 Jim The Inspector Man 5085349919 page 22 Commonwealth of Massachusetts Title 5 Official Inspection Form 61 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments. ' 850 Sea View Ave. Property Address Frank Saul Owner Owner's Name information is required for every Osteryille MA 02655 9-13-16 page. City/Town Stale Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet,of a private water supply well ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for 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. 3. Other: D) System Failure Criteria Applicable to All Systems: " s , You must indicate"Yes" or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters ` ® due to an overloaded.or clogged SAS or cesspool El ® Static liquid level in the distribution box above outlet invert.due to an overloaded or clogged SAS ❑ ® Liquid depth in 41019pW is less than 6" below invert or available volume is less than Yz day flow )..W111/N(,; t5ins.doc rev.6/16 Title 5 Official Inspection Form:Subsurace Sewage Disposal System•Page 4 of 17 Sep 14 2016 10,35 Jim The Inspector Man 5085349919 page 23 Commonwealth of Massachusetts Title 5 Official Inspection ;Form mpgSubsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 850 Sea View Ave. Property Address Frank Saul Owner Owners Name information is required for every Osterville MA 02655 9-13-16 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ , .Z 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 El tributary to a surface water supply, ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. •' ❑ ® Any portion of a cesspool or privy is within 50 feet of a.private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] _ ® The system is a cesspool serving a facility with a design flow of 2000gpd- El 10,000gpd_. $ El ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure: E) Large Systems: To be considered a large'system the system must serve a facllltywith a design flow of 10,000 gpd to 16,000 gpd. . For large systems, you must indicate either"yes" or"no'-to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El ❑ the system is located in a nitrogen sensitive area (Interim.Wellhead Protection Area_IWPA) or a mapped Zone 11 of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact.the appropriate regional office of the Department. t5ins dac.rev,til16 - Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 5 of 17. Sep 14 2016 10,36 Jim The Inspector Man 5085349919 page 24 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 850 Sea View Ave. Property Address Frank Saul Owner Owner's Name - information is O required for every sterville MA 02655 9-13-16 page. cityrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate yes"or"no" as to each of the following: Yes No . ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the.previous two weeks? El ® 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? 11 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) [31.0 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 9 Number of bedrooms(actual). 7 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms)- 990 . a 15ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Sep 14 2016 10:36 Jim The Inspector Man 5085349919 page 25 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 850 Sea View Ave. Property Address Frank Saul Owner Owner's Name information is Osterville MA 02655 9-13-16 required for every s page. City/Town State Zip Code Date of Inspection' D. System Information y Description: The system is a 2500 Gal. H-20 Tank D Box and 10 chamber's. Number of current residents: - 0 Does residence have a garbage grinder? ❑ Yes ® No 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 r 15-42 ,0000Ga1 g (last y. g (9P ))' 2015-420,000GaI's Detail: Sump pump? -- ❑ Yes ® No NA' Last date of occupancy: Date Commercia III ndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR'15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No. Non-sanitary waste discharged to the Title 5 system? r.' ❑ Yes ❑ No o Water meter readings, if available: r t5ins:doc•rev.6116 Tille 5 Official Inspection Form:Sutsurace Sewage Disposal System•Page 7 of 17 Sep 14 2016 10:36 Jim The -Inspector Man 5085349919 page 26 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 850 Sea View Ave. ` Property Address Frank Saul Owner Owner's Name information is required for every Osteryille MA 02655 9-13-16 page. Cityrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancyluse: Date Other(describe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes;attach previous inspection records, if any). ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator.under contract ❑ Tight tank. Attach a copy of the DER approval. ❑ Other(describe): 15ins.doc•rev.6/16 Title 5 Official.lnspeclion Form;Subsurface Sewage Disposal system•Page a of 17 Sep 14 2016 10:36 Jim The Inspector Man 5085349919 page 27 Commonwealth of Massachusetts' Title 5 Official- Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary:Assessments - 850 Sea View Ave. Property Address Frank Saul Owner Owner's Name information is psterville MA 02655 9-13-16 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 2004 Permit#2004-676. Were sewage odors detected when arriving at the site? ❑: Yes ® No Building Sewer(locate on site plan): Depth below-grade: feet Material of construction: ❑castliron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): , Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): 4, Depth below grade: feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑polyethylene ' ❑ other(explain) If tank is metal, list age: ears Is age confirmed by a Certificate of Compliance? (attach a copy of certificate), ❑ Yes .❑ No , 2500 Gal..Precast'H-20 Dimensions: r Sludge depth: t5ins.doc rev.6/16 Title 5 official In>peUlon Form:Subsurface$swage Disposal System-Page 9 of 17 Sep 14 2016 10:36 Jim The Inspector Man 5085349919 page 28 <C_\ Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 850 Sea View Ave, . M Property Address Frank Saul Owner owner's Name information is Ostervllle MA 02655 9-13-16 required for every . page. Citylrown Stale Zip Code . Date of Inspection. D. System Information (cont.) Septic Tank(cont.) 53" Distance from top of sludge to bottom of outlet tee or baffle 0" Scum thickness Distance from top of scum to top of outlet tee or baffle 8 18„ Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Asbuilt-Tape - Plane Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank at 4'below grade w/both covers at 30". In and outlet tee's. No sign of leakage or over loading. Note: Both covers should be raised and replaced for maint pumping. Grease Trap (locate on site plan): Depth below grade: feet r 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 l5ins.doc•rev.6116 Tllle 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 10 of 17 Sep 14 2016 10:36 Jim The Inspector Man 5085349919 page 29 Commonwealth of Massachusetts Title 5 Official Inspection Fora I Subsurface Sewage Disposal System Form- Not for Voluntary.Assessments 850 Sea View Ave. M Property Address Frank Saul Owner Owner's Name information is Cisteryille MA 02655 9-13-16 . required for every page. CityTFown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition; structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: . gallons per day Alarm present: ❑ Yes ' ❑ No Alarm level_' Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches,etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes - ❑ No t5ins.c6c•rev.6/16 Title 5 Qfricia:Inspection Form:Subsurface$swage oiaposal System•Page 11 of 17 Sep 14 2016 10:37 Jim The Inspector Man 5085349919 page 30 t Commonwealth of Massachusetts : Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 850 Sea View Ave. Property Address Frank Saul Owner Owner's Name information Is required for every Osteryille MA 02655 9-13716 r page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,.any evidence of leakage into or out of box, etc.): D Box was located on sRe. Box was inspected.wlcamera. Box look's clean and solid. Box is 5'to 6' below grade . . I Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No` t ' 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. Soil Absorption System (SAS)(locate on site plan, excavation not required). If SAS not located, explain why: t5ins.doc•rev-6116 Title 5 Official Inspeelion Form:Subsurface Sawaoe Disposal System•Page 12 of 17 Sep 14 2016 10:37 Jim The Inspector Man 5085349919 page 31 C`N Commonwealth of Massachusetts , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments. 850 Sea View Ave, - f Property Address " t Frank Saul Owner Owner's Name information is required for every OStetvllle MA 02655 9-13-16 page. City/Town State - Zip Code Date+of Inspection- D. System Information (cont.) Type: " =t ❑ leaching pits number: ® leaching chambers number 10 ❑ leaching galleries number: ❑ leaching trenches number, length: V ❑ leaching fields number, dimensions: ❑ : overflow cesspool number: P R ❑ innovative/alternative system Type/name of technology: L � Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp"soil,conc'tion of vegetation, etc.): Leaching is(10) 500 Gal. Dry well chamber's. Ck. D Box no sign of over,loading or solid a ry over. Chambers are 5' to 6'below grade. - 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 f Depth of scum layer . - Dimensions of cesspool ' Materials of construction Indication of groundwater inflow ❑ Yes . ❑ No 15ins.doc•rev.6/16 Till.5 Official Inspection Form:Subsurfaca Sewage Disposal System•Page 13 of 17 Sep 14 2016 10:37 Jim The Inspector Man 5085345919 page 32 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 850 Sea View Ave. Property Address Frank Saul Owner Owner's Name information is required for every Osterville -MA 02655 9=13-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, t etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic'failure, level of ponding,•condition of vegetation, etc.): 15ins.doc rev,6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 or 17 Sep 14 2016 10:37 Jim The Inspector Man 5085349919 page 33 Commonwealth of Massachusetts Vi Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ' 850 Sea View Ave. Property Address Frank Saul Owner Owner's Name information is psterville MA 02655 9-13-16 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately t5ins.doc-rev.6116 - Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 15 of 17 . a Sep 14 2016 10:37 Jim The Inspector Man 5085349919 page 34 s - TOWN 0V BARNSTABLE , LOCATION FKO Sf,A V�etJ �'e - 4 SEWAGE # 6'N VILLAGE '0.�;rf7-R'-v ZUYg ASSESSOR'S MAP & LOT I7 00L INSTALLER'S NAME&PHONE SEPTTC TANK CAPACI I`Y, So G C 8-1 i LEACHING FACILITY: ( ) c O C F�-C hf A t J Cf a (size) - �`�'- i NO. OF BEDROOMS 25�X BUILDER OR OWNER �u PERM ITDATE: !�'a 9' - COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Grgundwater 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 ,SriG gg - <;1 Pr A-Lt'48 , g �...' 3� J- Pr�-�gI � M Sep 14 2016 10:37 Jim The Inspector Man 5085349919 page 35 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System form -Not for Voluntary Assessments i 850 Sea View Ave. Property Address Frank Saul _ Owner Owner's Name required for is Osterville MA 02655 9-13-16 required for every - page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells No Estimated depth t high ground water: feet 6" Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 2004 If checked, date of design plan reviewed: Date Date ❑ Observed site (abutting pro pertylobservation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators,'installers - (attach documentation) El Accessed'USGS database -explain: You must describe how you established the high ground water elevation: T.H.on Design plan 2004 1 T-T no G.W.. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6116 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System Page 16 of 17 Sep 14 2016 10:37 Jim The Inspector Man 5085349919 page 36 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments yY 850 Sea View Ave. ' Property Address Frank Saul Owner Owner's Name reformation is Osterville MA 02655 9-13-16 required for every page. CityrTown State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary.A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file s 4 t5ins.doc•rev.6/16 Title 5 Vidal Inspection form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION S � , SEWAGE # VILLAGE *ram, t, ASSESSOR'S MAP & LOT/7 .3 1-60 INSTALLER'S NAME&PHONE NO�t�' iQCc 1 V. - y aL 3.5.1 SEPTIC TANK CAPACITY -C2 6-0 s LEACHING FACILITY: (type) G tiA ma-m CIO) (size) �;k, ,f NO. OF BEDROOMS BUILDER OR OWNER �2.u '� + PERMIT DATE: 4-o?9' 01 COMPLIANCE DATE: �S 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 A-9 -57q g� - 606 �WK No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIpplication for ;Diopool 6potem Con5tructton Permit Application for a Permit to Construct(x)Repair( )Upgrade( )Abandon( ) ED Complete System ❑Individual Components Location Address or Lot No.d 5o SPL(_ Y/'f K) /=��e Owner's Name,Address and Tel.No. �/ O.sterv,Ile �e'rnar L Fr4ne�s Assessor's Map/Parcel f o/ lq j'.sco sip) 19`1 e• - 'Jr_j'f r_ 15E r I q_ 00/ 003 obi Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Sat-�/oW-.3,3 il q L S/�tea. k 7 Pa�iee r 2r� o B 0` 1051 (3S�rvi'//ei Type of Building: Dwelling No.of Bedrooms _ Lot Size 53, US sq.ft. Garbage Grinder(/'✓Q Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design.Flow q q o gallons per day. Calculated daily flow � `3 4? gallons. i Plan Date • /' o ddoe4Number of sheets Revision Date 1V6i�)t Title Sil e ?& 1V,0ase-f —7h7 ra1(erre.rr$a-t d16-6S0_& V,'euwpvc— OSkrv.'lle d$'c[/J,Vea r . Size of Septic Tank d 6-00 7J o1© Type of S.A.S. l Q i v^� Description of Soil PO /0./000 TeS1- f/o% / /a�e1h . �'1 /aver Ion r 1//Z da.reVul,4A brown In e 4. 5a nA w/ Jerre -A"+yes k _ /6 „ g I l aYer I® iir 3/u aeon; �)e n�_�, br�'v'� h-r-A- S&n k tyf s o m r- fi"4 es 15-.70 4 AA 10-yt r lO u r A r/ alte rC SIP II n��f 6 rew me-4 52 n4 /sarn-e. nes . gyp- /38'' L� /d�,yyer ao s y /� o l;✓e ye//rw red .tin.(, ,no vhd4ax&r Nature of Repairs orlterations(Answer when applibable) COvr��e��. 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 ode and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo d f Healt Si /� Date / _�� Application Approved b Date / � 10 V Application Disapproved for the following reasons Permit No. r ("O`4 r7(P Date Issued / �'� Fee No. /.�d• ,. , THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V ; I _ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0(pprtcation for o °ar} ipgtent �on�tructiou permit Application for a Permit to Construct )Repair C' )Upgr da )Abandon(,. ); ❑Complete System Q Individual Components - Location Address or Lot No. J( .Sea Vi cto /9,/e Owner's Name,Address and Tel.No. te/Yv� llcernarQ Fra��cfs w GIK t. Assessor'sMap/Parcel 0/ [v,'SGOY7Si'�•� /=j�l� SU, /a 4 //4j- 00/ 003 ?0d1 r Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �f?i 2/de-3 3 4i y J�.uY�-���--°•' ('�'',�--���t'-�-;-'�`� �rcll i Vtirh �hy�'nr�r�'!.'y :�� ' 1 w 7 Pet r14.r r2,[� p'(>' fox lvS9 (,�S/er✓/'//� t ` Type of Building: Dwelling No.of Bedrooms Lott Size Jf 16 sq.ft. Garbage Grinder(/v Other Type of Building 'No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 1 ,25 gallons. . n Plan Date b Number of sheets Revision Date Na)C Title$,) e /Q Rr'P/Ceue-d .T/ri rPVcrnc 7* et-,' &4!FOS&& V avi9v Oc-krv,7jC Size of Septic Tank d 6W c Q Type of S.A.S. ��QG/i�i7 _ �J „ C,tg�rJvr✓. v Description of Soil >�'�_�D,/p 00 7`e-St No% / l a.W h * 8'' brown /nek, sand. w/ ,same -F'ncc z`t - /5 "' 61 /ayee /,9 wr -3/u deerK ,\lellni"1 6r4��11 ,L. SO no< tL�J -so c 'n�e /5-R ol 0, e r /D t �`/1 ,/a r x ,- /� ' L reran cW_ �� w/sorn,e . 'hes a, /38 A' r< /ay e�• �� G/!, o /i v� /ell sw nheX .f4 ;G -ho /ounce+-br Nature of Repairs or Alterations(Answer when applicable) e/�cvvn�e oaf. Date last inspected: Agreement: t 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 Healt . Signed ,44 Date -0-S7 Application Approved by Date. Application Disapproved for the following reasons Permit No. `1 -7(9 Date Issued a / THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Com�pfianre , THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed (X )Repaired ( )Upgraded( ) .abandoned( )by at ?SO Sect. View /9.Ve USf er✓i'llC_ has been constructed in accoe ance with the provisions of Title 5 and the for Disposal SystemConstruction Permit No, C�4 -la7b dated �a G Installer Ao , e � 42 �'Q,S/Ir-ve Designer ��/ �411 The issuance of this permit shall not be construed as a guarantee that the�system will.f ction as designed. Date `Jl� �d 5 Inspectors - _ No. �d0`�' ._. 1p G / --------------®------------Fee C� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Disspoof *pgtem Cou5truction Perron Permission is hereby granted to Construct(x )Repair( )Upgrade( )Abandon( ) System located at 8,5 0 ,Sege 1/,'ew 19 V er, OS k r v)'//e and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the d (f ihis, ernii Date:_ �{ Approved b '—�-- t Town of Barnstable oFIME r°'Y Regulatory Services ti yP �� Thomas F. Geiler, Director + BARNSfABLE. MASS. g Public Health Division 1639. �0 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: k4 el U Z1 ZOOT Designer: �ui.LWwWv E►4c,tw& se. l KI c, Installer: 1RCvc-, r- Address: Z gAZVX L (2_o oao Address: 8 q l?a In,o V c,MP_4tLLG 14 h OZGS'S On /a -d9-Oy '.t3�cc�A01c0.«<a ices was issued a permit to install a ¢C200L,-b�6 (date) (installer) septic system at b So S e A VLI- t.— o based on a design drawn by (address) EV-'s, ccr•�� dated t2 � �� jo4 (L�v 31�71oS (designer) —Z—I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. 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. OF SULPEM 20733 (Instal er's Signature NO.CIVIL (Designer's Signature) (Affix Designer's 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. Q:.Health/Septic/Desiper Certification Form � t # ' Town of Barnstable Board of Health P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,MS Wayne Miller,M.D. January 21, 2005 Mr. Peter Sullivan, P.E. Box 659 7 Parker Road Osterville, MA 02655 RE: 850 Seaview Avenue, Osterville A= 114-001-003 Dear Mr. Sullivan, You are granted approval to construct an onsite sewage disposal system designed to be connected to nine bedrooms at 850 Seaview Avenue Osterville, Massachusetts. The approval is granted with the following conditions: 1)The septic system shall be constructed in accordance with the plans dated December 13, 2004. 2) The designing engineer shall supervise the construction of the septic system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the plans dated December 13,2004. Sincer yours, W yne MtF r, M.D. Chairman BOARD HEALTH TOWN OF BARNSTABLE Q:HEALTH/WP/Sullivan9Bedrooms - ' 1 December-1, 2004 t Town of Barnstable Board of Health 206 Main Street Hyannis, MA 02601 - RE: 805 Sea View Avenue, Osterville Dear Board of Health, As owner of the above referenced property, please be advised that Peter Sullivan or John O'Dea of Sullivan Engineering has my permission to represent me before your board in matters relating to a septic system design at my property. Sincerely, Bernard.Franc au TOWN OF BARNSTABLE , LOCATION �� S eA SEWAGE #C�06"N�O VILLAGE �� �R� �� ASSESSOR'S MAP & LOT I,7 00t-dc3 INSTALLER'S NAME&PHONE NOQC�-1`• �{a- 5^�� SEPTIC WANK CAPACITY c26-0 C C 61 i LEACHING FACILITY: ( )�C'C' �'C�R Cte (size) NO.OF BEDROOMS ' ��1� `ff BUILDER OR OWNER PERMITDATE: 10 c2!_ 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 $a , Prg5q - so'qq R3 -Igo 98 1 d (� 15 � M Town of B1,.rnstable 1' Department of health,Safety,and Environniental Services �1"1 Public Health Division Date to���Io3 367 Main Street,I lyannis MA 02601 eAexrrreer B % lEur +" Date Scheduled Time-If 00 Fee 1'd, 100—f Soil Suitab lity Assessmoy for'Sma,g- e Disposal Performed By: Sbljwgn Eh41hfer1(\5 Witnessed By:.'5lwi la)-k[ J _ LOCATION & GENLItAI,INWAIVIATION Location Address850_SCq View-/wenU2 Owner's Name Robert 3. SPenli�haj<r Os�e ry i\12, 1�114" c Q e 4.,a l Re.1y T1.r>1- ----------------------- Address- 177- 01� {Gary Ro>�l ftI�Qr\, vnpk. or1$(o . Assessor's Map/Parcel: fly-p01-003 Engineer's Nantes„IlivavN Ens' � J lnefr;nJc` NEW CONSTRUCTION t/ REPAIR TcicphoncH Land Use - c:Saf41 Slopes(%%) O'3% Surface Stones Afjnp Distances from: open Water Body 5p0 t 11 Possible Wei Area Soot } R Drinking Water Well S00 Drainage Way 590 t it ;Property Line 40. + ' ft' Other:^ Il SKETO (S(reet name,dimensions of lot,exact locatlonsbf testholes&perc tests,locate wetlands in proximity to holes)- I f f k 4 (apt. Parent material(geologic) TOWN OF BARNSTABLE OCT .2 2 2003 O tagsh.Main. Depth to I3cdrock 506 HEALTH DEPT. Depth to Groundwater: Standing Water in hole: & Cr P, Wecping from I'il Face 2 N�� Estimated Seasonal Iligh Groundwater Eh. 2.S FROM T.0 3 t�fttvr�Dtr1RT R r 1RP`>> . D `I'EIMINN'ION iWI SEASONAL IIIOIY<'VVA�I' R I'A13LE Mcthod Used. NON - Sr--r=At b Depth Observed standing in ohs.hole: in, llepth to soil tiurillcs: Depth to weeping from side of obs`holc ' 01• in. Groundwater Adjustment R. Index Well N__- Reading Date: — .D)dex Wcll Ievcl __ Adi.factor Adj.Groundwater Level _. I'EROOLATION'I` ST Dot m o t mt o0 m S Observation Time at 9" 11=Z S Depth of Pere 301 Time at6" Start Prc-soak Time 1( 05 t Time(9"G") min 7M End I'rc-soak zo Rate Min./Inch Z.fO7 nilr\ t� - T Site Suitability Assessment: Site Passed ✓ Site Failed: Additional Testing Needed'(Y/N)° 'Original: Public health Division } Observation hole Data Tolle Colilpleted on Back j Copy: Applicant ll i11!,1'b.-BSE RVA I lON 110i,Y: .00Y 11<t lc ## Depth from Soil Horizon Sort Icxturc Soil Color Soil Other Surface(in.) (USDA) (Munscll) Mottling (Slruchrrc,Shoes,lluuldcres. mtb, SAND .S.onsistencv "/" 0-$ sou Fwts IS' I Some Ftut✓S IoyR 3_/y G m�SawD„/ 5-ZO" Z sortie t=lKes to N (o --- Zo-115, L mEa Nt> Z.sy ('01(" --- U 1 I' OBSE1tVA'I X;ON I>(t7L LOG .. >()<ulc Depilt from Soil I lurizon Soil Tcxlurc Soil Color Soil Surface(in.) Othther (USDA) (Munscll) Mottling (Structure,Sloncs,Ilouldcres. -10 i mED.SAND u/ SSLSIsIy_rlcy,ly U1:1L'CI) N loYl2 y/z lu-ISr � rneo. SAA1D•../ rtt, gN55 IOYK mtD_SquD� i3-zs' K z ,E �►, loYRy/c0 INED.SAND z.sy (01to �— - bEEI' CJY#SERUA'i"IIN 1tdL + Y()O lxalc Depth from Soil horizon Soil'I'cxlurc Soil Color Soil Surface(in.) Olhcr, (USDA) (Munscll) Mottling (Slruclurc,Sloncs,130111dcres. DELI' OUS RVA I ION IIULJL I OG I ulc## Dcplh from Soil Ilonzon Soil Texture Soil Color Surface(in.) Soil Other (USDA) (Munscll) Moulin g (Structure,Sloncs,Ilouldcres. nsi lcncy,lSir_��cl) Mood Ltcurauce Rate Mal): Above 500 year cloud boundary No_ yes Aill— Within 5UU year boundary No ✓ Yes Within 100 year flood boundary No t/ yes D W of Naturally Qccurrilig Pervious M< eria Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? YE5 If not,What is the depth of naturally occurring pervious material? c'crtiGcAtivn I certify that on �yx;I IY9S (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis Was performed by the consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature-- Date 1 G(23 10% 5 -OOo ___ __ -=f. :.:-., �. r,.i;;?►.osi- ter_':r;•+4d4! : � �'�-�.is - w f i^'_-:�.:�..r•`1 �:':;:. 5-7 WadxAe Ad*) �v Epp� / \ LOCATION MAP ASSESSORS REF: MAP 114.PARCEL 13 ZONE: RF-1 EX1511N6 AREA M IM S7.120 SF(RPOO) POOL FRONTAGE 041W 20' SETBACKS: FRONT30• SIDE IV REAR 15 G xvgwr�ou,u HEIGHT 30' f. 7 EXISTING 2•STORY WOOD FRM.IEO HOLr;E W/PARTUL BASEMENT i NEW I-STORYWO FRAMED GARAGE ON C ACE rP a. Sea vie (40'uTae� /qre i �Ue , srrE Part DATS: PER: • aAartarA" • WAM REC. BY Town of Barnstable sC�BD. DAT$: Board of Health 367 Main Street, Hyannis MA.02601 Office: $08462-4644 Susaa G.Raak,R.S. FAX 508-790-6304 Sumner Kaufman,MS.PIL Ralph X Murphy,M.D. •VARIANCE REQUEST FORM LOCATION Property Address: 850 Se"Niar� Q1 er,u d ``=Q,-,L Assessor's Map and Parcel Number- 114-ook-o03 Size of Lot:_ I-ZZ AUGS Wetlands Within 300 Ft. Yes Business Name: No Subdivision Name: APPLICANT'S NAME: Phone 'h Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSON } r , Name:�•Qrn" �,v,c�s t L�w,-, � Name: erk-6 1PQRnc= C �; 7501 Ave. S,:le iL0. 30 (OS"9 Address: &4},g Sc-s, i /Yn Z.o 8[�� Address: C�S�_l�P�1/11 1 OZ�SS _ � yg �: Phone: Phone: ACA--YZ.3 33 L I t VARIANCE FROM REGULATION • Re REASON FOR(Lst g) VARIANCE(May attach if more space needed) Cg'1 e t( �11A m.S NATURE OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed Septic System ❑ Checklist(to be completed by office staff-person receiving variance request application) Four(4)copies of the completed variance request form Four(4)copies of engineered piansubmitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) 'Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals(same owner/leasee only],outside dining variance renewals(same ownerlleasee only),and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least IS days prior w meeting date VARWNCE APPROVED Susan G.Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman,M.S.Pli. REASON FOR DISAPPROVAL Ralph A.Murphy,M.D. Q:/WP/VARIREQ E MO P 5V98I0• i/a" 2b9/T _ N a tt -y IS L c — r— F— J x J aes a 'Y 8 J I I I ® I r � ' _ leTL 210- ---- I - b _ BEDROOM ® . I I I UNFINISHED m IP F Q BASEMENT HALL UNDRY _-�--- -- _ --- II UPm ' Ab.3 —9m - - g/g B/0• 996/6' ' B'80/d" p — _ PIP_ F I - MINI MECH./ RAGE \> / � / \ ♦ a W I ; I � ...,. - .• \�\ \ � i Pam. 1 ' � 65' o - :.. - I o op I . I CRAWLSPACE I I I ;. I I • + E� • I ; r -�-- -- � � I: I : I 2 I I 1 \ l l ---- --- 2r i \ u. ✓ ti PERMIT Aeviafm D.m i GENERAL NOTES: STUD WALLS ARE 2x6 UNLESS NOTED OTHERWISE ae DIMENSIONS ARE TO FACE OF STUD UNLESS NOTED OTHERWISE �� Bhmt Nw / CD.&A��ENT`//CCRWW�LSPACPLAN E P*Rl NORTH I ' _ 8V1/" 1/d" V9/a• 5109/" q.19/e" g>9/g• .C� B ' E d —j,24. a_ 0 ----- - pa 121 - 111 y sue' e 9 a` SUMMER a -..25-5' I II IQTCHEN _ FAMILY - s O 2.1 c'EI IFn el/" V)I -- -------- -- 9 - - ------ - -- _J 1 1 I I it II Ia Il 11 I I I I I I lul d ,02�45' —p SF I - 2 oclusasovE�\ / IK KITCHEN II II I II % p PANTRY 25.5' _ 1�• ICI 3 STAIR 0r.nsuaru as.s a - � HALL 1 _REAR i eae PORCH _ FAMILY ENTRY SCREENED W LIVING \ MUDRM. 5. ' SCREENED c= ap O r2.t_Sare.Flx .�. .o. na__—1 a DINING \\ _ t 5 \ I �r o FAMILY PORCH \\ - a•as -- -- \ werr / eev r, +P—' \ SCREENED 25' Apr, Cn LOGGIA ' K O 2 M IL (,{' umu�secawlm 6 V �a LOGGIA +FRONT _ fm Im toe �' eIre^ HALL 2. 6 I I'i ii $24_63. - _ _ O s•oI r�vr eles/e^ a Irr 1401 it R. II O \ t rl = z I MAIN a SIDE _ m 'PORCH li ii a ENTRY : a — NG- R M O II II,,p53 �y FRO �25 i DI NGOFIlLCA11 I 2 POR as.t 2 4 83• 1 PERNM n-1— note Q t 2 3 Iss A62 t as.a As.a GENERALNOTES: o,s S OTHE WWAALLS ARE 2x6 UNLESS NOTED -17MI SE DIMENSIONS ARE TO FACE OF PLYWOOD ON THE OUTSIDE OF EXTERIOR WALLS AND FACE OF STUD EVERYWHERE ELSE `f UNLESS NOTED OTHERWISE ( I 4 Bhmt Na ///jjj I ASA �1 FIRST FLOOR PLAN P� A3.2 1 aLAI.E.1,4".I,O° NORTH J g�g�999999 �� - E IYd" &61 a" I N a � b O E"- k DROOM#5 CO B ROOM d 1 was a ® I _ b^Vt e 4 II RAGE I . I I I o LOUNGE A83 �1^ BE ROOM#4 ` a � � N F I y r FEM P 9 -#I - nss I II - pd..)H, BA #2� X r / seta• / _ / \ n - i! EDROOM 2 � I EDROOM#1--- �m r oa � H 1-�••1 --- a -- - -- ———— PIP DECK p w I I Iv M6A X0 n a7;- aie• 'uI IS 05ET I - 00 LOGGIA m v I • I I I a I b I I _ �I I . I I o BA #3 0 II ou O °� �• O b •�I (j..��, 51 I UPPER ENTRY IHERCL,O..S.EyI�f M.BEDR OM Pm °° I ® 3 A�I V] m LC VAK<18 LC.I _ a =F M.BATH m a ac PO CH D.m PERAM I 1 2 3 hG2 A6.2 M.2 R°vielon DBOB GENERAL NOTES: STUD WALLS ARE 2X6 UNLESS NOTED OTHERWISE °'g DIMENSIONS ARE TO FACE OF PLYWOOD ON THE OUTSIDE OF EXTERIOR WALLS AND FACE OF STUD EVERYWHERE ELSE UNLESS NOTED OTHERWISE f 0=&E��?�QLOOR PLANAr NORTH y 3 U i• Fr r r 6 N F———————— ———— --I--------� " I ❑ I F 6 I I e I I I I I I wes I I I I I I \ I I � I I / I I / F,— was • I I � o I i I - � 000 I I I I I \ I I I I I I I I \\ I x I I I I 2 I I PERMIT \ / as.2 aes wa.2 �� Bhmt Nu (D PI AN P A3.4 J sROOF ue.,,<•., NORTH CBDH FND/HELD PARCEL ID 1'14-001-001 ZONING INFORMATION Q� S S N,F CURRENT ZONING DISTRICT: RF-1 e9el ,,SS� DANIEL SCERT 589 2 W LYNCH OVERLAY DISTRICT: RPOD v �l1 ZO ro �i(i �,� BUILDING SETBACK REQUIREMENTS P .�� GA TE +� y��OQO bra ,� \FTC Required Existing Proposed oJ� �� / `qC'� Front Yard 30' 48.5' 62.2' Q QF;�� f \�tiF, \ Side Yard 15' 15.2' 15.2' LN 30 (T CBDH OAK_ Rear Yard 15' 136.5' 136.5' FND/HELD r 7 1 v OAK 27" �\ i PLAN REFERENCES: OAK i LAND COURT PLAN 2664-122 — LAND COURT PLAN 2664-120 o <... ` �`.. APN 114-001-003 Z c, V. 53.347t S.F. o 1.2t ACRES . -° LAWNb v \ \ , o , v� PARCEL ID 114-001-002 N/F ��� cn ROBER T J. SPENLINHA UER p CER T. # 172429� PATI I �� �� \ • rn� XISTI�G �\ ��AAAt (1 C E TI �\ � OF Afgss r SEPSTEM I �\ \ � gcyG� S GA"' �� TIMOTHY 6 , t; PARCEL ID 090-002-002 18 gENN "' • N/F x \ ELLEN C. WELD, TR � N . 8 CERT. 186071 4' f �k �c i ` Gi # \ 5p #8[J. ORY 5T \ a P P'v1t/z FRAME �' � �WOOD2 N f E _ 0 GATE PROPOSED DRII!EWA C GARAGE 152 PLAN OF j i =WOODED— `==l TO PROPOSED .GARAGE .\ ` \ EXISEND DEMOLISHED\ MAP 1 14 PARCEL 00 -003 Yni \ BENCHMARK 850 SEAVIEW AVE. \� N _ E EV ATON 22.99 OSTERVILLE, MA 02655 PROPOSED \ � N = (NA VD88) SCALE: 1"=40' DATE: 10/24/2017 DRIVEWAY ENTRANCE FLOOD ZONE �\ PONMEV Green Seal Environmental,Inc. o 114 State Road, Building B ENTIRE SITE IS LOCATED PROPOSED ti� \, - z GREEN Sagamore Beach,MA 02562 IN AREA OF MINIMAL FLOOD LANDSCAPING f 1g .24 y SEAL m` Tel:(508) 888-6034 HAZARD ZONE: ZONE X, \ PANEL 25001 CO757J REBAR �, I 9' y ti�.1997 a�a Fax:(508) 888-1506 DATED 07/16/2014 FND/HELD _ �� nr AV�• - www.gseenv.com y V V Y 0 40 80 120 Cj�• WAYS.�� - Ua • E BACK --- ------- e o PORCH ,............ -- �— -- -- s .._'. ..._P;R K2 i II - E 0 i i ! j kiT.:EM..,-'. lot E. wc ♦ 00 I I II II _I azwu�_J 1 I 1 FAMILY bA I I I ROOM !ul II II _ II 11 II I 'KrrCHEN I 1180°OQA115�- - —I I I 1 I neovE II • 1 1 - + II _____ _ __ _____ - ? REAR C1 PANTRY STAIR PORCH 3 0 HALL FAMILYLWRY - PORCH II II. CRE N N G II ----- — i'— 'i ��� S REE ED a .a a a ! II I I • IVIN s� I SCREENED 1 LOGGIA I ,. Q 0 LOGGIA � O0 I V _ v+ c.ewc:secow+rtn -I X n g 1 I FRONT HALL 9AR P.R. I 2 AI G vocl¢r000a 1 MAIN _ ENTRY - _ SIDE PORCH Q . f 1 U II W Il 11 U) II a I.1 N FRONT - PORCH II .. W 11 E �,� FIRST FLOOR PLAN Y 6 Q 6 i I #4 O E BED OM#5 COMP./STUDY - ROOM I . I I I I I I I I I I I ORAGE I ---------- I BEDRO #4 L UN E OPEN • �--- — — .0 BELOW I I � I I ) I I � i " MATH#1 i KU I. O D� BED OOM#1 / \ O I - ROOM`#2 ----- I a I I I • I I I i I I 1--sJ I LOGGIA �h'O DECK IISCLOBET M I P I • - I I M.VEST. I I I UPPER ENTRY O I I I BATH#3 — � I I M.BEDROOM O . I I es•wuim. — — -- ------ H CL09ET t I aesxciE P: � - S I I o BEDROOM#3 I - I I I ,�q : J a ' PO CH - orar«iunu+wur.r Ieeee Dale I naele o.� 1 1 e � u sneee No. l � SECOND FLOOR PLAN A3.3 OVERLAY DISTRICT: , AP Aquifer Protection District iP Neck 6 MW As Shown on Plan Entitled F.F EL.25.0 "Revised Groundwater Protection F.G.EL.23.0 Overlay Districts - April, 1993 o F.G.EL.23.0 a °•o j0 See Note 4(typ.) , -o O t 4 FLOOD ZONE: EL.21.0 �( � : *-a w,n'�"to Dwelling FF! EL.21.6 Top Zone C { >sQ r 1 Accessory .1- - - - � Community one No. '� ° �:, } . se Dwelling EL.19.7 10" 2500 Gallon 19" EL.19 #250001 0018 D Septic Tank T EL.1 .4 EL.1 July 2 1992 { 4'-3" H-20 T _ 1. ,.• .ti f - Flow Equilizers As Required ugnt q EL.19.0 Bot.El.17.0 ZONE. ,o Bedding,"T"s,&Baffels RF-1 10' as Per Title S If Encountered Remove&Replace a 6' Min All Unsuitable Soils Within 5'of Area (min.) 43,560 SF LOCATION MAP 20' The Outer Perinicter of The System = Fron t a e (min) 20' Man. Width (min) 125' 1"=2,000±' Setbacks: DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Approx.Groundwater E1.2.0 Front 30' Per T.O.B.Groundwater Map Side 15' ASSESSORS REF. . NOT TO SCALE Rear 15' Map 114, Parcel 001-003 Finish Grade DESIGN DATA 3'Max. i llll llll 1111 llll llll llll�llll lllh li{ (II{�IIII IIII 1 IIIAII►1- Falter Single Family - 9 Bedroom 9"Mtn Compacted Fill Fabric With NO Garbage Grinder 2" } T i 1/8"-1/2" Daily Flow= 110 x 9 = 990 GPD } T Pea Stone T J, ; - 3 Septic Tank: 990 GPD x 200% = 1980 GPD r4 Use 2500 Gallon H-20 Septic Tank 3/4"-1 1/2" LEACHING AREA LEACHING uoubie.washe�i 2' CHAMBER Stone 990 GPD/0.74 = 1338 SF Required H-Zo 1 Sidewall = 2(12' + 93')2 =420 SF =' Bottom Area= 12'x 93' = 1116 SF 4'-lo" 1536 SF Total Provided I 22x3 12' LEACHING CHAMBER DESIGN �► CROSS SECTION OF CHAMBER O NOT TO SCALE All Pipes to be Schedule 40. Use 10 500 Gal. Leaching Chambers in a I 12'x 93'Washed Stone Field as Shown. CB/dh � fnd 22x7 23x9 / \ea 28" oak cis Oo� �O6 of� s` 25x° P# 101600 P# 10 600 s 0 / 36.0' �� �9s�`y�o � 22x3 � h 24x8 PERFORMED BY SULLIVAN ENGINEERING PERFORMED BY SULLIVAN ENGINEERING 2a o . WITNESSED BY SAM WHITE T.O.B. B.O.H WITNESSED BY SAM WHITE, T.O.B. B.O.H ♦ 14 oak 10 6 24xo 1 ,�.. ° 24x6 DATE: 10/16/03 DATE: 10/16/03 23x5 Oil Tank I sfa�� ... °��- TEST HOLE - 1 TEST HOLE - 2 Exis Q I 23x5 P LAWN EL. 24.0 LAWN EL. 24.0 22x1 ff story 6- m sBcN 22x s W°o�aro9e 1 / `1 \ Ce/dh A LAYER IOYR 4/2 A LAYER 1 OYR 4/2 c N 24xo \ fnd DARK GRAYISH BROWN DARK GRAYISH BROWN fnd r_ \ �. `N Pad \ , L°/ Benchmark: 8" MED. SAND W/ SOME FINES 23.3 10" MED. SAND W/ SOME FINES 23.2 o.. ' Ca�c• I \ , Top of CB/dh fnd 2axt: 28" oak :0" oak \\ El.=23.89' NGVD'29 B 1 LAYER 1 OYR 3/4 B 1 LAYER 1 OYR 3/4 , ` _ 24xt DARK YELLOWISH BROWN DARK YELLOWISH BROWN 24x4 23- 0 1511 MED. SAND W/ SOME FINES 22.8 13" MED. SAND W/ SOME FINES 22.9 23x6 _ _ _ _ _ \ 28" oak B2 LAYER 10YR 4/6 B2 LAYER l OYR 4/6 23x4 .. Cane. Pad r � \ \ I 12 7' -TH-1 \ \ \ `} DARK YELLOWISH BROWN DARK YELLOWISH BROWN \ 24x3 \ \ 1`.. 20" MED, SAND W/SOME FINES 22.3 25" MED. SAND W/ SOME FINES 21.9 23x7 � • \ I 28" oak \ C LAYER 2.5Y 6/6 C LAYER 2.5Y 6/6 � \. OLIVE YELLOW OLIVE YELLOW \ - \ 138" MED. SAND 12.5 MED. SAND 23 4 4 23x L 251 i�� \ NO GROUNDWATER ENCOUNTERED 30'"--------- PERC TEST--------21.5 Lot \`. ' \ 9" � 12": 8 MIN. 53, 115± SF 23x7 e �� LESS THAN 3 MIN./IN 20.0 - _ _ - / _ 1.22± Ae. co Res 48 NO GROUNDWATER ENCOUNTERED 23x6 / Prop°a; \ \ , Po \ \ \ o \ f 24x1 \ O 23 �M\� SEPTIC NOTES 4.6. 0 / Proposed , �G, / 1. Water Supply For This Lot is Municipal Water. 24' spruce Septic System ,tip X / 2. Location of Utilities Shown on This Plan Are Approx. \ i t`e- At Least 72 Hours Prior to Any Excavation For This 1 2• \ 23x 7 \ M\0 , Project the Contractor Shall Make the Required 4 O \ \ Notification to Dig Safe (1-888-344-7233) Underground 24x2 3. The Contractor is Required to Secure Appropriate Cone. Structure � 24x3 � ` • 1s" pine Permits From Town Agencies For Construction 20" oak I ' Defined by This Plan. 4. Install Risers to Within 12" of Finished Grade. o / � f 5. All Structures Buried Four Feet or More or Subject 23x, _ _ to Vehicular Traffic to be H-20 Loading. / \ 6. Septic System to be Installed in Accordance With J / 2 xl I 310 CMR 15.00 Latest Revision and the Town of 18" a k / Barnstable Board of Health Regulations. \ sed / 7. All Piping to be Sch. 40 PVC. 23x2 / \ / , T C) � / N n 7 co Sea Z 23x ,' pf op°5of y \\\09zz w cr \ \W CID pip05 2 \ !\ \ ` 22x3 � \ % --23 osea �09 LEGEND: QQ Drain Manhole 22, Qs Sewer Manhole � � / •, ck Line ® Water Manhole Bui i......ng '.... 23x4 0 Misc Manhole \ ® Catch Basin _ o ❑ ® Drain I \ Hydrant f \ ,12�44"W CB/dh 0 CB/DH \\ I I W � S fnd . O PK nail I 2 x9 \1 - - - - \ \ t Fence Edge °f pavement Guy \ picket \ cicl� Utility Pole 15 .24 1 I u - �en w� d Deciduous Tree PETER Rebor \ I ieW SULL11% fnd ��fl.2973 I ^' Wid ) Coniferous Tree I J '�ye W\ (40 e \ � CIVIL N D • Tree flagged by others - Sign a Light Post \ _ t'W © Gas Gate \ -�ohw " ® Water Gate ; Revision: Modify Dwelling Location & Septic Configuration 3117105 Title: PREPARED BY.• PREPARED FOR: Notes: Site Plan Bernard Francis Saul CapeSury 1.) The property line information shown was Pro osed Im rovements Sullivan Engineering, Inc. Down Saul compiled from available record information. S PO Box 659 7 Parker Rood At Osterville, MA 02655 Osterville MA 02655 7501 Wisconsin Avenue 2.) The topographic information was obtained ^* 850 Sea View Avenue (508)428-3344 (508)428-3115 fox (508)420-3994 (508)420-3995 fax from on on the ground survey performed on PSullPE@col.com cop esurvgcopecod.ne:: Suite 15E or between 25/FEB/04 and 26/FEB/2004. Barnstable, (Osterviiie) Mass. _ � ` �--Bethesda, MD 20814 3.) The datum used is NGVD '29, a fixed mean 0, Draft: JOD Field: WHK/MDH 20 0 10 20 40 80 sea level datum. j Date: December 13, 2004 Comp/Review: PS Comp/Draft: MDH/RRL F9'G Prod. # 23026 Drawing # C444_3G1.dw