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HomeMy WebLinkAbout1460 SOUTH COUNTY ROAD - Health 1460 SOUTH COUNTY A=12.01 001.003 i o { 1 e � s i N, Commonwealth of Massachusetts Title 5 official Inspection Fora I_ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1460 South County Rd Property Address Don Kelly Owner Owner's Name , information is Osterville Ma 02655 9/2/15 required for every ----- ...__ -------...------ -----__.----------'----__ ------_ page. City/Town State Zip Code Date of Inspection ( Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. I Important:When filling out forms A. General Information ///Tn on the computer, J j use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono use the return -- --- ----- —------- key. Name of Inspector DiBuono Sewer and Drain ! rab Company Name— ---------------------- ------------— ------------ 8 Johns path Company Address ,erwn S Yarmouth MA 02664 i City/Town State Zip Code 508-364-9587 S113522 j Telephone Number License Number ( B. Certification I 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 1-1 Fails i ❑ Needs Further Evaluation by the Local Approving Authority i 9/2/15 Inspector's Signature Date i I The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a sharedisystem or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. . i (Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 i Commonwealth of Massachusetts _ Title 5 Official Inspection Fora _ Subsurface Sewage_Disposal System Form - Not for Voluntary Assessments - 1460 South County Rd v — Property Address — --------- Don Kell 'owner Owner's Name -_ --- - ---- ---- �._'_ -- ---- information Is required for every Osterville �'' ` Ma -02655 912/15:, page. . _. -- Clty/T'o"wn -- --- -- -- - --- State -----Zip Code - Date of Inspection B. Certification (cost.) A. Inspection Summary: Check A,B,C,D or E/ always complete all of'Section D A) System Passes: ® 'I•have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. '"Comments'. ,•c::Th;e._system contains a 1500 gallon tank as well as a concrete Distribution box. All tees and baffles are in place. The Distribution box is level and at normal level. The leaching.is made up of several epching chambers and at time of inspection levels appeared Ito'never have been at abnormal levels. B) System Conditionally Basses: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the Yepla'cenient 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): ,.IIL"; ,r,.`..) `I� � 4�..,�i Is; , . ....;i E � .'-"r �;i'Iz: _ ... .+ • 1�'i ii�:�; ;nii�Ji��(i�.) l_I )-i Y-11,3 tfa {(jt;:.1! �"l f!F;�)'1:1' dl��?.rtir-_,i�- t e .____-- 5"3 �::'T,1'•._F sq 114W 13z col t1(<'' dt" i«J7f?'ir;• ii[4V i �iiiVJ iDh ,::iri +:' - R !, ,> Jd; w a - ,., 1 :Sins•3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 'Fs G A 1460 South Count Rd Property Address Don Kelly--- ---- - - - Owner ------ ` Owner's Name information is " = required for every Osterville Ma 02655 9/2/15...:A. page. City/Town 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 ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection form •. r Subsurface Sewage Disposal System Form - Not for Voluntary - --= Y Assessments .. 1460 South County Rd — --------- — Property Address .............. -Don Kelly Owner -. Owner's Name information is tit,t ,t I required for every Ostervillte r ' Ma 02655 _ 9/2/15,, page. State -- Zip Code Date of.lnspection �r , B. Certification (coat.) t�. ..__ 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 d:is'tance:, r, t f'',: '.• ,t `, y:,, V11 E1�.7;� lE) .. ...•i� li'^L � f:ai V' `� .._f.- b'.)b:i� a` iV?Vfq odi is'sy-stem'passes`if-the wellwater ar alysts performetl°at a DEP certified laboratory, for fecal �? r- ,rO grata;colifo(mt•b'acteria indicates absent and the`presence of ammonia nitrogen and nitrate nitrogen is equal !st,:; ndl, 10 \�c oto.or•les's,th"an`5'ppm';provided that no other failure criteria are triggered. A copy of the analysis must be attachedito this form. 3.•'Other: , -- - -- , r 7 tir i riJr 3 ItT=1�t ritA?n D) System Failure Criteria Applicable to All Systems: it ,You rfi0s06dicate 'Yes" or"No" to each of the following for all inspections: 01 I . i. ua ?I+ fi'i1�� �.r �•. Backup-of sew c Iage into fa r ality or system component due-to overloaded or. li4v; tlgc,U ^IE: ti!u.`t 1cf6ggd& -ASPor cesspool's ' r ,,Discharge,grtpondirfg,of.effluent to:•th.e surface of thezground'or surface waters due to an-overl;oade•d_or,clo:gged,SAS,orr6ess060"1.�'-%" t Static liquid-level in the distribution:box above-outl0t,1nvert due to an overloaded r, r;t ❑. ®\ y or clogged SAS or cesspool 1 ' ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow Sins•3l73 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 1460 South County 'Rd Property Address ,f Don Kell Owner Owner's Name + information is required for every Osterville Ma 02655 9/2/15 - 1 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool•or privy is below high ground water elevation. ❑ ® 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.thari 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 forma ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. El ® The system fails..] have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the'system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a,surface,drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection r`Area "I A)`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 nasfailed. 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. 15ins•3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 5 of 17 + l vtr Commonwealth of Massachusetts _ U_= Title 5 ®fficia"I".Inspection. Form Subsurface'Sewag"e Disposal System Form - Not for Voluntary Assessments 1460-South County-Rd ------------------------------------------------ a-35 n.,,A t� .,,;�,�� Property Address ----------- ---- Don Kell �Ila)I ro%; Owner — ---- ----- -- wC Owner's Name information is r' . Vic" required for every, 0sterYlIle#„' Ma - - 02655 9/2/15vfc'off+ page.._ _.___.— ..._City/Town_- _=__ __.—._.__...___ State Zip Code ` Date of Inspection C. Checklist --- Check if the following have been done. You must indicate "yes" or,"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® We're 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 sand examined2 (If they were not jj available note as N/A) i;i�i1 ® El Was the facility or dwelling inspected for signs of sewage back up? -- l__i ® ❑ 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 S`yfsterri(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)] ®. System, Information < a.a -{ ,'r"• .. ,J . Residential Flow Conditions: r 1. G:7'i' (design): 4 ?JnBa�la qnt?yassIG 4 1J 0 Number of bedrooms -- ------ Number of bedrooms (actual): -- ------ rr,ni440 _1 aeY (_) DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): ----- -- - t5ins•3/13" "n Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 ,_4 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1460 South County Rd --- ----- ,-— ----- T-------- r Property Address —-- -- ---- --- Don Kelly Owner - -- ----- - - Owner's Name - - - - -- - - -------- information is i required for every Osterville _Ma 02655 ____ 9/2/15, — --- ---------------- page. City/Town ' . State Zip Code Date of Inspection" D. System Information Description: The system contains a 1500 gallon tank as well as a concrete Distribution box. All tees and baffles are in place. The Distribution box is level and at normal level. The leaching is made up of several leaching chambers and at time of inspection levels appeared to never have been at abnormal levels" - IF --------- ---- -- Number of current residents: ----.---------.--- 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 Seasonaluse? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage d 186 GPD 9 ( y 9. (gp ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: ----.------.-.----_.._ Date Commercial/Industrial Flow Conditions: Type of Establishment: --.__._.-.------___-_----------------------------------__._-- Design flow (based on 310 CMR 15.203): Gaiions per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): -. ----- ------- .-----=---------------. - Grease trap present?rw El Yes ❑ No Industrial waste holding tank present? .,., , , ..;- ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: -- -------- - ------___ t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 •• r } f, s Commonwealth of Massachusetts " -- -- Title 5 O�f f i"cial Inspection-F®rrn ' Subsurfac'e'Sewage'Disposal System Form- Not for Voluntary Assessments a. r t1 , 1460 South County Rd Property Address --------- --- -- __ Owrer Owner's Name --- --o � ;�• information is 0Stervllle, �;' ' f.I Ma , " "I L' , required for every r t - . .-- --- - --- nr - ----- 02655 9/2/15; ---- .page. Clty,/Town__.__ —. . . __ ___ _.._. State- -Zip Code, - Date of Inspection D. System Information (cont.) Last date,of occupancy/iJse: -- Other (describe below): 3 General Information Pumping Records: Unknown°°`Recoli me�hde'd)=)ri}fGi-' Source of information: — -------- --- __--.__.____. ( •i`n te) o_ ii0i�it;f10_ ;10) Gir'19rrirli(1' Was system pump as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: ---- - ------------- ----— -------... gallons How was quantity pumped determined? --------- ---- ------------- ----_—_._..__._.. Reason for pumping: - ----- — -... - - --- - --- --- ----..-- - ._. .._. Type of System: 11 ": ® Septic tank, distribution box, soil absorption system' ❑ Single cesspool t "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 r :inspection of the I/A system by system operator un' Yr contract' F"Ic !___t zeY 1_1 D SL?JIIU i`:J 1cTigi tftank. Attach a copy of the1DEP,approvaf�' ot)rrnilnuo '�� n n ET. Other(describe): t5ins•3/13 ' w Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 c) Commonwealth of Massachusetts Title 5 Official Inspection Form u� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ., y - a,•' 1460 South County Rd - 7 Property Address. -- -- — ---- 1, •f.1:` , Don Kew__ Owner Owner's Name --- _---------_------ -- --------:----------�='=.=----------- - information is r" required for every OSterVllle Ma 02655 912115„--- . _.._- --= ----- -----__-- -------- -- ------- - ;-,- -'--� •, — -- page. City/Town State Zip Code Date of Inspection D. SysteIll Information (Conti) ; Approximate age of all components, date installed (if known) and source of information: 18 years_ , Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grade: 28" feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): --------- --- - ---- -- Distance from privat&water,supply well or suction line: „ - --- - n..---- — - Comments (on condition of joints, venting, evidence of leakage,,etc.):. , System is vented throught the roof. Septic Tank (locate on site plan): ft Depth below grade: 2 2 ft ---- --- - -------- - feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 gallon- ---- - -------- ----...-- -- - ------- .__... - - -- --- ----=- - ------ --- -- -- - _ - - ---- - ----- -- - —�- ,•it, •,ia'��} - ( Ir ( tY` 1 S'J i; "1f tank Is metal; Iist age �, i ------ -- - --- ---------.. I.'ilif .li il;.-_f ;�;'1 r� f y + c `r 4 •years Is age confirmed by.a Certificate of,ComplianceZ(attach a copy;of certificate); ❑ Yes ❑ No 1500 Dimensions: --- --Gallon,--------- --------- 3" Sludge depth: --- ------------------ t5ins•3113 Title 5 Official Inspecqttion Form:Subsurface Sewage Disposal System•Page 9 of 17 b Commonwealth of Massachusetts ., Title 5 Official Ins ecti®ri ,F Subsurface`Sewage Disposal System Form - Not for Voluntary Assessments '• \fie% 1460 South Count Rd .: (+,rj' c s) r 1 , Property Address ull A rnoU - Don Kelly ` - = Owner _ - M131,a isn',YG nwil Owner's Name - - - iriformation is '11L i, c 0." required for every ,,Ostervllle Ma 02655 9/2/15 - — —; w Tir,: o page. .. .._- ---_City`Town-----.__. State --- ------ p. r ,-,Date of-Inspection D. System Information (cont.) Septic Tank (cost.) Distance from top of sludge to bottom of outlet tee or baffle 24 -------- -------____.__._.._. Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 42 Distance from bottom of scum to bottom of outlet tee or baffle 1 Sludge stick Howl 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.);itr ...� No evidence of Ieaking,Tees and or baffles in place at time of inspection_ Grease Trap (locate on site'plan): 1....t '. , NA 1b epth below grade: ' feet Material of construction.- concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain): Dimensions: --- -- ---... ---- - - Scum thickness Distance from top of scum to top of outlet tee or baffle r••i�.i�i;�':� 1,",c!!'a:;1 ice' `�'oj rl.[;t t�, t_1 a 'Y Distance fro m"bottom of scum to bottom of o11 utlet tee or baffle Date of last pumping - - -- - ---- ---- --- -...... Date tins•3;13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a`V�t 1460 South Count_Rd Property Address ' - - _.f• .ill Don Owner -------- ---- -------- Owner's Name ----- -___ information is .; required for every Osteryille_ ___- - Ma 02655 9/2/15 page. City/Town' State Zip Code Date of'Inspecton D.. System Lnfoi=mation (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.): Tees are in place and levels are normal. --------------- 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 El 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•3/13 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official 'Inspecti®n"foi irrri ` . Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 'y � dJuo?, fl.'.='-+1460 South County Rd - - - -- .—_ _ b _ ._ _. Property Address ti"il f,vr; -Don Kelly-__ Owner Owner's Name - ----- -- ----- -- -------- information is 1V" r 9+f Ji , cv, " required for every Osterville Ma 02655 - - :aT-- -- ----- — 9/2/15, + n 0, l-- wn__ r u page. _---- - — c _ 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 At normal-level --- --------- ` Comments (note if box is level and distribution to outlets equal,=any evidencepf solids carryover, any evidence of leakage into or out of box, etc.): Distribution Box is level and at normal level with no signs of carry over or decay. evil.7vor:: !;( 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. Soil Absorption System (SAS) (locate on site plan, excavation not required): • If SAS not located, explain why: ------------- 15ins•3/13 ', y 1r.- .. Title 5 Official - -------- --------------,—-- 0 al I nspection Form:Subsurface •Sewage Disposal System Page 12 of 17 P Y 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1460 South Countv Rd Property Address ----- ----- — --- ---- Don Kelly Owner Kelly Owner -------------------------------- -------- -------- ---------_-- .. ---" - Owner's Name _ • -------------- information is required for every Osterville Ma 02655 9/2/15 , page. City/Town: ____..__ _1 State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ---- -- ® leaching chambers number: 3 ❑ 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.): No signs of carry over and no signs of hydraulic failure. ------------ 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 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts ---' ` Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1460,South"Count 5Rd Properi�Address- t ; j , r i'J r..�.x. Doll lfiell ra Owner Owners --- information is 3 ;f :rta " required for every Ostervllle -- -- t Ma` 02655 9/2/15 _ - -. — -- -- page. Cdy/Town Y t_ wr' StateCode Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): No signs of ponding or hydraulic failure Privy(locate on site plan): Materials of construction: -- -- --------- ------ --- - ---- Dimensions it Depth/of solds"i: ---- -- ---- -------- t - Comments (note condition of soil; signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Assessing As-Built Cards Page i of 2 N1, � i It0 TOWN OF BANNSTABLE //o J 1 � 9 LOCATION L 51 h !n f2d. SEWAGE N j! W.-LAGE_2C\&rLV 1P_ ASSESSOR'S MAP&LOT _ INSTALLER'S NAME&PHONE NO.� SEPTIC TANK CAPACITY_[566 `}.g( .-• - LEACHING FAClLrrY: S� ht cty>x�( �.(SiZe)_�3 x 3 ti - NO:OF BEDROOMS y BUILDER OR OWNER �vtt�lA�rS PERMITDATE: 2d 9g —COMPLIANCE DATE: .. Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Fcct Private Water Supply Well and Leaching Facility (U any wells exist on site or widen 200 feet of leaching facility) Feet Edge of Wcdand and Leaching Facility(Uany wetlands exist within 300 feet of leaching facility) Feet Furnished by f . � 3� 1Z 3 ze y 936 �35 Sze t littp://\Nw�a,.to�N-nofliarnstable.Lls/Assessing/HMdisplay.asp?mappal•==1?0001003&seq=1 8/27/201 i Commonwealth of Massachusetts Title 5 Official In8pecti®n Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments A,a' 1460 South County Rd_ Property Address -------- —.---- ...-- - --- - --- ---- --- -------- - Don _— Owner ---- —-------- -------- Owner's Name -- ------- ------------- information is required for every Osteryille — Ma 0265_5 _ 9/2/15_ page. City/Town 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•3113 Title 5 Official Inspection Forms Subsurface Sewage Disposal System•Page 15 of 17 L. - 7 Commonwealth of. Massachusetts Title 5- Official Inspection Forrb _ - -- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments. o — 1460 South'County_Rd---- Property Address Don;Kelly----------- - -- -- = Owner - - --- --- -_---- ------------- ----- --.- --_ Owners Name-, 01!r6��r vie infdrmation is r7 v required for every r+cQstervil.le,c c <•' Ma 02655 page. -' City/Town—" -- - __"—" State—, Zip.Code r.,MI*Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12+-ft -___-__ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 9/3/98 — ---- ----- - - 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 dated 9/3/98 indicates NGE at 10' Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins•3113 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 16 of 17 • '' Commonwealth of Massachusetts �4 Title 5 Official Inspection Fora IR — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments \A 1460 South Count Rd Property Address -- Don Kelly Owner — — ---------- -- --- ----- --..__._..— --- ----- -- ---- ----------- -,•-----------------Owner's Name information is - - required for every Osterville Ma 02655 9/2'1'5 page. Clty[Town State Zip p Code Date_of Inspection• 4; `E. Report Completeness-Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems) completed I ❑ System Information -- Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file l.,f.li•:,,1 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 K._,_ J r•_ - -,Fe�ass,,. t t Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 1460 South County Rd. Property Address Don O'Neill Owner Owner's Name information is Osteryille Ma. 02655 6/29/2010 required for every page. City/Town State Zip Code Date of Inspection 1 t Inspection results must be submitted on this form. Inspection forms may not be altered in any 1 way. Please see completeness checklist at the end of the form. Important: A. General Information Whenfilling out formson , I forms the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name t� P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this adess 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 o� ❑ Needs Further Evaluation by the Local Approving Authority 6/29/2010 In ec is Slgnat a Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sea Disposal Sys te •P g 1 of 17 Commonwealth of Massachusetts L Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1460 South County Rd. Property Address Don O'Neill Owner Owner's Name information is required for Osterville Ma. 02655 6/29/2010 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,^M 1460 South County Rd. Property Address. Don O'Neill Owner Owner's Name information is required for Osterville Ma. 02655 6/29/2010 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 1460 South County Rd. Property Address Don O'Neill Owner Owner's Name information is required for Osterville Ma. 02655 6/29/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 0 The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 1460 South County Rd. Property Address Don O'Neill Owner Owner's Name information is required for Osterville Ma. 02655 6/29/2010 every 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: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. l5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1460 South County Rd. Property Address Don O'Neill Owner Owner's Name information is required for Osterville Ma. 02655 6/29/2010 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? Z ❑ 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 1460 South County Rd. Property.Address Don O'Neill Owner Owner's Name information is required for Osterville Ma. 02655 6/29/2010 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2008:373,000 g ( y g (gp ))' 2009:257,000 Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 6/29/2010 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 1460 South County Rd. Property Address Don O'Neill Owner Owner's Name information is required for Osterville Ma. 02655 6/29/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 1460 South County Rd. Property Address Don O'Neill Owner. Owner's Name information is Osterville Ma. 02655 6/29/2010 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: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.no evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Sludge depth: 6" t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 1460 South County Rd. Property Address Don O'Neill Owner Owner's Name information is required for Osteryille Ma. 02655 6/29/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 6" Distance from top of scum to top of outlet tee or baffle 2" 811 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. 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 l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1460 South County Rd. Property Address Don O'Neill Owner Owner's Name information is required for Osterville Ma. 02655 6/29/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): `Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 1460 South County Rd. Property Address Don O'Neill Owner Owner's Name information is required for Osterville Ma. 02655 6/29/2010 every page. Cityfrown 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 No 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.): Box is Ievel.Box has one outlet Iateral.No evidence of solids carryover.No evidence of leakage. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 1460 South County Rd. Property Address Don O'Neill Owner Owner's Name information is required for Osteryille Ma. 02655 6/29/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: z leaching chambers number: 3 ❑ 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.): Sandy dry soil.No signs of hydraulic failure.Chambers had 4"of water at time of inspection.Stain line observed 10" below invert. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 1460 South County Rd. Property Address Don O'Neill Owner Owner's Name information is required for Osterville Ma. 02655 6/29/2010 every 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, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1460 South County Rd. Property Address Don O'Neill Owner Owner's Name information is required for Osterville Ma. 02655 6/29/2010 every page. Citylrown 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 3 der 3 2,6 y 936 5 3Z qq . 5 SS t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments �M 1460 South County Rd. Property Address Don O'Neill Owner Owner's Name information is required for Osterville Ma. 02655 6/29/2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of LC 25' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: As-Built ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 1460 South County Rd. Property Address Don O'Neill Owner Owner's Name information is required for Osterville Ma. 02655 6/29/2010 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TL 310 CMR: DEPARTMENT'OF ENVIRONMENTAL PROTECTION !I 15 204• Increases in Design Flow to System No person shall inQrease the actual or design flow to any cesspool or to any other system above the existing approved capacity,or change the type of establishment of a facility served by a cesspool,• unless the cesspool or system is upgraded first. Upgrades to accept increased design flow shall be performed in full compliance with the requirements applicable to new construction unless a variance is allowed pursuant to 310 CMR 15.414.For purposes of 310 CMR 15.204,the approved design flow shall be the flow listed in the most recent Disposal Works Construction Permit. 15:211: Minimum Setback Distances (1) All systems must conform to the minimum setback distance for septic tanks,holding tanks,pump chambers,treatment units and soil absorption systems,including reserve area,measured in feet and as set forth below. Where more than one setback applies,all setback requirements shall be satisfied. Septic Tank Soil Absorption System Holding Tank Pump Chamber Treatment Unit d Grease Traps �.. ;J Property Line 10[5] 10[5] 7 Cellar or Crawl Space Wall, J Swimming Pool(inground),foundation drain 10 20 Slab Foundation 10 10 Water Supply Line(pressure) 10[1] 10[1] Surface Waters(except wetlands) 25 50 Bordering Vegetated Wetland(BVW), Salt Marshes,Inland and Coastal Banks �550 .'. Surface Water Supply- -���.5 Reservoirs and Impoundments . 400 400 Sow" --------� Tributaries to Surface Water Supplies 200 2 0 p � (`t'` f Wetlands bordering Surface Water Supply or Tributary thereto 100 0 100 I` N� 100[2] / V Certified Vernal Pools 50 l � � Private Water Supply Well or Suction Li e 50 200' / Public Water Supply Well (2) (2) CAIrrigation Well 10 25 "! r Open,Surface or Subsurface Drains whi ll: discharge to Surface Water Supplies or em � tributaries thereto 50 100 _II Q Other Open,Surface or Subsurface Drains rY (excluding foundation drains)which intercept seasonal high groundwater table[3] 25 50 Other Open,Surface or Subsurface Drains KG t (excluding foundation drains) 5 10 S U G Leaching Catch Basins& Dry Wells 10 25 Downhill Slope not applicable 15[4] [1) Disposal facilities shall beat least 18 inches below water supply lines. Wherever sewer lines must cross water supply lines,both pipes shall be constructed of class 150 pressure pipe and shall be pressure tested to assure watertightness. ii [2] The required setback shall be 50 feet where the applicant has provided hydrogeologic data acceptable to the Approving Authority demonstrating that the location of the soil absorption system is hydraulically downgradient of the vernal pool.Surface topography alone is not determinative. :I 4/21/06 . 310 CMR-512 necessary by ametal detector. (6) In areas where salt water or other pollutant intrusion is known or likely to occur, the Board of Health, working with a designing engineer, may specify the well screen level, pumping rate, water storage capacity, or any other construction parameter which must be used to ensure that water of adequate quality is obtained. C. Well driller's report.Within 30 days after completion of the construction of any.well, the well driller shall submit to the Board of Health a copy of the water well completion report. The Board of Health will not issue a.certificate of approval for the well until this report has been received. D. Well destruction. (1) Prior to destruction of any well, a well destruction permit must be obtained by the owner or his agent from the Board of Health. The Board of Health will require a site plan showing the well location, including information on the Assessor's map, parcel and lot number for the property on which the well is located, prior to issuance of the well destruction permit. (2) Any abandoned well shall be,filled and sealed with clean puddled clay, neat cement grout, or.concrete grout in such a manner as to prevent it from acting as a channel for pollution to the groundwater. (3) Within 30 days after completion of the destruction of any private well, the well owner or.well driller acting as agent for the well owner shall submit to the Board of Health a report containing the following: (a) The name of the owner of the well; (b) The geographic location of the well; (c) Any preliminary gJaanafKj--arredTilfin19; (d) Types pths, and materials of seals used. E. Well lo tion. (1),1In general, wells intended for human consumption shall be located as\ar as ssible from potential sources of contamination. The following minimum distances are required: (a) Property line: 10 feet. (b) Roadway: 10 feet from edge of road layout(not edge of pavement). (c) Leaching catch basin/dry well: 50 feet, but recommend that this distanc be maximized. (d) Utility rights-of-way: 50 feet, but recommend that this distance be max' ized. (e) Septic tank: 100 feet. (f) Septic leaching facility: 150 feet. (g) Septic distribution box: 100 feet. (h) Subsurface drains: 25 feet, but recommend that this distan be maximized, as pollutants frequently travel along the outside of subsurface drain pipes. Where, in the opinion of the Board of Health, adverse ditions exist, the above distances may be increased. In certain cases, the Board of Health may require th ner to provide additional means of protection. Where possible, e well shall be located up the groundwater dient from sources of contamination. F. Water qua (1) Prior to appro a well and approval of a disposal works construction permit application, the owner or his agent shall take a water sample(s)from the well and submit it to a state certified testing laboratory for analysis, with the cost to be borne by the owner. The results of all analyses shall be submitted to the Board of Health. At a minimum, water must be tested for the following chemical and.bacteriological standards: total coliform, nitrate-nitrogen, pH, conductivity, sodium, iron, and EPA methods 502.1/503 or 502,2 or 524.1 or 524.2. These tests include analyses for purgeable halocarbons and purgeable aromatics, as well as analyses for petroleum hydrocarbons or pesticides. (2) The Board of Health will determine potability of the well water using as guidelines the National Interim Primary and Secondary Drinking Water Standards and the U.S. EPA Maximum Contaminant Levels(MCLs). The water quality standards for common parameters are as follows: Primary Standards Total coliform 0 colonies/100 ml MF Nitrate 10 ppm /V L-T. 4 b �p 2 N � o n 9 " LoT o V 1.33 ►grip . z i xfa 284. 78 ' LoT 2 LOT- 17 cl * ED PLOT CERTIFIED T PLAN ER I F� O LOCATION OSTE-EviL. JE , NAGS I CERTIFY THAT THE FOUNDATION SCALE 40 DATE SHOWN HEREON COMPLYS WITH THE SIDELINE AND 'SETBACK PLAN REFERENCE REQUIREMENTS OF THE TOWN OF BARNSTABLE AND IS NOT, LOCATED IN THE F400 DATE s Z? 9$ UinLL THIS PLAN IS NOT BASED ON AN B A X TE R W Y E, INC, REGISTERED LAND SURVEYORS INSTRUMENT SURVEY AND THE O S T E R V I L L E^- MASS. OFFSETS SHOWN SHOULD NOT BE USED TO DETERMINE LOT .LINES. A PPL I C 6NT ZAY SIDE &tbit1G Co nV3c . °D TOWN OF BARNSTABLE L ATION t.o� �ctsh Crum:— SEWAGE # VILLAGE GnN YLV UZ ASSE�S{SOR'S MAPf& LOT 1,10 � INSTALLER'S NAME&PHONE NO.� 7 009— _V08 SEPTIC TANK CAPACITY LEACHING FACILITY: (type)A\16�0 JOB-&a wmOP '.S (size) 13 x 33 NO.OF BEDROOMS (� BUILDER OR OWNER tC'�A✓Sty �� � PERMITDATE: 2 - d -i i 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 ZA Aj , • 3 zb � T(c f 3 G"b Z� a Z7 n 16 r 3Z TOWN OF BARNSTABLE LOCATION`off 3 Svik nle (?d SEWAGE # VILLAGE-M''e6-V AIP, ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO._ E(!O SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 6 O OL- ' (size) NO. OF BEDROOMS BUILDER OR OWNER 90KI&L PERMITDATE:_ R -2& --Y$ 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) y 3 Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Feet r , No. / / " L{S Fee l f $` THE COMMONWEALTH OF MASSACHUSETTS Entered in compute 5�/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for Digaar *pgtem Construction Vermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. ` U e Owner's Name,Address and Tel.No. `/ Assessor's Map/Parcel !2-6 G�G�l lM� , O� `771—t/0 Vd Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. J#.e �)r a1dA10 — b co Type of Building: Dwelling No.of Bedrooms Lot Size_ a X 7 sq. ft. Garbage Grinder(A14 Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures t� �/ Design Flow 97o O gallons per day. Calculated daily flow 7 f6 gallons. Plan Date i `a�q7 Number of sheets a Revision Date Title L,d T' .1 C `76 k 7 Size of Septic Tank//�� 1500 Type of S.A.S. Description of Soil LI& AJQl a4&_ J, 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 C e and not to place the system in operation until a Certifi- cate of Compliance has been issue Boar of Health. Signed Date Application Approved by Date 4 7 Application Disapproved for the follo g reasons Permit No. Date Issued 0'D 3 . �j, No. ! Fee jt f $' a THE COMMONWEALTH OF MASSACHUSETTS Entered in compute Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYicatfon for Permit Application for a Permit to Construct( )Repair( )Upgrade( �)Abandon( ) ElComplete Systern 0 Individual Components Location Address or Lot No. /P U �(-�_D (� Owner's Name,Address and Tel.No. Assessor's Map/Parcel w�� �/(�/ ( �� g ,�+ 77!_l 7 12-6 001. 6d3 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 6WO I�oC— CO Type of Building: Dwelling No.of Bedrooms y Lot Size sq.ft. Garbage Grinder(Alo Other Type of Building -rA64 w No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow F0 gallons per day. Calculated daily flow 1 Z 6 gallons. Plan Date 3/-7/97 Number of sheets Revision Date Title /JJ T 4,C 76 k 7 Size of Septic Tank l.5,0 U Type of S.A.S. Description of Soil d4 4-a4 a& 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 C de and not to place the system in operation until a Certifi- Cate of Compliance has been issue Boar of Health. 4 Signed Date Z C) Application Approved by Date Application Disapproved for Re folio ng reasons i Permit No. - 6t 5— Date Issued ----------------------------------------�-- THE COMMONWEALTH OF MASSACHUSETTS a BARNSTABLE, MASSACHUSETTS a Certificate of pomp tance THIS IS TO CERT , that the On-site Sewa a Disposal System Constructed(V )Repaired( )Upgraded( ) 7 Abandoned( by at ./`- (o has been constructed in accordance j with the provisions of Title 5 and the for Disposal System Construction Permit No. 7 /y�� dated 1 Installer Designer The issuance of this permit shallnot be construed as a guarantee that the system Nyill function as designed. Date "! s Inspector { ——————— —————— — — — ————— —— i No. — -- -- Fee't i i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS i 0i5po5al */pttem Construction Permit Permission is hereby granted to ( v Construct Repair( )Upgrade )Abandon( ) System located at 1 ylo �� 11.t� 1/ � � i� o 9 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to j comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date: i d ` Approved by j�, esl&" VATA4� ET FAM IL.f PL.A hl. d N B AGIC- uErzEVF- LI�n Ga¢r3AL� Gwa.ty�. 1 VA1L`' FLOW - L� X tit, = �G(�D Lolr A �J Si Tivl Ca�ury �c� � SW-nc. TAHL - MV 9200 �?o&oL> uSF_ (Soo GAL. L}Iw, 5`(s K — [(.'W x 2-D AT-YU C-AroN AMA 2Gq b. 121e7 &Pm 4 014 j dPpUG,aToN AGZ.F� v�516N �.— — .�XP— � - Itl--- ,/ALL APT-A z G4 x 2 x4-=43'Z SF t-I"AI L of LF-A6WQl - TzuLi41=5 �TTo/Y1 Ae�;4 = � x 4 x 2= 4,o D Sr �• I Lal.r4TIo�J ATE L c,MIU�I { "''2; '/8'-�i scow I 4` dF OF JA �G PETER gMHARa '1" SULLIVAN A2 enxTM 1{. NO.2;?733 c a "'Vo 24M CIVIL � -,�c('IoW 0P .. r-&-=4,1 T A-Q-2 FG=41 Loans 4 A e uJv Sor3solt, $ Wv t pKT I IMl 3�•s; S 2 I.z,1l-a 'Tv-tF1je-P w 38'L Bo>< 104 38•1- Good�,AL.. e. 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A ppL p C ANT ?3A`(S1 D�- I uJUZJNG Co: -rQC— AsBuilt Page 1 of 1 TOWN OF BARNSTABLE �/� L ATION IOC �ef SEWAGE ti '`'j—( , VILLAGE_Z `�V1-V '" ASSESSOR'S MAP&LOT�2d a r_nR'INSTALLER'S NAME&PHONE NO. zl'E d / 4109 SEPTIC TANK CAPACITY CSG\d LEACHING FACILITY: (type)��i 5V -(�g�6e�S.(size) 13'X /r NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: -:2e -4g 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 Z, 5 Z 3 7,6 r S 3Z f http://issgl2/intranet/propdata/prebuilt.aspx?mappar=120001003&seq=1 9/14/2015 r Wx12" TRANSOM ABOVE.TOP PLATE ,n ---- u l Ln — F' NOTE: . I (� yl 3: 43 — 5/5" ANCPOR BOLTS v I 1i•qq5 y' EMBEDDED BEDDED 7" SPACED 45" O.C. I..: .NEW 12I i FROM CORNERS I I CRAWL I I = WASHERS 3N3"x1/4" I SPACE o NEW MASTER -- 1 I I 2" CONC. DUST CAP I I Q VAPOR BARRIER - C I I LOSET CQ —.l LLI ADDITION p " 8x46 CONCRETE WALL I — " I " I 10 x b CONTINUOUS FOOTIN41 I ± -- ---- - -- -_..------------ - —— i I � _ POKT / 2668 CREATE o ACCESS O Vr 1 I - Q � I OT i o Q O Wow 2068 EXISTINGr m EXISTING j o. EXISTING o MASTER BEDROOM �— > FULL �o BATHROOM zo6B ; BASEMENT I / Ln 0 2668 i o Wow. 6 w z 2668 - 3 O . T. N FOUNDATION PLAN SCALE: 1/4" s.1'-0" Q r Q 0 ,I RIGID WIND WASH BARRIER REQUIRED 1 AT EXTERIOR EDGE OF EXTERIOR WALL TOP PLATE RIDGE VENT EXISTING i TYP. ROOF STUDY I' �' 12 2x12s @ 16" o.c. Z I' SIMPSON H2.5 Q q R38 F.G. INSUL./ I.U. 11 FASTENERS AT ALL 5/B" PLYWOOD SHEATHING/ ' RAFTER / TOP PLATE 8 MATC0 EXISTING SWINGLES'S @ 16 O. W � JUNCTIONS TYP. ------_--- -7.U O . TYP_ EAVES CL 1I 1x8 FASCIA / Ix4 SECOND MEMBER LuQ CONTINUOUS VENTING SOFFIT . Z 1x8. FRIEZE BD. W/ BED MOULDING CL y O (n Q) BLOCKING W-O"O.C. X TYP. EXTERIOR WALL IN FIRST TWO JOIST w 2xb EXT. STUDS @ I6" O.G./ BAYS FROM GABLE WALL u 6" R21 F.G. INSUL./ - F 1/2" PLYWOOD SHEATHING/ Em Q TYVEK WRAP/W.C. S 41NGLES 3'-4" `1'-6" 4'-2" 3/4" TtG OSB SUBFL R 17'_0" - AILED t GLUED TO IST . r 2xlOe @ I(' O.G. SHEET 2 OF 2 FIRST FLOOR PLAN R30 F.G. INSUL. II _ I .I -1� Ti=11i-n. : CRAWLII�Ti�ll�ll_' SCALE: I/4 - 1 -O TI _rill=l "SPACE 2 GONG. DUST CAP VAPOR BARRIER y4• . ,; SECTION JOBS: 1017 SCALE: 1/4" = 1'-0" IDRANN BY:. KW ne'rF: lni�iln I j � r I f 7 7 1� t { 'i ;i F ZH LOT 4 ROAD N/F M CHERYL A. WEBSTER CB/DH FQ�D FOUND `J.,•t N6432 40"E 273.34' / R.R. TIES PROJECT PLAY LOCATION Fart HOUSE j :. J, SOUTH COUNTY 0 6. AREA ^ ' N. '` ROAD `�... LAWN ^� m m W KOI LOCUS MAP N m� POND p� a Sce/e. f=2000' m q V (��,ocva o " LAWN P IN NE LAWN ZONE: RC /7� z CglPq p PORCH ENCLOSED •3' LOT 16 FLOOD ZONE. C 123.3' r m N/F Pon el No. 250061 0016 D JOH N F. DECK LYNCH PLAN REFERENCE. 7687E m O O STONE PCvL Ge Czoe 0., q Z �LESTON 1C DGE — ao qOr O m 1. N STONE DRIVEWAY N "I CERTIFY, TO THE BEST OF MY KNOWLEDGE. THE STR RES SHOWN cq ON THIS PLAN ARE SHOWN AS THEY EXIST -HE d". —s Obi WALKWAY S C(\ EDGE DATE: 2 .. P AVER �< `t t*i S` �12.01 N . x EXISTING 2�-p ►, 90 FLAG - HOUSE 20= O POLE #1460 A V'T'O MAT IC REGISTERED PROFESSIONAL LAND SURVEY F LAWN SEPTIC 24'-0" � CvR . o J TANK APPLE REE CATCH �_. _.I O 35�c)v I CERMF 114AT THE CTRU"TURES ARE LOCATED IN FLOOD HAZARD ZONE BASIN `r I \ \ U EXISTING SEP 11C C AS SHOWN ON COMMUNITY NEL NUMBER 2R0001 0016 D AND THAT 1 O SYSTEM FROM FLOOD D ZONE C IS 0 A SP IAL FLOOD HAZARD ZONE. \V AS—BUILT TIE 16" LOT 3 \\` HBULK EAD D.BOX Q CARD OAK �2. 57,950f S.F. RAM 11.4' REGISTERED PROFESSIONAL LAND SURVEYOR DATE GIN Of A44S SHED m FOOL. �ya� �y m STONE EDGE O p EQvl1?6�EA1-C C�i�Y LAWN COVER rn -+ X LABRIE " 9 0 9 LEACH 9 a� 4� m > m FIELD GARDEN ��ssr NqlEWoSaP Qi Q Qi CzA"ft m ca � N CER TIFIED PLOT PLAN m z CB/DH R.R. TIES FOR 1 FOUND N64'32'40'E S64'32'40"W �104.66' 180.12' DA NIEL KEL L Y — LOT 1 LOT 17 #1460 SOUTH COUNTY ROAD N/F VINCENT P. & ROBERTA E. NICHOLAS S. &JOY A. MATHS OSTERVILLE, MA DAMORE Scale: 1 n=20' Dote: MAY 23, 2012 GENERAL NOTES: 0 arwick & associates Inc. a?AWV er. c.M., R,AW DAM dl,=112 83 County Road Box 801 1. HOUSE NUMBER: 1460 0*-CAED or. shi mr r I or t 2. ASSESSOR'S NUMBER: MAP 120, PARCEL 001, LOT 003 20 0 10 20 40 North FalmoutA Afars 12556 P`Land Pb*Cta 2004 j YA f2alA6 I dw9 I w>r2U01BAW•d*9 3. LOT COVERAGE BY EXISTING STRUCTURES: 5,056 S.F./58,067 S.F. = 9.0% (508) 563 — 7777 SCALE: 1 INCH = 20 FEET