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0269 WEST BAY ROAD - Health
26,9 est ay Roach, Osterville P ' A = 116 109 1 ,1 i R J ¢I o Y r 4 TOWN OF BARNSTABLE :ILOCATION��� 1�� v ed SEWAGE# —0 `VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. w j d e less" LLC. S0?-y,7M77 SEPTIC TANK CAPACITY /000 C,G, t LEACHING FACILITY.(type)oZQ/. 36 :9 dO (size) IL 5 /x a.' NO.OF BEDROOMS 3 99 OWNER A14ri A.6'e. 1 PERMIT DATE: COMPLIANCE DATE: d �•3 Separation Distance Between the: ^,y , ,t,p-{e�• Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �nc�v�1"feP dtFeet 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 A / 300 feet of leaching facility) �/v Feet FURNISHED BY �_� s 1 s® Off, 0�No. f Fee HE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes �\?o 2pplitation for disposal 6pstem Cunstruttiun Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 2(oj UJC5-F BAN RD Owner's Name,Address,and Tel.No. 05TeizI I LL6 MAI" ABC-(- Assessor's Map/Parcel ((p (® S gL)P_' C-'r Installer's Name,Address,and Tel.No. $O%'4 7-$1S7-7 Designer's Name,Address,and Tel.No. 50 8-473—03 77 Joey DE LIL c -►Tc, �t�d 6��l.1(. 1.1G� X71i c_ Type of Building: Dwelling No.of Bedrooms Lot Size I d 10 8 3 t sq.ft. Garbage Grinder( ) Other Type of Building RESCD66&11i AL., No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided .3 5 S , 3- gpd Plan Date oZ " 5 — 0114 S Number of sheets Revision Date Title ,I,(d9 I,-J 6_ST Byt 7 0S TC-7P.-1t I ( L C- Size of Septic Tank 1��fa Type of S.A.S. a0 (3 l B 7`FF c)S gEPC Description of Soil M-- t U So4AU j) (P � �i�t c5�� fPf-A-&j Nature of Repairs or Alterations(Answer when applicable) h S� L--XtS-rf cjC�[00 1 C�-c.L&dL) -SEPT lG_QWK� Date last inspected: Agreement: ' The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of H th. i e '`- Date Application Approved by 4ZAN Date Application Disapproved by Date for the following reasons Permit No. Date Issued :� 1/ No. _ Fee , THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION , TOWN OF BARNSTABLE, MASSACHUSETTS ltlYication for QBAY *pstr"' Construrtion 3dErluit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ;J pR LJG5T BAN IZ'p Owner's Name,Address,and Tel.No. � Assessor's Ma /Parcel QSfE(Z,41U6 MAI" AE5 t.,, p lll010 c s 13Q9 C;T"' Installer's Name,Address,and Tel.No. _50%'4 77-$%-1"T Designer's Name,Address,and Tel.No. 508-473-0 �1 c�4oCwc DE E �Clsr LA.C_ mac. C—N C-A N eaz t ock rN c.. 1 3 �v L�2Ct A 1PU-b`� a g5 CaO J, 14LAJ l_, Type of Building: Dwelling No.of Bedrooms Lot Size 101,083t sq.ft. Garbage Grinder( ) Other Type of Building Qt=S(IX- )T1f4c,.., No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided gpd Plan Date e2 S �,d d( %� Number of sheets Revision Date Title ;U.4 W ES-T ,BA4 P[)A D 0S Tl-.,VuV 1 [.(►C Size of Septic Tank t ,ph�j Type of S.A.S. A0 Description of Soil i' gCD(ouA So4QD_(� (,�� J�tT PC..AAJ Nature of Repairs or Alterations(Answer when applicable) U S. Q- CI S-r 1&t 000 G0-c Lo&) SEPT K_T3-NK IU&A-J 0-0 a)(� T D A0 AK. 3 G 1+C 14 -10 Atop i iCt=c)S KS (i.) A, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of H th. gine) � �� � . Date "(p/" QApplication Approved by �i /,'�,'- /„/� �`/ J� /I Date / Application Disapproved by Date for the following reasons s Permit No. Date Issued A / -------------------------------------------------------------- ------------------------------------------------------------------------ TH F�COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS CPrtif icatt of Compliante THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X, Upgraded( ) Abandoned( )by (2 A-p(_7 �a(bE-. l l.L.,C.. at WC-9-r y V 1 LLC has been constructed in ac co dbce with the provisions sions of Title 5 and the for Disposal System Construction Permit No. / ated s Installer (I_A P C W t i)C (7� POJ S e7S (.LC. Designer SC. ,( &l #bedrooms ,� Approved design flow � 3Q gpd The issuance of this permit shall not be coh/stru�ed as a guarantee that the syste will n 1* design r ed. Date J //! ✓ Inspector ------------------------------ No. A�mJ( Fee02 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Zisposal .pstrm Construction VPrmit Permission is hereby granted to Construct( ) Repair(A Upgrade( ) Abandon( ) System located at AGC) we-,CT- B A y lZb 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:Constructio mus/be co pleted within three years of the date of this permit. . Date Approved by �/ - r i is Town of Barnstable 'y Department of Regulatory Services " } .,► .>,�� F Public Health Division Date /x" ,,AB& _ 209 Main Street,Hyannis MA 02601 Date Scheduled /`� ✓ Fee Pd. '��Time Soil Suitability Assessment for Sew e Disposal Performed By: Ht&o--A eim e�')W , 6"7-_GSL Witnessed By: LOCATION& GENERAL INFORMATION Location Address +� �j `, A '" , A4.9 1 w t5� b 1 R lJ Owner s Name: M4"...A B 4--G:.. ..,.,-. OS TER Z.LAddress 153 Coktk&VWJ1(L Sr SC e0iMee-ta Assessor's Ma /Parcel°° t M t4P� P I I `1�,0;�,�� Engineer's Name dAPCto--;1tD6 EJTeRP&SC5 508-273.037 7 NEW CONSTRUCTION REPAIR _ Telephone# 15'0$_l f 7 1j Land Use. s tn�le �amit dP Yuien) Slopes(96) D I Surface Stones 'Distanceg from: Open Water Body ft Possible Wet Area ft Drinking Water Well _ ft Drainage,Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,iocate.wetlands in proximity to holes) SEA' a,�1ac�d,,P.t� � • . ,f t. � • la` s In Parent material(geologic) 0 U E w a 5�1 Depth to Bedrock Depth to Groundwater. Standing Water in Hole:_ 7(2 6 b g S' Weeping from Pit Face Estimated Seasonal High Groundwater u DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Dt,ecA 6osefu-Arb n Depth Observed standing in obs.hole: 7 t 2 In, Depth to soil mould:-_;, . in, . Depth to weeping from side of obs.hole: -> —in. droundwater Adjustment Index Well# Reading Date: - Index Well level`--= Adj,thetor,, = Adj.droundwater Levid PERCOLATION TEST bate s-5-13 Time Observation A Hole# I y.. Time at 4° _,_ Depthf Perc + Tlma at 6^ ' n:II w Start Pre-soak Time @ A}f) Time(V.611) End Presoak ` Rate Min;/Inch t 2- Site Suitability Assessment: Site Passed yes Site Failed: Additional Testing Needed(Y/N) N Original: Public Health Division Observation Hole Data To Be Completed on Back-------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:ISEPTICIPERCPORM.DOC ` DEEP-OBSERVATION HOLE LOG . Hole# +2- Depth from Soil Horizon Soil Texture .Sdil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. enngiste.cV,%,(]ravel) tS -t 2 — t2- 3(,. 5/e DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture I Soil Color Soil Other Surface(in.), (USDA) (Munsell); Y 1 :Mottling +'(Structure,Stones Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. O It r r `-' DEEP OBSERVATION HOLE LOG Hole# Depth from "; Soil Horizon 'Soil Texture Soil Color Soil Other Surface(in.), (USDA) (Munsell) Mottling (Structure,Slopes;Boulders. Consistency. Flood Insurance.Rate Map: Above 500 year flood boundary No�� Yes— Within 500 year boundary No_ Yes ' Within 100 year flood boundary No..✓ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for"the soil'absorptibn system? Yes If not,what is the depth of naturally occurring pervious material? ,.. Certification I certify that on (date)I have passed the soil evaluatonexamination approved by the � De p artment of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and perience described in 3 10 CMR 15.017. Signature- Date 2-5-13 Q:45.EP11MERCF0RM.DOC Town of Barnstable Regulatory Services Thomas F.Geller,Director SA� Public Health Division y1;!1 Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790.6304 Date: 2-1-i 3 Sewage Permit# 7-0�3 " 0 y y Assessor's Map/Parcel I l(o 9 Installer&Designer Certification Form Designer: S G E��tneec t n�j , ?'h G. Installer: Ga(�ewtde. r�ket�c(szS Address: 18.54 cconbecrY 14!tiWg Address: C-oSA uJrz(6lr H.A 01638 ��--s4a-. �h n ,08•Z�3-0377 On 2 / 3 C 6%k "z t� « was issued a permit to install a (date) (install r) septic system at 269 we,5�- 241 R o r d based on a design drawn by (address) G E n 9ir�cuing ,Yhc- dated FebNerY 5 , 2 a�3 (designer) �I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e, greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if required) ected and the soils were found satisfactory. - SH� JOHN L. CHURCHILL �a JR. o k ' tune) ivtL 41 P,0 ignature �A tx De gn Here P ,ASE RETURN TO ARNSTABLE PUBLIC HEAL DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTAB E PUBLIC HEALTH DIVISION, THANK YOU. ciAoffice fomnsldesisnerwrtification form.doe n Town of Barnstable Barnstable V HKE Teti Regulatory Services Department ;""ac I 9 llAAitNS'rABLE. MASS. p Public Health Division �m 0 �p &639. �m 'EOMA�> 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7008 3230 0002 5178 2787 December 14, 2012 Ms. Mary J. Abel 41 Coach Road Glastonbury, CT 06033 The septic system located at 269 West Bay Road, OSterville, MA was last inspected on 11/27/2012 by James D. Sears, a certified septic inspector for the State of Massachusetts. The Health Division has.determined that the system ".Fails"-under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) C The System is in hydraulic failure. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH o an, S. CHO Agent of the Board of Health I Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\269 West Bay Rd.Dec2012.doc Parcel Detail http:Hissgl2/intranet/propdata/ParcelDetail.aspx?ID=6685 -7777 t ., „» YMwnArMA � Logged In As: Wednesday, December 12 Parcel Det}ail 2012 Parcel Lookup Parcel Info r Parcel ID 116-109 I Develope LOT 2 . Location 269 WEST BAY ROAD. I Phi Frontage .. Sec Road : SecFrontage village OSTERVILLE I Fire District C-O-MM Town sewer exists at this address No I Road Index 1808 r44, Asbuilt Septic Scan: Interactive C,,, i ,; i T. 116109_1 - Owner Info Owner ABEL , MARY J Co-Owner Streets 41 COACH RD Street2 L' City GLASTONBURY I State CT zip 06033 Country Land Info Acres 0.27 Use Single Fam MDL-01 I zoning RC Nghbd 0116 Topography Level I Road'Paved Utilities Septic,Gas,Public Water I, Location Construction Info Permit History Issue Date Purpose Permit# Amount. Insp Date`. Comments 11/01/1994 B37207 $6,000 01/15/1995 00:00:00 oS FAMROO 06/01/1981 B23192 $0 01/15/1982 00:00:00 OS DECK 10/01/1979 B21772 $0' 01/15/1980 00:00:00 OS REMODE Visit History Date who' Purpose 10/24/2006 00:00:00 Paul Talbot Cyclical Inspection 03/01/2004 00:00:00 Paul Talbot Meas/Est 09/24/2003 00:00:00 Paul Talbot Meas/Est 06/04/2001 00:00:00 SM Meas/Listed-Interior Access 11/22/2000 00:00:00 John Greene Cycl Insp Comp http://issg12/intranet/prOpdata/ParcelDetail.aspx?ID=6685 12/12/2012 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 269 West Bay Rd. Property Address Mary Abel Owner Owner's Name information is Osterville MA 02655 11 27-12 required for every page. Cityfrown 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 and of the form. ImportflIEN Out ffns n A. General Information ..N�t`"""""'� £firing out farms "v'� ��LZt1 OF&4 iii��i on the computer, I '-Y `����cp.• s -, .use only the tabInspector / I �2 key to move your 1. 3��.` JAMES :m cursor-donor _� R use the return James D. Sears SEAS —�i key. Name of Inspector =,k Capewide Enterprises LLC %��•°FR F���:o� Company Name 6 INS P�'�80': 153 Commercial St. _ � Company Address Mashpee MA 02649 City/rown State Tip Code 508-477-8877 S1623 Telephone Number License Number B. Certification certify that 1 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. )am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CM 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 11-28-12 �pectors Signature Date ' The system inspector shall submit a copy of this inspection report to the Approving Authority x4oard of Health or DEP)within 30 days of completing this inspection. If the system is a shared syste.0l 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. report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. d 65 151n5.1 S/1 o Title 5 DQaal trrspetllon Fortrc Subsurface Sewage Oisposal System-Pagel of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 269 West Say Rd. Property Address Mary Abel Owner ovdner's Name informrequired tion is Osterville MA 02655 11-27-12 required far every page. Cityrrown state Zip Code Date of Inspection B. Certification (cost.) 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: B) System Conditionally Passes: ❑ One or more system components as described in the"Condifionai 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 extiltration 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): !Sins•t 1 r10 T+ue 5 Ometo tnveai n Form:Subsurfeoe sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 269 West Bay Rd. Property Address Mary Abel Owner Owners dame ii etion is required for every Osterville MA 02656 11-27-12 page. Cityrrown State Zip Code Date of Inspection B. Certification (cost.) B) System Conditionally Passes(cunt.): ❑ 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 t5ina-11110 Titte 5 OMW Inspection Fmw..Subsurface Sewage Dispoael System-Page 3 of:7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 269 West Bay Rd. Property Address Mary Abel Owner Owner's Name information is required for every Osterville MA 02656 11-27-12 per. CityfTown 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. ❑ 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: 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 ❑ IE 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 imawl is less than 6"below invert or available volume is less than %day flow t5ln3-1111 o Title 6 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 ` 269 West Bay Rd Property Address Mary Abel - -- Owner Owner's Name information is osterville MA 02655 11-27-12 required for 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: ❑ JZ 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 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 ❑ ❑ 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. 151ns•11110 T111e 5 official MspeeBon Famr.Subsuftcs Sewage Disposal System•Pape 5 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 269 West Bay Rd Property Address Mary Abel -- Owner owner's Name information is required for every psterville MA 02655 11-27-12 page Cdylrown State Zip code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following; Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break our ® ❑ 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)1310 CMR 15.302(5)] D. System Information' Residential Flow Conditions: NA Number of bedrooms(design): Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 15ins• 1l10 Title 5 Officlet trspedon Form:Subsurface Sewage Disposal System•Page 6 of 17 ...,, �.. �......,ter Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 269 West Bay Rd. Property Address Mary Abel Owner Owner's Name information is osterville MA 02655 11-27-12 required for every page CitylTov+rl State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal Precast Tank and 4'pit Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [f yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 2010-84,000Gal 2011-112,000GaI s Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA p �� 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, W available: 151ns-i 1n o Title 5 OMW Mspedw Fom[SubsWsce Se"pe Disposal System•Page 7 of 1 T Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 269 West Say Rd Property Address Mary Abel Owner Owner's Name information is Osterville MA 02655 11-27-12 requited for eery page. City/Town state Zip Code Date of In D. System Information (cunt.) Last date of occupancy/use: 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 DEP approval. ❑ Other(describe): t 7ir�s•11 M U PRO 5 orflaal Inspection Form:SuostMaoe Sewage owposd system•Pepe a of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fo.ft Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 269 West Bay Rd. Property Address Mary Abel Owner owners Name Information is required for every Osterville MA 02655 11-27-12 page. Cityrrown State Zip Code Date of Inspedlon D. System Information (cont.) Approximate age of all components,date installed(if known)and source of information: 1980 Permit # 22-80 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 38"feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting,evidence of leakage, etc.): Pipeing is 4" PVC SCH 40 Septic Tank(locate on site plan): Depth below grade: 29"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 Gal Precast Sludge depth: 2" t5 ns-1 ono Title 5 Oftel Irtspeeftoi Forrrr Subsurface Sewage Disposal System-Pepe 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 269 West Bay Rd. Property Address Mary Abel Owner pwner's Name information is required for every Osterville MA 02655 11-27-12 page. City/Town state Zip Code' Date of Inspection D. System Information (cont.) Septic Tank(cunt) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 1z' Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Asbuilt-TapeSludge 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 and outlet cover at 29" below grade wlinlet cover at 16", Tank at working level wl inlet tee, outlet baffle 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 t5ins-11/10 Title 5 Offidal Inspection Form:Subuxfece Sewage Oisrosa!Sotem•Page 10 of 17 C Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 269 West Bay Rd. Property Address Mary Abel Owner Owner's Name information is O required for every sterville MA 02655 11-27-12 page. Cityr 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.): n 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 Wns-11110 Title 5 OfRkisl Inspection Form:Subsurfece Sawage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 269 West Bay Rd. Property Address Mary Abel owner Owners Name information is Osterville MA 02655 11-27-12 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(it present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): 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.): SoN.Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15ma•I�NO TRIO 5 Official Insp ection Disposed srslam-Page 72 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form UMT Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 269 West Bay Rd. Property Address Mary Abel Owner Owner's Name information is Osterville MA 02655 11-27-12 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Type: ® leaching pits number. 1 ❑ leaching chambers number. ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology. Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Leaching is one 4' precast pit, Pit at 58" Below grade w/cover at 2T , Pit is full, not leaching, Need to replace leaching_ 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 tins.11110 TNIe 5 Dlfldel InspeWon Ftum:Subsurface Sewage Disposat System•Page 13 d 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 269 West Bay Rd. Property Address Mary Abel Owner Owner's Name information is re uited for every Osterville MA 02655 11-27-12 page. Cityfrown 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.): t51rro 1111 D 71119 5 Official Inspection Forth:Sutuurfece Sewage Disposal System-Pape 14 of 17 r• Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 269 West Bay Rd. Property Address Mary Abel Owner Owner's Name information is required for every Osterville MA 02655 11-27-12 page. C4frown State Zip Code Date of Inspection D. System information (cons.) 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 0 A B . A t MIS-111110 Idle 5 Officfer Inspedion Form.Subsurface Sewage 04osM System-page 15 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 269 West Bay Rd. Property Address Mary Abel Owner Owner's Name information is Osterville MA 02655 11-27-12 reQUlred for every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 0 Estimated depth to h ground water. 12' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked,date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Auger 12'No G.W. Auger Tbelow bottom of pit Before filing this Inspection Report, please see Report Completeness Checklist on next page. ulna-t too rule 5 omal trupecdon Forth:Subudaoe Sewego obposal System•Page'18 of 17 Commonwealth of Massachusetts v Title 5 official Inspection Form �+ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 269 West Bay Rd. Property Address Mary Abel Owner Owner's Name y information is osterville MA 02655 11-27-12 required for every page. CRyrrown 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 rile F i y t5ins-11110 Title 5 Orfidel 1lspedJon Form:Subsurface Sewage olsposal System•Page 17 of 17 ` , — ^ ,.',-,,-'-,7,;.�,"��",:�.,:,.,-.�I-....��)':,I,,-,,�._,"-,.1I IIt'_--.,X"I,;1,Y".,�1,,,-,vI—.,,�-""-�,�I"-."-,.v-,,�_.,;'_�,..,��_."-.,,,7`-__,,,.1;.,,�-..n,-���-1-�;,1"�,, ,4 �,�.,,-I14,.7�,,\1�I'"I-,�,.,,-�_�-�,-^^D9I.�.,,-,I�I,-,.���-,".._,"�;-,.,-.�l,I,,_�,",,-�..,,"!',.e,,I�.�.�-_�_."—I,%��_.,�-.",.:,.:.�,.'.--,_��,I�,�,;I-,,'-"I,,1_,..�.,`.I"-,�.i1I-""-.,._,'.,-.__-�.,,-_�:-,_1"".�',—I._�,_1.',��,,-,�.,).,,�-��?:�,I,-"I ki-,.*"'�.'�..-,-�.��".I,�,,�'._,�,.,;_�.i_i.f-(..*"�-,�,,,"�-�,,,.,---�1��",-f-.;;,\"4 I�.,,'I.,;,1".;-.�,�"e.:�I�7,'-",T-I"--4-..,.J,�",--1�,,._..Z-I"�.,`.:.,._...;.-�1,,,.-�,��.-,�., Ii ` f Y y f + �. , -ram--�r.• , t 1. '+ t. 4i I � J t . ICI q ^.!.- �, ... ++.Y..,a r .;,wt ` r:, r {Y -j "� . I 4 jI 1 ' r 4,,^ " ✓ 1`'." t " +5 F � -.v,.,v a. , r t. _ r r ,. ...t r ``y-^1' , y4, 11 9 ';5 'S Y c + r y s.,. sN � r t Y { i4 , ,�. 4 9 j �, E A S 4,S` !. A z..^ * -M1e 4).,v .`ter ..", Vie.' J "; �i ... 'y L Septic System,Inspect�on Report � {' `` p 1� �,m rs� pv � f ti '.. .T'1 ^7t y .:><"x{ t",� V,, .Jr S" YY _•'"` SM'Ci �� � ), r r=Z•. to °� ;� , 44 ` 269 West Bay Road ,' t,- }: �` 4 13 , -;, �>$ `Ntervflk,Massachusetts:i *, t �- p' % i,4 - w u t t I • y ri . .y. % '"; A S ,. .. f.7 >°�s ° t : .Y .r-. ,,,,. �' ^r ;.., fir! It` ,^ .� ��' I ✓ r' '� 1 20�3 x J, 'S , x } s ' ` "� ,• 7i. November &2003" u, kTOWN,OF aARN' ae [<k NEA J ST �E = 1 t 4 ` ,� .' r` 1, if:.; r . , yl - ✓ e w i- . s � °�° � r 11 -, � t , ;! a S- r1 .M1 .. w w r + - �'+ 'e„*'' u. 11 g: ° F h R-+k•++ .s +ia i w,:.J f s T } f .- Prepared�jFor. , V i _t ^."-. ; '. •S` ,1 f - :' 4' t_ .P.a."'' ! 4 +w,:,:d f°' t T:.fie'°-`�-1308 Y d� r :C as 4 i.. E r. I _ - .�, { t _ 4.. ._... ...,-,..e..;e.,,,ti .,�3 t'. Y r - - {}} ,. �P- t , r .� �° r i JohrirLamere' ° ,� ° ddV� . `4 -> ^ t� 269.West Bay Road - � '� ._ �` '+ , ' Osterville;Massachusetts 02655 t'' ,M :MAP- :_ ' -, ,�,,` , _ :' r .f }, i xy R s" 4 d`'i �[;' Tel`\S_ .\ (;,AR t� , 4 CEL-� � s d t 1 ;, r �3 y .�.t �: , } ,+ q ,1 s, ,.I c a r. Pe`• .N I :,r V yr` y S C� ./ ✓""-.'r` an.e,,.. - . 1 P'� S 'Y F r 44 } /.. J; t."�.6�f; `• `: 4t i 9C.. gkri•,�' 'tt } +' It �. ,. , , y s f. a 'F, ,t , P'!, m J .. �,� 1 ` d l ` , .— t ( >< f t ' r r. 4 w , ;Y _ e� 1 , ,,J 'i P r ~h S h S i Sr ,.F T. J 1 > .Z t ; �, 1 y ,1 j 4. �'} y j'' l' } r } . y .:.v S SIB '". t ,;,° r .,been 11 ' °y Pro'vidingfInnovative Solutions For ' . , 4 � t } .OJT �� irr - , r ;t t c.",r "' , r`" f f r " _ Solid_Waste"` <_ s` �� Health& Safety r L'�,. : ��, g fHazardous'Waste r v I :_g� Environmental Monitoring; 1rO 11 e. : P Materials-Management _ ' Compliance Outs,-rc I ', • t d " I ' ., - - a ,,j' y .a' r o. t w • ww greensealenvirorimental com y - 4 5 Phone* (508) 888-6034 M t ' _ ,. rv, Fax (508) 888=1506,`� 28-Route 6A, Sandwich, MA'02563 r ;k , G f. ?• 1 .. ''.. 1 p d ) f -f" + •`i r V ., `i r � 6 Y - , ., .1 ,.. S.. , ., Y COMMONWEALTH OF MASSACHUSETTS z w EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS"' a AL PROTECTION DEPARTMENT OF ENVIRONMENT 1 F - e TITLE 5 ' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 269 West Bay Road,Osterville Owner's Name: John Lamere Owner's Address: Same as above Date of Inspection: November 14,2003 Name of Inspector: (please print) Terry F.Bauer Company Name: Green Seal Environmental,Inc. Mailing Address: 28 Route 6A - Sandwich,Massachusetts '02563 ' Telephone Number: (508)888-6034 CERTIFICATION STATEMENT " I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ' X Passes Conditionally Passes z Needs Further Evaluation by the Local,Approving Authority Fails Inspector's Signatu e: Date: November 18, 2003 The system inspector shall submit a c of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments: In the opinion of the inspector, the septic system appeared to be in good working condition on the day of inspection. However, pumping is also recommended at this time due to the amount of scum and sludge in the septic tank. Please note that the high groundwater elevation is an estimate only based on Town of Barnstable GIS information. ****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 age 2 of 11 ' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART A CERTIFICATION (continued) " Property Address: 269 West Bay Road,Osterville ' Owner: John Lamere Date of Inspection: November 14,2003 Inspection Summary: Check A,B,C,D or.E/ALWAYS complete all of Section D A. System Passes: p . X I have not found any information which indicates that any of the failure criteria described in 310 CUR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A One or more system components as described in the"Conditional Pass"section need to be replaced or, repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the ' existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health):. broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times'a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced " obstruction is removed ; ND explain: Page 3 of 11 ' OFFICIAL INSPECTION FORM,NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 269 West Bay Road,Osterville ' ' Owner: John Lamere Date of Inspection: November 14,2003 C. Further Evaluation is Required by the Board of Health: N/A y Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment, _ 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply: The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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: ` Page 4 of 11 i r . OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 269 West Bay Road,Osterville Owner: John Lamere Date of Inspection: November 14,2003 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: ' Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or ' - clogged SAS or cesspool }X -Static liquid level-in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than%2 day flow �. X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. _ X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface ' water supply. _ X Any portion of a cesspool or privy is within a Zone I of a public well. _ X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia - nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] No (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to .F determine what will be necessary to correct the failure. E. Large Systems. N/A To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped AZone II of a public water supply well , If you have answered"yes"to any question in Section E the stem 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. f Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART B CHECKLIST Property Address: 269 West Bay Road,Osterville Owner: John Lamere Date of Inspection: November 14,2003 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health(None Avanabte) X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ' X _ Was the facility or dwelling inspected for signs of sewage back up? t AR X _ Was the site inspected for signs of break out? , X — Were all system components,excluding the SAS,located on site? X _ 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? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? 1 The size and location of the Soil Absorption System(SAS)on the site has been determined based on: R Yes No ' X _ Existing information.For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C.is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)l R 1 - u Page 6 of 11 ' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C SYSTEM INFORMATION Property Address: 269 West Bay Road,Osterville Owner: John Lamere Date of Inspection: November 14,2003 ' FLOW CONDITIONS RESIDENTIAL 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): 110 gpd x 3 bedrooms= 330 gpd(392.7 gpd provided). Number of current residents: 1 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No, [if yes separate inspection required] Laundry system inspected(yes or no): N/A Seasonal use: (yes or no): No Water meter readings,if available(last 2 years usage(gpd): 2001—68K gals(186 gpd), ' 2002—61K gals(167 gad) Sump pump(yes or no): No Last date of occupancy: Presently occupied. - ' COMMERCIALANDUSTRIAL N/A Tv pe of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sq ft,etc.): 4 Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):— Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: } Last date of occupancy/use: ' OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: No records available Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM =Septic tank,distribution box,soil absorption system Single cesspool _Overflow cesspool —Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ' —Tight tank —Attach a copy of the DEP approval X Other(describe): Septic tank and SAS. No distribution box present. I ' Approximate age of all components,date installed(if known)and source of information: According to Health Department records,the septic system was installed in 1980 and is therefore approximately 23 years old. Page 7 of 11 OFFICIAL INSPECTION FORM—SNOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C SYSTEM INFORMATION(continued) Property Address: 269 West Bay Road,Osterville Owner: John Lamere Date of Inspection: November 14,2003 ' BUILDING SEWER(locate on site plan) Depth below grade: 12" Materials of construction: cast iron X 40 PVC other(explain): 1 Distance from private water supply well or suction line: N/A Comments(on condition of joints,venting,evidence of leakage,etc.): No evidence of leakage,all joints appear to be in good condition on the day of inspection. tSEPTIC TANK: X (locate on site plan) Depth below grade: 2'3" Material of construction: X concrete_metal_fiberglass___polyethylene _other(eaplain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of ' certificate) Dimensions: 10' x 5'x 4' Sludge depth: S" Distance from top of sludge to bottom of outlet tee or baffle: 3' „ ' Scum thickness: 12" Distance from top of scum to top of outlet tee or baffle: 2" Distance from bottom of scum to bottom of outlet tee or baffle: 14" How were dimensions determined: Direct measurement , Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Inlet baffle and outlet tees in good condition. No signs of leakage,liquid level at outlet invert. Pumping ' recommended due to the amount of scum and sludge. . GREASE TRAP: N/A (locate on site plan) Depth below grade: Material of construction: _concrete_metal fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 269 West Bay Road,Osterville Owner: John Lamere Date of Inspection: November 14,2003 ' TIGHT or HOLDING TANK: N/A (tank must be pumped of time of inspection)(locate on site plan)- Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: ' Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no), ' Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: N/A (if present must be opened)(locate on site plan) , Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of ' leakage into or out of box,etc.): PUMP CHAMBER: N/A (locate on site plan) ' Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 ~ OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ; Property Address: 269 West Bay Road,Osterville Owner: John Lamere Date of Inspection: November 14,2003 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) i If SAS not located explain why: Type X leaching pits, number: 1 leaching pit[4' deep x 6'diameter with 2'of stone all around(assumed)] leaching chambers,number: ' 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 hydraulic failure. No ponding. No lush vegetation. Soil not saturated. ' CESSPOOLS: N/A (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: ' Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): ' Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): ' ' PRIVY: N/A (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): I Page 10 of 11 ' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 269 West Bay Road,OsterviRe Owner: John Lamere Date of Inspection: November 14,2003 ' SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or ' benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. t1 , ' Please see attached sketchs 1 y t C' Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ` PART C SYSTEM INFORMATION(continued) Property Address: 269 West Bay Road,Osterville Owner: John Lamere Date of Inspection: November 14,2003 ' SITE EXAM Slope: Mostly flat in SAS area Surface water: West Bay approximately 850 feet to southwest,North Bay approximately 850 feet to west Check cellar: No water ' Shallow wells: None in site area Estimated depth to ground water 11.6 feet(below the ground surface at the SAS) Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: ' Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) X Accessed USGS database-explain: You must describe how you established the high ground water elevation: Record high groundwater was determined by comparing Barnstable GIS surface elevation data to USGS/Cape Cod Commission groundwater data. The bottom of the SAS(leach pit)was measured to be approximately 8.67'below the surface. Using the Cape Cod Commission method to estimate the record high groundwater elevation,the site was found to be within the area of groundwater indicator well MIW - 29 (Zone A). According to the June 1992 groundwater adjustment data from the Cape Cod Commission web site,the adjustment for that well to reach the record high groundwater elevation is 1.8'upwards. The surface elevation was recorded by the Barnstable GIS Department to be 13.6 in close proximity to the SAS. The groundwater elevation was estimated from GIS information collected in June 1992.to at elevation 2 [this elevation was interpolated from sea level at West Bay(elevation 0)to the nearest recorded contour line to the east of the site on the GIS map(elevation 5)]. When subtracted from the ground surface elevation(13.6 ' -2)the resultant separation is 11.61. , The depth to the bottom of the SAS (8.67') was then subtracted from the separation between groundwater and the surface (11.6' —8.67') resulting in a separation of 2.93' between the SAS bottom and groundwater. Finally,the water level adjustment for the indicator well was subtracted from the separation between the SAS bottom and ground waster(1.8'—2.93)resulting in a 1.13' separation between record high groundwater and the SAS bottom. Please note that these calculations are estimates only from published information and the measurement to the SAS bottom collected on the day of inspection. 4 1 1 Lxus MAP & SeeiIc Svsiem SiceTcx 1 1 1 1 ;,4 S� • ss 9 1� , ...�,�a 4 m, '": .Gran eery tt • / f IC o 0 o v ra 4 �``\• ah { mpg 1 �48 k `�• # �' � �'- ,ro ii is ct .,,,,.. s��, �';: ,../ � � mot' ' �y ..,�....- , n rry ���a•a 0 r' ff4 ? Fg. t. a �? iiq-. tom, ����5 �,.✓.- �, " �� .r l � �+,�,,�. �S9 '. ���'' t�t.S�• .�„ � ,y,+,•� � � r; _�° I ,t �sr. r . . 4 '•. , �' .gyp-' G�rnrwber ;�� �•� ��'�\ C , a •✓ !` 1] 1 • 4 "l1 1, C,.,, 7 `� Q�"� fl�. �L � . g C�yA +• - 5fia y `a : i- rr mP '., `` � k t� 9i!.,. .J � � �s�,�ya�,° ,.',,•� •'V�fi'��� •a���.. �, �� r�.r � '4,. 1"j'�. cry i ,Q� � i Q i3t 'wry c �gRg a L o AM k .� 4Qr �� ��,. OSF• gr Ito (L 141 ,t ort7� ��JS �3.. �. le nnA u r .s.. } •{ f:t • ,b1+. ?` "y_ J r, .$ ''i.1 � e -fim � ° � :�.�•� .:3�� \. ' ;s,..3 � t. w.-� `^..r9 a; - !f ''`�' . f'.mac ? `a,'�' • TIeP•�. �` a �� 1�. IV -^r�,�b `�,,! • �# j ,ram ` o S. ,• "ti *iy �'"71 _.lygl 2' S- 3.. seacl jr di 6,..,-P,,u !t . � .. b'" a ' � •gyp q 2• } t'• t . ,•���,;�� , a5 7 +ice �� N� .�,R,�� �� y, .�,r+ ,.r♦ i° ` ;~ 3v. AQ� 'a ;� `:� �' q 0,f®�ae�,.� -j '�l ,��� _ .• �4A4®111�'E�4 •® + Qa '" y�� v�n, .mac' to o ., •: ' �,� ' 16o W a .. '+�a.,x,, .+: rip -/A� • ♦ •y J Name:COTUff Location: 0410 38'20.2" N 070°23'33.0" W Date: 11/18/2003 Caption: Locus Map Scale: 1 inch equals 2000 feet 269 West Bay Road Ostenrille,MA ' Copyright(C)1997,Maptech,Inc. Septic System Sketch I Notes: The septic tank inlet riser is 1.5' ' down from the ground surface. The SAS riser is 2' down from the ground surface #269 0 . Septic Lm Tank — --- ► �1 1 Irrigation LV Line 1 West Bay Road Cross Section Ground Surface 2.25' 4.1 y, 1 . Septic Tank n • t. SAS. Foundation Estimated High Groundwater T 1.13' NVIA P1 Location: 269 West Bay Road" F1gl1I'e 2 Osterville, MA Not To Scale -_ Date: November 14 2003 ' Based on Visual Observations No. .. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Q.------.... .. .[ ,�1.oF... � �L l.0 J .................................... Allp iration for Dispooa1 Works Tontaurtion Verntit Application is hereby made for a Permit to Construct ( ) or Repair (A an Individual Sewage Disposal Systemat: '.....s�`.'1. ?. .., 1 .)B ..RL2�e j........... ....................••---•----•--...-------- -•-• --•-••--------...................•----......_. or Lot No. Add p__,. ' a.L° '" . r �a- . .................. 1a1.1'.� ... ............................................ Owner ddress Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria P-4 Other fixtures -- ._...-••••--•--••-----•• . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--_---------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 4 Percolation Test Results Performed by................ ......................................................... Date........................................ aTest Pit No. 1________________minutes per inch Depth of Test Pit............_....... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test,Pit.................... Depth to ground water........................ P4 ••-•••• ------... - ------------------•---.. ODescription of Soil...............-��� (1 --•--------------------------------------.....------••------.------•--....._.. x W •---•••••••-----------------••----••--•••---•-•••-•-----------•-•-•-----•-•--••-•-•----•----;----•----------------=---------- ••-•--------•...-------- UNature of Repairs or Alterations—Answer when applicable--____J.=1.00..-_r4.W.J .__ -"..�_=�� R1. . ...-----•------------•-•........................•-------•---------------------------....................----....--------------------•-------•-------------------------------................._..-------• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI':I.. , 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee sued by the board of 1 alth, Signed �i ........: .. 'fie ..... C-%...`d C ---- Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons---- ----------------------------------------------------------•----------------------------------------......... ....-•-•-•-----------------------------------•--•--------------•-•-...........------------•-----.........-----•--------------••-------•-----------•-...-----•------------••-----•-----------.......----- yy Date Permit No. .... Issued.... � --'- � - Date r THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A , m / IL DATA 4 A— 416 F�s... .........f--...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Applirattiun for Disposal Workg Tunitrurtiun runtit Application is hereby made for a Permit to Construct ( ) or Repair ( ' ) an Individual Sewage Disposal System at: ... .... - •• ....... -•••••......•-----•............. ........•-- -•........-----••........•--•-...---•- �-� Locatipn Address •. _ _}''' / or Lot No. -•---• r. 4...,, ................•. :--.... ................................................... .................._..........................................._...................... Owner Address -.• W •--h- ,/ // i !! _ ,. l_la...r If Installer Address Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms................................._..........Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ..---_..__-•-•• -•••-••-••••••••••-=--••••--•-•-•••..............•-••••••••-••-•-•••-------••--._..._.--•-••......... .....__...._........... W Design'"Flo .:•.___________________________ ............. per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ W I x Disposal Trench—No_____________________ Width.................... Total Length......._............ Total leaching area....................sq. ft. Seepage'Pit`.1NO..............___.... Diameter............._...... Depth below inlet.................:.. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ (z, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ri •••-----••-------------------...... --+......_-_..--- ---......_._..----.....-----•--......---............ ODescription of Soil........................... ..:_-•-•'-•---•.. '•l p..:............•---•••------•--•-•___-•--•--••......----•----...._...........-•-••-••••.............•.••... x V .......................-•••-•--------------••--••-....••--•••••-•-._.._............_...........--•--•--•.....----•-----••-•___._--••----•----••-.....--•-•-••-•.....•-•.........-••---•-•-••--••••...... UW -"-•----•"--•----•-•---•-- •-•----------------•-•---•-"•--•---•-"...----•----•--•-••-•----•------...-------•----•----.._..------------......--••-- -••-•-•------.............................. Nature of Repairs or Alterations—Answer when applicable_____ ..�...'.....'__.._.___f_ . '/�� ___...__.....'__ft__f__... -•••-•---•-••••-•••--••-••----•--...••-•••...............•••-•-••....----•---•-•••.................-•-•--•-••-•--••--------___.____••-•--••._....•--•-••-••••••••••••••--•-•........__...........-•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of LITL_ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until.a Certificate of Compliance has been--issued by the board of health. Signed--- = y--� r .......................... Date ApplicationApproved By.................................................................................................. ......................................... Date Application Disapproved for the following reasons:----••------------------"--••--------------------"----------•---------•---------•--------- ._......._.... Date ......----••-•-•...........•-•--•... Issued.... ... Permit No..................... ^,1�—' i •..............^ . --•--•---- Date +rk 4 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF........1.... `..J-I.1 .......1 1..:.....%...:::....................__... &rtifiratr of Tautplinnrr THIS IS TO'CERTIFY, That the Individual Sewage Disposal System-constructed ( ) or Repaired (�) by.............••••.\ ........r.... ........... ' .................................................`- ._... Installer - atat f C/ f / t f . ----------•----•............. .........................•..........................._.................................................................................................... - has been installed in accordance with the provisions of TIe 5 of The State Sanitary C cd a desc ib d in the � _ f�application for Disposal Works Construction Permit No.___ _ __ ._a_ __...__. datedy..!_'_-� � - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WIL FUNC ION SATISFACTORY. DATE.........., ............. Inspector......... = .......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C✓' ,Z �r `OF..--.P!M -. /�_:>-�_ .._...... No......................... 1.. FEs ,-�........................ Disposal VorkvrTunstrudiun randit .. Permission is herebygranted....____. !___.__f, l{c_ Lc < '�_r:____------....^..� r................................................... to Construct ( ) or Repair � X) an,Individual Sewage Disposal System, -7�— at No._. ! !_. J l J�_ •--- F' !'_/.....l JC -•----`` '— =! �'J 1``:}11 `!` .....-/ M / Street ) J} W as shown on the application for Disposal Works Construction P r t No Dated....... _/_...___.__.G_/_______________±... •-- ---------•-----•--......f Aealth` ---------••-----•--------- . Board o DATE...... .................................................. FORM 1255 HOBBS & WARREN INC. PUBLISHERS Y1 4 ..? ?..�1 Fss. .-.../...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �l Y .0-K)AY..............OF....... Appliration for Disposal Works Cnnnstra lion rrutit Application is hereby made for a Permit to Construct or Repair Tan Individual pp y ( ) p ( ) - Sewage Disposal Syston at: -3.44 lie .................................................................••-------------............-•---- Lac 'on-Address � or No. � ner -------------------------------- -►.akTLddress ................................................... Installer Address dType of Building ? Size Lot----------------------------Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (Ally) aOther—Type of Building ............................ No. of persons--•-•____-__-:__.___•__--___ Showers ( ) — Cafeteria ( ) f-4 Other fixtures ........................................ -------------- ------------------------------------------------- •------ •-•-•---------.._......... . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank?Z Liquid capacityl%n..gallons Length................ Width................ Diameter_.._--_-_-___-_- Depth................ x Disposal Trench—No..................... Width.................... Total Length.............V Total leaching area....................sq. ft. Seepage Pit No......,/--__-____-- Diameter..S..:.......... Depth below inlet....._6........... Total leaching areaoW._.0-_.-sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by......................................................................••. Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' ---------------- -•----------------------------------------------------- ODescription of Soil.............................................................................................................................................. x W •-•••--•-•--------•..............•-------•-••••-•-••-•••--•--------••--•••----••••--••---•••••--•••-------•-•---•-• - U Nature of Rep irs or Alteration An wer when applicable._..-- ______ __._ .�i__ _-____ g The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' s Dd by the boar of hPalth. �d Signed . ----- --- •........ .... .... ...... ;�'" /7 Q - --_------- -- •-•--••- Da Application Approved By--••--•---� . . --•--•-• -•-- •-• � ------.. Date---------7 Application Disapproved for the following reasons:................................................................................................................ ------------------------------------------------------------•----•-------•-•----•------------•---...-------------------•--------------•----------------------------..._.......---•------•-•-•••--------- Date PermitNo.......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /�/R .r Y..�`.' .J................OF........,- �,4.�2N.. .t.............................. Trdifiratr of fP ompliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (LI'll bye .................................-----•----------•---••-•---•-----••------...-•----•-----------........-----...................--------•-- . Installer r at.- -moo? ..IFS?._..... .47....n—I':-•---......O_SO`'2!/jle/ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as describe in the application for Disposal Works Construction Permit N ...._ _._%._ _ -_.__ ail_._.__._. dated_ ' .'--- _,_...___.._.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ®.> ~.1..!�/...............OF...... /DNS?/R.>�-4-�.................................... 00 No............ 9 .�... FEE--�-=•''-. ..... Disposal Works LTnnsirur#inn rrmii Permission is hereby granted 4 s4R_....__ ,C��- :� -•-----------------...................................................................... to Construct ( ) or Repair (V_f an Individual Sewage Disposal System at No..-L,P _ ........... .......... '...........FID.----------------0.S-;P—e,&L,ellk 4.4 r........------.................. Street as shown on the application for Disposal Works Construction er t � ated.......................................... •• ------- -- ----- -----• • . ..A........................... Boa d of Hea h DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS .'.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �. .. ... ........OF..... A.A.fq..rA. .C..ff........._...---...------------------------ } Applira#iun for Disposal Works (Eons Lion ramit Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal Z.;n t: `+ w { . . - 1-- ' •.............. .......•..-_. ........_.. ...................------------ Loc ion-Address or No. r jner y a (Address a 1�.-, G -c• ............................................................. IB C !" _ ..: . 1-4.................................................. Installer Address Type of Building Size Lot............................Sq. feet g— Expansion Attic'( ) Garbage Grinder (Ate) Dwelling No. of Bedrooms....................................... — Other—Type of Building .............. No. of persons............................ Showers Cafeteria Q4 Other fixtures -------------------------------- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank Liquid capacityt& 9_..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width_.................. Total Length............y...... Total leaching area....................sq. ft. Seepage Pit No.....t�........... Diameter_$---------- Depth below inlet....i6_.._.._._.. Total leaching arej"_._.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) . , Percolation Test Results Performed by------------ ............................................................. Date........... ............................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ pd .................................................................................... ...:..---.--------------- ••-------- •---------------------------------- 0 Description of Soil........................................................................................................................................................................ x fzl ........---•....................................................: __.___._._................_ .. .. s ._ [3�`p . Y U Nature of Repairs or Alteration Aoew An wer when applicable____ t ✓ _ : . :__.. ......: Agreemen . The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been s ed by theW.FrAoflth�^-�a O _.. ems Da e Application Approved BY /Sihgne . ' Date Application Disapproved.:.f or the following reasons:.................•-----••--•--.....-✓✓✓-------------•---•--•-------------------------------------•---------------. --•--•--••-----------------•---------•----•-•----------------•-•-•---•----•------•-•------.....--•--------•---••--------------•-------...•------•-•----------------•--•-----•------••-••----•--....-•--- Date PermitNo:.....................................................•-.. Issued-................................=...................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Jt .> .................OF...... `............................. Trrtifirtttr of To�mplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by :•--- - ..... ',✓ ._........................... ------- = -----------------------------------------------------------------------------------•-•.......-- _ Installer has been installed in accordance with the provisions of T TrF 5 of The State Sanitary Code as describe in the application for Disposal Works Construction Permit II ------..> -------- dated_ -.�" 2-A/..... -7�--------------- PP P s" -,�- � ----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................•-•----•--•-•-•----•--....................--------•--•-•---•---- Ins pector........................................----- ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD .OF .HEALTH 00.. .................OF...... e . : . .................................... No 9. .. FEE._ :.............. Disposal Works TwOns r ion "permit Permission is hereby granted.4.1.4.------ - .4' .......................................................... to Construct ( ) or Repair ,an Individual Sewage Disposal System .� at No.� .. t "'-•----•---- ?-'i�`tiz--------- �" ' ...-•----..' .. "'�" �1. .+ ........... ` ., Street as shown on the application for Disposal Works Construction Per it ated......................................... .. ..•...• . ..... ----------•••.............._ Bo d of Hea9th DATE.............................................................................. } FORM 1255 HOBBS & WARREN, INC., PUBLISHERS ,i' LOCATION SEWAGE PERMIT NO. oK,9 (,L)C 5�- 13, VILLAGE INSTA LER'S NAME i ADDRESS -4:4 e U I l D E R OR OWNER eA/ DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED /� / /_ ©� r Jr 1 r CC k)oa E , iv i 4: Ion 1 5 I�x cz r' F y m - 1.ALL EXTERIOR WALLS SHALL - - - BE 2X6 0 16"O.C.UNLESS OTHERWISE NOTED. A.5 F.=°741_5° ° A.5 2.ALC INTERIOR WALLS SHALL - - - - BE 2X4 @ 16"O.C.UNLESS c- OTHERWISE NOTED. 15'-O' x 7'-01 ' -'� x 35'- _ - x JT-O' - _ - - 3.CONTRACTOR SHALL VERIFY ALL WINDOW ROUGH OPENINGS M , - - PRIOR TO ORDERING WINDOWS. T___ ________ ___-_____-\ -: __���_______PATIO LINE ____- .. 4.CONTRACTOR SHALL VERIFY ', \ - •- - - ALL DIMENSIONS PRIOR TO E . REMOVE EXISTING GARAGE -' - - CONSTRUCTION.CONTRACTOR FOUNDATION WALL!SLAB - ASSUMES RESPONSIBILITY FOR ANY MISSING OR INCORRECT DIMENSIONS NOT BROUGHT TO — — -- —— ——� —-- .TYPICAL NOTES: DESIGNER. ON OF THE - I -- -- r - - - 10'THICK z 4'-B° \I �. BM. - I •„ 'r STRUCTURAL ENGINEER/DESIGNER TO PERFORM FRAMING iN5P5ECTION HENTI _ - CRETE WALL ON I I PKT I - r - C II PROPOSED - WHEN FRAMING IS COMPLETE AND.PRIOR TO ENCLOSURE BY INTERIOR GENERAL NOTES J a _ - E i MA ANCHOR BOLTS O%°O.C. CONTINUOUS FOOTING I CRAWL SPACEI I WALL PLASTER BOARD/FINISH. - ' 1 MINN 7' EI�.77PE MENT CONCRETE FOOTING I. - - , w/3"x3'xl/4 PLATE WASHER. BM. CONTRACTOR SHALL SCHEDULE.AND PROTECT FORM WEATHER ALL EXISTING HOUSE COMPONENTS AND INTERIORS DURING CONSTRUCTION \ i STEP I I I .. _ c AND CONSTRUCT TEMPORARY 5TRUCTURES/ENCL05URE5 AS MAY BE '.NECESSARY TO ENSURE SUCH PROTECTION. 1\I - - ■ ■ ■ ■ _ I I - I CONDITIONS CONTRSHAACTOR TO SITE ANDINSPECT DURNG CONSTRUCTION AND EXISTING PROPOSED OTIFY DESIGNER' L—IIIw-4-3)2z12 DROPPED I I o. OF ANY DESCREPANCIES AND/OR CHANGES THAT MAY BE ENCOUNTERED. CONTS - VERIFY w/GRAD SHORING ETC,TOR STO MAIALL CNTAIWPROTECTONSTRUCT D EXISTING HOUSE AND MAINTAIN TSTRUCTURAL N.NOTES 1Z9/14 TO SLAB T. I I O.MIL VAPDORTREOTVARDER j el EX15TING FOUNDATION ;p III 3-2x8 HDR * _ INTEGRITY OF EXISTING HOUSE. _ WALL TO BE REMOVED I - CONTRACTOR SHALL SITE INSPECT/VERIFY ALL EXISTING VS.PROPOSED NO. REVISION DATE -- - - — 3 I/2"CONIC.FILLED -PROPOSED - O II _. r——1 I. W CONDITIONS PRIOR TO AND DURING CONSTRUCTION AND MAKE ADJUSTMENTS^ j .. _ o )2x11 DROPPEIIIAS NECE55ART TO ENSURE COMPLIANCE WITH DESIGN PARAMETERS AS - COPYRIGHT —- 5TL.LALLY COLUMN CRAWL SPACE ^� - - I I IDN 36'x36'xl2'DP. 1 - I I aW� WORK PROGRESSES. ITS CO EXPRESSLYTHESERVES i < S COMMON AW COPYRIGHT.THESES DROP WALL FOR I o _ CONIC.FOOTING, T7P. ' - : 1 4°z4"x.25" EI �t-K< - PLANSARE NOT TOREREPROWCED BILCO BULKHEAD II L III J I 1 p( tU - CHANGED ORCOPIEDIN ANY FORM ORB'-5". 7'-71 - b'-4° `-° - I TUBESTEEL I. .I d - MANNERVJ WisoEVER WLIHOUiFIRsr ERIFY SIZE / - I I- COLUMN 7 I g°` BASEMENT NOTES:A RADE TO DU5TCAP I - - - OSTAwING THE ExPREss wnmEN L-— —— I 1 r T- 1PERMISSION AND CONSENT OF NORTHSIDEA.5 I . I _ Ir— 1 r——1 Ir 1 II-——-I I I I :I - III I I 'QQ� I.'MAIN FOUNDATION WALLS TO BE 10-POURED CONC.W/20*5 BARS TOP DESIGN ASSOCIATES. , L———— I_ __J _ ———i_ — ——— I III r / Q�3w - !BOTTOM REST FOUNDATION ON 10°X20°STRIP FOOTING. _ — — —— —— ——— =__ „ r 1 - h °QISm PROVIDE 3*RS HORIZ.BARS CONTINUOUS IN STRIP FOOTING W/ ` - - 4'x4"z 25' r I j I-F — - - —— -- ——— —J- �Ir —— J -BR KEYWAY.PROVIDE#5 VERT.DOWELS O 24"O.C.HORIZ. EXTENDED BUILDER: _ ' r ,,7 Welch TUBE STEEL SM.- I 1 L —J L_— L—_J L——J. BM. _ —_ -I_ —�_} --- --- I Q - 3'-6'MIN.ABOVE TOP OF FOOTING.PROVIDE 5/6'ANCHOR - • KCllC1211 yy el('/1 COLUMN I PKT j 3)2z12 DROPPED - PKT — ==- = ■' '" BOLTS O 36-O.C.MAX.MIN 7'EMBEDMENT w/3'x3°xl/4'PLATE WASHER T CONSTRUCTION Inc. EXISTING FOUNDATION 4'x4'x.25' - REMOVE EXISTING GARAGE 3)Zxl2 DROPP I r- / WALL TO BE REMOVED TUBE STEEL FOUNDATION WALL t SLAB 2.ALL STRUCTURAL STEEL COLUMNS TO BE 3 1/2°CONCRETE FILLED LALLT COLUMN UP EX STING - 9 1/2'CONIC.FILLED PT" I... _ .COLUMNS TO EXTEND TO FOOTING BELOW.PROVIDE b'xb'z5/B°.CAP PLATE SaSC MAm SLmet Poe 690 - ' 5TL. LALLT COLUMN I ..t Txl2'x3/4'BASE PLATE W/2 @3/4° D1A.BOLTS.WELD ALL CONNECTIONS O+mrvdlq MA o2655 ' - P-T.4x4 POST I I CRAWL SPACE - ON 36"x36°x12"DP. - I I. - :'FOOTINGS TO BE 36°x36°xl2'SQUARE CONCRETE w/3 ss5 BARS EACH wA7- 50R a28-esoo - ` E - ON 36'z36'z12"DP. I I - CONC.FOOTING, TYP. ,o„pkcnmuooawacn.com - A'7 CONIC. FOOTING b'-5' 10'-101, 9'-O' mI - 3. DOUBLE FLOOR JOISTS UNDER ALL PARALLEL PARTITIONS. ———— J I 3-2x8 HDR I °� ,4.CONCRETE SLAB TO BE 4-POURED CONC.ON COMPACTED FILL. I f r 1 c CUT JOINTS ALONG WALLS AND BEAM COLUMN LINES. DESIGNER: PROVIDE sty KEBABS O -i- 3 1/2'CONC.FILLED I I - - T m IS O. .VERT IN ( - .�—— -� I PROPOSED I 5. CONTRACTOR TO PROVIDE BASEMENT VENTILATION AS - NORTHSIDE .. _ -' r E 12"IN FOUND.WALL 5TL. LALLY COLUMN \14 I I I t I. .ON 36°x36'xl2'DP. CRAWL SPACE I I o - REQUIRED BY CODE(WINDOWS OR MECHANICAL) DESIGN . CONIC.FOOTING, TYP. I 6,CONTRACTOR SHALL ENSURE THAT ALL FOUNDATION WALLS MAINTAIN .1 I —————— yl BM. 'I I 2x12 DROPPED m - r— .1 r——1 BM• IO°THICK x 4'-B° E- I 4'-0'.MINIMUM COVER. ASSOCIATES F f———— PKT - PKT CONCRETE WALL ON \ / L——J I _I_ ___I—_ —_I—_-_—_—_—_—_—_ CONTINUOUS 20's10° I ■ w 7.PROVIDE WEB STIFFENING PLATES AT ENDS OF STEEL BEAMS, TYP DIAINRVERBIDENTIAL&COMMERCWLDESIGN ' EXISTING FOUNDATION CONCRETE FOOTING r - I CONTRACTO SHALL - - ° 191 MAIN STREET'YARMOUTNpORT'MA026T5 t - 8.SEE STRUCTURAL DRAWINGS FOR LOCATIONS OF ALL STRUCTURAL COLUMNS MAINTAIN 48 MINIMUM : c d WALL TO BE REMOVED - I I I I I - FOOTING COVERAGE O——l --J L——J - i:.I I .o,` 9.CONTRACTOR SHALL NOT SCALE DRAWINGS FOR DIMENSIONS. ANY MISSING, '(soe)sszaiLO Isosl sez-ssoz I I I EXISTING 3)2x 12 DROPPED BELOW ———— ——J ) INCORRECT,OR QUESTIONABLE DIMENSIONS NOT BROUGHT TO THE ATTENTION NORTHSIDEDESIGN.COM F I - STEP - - - EXISTING FLOOR JOISTS OF THE DESIGNER BECOME THE RESPONSIBILITY OF THE CONTRACTOR. northsiael@mmcasenel 4"CONC.SLAB ON ap CRAWL SPACE FOR BRIG WALL ABOVE I - 10 MIL VAPOR RETARDER L—— I —-I ' - - ———— ———— FIRST INTENT OF DESIGN IS TO ALIGN NEW FIRST FLOOR SPACES W/EXISTING iv P.T.4n4 P05T I _ - - - FIRST FLOOR. CONTRACTOR DES SHALL ADJUST TOP OF FOUNDATION WALL AS STRUCTURAL ENGINEER: GARAGE SLAB CONIC.FOOTING - - - _ NECESSARY TO ENSURE DESIGN INTENT. -� - - PITCH I/B'PER FOOT PROVIDE a5 REEfARS O _ TAYLOR I I IS Q.C. OERT IN DESIGN ILLC` q -L——J a EXISTING FOUND.WALL 6'-b' 4'-2' 13'-3' 10'O°- '-6" - s5'-2' BACKFILL W/CLEAN - - I ■ COMPAGTED FILL - ": .. - _ _ _ _ - _ . I EX15TING FOUNDATION WALL TO REMAIN ,. .B - - - '°. + STAMP: DEEP EARLY ENTRY '�E I CONTRACTION JOINTS 10'THICK z 4'-B' CONCRETE WALL ON PROVIDE o5 REBARS O CONTINUOUS 20-xIO' 12"O.C.VERT IN EXISTING FOUND.WALL - - EXISTING FOUNDATION CONCRETE FOOTING °'• '-' . � �WALL TO REMAIN , ' PROJECT: - PROPOSED �I _ CAPPELLUCCI ■ I I RESIDENCE 69 WE T BAY IRD x PROP TOP OF WALL I 4. OSTERVILLE, A. L——12 AT DOOR OPENINGS———J - _ - "°' . i ■. i _ - _ - - _ TITLE: --- ---- — ' ' FOUNDA ON PLAN .SCALE:1/4"-1'0" PROJECT#: SHEET '; A.5 14-01 A.0 DATE: OF .- 717/14 x 74'-9° h 1.ALL EXTERIOR WALLS SHALL BE 2X6 @ 16"O.C.UNLESS T-O' x°'u',_V' C x IT-O' _ OTHERWISE NOTED. A.5 2.ALL INTERIOR WALLS SHALL B BE 2X4®16"O.C.UNLESS OTHERWISE NOTED, 3.CONTRACTOR SHALL VERIFY ALL WINDOW ROUGH OPENINGS ' PRIOR TO ORDERING WINDOWS. 4.CONTRACTOR SHALL VERIFY ALL DIMENSIONS PRIOR TO CONSTRUCTION.CONTRACTOR ASSUMES RESPONSIBILITY FOR ANY MISSING OR INCORRECT - DIMENSIONS NOT BROUGHT TO THE ATTENTION OF THE DESIGNER. PROPOSED FwGD 6068 T PATIO - "ADH2638 - - b - GENERAL NOTES 7'-6' 12'-4° 2-ACW2034 - j..+ - t PROPOSED ' FWGD 336 FWGD IIIO68-4WGD 336B5 MASTER BEDROOM RENG NOTES 1219114 , .I PROPOSED KITCHEN PROPOSED 2668 ADH2638 NO. REVISION DATE 15'-0k11'-0- I BARN DR. I DINING ROO I q'_q° Io'-2• coPrwGHT NORTHSIDE HEREBYEXPRESSLYRESEf S ITS COMMON UlW COPYRIGHT.THESES ® E1°i _ PUWBARE NOT TO BEft ANY FOR O IVK-2 I I —— CHANGED OR COPIED W ANY FORMRG 45 A.5 ® 12'SO.COL. - _ I 2-2068 iIl, _ --_-'__-_ MANNER Nrt61TSOEVER WIfHOUi FIRST OBTAOINGTHEE WESNRITTEN PERMISSION AND CONSF1iT aF NORTHSIOE BOXED BEAM _ ml DESIGN ASSOCWTES. _ —_______—_— + 2668 E11r \\LIVING ROOM T i BUILDER: = I I I Kendall Welch 266 BENCH DECK CONSTRUCTION Inc. 1 11 1 I II 8<6C M°iAA FOR 4.7'-8° V-4' 4-0' wv N 11 I I 11 Osillq MA MA 02655 I 508 428-4500 of VLL . I 1� II, ra�kendallwtl.velcE.wm T I I II iL-------- {� DESIGNER: 2-2068 I I I 11 NORTHSIDE m iv �Eo PANTRY `s I I I ADH2O34 i� II u _ _PR _____ �m n I ❑ I 5_D <VI b � ,8II1�_�e�-JI, ___}liIi�_-yJ�I,'�IIJr c_♦ _c_--_--_/TTT(C!WuI mo I c �Re�r PROPOSED �F------IW�IIII nNo0r0.thTiHltlSeID3E@DrDESIGN 12°so.coL. MASTER BAT DINING ROOM III ASSOCIATES T ESLAUND v `=-j DISTIRUNE RESIDENTIAL&COMMERCIAL DESIGN 200 2-2668 M1 MAIN STREET•YARMOIRHPORT'MA 02675 I (508)362-2230 (SO)62LINNE2-2068 e 26E2 In STEP UTILITY RM. PROPOSED LIVING R KITCHEN OPOSERM.0 ADH26ge ADH264B -- DD STORAGE BATH ADH2648 m :1 STRUCTURAL ENGINEER: 2668 L-==-------a1 TAYLORW ` - -11 266E 10' DESIGN LLC O° 6° x 5'-2' t -�' r' 7'-4° 'v 11'-4' 6 ♦ (� II BATH FAMILY ROOM IT --_v�-- F__JL____=___ PROPOSED - - • II II 1'I ILal (`/ STAMP: ` PROPOSED GARAGE 2 ——06_ BEDROOM#2 ADH264B i��0 i r,( p-=i BEDS= m .. L 14'.6'R25'-O � ^' 2-2066 r�I�=� _ _�' II X II Ir=-TI IIF F313� OPEN TO \ ^ 1, JI I_ Ip II ICa r PROPOSED GLGE. .9 ABOVE , W s-14�B eVLIN - LAV. I UP PROPOSED 266E -=s5 !���A�L I FOYER PROJECT: r; r-----------T ADH264B ADH2'I 48 ADH264B ADH264B ADH2648 ADH264� FIRST FLOOR DEMO PLAN PROPOSED I - SCALE:Ile'=1'-0' I I CAPPELLUCCI I I - ' EXISTING AREA RESIDENCE Ist FLOOR LIVING x1360 50. FT. m I I ' - 2nd FLOOR LIVING x480 5O.FT 269 WEST BAY RD. I - - - OSTERVILLE,MA. 9070 2HGD I PROPOSED AREA „ - let FLOOR LIVING 308 50. FT TITLE: 2nd FLOOR LIVING SB2 50. FT. •+ EXISTING GARAGE AREA FIRST FLOOR COVERTED TO LIVING 340 50.FT MTi—AL PROP125LU PLAN 0' V_. 4'41. I'-O' x 5�_2��... x 6'-7° SCALE 1/4.,_1,-0"RAGF AREA RqR FT 0 1 2 4 e a - _ PROJECT#: SHEET _ A B C A.5 NOTE- ALL WINDOWS ARE TO BE WALL KEY 14-01 A.1. ANDERSEN A 5ERIE5 EXISTING WALLS ./APPLIED GRILLES INSIDE AND OUTSIDE WALLS TO BE REMOVED DATE: OF PLYWOOD PANEL AS NEEDED Y - FOR STORM PROTECTION - _ ® PROPOSED WALLS 71-//14 11 Ir B O _ 1.ALL EXTERIOR WALLS SHALL A.5 A.5 BE 2X6 @ 16"O.C.UNLESS OTHERWISE NOTED. 2.ALL INTERIOR WALLS SHALL BE 2X4 @ 16"O.C.UNLESS • - - - - OTHERWISE NOTED. - - 3.CONTRACTOR SHALL VERIFY �• 4 ALL WINDOW ROUGH OPENINGS PRIOR TO ORDERING WINDOWS. 4.CONTRACTOR SHALL VERIFY ALL DIMENSIONS PRIOR TO CONSTRUCTION. CONTRACTOR _ - ASSUMES RESPONSIBILITY FOR ANY MISSING OR INCORRECT 1 - DIMENSIONS NOT BROUGHT TO 1 22'_0" THE ATTENTION OF THE i 35'-4V' I - 1 DESIGNER, 2 34'- I ... .. + - GENERAL NOTES - -------- -- ----- ------ --------- --------- -------- - - r.. I ----------------------- PROPOSED I I I I m 1 ROOF DECK - - ENG NOTES 1219114 o 1 - - NO. REVISION DATE COPYRIGHT 7,-2' ITS COMMON DE l \ ITS COMMON TT COPYRIGHT.THESES - PLANS ARE NOT TO BENREPRODUCED MO A.5 1 r----- _�________� CHANGED OR COPIED IN ANY FORM OR I I MANNERNMATSOERESSIf RITTEN RST OBTAWWG THE EI(PRE$S NRITTEN ADN2640 i PERMISSION AND CONSENT OF NORTHSIDE 1 DESIGN ASSOCIATES. FWGD 6068 FWGD 606E I I m I 1 BUILDER: PROPOSED p - r---------------------= _ Kendall Welch BATH ; CONSTRUCTION InC. 646C M"hA E—POR 4_7y" 1 ` P 2-1668 PROPOSED �. I Oxlerville.MA 02655 B E D ROOM i— S0s 4ze-49.0 26'10' V 13' 721'-S IF------ ---- ------------11 I ro"©k-d.II.d—kh.-. .04 T WA�L PROPOSED ATTIC Ir---------------- iv _J p rr�ag �,r ,1 N : 27'-4'WALL LOFT 266E ACCESS DESIGNER '+ ADN2640 H26 DH264B ADH264B/� '�,L V-4° ' I4'-0" DOOR -- 1j 11 B M II 11 II NORTHSIDE • EDROO ______ __ - 266E J �j LL____,II -------- -- ----' ---- — DESIGN L ASSOCIATES DISTINCTIVE RESIDENTIAL&COMMERCIAL DESIGN n ' PROPOSED i _ I L , - ♦41I I -L�4 M1 MAIN STREET'VARMODTHPORT•MA02675 LOFT II m `y HEQBCdSI 11 15081362.2210 IsDsl36z9- 1 NORTHSIDEDESIGNCOM w } 2-206B II IL IL__]I N— RcrtN.me1@"PmrasL.D"I ADH264B IJI Ir WALL, I Iron _J rL J, �jj STRUCTURAL ENGINEER: ___1-------------------------------------- — -- -----� -------- ADHz64o r 11 TAYLOR ATTIC II II DESIGN LLC ACC ES II II 26'-O°WALL DOOR 26'-0'WALL S6'-0-WALL 26'-O'WALL - ------------------------------------------I - STAMP: SECOND FLOOR DEMO PLAN SCALE:ol 1/8'=1'-R - •. °O * - PROJECT: STORAGE - - - PROPOSED EQUAL, EQUAL- CAPPELLUCCI CENTER O\ER DOOR BEIOW - RESIDENCE ATF 024 - 269 WEST BAY RD. OSTERVILLE,MA. 6�_0. 4'-2" - 6,_0. 4,_2" 5;_9. 1 CTR.w/RIDGE - - TITLE: NOTE CONTRACTOR TO PROVIDE FALL PREVENTION ON ALL WINDOWS - SECOND FLOOR 15'6' 2 42'-4V° WITH SILLS ABOVE 72'ABOVE FINISH GRADE PER CODE.ALL PLAN WINDOWS SHALL HAVE FALL PREVENTION DEVICES AND SHALL COMPLY WITH THE REQUIREMENTS OF A5TM F209D. WINDOW OPENING DEVICES SHALL BE SELF ACTING AND SHALL BE POSITIONED TO PROHIBIT THE FREE PA55AGE OF SCALE:1/4"=1'-0" A 4'DIAMETER RIGID SPHERE THROUGH THE WINDOW OPENING WHEN THE WINDOW OPENING LIMITING DEVICE 15 INSTALLED IN ACCORDANCE WITH THE MANUFACTURER'S INSTRUCTIONS. 0 1 2 4 6 PROJECT#: SHEET v NE, WALL KEY ALL WINDOWS ARE TO BE 14-01 A.2 AND ERSEN A SERIES 0 EXISTING WALLS w/APPLIED GRILLES INSIDE AND OUTSIDE �_____� WALLS TO BE REMOVED DATE: OF PLYWOOD PANEL AS NEEDED 4• FOR STORM PROTECTION ® PROPOSED WALLS 7nn4 1 1 T.O.F. EL.= 15.5'+- INISH GRADE OVER D-Bt-A= 15.3'± 4"SCHEDULE 40 PVC MIN. SLOPE 1 % PROPOSED 4" PVC VENT FINISHED GRADE OVER BIODIFFUSERS= 15.4' - 15.1- GENERAL NOTE S PROVIDE EXTENSION RISER INSPECTION PORT WITH SLOPE @ 2% MIN. WITH COVER OVER INLET & REMOVABLE WATER-TIGHT COVER OVER UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION ACCESS BOX TO WITHIN 3"OF FINISH GRADE OUTLET TO WITHIN 6"OF F.G. RISER TO WITHIN 6"OF FINISHED GRADE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL.= 15.1'± F.G. OVER TANK EL. = 15.3'-+ 5- DIA. OUTLET(S) F.G. (ONE PER OUTER ROW) CODE AND ANY APPLICABLE LOCAL RULES. 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE CRAWL DESIGN ENGINEER. 14.1'+ EXISTING 4" PROPOSED 9"MIN. SEE NOTE 21 36"MAX. 3.82'MAX. TOP OF SAS B.O. 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL PVC SEWER PIPE 11 .58' SEWER PIPE < SYSTEM UNLESS OTHERWISE NOTED. 6" 3" 3"DROP MAX 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 2-DROP MIN 3" 9" MIN-SLOPE @ 1% L 29'± PROVIDE WATERTIGHT ELEVATION = 11.58' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 100, JOINTS (TYP.) 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 4"PVC IN FROM 1.33' 4'PVC OUT TO y 16" 14" \-*1 1 .7'± SEPTIC TANK (TYP.) 10.75-(TYP) THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. OUTLET .'I ITI aT Tc:c: CONTRACTOR TO PROVIDE -11 7 LEACHING FACILITY 0.90, MIEM[E 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. SPECIFIED DROP BETWEEN INLET AND OUTLET CONTRACTOR I CONTRACTOR SHALL 12" T6' -2.875'(34. 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 11 .40' 11 .15' 10.25' (Iaid flat) SHALL VERIFY SIZE 48" VERIFY CONDITION 0 OUTLET TEE MIN. 11 .23' F AND CONDITION OF EXISTING TEES 5.01 (TYP-) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK EXISTING SEPTIC AND REPLACE AS GAS BAFFLE 6"CRUSHED STONE (TYP.) 5' MIN. 11.5' TANK NECESSARY REQ'D FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS OVER MECHANICALLY NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH COMPACTED BASE 25.0' AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX (TYP.) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= < 4.80 BIODIFFUSERS (END VIEW) 15.00' ESTABLISHED ON A NAIL SET IN UTILITY POLE#63/29 AS SHOWN ON PLAN. ' BASE. FIRST TWO FEET OF OUTLET 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. BIODIFFUSERS (PROFILE) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW (BY INFILTRATOR SYSTEMS, INC.) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES TO THE DESIGN ENGINEER. *CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL ARC 36HC (#3616BD) BIODIFFUSERS (H-20) 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONIC. STRUCTURES SHALL BE MADE WATERTIGHT. TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE --------- NOT TO SCALE NOT TO SCALE 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM • 13855 APPROPRIATE AUTHORITY. PERC NO. ZONE 2 INSPECTOR: David W. Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE EVALUATOR: Michael Pimentel, EIT,_CSE THEY SHALL WITHSTAND H-20 LOADING. C.S.E.APPROVAL DATE: Oct. 1999 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. 2 DATE: February 5, 2013 TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. ELEV TOP= 15.30' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, ELEV WATER= <4.80' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). PERC RATE <2 m 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN A/ in./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. • ItJ Cl) 4 DEPTH OF PERC= 36"-5A 16. PROPOSED PROJECT IS LOCATED WITHIN: W • 6 0 '0 TEXTURAL CLASS: 1 ASSESSOR'S MAP 116 PARCEL 109 a- 00 0 OWNER OF RECORD: MARY J.ABEL oil LOCUS 0 WEST BAY ROAD .0 0 0" MANAGING MEMBER OF CBA VENTURES, LLC Benchmark 15.30' 0 jic ADDRESS: 41 COACH ROAD Spike in U.P.#63/29 0 (35'WIDE LAYOUT) I • Fill an GLASTONBURY, CT 06033 Elev. = 15.00' z • 12"F PAVEMENT 14.30' Approx. M.S.L. EDGE O a. X FEMA FLOOD ZONE B&C U.P.# 3/30T-- "/w O/H/W N U.P.#63/2 gas COMMUNITY PANEL# 2500010016 D '4 "W O/H/W :1-3 7 B Loamy Sand BUSH lit .0 Neck BUSH 1 OYr 5/6 17. DEED REFERENCE: DEED BOOK 18059, PAGE 21 Q ti TV F 90.56' =30. 12 PINE 0 PROP. TOTAL 20 ARC 36HC 4"CHERRY TP2 18. PLAN REFERENCES: 1.)PLAN BOOK 219, PAGE 97 (#3616BD) BIODIFFUSERS (H-20) 75 36" 12.30' 2.) PLAN BOOK 70, PAGE 19 TP 1 15xT IN A FIELD CONFIGURATION 12 E 15-, N 1 8049'20"W Perc 3.)PLAN BOOK 14, PAGE 53 f 1� W w 8. 1 7.23' 4.)PLAN BOOK 81, PAGE 7 1 �LP 54" 10.80'PROPOSED INSPECTION PORT 151hx . / . "? i WITH ACCESS BOX (TYP OF 2) 8.1 01� 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. WALK C Medium Sand 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY PROPOSED 4" PVC VENT PIPE; EXACT LOCATION PER OWNER- PR. D-BOX 10 ANY LIABILITY e) 2.5Y 6/6 FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME O SHRUBS 3> (loose) FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. 0 SHRUBS STOOP 7 �3 74 21. IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE #269 0 LOCUS PLAN_ APPROVAL IS REQUESTED FROM 310 CMR 15.221 (7): 1 (1.) A 0.82-WAIVER(3.00--3.82')FOR THE MAXIMUM COVER OVER THE LEACHING SYSTEM. MAP 116 EXISTING 7 SCALE: 1"= 1000' I 3-BEDROOM 126" 14.80' PARCEL110 < DWELLING Z/, EXISTING LEACHING PIT TO BE No Moftling,Weeping or Standing Observed TOF = 15.5'± z 0 BOTTOM OF PUMPED, FILLED WITH CLEAN � 0 /-1, TEST PIT DATA C4 0 COARSE SAND &ABANDONED DESIGN DATA 6/ CRAWL=14.1'± LEGEND 13855 C? Q EXISTING 1,000 GALLON SEPTIC TANK PERC NO. 50xO' EXISTING SPOT GRADE eA 0 TO BE UTILIZED IN THIS DESIGN INSPECTOR: David W. Stanton, R.S. 50 EXISTING CONTOUR GARAGE EVALUATOR: Michael Pimentell, EIT, CSE NUMBER OF BEDROOMS(DESIGN) 3 C.S.E.APPROVAL DATE: Oct. 1999 PROPOSED CONTOUR DECK DESIGN FLOW 110 GAUDAY/BEDROOM DATE:- February 5, 2013 -Cm- TOTAL DESIGN FLOW 330 GAUDAY TEST PIT#: 2 O/H/W EXISTING OVERHEAD UTILITIES MAP 116 DESIGN FLOW X 200 % = 660 GAUDAY ELEV TOP= 15.30' E/T/C - EXISTING UNDERGROUND UTILITIES MAP 116 PARCEL108 USE EXISTING 1,000 GALLON SEPTIC TANK ELEV WATER= <4.80' -W-W EXISTING WATER LINE PARCEL109 MAP 116 12,083 S.F.± PERC RATE GAS EXISTING GAS LINE PARCEL111 DEPTH OF PERC j& SWING TIES SCALE: 1 20' INSTALL 20 - ARC 36HC (#361613D) BIODIFFUSERS (H-20) TEST PIT LOCATION 00*' 6'� DESCRIPTION HC-1 HC-2 TEXTURAL CLASS: b SYSTEM CAPACITY --- EXISTING 1,000 GALLON SEPTIC TANK BIODIFFUSER CORNER(1) 42.5' 23.6' j 0. (TOTAL L.F. OF BIOS)(4.8 SF/LF)(0.74 GPD/SQ.FT.)=GPD 15.30' / 1 BIODIFFUSER CORNER(2) 37.7' 13.1' (100.0')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 355.2 GAL. LEACHING DAY Fill PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE BIODIFFUSER CORNER(3) 15.6- 34.0' TOTALS: 12" 14.30' PROPOSED DISTRIBUTION BOX BIODIFFUSER CORNER(4) 25.1- 392 TOTAL NUMBER OF BIODIFFUSERS: 20 B Loamy Sand PROPOSED ARC 36HC(#3616BD) BIODIFFUSER(H-20) TOTAL NUMBER OF COUPLINGS: 0 1 OYr 5/6 WEST BAY ROAD TOTAL LEACHING AREA: 480.0 (35'WIDE LAYOUT) TOTAL LEACHING CAPACITY: 355.2 REV. DATE BY __I_APP'D. DESCRIPTION 36" 12.30' PROPOSED SEPTIC SYSTEM UPGRADE NOTE: PREPARED FOR: EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER CAPEWIDE ENTERPRISES (4 5-Y 1) "MODIFIED APPROVAL FOR GENERAL USE" ISSUED TO INFILTRATOR C Medium Sand 9.7' SYSTEMS, INC., DATE OF ISSUANCE OCTOBER 3, 2003 (LAST MODIFIED 2.5Y 6/6 LOCATED AT MARCH 14, 2012). TRANSMITTAL NUMBER=X235253. (loose) 269 WEST BAY ROAD (3 2) OSTERVILLE, MA 02655 SPECIAL NOTES: HC-2 SCALE: I INCH 20 FT. DATE: FEBRUARY 5,2013 HC-1 126" 4.80' 0 10 20 40 80 FEET 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC 011 No Moftling, Weeping or Standing Observed SYSTEM COMPONENT. #269 / .rEXISTING 0 PREPARED BY: 0� 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED 4RVED FOR BOARD OF HEALTH USE jOHN L. JC ENGINEERING, INC. 3 BEDROOM RESERVED CHURCIAILLJ LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. DWELLING yak civii- 2854 CRANBERRY HIGHWAY REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TOF = 15,5'± NO. 80 TEST PIT DATA. BOTTOM OF A EAST WAREHAM, MA 02538 CRAWL=14.1 ...... 508.273.0377 3.) ENTIRE PROPERTY IS LOCATED WITHIN THE ESTUARINE WATERSHEDS. SITE PLAN - ----- Designed By: 'Ehecked By: JLG JOB No.2375 SCALE: 1" 20' Drawn By: B S M MCP