HomeMy WebLinkAbout0295 WIANNO AVENUE - Health ue 7�--295 Wianno Aven ' E
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
295 WIANNO AVENUE
Property Address
Owner Owner's Name
information is
required for every OSTERVILLE MA 02566 04/13/2019--,
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any'
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. Inspector Information
on the computer, JR
use only the tab OHN P GRACI S
key to move your Name of Inspector
cursor-do not GRACI SEPTIC INSPECTIONS LLC
use the return Company Name
key. -
BOX 2119
� Company Address
TEATICKET MA 02536
Citylrown State Zip Code
508-548-7500 S1468
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined
that the system:
1. ® Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evalu tion by the Local Approving Authority
4. ❑ Fails
04/13/2019
Inspector's Signature Date
The system inspector all submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)withi 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater, a inspector and the system owner shall submit the report to the appropriate
regional office of the D . The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: This report only describes conditions at the time of inspection and under the
conditions of use at that time.This inspection does not address how the system will perform
in the future under the same or different conditions of use.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
295 WIANNO AVENUE
Property Address
Owner Owner's Name
information is required for every OSTERVILLE MA 02566 04/13/2019
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
SYSTEM PASSES TITLE 5 INSPECTION.
2) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or:"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of ,
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ IND(Explain below):
NA
l5insp.doc•rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 2 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
295 WIANNO AVENUE
Property Address
Owner Owner's Name
information is required for every OSTERVILLE MA 02566 04/13/2019
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below):
NA
❑ 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):
NA
3) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
295 WIANNO AVENUE
Property Address
Owner Owner's Name
information is required for every OSTERVILLE MA 02566 04/13/2019
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will fail unless the Board of Health(and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
c. Other:
NA
4) System Failure Criteria Applicable to All Systems:
You must indicate"Yes"or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
iSubsurface Sewage Disposal System Form -Not for Voluntary Assessments
295 WIANNO AVENUE
Property Address
Owner Owner's Name
information is required for every OSTERVILLE MA 02566 04/13/2019
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than %day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure. .
5) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section CA.
Yes No
❑ ® the system is within 400 feet of a surface drinking water supply
❑ ® the system is within 200 feet of a tributary to a surface drinking water supply
❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
295 WIANNO AVENUE
Property Address
Owner Owner's Name
information is required for every OSTERVILLE MA 02566 04/13/2019
page. Citylrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered"yes"to any question in Section C.5 the system is considered a significant
threat, or answered"yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes"or"no"for each of the following for all inspections:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® El Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
�ev iS�o�
Commonwealth of Massachusetts
Title 5 Official Inspection. Form,.
�nA
Subsurface Sewage Disposal System Form-Not for,Voluntary..Assessments,
295 WIANNO-AVENUE
Property Address .
�a
Owner Owners Name
�.
information is required_for every OSTERVILLE MA _ 02666` 04/13I2019 "
� �>
page.e. CItyR'own state Zip:Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Ni;mber`of bedrooms(design): 7— - Number of bedrooms(actual): 2_ottage -
DESIGN flow based on 310'CMR 15.203(for example: 110 gpd x.#of bedr000ms)-.
770
Description;
PERMIT NUMBER 2004-365
Number of;current residents;
Does residence have a:.garbage;grinder7 ❑ Yes :No.,
Does residence have a waterareatment unit'? ❑ Yes No
.If yes; discharges to: --- —
Is Iaundry on a separate`sewage system?(include laundry system inspection Yes No
.information in this. report..)
Laundry system inspected?. ❑ Yes ( No
Seasonal use? ❑ Yes 0 No;,
'Water meter readings, if available last 2, ears usa e d TOWN ^_ _
g (. y y 9 (gP. ))
Detail;
20177226,000 2018-218 000
Sump pump? ❑ Yes Z No
Last date:of occupancy:- D eCUPIED
t5insp,doc-rev.m&' 2018 Title 5 01ficial Inspection Form:Subsurface.Sewage Disposal System r Page 7 of 18
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
.r 295 WIANNO AVENUE
Property Address
Owner Owner's Name
information is required for every OSTERVILLE MA 02566 04/13/2019
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information: NA
Was system pumped as part of the inspection? ❑ Yes ❑ No
If yes, volume pumped: NA
gallons
How was quantity pumped determined? NA
Reason for pumping: NA
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
295 WIANNO AVENUE
Property Address
Owner Owner's Name
information is required for every OSTERVILLE MA 02566 04/13/2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
NA
Approximate age of all components, date installed (if known)and source of information:
2005
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: 3911feet
Material of construction:
❑cast iron ®40 PVC 40 PVC
❑ other(explain):
Distance from private water supply well or suction line. 10 PLUS
feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
2000 GALLON SEPTIC TANK APPEARS TO BE STRUCTUARLLY SOUND AT TIME OF
INSPECTION.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
295 WIANNO AVENUE
Property Address
Owner Owner's Name
information is required for every OSTERVILLE MA 02566 04/13/2019
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
Depth below grade: 30"feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
2000 GALLON SEPTIC TANK WAS CONSTRUCTED OF CONCRETE
If tank is metal, list age: NA
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 2000 GALLON STANDARD
SEPTIC TANK
Sludge depth:
5"
Distance from top of sludge to bottom of outlet tee or baffle
29"
Scum thickness
2"
Distance from top of scum to top of outlet tee or baffle
6"
Distance from bottom of scum to bottom of outlet tee or baffle NA
How were dimensions determined? MEASURED
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
2000 GALLON SEPTIC TANK APPEARS TO BE FUNCTIONING PROPERLY AT TIME OF
INSPECTION . RECOMMEND PUMPING EVERY 2-3 YEARS DEPENDING ON USAGE.
t5insp.doc•rev.7126Y1018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
r
Commonwealth of Massachusetts
jd Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
295 WIANNO AVENUE
Property Address
Owner Owner's Name
information is required for every OSTERVILLE MA 02566 04/13/2019
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap(locate on site plan):
Depth below grade: NA
feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain):
NA
Dimensions:
NA
Scum thickness NA
Distance from top of scum to top of outlet tee or baffle NA
Distance from bottom of scum to bottom of outlet tee or baffle NA
Date of last pumping: NA
Date
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
NA
8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade: NA
Material of construction:
❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
NA
Dimensions: NA
Capacity: NA
p �' gallons
Design Flow: gallons per day
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M � 295 WIANNO AVENUE
Property Address
Owner Owner's Name
information is required for every OSTERVILLE MA 02566 04/13/2019
page. CityrFown State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(coat.)
Alarm present: ❑ Yes ❑ No
Alarm level: NA Alarm in working order: ❑ Yes ❑ No
Date of last pumping: NA
Date
Comments(condition of alarm and float switches, etc.):
NA
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert BOTTOM OF PIPE
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.):
DISTRIBUTION BOX APPEARS TO BE FUNCTIONING PROPERLY AT TIME OF INSPECTION
t5insp.doc•rev.7/26/2018 Title 5 Oftic'al Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
295 WIANNO AVENUE
Property Address
Owner Owner's Name
information is required for every OSTERVILLE MA 02566 04/13/2019
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
NA
*If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
NA
Type:
❑ leaching pits number: NA
® leaching chambers number: 6
❑ leaching galleries number: NA
❑ leaching trenches number, length: NA
❑ leaching fields number, dimensions:
NA
❑ overflow cesspool number: NA
❑ innovative/alternative system
Type/name of technolo NA
9Y� .
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
F� Subsurface Sewage Disposal'System Form -Not for Voluntary Assessments
295 WIANNO AVENUE
Property Address
Owner Owners Name
information is required for every OSTERVILLE MA 02566 04/13/2019
e. City/Town State Zip Code Date of Inspection
page. P
D. System Information (cont.)
11. Soil Absorption System(SAS)(cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
LEACH FIELD CONSISTS OF 6-500 GALLON LEACH CHAMBERS. LEACH CHAMBERS WERE
EMPTY AT TIME OF INSPECTION. BACK COTTAGE AND MAIN HOUSE ARE ON ONE SEPTIC
SYSTEM.
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration NA
Depth—top of liquid to inlet invert NA
Depth of solids layer NA
Depth of scum layer NA
Dimensions of cesspool NA
Materials of construction NA
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
NA
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18
Commonwealth of Massachusetts
p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
295 WIANNO AVENUE
Property Address
Owner Owner's Name
information is required for every OSTERVILLE MA 02566 04/13/2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy(locate on site plan):
Materials of construction: NA
Dimensions NA
Depth of solids NA
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
NA
R
t5insp.doo•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
Commonwealth of Massachusetts
p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
295 WIANNO AVENUE
Property Address
Owner Owner's Name
information is required for every OSTERVILLE MA 02566 04/13/2019
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
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t5insp.doc-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
. Commonwealth of Massachusetts
F Title 5 Official Inspection Form
M1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
295 WIANNO AVENUE
Property Address
Owner Owner's Name
information is required for every OSTERVILLE MA 02566 04/13/2019
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 10+
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: 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:
HAND AUGER
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
295 WIANNO AVENUE
Propefij Address
Owner Owners Name
information is required for every OSTERVILLE MA 02566 04/13/2019
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
® A. Inspector Information: Complete all fields in this section.
® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
® C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria)and 6 (Checklist)completed
® D. System Information:
For 8: Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
i
t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
{ TOWN OF BARNSTABLE
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,LOCATION `� ���� �%'1 O At/� SEWAGE # 2 00Y"US
uILLAGE osre r 4/i Ile ASSESSOR'S MAP &LOT
INSTALLER'S NAME&PHONE NO. J,
SEPTIC TANK CAPACITY -0 do
LEACHING FACILITY: (type) y`�0 4 C�G,-1 4Y�T(size) 106`..2 J .
140.OF BEDROOMS
BVALDER OR OWNER
PERMTTDATE: ��q��r ®s COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of,leaching facility) Feet
Furnished by
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A W
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TOWN OF BARNSTABLE
LOCATION cX'"'S (A)/"o Ave. SEWAGE #
VILLAGE S'fefut ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY CW000I1
LEACHING FACILITY: (type) �j/�lA� k I'1T (size)
7-10. OF BEDROOMS
JBTJILDER OR OWNER 1Gk C.AIr1
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leac ng facility) Feet
Furnished by 'o/1 SpCon T Fo/C`
ca
CD
W
Q.
W _
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No. Fee +
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
;Y
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
3ppricatton for Otopool *pgtem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade(vl)Abandon( ) Complete System ❑Individual Components
Location Address or Lot No. Z95 U iRriiD A.�R. C�G_re, Owner's Name,Address and Tel.No.
< AP_, MA. A,Are- v r•,`� Cain
Assessor's Map/Parcel (yo_ ,ZOO Z S Uw kn AVL�
b rv'1 S
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
p SJI�\k`A GYY�\1eQri�Ac.,
`// 7 tirVlP/ ?,o-a _J
os Vt o So6- Z�-33�
Type of Building:
Dwelling No.of Bedrooms :7 Lot Size 00(0 A&cS tq-4. Garbage Grinder(, b)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow -770 gallons per day. Calculated daily flow 7 8s gallons.
Plan Date 14r\_ Z1.2004 Number of sheets Z Revision Date
Title Q ► _
Size of Septic Tank Z960 Type of S.A.S. �_-Sbo 6F41.. LZa(1+\;nc_C, 10er5
i t\
Description of Soil: 0-4N L wn t L.ogw-)
;F Ft to -�3� CG er— ► SMW..SkPb w 'IBC
-SZ" LA f 0 "
_SZ Re Z. tZ 1�jrer )0yK '7/q n1eP -'A-VD Q - 1073 0
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued s and of a th. / S
Signed Date
Application Approved by I Date
Application Disapproved for the following reaso
Permit No. Date Issued
P�
N. r Fee
k
,,THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
• Yes!
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS,
R 2ppricatiou for Migog;a[�6pztem Con!6truction Vermd
Application for a Permit to Construct( )Repair( )Upgrade(v/)Abandon( ) E rComplete System O Individual Components
Location Address or Lot No. QS U lgmo Owner's Name,Address and Tel.No.
Assessor,sMap/Pazcel '.yo- ' �� - S tji-,o na Av
v��W Oz(,C5-
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
os 508_47A-334
-Type of Building:
Dwelling No.of Bedrooms -7 Lot Size(l.(o AuZc s IQ-ft.. Garbage Grinder(,UO)
Other Type of Building /N N_o.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow '7 7 0 gallons per day. Calculated daily flow 78.5 gallons.
Plan Date 5� P Z 1, Z M4 Number of sheets 2 Revision Date
�.._ Title }1P0eV5e_ck SCA,�-_ UQtircj P__
Size of Septic Tank tpao Type of S.A.S. (o-Soo (&L Qt '., _LAG ,bas
Description'of Soil, 0-4 L A we\ t L oQ yn
4-13' A Ca er l oyf,3 Z. Low 1` -Z 3" R Lc, Rr tb`I' S/ t1r��.5+>z�D c- Stir+�c. F ovtS
-SZ" .A( CAS _ 107_ o n)GD ! JA (_P�( 0 -M" <ZM_1A.
Z- CZ- CZ Lcyu Mk 7/y v�li s-� _`AWk-) (See. Ot- 1073(o)
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
M The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued y"fhts 'oard of Health.
�57
Signed/�1 ��"�"k^ C J��U� �_ _ /l _ ,�. Date � �
Application Approved by ' ��� 1E�Date
Application Disapproved for tie following reasong' >
Permit No. ( ..- _ _ Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded(--)
Abandoned( )by
at Z!s W ic,r�a NU 9 . w( has been constructedin accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. �'4�dated
Installer .�'_,A�l rC� Designer .. � !� :�..�,.
The issuance of this perms shall 'ot be construed as a guarantee tha the system wil u coon as designed. _
Date-(��� � Inspector--- ��.�
--- p j-----------------------------------
No. l �(!i'.✓ Fee {i too
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Mi$po!gar *p5tem Con5truction Permit
Permission is hereby granted to Construct( )Repair( )Upgrade(—)Abandon( )
System located at ZZIS- W116%a rNa lbw-e-._
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction inst be completed within three years of the'late pertni
Date: '7 / `7 Approved-b_
-T:
r
J11t 1 UH AUUENDUM File No. AG051164R01
rrower AIN
Property Address 295 WIANNO AVENUE
Cfty OSTERVILLE County BARNSTABLE state MA
-% Lender/Client CAPE Zip Code02655
�QD 5 CENTS SAVINGS BANK Address PO BOX 10. ORLEANS 'MA 02653
J o i
.
I
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Fw-pan r173
1960 Forms and Worms inc.315 Whilnev Ave_New Haven,CT 06511 All Rights Reserved 1(800)243-4545 Item' 112900
' own of.Barnstable
•.�F� 'Ow� Regulatory Services
Thomas F. Geiler,Director , .
MASS&
`g Public Health Division
TEo l�ai Thomas McKean,Director
200 Main Street,4yannis,114A 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: 7 2!, Za,f
Designer: S U LL L V9" E1/C-1NE ffP__ y ,1/1/e_ Installer: J.
Address: 7 FARILER- QaAlD Address: /00 49i 33 9'
C�s7-E�✓i L_L E n'J�4-5 f i v Sd�h /1�dI t7a G�icf
On jg- D was issued a permit to install_a
(date) (installer)
septic system at 29S W1 AN/NU AVE OsTZ-2V1L Lr- based on a'design drawn by
(address) ra J
GULL IV,4PC-AGI/LCER1n/y INc- _ dated -4"clNE ZI Zoo
(designer)
k<certify that-the septic'system referenced above as installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
7141s ce2tlt=y C�`v1Pc.raM�� r.✓ITHT1TLEV
"CkF1S tJoFS ►�a�7"G E Rt1 FBI Ca/yIP�-I�NGE w�T N PLUM [31n/y OR- EL EGtR►c�yL.�D ESQ
OR ANY OTF+ER
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.
w
(Ths
-
taller's Signature) -
(Designer's Signature) ( 'sSfad er
PLEASE RETURN TO BARNSTABLE PUBLIC_HEALTH DIVISION. CERTIFICATE
OF COMPLLANCE `VILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE $_4RNS-TABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:Health/Septic/Desiper Certification Form
COMMONWEALTH OF MASSACHUSETTS .
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL
D i,t( !
TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 295 Wianno Avenue
Osterville MA 02655
Owner's Name: Richard Cain
Owner's Address:
Date of Inspection: Mav 25. 2005
Name of Inspector: (Please Print) James M. Ford
Company Name: James M. Ford
Mailing Address: P.O.Box 49
Osterville,MA 02655-0049
Telephone Number: (508) 862-9400
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
✓ Passes
Conditionally Passes
Needs urther Evaluation by the Local Approving Authority
Fails
Inspector's Signature:
Date: Ma 26. 2005
The system inspector shall\subma copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,00o
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection-and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page 1
�A
Page 2 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM '
PART A
CERTIFICATION (continued)
Property Address: 295 Wianno Avenue
Ost.erville, MA
Owner: Richard Cain
Date of Inspection: May 25, 2005
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"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:
2
r
Page 3 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 295 Wianno Avenue
Osterville. MA
Owner: Richard Cain
Date of Inspection: Mav 25. 2005
I
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
Cesspool or privy is within 50 feet of a surface water
— Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
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:
3
Page 4 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 295 Wianno Avenue
Osterville, MA
Owner: Richard Cain
Date of Inspection: May 25, 2005
D. System Failure Criteria applicable to all systems:
You must indicate either"yes"or"no"to each of the.following for all inspections:
Yes No
✓ Backup of sewage into facility or system component due to overloaded,or clogged SAS or cesspool
✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
_ ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z day flow
✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped_. ,
✓ Any portion of the SAS,cesspool or privy is below high ground water elevation.
✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
✓ Any portion of a cesspool or privy is within a Zone 1 of a public well.
✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large System:
To be considered a jarge 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
I 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 I1 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.
4
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Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 295 TVianno Avenue
Osterville, MA
Owner: Richard Cain
Date of Inspection: May 25, 2005'
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?
n/a Were as built plans of the system obtained and examined?(If they were not available note as N/A)
✓ _ Was the facility or dwelling inspected for signs of sewage back up?
✓ Was the site inspected for signs of break out?
✓ _ Were all system components,excluding the SAS,located on site?
✓ _ Were the septic tank manholes uncovered,.opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions, depth of liquid,depth of sludge and depth of scum?
✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes No
✓ _ Existing information. For example,a plan at the Board of Health.
✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [310 CMR 15.302(3)(b)].
4
5
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 295 Wianno Avenue
Osterville, MA
Owner: Richard Cain
Date of Inspection: Mav 25. 2005
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): n/a Number of bedrooms(actual): 5
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550
Number of current residents: 2
Does residence have a garbage grinder(yes or no): No
Is laundry on a separate sewage system(yes or no):_ Yes(on front system) [if yes separate inspection required]
Laundry system inspected(yes or no): No
Seasonal use(yes or no): No
Water meter readings, if available(last 2 years usage(gpd)): Unavailable
Sump Pump(yes or no): No
Last date of occupancy: Currently occupied
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sqft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no)
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:_ Pumped vearlv-per owner
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
1(2) Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight Tank Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
Unknown
Were sewage odors detected when arriving at the site(yes or no): No
6
f
Page 7 of 11
y
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 295 Wianno Avenue
Osterville MA
Owner: Richard Cain
Date of Inspection: May 25, 2005
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: _cast iron _40 PVC _other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: ✓ (locate on site plan) (Cesspool acting as a septic tank)
Depth below grade:
Material of construction: concrete _metal _fiberglass _polyethylene
✓ other(explain)_ Cesspool block
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate) Front System Back System
Dimensions: 5'W x 6'T x 8'bottom to trade 5'W x 6'T x 9'bottom to grade
Sludge depth: 10" 10"
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness: 1" 12"
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
How were dimensions determined: _Measuring Measuring stick
Measurin stick
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
The kitchen and laundry flow to the front system. Steel cover to grade Bathrooms flow to the back systern No outlet tee was
Present. A steel cover was 3"below grade
GREASE TRAP: None (locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage, etc.):
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 295 Wianno Avenue
Osterville, MA
Owner: Richard Cain
Date of Inspection: May 25, 2005
TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alann in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: None (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: None (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no)
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
r
8
Page 9 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 295 Wianno Avenue
Osterville, MA
Owner: Richard Cain
Date of Inspection: Mav 25, 2005
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
✓ leaching pits,number: 1 -6'x 6'0000 aL)_
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
✓ overflow cesspool,number: 2
Innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,dam soil condition ondition o g P f vegetation,etc.):
c.):
Front system: The overflow was 5'W x 7'T x 10'bottom to grade and had 1'ofliauid on the bottom There did not appear to be
any signs offailure. A steel cover was to zrade. Back s stem: The first overflow was 5'W x 5'T x 10.Y bottom to jZrade and had
Yof liauid on the bottom An outlet tee was present A steel cover was to Qrade The second overflow(1000 al it had "of
liquid on the bottom. There did not appear to be any signs offailure The bottom to-grade was approximate12' —
CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Commnents (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: None (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Conunents(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
9
Page 10 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 295 Wianno Avenue
Osterville,MA
Owner: Richard Cain
Date of Inspection: May 25, 2005
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.
A
y-7
10
i
a
Page 11 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 295 Wianno Avenue
Osterville, MA
Owner: Richard Cain
Date of May
Inspection: 25 2005
p v
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 25+/- feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain: topographic and water contours maps
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Using Barnstable topographic and water contours maps the snaps were showing approxitnately 25'+1-to ground water at this
site.
This report has been prepared and the system inspected and passed as of the date of inspection. This report is
not a warranty or guarantee that the system:will function properly in the future. There have been no warranties
or guarantees, either expressed, written or implied,relating to the system, the inspection andlor this report.
11
LOCATION-:, SEW&C�E PERMIT UO.
IMSTQLLER 5 U&1 AE ADDRESS
GUILDER'S I.I Fr ADDF3E55
DATE PERMIT ISSUED 2T - --
D ATE COMPLI &&ICE ISSUED ; ��
1
r tNt � Till
V�
I
E�
�90 . ............ FincZ...................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
OF......... -—----------
;�� ---- --- .....................................
Appliration -for M_qvviial Workil Tantitrurtion Punift
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
A-_;r?--------------------- ................................................................................................
Location- ess or Lot N&t
_0Z ......C.'ska-k�aL-------------------------- .....
Owner Ad re
0)4(?..................................... ... ......................................................................
(Z AJhj
C_14
I tail,
nsta elf Address
Type of Building Size Lot-----_--------------------Sq. feet
U
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic Garbage Grinder ( )
Other—Type of Building -----------_-------------- No. of persons..-___--.---_-_.._--.__--.-- Showers Cafeteria ( )
Other fixtures -----------------------------------------------
------------------------------------------------------------------------------------------------------
Design Flow--------------------------------------------gallons per person per day. Total daily flow.............................................gallons.
P4 Septic Tank— 'quidcapacity------------gallons Length................ Width................ Diameter__.---..-.-.__-- Depth._.._._.......
Dispos rench No. .................... Width....._........_.._.. Total Length-------------------- Total leaching area,..... ------------Sq. f t.
.... ........ ..ox
Seepage Pi. NO.......... .......... Diameter-_----------------- Depth below inlet_......._........... Total leaching area-------- ......_sq. ft.
p
Other
i. '13 tio
he istri tion ox ing tank
r OS
7 _ s
Sa � 0 --------- ................................................................ Date---------------------------------------
Percolation T
t
Test it o. iiinutes per inch Depth of Test Pit------------_------ Depth to ground water--------------_---.___.
P1 0. .... .�
Test P1 o. 2................minutes per inch Depth of Test Pit-.--__-__-__________ Depth to ground water-_---.-----.---.--_-____
------------------------------------------------------------------------------I-------------------------------------------------------------------------------
0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------
X
U -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------
------------------ -------------------------------------------------------------------------------------------------------------------------- .................. ................................
U Nature of Repairs or Alterations—Ans �pr_when applicable..________1-- .6.N.1----------15:717w��---------
-------------------------------------------------a
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees to place the system in
operation until a Certificate of Compliance has bee t bO h.
Sig ... .. ... ..... .. ....... ....... ... ----------------------- .. .... .. ........
DDatApplication Approved By------ .... ............"-. _-------------------- ------ -- ---
Application Disapproved for the following reasons:...............................................................................................................
...................................... .................................................................I...............................................................................................
Date
PermitNo........................................................ Issued. *-------------------------
Date
No....... ............ ....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...._oF.._..-..t ..............................:..............
AVV irafion -for Ii!iVuiitt1 Works Totuitrurti u Vrrmft
Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal
System at � J
'
—11
---------------------------------------- ---•-------•--••-•-•••••............-------- --_ •-•••-••••••......---•-------•-------•---
A.)
Location.,"jress or Lot IVz
e 4 d � =`' -------------------------- !� _ 14' Part . ° . i",gr�Z•€ 1
f d Owner ^ Address
a ......._ .__._.___.__._.._..____..__.._.._.._.__.. ......... . ..-_.•__.
Installt_er Address
Type of Building Size Lot----------------------------Sq. feet
_ Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
p, Other—Type of Building ____________________________ No. of persons--------..-._.---_-_--_---_. Showers ( ) — Cafeteria ( )
dOther fixtures -------------------------------------------------------------------------------------------- --------------------------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank�._Liquiidcapacity__--_---___gallons Length---------------- Width---------------- Diameter---------....... Depth---------------
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 Distriib tion+box ( ) Dosing tank ( )
aPercolation T f Results �P fofrr ed 4 Y------------------------------------------------ - -------- Date
ITest PittNo.iI-- _ ---.minutes per inch Depth of Test Pit.................... Depth to ground water._.---._----.-._-..__--
f� Test Pit No. 2................minutes per inch Depth of Test Pit-_-______________- Depth to ground water--.---_-_----_-..-_--___
--------------------------------------------------•------------------.......................................................................................
ODescription of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------
x
:I U -------------------------------------.-----------------------------------------------------------------------------------------------------------------------_-------------------------------------------
------------------------------------W
U Nature of Repairs or Alterations—Answer when applicable--------- ---.. < 3 s
� 1 ---- _ Aa _1.4...•---•-....!.--t......./ ... .......... .f _ i
-----------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI 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.
---------------------------
.. r
Application App4W Date,
roved BY '- --------``�f` f
/Date
Application Disapproved for the following reasons:-------•--------- ------------------------------------------------------------------------------------••--•.
--••••-•-•--•--------••••-•••••••-•-------••-•--••--•----------•----•--•-•-------•-•••••--•---------••--••••••••-•-••---•-------------------------------••••--------------------------------------------
Date
PermitNo......................................................... Issued........................................................
Date
Ct
THE COMMONWEALTH OF MASSACHUSETTS F
BOAR,9F HEALTH
............. .. ..................O F................. ......................_......................
Itrrtifiratr of TlantPhaurr
I/O C&�RT),FY, That the Individual Sewage Disposal System constructed ) or Repaired
by i ---------~`--- --------------------------------
:
- -- --�........---^'tom-� �."•'
staler ` . 9
tom, --------.................---------------- ------------,.. ------'�--------�--� ----•- - U✓
has been installed in accordance with the provisions of . 41d XI�of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No_________________---- ................ date`d.. 2_�'y ...............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
�✓a--, ` :......�...... . ...............8 oFR •H, ,a" ......................
No.........................
FE -
%ttra for �hfitrurtion "Proof
a
Permission is hereby grid ----- ............................................
to Con uct ) br Repair _) a I1t�davtdual Sewage f i posal System
—
on
(, t�- + -
at No��---�"=�¢........�, �. / S �/ �� •••-• ------------
,
Street `� .�
as shown on the application for Disposal Works Construction' ermit o_____________"t�... Dated ..............................
L -
DATE.:=-•---------•-- -----------.................................................. Board of Health
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
i`.
J
��_-.,
ff
- _
. J
1 _
-- -.. ,
P# 1057.36
F.F EL.36.3 - - PERFORMED BY SULLIVAN ENG.
F.O.EL.35 F.G.EL.34 WITNESSED BY: DAVID STANTON
Sae Note 4(typ.) - ,Z. JUL:Y 1.5, 2004 E L. 3 4,0
n n
4" LAWN & LOAM 33.7
329 FnTA LAYER 10YR 3/2
(See Nora 9) -_ _
- Top El.31.5
VERY DARK BROWN ,
EL.3t.6 2000 Gallon .E v x( 13" LOAMY
Septic Tank EL.31.2 s n s - yi r - 2'
H-20 Flow E uilizer3 = B LAYER 10YR 5/8
A3 Requ>r y.. ,,... ;. L �y DARK GRAYISH BROWN,
f r r 23" MED' SA
Bot .23.8 ND W/SOME FINES 32,1
Bedding,"T"3, C 1 LAYER 1 OYR 5/6
Ip'
as Perr Tit If Encountered Remove Sc Replace - -
& All Unnittable Soils Widdn T of BROWNISH YELLOW
Titlea 5 The outer Perimeter of The System
1 a Min.-slab - _
2W Min-Foundation U MED. SAND
l' No Groundwals 4 9' PERC TEST 293
DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Encountered(See Pere) 52" < 2 MIN. /INCH 29,7
NOT TO SCALE C2 LAYER 10YR 7/4
►' LIGHT YELLOWISH BROWN'
t 12211 , MED. SAND 23.8
NO GROUNDWATER
NOTES - - FudshGrade
APPROX.GROUNDWATER @ EL.2.5
1. Water Supply For This Lot is Municipal Water.
Fats
2. Location of Utilities Shown on This Plan Are Approx. Compacted Fill Fabric
At Least 72 Hours Prior to Any Excavation For This
a Design Data
Project the Contractor Shall Make the Required
Notification to Dig Safe(1-888-344-7233) _ Pe on
r ,
Pea Single Family - 7 Bedroom
3. The Contractor is Required to Secure Appropriate i ram.
_ With No Garbage Grinder
Permits From Town Agencies For Construction Daily Flow= 110 x 7 = 770 GPD
Defined by This Plan.
4. Install Risers to Within 12"of , , Septic Tank: 770 GPD x 200 % = 1540 GPD
Finished Grade. LEACHING- Use 2000 Gallon H-20 Septic Tank
r CHAMBER. 3/4"-1 In^
'•` - H-20 5' - r
5. All Structures Buried Four Feet or More or Subject Double Washed
to Vehicular Traffic to be H-20 Loading. _ ; Leaching Area
6, Septic System to be Installed in Accordance With `
4'-10° - 770 GPD/0.74 = 1041 SF Required
310 CMR 15.00 Latest Revision and the Town of
Barnstable Board of Health Regulations. 12,-,0„ S Sidewall: 2(145.7).= 291.4 SF
7. All Piping to be Sch. 40 PVC. i Bottom Area: 769.&SF -
8. Wherever Sewer Lines Must Cross Water Supply CROSS SECTION OF CHAMBER 1061.2 SF Total Provided
Lines,Both Pipes Shall Be Constructed of Class 150 NOT TO SCALE
Pressure Pipe And Shall Be Pressure Tested To OFkd�� e Leachin Chamb Desi n
Assure Watertightness. ITEM _, -g er g
9. The contractor is required to confirm the invert W P4
NO.�SIMI 7?- All Pipes to be Schedule 40. Use
elevation of the house sewer line post re-plumbing. e11" 6-500 Gal. Leaching Chambers in a
The existing exterior house sewer line may be used �'
Washed Stone Field as Shown.
if it is in compliance with 310 CMR 15.222, and
meets the invert elevation. d
Title:
SITE Prepared By Prepared For:
PLAN Date: June 27, 2004
CD
PROPOSED SEPTIC UPGRADE Sullivan Engineering, Inc.
AT PO Box 659 Richard & Andrea Marie Cain rt
295 WIANNO AVENUE Osterville, MA 02655 2 Oste wianno Avenue Scale A5 . Noted N
rville, MA. 02655
(508)428-3344 (508)428-3115 fox 0
BARNSTABLE, (o.STERWLLE) MASS PsuuPEcool.eo,, Project #i 24006 N
1
ZONE: FL606{ZON1E:
1 �: t• Notes:
1.) The property line and topographic information
.. as RC Zone C
•� — `� ;EaaE-B,. Area (min.) 87,120 SF Community Panel No. was obtained from the Town of Barnstable GiS.
•�o• ' �' • " `:= OC Frontage (min) 20' #250001 0016 D ) property
•••.• Width (min) 100' y , 2. For actualafine —78. anon
e Jul 2 1992 see Land Court Plan 2664-78.
••i� i�;,o - � ,,,,f' Setbacks:
.q•#a: � �,+B r.,,,i J.) The datum used is NGVD '29, 'a fixed mean
Front 20'
sea level datum.
' "'• / Side 10'
•I••e y Rear 10' 4.) The intent 'of this plan is for the permitting
of the septic upgrade only..and is only valid
Neck ✓ + 'with an original stamp and signature.
• �"` ; y OVERLAY DISTRICT:
,
AP — Aquifer Protection District
t
1A �'' • , `� As Shown on Plan Entitled
"Revised Groundwater Protection i
_ o� "� � e• . 36
Overlay Districts" — April, 1993 36
i
LOCATION MAP: 1 i
Scale: 1" = 2000' 1
ASSESSORS REF.:
Map 140, Parcel 126
I
/ � -
--
G
h1 G TH
20' p
j Lot Size: 0.6 Acres , ` M a 0 10
Field S one p Min
R et. Wall.
W / Existing °o o N Proposed
ao
o I / 7 BedrOOm septic Upgrade ZI
p
o
Dwelling
�1 g
Lr o ?o I
T
W
I' e-Plumb I
Sewer Line
C
X Note: Existing Septic Systems To Be -
Cb
I Removed Or Abandoned
225.00
T O
0733
Cam. '
34
Title: SITE PLAN Prepared 8y: Prepared For: Date: June 21, 2004 L
PROPOSED SEPTIC UPGRADE CD
Sullivan Engineering, Inc. Richard & Andrea Marie coin
30'Scafel 1"
AT PO Box 295 Wianno Avenue
295 MANNO AVENUE osterville, MA 0 2655 =. '
_ � Osterville, MA. 02655 a
BARNSTABLE, (OSTERwuE) MASS (508)428-3344PSOBPEG8ol.c1o9 fax Project #: 24006 �,
� Z
{F
REWORK PIPES 1�
IN THIS AREA 11cl. Li
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FAMILY _ TREAD MIL GARAGE
GAME ROOM 4 j I _, M
— — — y REWORK PIPES
L — X �~ GYM IN THIS AREA??
04
EXISTING �^ N
COLUMNS o 00
--- N SOFFIT Q
— — — — STEELBE — — — O 11 — — — — — — — — STEM LVL BEAM ABOVE --- Q
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FRONT ELEVATION n MAIN
EVATIONS
- CONTRACTOR 10 VERIFY ALL DIMENSIONS IN THE FIELD.
. - - - CONTRACTOR SHALL VERIFY AND COMPLY WrrH ALL LOCAL CODES. J-A,�� �
�a
CONTRACTOR ASSUMES ALL RESPOSIfSIITY. _ � A.4.0
tea. ,ir.,•�
r
WIANNO'COTTAGE PARTNERS, LLC
• - - - 27 Tby—Len ai -
n O...i,111..,MA 02655
wT.I:3095095782 Fax:508 4281203
WIANNO
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COTTAGE &
�. . . BOATHOUSE '
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_. 4 D61.a JST. gtee tc.ACLw S.y►tz.Ab D•Fn..s rAvnp-.L( U•D,A�-
FIRST FLOOR PLAN - n
CONTRACTOR TO VERIEY DIMENSIONS DJ. E ALL ENSI NS THE FlF.1D.
.. .. - o STEwti."cawwJ 4P�D� -pswrr De-.6rRab
_ _ ;�P�.f f r•t ...- CONTRACTOR SIl4[L VERIFY AND COMPLY FATH ALL LOCAL LADES.
d(D a
• 13 P05F DN - - CONTRACTOR ASSUMES ALL RESPOSIBIL". �i°' - - A-1.0 ..
WFANNO COTTAGE PARTNERS,LL-C
.. - 27 TArm.L..a ,.
0.te rrllle,NA 02653 ..
T.1:S08509$782 F..:508 428 1205
WIANNO
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-SECOND FLOOR PLAN
- - - V4i7-0• -Zf/D.C'[4• I WMRACTOR TO VERIFY ALL DIMENSIONS IN THE FlELD.
Cqu/vC7 Jbmrs= U.O.d. - 1OP paD Z s,( '�
- X 'FOXY vj; L'f yi'/0t`f9+00D' CONTRACTOR SHALL VERIFY AND COMPLY WNH ALL LOCAL CODES.
. IN pcn P I CONTRACTOR ASSUMES ALL RESPO9FAFtt.
A.2.0
o s7v Del m oehs/2m5
E
' WIANNO COTTAGE PARTNERS, LLC
- 27 TErd.. Lv..
_ Ost-119e,MA 0265S
T.1:500,5095702 Fax:SO&428 1205 -
WIANNO
COTTAGE &
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`L�15 7 9'J2 T1Z�IbG�lQ�`I CONFRACiOR ASSUMES ALL RESF'OSIBRRY. A.O.O
32'-0" WIANNO COTTAGE PARTNERS, LLC
18'-101/2' 4'-0' 5'-91/2' 3'-4" 9'
' 27 Thyme Lane
Osterville , MA 02655
OUTDOOR Tel: 508 509 5782 Fax: 508 428 1205
o SHOWER 2'-6" 1'-6' 1'-10'
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-------------
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12—0 11 -3 8/—9p 1e STRUCTURALAL
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Revisions
CONC. — ( I I No. Description`���� P Date
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,
/ 241-0" 8'-0' g"
32'-0"
Drawing Tide
- BOAT HOUSE
FOUNDATION / FLOOR
FOUNDATION PLAN ROOF PLANS
1/4"=T-0" CONTRACTOR TO VERIFY ALL DIMENSIONS IN THE FIELD.
job Number. Drawing No.
CONTRACTOR SHALL VERIFY AND COMPLY. WITH .ALL LOCAL CODES. Drawn by
CONTRACTOR ASSUMES ALL RESPOSIBILITY. Checked
Date 08/15/2005 A*6eUA
Plot scale
East
\ /
\ \ \ /' „4� ��• '�r� Bay Rd
eck
32/• •� Lake
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e�
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ASSESSORS DATA:
`\ ' ,•`� 1 \ \�. 33 140-128
AN
'`� LOCUS ADDRESS.-
00�365 �` •� .ram / a \ \\ 295 AIANNO AVE, OSTERVILLE
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m � p0�` �\ .f:::._..•=� �;'��� �� .� � ;' '� - ' '\ \ REFERENCE CERT.• 152007
• ,P� � `� :::.'� ,.' �r , ♦ ��„' ,k%I 34 ,• \ \ \\' REFERENCE PLAN. LC 2884-78
`° es Existing ZONEW DISTRICT. RC
Storm Drain \ \ \o \ ♦ : I \ \\ \ \ BUILDING SETBACAS:
\ •�'o \ \ \- FRONT - 20'
J .r0o `.-• cs�a :'� g4"' jak .14!rD REU? - 10'
�; \ \. \\ 0VERIAY DISTRM.'
.... � ND/ AP A RPOD
30
... .. — _ -
• .p ^:.; �,, � � - _-.,.'� , \.' .i4"r LOT' CO WR BY STRFJ'GY iil�[ES.'
�g 74
EXISTING = 8.57.
13" Holly PROPOSED = 18.89
37 =::. 58.21 ::. \ peg / �tsti FEMA DATA: ZONE "C"
I '� PANEL 250001 0018 D
io MAP REV JULY 2, 1992
36 4e�V
= '
15 Spruce
76qy' I ♦I / ea i
9
35.9' <` io4o I ,
4
L T 90 105 18" 8 Ip
25, 75fsg fL _ / 1135 4
Si t o P1 a.n Of La n d
38 II GRAPHIC SCALE Prepared Far
o'er
32.s' �,d , 20 0 10 20 40 so 295 WIANNO A VENUE
64 In
A' 49'
•r.
IN FEET Osterville, Massa ch use t is
1 inch = 20 it
'ram Scale.- I" = 20 Date.- August 17 2005
Prepared By.•
Stephen J. Doyle and Associates
42 Canterbury Lane, E. Falmouth, MA 02538
+� . 508/540-2534
BM TOP CB F Telephone
ND. +pp �...
ELEV. 35.41 •Op ►►
DATUM.• NC VD- ��9 ��a_o k of 41,4ss � .R a vi S i co .z-i S 2 o C -1-C'
STEPHEN � �
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NO. DATE DESCRIPTION BY