HomeMy WebLinkAbout0448 WIANNO AVENUE - Health 448 WIANNO-AVENO�I �s t
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oar
Town of Barnstable P#- �J 0 (a
$ Department of Regulatory Services
Public Health Division Date l o -k\ - o
$MA �� 200 Main Street,Hyannis MA 02601.
Date Scheduled 1 7 Time 1/ Fee Pd.
Soil Suitability Assessment for Sewage Di osal
Performed By: 5.- 1 t; Witnessed By:
LOCATION&GENERAL INFORMATION
Location Address Owner's Name V
t
�y 1 1l J 1 l.li C�.— Address i v
Assessor's Map/Parcel: Engineer's Name SZ'V--O_
NEW CONSTRUCTION REPAIR Telephone# <D 0
Land Used _� Slopes(%)__'L f ZO Surface Stones "t 1
Distances from: Open Water Body �k 16_ft Possible Wet Area 4_1_ ft Drinking Water Well J ft
Drainage Ways . ft Property Line k,�, ft Other ft
SKETCH:(Stye tct ame,dimensions of lot,exact locations of test holes&perc tests,locate wetlands fn proximity to holes)
�o-1(-z-
913 9c�o �� q> CD
~_.. _..., .,:.:." .... .... �.,.•,:- ..�- �-ter--^-r_
\ f lJ
girl
0
Parent material(geologic) Depth to Bedrock mbq�
Depth to Groundwater Standing Water in Hole: 1�A It / Weeping from Pit Face
Estimated Seasonal High Groundwater
D
E
T
E
RAHNATION FOR SEASONAL HIGH WATER TABLE
Method Used: C,udaS7T%.X__
Depth Observed standing in obs.hole: _ —in. Depth to soil mottles: In.
Depth to weeping from side of obs.hole: in, Groundwater Adjustment tt.
Index Well# Reading Date: Index Well level .e, Adj.fhctor Adj.Groundwater Level,, e
PERCOLATION TEST bate \- Ifnmu
Observation
Hole# Tima at 9"
Depth of Perc T t Time at V r
Start Pre-soak Time @ o __L;_UL 'lime(9"-6")
End Pre-soak ._� 1
Rate Min./Inch. L�'
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/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:\SEPTIOPERCFORM.DOC
DEEROBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Cher
Surface(in.) (USDA) (Munsell) Mottling (Structure.Stones;Boulders.
sistengy,
\ Gravel)
D " of r\fit- vt✓ e 13t�tC, .L0F�C..
1- tz A
•G.. 'y
f-'�1`�• r� Z,� to � ..._�— �.u ,
DEEP OBSERVATION HOLE LOG Hole# -C>
Depth from Soil Horizon Soil Texture Soil Color Soil r
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.
L. 1 vet �► lA
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil er
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
i to
L
f
rd+� v 0l4�
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil er
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
4 1h_1 L
e 1 y 'Z.
tt
JfJ�tl 1't� ���IZ Aye e1�.
Flood Insurance Rate May: .
Above 500 year flood boundary No Yes
Within 500 year boundary No= Yes
Within too year flood boundary No—%, Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervio material exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring pervi us material?,_. ,,.
Oertifcation
I certify that on 31 ti f. (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with .
the required training,expertise and experience described in 10 CMR 15.017.
Signature Date .Z`0 (.0 ,
Q:\.S.EpTlLVERCFORM.DOC
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M e'' 448 Wianno Ave
Property Address
Thomas and Victoria Vallely Trustees ,'
Owner Owner's Name
information is CO
required for every Osterville Ma 02655 5/4/18 4.
page. Citylrown State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered iri==any
way. Please see completeness checklist at the end of the form.
Important:When
p filling out forms A. General Information - (Z-1 g
on the computer,
use only the tab 1. Inspector:
key to move your ,
cursor-do not Michael DiBuono
use the return Name of Inspector
key.
DiBuono Sewer and Drain
Company Name
35 Content Ln
Company Address
Cotuit MA 02635
City/Town State Zip Code
508-364-9587 SI 13522
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000).The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
5/7/18
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
L U
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
448 Wianno Ave
Property Address
Thomas and Victoria Vallely Trustees
Owner Owner's Name
required fo is Osterville Ma 02655 5/4/18
required for every
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
System contains a 1500 gallon septic tank. As well as a concrete distribution box and 18 Standard
infultratos. Camera inspection to distribution box showed no signs of failure
B) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5irls•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5. Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
448 Wianno Ave
Property Address
Thomas and Victoria Vallely Trustees
Owner Owner's Name
information is Osterville Ma 02655 5/4/18
required for every
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of.Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health): `
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
w W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
° 448 Wianno Ave
1y
Property Address
Thomas and Victoria Vallely Trustees
Owner Owner's Name
information is required for every Osterville Ma 02655 5/4/18
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ 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:
Y pP Y
You must indicate "Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1/2 day flow
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
NN Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
448 Wianno Ave
Property Address
Thomas and Victoria Vallely Trustees
Owner Owner's Name
information is required for every Osterville Ma 02655 5/4/18
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cons.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ E Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA) or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
N Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 448 Wianno Ave
Property Address
Thomas and Victoria Vallely Trustees
Owner Owner's Name
information is required for every psteryille Ma 02655 5/4/18
page. Cityrrown 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 N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ ® Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 5 Number of bedrooms (actual): 5
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
550
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
;M 448 Wianno Ave
Property Address
Thomas and Victoria Vallely Trustees
Owner Owner's Name
information is Osterville Ma 02655 5/4/18
required for every
page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: Vacant
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® -No
information in this report.)
Laundry system inspected? ® Yes ❑ No
Seasonal use? ® Yes ❑ No
Water meter readings, if available (last 2 years usage (gpd)):
238 Gpd
Detail:
Sump pump? ❑ Yes ❑ No
Last date of occupancy: Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
448 Wianno Ave
Property Address
Thomas and Victoria Vallely Trustees
Owner Owner's Name
information is required for every Osterville Ma 02655 5/4/18
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: Not provided
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
448 Wianno Ave
Property Address
Thomas and Victoria Vallely Trustees
Owner Owner's Name
information is required for every Osterville Ma 02655 5/4/18
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
Jully 22nd 1994
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 2
feet
Material of construction:
® cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
System is vented at the roof line
Septic Tank(locate on site plan):
Depth below grade: 1
feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
1500
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions:
Sludge depth:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 448 Wianno Ave
Property Address
Thomas and Victoria Vallely Trustees
Owner Owner's Name
information is required for every Osteryille Ma 02655 5/4/18
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank (cont.)
Distance from top of sludge to bottom of outlet tee or baffle
24" I�
Scum thickness
3"
Distance from top of scum to top of outlet tee or baffle
42"
Distance from bottom of scum to bottom of outlet tee or baffle Sludge stick
How were dimensions determined? Tape Measure
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
448 Wianno Ave
Property Address
Thomas and Victoria Vallely Trustees
Owner Owner's Name
information is required for every Osterville Ma 02655 5/4/18
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank tank must be pumped at time of inspection) locate on site plan):
9 9 ( P P P ) ( P )
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level.' Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
b,
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4�M 448 Wianno Ave
Property Address
Thomas and Victoria Vallely Trustees
Owner Owner's Name
information is required for every Osterville Ma 02655 5/4/18
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert Level and at normal level
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form'
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
448 Wianno Ave
Property Address
Thomas and Victoria Vallely Trustees
Owner Owner's Name
information is required for every Osterville Ma 02655 5/4/18
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology: 18 standard Infultrators
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Clean and dry
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth —top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
448 Wianno Ave
Property Address
Thomas and Victoria Vallely Trustees
Owner Owner's Name
information is required for every Osterville Ma 02655 5/4/18
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 448 Wianno Ave
Property Address
Thomas and Victoria Vallely Trustees
Owner Owner's Name
information is required for every Osterville Ma 02655 5/4/18
page. City/Town State Zip Code Date of Inspection
D. System Information {cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
❑ hand-sketch in the area below
® drawing attached separately
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
448 Wianno Ave
Property Address
Thomas and Victoria Vallely Trustees
Owner Owner's Name
information is required for every Osterville Ma 02655 5/4/18
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 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: July 22nd 1994
Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Test hole data on plan
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
5/7/2018 Assessing As-Built Cards
TOWN OF BARNSTABLE
. LOCATIO, ►��15�� L✓/IJMD �C° SEWAGE# 580
VILLAGE 0 S7-er ASSESSOR'S MAP&LOT�6� . {p
INSTALLER'S NAME&PHONE NO.
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BUILDER OROWNER 1?AU {MG UOr1B 1c� ^�"
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the: ye
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any weus 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
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Commonwealth of Massachusetts
H W Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
wM 448 Wianno Ave
Property Address
Thomas and Victoria Vallely Trustees
Owner Owner's Name
information is Osterville Ma 02655 '5/4/18
required for every
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
❑ inspection Summary: A, B, C, D, or E checked
❑ Inspection Summary D (System Failure Criteria Applicable to All Systems)completed
❑ System Information— Estimated depth to high groundwater
❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
THE COMMONWEALTH OF MASSACHUSETTS ." Lf r3�a 1
BARNSTABLE,MASSACHUSETTS
certificate of Compliance
THIS 8 TO CERTIFY,that the On-site Sewage Disposal.system Constructed( ) Repaired Abandoned( )'by p ('� Upgraded(
)
_ Vr�E�.on® �C�� � 'lrcc�o.
at Arc leW has been constructed in accordance
with the provisions of Title 5 the or Disposal System Construction Permit No.
dated
Installer '���lh e _ , Designer {rei t
#bedrooms Approved desi ow
gPd
The issuance of this permits I n t be construed as a guarantee that the system wi ct' i d. .
Date
` Inspector
---------------------------------------------------- -
h
35 CONTF-NT LN COTUIT MA, 02635
MIKE@DRAINCLEANINGCAPECOD.COM
(508)364-9587
FALLS,ARLINE J
456 Marstons In
Cummaquid
DiBuono Sewer and Drain is pleased to submit a quote for the following septic system repair(s) to the above
mentioned property:Scope of work:3 Bedroom system to be installed according to engineered plans.Dig-Safe to
identify underground utilities.
• Obtain septic upgrade permit for the above property
• Remove fence and set aside.
• Remove shrubs in way of excavation site and set aside for replanting
• Excavate,Pump and fill existing septic tank,Cesspool and or pits.
• Install New 1,500 septic tank unless able to use existing tank
• Tie existing main line into septic tank.
• Pipe from septic tank to new distribution box.
• Excavate leach field. Observe material and install leaching components according to plan.
• Cover leach field with silt blanket.
• Hydraulic cement as needed around pipes at entry points
• Install all necessary Tee's,and gas baffles as per engineered plans.
• Install all risers and covers to proper elevations per engineered plans
• Call for inspection from the Board of health.
• Backfill and machine grade excavated area.Loam and seed disturbed area's
• Clean up work site.Not to include any landscape construction.
• Replace and repair any and all damaged irrigation lines and or heads
• Contract Price:$12,800
Notes:Damages to unmarked utilities,are the responsibility of the homeowner to repair.
Deposit of$10,500 due on acceptance of contract.Remainder due when town issues certificate of compliance.
DiBuono Sewer and Drain will reinstall fencing as is.As well as any shrubs to be transplanted back to original
positions. DiBuono sewer and drain will also loam and seed disturbed area. DiBuono sewer and drain will not
guarantee growth of any grass or shrubs after transplanting and is the home owner's responsibility to water and care
for.
Respectfully Submitted,
Michael DiBuono
President
DiBuono Sewer&Drain Date:
n
v�
�tHEZI
Town of Barnstable
Board of Health
Mai 200 Main Street, Hyannis MA 02601
Office: 508-862-4644 Wayne Miller,M.D.
FAX: 508-790-6304 Susan G.Rask,KS.
Paul Canniff,D.M.D.
January 23, 2007
Mr. Stephen Doyle
Stephen J. Doyle and Associates
42 Canterbury Lane
East Falmouth, MA 02536
RE: 448 Wianno Avenue, Osterville A= 163-026
Dear Mr. Doyle, '
You are granted permission, on behalf of your client,Victoria Vallely, to construct an
additional onsite sewage disposal system designed to be connected to a proposed two
bedroom guest house addition at 448 Wianno Avenue, Osterville, Massachusetts.
This permission is granted pending the submission of floor plans for the existing main —09
house. You testified that the main house contains five bedrooms and the proposed
addition will contain two bedrooms. Thus, the total number of bedrooms will equal
seven bedrooms at this property.
The septic system shall be constructed in accordance with the submitted plans dated
November 21, 2006.
Sinc rely yours,
i
W yne ller, M.D.
Chairm
BOARD OF HEALTH
TOWN OF BARNSTABLE
f
Q:HEALTH/WP//Doyle7B edro oms V allaley07
pU DATE:
REC.BY
MASS Town of Barnstable
SCHED. DATE: / 7 ,
Board of Health . f� -, -
200 Main Street,Hyannis MA 02601 ,
Office: 508-862-4644 Susan G.Rask,R.S.
FAX 508-790-6304 Sumner Kaufman,M.S.P.H.
Wayne A.Miller,M.D.
Application to Construct or Expand to Six (6) or More Bedrooms
LOCATION
Property Address:
Assessor's Map and Parcel Number x Co 3 .- eta Size of Lot: `�8., q(e O
Wetlands Within 300 Ft. Yes Business Name: .
No Subdivision Name:
APPLICANT'S NAME: V A Cl�o rra,tlS \,l Phone
Did the owner of the property authorize you to represent him Jr her? Yes No
PROPERTY OWNER'S NAME CONTACT PERSON '
Name: �1 1r 1,t� �l Name:
£f�
STEPHEN J.DO LE_ ND kSSOCljy-
Address: 20 P Ian A Address: 49CANTER®U0Y,16A'—
1 A FAST FALMOUTH,MASSACt USETTS 02636 vo
Phone: L.1"C n i��, T `-AA 014-4 ::12 Phone- SOS/540 25 --
�1 �1
Checklist
/ Please submit copies in 4 separate completed sets
Four(4)copies of this application form
r Four(4)copies of engineered plan submitted(e.g.septic system plans)
Four(4)copies of labeled dimensionat floor plans submitted(e.g.house plans)
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LOCATIQN ! y (,✓/4440 /al/� SEWAGE # 9 L7'
VILLAGE O ST'CrV, ASSESSOR'S MAP & LOT 143 Dot(O
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY /r+ 1
LEACHING FACILITY: (type) /4F' /r7 t, /A�0/S (size)
NO. OF BEDROOMS
BUILDER OR OWNER ?A M e— U(3rIOU CA
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 leaching facility)''( Feet
Furnished byl1S/1GC /Or)
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INSTALLER'S NAME & PHONE NO. J 6-U i (ax Q j,¢ �
SEPTIC TANK CAPACITY )- oC> Ctcd l
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LEACHING FACILITY:(eyge)-,-T�, F.,Lr fuT�crv�� (s:zej
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER`
DATE PERMIT ISSUED:_ ®r�
DATE COMPLIANCE ISSUED: � i
VARIANCE GRANTED: Yes No
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THE COMMONWEALTH OF MASSACHUSETTS
�t� 2 BOAR® OF HEALTH
Apptiration for M-4pati al Workii Tonitrnrtion Vamit
4 �
_ Application is hereby made for a Permit to Construct (V-1)1"or Repair ( ) an Individual Sewage Disposal
System at:
....:�:�W lAt-lva® *!1.±...�----- f-o-r- 'L C(_�PL Ica�4 � M2� P 1t�3
- ---------• .............................. --- • ----
7'7 I1 Location•Address or Lot No.
.� 7 -P Ar�-� c i A-• i k t�-t.+... .....................• . �• .................S i•.a i l-!-d.!�!f i�:.}.4�.:-!�Q......
Owner Address
W�
................................. -------------------------------
--•--------------------------------•-------•---•-------------------------
................
Installer Address
Type of Building Size Lot--- ...Sq. feet
U Dwelling—No. of Bedrooms...._.._F.!V E.1...................Expansion Attic (ivo) Garbage Grinder (No)
Other—Type of Building ....... No. of persons.......t4&------------ Showers — Cafeteria KtD.
Otherfixtures ....... ................................................................................................................................71 Design Flow....._..1- ...........................
i o gallons per person per day. Total daily flow--------- ......................gallons.
W �10.. (01 !.. !o'Q.r
W �Septic Tank—Liquid capaclty..5�_.gallons Length- WidthP____�.______.. Diameter__.___l.A_____. Depth_._.___......__. '
x Disposal Trench—No. ____18..........._ Width.....0 .......... Total Length.....�aA._...... Total leaching area..:!!�!:Z........sq. ft.
3 Seepage Pit No.... IA.-_-___- Diameter.....-!.16...... Depth below inlet...!-+_1 ....... Total leaching area._ !tJA......sq. ft.
z Other Distribution box (✓S Dosing tank (too)
Percolation Test Results Performed by--- ?�? __.4--►-+`f•r�--•,--! =----------------•----- Date... S .ate:��._._._.-__.
aTest Pit No. 1...E-2.....minutes per inch Depth of Test Pit.....!�............ Depth to ground water_±�__•-___--.
Test Pit No. 2..............minutes per inch Depth of Test Pit-----1.!............ Depth to ground water........................
a ----------------------------- ------•••---••••••-••----••---•••--•---•---------••---•---•--••-•-•-------•-•---•---•----•----•-•--•-••----•--•-•----•--.......
O Description of Soil-- i s a:�L.g� L1`'uP� --�. - aa�o s�n-�e a ............................
V •--_.... 2.S �...6t ?'
• .------- -- •----
s ` •-------•---------------------------•------•-•--•--•---•
-----•-••-----------------••-----------------------••--••-•--------•--•-•---...............---•••--------••..•• .......................................................................................
U Nature of Repairs or Alterations—Answer when applicable....�:/A.................................................................................
-------------------- -----------------------------•--•-----•--•-•----------------•-----------•----••--------------------------•--•-------•--------•-•--------------------------------.......-•--••
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of ComplianNal s ed by the board of health.
Signed ------- '_------------------------------------------------------ Ada
..........
te
Application Approved By ....... ...4,_ �__1--------------------------------------------------------------------------------- -'��_
Application Disapproved for the following reasons: -------------------------------------------------------------------------------------------------------------------------
.................. ......................................................... ........................................................................ ......................................... .. ...................
D.ate....................
Permit No. ......:�..tf...-..t,'��C�.- ............. Issued ..........-.:
,w�-�� Date
e
THE COMMONWEALTH OF MASSACHUSETTS
l BOARD OF HEALTH
............. OF..... ---..............
ApplirFation for Dhipaii al Wurkg Tomitratrtiutt Frrutit
Application is hereby made for a Permit to Construct (__1 or Repair ( ) an Individual Sewage Disposal
System at: / ti
f 4L4-S\t,t a t-1 t.a c� A�I r Q--_S'�•al,l i i:l..l,:^ t.
- ............................•-•--•-•- • . ----•-•• •... ...._..... .........................................-- ............
Location-Address or Lot No.
1 t r a c_I �A j-t2 . `dr 4 >"tyl I c;
L
' ..............•----- - .............. ................................ -•----------......----�-----......i--------------..-.--------
Owner Address
W '
Installer Address
� = ~�1`�3 ri tc Cn
U Type of Building Size Lot________________•---------•Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic (r+U) Garbage Grinder (No)
a a Other—Type e of Building''.' No. of persons '1A_____________yp g _._._.. p Showers (r��) — Cafeteria (rtU)
'1 Other fixtures -------' c?ti,` -----------------------------------------------•---"--•-----....... ---------------•---•----------------------------.
Design Flow............�...........................gallons per person per day. Total daily flow........ .......................gallons.
1:4 Septic Tank—Liquid capacity.!? ..gallons Length. .... Width__.53.. _. .. Diameter. ...... Depth.�!c:'.......
x 'Disposal Trench—No. .._.!13.........._. Width.....!!.......... Total Length..... .......... Total leaching area..-? _---•-_--sq. ft.
Seepage Pit No.... -------- Diameter_... ...... Depth below inlet-._r' s ....... Total leaching area.._!.'ze'.......sq. ft.
Z Other Distribution box ( Dosing tank (wo,)1
~' Percolation Test Results Performed by._.�x1e-: = ..14-±c......................... Date_. .: :• '. ...........
aTest Pit No. 1---�.4'.....minutes per inch Depth of Test Pit_____ .'..__..._... Depth to ground water.. nn� ..........
Test Pit No. 2.......: ......minutes per inch Depth of Test Pit.____'._±..--------- Depth to ground water-.-`'_..................
ts+' -------------------------------------------------------'---------------------'-•••--••••.._....................................•............................
o
Description of Soil.....-- --------••--------------------•-•--'•-•. •---••'•-••--•-•-•-•--••-••---••-•--•-•••---•---..--•--
x ...a ♦. �. .. . ... .. 5... a 1 . A. ..:... i r. f,..(........�A�� �M...... 7
W •--•---------------------------------------------------•------••--•-•'•-•-..............--•'-----••-----••...--•---------------....•••••-•----------•...................._..........................._.
UNature of Repairs or Alterations—Answer when applicable_-__F-1A.......:..........................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the board of health.
Signed -------------------------- ------------------------------------------ ------------------ ----------------------------------------
Date
Application Approved By ....... � w.-... ...per
Application Disapproved for the following reasons: ................................................................... ......... . .. .. ................................
--------------------------- -------------- -- -- ----------............--.....---------....---------- .-- ................:........................................-------------- -------..-------------------------------
Date
PermitNo. -1{r .. .- ..cam-.... .... Issued ........................ ....................
( Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT
..�.. ----------------- OF 15 -----
�... -� ---- ...............................
C�ertiti ate of C�arayliance
THIS IS C RTIFY, t the Indjvidual Sewage Disposal System constructed O or Repaired ( )
y v
.......................... .. ...........
b er
� Installer i
at -"- .-.... -.r— _- " `� :L g3: i -. f9,1:Z v.t "----4._.4E W..--- v - ._. ------ -- .....................
r >.
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ... .�..- .,�-:.. ?.r.1....... dated ------------------------------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
` Inspect ......
=�.._.. ..DATE..... THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No.... !-�... �,> �z t.:� OF l: FEE....jz _'.....
i �rrr or
��ttttilaat rrZYtit
Permission is hereby granted..-•'-' � 4'.. ...............................................................
to Construct (\,,) or Repair ( an Individual Sewage Disposalgystem
at No.......... L :�Y,....-l __!-rAlk=:1?.............
W Street
as shown on the application for Disposal Works Construction Permit Nod .>.;lr'.. Dated.._...Ja-::-...:.jc'''_
•-•--•-•---------------------•---••'---------•--------------------------•---.....•--•---•-•••-•••-....._
i` Board of Health
DATE................................................................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
BARTER NYE9 INC. <
Professional Land Surveyors and Civil Engineers
812 Main Street a Osterville, Massachusetts 02655 Tel. (508) 428-9131
FAX(508) 428-3750
WILLIAM C. NYE, P.L.S.-President PETER SULLIVAN, P.E.-Vice President-Engineering
RICHARD A.BAXTER, P.L.S.-Vice President
October 10, 1995
Board of Health
Town of Barnstable
367 Main StreetY f�
Hyannis , Ma . 02601 :o
a �
Re: 448 Wianno Ave, Osterville
Map 163 Parcel 26 .
Board of Health No. 94--580
Dear Board :
In accordance with the terms .of your permit please be advised
that I personally inspected the above system several times
during its installation . In addition I .had our field crew
verify all inlets/outlets for the system. Based on this
information I certify that the system has been installed in
accordance with the plan of record . However , I did make a minor
field change with respect to piping the leach field from the
D-box. Rather than using a manifold and hitting the system from
the side we piped from the top.
I trust that his meets your present needs . If you have any
questions please feel free to call me directly.
Very truly yours ,
ell OF
xX e & e In
sue. F�'�R
11� N U L L I I.,
ter Sullivan , P. B. ` p ,;e, !s
V. P. Engineering
g gell
t� .012A
y",
MEMBERS OF
CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS I AMERICAN CONGRESS ON SURVEYING AND MAPPING
MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS �� �f
COMMONWEALTH OF MASSACHUSETTS [
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PRO T>✓CTI Nt pri j.. a
TITLE 5
OFFICIAL INSPECTION FORM NOT.FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
r
CERTIFICATION
Property Address: 448:Wianno Avenue
COsterville, MA 02655
Owner's Name: Philip Dubugue c3�`�
Owner's Address:
Date of Inspection: September'15, 2005
Name of Inspector: (Please Print) James M Ford
Company Name: James M. Ford
P Y
4
Mailing.Address: P.O.Box 9
,
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 � t
Condit•onally,Passes
Need urther Evaluation by the Local Approving Authority
Fails
Inspector's Signature: . Date: September 18, 2005
The system inspector shall sub t a copy of this" inspectionreport 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
****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.
Page 2 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 448 Wianno Avenue
Osterville, MA
Owner: Philip Dubuque
Date of Inspection: September 15, 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
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 448 Wianno Avenue
Osterville, MA
Owner: Philip Dubuque
Date of Inspection: September 15, 2005
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: 448 Wianno Avenue
Osterville, MA
Owner: Philip Dubuque
Date of Inspection: September 15, 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 large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped
Zone 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
11.314. The system owner should contact the appropriate regional office of the Department.
4
f
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 448 Wianno Avenue
Osterville, tV.A
Owner: fhilip Dubuque
Date of Inspection: September 15, 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?
✓ _ 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 backup?
✓ _ 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)].
5
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM.
PART C
SYSTEM INFORMATION
Property Address: 448 Wianno Avenue
Osterville, AM
Owner: Philip Dubuque
Date of Inspection: September 15, 2005 °
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms (design): 5 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: 0
Does residence have a garbage grinder(yes or no): n1a
Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required]
Laundry system inspected(yes or no): No
Seasonal use(yes or no): Yes
Water meter readings, if available(last 2 years usage(gpd)): Unavailable
Sump Pump(yes or no): No `
Last date of occupancy: Weekend use
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): ¢pd
Basis of design flow(seats/persons/sgft,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 infonnation: None on file-per treatment plant
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
Other(describe):
r .
Approximate age of all components,date installed(if known)and source of information:
Installed on 312195-per as built card
Were sewage odors detected when arriving at the site(yes or no): No
6
Page 7 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 448 Wianno Avenue
Osterville, MA
Owner: Philip Dubuque
Date of Inspection: September 15, 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)
Depth below grade: 9"
Material of construction: ✓ concrete _metal _fiberglass _polyethylene
_other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 1500 gal.
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: 10"
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: 10"
How were dimensions determined: Measuring 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.):
Tees were present. The liquid level was even with the outlet invert. There did not anneal°to be any signs of leakage
Recommend pumping.
GREASE TRAP: None (locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:,
Date of,last pumping:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
7
j
Page 8 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 448 Wianno Avenue
Osterville, MA
Owner: Philip Dubuque
Date of Inspection: September 15, M05
TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal fiberglass _polyethylene _other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches, etc.):
DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Even
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
The D-box was level. No solids were present.
PUMP CHAMBER: None (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no)
Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.):
8
Page 9 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 448 Wianno Avenue
Osterville, M4
Owner: Philip Dubuque
Date of Inspection: September-15, 2005
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
` Type
leaching pits,number:
leaching chambers,number: ti
leaching galleries,number:.
✓ leaching trenches,number, length: 18 infiltrators-58'x 12'(per design plans) `
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.):
The interiors were clean. There did not appear to be any Sign offailure. The boitorn to grade was 3'.
CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction: '
Indication of groundwater inflow(yes or no):
Comments (note condition of.soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): .
PRIVY: None (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
" r .
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: 448 Wianno Avenue
Osterville, MA
Owner: Philip Dubugue
Date of Inspection: September 15, 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.
O O a
Cam- aO•7 3
�13 " 3s'S
58 "
10
Page 11 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM;INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 448 Wianno Avenue
Osterville, MA
Owner: Philip Dubugue
Date of Inspection: September 15, 2005
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 9.7'+1- 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: 1995
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:
The bottom ofthe leach field to grade was 3'. A test hole was done when the system was installed and water was observed at 9 7'
Using Cape Cod Commission technical data, the high ground water adjustment for this site(MI W 29 Zone A)was 1 8'
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 and/or this report.
11
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE. OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
a -
* TITLE 5
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
RECEIVED `
Property Address: 448 Wianno Avenue
Osterville, MA 02655 OCT 3 0 2001
Owner's Name: Paul McDonough Jr.
Owner's Address: 2 Spruce Street TOWN OF BARNSTABLE
Boston, MA 02108 :,HEALTH DEPT.
Date of Inspection: October]], 2001
4
Name of Inspector:(Please Print) James M. Ford
Company Name: James M. Ford' - *Map. 163
Mailing Address: P.O.Box 49 -Parcel.026
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
N urther Evaluation by the Local Approving Authority
Fail
Inspector's Signature: Date ;October 12, 2001
The system inspector shall sub a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 ;
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to,the system owner and copies sent to the buyer,if applicable,and the approving
authority.
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 I
Page 2 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 448 Wianno Avenue
Osterville. MA . .
Owner: Paul McDonough Jr.
Date of Inspection: October 11, 2001
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)inthe 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.
- i
a
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
Page 3 of 11
OFFICIAL,INSPECtION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 448 Wianno Avenue
Osterville, MA
Owner: Paul MCDonowh Jr.
Date of Inspection: October 11, 2001
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: 448 Wianno Avenue
Osterville, MA
Owner: Paul McDonough Jr.
Date of Inspection: October 11, 2001
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 if large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
1Td•
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped
Zone II of a public water supply well
If you have answered`yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
t
4
Page 5 of 11
}
OFFICIAL INSPECTION FORM.- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
.CHECKLIST
Property Address: 448 Wianno Avenue'
Osterville, MA
Owner: Paul McDonough Jr.
Date of Inspection: October 11, 2001
Check if the following have been done: You must indicate"yes"or"no"as to each of the following; '
Yes No
✓ Pumping information was provided by the owner,occupant,or Board of Health° "
✓ Were any of the system components pumped out in the previous two weeks?
✓ Has the system received normal flows in the previous two week period?
✓ Have large volumes of water been introduced to the system recently or as part of this inspection?
✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
✓ Was the facility or dwelling inspected for signs of sewage back up?
✓ Was the site inspected for signs of break out?
i ✓ 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 6
✓ Existing information. For example,a plan at the Board of Health.
✓ Determined in the field,(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)[310 CMR 15.302(3)(b)]:
5
Page 6 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 448 Wianno Avenue
Osterville, AM
Owner: Paul McDonough Jr.
Date of Inspection: October 11, 2001
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 5 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): Yes
Is laundry on a separate sewage system(yes or no): No [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)): 2000-464,000 gals.; 1999-309,000 gals.
Sump Pump(yes or no): No
Last date of occupancy: Weekend use
COMMERCIAIJINDUSTRIAL
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:
" I
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:None on file -per treatment plant
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
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
Mar. 2195-per as built card
Were sewage odors detected when arriving at the site(yes or no): No
6
a
Page 7 of 11
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION;FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 448.Wianno Avenue
Osterville, MA
Owner: Paul McDonough Jr.
Date of Inspection: October 11, 2001
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: _cist iron ✓ 40 PVC other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: 9"
Material of construction: ✓ concrete metal —fiberglass polyethylene
other(explain) '
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate) >
Dimensions: 1500 gal.
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle- 30"
Scum thickness: • 3"
Distance from top of scum to top of outlet tee,or baffle: 10"
Distance from bottom of scum to bottom of outlet tee or baffle: 11
How were dimensions determined: Measuring 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.):
Tees were present The liquid level was even with the outlet invert. There were no signs ofleakage. Recommend pumping every
three years
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.):
i
. 7
Page 8 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: . 448 Wianno Avenue
Osterville, AM
Owner: Paul McDonough Jr.
Date of Inspection: October 11, 2001
TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: _concrete metal _fiberglass _polyethylene _other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day,
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Even
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
The D-box was level There were no signs of solids or leakage. There were no signs of failure or backup from the leach field.
PUMP CHAMBER: None, (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no)
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
8
Page 9 of 11
OFFICIAL INSPECTION'FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 448 Wianno Avenue
Osterville, MA
Owner: Paul McDonough Jr.
Date of Inspection: October 11, 2001
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
r
If SAS not located explain why:
Type
leaching pits,number: '
leaching chambers,number:-
leaching galleries,number:
✓ leaching trenches,number,length: 18 infiltrators-J4'x 12'(per design,plans)
leaching fields,number,dimensions:
overflow cesspool,number:
Innovativetalternative system Type/name of technology:
Comments(note condition of soil,,signs of hydraulic failure,level of ponding,,damp soil,condition of vegetation,
etc.):
Infiltrators were located but not dug up There were no signs offailure in the D-box. The bottom of the infiltrators to grade was
approximately 3'
CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments (note condition of soil,signs of hydraulic failure,level.of ponding,condition of vegetation,etc.):
PRIVY: Norie (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.):
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: 448 Wianno Avenue
Osterville,MA
Owner: Paul McDonough Jr.
Date of Inspection: October 11, 2001
Map: 163
Parcel:026
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.
AQ- 3S U
Ca- a�•� 3
�13
58 '
. 4
10
Page 11 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 448 Wianno Avenue
Osterville, AM
Owner: Paul McDonough Jr."
Date of Inspection: October 11, 2001
SITE EXAM
Slope A
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 9.7' +/- feet (Adjusted High Ground Water Level is 7.8)
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: 1995
Observed site(abutting property/observation hole within 150rfeet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators,installers-(attach documentation)
AccessedUSGS database-explain:
You m descri
be how you established the high round water elevation:'
must y lg g ,
The bottom of the leach field to ade was approximately 3. A test hole was done when the stem was installed and water was
f gr pp v sy
observed at 9 7'(per design plans) Using the Cape Cod Commission Technical Bulletin the high groundwater adjustment for
this site(MI W 29 Zone A 8101)was 19'
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 and/or this report.
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4„ SCHEDULE 40 P.V.C. OR EQUAL met
MIN. PITCH 1/4" PER FOOT PROFILE OF lYein
TOP OF FOUNDATION
ELEV.-= 13.0'
10 MINIMUM SEWAGE DISPOSAL SYSTEM �.
(NOT TO SCALE) East
Bay
=
q1SER
EL= 11.5,, EL= 11.0'
,,,,,,,,,,,,,,,,,,,,,,,,,,;a:, 6 A ,,,,,,,.,,,,,,,,,,,RISER ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,.,,,,..,..: ,,,,,,.,,,,,,,,,,,,,,,,,,,,,,.,COVER CONC.
RISER & +----4" PVC OBSERVATION PORT CAP TO GRADE
COVER LEVEL. 2" of 118" •- 112" Peastone
FOR2' El. 9.6,2., F W L N ........................I............ ... ..................,...........................:....,:........
EXISTING
INVERT i10 14 INVERT INVERT
INVERT MIN. EL= 9.50' a SUMP INVERT INVERT °8 p8
EL= 10.17 EL 9.87 EL= 9.62 EL= 9.30 o » » T
4 BAFFLE EL= 9.12 gpo,Q 3.14 - 1-112 Double Washed - Crus Stone b oo Neon Pony
6" BASE OF CRUSHED STONE OR o0o Qdo" o ° °e oo� o0 0 0°0 oo Crpstal
MECHANICALLY COMPACTED a "or�� Q . 075 °o °° o El. 8.5' f°
Hfoc 6" BASE OF CRUSHED STONE OR 24' I-Ic? C' U.S MA1
�� MECHANICALLY COMPACTED PROP. DB-4 Total Field l dth 24
a�
_ DISTRIBUTION BOX No. of Fields 1
�; N �6 S�4•S9,°a„ P R O P O S E No. of Distribution Lines Each Field 2 5.0'
W Note: Length of Distribution Lines 23.5' 3.5' 8.0'
1 ,500 GALLON TANK
� tieoce
Remove all unsuitable material 5' around SAS ADJ. HIGH GROUND WATER ELEV.
down to the ,C� layer and replace with clean 0.5'
ran ular sand per 310 CMR 15,255 3 BOTTOM OF TEST HOLE ELEV. ASSESSORS DATA:
\ \fix�sr�Nc b°� 1G � I MAP 163 PARCEL 26
FO
3 \6 OrpgrN NEpG
LOCUS ADDRESS..
#448 N'IANNO AVE, OSTERVILLE NA
3�4„ 1-112" Washed Crushed Stone
~ 2" of 1/8,, _ 1/2" `Peastone REFERENCE CER7° 178235
z
POND \
( TOO O QO
�$ ZOMNG DISTRICT.` RF'-1
rn W �, _ � � 5 0
OVERLAY AP AND RPOD
0.CS 10-
0
�' �� 4' max. BUILDING SETBACKS:•
0* z-ExISTING AWN Nc S 96 4' ;max. FRONT - 30
c 68• L 1010 COASTAL ��.� <'s3°;22 Total Width 13' SIDE AND REAR - 15
6 / T�- � BANK SUFFER��'`. `,
4 `°"w PROPOSED I Eff De th of Field e"
50' COASTAL �"' P
8 BANK BUFFER PROPOSED LEACH BED
tiA LOT 2 / REs 45' 1500 GAL
ly� C ERI,e TANK 24. AS RESERVE » » ,
O0. 98,960±sq.ft. A4 12- F UNE ' D/ �\\ � FEMA ZONE A13 BFE 12 0
B1 (.2 B3 B4 ,'� ' o / , �,\ FIRM PANEL 250001 0016 D
MAP REV. DULY 2, 1992
�D P BANK TRANSECT B
. I 2--EXISTING AWN-2 HINC
DESIGN DATA . JEXISTINI
{ LAWN DUSTING STFM / ?Q DTP zjs 314 0 X BM:
150ANKAt (A / \ ^)9 r. TOP C8 '.
\ o w I Q TP4 ELEV, 11,55 Y
TOTAL PROPOSED DESIGN FLOW = 7 BEROOMS `.// Two eEOR000M / DATUM: GIs
5 BEDROOMS EXISTING (DWELLING) ;zpo cu\sT HOUSE X' �oo�o °°
2 BEDROOMS PROPOSED GUEST HOUSE \ L f / 11.0
( ) ! 21 / X $
EXISTING SYSTEM TO REMAIN FOR EXISTING �s�s POND ��+? XISTING - 12 23�f
N0 BASEMENT
FIVE BEDROOM DWELLING
LUNG
STONE
00� PROPOSED TRELLIS W c d
/z<" r� � 'o �r '3.3R NO COASTAL BANK
PROPOSED 2 BEDROOM DESIGN FLOW: \ G �,'� 14.2y I I
GARBAGE DISPOSAL................NOT ALLOWED \ 0, �� 12�
TOTAL ESTIMATED FLOW c, : m I,. ' DEP
(110 GAL./BR./DAY X 2 BR.) _'220 __ DEP AND TA.B. BANK \ \ c ' 10 ( ( ( I
/ 8 0+0 0+14.07 0+31.60 0+55.46
�-�J Al A2 A3 A4
INSTALL: °F g
13 WIDE X 24 LONG LEACH FIELD WITH 6 EFFECTIVE DEPTH OF 4 6 6 ,o
DOUBLE WASHED STONE AND (2) 4" PVC DISTRIBUTIONS LINES '�s ao \ o
(DISTRIBUTION LINES SHALL BE 23.5' LONG -' LAID TO 0.005% SLOPE) r� �'--- - 12 sr°"F i \ d
c d 13.4x
BOTTOM AREA ONLY: (13' x 24')(.74)= 230 GAL/DAY DESIGN FLOW \ 13sx
N04'40'40„E , 13.6l6
106.p
O \ I DEP (
N� i
- F \ 0+0 0+14.71 D+29.41 0+44.26
)8 Bi 10 82 83 84
99 I
GENERAL NOTES -
GRAPHIC SCALE Tennis - 12 '� 8
Court 14
10
1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P., 30 0 1s 3o eo ,so \
.,
TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS
FOR SUBSURFACE DISPOSAL OF SEWAGE. 16 _o
IN FEET ` , tB Lj 8.8% NO COASTAL BANK I '
2. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE o
1 inch = 30 ft. s
CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE °y o
UNDER OR WITHIN 10' OF DRIVES OR PARKING AREAS THEN THEY
MUST WITHSTAND H-20 LOADING.
3. UTILITIES SHOWN ON PLAN ARE APPROXIMATE ONLY, b / DEP AND T.O.B. ----� I $
THE EXCAVATION CONTRACTOR SHALL CALL "DIG-SAFE" AT 14 ! ; I I
1-800-322-4844 AT LEAST 72 HOURS PRIOR TO ANY EXCAVATION o / i 0+0 0+6.0 0+12,29 0+18.16 " 0+40.84
TO VERIFY LOCATION 'or Cl C2 C3 C4 C5
4. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE
OR WITHIN 6" OF GRADE SHALL BE MORTARED IN PLACE. Health Agent.- Don Desmairis � � �sR9
SITE PLAN OF' LAND
5. FINISH GRADE SHALL HAVE A MINIMUM OF 2% GRADE Test Date: 11--07--06 / Depicting The Proposed Guest house For
OVER THE S.A.S. AND DISTRIBUTION BOX. Soil Evaluator.- Stephen Do le /
6. SEPTIC TANK SANITARY TEES SHALL BE CONSTRUCTED OF y 445 WIANNO A VENUE'
SCHEDULE 40 PVC AND SHALL EXTEND A MINIMUM OF 6" ABOVE COASTAL WETLAND HIGH GROUNDWATER ADJUSTMENT=1.5' ►►►'"����
l �_ .►P�0OTtatissgc t: In
THE .FLOW LINE AND SHALL BE ON THE CENTERLINE AND PERC <2 MIN/INCH 16 � � 2a � ��,� 4�s eAFo y�, ,,
LOCATED DIRECTLY UNDER THE CLEANOUT MANHOLES. o ?v OS tt�rville Massa Ch use t tS
7. THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES. TH #1 TH #2 TH #3 TH #4 16 d , i c szEP�+EN N
EL. 11.5' EL. 11.5' EL. 11.5' EL. 11.5'
8. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS 0„ 0'� p" zp'� 2z / �1D`b i o pOYLE ► Scaler 1" = 30' Date. November 21, 2006
BAFFLE, 4 INCHES IN DIAMETER AND CONTRUCTED OF 4" PVC. ; ��0#375�
FILL FILL FILL FILL 24 ► PES, .�o�i,` Prepared By.•
9. CONTACT DOYLE AND ASSOCIATES 48 HOURS PRIOR 48" 48" 48" 4$" 32, ' / Nos P`r�� Stephen J. Doyle and Associates
TO ANY REQUIRED INSPECTIONS. Sr• y Lane, ,
B LS 10YR 4 6 B LS 1 OYR 4 6 B L5 10YR 4 6 B LS 10YR 4 6 F �oCG 42 Canterbury E. Falmouth MA 02538
10. CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND / / / / /�� Telephone: 5081540-2534
ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING „ " ' " 28 o'er .R e� vi s 3 o n
EL. 5.5 72 EL. 5.5 72 EL. 5.5 72 --- EL. 5.5 72
WORK ON THE SITE, MED. 73"(perc) MED. MED. 73"(perc) MED. ��? \ ary 'A OF
11, NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE C TO ADJ. HIGH C TO ADJ. HIGH C TO ADJ. HIGH C TO ADJ. HIGH , °�
EL. 3.5.0 EL. 3.5.0 EL. 3.5.0 EL, 3.5.0 cHrzrsTltZe
WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT FINE WATER FINE WATER FINE WATER FINE WATER FAIRNENY
IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY, SAND SAND SAND SAND No. 926 y
STANDING " STANDING , STANDING " , STANDING „ w �F w4
EL. 2.0 114 EL. 2.0 114 EL. 2.0 114 EL. 2.0 114 �y� ��sTEa
WATER WATER WATER WATER
2.5Y 6/6 2.5Y 6/6 2,5Y 6/6 2.5Y 6/6 0° SANITaR�a1'
.h
132" 132" � 132" � 132" �yh
EL. 0.5 EL. 0.5 EL. 0.5 EL. 0.5
--06 N0. DATE DESCRIP 170N BY
i
I
ors... - w:.,:. r.-•.. ca�a�
INSTALL RISERS AS REQUIRED TO
WITHIN 12" OF FINISH GRADE DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM
ALL STRUCTURES BURIED FOUR-
NOT TO SCALE
FEET OR .MARE_-SHALL BE H-20
FINISH FLOOR EL = 14.6'
�
(18) -- 3' x 6' STANDARD INFILTRATORS PERCOLATION TEST 00
PROPOSED TOP OF PIER EL = 13.0' cD
PIER WITH 2 OF STONE ON SIDES AND BETWEEN P--4323
FG = 12' f 9-UNIT SECTIONS, 2"' OF STONE ON ENDS TEST HOLE #2 05-07-85 9: 30 AM
TEST HOLE #1EL 11.2'
EL - 10.9' ° BAXTER & NYE, INC. (ENGINEER) C
D.B. 4' PVC MANIFOLD CONLON (BOARD OF HEALTH) U
FG = 10.5 f ° SUBSOIL 2.5 BOTELLO (EXCAVATOR)
• � REF: TOWN OF BARNSTABLE BOARD OF -
HEALTH ON-SITE SEWAGE DISPOSAL 2.5
CONSTRUCTION GENERAL REQUIREMENT 1.15 PERCOLATION RATE: 1" IN '2 MIN OR LESS
MEDIUM
EL = 8.8 SAND
6' CRUSHED O O
CONCRETE STONE U
6 PERC CORRECTED WATER EL = 3.8'
FOOTING , 20' _ 1_0.5' 16' 2.5' ' 2.3' HIGH WATER CORRECTION 0
10' MIN OFFSET 10 WATER o 9.r
MEDIUM WATER EL - 1.V z
1500-GAL 5 12' SAND Q
SEPTIC TANK ~�
• J
11 (m 0.21
:. DESIGN DATA:
_ I
PROPOSED 5-BEDROOM SINGLE FAMILY DWELLING
DETAIL LEACH FACILITY NO GARBAGE GRINDER
DESIGN FLOW: 5 x 110 GPD = 550 GPD -
SCALE: 1" = 20'
SEPTIC TANK: 550 GPD x 150% = 825 GPD
DISTRIBUTION Box USE 1500-GALLON SEPTIC TANK
67' LONG 4' PVC ip MANIFOLD WENDS CAPPED /
n
SEE TOWN OF BARNSTABLE BOARD OF HEALTH ON-
ri � � ^ ,; SITE SEWAGE DISPOSAL CONSTRUCTION GENERAL
•: N REQUIREMENT 1.14 RE LEACHING FACILITY 250 FEET
3' oj FROM WATERCOURSE
•a. .t N
5' :.'. ...:. .• . . .:.• N BOTTOM AREA REQUIRED: 550 GPD/0.75 G/SF/D _ 733 SF
6' USE (18) - 3' x 6' STANDARD INFILTRATORS WITH 2-FEET
54' 2
F
-- -..-- - --- - -- --- cTnn _t1►�I_�nJn nRR FT -I) T - FC LOt�IS._2-FF;T_ - -
I STONE ON ENDS
I TOTAL DESIGN: 767 SF
it
NOTES: `
1. ELEVATIONS REFER TO NGVD
10
2. BORDERING VEGETATED WETLAND DEFINED BY K. S. BARNICLE, co
WETLANDS SCIENTIST, FUGRO-McCLELLAND EAST, INC., FLAGGING �'
DATE: . 06-01-94, FIELD LOCATION DATE BY BAXTER & NYE, INC.:
06-13-94
_3. SOIL TEST P-4323 (05-07-85) BY BAXTER & NYE, INC.,
ADJUSTED GROUND WATER ELEVATION = 3.8 NGVD PER WELL
TSW-89/ZONE A 4 0
4. CURRENT ZONING DISTRICT: RF 1 N
' S 6 pp,pp"V�I N87'41'30"W ��3 32,
MINIMUM AREA: 43,560 SF '
FRONTAGE: 20' , 3p 3g' 47.47' 43 S Op•,W N
LOT WIDTH: 125 6
SETBACKS (FRONT/SIDE/REAR): 30/15/15
MAXIMUM BUILDING HEIGHT IN FEET: 30 /
OR 2 1/2 STORIES, WHICHEVER IS LESSER \
5. LOCUS WITHIN AQUIFER PROTECTION OVERLAY DISTRICT /
0
0
6. LOCUS IS PARCEL 26 BARNSTABLE ASSESSORS MAP 163 / �O
7. SITE FALLS WITHIN FLOOD ZONES A13 EL 12), B AND C, / ,� LINE OF FLAGGED BORDERING �T
FLOOD ZONE LINES SHOWN ON THIS PLAN( ARE DIGITIZED FROM
TOWN OF BARNSTABLE FIRM COMMUNITY PANEL No. 250001 0016 D .����� VEGETATED WETLAND BY ilL A-I O
(REVISED: JULY 2, 1992) � FUGRO-MCCLELLAND EAST
r.,�` ,��o`� FLAG DATE: 06-01-94 A-2 •2
LOCATION DATE: 06-13-94
_ 8. LOCUS IS SHOWN AS LOT 2 ON LAND COURT PLAN 7684C
I / 4 A-3
(1 Sp I
DATED: MAY 21, 1969AL/ 3 BUF e T
A-6 A-4 F '
/ A-8 A-7 JIL
A-5
4.0
3.5
.^� .A 4.5 6
tr7�
>A-14 A-12 3.1 b
A-13 = 3.3 3.9 CD
r .�L 4 w cr
• A-17 " aio a-11
>A-18 x 3.7 Z
/ 10 ,
A-15
>A-16 /
28 6
/ A-19 "-
-2.6 S
0' /
4 4 c w
/ 28 z v
Y 3.7 C o CO o 3.8
Ia) j
��� o o - 7.3
p f --� x 6.6
F
.9 o WORK LIMIT LINE
4 DEFINES LIMIT
tiF rA 8 OF PROPOSED
6 ' 7 0 00.E 1 J CONSTRUCTION
� 6g, I
t .4
• oz
* 9.7 FROAO 1 1 O
10 10 It
1•oAgMi�rSFa Q��
\ 1 61.7' A�FR F< kcc x 11. QQ
11.2 p 71?0• TP 24.4• 9.7
{ 2' PLIRPL H.#1
10 BEECH 10.5 70, RESERVE
AREA
Alp
�� Q 12 e ZONE A13 (EL 12
ZONE B
/ 9.
_ .2 r H. 10 SB FN D
^� Q� .
\ �,Q EL = 10.88'
/ �Z Z� ,• 8. 8 7 9 '• �0 10.5 (NGVD
<O T.H.#3
5 10
10 0', 10
10 F 1 O
� _ p
CB/DH FND
L 0 T 2 11.5
.a
TOTAL AREA: 98,966 SF f
2.27 ACRES t
50 \
ZONE B
ZONE C
^� o
\ h /
P LOT PLAN OF LAN D
IN
5. 6, 9' BARNSTABLE (OSTERVILLE) MASS.
6' 5' 40
cn 'V
in 16' O 1.
SSS. FOR
7.
,
q OF
o F� �0 448 WIANNO AVE REALTY TRUST
F 2Q SCALE: 1 " 40' JULY 22, 1994
rs 16
' \ 3, of
s 2 � � .
PLAN REVISIONS DETAILED BELOW LEFT
38' PETER
4. :► 20' 4. 10, SULLIVAN BAXTER & NYE, INC.
Igo.29733
REGISTERED LAND SURVEYORS
& CIVIL ENGINEERS
eQs-r �� OSTERVILLE, MASS.
off E
w w
`� gl Z�19
BUILDING DETAIL
4 9-26-94 INCREASE SSYT 5-BDRMS JRE GRAPHIC SCALE
SCALE: 1' = 20' 3 9-12-94 REVISE WORK LIMIT LINES JRE
i
9-7-94 REMOVE DECK ENCROACHMENT JRE ��'�4
34' FROM BUFFER ZONE g H
1 9-7-94 REVISE HOUSE DIMENSIONS r JRE �a•29874 ( IN FEET )
1 inch = 40 fL
N0. DATE DESCRIPTION BY ,
94069 (PL02.DWG)
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