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HomeMy WebLinkAbout0102 WIANNO CIRCLE - Health 102Wanno 'Circle Osterville ;P ` A = 140 113 s 1� n I I y. 1 t 9 P i �, ,. ., �. _ � �� �,� _ w a r - (r... . V . F m . . . y.. . .. , . ,� _ .. <, __ .. .. a ,. -- � - , �., .� , ,� . o r, ., 4 _ .. _ , , . �:, � - < .._ �. , . . .. �. c -� � ,;� .��' , . � , �.- ,. � _ � , � •, �. .. �. � -., ,. , , t, ,. . � . ._ � � �.. ,. ,- , a. . � 3� - _ t ,. a .. r "s . eb ��, � t COMMONWEALTH OF MA$SACHUSETTS — a EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS °f DEPARTMENT.OF ENVIRONMENTAL PROTECTION ASSESSORS MAP NO: I D PARCEL NO: TITLE 5 OFFICIAL INSPECTION FORM-;NOT FOR VOLUNTA1gY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM, PART A CERTIFICATION Property Address:` 402 Wianno Circle Osterville:MA 02655 Owner's Name: Jiro&Jean Curlev St-1-�- L �Q Owner's Address: Date of Inspection: May 12:M09 . Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford .Mailing Address:. • P.O.Box 49 Ostervflle.MA 0265S-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. � he inspection was performed based on in 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 - Ne s.Further.Evaluation by the Local Approving Authority Fai s ds Inspector's-Signature: Date May 1.8, 2009 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 ' . 6/1572000 page l Page 2 of 11 ` OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 102.Wianno Circle Osterville,MA Owner: Jim&Jean Curlev Date of Inspection: May 1.2. 2009 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 systetn'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: 102 Wianno Circle 0st&w1le.MA' Owner: Jinn&Jean Curlev Date of Inspection: May 1Z 2009 . 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 thatprotects 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 aseptic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The.system has aseptic 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.pf 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: 102 Wianno Circle Osterville, MA Owner: Jinn&Jean.Curley Date of Inspection: May 12, 2009 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 o cesspool r clogged SAS or Liquid depth in cesspool is less than 6"below invert or available volume is less than.%2 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'l00 feet of a surface water supply or tributary to.a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone l of apublic 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 thewellj IiYee 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.] 110 (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 asurface drinking.water.supply _ the system is within 200 feet If 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 Il of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has.failed. The owner or operator of any large system considered a significant threat.under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 f Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:- 102 Wi'anno Circle Osterville, MA Owner: Jinn&Jean Curley Date of Inspection: Mav 12, 2009 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 )p 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)]. I 5 Page 6 of 11 - OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 102 Wianno Circle Osterville. MA Owner: Jini&Jean,Curley Date of inspection: May 12, 2009 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):. 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440. _ 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): n/a '[if yes separate inspection required] . Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, i,f available(last 2 years usage(gpd)): Unavailable. Sump Pump(yes or no): No Last date of occupancy: Week end use COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203), gpd 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 information: Unavailable Was system pumped as part of the ih. spection(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 technologyr' 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: Date of installation 1111212004 per as-built card Were sewage odors detected when arriving at the site(yes or no): No • 6 Page 7 of. 11 - OFFICIAL INSPECTI'O,N FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 102 Wianno Circle Osterville, MA Owner: Jim&Jean Curley Date of Inspection: May 12, 2009 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 lan Depth below grade: 16" Material of construction: ✓ concrete _metal ' fiberglass —polyethylene- _other(explain) If tank is metal list age: . Is age confirined by Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500 Qal. Sludge depth: 2„ Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 3" Distance from.fop,of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: ]0" How were dimensions determined: Measuring stick Conunents(on pumping recormnendafions,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.). Cement tees were present. The liquid level was even with the outlet invert There did not appear to be any s- inns of leakage 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 outletaee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet:invert,evidence of leakage,'etc.): Page 8 of 11 . r OFFICIAL INSPECTION,FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:. 102 Wiann o Circle Osterville, MA Owner: Jinn&Jean Curley Date of Inspection: May 12, 2009 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 normal PUMP CHAMBER: 'None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Commnents.(note condition of pump chamber,condition,of pumps and appurtenances,etc.):' ;T - 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: 102 Wianno Circle Osterville, MA Owner: Jinn&Jean Curley Date of Inspection: May 12. 2009 SOIL ABSORPTION SYSTEM(SAS): ✓ .F (locate on site plan,excavation not required) If SAS not located explain why: . Type leaching pits,number: leaching chambers,number: 3-S00 eal. chambers 12 8'x 33 3'x 2'per as-built leaching galleries,number: leaching trenches,number,length leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure,level of ponding;damp soil,condition of vegetation,etc:): The Chambers were dry and clean There did not appear to be any signs of failure A camera was used for the inspection 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);.... . Continents (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: Coir vents(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 I Page 10 of 11 'a OFFICIAL INSPECTION.FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 102 Wianno Circle Osterville.MA ; Owner: An&Jean Curley Date of inspection: Mav 12.2009 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. L,,I.Lk as r a 3 3 3 s Yo 0 " 1 10 Page 11.of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.0 SYSTEM INFORMATION(continued) Property Address: 102 Wianno Circle Osterville. MA Owner: Jim.&Jean Curley Date of Inspection: Mav 12. 2009 SITE EXAM. Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25 +/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS): ✓ - Checked with local Board of Health-explain:. Topographic and water,contours tizapS Checked with.local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours mans the inaps were showinzapprox nzately 25'+/ to ground water at this site. This report has been prepared only for the septic systemi and components described herein. This septic systeni/zas been inspected and passed as of the.date of inspection. This report is not a warranty or guarantee that the systeni will f properly f Have been no warranties or guarantees, either expressed, written.or iniplied, unctionin the' uture. There' relating to the.septic system; the inspection,this report andlor any components of the septic systeni which have not been located and inspected.. 11 L • Town of Barnstable P# u 0 Department of Regulatory Services Public Health Division DateMASS. � i639 �e� 200 Maio Street,Hyannis MA 02601 ATEO MAC�' Date Scheduled Time I Fee Pd.� r d� Soil Suitability Assessment for Sewage DzsposaZ Performed By i '� t Witnessed By: D C�- LOCATION &GENERAL INFORMATI N Location Address i U w1'v,^^ a:r t Owner's Name ' y� I Address Assessor's Map/Parcel: l Li G' 113 Engineer's Name NEW CONSTRUCTION REPAIR Telephone# Land Use �.. Slopes(%) Surface.Stones Distances from.: Open Water Body—�`-` —ft Possible Wet Area oD ft Drinking Water Well eft Drainage Way t ft Property Line _ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) I 171 v/�, 119, V � i Parent material(geologic) l 1 Depth to Bedrock Depth to Groundwater. Standing Water in Hole: � Weeping from Pit Face„,,, , _ �. i Estimated Seasonal High Groundwater eL. �•� DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: *��atrw= Depth Observed standing in obs.hole: __ in. Depth to Sail mtiltlu,,; Depth to weeping from side of obs.hole: • — ill, Groundwater Adjustment A. Index Well# Reading Date: Index Well level— Ad).factor.,,,. Adj.deaUndwOter Level V PERCOLATION TEST Date 01- Time Observation Hole# __�___ Time at 9" Depth of Perc ' Time at 6" Start Pre-soak Time @ .p ';� Time(9"-6") End Pre-soak Rate MinAnch 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. QASEPTICIPERCFORM.DOC L_ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel z.W--(.er --- DEEP OBSERVATION HOLE LOG Hole# `L Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsistenc %Gravel Me DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. or'sisten o ravel Flood Insurance Rate May: Above 500 year flood boundary No_ Yes _ Within 500 year boundary No— Yes Within 100 year flood boundary No_ Yes a Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervio s material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pery us material? Certification I certify that on i (date)I have passed the soil evaluator examination approved by the Department of Enviro ental Protection and that the above analysis was performed by me consistent with the required training,expe ise an perience described in 310 CMR 15.017. Signature Date L,.A— Q.\SEPTICIPERCFORM.DOC a Commonwealth of Massachusetts ■ 1100011313 Ll Asbestos Notification Form ANF-001 Decal Number Important:When filling out A. Asbestos Abatement'DescriP tion forms on the computer,use 1. a. Is this facility fee exempt-city, town, district, municipal housing authority, owner-occupied only the tab key residence of four units or less? I✓i Yes ! No our I to cursor move do not b. Provide blanket decal number if applicable: Blanket Decal Number use the return key. 2. Facility Location: l.J�R.nnU I jAllergio i 1102 Winno Circle a.Name of Facility b.Street Address SAW BARNSTABLE j !MA 0265 c.City/Town d.State e.Zip Code f.Telephone Number INSTRUCTIONS 3. Worksite Location: r 1.All sections of this 'exterior j I form must be a.Building Name/Building Location b.Building# c.Wing d.Floor e.Room completed ir.order to comply with 4. Is the facility occupied? ❑Yes R] No DEP notification requirements of 310 CMR 7.15 5. Asbestos Contractor: and the Division 'NEW ENGLAND SURFACE MAINTENANCE 1850 WASHINGTON STREET of Occupational i i Safety(DOS) a.Name b.Address notification WEYMOUTH i02189 1781-337-2117 requirements of 453 i I CMR 6.12 c.CityFrown d.Zip Code e.Telephone Number 'AC000196 f.DOS License Number g. Contract Type: (�Written I Verbal i h.Facility Contact Person i.Contact Person's Title IJOHN P VALLIQUETTE !AS060773 6' a.Name of On-Site Supervisor/Foreman b.Supervisor/Foreman DOS Certification Number n/a n/a a.Name of Project Monitor b.Project Monitor DOS Certification Number n/a in/a 8' a.Name of Asbestos Analytical Lab b.Asbestos Analytical Lab DOS Certification Number =0 9 11124/2004 111l2412004 a.Project Start Date(mmldd/yyyy) b.End Date(mm/ddlyyyy) 0 8-4 j i �N c.Work hours Mon-Fri. d.Work hours Sat-Sun. g--o 10. a.What type of project is this? oitJi Demolition 1 Renovation Repair ❑Other, please specify: b.Describe 11. a. Check abatement procedures: o Fj Glove bag ❑ Encapsulation o Enclosure I Disposal only ✓! Cleanup ❑ Other,specify: -- Full containment b.Describe _ =Q 12. Is the job being conducted: I✓i Indoors? Outdoors? ■ anf001ap.doc-10/02 Asbestos Notification Form-Page 1 of 3 Commonwealth of Massachusetts ■ 1100011313 Asbestos Notification Form ANF-001 Ll Decal Number A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed, enclosed, or encapsulated: 10 1 130 j a.Total pipes or ducts(linear ft) D. I otal other surfaces square c.Boiler,breaching,duct,tank I d surface coatings Lin.ft. Sq.ft. .Insulating cement Lin.ft. Sq.ft. e.Corrugated or layered paper I f.Trowel/Sprayer coatings pipe insulation Lin.ft. ,Sq.ft. Lin.ft. Sq.ft. i 7­71 r ­ ' . g.Spray-on fireproofing i h.Transite board,wall board 30 Lin.ft. Sq.ft. Lin.ft. Sq.ft. i.Cloths,woven fabrics L I j.Other,please specify: i I Lines S_q ft.__- ___ i Lin.ft. Sq.ft. k.Thermal,solid core pipe insulation Lin.ft. Sq.ft. I.Specify 14. Describe the decontamination system(s) to be used: as required 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g): las required 16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: a.Name of DEP Official b.Title c.Date(mm/dd/yyyy)of Authorization d.DEP Waiver# e.Name of DOS Official f.DOS Official Title I �N g.Date(mm/dd/yyyy)of Authorization h.DOS Waiver# _0 17. Do prevailing wage rates as per M.G.L. c. 149, §26,27 or 27A—F apply to this project? ❑Yes Q✓ No B. Facility Description �0 1. Current or prior use of facility: residence �o 2. Is the facility owner-occupied residential with 4 units or less? Q Yes ❑ No same I 3' a.Facility Owner Name 1b.Address o c.City/Town d.Zip Code e.Telephone Number(area code and extension) LL 4' a.Name of Facility Owner's On-Site Manager Ib.On-Site Manager Address Q c.City/Town d.Zip Code e.Telephone Number(area code and extension) ■ anf001ap.doc•10/02 Asbestos Notification Form•Page 2 of 3,,■ i Commonwealth of Massachusetts 100011313 Asbestos Notification Form ANF-001 Decal Number Ll B. Facility Description (cont.) I � i 5' 'a.Name of General Contractor b.Address j c.City/Town d.Zip Code e.Telephone Number(area code and extension ----------------- i I i I f.Contractor's Worker's Comp.Insurer A.Policy Number h.Exp.Date mm/dd/ i 6. What is the size of this facility? a.square Feet b.Number of floors C. Asbestos Transportation and Disposal 1. Transporter of.asbestcs-containing material from site to temporary storage site.(if necessary): 1NESM Note:Transfer a.Name of Transporter � 7 b.Address Stations must ! comply with the c.City/Town d.Zip Code e.Telephone Number Solid Waste Division 2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site: Regulations 310 CMR 19.000 Waste Management a.Name of Transporter b.Address c.City/Town d.Zip Code e.Telephone Number 3. i a.Refuse Transfer Station and Owner b.Address c.City/Town d.Zip Code e._Telephone Number 4. iTURNKEY LANDFILL(WASTE MGT NH) a.Final Disposal Site Location Name b.Final Disposal Site Location Owner's Name 7 ROCHESTER NECK ROAD ROCHESTER c.Final Disposal Site Address d.City/Town NH 103839 I ; e.State f.Zip Code g.Telephone Number �o D. Certification �N The undersigned hereby states, under the :Jim Doyle penalties of perjury,that he/she has read the a.Name b.Authorized Signature �o Commonwealth of Massachusetts regulations j for the Removal, Containment or c.Position/Title d.Date(mm/dd/vvvv) Encapsulation of Asbestos,453 CMR 6.00 and ; 310 CMR 7.15,and that the information i contained in this notification is true and correct e.Telephone Number f.Representing to the best of his/her knowledge and belief. o g.Address i V. h.City/Town is Zip Code anf001ap.doc•10/02 Asbestos Notification Form•Page 3 of 3 Commonwealth of Massachusetts i 1100011314 i Asbestos Notification Form ANF-001 Decal Number Ll Important: ortant: A. Asbestos Abatement Description,filling out " forms on the computer;use 1• a. Is this facility fee,exempt-city, town, district, municipal housing authority,owner-occupied only the tab key, residence of four units or less? 'E Yes '—' No to move your cursor-do not b. Provide blanket decal number if applicable: Blanket Decal Number use the return key' 2. Facility Location: _ 'Allergio 1102 Winno Circle a.Name of Facility bb.Street ry - }Barnstable ' 1MA 102655 __�_ �1•° 1 c.City/Town - d.-State e.Zip Code f.Telephone Number - INSTRUCTIONS 3. Worksite Lbcaticn: basement 1.All sections of this j form must be a.Building Name/Building Location b.Building# c.Wing d.Floor e.Room completed in order to comply with 4. Is the.facility occupied? i,-7.Yes !,�i No DEP notification requirements of 310 CMR 7.15 5. Asbestos Contractor: and the Division of Occupational 'NEW ENGLAND SURFACE MAINTENANCE "' 850 WASHINGTON STREET Safety(DOS) a.Name b.Address notification requirements of 453 iWEYMOUTH 02189 781-337-2117 2MR•6.12i,, c.City/Town d.Zip Code e.Telephone Number is r 1 t;:,. .'' •,L i. sa s 7-1 AC000196 w er ntract Type: Written f DOS,License Number gs1 UKFb o �i a h:Facility-Contact Person i'Contact Person's_Title. ._.. __ _ ___....__.._.__..... ...... JOHN P-VALLIQUETTE ter 1 IAS060773 6• a.Name of On-Site Supervisor/Foreman b.Supervisor/Foreman DOS Certification Number �S. Cohen ' ' ; IAM060787 7' a.Name of Project Monitor, b.Pro ectMonitor DOS Certification Number Envirotest Lab ! IAA000128 8. a.Name of Asbestos Analytical Lab" b.Asbestos Analytical Lab DOS Certification Number 112/02/2004 = 12/02/2004 a-O 9• a.Project Start Date(mm/dd/yyyy) b.End Date(mm/dd/yyyy) I �0 18-4 , r �N c..Work hours Mon-Fri. d.Work hours Sat-Sun. =0 10. a.What type of project is this? —0 ;^ Demolition �✓ .Renovation Repair. -`-F—]"Other, please specify: b.Describe . 11. a. Check abatement procedures: 1=! Glove bag . Encapsulation ��o 'Enclosure'_ __' ._ ❑ Disposal only ` �.._ . ... .•.._ �._ _L Cleanup .__._. [I Other,specify:... -- 12 Is the lob being conducted ✓11ndoois� r'Outdoo.rs� Warif001ap.doc•10/02 ,; ' ., rs r >' Asbestos Notification Form-Page.1 of 3 ___ _ Commonwealth of Massachusetts 1100011314 Asbestos Notification Form ANF-001 oecaLNumber Ll A. Asbestos.Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed, enclosed,or encapsulated: j01 :1000 a.Total pipes or ducts(linear ft) b.7—otal other surfaces square c.Boiler,breaching,duct,tank cement Insulating surface coatings Lin.ft. Sq.ft. d. Lin.ft. Sq.ft. e.Corrugated or layered paper �� Ir s er coatings ra TroweVSpy g I i pipe insulation Lin.ft. Sq.ft. f. Lin.ft. Sq.ft. r l i g.Spray-on fireproofing h.Transite board,wall board Lin.ft. Sq.ft. Lin.ft. Sq.ft. i.Cloths,woven fabrics is Other,please specify: (Lin.ft. � S Lin ft Sg ft k.Thermal,solid core pipe I j j �i Iyat insulation Lin.ft. Sq.ft. I.Specify 14. Describe the decontamination system(s)to be used: !as required 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g): jas required 16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: a.Name of DEP Official b.Title r c.Date(mm/ddlyyyy)of Authorization d.DEP Waiver# I . e.Name of DOS Official f.DOS Official Title 1 g.Date(mm/dd/yyyy)of Authorization h.DOS Waiver# 17. Do prevailing wage rates as per M.G.L. c. 149, §26,27 or 27A—F apply to this project? ❑Yes[! No B. Facility Description �0 1. Current or prior use of facility: 1 residence �o 2. Is the facility owner-occupied residential with 4 units or less? ✓Yes ❑No 3' a.Facility Owner Name b.Address o c.City/Town d.Zip Code e.Telephone Number(area code and extension) .-LL 4 I a.Name of Facility Owner's On-Site Manager b.On-Site Manager Address __Z ( i Q c.City/Town d.Zip Code e.Telephone Number(area code and extension) anf001ap.doc•10/02 Asbestos Notification Form•Pa qe,2 of 3,� Commonwealth of Massachusetts ■ 1100011314 Asbestos Notification Form ANF-001 Ll Decal Number B. facility Description (cont.) 5' a.Name of General Contractor b.Address c.City/Town d.Zip Code e.Telephone Number area code and extension f.Contractor's Worker's Comp.Insurer .Policy icy Number h..Exp.Date(mm/dd/yyyy) 6. What is the size of this facility? I a.Square Feet b.Number of floors C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary,storage site(if necessary): NESM I I Note:Transfer a.Name of Transporter b.Address i Stations must comply with the c.City/Town d.Zip Code e.Telephone Number Solid Waste Division 2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site: Regulations 310 CMR 19.000 'Waste Management j a.Name of Transporter b.Address I c.City/Town d.Zip Code e.Telephone Number 3. a.Refuse Transfer Station and Owner b.Address c.City/Town d.Zip Code e.Telephone Number 4. iTURNKEY LANDFILL(WASTE MGT NH) a.Final Disposal Site Location Name b.Final Disposal Site Location Owner's Name 7 ROCHESTER NECK ROAD IROCHESTER c.Final Disposal Site Address d.City/Town INH j 03839 e.State f.Zip Code g.Telephone Number M �O D. Certification N The undersigned hereby states,under the (Jim Doyle penalties of perjury,that he/she has read the a.Name b.Authorized Signature �o Commonwealth of Massachusetts regulations ( �— for the Removal,Containment or c.Position/Title d.Date(mm/dd/vvw) Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15,and that the information contained in this notification is true and correct e.Telephone Number f.Representing to the best of his/her knowledge and belief. j o q.Address i h.City/Town i.Zip Code ■ anf001ap.doc•10/02 Asbestos Notification Form•Page 3 of 3 ■ ova- , No .................... F,ss..,/ ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD PF HEALTH _..4&uAk-OF...... .... .................................... . � ,Apure#inn for Dhipmial Warkii Tiatmarnrtion Vrrnift Application is hereby made for a Permit to Construct ( ) or Repair ( In ividual Sewag \_Disposal System at: Ty rV0,0t.'— W ° Lo o ddress or Lot No. Owner Address a c .--------: .... ....................................................... ............................... .._-_._.._....._._.._.._.............__. Installer Address Q Type of Building Size Lot...-------------------------Sq. feet U Dwelling 1-No. of Bedrooms------------�__________ _____________Expansion Attic ( ) Garbage Grinder ( ) aq Other—Type of Building .---_--.--_--------------- No. of persons......._----__-__---__---_- Showers ( ) — Cafeteria ( ) Pa Other fixtures ----- ------------------------ - - W Design Flow__ ____... �_______________________gallons per person per day. Total daily flow__-_--_-. 60 gallon~. ---------------------------- WSeptic Tank Liquid capacity/jC-1"0gallons Length................ Width................ Diameter_--.-_-..-_--_ Depth..-.--._--:---- x Disposal. Trench—No_-------------------- Width-------------------- Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No.......!............ Diameter.... 6 --. Depth below inlet..... ........... Total leaching area.__.__.----------sq. t`t. Z Other Distribution box ( ) hosing tank ( ) (�, 7S aPercolation Test Results Performed by-------- -- ----------------------------------•----•-----•---------------- Date........................--------------- ,� Test Pit No. 1..._----------__minutes per inch Depth of "Pest Pit.................... Depth to ground water..----_---.-..-._-.-__-- f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to vAound water..._.-.---_----._-__---- �+ ir----------rt --- --- - -- ----- Description of Soil---------�--0...---....--......- ---��•--=----. / ...---------...------...-------------.....--•-----�..--- �_'�___�e .. x W U Nature of Repairs or Alterations—Answer when applicable._---------------------------------------------------------------------------------------------. -------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: , The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' ued by ghee board of he*h. ° 0 te Application Approved By----- ... --------------------- . _-_ ...__.. Date Application Disapproved for the following reasons:-----•-----------------•-------------------------------•-•----•---------.---_--_--..-..---....----•--------•-•-- --....-•-----••.....................•-• ------------•-- Permit No. Issued 7 Date---•-. Date No.................n....... FRx... ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH --------.OF.................................... ----------......................................... Appliration -for Mapuiial Works Tomitrurtion Vantit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ,3_3 ................................................................................ I- Loc.�..,. r Lot No. S . ........ ......................... .................. ........... ..........................................0...................................................... Owner Address Installer Address Type of Buildly Size Lot............................Sq. feet Dwelling !—No. of Bedrooms-------------Q2...........................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons..____--__-_______-____---__ Showers Cafeteria QI Other fi 11tures ---------------------------------------------------------------------------------------------------------------------------------------------------- Design Flow.. _6­0 _-gallons per person per day. Total daily flow..........02 00 allons. ----- ------------------------ .............................g, Septic Tank Liqu id d capacity,/�if7�allons Length................ Width_.____._..._....... Diameter._...__._.._____ Depth._..._.___..... xDisposal Trench—Nc...................... Width-__--___-____--_____ Total Length._..........._...._. Total leaching area........ ...........Sq. f t. Seepage Pit No-------/------------ Diameter..../ ....Z....... leaching area------- ... Depth below Total leach' -------sq. it. 7 73- Z Other Distribution box i5osing tank ( ) 0 - / Percolation Test Resu mtespetsrformedDate........................................ 0-1Test Pit NoI . mrinch Depth of Test Pit.................... Depth to ground water-----------------_---- rXq Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water-_--------------------- ------------•"I--- .......................... S------- - / --;�------------ 0 — 1 Description of Soil--------- ................. ................................................. �4 ----------------------j------ ------------- -------- ......................................................................................................................................................................................................... --------------- ------- ------------- ----------------------------------------------------------------------------------------------------------- ----------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement:' The undersigned agrees to install the aforeclescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been,i4ued by the board of he 11h A. ttssCC Si d ......................... ........rt-e 7 Application Approved By. .. .. ....... ...... Date Application Disapproved for the following reasons:---------------------------------------------------------------------------------------------------------------- ...................................................................................................................................................................................................... Permit No. Issued.... .. .. ,ate............ ........... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........OF... ..................... (Infifiratr of 0XImplitturr THIS 0 TIFY, That the Individual Sewage Disposal System constructed ZT-®r Repaired by...................... ............. .... --- ---- .......................................................................................... -----------------...��instali at..--Z2... . ...Vt. .... .. ....... ........ ...I...... .......................................................................................... has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No------t—F---7. .. . .......... dated.....7-7-1........Z.1 ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS RUED A5 A GUARANTEE THAT THE SYSTEM WILL FUNCTIO)4 SATISFACTORY. DATE.......440�. .............................................................. Inspector-----;P -------------11�­............ --------------- THE COMMONWEALTH OF MASSACHUSETTS 77. BOARD OjF HEALTH 7 .....OF.......... ................................. No...tJ7.—./.......... FEE_/49�------------ Permission is hereby granted.................................................................. to Construc,(/�/or Re i , I ( ) an a age,0,p d& I sew osal ��tem ... .... er a- I J-- - .. ---- ------------------------------------------------------------------------- Strek a .7J as shown on the application -7.) on for Disposal Works Construction P No.. . .........../-? Dated--—---- - ..... .... ..... ....... ............................ Boar ..of Health .................. ------------------------------------- DATE.....it. 4- 7 _ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) IMF^ DAmA TOWN OF BARNSTABLE V LOCATION 10a. UJ I AAA 0 C l rG SEWAGE# 6q - J l VILLAGE ��1-Z ASSESSOR'S MAP&PARCEL NO 113 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY S� LEACHING FACILITY:(type) 3 ' SCJp CA�, C, ,(size) /ate 33.S X NO.OF BEDROOMS / OWNER C.Urle, Gr PERMIT DATE: COMPLIANCE DATE: 'Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY s. ,ihe . V ^ O a43 i 3 a 3o a� 3 3s Yo y y 410 Y(0 �� TOWN OF BARNSTABLE t`� 'AT10N i vo{ l�r/;o.�ny %t': SEW' VILLAGE 05ferN• ASSESSOR'S INSTALLER'S NAME&-PHONE NO. SEPTIC TANK CAPACITY Ira 09 LEACHING FACILITY: (type) 3' I chi-v-7A22 (size) 92)(53. S-x� NO.OF BEDROOMS BL`ILDE OR OWNER f`P e'1 PERMITDATE: //' S' 01Y COMPLIANCE DATE: I Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Y70 • L t ®••gas O'rG�'r ._ _.. .�.^ --, 2 e�"OYmrvy D-adx 3 S /c�udi.A /O tv f II-, r TOWN OF BARNSTABLE LOCATION U (--J)A/1'1 O GI�(�� SEWAGE # NM,LAGE U M fyl l� ASSESSOR'S MAP & LOT l y INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY IM . GQ LEACHING FACILITY: (type) �' 1n r, r� �'1 (size) NO.OF.BEDROOMS 3 BUILDER OR OWNER Bill CCr t 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 leachipg facility) --�— Feet Furnished by�r►spGtTiD� A Q i 3T a� y s7 a9 1" c I I� w p 5 y No., ® FEE 1510 r' 90 COMMONWEALTH OF MASSACHUSETTS, Board of Health, cri�Cr� MA. APPLICATION FOR DISP®SAI. YSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) - O Complete System 0 Individual Components Location t()-L N"�g CAM, j Owner's Name Map/Parcel# Address Lot# , Telephone# Installer's Name Designer's Name,TEPHE` �. J.DQE AN Address Address 42 CANTERBURY LANE Telephone# Telephone# 508/540-2534 Type of Building Lot Size sq.ft. 2wellr in o.of Bedrooms Garbage grinder ( ) -Type of Building No.of persons Showers ( ),Cafeteria( ) Other Fixtures Design Flow (min.required) AdcQ gpd Calculated design flow Design flow provided gpd Plan: Date 0� � � Number of sheets 9 Revision Date Title 5;gr!6 yA�A `o';e- C(s 10—L Description of Soil(s) 1;1%rt (�Z La Soil Evaluator Form No. to wy) Name of Soil Evaluator 5• Date of Evaluation to"0 DESCRIPTION OF REPAIRS OR ALTERATIONS The tmdersi d agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further a es o t to ace th to o e lion until a Certificate of Compliance has been issued by the Board of Health. Signed Date �"�� t� No r}]} , �i . r I 6, FEE /. •'�" P C®M ®NW ,LjH`,O4M 4SSACHUSETT. 1 Board of Health, ':I "7Lt`�-, MA. APPLICATION FOP DISPOSAL YSTEM CONSTRUCTION PERMIT Application for a Perm to Construct( Repair( ) Upgrade( Abandon( ❑CompleteSystem- ❑Individual Components Location p w Owner's Name I Map`/Parcel# ' p \1 Address Lot#- r ''j Telephone# I ' 'Installer's Name Designer's Na I. �'fEPHE\J. DO1 LE AND ASSOCIATES ;t Address Address 42 CANTERBURY LANE EAST FALMOUTH MASSACHUSETTS 02536 Telephone# Telephone# 508/540.2634 Type of Building Lot Size" iA w�- t sq.ft. Crwt-�elling- o.of Bedrooms Garbage grinder ( ) er-Type of Building No.of persons Showers ( ),Cafeteria( Other Fixtures re Flow n Desi min.required) AAA j g ( /q ) gpd Calculated design flow�� Design flow provided���. gpd Plan: Date W Number of sheets Revision Date TitleLtr�w..i1 oi�' -aA•�1A7cG, 1D"t. W�►-1t1��� �t1. ' Description of Soil(s) Soil Evaluator Form No. 1J 0lo Name of Soil Evaluator S Date of Evaluation Its 10 "0 DESCRIPTION OF REPAIRS OR ALTERATIONS ft . The undersi d agrees to install the above described Individual Sewage Disposal System in accordance%ith the provisions of TITLE 5 and further agr es to I-ft t to Vlace the system o eration until a Certificate of Compliance has been issued by the Board of Health. Signed Date LH. e- ✓I i O %- el�,�O& No. �(./'c FEE 6`6 X �f COMMONWEALTH OF MASSACIIUSETTS 4} Board of Health MA, CERTIFICATE OF COMPLIANCE r Description of Work: ❑Individual Component(s) ❑Complete System The undee'r�sii ned hereby/�certify�the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ,Abandoned (. ) r} at /0- A /)PAU/610 Ll lt-(-L has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow (gpd) Installer ! G- ,l Designer: Inspector: Dater The issuance of this permit'shall not be construed as a guarantee that the system will function.as designed. No. FEE I COMMONWEALTH OF MASSAC14USETTS Board of Health, DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is herebygranted to; Construct( ) Repair( ) Upgrade( ) Abandon( ( ) an individual sewage disposal system at / _ V as described in the application for Disposal System Construction Permit No. , dated Provided: Construction shall be'.completed within three years of the date d is 1 local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkln Co.Boston,MA Date 11U Board of Health i TOWN OF BARNSTABLE 'G� LOCATION SEWAGE # IVILLAGE fer y;L/-C .ASSESSOR'S MAP & LOT /J!O-//3 INSTALLER'S NAME&PHONE NO. J, C. tag /7 o SEPTIC TANK CAPACITY !rO 47 LEACHING FACILITY:-I.h'pe) (size) NO. OF BEDROOMS BOR'OWNER PERMTTDATE: //— COMPLIANCE DATE: 1 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water.Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by A Covers 9 44 Town of Barnstable '"E Regulatory Services Thomas F.Geiler,Director * anexsrasis I � Public Health Division 6 ,,• Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date:`/ Sewage Permit# ®�y r _��Assessor's Map�Parcel /��1113 Designer: SEEPHEN d DO +SSOCIAT Onstaller: 42 CANTERBURY LANE dr1d �0�OX 33,g Address: EAST FALMOUTH,MASSACHUSETTS 025M Address: 508/540-2534 A,�,roNs On /�" 5' ®y qa was issued a permit to install a (date) (installer) septic system at 1 Z ' ���L�� based on a design drawn by (address) Sftbl�r� J 190�z/e Qs-W, dated (designer) i certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. ��°AA"� ,4-4 ®�����of 144,S''S �a o Q. C STEPNE:N (Installer's Signature) m (Designer's Si ature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc .. ' �. • TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE �� r`y t�1,Q., ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SCO C1 L-a,J\V- 2 -SN SEPTIC TANK CAPACITY 1 b0 - L- kC. LEACHING FACILITY:(type) �S"n�e.`�r� �(si'ze) �Jr ShL-4, NO. OF BEDROOMS PRIVATE WELL O, PUBLIC4 TER BUILDER OR OWNER C�\ DATE PERMIT ISSUED: �,� lei DATE COMPLIANCE ISSUED: .VARIANCE GRANTED: Yes No J . . R ASSESSORS MAP NO:_� o ---- No.._T4 133 PARCEL NO: I Fi3ca.. ............ THE COMMONWEALTH OF MASSACHUSETTS .. BO�eRD OF HEALTH APPROVE® T"" WN OF BARNSTABLE Barmuaft ;, .� on is ere b rmit to Construct ( ) or Repair ( .v an Individual Sewage Disposal System at: ..a '� ............ ....... ..i.��,.�re-�. -�••---•----•--•---•-- 1. Local' i eVd rss or Lot No. 1 \t� Cr✓\ 4"t ��i�,Q� w er Add s a moo. (� c Installer Address Q Type of Building Size Lot............................Sq. feet V Dwelling— No. of Bedrooms----------------------------_ _ . -Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures _______________________________ __ W Design Flow............................................gallons per person per day. Total daily flow......................._....................gallons. WSeptic Tank—Liquid capacity-_/aQ.gallons Length________________ Width................ Diameter................ Depth................ x Disposal Trench—No. .....:................ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test,Results Performed by.......................................................................... Date---------------- -------- ,4 Test Pit IN6..1•-.__- _......minutes°per inch Depth of Test Pit-------------------- Depth to ground water........................ fZ4 Test Pit, o�2:_.-- _-_---minutes per inch Depth of Test Pit.................... Depth to ground water........................ A; -------------: ...... Description-:of Soil �`-----------------•-------------------------------••-•---•--••-----------------------------------------...----......-.............................................. U . 2. W .........•------------------------------- a......t:. . U Nature of Repairs or Alterations—Answer when applicable 1.___ .._ ..��-Cam...._ 5 _ �.Q-... _L h. ....... 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 is rd of health. oldSigned ..... ................. .... .� �.....:.... Dace ApplicationApproved By ........ .. .. .................................................. Date Application Disapproved for the following reasons: .......................................... ......................................................................................... ------------------------------ -- -------- ------------------------------------------------------------------------------------------------------------------------------------------------------------ ............................ Date PermitNo- ------------------------------------------------ . Issued . ......................................................... Date 1�9 r No..IV-..3.3 I Fx$..:_.. �a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou fu DtraIju3tt� urk� (�uflt�trur#tun Prmtt plication rs hereby r oermit to Construct ( ) or Repair ('� an Individual Sewage Disposal System at: ..... ------- If...0.---.=.........------------------- ..................................... --.3-3-............................................. Lwat" n Address or Lot No. W - K....-----.'•=^-- r-..------ -------•-------------------- C -:-c..:-._........-.-------•--•-••-•-----......t..-------•---...---•--. w c� �� Add c s ------. ...V. -r.-•--- j{� Vic. p fir ` 2C)------... ................... Installer Address Type of Building Size Lot............................Sq. feet ., Dwelling— No. of Bedrooms_______________________________________-----Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons_---.___-__-__-•-._----_--. Showers ( ) — Cafeteria04 ( ) Other fixtures d -- --•------•--••--------------------------- -----•------------------------••---•--_---------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity-_ ONgallons Length---------------- Width---------------- Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length-------------------- Total leaching area------_------_----sq. ft. Seepage Pit No---------------------- Diameter.................... Depth below inlet-------------------- Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. l................minutes per inch Depth of Test Pit---..-•--.--•--___-- Depth to ground water........................ fi, Test Pit No. 2.................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 •--•-••--•-•..............•------••-•---------•-•--------•---•-----------•--•-•----------....................---•------•---------------........------..----_. 0 Description of Soil........................................................................................................................................................................ x U -------•-•----...---•---•-•-•---•--•--•--•---•--------------••--------•--•-----•---------......-••--------•-------•--••......--••---- ............................................................. W ------.................................. 0 Nature of/Repairs oyyr Alterations1—A,n[s�w�etr when applicar(blef..... ..... ....(�-_G�- Ce SS-�Q 6-(---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Enviroriinental Code—The undersigned further agrees not to place the g is by-4e—board of health. ``�A r S �) r4 �1 system in operation until a Certificate Signed as been - - _ Y PCompliance - ---------------------------------------- �..- ---------------------- Due Application Approved By ..... �<--.-.5.-�' ...'. ..7.'..�. �. Dace Application Disapproved for the following reasons- -------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- ---------------------------------------- Date PermitNo- ----------------------------------------------------------------- Issued -------------------------------------------------------t- ...... Dare _._—____—._._, _-_. __—._—_.._---r ---„ __________________,o_, 11 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cfertifirate of Tomplian.ce T IS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( �) by ..... C..... C.. c .� ---------------------------------------------------------- - ................. . Inscdler at ..---------�. ...... .........^!`( ------C. (_. --- .................................................................-...................................................... has been installed in accordance with the provisions of TITLE 5��oppf The State Environmental Code as described in the application for Disposal Works Construction Permit No. ._.-7.. .-. ...... � ........ dated ....._... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.... ..............�._'..�......... j--------------- ----------------------- ---- Inspector ........._........ E\__) ------ ------------- --------_------------_--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH c� pp TOWN OF BARNSTABLE No...,..�.�.�.�?..�j FEE.=--•()-•�--- Diup.latia1 urkv Tonotrurtiurt " rmit Permission is hereby granted------- ------------------------------------------------------------------------------------•.----- to Construct ( ) or Repair (V) an Individual Sewage Disposal System atNo. i C�� - rs^� ------------------------------------------------------------------------------------------------------------------------- Street as shown on the application for Disposal Works Construction Permit No{y ._ Dated--------- _r-=j . tom' ---•----------- -------------------- DATE................ --"..... ---/....................... Board of Health .FORM 36508 HOBBS&WARREN.INC..PUBLISHERS COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROT uIVED JUL 292003 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 ' OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 102 Wianno Circle Osterville, MA 02655 Owner's Name: Bill Eldridge Owner's Address: Same Date of Inspection: July 3, 2003 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Map: 140 Mailing Address: P.O. Box 49 Parcel: 113 Osterville,MA 02655-0049 Lot: 133 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fai Inspector's Signature: NM Date: July 6, 2003 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. 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: 102 Wianno Circle Osterville, M4 Owner: Bill Eldridge Date of Inspection: July 3 2003 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: 102 Wianno Circle Osterville, AM Owner: Bill Eldridge Date of Inspection: July 3 2003 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: 102 Wianno Circle Osterville, AM Owner: Bill Eldridge Date of Inspection: July 3 2003 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 '/2 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 15.304. 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: 102 Wianno Circle Oster011e, MA Owner: Bill Eldridge Date of Inspection: July 3 2003 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: 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)]. I 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 102 Manno Circle Osterville, AM Owner: Bill Eldridge Date of Inspection: July 3 2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: I 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)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied C O N"AE RC IAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd 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 information: Pumped 2 years ago-per owner Was system pumped as part of the inspection (yes or no): No If yes, volume pumped: _gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records, if any) Inn ovative/A Item ati ve 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: Jun. 6194-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 9 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 102 Wianno Circle Osterville, AM Owner: Bill Eldridge Date of Inspection: July 3, 2003 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: I " 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: 1" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: I" Distance from top of scum to top of outlet tee or baffle: 9" Distance from bottom of scum to bottom of outlet tee or baffle: 14 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 of leakage. 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 I - Page 8 of I I w ' OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 102 Wianno Circle Osterville, MA Owner: Bill Eldridge Date of Inspection: July 3, 2003 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. There were no signs of backup or failure 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: 102 Wianno Circle Osterville, MA Owner: Bill Eldridge Date of Inspection: July 3, 2003 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: ✓ leaching chambers,number: 4-infiltrators with 2'stone-per as built card leaching galleries,number: leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation,etc.): There were no signs of failure from the leach field. The bottom to grade was approximately 46". 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.): 9 I Page 'i 0 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 102 Wianno Circle Osterville, AM Owner: Bill Eldridge Date of Inspection: July 3 2003 Map: 140 Parcel: 113 SKETCH OF SEWAGE DISPOSAL SYSTEM Lot: 133 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. Q t t I a 3 O 0 , y d c ct J C� 10 Page I I of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION (continued) Property Address: 102 Wianno Circle Osterville, AM Owner: Bill Eldridge Date of Inspection: July 3, 2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25 +/- feet Please indicate (check) all methods used to determine the high ground water elevation: r Obtained from system design plans on record-If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high groundwater elevation: Using the Barnstable topographic map andthe Cape Cod Commission watercontours map the maps were showing approximately 25' to ground water at this site This report has been prepared and the system inspected and passed as of the date of inspection. 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WE6T BARNSTABLE ryd,OT66B BOB)80.0930 • o CO' B'-6' - 6'b' 6'6• I'-Y 4'-4• Y-0• Y-g• V.4° STEP fd - 9Y-0 y Q `SJg'ME CODE DRYWALLI �ap 9 EXTERIOR DECK - - * ® �! •__! k3 - ' 4 74Xm 4'THICK _I L - LONG T+ � _ _ _ LANDNG SLAB I II Y 9 L 9 I ® BATH =JBH W/CLG. I m S11 618•LVL'. -ESE ra FLUSH- O-- 7Sx74-3 = _ ====c=v=__- Q KITCHEN 'g DINI� s 8 4g Y 4 � �L FAMILY ROOM � R �a I r.s.• � �� � Tr V .,. MNDROOM Y iE• I L.-X re A raua ----- Yd co. ---- - Rim W/CLG. STEP - R3 P i ;0 9 DINING _ STUDY FRONTi °C E g ENTRT 4 w CATHEDRAL .. ' 23'41%' 3'4IT4' V.S. 3'-6' 1 4'6° 2Bx20 2BX2S v Y I 37x3{TEMP. 32X34 TEMP. u - UE COVERED =a PORCH a �a FIRST FLOOR PLAN m)o-vB'LvC.' IN vNDR.ABOVE . BEEP b'-0' 7-6' Y-ir d•b i' q'-Ib' 9'-WM' b'-0' YO° 9'-0' Y.O. . C\ 26 3Y-0' 38'.0' -. 73-0' DUILDER JOB ADDRESS MR d MRS GEORGE ALLiEGRO DESIGN CUSTOM TWO STORY HOME DATE REVISION DRAWN BY PAGE SCALE 10-04-2004 # 1g of 7 I/4"_ I'-D" ✓B UES�/lS a�102 WIANNO CIRCLE - OSTER V ILLE MA.' NOT I PVRCRASE OF DRAWRNGg LEAVE6 PIdtGNA6ER RESPONSIBLE FOR COMPLIANCE WITH ALL 2 EXACT SUE AND REINFORCEMENT OF ALL CONCRETE FOO71NG8 3 ALL FOOTNGS SHALL ExTEND BELOW FROSTLRE VERIFY DEPTH. LOCAL BUILDING CODES AND ORDNANCE&J ESE MAD NOT BE HELD RESPONSIBLE MUST BE DETERMINED BY LOCAL BOL CONDITIONS AND ACCEPTABLE 4 VERIFY STRWCTIIRAL ELEMENTS FOR DESIGN t 9UE WEST BARNSTA13LE MA.0766E BOBS 3E-0930 FOR SUE CONDITIONS OR FOR THE USE OF THESE DRAW9NGg pLRNG CONSTRUCTION. PRACTICES OF CON57RWTIOX VERIFY DESIGN WPM LOCAL ENGINEER. 2M LOCAL ENGNEER AND BULONG OFFIGWL6. r 2004 r 21X24 ° • . �TYP.RAIIJ 4G `tl.'_x Tcalr f7`.! yoy � •. ROOF DECK A m ------------- --------------- ROOF >•e - - - --- 6 �:....� 'IT 9'-0' 24Xm MXSO 5.�, RAISE SIIDER LP ' tdX2t-7 ' 9 CLG.LINE - 1p 0 BATH o _q o BEDROOM#3 ® I V 'b'� ,�-'. 1 I a V OC. 1 0 r: BEDROOM#4 1 I X f fd a a0-4 9 RAILING WALL io t :p Am 4 x 1 y I •�• VO `^ r+• AW CA 210Cd O CI s @ BEDROOM 02 FRONT ENTRY a 16,oc. - --- a IS,ot_ -- BELOW 14.44. Q•x CATHEDRAL V-0V I'-Iob 4'6' 5'� 4'-6' 3'A' 1 f4xt¢ uxa � Q � Z i BEDROOM#1 u x i.. A m ., u LENNG LINE ` Y o ' I I SECOND FLOOR PLAN - I L6 C1 —- —N6 C1 --2.6 CA _ .4 -9 aVOL. 1 a16'oz. 1 1 a%Ior_ 9 S.-S. 4,$. B.Q. 4,.0. B'Q. 31X7t 14XII G T4Xt2 ---- --------------------- ------ ------- -------- 6'-0' O•{' Q'{.• 6-0' 1' ' 940f0' 6'-0' S-0' 9' • III IT 15-0. J . BUILDER JOB ADDRESS MR d M IA GEORGE ALLIE(sR0DESIGNDATE REVISION DRAWN BY PAGE SCALE CUSTOM TWO STORY HOME 10-04-2004 # JB P+OF 7 , 1'-0^ ✓B D�si�ns �G7 102 WIANNO CIRCLE OSTERYILLEMA, NOT 'LOCALBWLDMGCODES AND ORDMANCE9gJBp�EWaNO NOT BE WELDREPONSMLE MUBTBEDETERMMmBTLOGALTBOLLONDITONBANpACLEPTABIE 4VER3 ALL FlSTRUCTURALELEMENTSWRDEBWNn ��I�D� X gpB)3E0930 FOR SITE CoIIDRIONO OR FOR THE USE OF TNE6E pRAWM40 DL RING CONSTRUCTION. PRACTILE9 OF GON97RUCTION.VERIFT DESIGN WI1H LOCAL ENGRIEER WITH LOCAL ENGINEER AND BIBLDINCI OFFICIALS. WEST BARNS' MA.03668 3ry . Tip,10•DTAM•CONC,FETED Y•1' b!' Y3' Y�!' Yg' TUBE ON Tq•XSI•XV FT& ' 7X6 P.T.6EL - ' OR EOILLL I 1 � r-DTB'.pT..� 7P.HANG1726 IO•DWT.COW FILLEDTUBE ON 1' 1 1 OR C•OB4l.')(14'%G'Fl0. p'.�• 1 I - S-DTBLGIRDEFt TTP.RIM _ _ 19 E I P GBiDER BEIDW TTP.pLOCKOIG - 1 I . t I I »oc,uuvwlm . I I i A1ARTpHMC°tt MICE IX•� IXIO6l]19T . 1 1 6V01 ENG,1"19T I. - M UHxr�m.eam I I PER MANE. I �XocrtlA°a ) TSm P1U#M 1 L__l 1 _ R.P).•i'OG ���WCmLI�'ClW �l •--- ; wr.a I+FrasaTwwnaeem .murosrAexw EIm.CFGOI.OpT PCWam°rn°m l.R __ _____________ __ '-O IXSUID°BIe°U®IOeDIm tm°IBeea.ovAlm n _____________ a nacK°Ioa-WUl.nam A. fa•opmloeot. GRADE - r. DER BELOW o o:AtYl1°I°Ntl EXT.DECK DETAIL - IVIV ENS.I JOIST -� }MA— 6VB'ENG.I A�IS7 TYP.HANGERS / PER nANF. . .. �IFVB'tTTG,I HOIST � ` PER MANIIF. nP.HANGERS D(B 1'T S TYP.HANGERS D(B PT �DtB'.PT-� fl 9 - _ _ TYP.NANGER6 ,[41B•LVL'. L. e�w'oa.� - - -e -- e - o-vB'LvC. nP.uANGERb 10'O-.-.0 C.FILLED J 71.E{E ON TA•X247(fY FTC. lYP•MAHGER°y, OR EOIIAL 1-Dc10 PT . ��• �'Y E'3' TUBE 2-DLAM.CONC.BIG FOOTT Fl�LLED 6TC OR EQUAL M1VB'ENS.I.IOIST PER MANIF. FIRST FLOOR FRAMING PLAN nP HANGERS - �EARNS WALL BELOW . nP.HANGER9 B-VB°LVL'. nP.HANGER o-ve°EN0.1,gBT -a - - L PER nANtff. . ° ° SECOND FLOOR FRAMING-ELM DATE REV15ION DRAWN BY PAGE SCALE BUILDER: JOB ADDRESS MR t MRS GEORGE ALLIEGRO DESIGN CUSTOM TWO STORY HOME I'-0"10 04-2004 # )3 n�oF 7 I/4"= ✓B U�S�/7S Q 102 WIANNO CIRCLE _ J OSTERV ILLE MA. I PURCHASE OF DRAWN"LEAVES PURCHASER RESPONSIBLE fOR COMPLIANCE WITH ALL T EXACT 51TE AND REINFORLEnENr OF ALL CONGRE7E FOOTRIGB 3-ALL FOOTINGS SHALL EXTEND BELOW FROSTLRE VERIFY DEPTH. 'NOTE LOCAL BUILDING CODES AND ORONANCES.J B DESIGNS MqT NOT BE HELD RESPONSIBLE WIRY BE DETERMINED BT LOCAL SOL CONDfipN9 AND ACCEPTABLE A VERIFY STRUCTURAL ELEMENTS FOR DESIGN°elg 1C BOB)3Ti-O'1'JO FOR SITE CONDITIONS OR FOR THE USE OF THESE DRAWINGg DURING CONSTRUCTION. PRAGIKES OF GON6TRUC710N.V ERIF7 DESIGN WRN LOCAL ENGINEER. WITH LOCAL ENGINEER dNJ BURDWG OFRLIALS. WEST BARNBTABLE I.A.0., \ RIDGE VENT > ¢RIDGE 150 ASPHALT PAPER 12 ASPHALT SHINGLES , DOD RAFTERS 6 IS'OC. ROGE VENT - VY PLY.SHEATHNG ZOO Rb60 ¢ BF ASPHALT PAPER �6 . ASPHALT 514WARD / ZEI.CAB V.OL_ DID.CA IS OG D(B'.®tl'rOC. TYP.HANGER D336 INSUL 7RAPPM 1•2t0'. W WALLBOARD Q - / � / e / BEDROOM 02 BEDROOM p3 - - ZOD RAFTERS A 16'OC. DIB RAI TERS®I6'or- VP PLY.SHIFANNG - VY PLY 814FATMM - - BP ASPHALT PAPER N ASP IALT PAPER -- - ASPHALT SHINGLES R30 N6w NAILED 1 GLUED. 3/4•7/6 FIR PLY. A SHINGLES - IFVB ENG.I JOIST n-vB ENG.I J016T wm.w N3 STRAPWALLBOAPING - 36VB'LVL'. HYI•II�RW I/l RD R30 I761.1 - VY WALLBOARD COVERED STUDY FAMILY ROOM O.C. C - s PORCH I?PLY.SHIATNINC. 1 iron WRAP OR EOIIAL �r FIR PLY. bB'e 9 IB'OLD ' HALED 1 GLUED. R3B IIBIW_. H%G.YifUl. . T Day.P7 G.olrt.r'aA SVB'ENG.I JOIST POST ANCHOR 4V8 ENG.I JOWT r__________________________________ R5IMUL. 3•2OY.GIRDER ® 3/4'AC PLY I , 1 34R'CONC,BLED EXISTMG i ROOF DECK 1 LOLLY cotulMN. BASEMENT He'.B V o`er_ _ _ _ _ _ _ _ _ Dr¢RIDGE 4, CONC.6LAS W Q n It 7YO'.B 16'or— V y W m R —o CROSS SECTION(A) �w0•.ew'oc.� 11 0 � � tt m 3S tS � GE VENT D(¢R O IDGE DC¢RIDGE -Dtb'e 9 16-O.CT TYP•2 D(6'e VY PLY.RAFTERS 0NG OC. ¢ BI ASPHALT PAPER y9 js ASPHALT SHINGLES . ¢ P n I n M¢ROGE DGB RAFTERS 6 16'OL. V ENT ¢ VP PLY,SHEATHING DOD RIDGE 1 SO ASPHALT PAPER �6 Il p 1 ASPHALT SHINGLESLo Ldiiiii gg 4 9 9 P ® S DOO'.B H6'OC. II ® III G 2Xe.ZA 916 O.C. I I 2XV.c OjC, �- 2x6'.CA 0 I6'OC. R30 IN6UL. IX3 STRAPPING VT'WALLBOARD ttP.T]%b'. BATH DIV.0 VOC. 2(O'.0 le OC. DOo RAFTERS®v,•oL. / // BEDROOM VI - 7/Y PLY.SHEATHING / VY PLY SHEATHING L _ G.ASPHAU PAPER SI ASP IALT PAPER V ASPHALT SHINGLES 3/4°T/G FIR PLY. A6PN SHINGLESx$ O e O UI p 9 p`6 IT�IIIO�T�1 RID NSIC, NAKED I 5 BI K u'VV�+ II-ve•ENG.I.OISr - W_® _@ W W0 jgj @ 1W d0 @ W IX6 T/G BROS. STRAPPING •- `� 3IFVB•LVL'. F3/4'BED MLO& K L1A R30 M816. ® m js tt n UI II d . VI'WALLBOARO I ROOF FRAMING PLAN FRONT ENTRY nca'.s I6'ot. - - ttP,2 Dc6'. 9 COVERED DINING AREAVf PLINY.6HEaODING q ttP.:D(6'. P.FDI6'. - �� u PORCH 9 VNIXG WRAP OR EQUAL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ST 34'VG RR PLY. R30 N&L. - - IX/DECKING NAILED 1 GLUED, -t - i POST ANCH 7 OR NC1 PT MB Ot. avB'ENG.I JOIST - - - ' TYP.HANGERS 3-ZI¢•.GIRDER RB NSUL ® 3/4•AC PLT.. 1 3-W CONC.FILED. ' T4 I 1 LOLLY COl mil". EXISTING _ ' /�, AJ / ' BA EMENT I • // / // 4'THICK CONC.$LAB r GROSS SECTION(B) n 5U1LDES JOB ADDRESS MR d MRS GEORGE ALLIEGRO DESIGN CUSTOM TWO STORY HOME DATE REVISION DRAWN BY PAGE SCALE a awl 102 WIANNO CIRCLE 10-04-2004 # J9 e 6 OF 7 I/4". 1'-O" JB D6s�n$ OSTERV ILLE MA. I PURCHASE OF DRAWINGS LEAVES PURCHASER RE Po BLE FOR COMPLIATCE UIHI ALL 7 EXACT Slff AND RENFORC(T1ENf OF ALL CONCRETE FOOTMC S 3 ALL FOOTINGS SHALL IXTEND BELOW FR06R1WE VER FY DEPTH. NOtE LOCAL BUILDING CODES AND ORDINANCE$.J S DESIGNS MAY NOT BE HEIR RESPONS BLE MLLST BE DETERMINED BY LOCAL SOIL CONDITIONS AND ACCEPTABLE 4 VERIFY 6TRUCTURAL ELEMENTS FOR DE6 GN l6 2E WEST BdRNSTdBIE MA.OTb68 - FOR SITE CONDITIONS OR FOR THE USE OF THESE DRAUINGSOIRIW CONSIRUCTON. PRACTOES OF CONSIRUCTON.YERffT DESKGN WI1H LOCAL ENGMEER WITH LOCAL ENGINEER AND BWIDNG OFACIA44. 6OB13T5osT0 1[z 1 I , I RIDGE VENT 1 , TXR RIDGE 1 1 I R DNO RAFTER$916,or- 1 DtB RAFTERS B Ib'OG RIDGE VENT �b VJ'PLY.sNEATN$1G - - - 1 2X6 BLOCKS yIIO RIDGE G1 ASPHALT PAPER RIDGE YEM RIDGE VEIN I 2Xb RAFTER YO'PLY.SHEATHING ASPHALT 9HNGLEO 7Xm R0)GE ZXR RIDGE MS RAFTERS A Ib'OL, 1 B•ASPHALT PAPER 2 WS RAFIER8 A 18'OL. VY PLY,SHEATHING I ASPHALT SHMGLE9 - -VS'PLT.84FE47HNG I51�ASPHALT PAPER � I D•ASPHALT PAPER ASPHALT SHINGLES 1 • R ASPHALT SHI GM R - I VY WALLBOARD D(b'F CaBIb'OL. W�- ® Df4'•®*'Or- DT3 STRAPPING 9 IXS/IX3 RAKE BRD. R % UI'WALLBOARD ofPLINYam,sLEiTHM acs•caa oc. IX550FFR TYVEK CRAP OR EQUAL BIDING 7X6'•Ca A ib'O.C. R30 INSTIL. - ^ • .. •. BEDROOM#4 ROOF DECK • 4f NIGH R ye NARD ® FV2 BED MLD. aD"pTaEm IXb FREIZE BIRD. SNARED 4 GLUED. 4'T/G Y. / , RIBBER RAKE - ���� ENTERTAINMENT ROOM =m D--w ENG.I JOL9T IFVe ERG,I JOIST • . ® DT3 STRAPPING ttP.HANGERS Y4'i/G FR PLO, UY WALLBOARD LVL'• NdCFD/GWED. R38 INSU- 4 Am 11-w*ENS,I JO15T SVB'ENG,I JOIST R30 IIL415.. T•ve'LVL'° HALL PANTRY KITCHEN C - L13 STRAPPING $W'FL.WALLBOARD V!WALLBOARD u4'°10 W OL.. . 3/4'T/G FIR PLT. RD INSULATION �e HALED/GLUED, GARAGE IY PLY,8HEAIHMG = - I•vB'fTIG.l,p16T 8V8'ENG.I JOIST - TTVEK WRAP OR EQUAL SIDING . }DOY•ORDER R9 INSTIL 3-VY -o - CRAWL Q CONC.SLAB r LDLLT COLIIITN. BASEMENT - SPACE - BASEMENT - - - iol�icc.SLAB •-- - -- �n .., .... .- _ / CROSS SECTION 01 CROSS SECTION IC) o r D GABLE/EAVE DETAILS EAVE o 4 SCALE •IFT. ASPHALT SHINGLES ., 150 ASPHALT PAPER ASPHALT SHINGLES - 150 ASPHALT PAPER VT PLY.SHEATHING 1/2 PLY.SHEATHING � - 61DEWALL - r TYvEK OR EQUAL - VENTED DRIP EDGE - VENTED DRIP EDGE V2 PLY,SHEATHING L� 5°ALUM.GUTTER 5°ALUM.GUTTER - D(8 FACIA DC8 FACIA SHINGLES STARTER 'D(8 SOFFIT COARSE D(8 SOFFIT .o;I 2Xb P-T,SILL IX&FREIZE 1-V2 BED MLD, - _ - - I-V2 BED MLD. I/2X6 SILL SEALER ' \—I D(b FREIZE p I/2X8°ANCHOR BOLTS e 6'O,G. D EAVE DETAILS _ EAVE p FdvE DETAILS jD SILL DETAILS o 0 EAVE SILL 1 - BUILDER JOB ADDRESS AWN BY PACE - MR d MRS GEORGE ALLIEGRO �` �, CUSTOM TWO STORY HOME Q87� REVISION DR SCALE 0 102 WIANNO CIRCLE 10-04-2004 # JB # "/oF 9 I/4 . 1'-0° �.WE.TSARH.STABLUE OUTERVILLE MA. 1 PURCHdSE OF DRgSRNGB IEdvE6 PURCHASER RESPONSIBLE FOR COMPLIANCE CTTH ALL 2.EXACT SITE AND RENFORGEMENT OF ALL CONCRETE FOOTINGS 3 ALL FOOTINGS SHALL EXTEND BELOW FROSTLIKE VERIFY DEPTH, LOCAL BWLDNG CODES AND ORONAHCEO.J B DESIGNS MAY NOT BE HELD RESPONSIBLE .MUST BE DETERMINED B7 LOCAL SOIL CONDITIONSAND ACCEPTABLE 4 VERIFY STRUCTURAL ELEMENTS FOR DESKaN f SIZE FOR SITE CONDNONS OR FOR THE USE OF THESE DRAWNGSDURING CONSTRUCTION. PRACTICES OFCONSTRUCTION.VERIFY DESIGN MTN LOCAL ENGINEER. WITH LOCAL ENGINEER AND BULDING OFFl MA.OObbB Raft 0ju� M �k Vi IV 77, "'s, 6" 6" 1/6" to IA- llasbed Stone ®3" Mck '7 l ,l l!ll l �� 6"///[/ ///// /� FYaiob Grade Al Sot ® 1� 6„ / 8.5'- El. 27.33' ' _�. oao �t�o to'ifin 14' r Sump V RL INY EL °a a' q m _ mo a m El. 24.5' INY EL INY EL INV EL 26.80' 27.85' �_\Al Moir line.- 27.40' 2Z 00' -;e'stave; : 28.50' 4 3/4" - 1 1/•2" lYasbed stole awgSa d Zesel M. 4 5 HOLE DIS7RIBUYY0N BOX - 33.5' PRECAST REINFORCED CONCRETE DISTRIBUTION BOX PROPOSED LEACH TRENCH �o °@ 1500 GALLON SEPTIC TANK Install on a level base, Minimum wall thickness = 2" c Minimum inside dimension = 1,2 Bottom of Deep Observation Hole El 19.5' 1500 GALLON REINFORCED CONCRETE SEPTIC TANK Outlet inverts shall be 4 equal to each other and at and o a Pond � Minimum Construction Materials Per 310CMR 15.226 2 2 minimum below inlet invert. y � � Adj. High Ground Water AEI 15' . Tees shall be constructed of Schedule 40 PVC and shall extend a The distribution lines from the distribution box shall all have ..- 12.83 minimum of 6" above the flow line of the septic tank and be on equal inverts as determined by flooding the distribution box to i the height of the distribution line invert after all lines have the centerline of the septic tank located directly under the �' = yew --W-1 i 34 clean-out manhole. been sealed in place. . N •'dct••: m : d' 24" The inlet pipe elevation shall be no less than 2" nor more than 3" Invert adjustments shall be made by filling with durable and 58" above the invert elevation of the outlet pipe. nondeformable material permanently fattened to the line or Septic tank shall be installed level and true to grade on a level, reconstructing the lines until all inverts are of equal elevation. Number of Trenches - I .LUC' U,S' MAP stable base that has been mechanically compacted and on which New Number of Chambers 3 6" of crushed stone has been placed to ensure stability and Septic Tank PROPOSED LEACH TRENCH - END VIEW N.T.S. to prevent settling. Loca tion Install Three 500 Gallon Units 15, 16' (150o Gallon s Septic tank shall have a minimum cover of 9". ) with Four Feet of Stone at Sides and End Two 20" manholes with readily removable impermeable covers ; N8R-05'45"E 135.94 of durable material shall be provided with access ports ! e The outlet tee' shall be equipped with gas baffle. ; ; 32.4 30.8 0 (bi LOT 133 . 12.83 14,665f sq.ft.... 30.1' 10' 1oa8�-o �i 31.0 a 7P1 i 38' a Proposed SAS Trench TPI - El. 30. D' ' i _.�0.97 .. 10, 0 0 0 0" i 44. 7� • •.. 16 �' s Soil Log 2 Performed By S. Doyle 29.77 .,......- .............a A SL 1 O.Yr 312 BO h D. Stanton a 0 5„ Date. October 4 2004 o u1 30 5' 10 r 5 4 Pere Rate: G2 Min/Inch (C1) o 31.06 4 �� a 35 _ e o Assessors Map 140 Parcel 113 .LS y �? � i,0 OR 11 30.1' ti 30 (EI 27.5) i m ! �� �- �, Zoning District.• RC o „C,1, o! =y i �, ---, �� r_ Existing Overlay AP - RCOP FINE Bottom Perc 31.25'! �� Deck 54'" i _ ILuzg Building Setbacks: 2 5y 616 .._..__ Dwe SAND " 1 10' , 1 Addition - Front - 20' 72 ..... proposed Side & Rear - 10' "L'z ! f '� � Deck o Locus not in a flood hazard zone. B� To CB � � i � /�� � � t 30.5' !� FINE' 10yr 518 p ' � 30.74' ' i � • ' ! ).`.w•'' EL 29 74 w.............,• ..- o � Reference Plan. SAND Datum: NGVDf / o 90 zs 12' �. 30.36' i u proposed o L.C. 2884-83 „C,, i o .- _- Garage­4 FINE 2.5y 616 �; - Ling Paved DrrveWay :_31.03 _ -- j� 28. 7' SAND 126'► i _Ex �.....� i El. 19.5' 29.02' No Water Encountered i 30.8' `Adj. High Ground Water <El. 15' (Mapped) ' �- a N89700"E 129.89 , Septic Plan of Land Prepared For.• e 31.0' 102 Wi a .Z2.n o Ci rel e Denotes Spat. Elev (Typ) GENERAL CONSTRUCTION NOTES In 1. All the workmanship and materials shall conform to R E.P Title 5 0s t erVlll e, Ma ssa ch use t is and the Town of Barnstable rules and regulations for the subsurface GRAPHIC SCALE disposal of sewage. 20 0 10 20 40 80 Scale: 1" = 20' Date: October 8, 2004 2. At least one access port over tank tees shall be accessible Prepared By.- within 6" of finish grade, with any remaining access ports brought Stephen J. Doyle and Associates to within 6" of finish grade. ( IN FEET ) 42 Canterbury Lane, E. Falmouth, MA 02536 3. All components of the sanitary system shall be capable of 1 inch = 20 ft. Telephone. 5081540-2534 withstanding H-10 loading unless they are under or within 10 ft Design Data: -R e vas -1 o� -81 © c k of drives or parking. H-20 loading shall be used under or within ►,A410 ft of drives or parking unless noted. Plastic equals may be Four Bedroom = 4 X 110 gpd = 440 gpd Required Flow �,tH or>,y,�ss s►° a�® used in lieu of all recast units 90 a�a``" Ssso << No Garbage Disposal ti� ' �� �"-�RF 4. The exca va torontractor shall verify the location of all site w+u.u►M Use. Chamber Trench 33 51 x 12.83'W x 2' Eff De th IIESERM,W ► < sTEPNEN utilities prior to any excavation, and shall be responsible for 1' rvo 2J y; ; � all matters relating to electric easements [3-3 5' + 33.5 + 12.83 + 12.83] x e o = 185 DOT E ys 5. Sewer pipes shall be 4" Schedule 40 PVC laid at a min. 0.02 slope. 33.5' x 12.83 = 429: wF+� �P 6. Any masonry units used to bring covers to grade shall be 614 x 0.74 = 454 GPD Total Design Flow � � \� °.`q� su mortared in place. �. < (a q t� �e'oq�cs NO. DATE DESCRIPTION BY 7Finish grade shall have a minimum slope of 0.02 ft per foot l D t � c) Vi �e vvi - IV, W, Fin" Grade M 30t l o 112' Nashed Stone ®3' TAick6" 6" / l /! !/ '7Grade a 30'tm 6 /I 0"D RVA? 6" / 8.5' � RL�1sR El 27.33' _- olio or=o 10' •� 14'arts INV EL sip V EL INV EL ° d --- o o ®a o A INV EL, \M&W Flo Line.- INV EL 27.00' .e,see. . 26.80 26.50 4' 3/4' - 1 1/2' Fashed Slane , 27.65 Mgnfd Level .re. 27.40' ¢ 5 HOLE DISTRIBUTION BOX •r--- _ 33 5' n� o PROPOSED LEACH TRENCH 1500 GALLON SEPTIC TANK PRECAST REINFORCED CONCRETE DISTRIBUTION BOX o Install on a level base Minimum wall thickness = _2„ toc Minimum inside dimension = 12" Bottom of Deep Observation Hole EL 19.5' 1500 GALLON REINFORCED CONCRETE SEPTIC TANK Outlet inverts shall be equal to each other and at Pond o d Minimum Construction Materials Per 310CMR 15.226(2) 2" minimum below inlet invert. end Adj High Ground Water �E'L 15' Tees shall be constructed of Schedule 40 PVC and shall extend a The distribution lines from the distribution box shall all have �-- 12.83 minimum of 6" above the flow line of the septic tank and be on equal inverts as determined by flooding the distribution box to the centerline of the septic tank located directly under the the height of the distribution line invert after all lines have clean-out manhole. been sealed in place. 34 6- - .- ,24" � The inlet pipe elevation shall be no less than 2" nor more than 3" Invert adjustments shall be made 'by filling with durable and - 1P 5a�4- wH 4' ° above the invert elevation of the outlet snipe. nondeformable material permanently fastened to the -line or Septic tank shall be installed level and true to grade on a level, reconstructing the lines until all inverts are of equal elevation. Number of Trenches - 1 stable base that has been mechanically compacted and on which New Number of chambers - 3 6" of crushed stone has been placed to ensure stability and Septic Tank PROPOSED LEACH TRENCH - END VIEW N.T.S. to prevent settling. Loca tion Install Three 500 Gallon Units 15 16 (1500 Gallon with Four Feet of Stone at Sides and Ends Septic tank shall have a. minimum cover of 9". ) Two 20" manholes with readily removable impermeable covers ; _ » of durable material shall be rovided with access ports. , N89 05 45 E 135.94 � o The outlet tee shall be equipped with gas baffle. P , A4 30, � o a Cb; LOT 133 12 83 ._ 14,665f sq.ft, 30.1' 10' i 38' a Proposed SAS Trench TPI El. 30. 0' i _. 0.97' - C a d I D„ i 44.7� 6' �' 10 Soil Log 29.7T 4' 2 „A» Performed B . S. Doyle i o ,� .. 8 i b o deb 1 SL I0yr 312 BO.f.I: D. Stanton % o �j. 5„ Date. October 4 2004 16.. - 3;5 c o Pero ,Rate.• <2 Min/Inch (C1) i o 31.06 q\ 35 _ o cp Assessors Map 140 Parcel 113 LS IOyr 5/4 30.1' 30" (EI 27.5) i _ro �, i 21, Zoning District.• RC 11 01 oo�i y i i� i �,�--- Existing Overlay AP - RCOP ; , b c k e 31.25 � Bottom Pero � I D FINE 2 5J, 6/6 54" i ► t ii D welling Building Setbacks. SAND „ 10' ' , ► - �, Addition Front - 20' i � ................. 72 i ' Pr'oPosed ik: Side & Rear - 10' "Cz BM Top CB i . i� ��'�' �� 30.5'Jeek Locus not in a flood hazard zone. FINE 10yr 5/8 3a 74 El 29.74' f W ; = �_ SAND Datum: NGYDf ..... ...........yi,........ /,- `_ .. , o o Reference Plan. 90 30.36 % �._ _._-- --' Prof°Sad rp .L:C. 2664-83 Garage --- C3 'bi , D.-vewaY 31.03 � 28. T FINE 2.5y 6/6 �'; Exsting Paved ri _- _-^_ �=1 SAND „ i cp __ _- -- J 39' 126 -' � El 19.5' 29 02 -- i No Water Encountered 30.6' Septic Rl a n of Land Adj. .High Ground Water AEI. 15' (Mapped) r !- a N897;'10"E 129.89 �' Prepared For a 31.0' 10,? Wianno Circle Denotes Spot Elev (Typ) GENERAL CONSTRUCTION NOTES In 1. All the workmanship and ma terials shall conform to D.E.P Title 5 GRAPHIC SCALE Os tervill e, Ma ssa ch use t is and the Town of Barnstable rules and regulations for the subsurface disposal of sewage. -20 0 10 20 40 80 Scale: 1� = 20' Date: October 8, 2004 2. At least one access port over tank tees shall be accessible within 6" of finish grade, with an remaining access ports brought Prepared By.- g g P b° Stephen J. Doyle and Associates to within 6" of finish grade. { IN FEET ) 42 Canterbury Lane, E. Falmouth, MA 02536 3. All components of the sanitary system shall be capable of 1 inch = 20 ft. Telephone. 5081540-2534 withstanding H 10 loading unless they are under or within 10 ft Design Data.: e L -Z o -Z-IC of drives or parking. H-20 loading shall be used under or within 0,1 10 ft of drives or parking unless noted Plastic equals may ,be Four Bedroom 4 X 110 gpd 440 d Required Flow a�'Mrs ►°°A6�A'"®, bP 4' � s � KH or 4,.c used in lieu of all recast units No Garbage Disposal wru.unn 9cyN ;'��aCls r- E,cy�°�: 4. The excavator1contractor shall verify the location of all site Use: Ckamber Trench ' ' uWILLIA w �• sTEPHEN utilities prior to an excavation, and shall be responsible for ch 33.5 L x 12.83 W x 2 Eff/Depth �, a " P Y P NO 23971 v, ® " 00 J. all matters relating to electric easements [33.5 -t• 3.3 5 + 12.83 + 12.83] x 2 0 = 185 , a � 5. Sewer pipes shall .be 4" Schedule 40 PVC laid at a min. 0.02 slope. 33.5' x 12..83 = 429 6. Any masonry units used to bring covers to grade shall be 614 x 0.74 454 GPD Total Design Flow ��� ' � su ¢ mortared in place. 10 7 ��Finish grade shall have a minimum slope of 0.02 ft per foot. NO. DATE DESCRIPTION BY� �� 4