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HomeMy WebLinkAbout0175 WIANNO CIRCLE - Health _ 175 Wianno Circle Osterville A= 140-097 r°• Commonwealth of Massachusetts NO- 0q7 �s Title 5 Official Inspection Form 11. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments S. 175 Wianno Circle r- Property Address Lane Owner Owners Name c, information is required for every Osteryille ✓ MA 02655 5/6/19 page. City/Town State Zip Code Date of Inspection ' Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. Inspector Information �=- Frank Nunes lit Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown . State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 5/6/19 Inspector gnature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board. of Health or DEP)within 30 days of completing this inspection. If the system 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 form should be sent to the system owner and copies sent to. the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform , in the future under the same or different conditions of use. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 1t _ i Commonwealth of Massachusetts �d Title 5 Official 'Inspection Form l Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Wianno Circle Property Address Lane Owner Owner s Name information is required for every Osterville MA 02655 5/6/19 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass.. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 i Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Wianno Circle Property Address Lane Owner Owner's Name information is required for every Osterville MA 02655 5/6/19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, y safety and the environment: ,a. t5insp.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 175 Wianno Circle Property Address Lane Owner Owner's Name information is required for every Osterville MA 02655 5/6/19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: . r 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No. El ® Backup of sewage into facility or system component due to overloaded'or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form I• I' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments _ 175 Wianno Circle Property Address - Lane Owner Owners - information is required for every Osterville MA 02655 5/6/19_ page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert o'r available volume is less than %day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or, obstructed pipe(s). Number of times pumped: ❑ ` Z Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This• system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.) ❑ ` ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure, criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be , .r necessary•to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to.the A questions in Section CA.' Al } Yes No s ' ❑ ❑ 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 ❑ ❑ Y rY 9 a El Elthe system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t t5insp.doc•rev-7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 i Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ti 175 Wianno Circle Property Address Lane Owner Owner s Name information is required for every Osterville MA 02655 5/6/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? El ® 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? ® Q Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts t: (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Wianno Circle Property Address Lane Owner Owner's Name information is required for every Osterville MA 02655 5/6/19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? y ❑. Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection, ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? f ® -Yes ❑ No Water meter readings,.if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Seasonal Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Wianno Circle Property Address Lane Owner Owner's Name information is required for every Osterville MA 02655 . 5/6/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR'15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No i Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No ` Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: ' No recent pumping per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped:.: gallons How was quantity pumped determined? Reason for pumping: ' t5ins .doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 P Pe 9 Po Y 9 Commonwealth of Massachusetts ,io Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments - 175 Wianno Circle Property Address Lane Owner Owner's Name information is required for every Osterville MA 02655 5/6/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 2013 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No, 5. Building Sewer(locate on site plan): 1211 Depth below grade: - feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): 10, Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 9 of 18 f Commonwealth of Massachusetts r= ro Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Wianno Circle Property Address Lane Owner Owners Name information is required for every Osterville MA 02655 5/6/19 page. Citylrown State Zip Code .Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 6-12"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) Inlet is 6" below grade and the outlet is 12". Outlet cover raised to 6" If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500g 1 Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle >12" Scum thickness trace >2„ Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle >2° How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3yrs to prolong the life of the system t5insp.doc•rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts. F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 175 Wianno Circle Property Address Lane Owner Owner's Name information is required for every Osterville MA 02655 5/6/19 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet•tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts �o Title 5 Official Inspection Form I° Subsurface Sewage Disposal System Form Not for Voluntary Assessments 175 Wianno Circle Property Address Lane Owner Owner's Name information is required for every Osterville MA 02655 5/6/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level' Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 011 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.): H-20 D-box is 2'below grade, cover raised to 6", no adverse conditions t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 175 Wianno Circle Property Address Lane Owner Owner s Name information is required for every Osterville MA 02655 5/6/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): . Pumps in working order: ❑ Yes ❑ No` Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber,.condition.of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required):- " If SAS not located, explain why: Type. ❑ leaching pits number: ® leaching chambers number: 4 ❑ leaching galleries number: ❑ jeaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: { ❑ innovative/alternative system -Type/name of technology: t5insp.doc•rev.M6/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of18 r Commonwealth of Massachusetts ' r= Title 5 Official Inspection -Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Wianno Circle Property Address Lane Owner Owner's Name information is required for every Osteryille MA 02655 5/6/19 . page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Chambers were video inspected, there was aprroximately 2"of effluent in them, no indication of past hydraulic failure 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts �a (o Title 5 Official Inspection Form I° Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 175 Wianno Circle Property Address Lane Owner Owner's Name information is required for every Osterville MA 02655 5/6/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Iig Title 5 Official Inspection Form I° Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Wianno Circle Property Address Lane Owner Owner's Name information is required for every Osterville MA 02655 5/6/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately t 4- t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 L Commonwealth of Massachusetts ,ig Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 175 Wianno Circle Property Address Lane Owner Owner's Name information is required for every Osterville MA 02655 5/6/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: >150" feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 2012 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: 4' seperation per compliance on file ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping, the site is at 30'msl and nearby surface water is at 4'msl You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/X18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 175 Wianno Circle Property Address Lane Owner Owner's Name information is required for every Cisterville MA 02655 5/6/19 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed& Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For.15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection onForm:Subsu rface Sewage Disposal System•Page 18 of 18 TOWN OF BARNSTABLE LOCATION el IL.ac.S SEWAGE#Zo/Z-�3 9 VILLAGE e fSTC A.Vi` C ASSESSOR'S MAP&PARCEL 7 INSTALLERS NAME&PHONE NO. /V O�ntc�,,� ��✓�^� ✓��3gt�J9� 7�f SEPTIC TANK CAPACITY LEACHING FACILITY:(type)('4 S'o d G- -OA9„A; (size) 4 Z X 1 Z•u NO.OF BEDROOMS OWNER ,E JZ /iI,91Ty cS-w PERMIT DATE: 7,Z 7 2— 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) N'� Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) N�� Feet FURNISHED BY M Kam` eO e-L or y �to," at 14v s� A 2- Sv. 3 23.3 d a Z � 3 � -- � f �. � n • J 37s l No. V v 1 •- _ Fee 5 .l THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH-DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes fixation for s osaf*Pstem Construction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. q t�C!f, Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 1 qD c7 g 7 Installer's Name,Address,and Tel.No.,p g -3 5� ._g Designer's Name,Address,and Tel.No. P,,-L Sv t,c.w V 0 �✓�^� i5 n Nc i vti� ��rC—dc Sv��•v / Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) S SO gpd Design flow provided S S9 gpd Plan Date VQ LY 2 r ZO j'Z. Number of sheets `,/� Revision `Date aa� Z Title 5►TC-?� v �; o rP�Ci7 ' M PQ O-V Ewt EI T'S AT IZIs �c.ltAuycy 0 C%a(-Lr- Size of Septic Tank ksbo Type of S.A.S. 12`-t 0" X 4 2' GA�Ly Description of Soil A - c) R - \2 6Qe-f ry0 -6e c AA-t tD Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described,on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of d 12-S 3 e ,12 Date Application Approved by Date 7 7 7/! Application Disapproved by Date for the following reasons Permit No._Do 'a. 3k 3 Date Issued77 �- 47 NO. Fee tt - ' . THE COMMONWEALTHI•OF*MAS:SACHUSETTS h� $ntered computer.J r I' Yes PUBLIC HEALTH 1VISIOfN - TOWN O"F BARNSTABLE, MASSACHUSETTS Yv -{ application for �.� osaY.: psiterrt constructiDnerntit r 11 Application fora Permit to1q9psteuct( ) Repair( ) i Pgrade(X Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel -7 Installer's'Name,Address,and Tel.No. g -3 7v -� D signer's NCame,Address,and Tel.No. `­b, k n" V,kd,v*.'r Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd '' Pl'an Date Number of sheets Revision Date lt�a t. Title 5 r +?Law \�(W PC 6 C C) 1 w, P Z UV E"_wl l✓,j 7,S K l 1-7 S W s FKL V%V G C N s2C.L.Z_ Size of Septic Tank �Sbo Type of S.A.S. l 2 ' O� �C 1122Z," C>^4_L,--f A Description of Soil � � `8�� � i2� (' a7—QE�1ti0 I& 12r - -51 6Jr�h.x \5 :5,­N1-> i> >CNkZ. 7/6 c) GZouti+l\A-t A---\,c{2 ry Nature of Repairs or Alierations(Answer when applicable) i Date last inspected: Agreement: ;y The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in f accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of _._(�J ate Application Approved by Date :17 Application Disapproved by Date e . for the following reasons ^- Permit No. D r,-->- ' 43k Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded Abandoned( )by at �"7 S W (�.�v rjo �,1 has been constructed in accordance l with the provisions of Title 5 and the for Disposal System Construction Permit No��a Q 3 r dated 7 )� 7/ � ro;x. Installer Designer #bedrooms Approved design flow and The issuance of thi'permit shall not be construed as a guarantee that the system willlZne ion as designed. Date a-I S�I Inspector f1M- ,(r- _ NO. O�� O� =O`���= Fee 1490 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair air( ) Upgrade,(,�X•) Abandon( ) System located at \_7 S VA %�w nJ Q 1 (Z'(..t-(:, t.. 1 yc <-f�_ and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date-of this p it. Date Approved by �% 02/20/2013 16 49 5084289617 SULLIVAN ENG INC # PAGE ;: 01 # . % > To.w n.of Barnstable s $ �Regulatory Services w.. Thomas K Geiler,Dirittoc P'uiblic,Updth Mvision: Thomas McK;*)Director' , . aoo ta, t,xy. Stree ands MA 42601 eD - Offim 509-8624644 Fax 508-790-6304 � Tntal1stk: 1Ignr ti�ion Form x Date: i /9 'M Sewage Perm it#204?~232 Assessor's MapTsircel 1y dy 7 De it'w.:. .(/.. dr �JCG�/ -.J/Q✓/./+ --. .7 04"'ta( Zp e b Addrw: 'Pv�• s ,�prt r : fr E Address: av,c 9 4., .(� / G � � /� ,'w� `�-^4.v •���'✓f + R pVYMt was issued'a (date) (installer) septic system at t 2 s-Q%''&r►Aa C.rcle_ ®3 r�r;/�c; �c,4 -bnsed`.on a design drawn by (address) r dat ? (designer).' certify that the septic:,systemrefereneed`above was installed substantially according to the d sign,which'may iiwlude.mmor`approved changes such as lateral relocation of the distribution box and/or septic tank.for Sys►•;° I that the tic em referenced above*as installed with major change' ^�., certafY Septic� (ix.grevler than 10.' lateral relocation of the SAS or vertical relocfarion of an component of-the septic systeth)but in accordance aiith`State&Local` yo4-` a1,11 �► ` Regulatio Pl ` eta .,C, C»i( ns an rowsion or certified as-built by designer to follow. n (Installer's SignaIli OF ture) JOHN K O'n � M cd CIVIL' N0.48168 (Desi 's S' lure (Ac.D e) --- L ><:rC"Fnrwt.Tfr nivraTnrr r'ERTIFtCATE OF' COMPLL*ANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-AMT CARD ARE RECEIVED BY THE BARNSTABLB P[1BLIC HEALTH DIVISION.'THANK YOU Q Healtb/Septic/Daer Certificaaati Farm 3-iG-o4.doc, • r .4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Farm- Not for Voluntary Assessments 175 Wianno Circle Property Address Jeremiah Doyle Owner Owners Name information is required for every Osterville MA 02655 8-21-12 page. Cityrrown State Zip Code. Date of Inspection Inspection results must be submitted on this form. Inspection fortes may not be altered in any way. Please see completeness checklist at the end of the form. important When Filing out corms A. General Information `"`��u�uuuupig7 on the computer, jN OF MtiS i, use only the tab 1. Inspector: 20 �� s9�y key to move your a O G cursor-do not JAMES use the return James D. Sears key. Name of InspectorC4__ Capewide Enter rises, LLC Company Name 153 Commercial Street �SlINSP ` rnnnunat CompanyAddress Mashpee___ MA 02649 C*fTown State Zip Code 508-477-a877 S1623 Telephone Number License Number B. Certification 1 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 ins action. The inspection was performed based on my training and experience in the proper function and m` lenanceW on sit sewage disposal systems. 1 am a DEP approved system inspector pursuant to{S. ction 19.140 of- Title 5(310 CMR 15.000).The system: CIO) ® Passes Q Conditionally Passes ❑ Fails I . v Needs Further Evaluation by the Local Approving Authority _A'. two z- .- 8-22-12rvq spectors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""*This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under Y the same or different conditions of use. LSins•11110 title 5 official Form:SubsuAaee Sewage Die eel System•Page 1 of 17 Z•d d0£:ZO Z i- 0Z 8nV r Aug 23 12 02:23p p•2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Wianno Circle Property Address Jeremiah Doyle Owner Owner's Name information is Osterville MA 02655 8-21-12 required for every page. c4frown state Zip Code Date of Inspection B. Certification (cont.) Inspection Summary Check A,B,C,D or E I always complete all of Section D A) System Passes: ® 1 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. Check the box for"yes", "no"or'not determined" (Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below); t5ins•11110 Title 5 otfidal Ywpecnon Form:sunaofats se"a Disposal system•Page 2 of V Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Wianno Circle Property Address Jeremiah Doyle Owner Owner's Name information reis every Osterville re aired for eve MA 02655 8-21-12 page. city/Town state Zip Code Date of Inspection B. Certification (coat.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 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. Check the box for"yes","no"or"not determined'(Y, N, ND)for the fallowing 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 A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the.tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): Gns-11110 TIRe 5 018r3at in spection Form SuDsurfew Sewage Dispose!System•Page 2 of 17 £'d d0£:ZO Zl, £Z 6nb' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Wianno Circle Property Address Jeremiah Doyle Owner Owner's Name information is required for every OSterviife MA 02655 8-21-12 page. otyrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cant.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ NO(Explain below)- ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation:is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health., safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(i)(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 Title 5 Official Inspection Farm:Submview Savage Disposes System•Page 3 of 17 ti'd d0£:Z0 Z1• £Z 6ny Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Wianno Circle Property Address Jeremiah Doyle Owner Owner's Name information is required for every OSterville MA 02655 B-21-12 page. cityrrown State Zip Code Date of Inspection B. Certification (cunt.) 2. System will fail unless the Board of Health(and Public Water Supplier, iif any) determines that the system Is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply.well"*. Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® 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 oarepael is less than 6" below invert or available volume is less than Y2 day flow Ts- tSiM-17/10 Title S ORidal Inspection Fonts Subawfaee Sewage Oiaposal"am.Page a of 17 9-d d LE:Z0 Zl, £Z 0ny Commonwealth of Massachusetts Title 5 Official Inspection Form 19M Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 175 Wianno Circle Property Address Jeremiah Doyle Owner Owners Name required for is ry, Osterville required for eve MA 02655 8-21-12 page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation_ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ 2 Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal colliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. Ej Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either°yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface.drinking water supply ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA) or a mapped Zone 11 of a public wager supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•1f»0 rde s Ofhder hspettion Form Subsurface Sewage Dlspegel System•Page 5 of 17 9-d dl•£:ZOZl, £Z 6nV Commonwealth of Massachusetts Title 5. Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 175 Wianno Circle Property Address Jeremiah Doyle Owner Owners Name information is required for every Osterville MA 02655 8-21-12 page- Gityffown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: i Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ IR Were any of the system components pumped out in the previous two weeks? 10 ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® Were as built plans of the system obtained and examined?(if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge and depth of scum? ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): NA Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15,203(for example: 110 gpd.x#of bedrooms): 330 i5ins-11M0 Title 5 Official Inspection Form.subsurface Sewage Disposal System-Pne 6 of 17 L•d d 60:Z0 Z l EZ 6ny Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Wianno Circle Property Address Jeremiah Doyle Owner Owners Name information is required for every Osterville AAA 02655 8-21-12 page. Cityffown State Zlp Code Date of Inspection D. System Information Description: The system is a 1500 Gal Precast tank D Box and two pits Number of current residents: 5 j Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2010-155,000Gal g y g (gp �� 2011-131,000Gal Detail: Sump pump? ❑ Yes Z No Last date of occupancy: Present Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flown(based on 310 Cl1AR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: tsins-11110 Title 5 OStl ial Inspection Forrrr Subsurface Savage Disposd System•Page 7 cF 17 g'd dZ£:ZO ZI, £Z 6nV Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments IW4 175 Wianno Circle Property Address Jeremiah Doyle Owner Owners Name informatrequired is Ostelville MA 02855 8-21-12 required for every page. Citylrown State Zip Code Date of inspection I D, System Information (cant.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information- NA Was system pumped as part of the inspection? Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Afternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): ►sins.I M 0 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 6'd dZ£:ZO Z6 CZ 6ny Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 175 Wianno Circle Property Address Jeremiah Doyle Owner Owner's Name information is required for every Osterville MA 02655 8-21-12 page. cityrrown State Zip Code Date of Enspedion D. System Information (cunt.) Approximate age of ail components, date installed (if known)and source of information: One old pit/ Tank, D Box, Pit 1995- Permit#95 -531 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): . Depth below grade: 42"feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40 Septic Tank(locate on site plan): Depth below grade: 341 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene Q other(explain) . If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal. Precast Sludge depth: 211 t51ns•MID We 5 016da1 Inapedbn Form:Subsurface Sewage Disposal System•Page g or 17 �I 0 L•d dZ£:ZO Z L £Z 6nV Commonwealth of Massachusetts Title 5 Official Inspection Fora' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Wianno Circle Property Address Jeremiah Doyle Owner Owners Name requination is ery Osterville MA 02655 8-21-12 required for ev page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" - 1, 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 17" How were dimensions determined? Asbuilt-Tape Sludge-Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tank at 34" below grade w/covers at G", Tank at working level, inlet baffle, outlet tee No sign of leakage or over loading Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain):. Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle — Date of last pumping: Date isms-ivno We s Official m apedion Fam:Stbsurfaee Sewage Dlspoael System-Page 10 of 17 l,6'd d£Z:Z0 Z 6 £Z Bny Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Wianno Circle Property Address Jeremiah Doyle Owner Owners Name information is required for every Ostervilie MA 02655 8-21-12 page. Cityfrown State Zip Code Date of inspection D. System Information (cunt.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: . ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order, ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No l5ins-11110 Title 5 Official Inspection Form:Subsurf m Sewage Disposal System-Page 11 of 17 Zl'd dCC:Z0 Zi, £Z 5nV Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Wianno Circle Property Address Jeremiah Doyle Owner owner's Name required foon r every Osterville required for eve MA 02655 8-21-12 page. Cityrrown State Zip Code Date of Ins pection D. System Information (cunt.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 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.): D Box is 16"x IT-44" Below grade w!two line's out box is dean and solid, No sign of over loading or solid carryover Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order. ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5lris•11110 Title 5 OfSdal kwpeatlon Fern:Subaurface Sewage Disposal system•paga 12 of 17 £6 d 'd ££•ZO Z I• £Z 6 nb' Commonwealth of Massachusetts 'title 5 Official Inspection Form ki�z�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 175 Wianno Circle Property Address Jeremiah Doyle Owner owner's Nance req required for is every Osterville re cared for eve MA 02655 8-21-12 page. Citylrown state Zip Code Date of Inspection D. System Information (cont.) Type-, ® leaching pits number 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number. ❑ innovativelalternative system Typetname of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is two pits older pit is 37" below grade w/cover at 2"3"water, newer pit is 39"below grade w/steel/cover at 14", Pit has 4 of water, Pit has 2`stone, No sign of over loading or solid carry over Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction 4 Indication of groundwater inflow ❑ Yes ❑ No tsins•1 t!t o Title 5 OtfiHal Ins pegbn Form:Su6surfece Sewage Oisposel System•Pepe 93 of 17 tq,d dt,£:Z0 Z[ £Z 6nV Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Wianno Circle Property Address Jeremiah Doyle Owner owner's Name information is required foreve ry Osterville MA 02655 8-21-12 page. Citylrawn State Zip Cade Date of Inspection D. Systems information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Mina•1 WO Tilde 5 Official In on Form:Subsurface Sew a DI ag spoael System•Page 19 of 17 9 l,•d dt e:ZO Z l, £Z 6nV Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Wianno Circle Property Address Jeremiah Doyle Owner Owner's Name information is required for every Osterville MA 02655 8-21-12 page. C►tyfrown State Zip Code Date of Inspection D. System Information (cost.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 3 B i D E c rc ` Pik= 3 ;, R 3 t5ins-1ilia Tine 5 O(fidei lnVeetion Form:SubsLOeos Sawe9e Oispaael System•Page 15 of 17 9l'd dte:Zo Zl CZ 6nV i_ _ . wC Commonwealth of Massachusetts Title 5 Official Inspection Form I. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Wianno Circle Property Address Jeremiah Doyle Owner Owners Name information is required for every Osterville MA 02655 8-21-12 page-' Cityfrown State Zip Code Date of Inspection D. System Information (cost.) Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 1501,feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked,date of design plan reviewed: pare ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: T.H 7-26-12 ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: . T.H 7-26-12 on site no water at 150" Before Filing this Inspection Report, please see Report Completeness Checklist on next page. tsins•11110 Tille S Offer Inspedion Form:Subsurface Sewage Disposal System-Page 16 of 17 L l,'d d5C:Z0 Zl CZ 6ny i !� I.J.f. � )� ' �ULL1'vAlti L-II(:i iNU j _1' �.� � eb. 2�. �(�13 ' 7.G,�AM Ncrfhern FGvi �g Vo, 2�?b P, > ' 1 Town of Barnstable Regulittory Seises Thomas F. Gtilear,Direder' Pubuc UtAth NASIOR '1 hemAs McKean,Director 200 MCI Street,HT ais,MA 02601 Chace:508-8624644 Fax;508-790-6344 a Form date; SeWage 1lermitOX2- 1 Asstqe[js rajsrptparce1 lV . ;4_1 P' /a'a;CC." s �j�': ' v �J71$diA l JCGI/. i ✓t s+� Add : Address-. a W.ceo� C41.7 17 was 198u8d'9 Tt7�j1C irst€iil (cite) �; �� septic systeM at t 2?s'-¢,r,kd C,rc_l (a MA based on a dckp' draw.by (address) I certify that the septic.sYstem ref�renced above was.ipstaed sub8'twtlydly according to the desiM which may imiude n or approved cba s such as. lateral relocation of the disaributi&box and/or septic tank.4, I certify'that the septic cyst=referenced above was installed with major chatser R1@ (i.e.grwer thaa 10.' lateral ieloafion of the SAS or any'vertu rclocatavn al:any � component of the septic systorn)bat in.accorr with State&Local �� �11 Re lations:Plays rovision ar&ed as-bt�filt by designer to follow. O J OHN C, r +� CIVIL y No.481—-----jut—ok t3� (De.a 's S" (Affixor .� ®) CONWLUNCE NOT BE ISSUED UMIL BOTH' FORM AND AJ$101 xTuixu IFiIVIZDI BY THI'DARNSTABLE PUBLIC NTH DrMION,THANK YOU, Q:Hcdth1,9epfiu/D&Aiper CeftiHcadcm Fmm 3-26-04.d6c f iy u. L T n� F R ^ f n wrw � Lf� .5; !.S•5 C fV •� � 04 G 0 ti �n h ti ram: TOWN OF BARNSTABLE 1LOCJU-1 jN 17-S— SEWAtrE#Z G+f2 - r VILLAGE. I STC ue t_c iEF AS��SEESSOR'S DIIAP PARCEL 140 � 7 INSTALLERS NAME&PHONE NO. I�!a n.r'rr c�,,� J�7 yr••� 5`CJ®�g��l� �.� � SEPTIC T.kNK CAPACITY Z-S-0 0 LEACHING FACILITY: (type)(4) G- (size) 4- e X j 2 & NO.OF BEDROOMS — _ OWNER �n 1 r..r �/ PERMITDATE:__ ?LZ7 /' 2-- CO21PIPLIANCE DATE_ Separation Distance Between the: Maximum Adjusted Groundwater Tab➢e to the Bottom of LeachingFacility Feet Private Water Supp➢y Well and Leaching Facility(If any wells exist on site or within 200 feet of➢eaching facility) Fee# Edge of Wetland and Leaching Facility(If any wetlands exist ��� within 300 feet of leaching facility) Feet FURNISHED BY .5. G N 'LTl _J j l• n 3 TEE CONMONWEAJ€..'F E OF 1%4LSSACRUSETTS - BARISTABLE,IVLkS.SACHUSETTS Certi rate of QCatr pliana THIS IS To CERTIFY,that the On-site Sewage Disposal system Constructed{ ) Repaired{ ) Upgraded(W) Abandoned( )by Ald n fi 3 G�••+ �-�4 tr C.oso-:7••.� '�+4/i �+-4-- at— ��_+ 5 V� t'_ -- -— has teen constructed in accordance with the provisions of?itle and the for Disposal System Construction Peanit 1$ dated IrWmner Designer #bedroorns Approved design flow .�+S­2 • f gpd The issuance of this it shall of be construed as a guarantee that the syst —11 ' ion i Date Inspector G 6 ti LT Town of Barnstable PO �-- Departitnent of Regulatory Services F Public Health Division Date 7'. /a - I a2 1639• 200 Main Street,Hyannis MA 02601 . lED RAKE� Date Scheduled / Time / Fee Pd. SOD• OO Soil Suitability Assessment for Sewa e ,Disposal Performed By:6L4i I;Va"1 L njj neer.)�1 � �• Witnessed By: LOCATION& GENERAL INFORMATION Lo a'on Address 1�: CI iCS4. Gy f!G Rs W;%Lhno C��/r-�� Owner's Name JGY�r+�r Ga Fo—frM0,v+ &-f - GSV Address ,t a m0 I(;}•./1/1 . .Oaf. 78 Assessor's Map/Parcel: O�Q. Q�� Engineer's Name5 LO I i V4.KC- NEW CONSTRUCTION REPAIR Telephone# Sof-Aj ea.F''3 3 el C� Land User) en ( Slopes(96) 0""93,eel�', Surface Stones ,�f9o�� Distances.from: Open Water Body Possible Wet Area 5"o 4- ft Drinking Water Well 7Qd 4 g Drainage Way I. ft Property Line J ft . Other ft. SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) .Parent material(geologic) Glae I'd;01,41d Depth to Bedrock SSG f Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater, DETERMINATION FOR SEASONAL HIGH WATER`ABLE Method Used: Depth Observed standing in.obs.hole: in,. Depth to Soil mottles; 1n: Depth to Weeping from side of obs..hole: jn, ©roundwater Adjustment Index Well# Reading Date:- Index Well level Adj.&clor, ,.r,^ Adj.Groundwater Leval,, PERCOLATION TEST bate Time_•_�__. Observation / Hole# 2- Time at 9" �12 Depth of Perc �/j: 5/{� Time at G" 7:2 U 7`3 L Start Pre-soak Time @ IU 2c JD =30 Time(9"-6") . 70 SVC 72 'SSG EndPre-soak RateMin./inch 2"�":� <2"+i"�h Site Suitability Assessment: Site Passed X Sitc.Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back--------- ***I£percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISEPTIC\PERCFORM.DOC 1 n DEEP.OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Sdil Color Soil Other Surface(in.) I" (USDA) (Munsell) Mottling (Structure,Stones,'Boulders, ronsistency,Worawn 312 ]l-Si �j sa^d toYR.6/B 5i-iso" C rhd 1oYg '716 DEEP OBSERVATION HOLE LOG Hole# Depth from . Soil Horizon Soil Texture Soil Color Soil" Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,noulders. Qgnsistertcy,%G ve LZ � ,L.. .•. ��� to f'R.s/r ' _ G I (2 S Q a ticp to . DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) ', (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%G e _ LU fug( lag 3/2 A; to Sak to YI'c sf� 10 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil . Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. consistency, — �6cr�n S� C� 2 312 D e7x 7/ Flood Insurance Rate Map: Above 500 year flood boundary No— Yes ___ Within 500 year boundary No X, Yes.�.� Within 100 year flood boundary No._. Yes Depth of Naturally occurring Pervious Material Does at least four feet of naturally occurring pervi us mtiterial exist in all areas observed throughout the area proposed for the soil absorption system? 's If not,what is the depth of naturally occurring pervious matar(al? _ Certification . I certify that on i 2o1Z (date)I have passed.the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described-in 110 CMR 15.017. Signature.�&Z Datt: 1&4201Z Q:1S"EPTIC�PERCFORKDOC PfT i.?a ae/e vo-1 4� t 7 06, .PV1 � , � . t No... ._. F>ms............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratilatt for Uinpwial Onrk,s C owitrurtinrt ramit Application is hereby made for a Permit to Construct ( ) or Repair (x) an Individual Sewage Disposal System at: ' ................1.......�4...�..................��{.:. r ................................ ........................................................... Location-Address or Lot No. "L�..�Albl�......h?:�c. f:�f�l. �IS'..J.�i/�1,V�ci%__• /1? 1 = hsTf'/Z.:/�//L :............ .... •- Owner Address .......................................................... Installer Address Q Type of Building ` Size Lot.................... .....Sq. feet U Dwelling— No. of Bedrooms----------- __---__.-__-Expansion Attic ( ) Garbage Grinder ( ,) ay Other—T e of Building ............................ No. of ersons----__-__--__-____-_---.-.-_ Showers Other—Type g p ( ) — Cafeteria ( ) QOther fixtures ----------------------•------------------....------...._....--------------•------------- ---••--•-•-•......•---••-------- ....-----• W Design Flow............................................gallons per person per day. Total daily flow---------------------------------...........gallons. WSeptic Tank—Liquid capacity-_-._-_----gallons Length-------------_.. Width---------------- Diameter------.--------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------.._--..-.--_- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. ` Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I................minu",tes per inch' Depth of Test Pit.................... Depth to ground water-..------_--_---_--- f Test Pit No. 2...........---,-minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ................................................. •---••-•---......................--------.................................................................. A0`10 .. Description of Soil.......................................................................................................................................................................... ...........................--....-•-•--.....__...--•--••-•-----•-------------.......__......------.._._.---••-•-------••--•------•-•----------•--_.........-•---•--••--......-•--------••------........ W _ U Nature of Repairs or Alterations Answer when applicable /l�/ n1�C, /:z . .-•- - ^---•--........--••--. Agreement: e The undersigned agrees to install the afore`�described 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 Ce _ icate of Comp l �Icee- as- een issued by the board2 f health. g , SI ned ........v �! . S / /f C ................Date..-.........i..-. Application Approved By ...........G ......... 1.. . _.....��/1 .�--- --------------------- ­------------------------------------- Dmre Application Disapproved for the following rea o r: -------------------.......................................................................... ....................... ............................ ... / ... - Dace Permit No. .............................�3­ Issued ................./... �........ .... Dare/ THE COMMONWEALTH OF MASSACHUSETTS { BOARD OF HEALTH TOWN OF BARNSTABLE Ter#tf rate of Tomplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal,Sys.tem constructed ( ) or Repaired by —---------------------- - .. ... ... ..... ......................._... ............_..._........................... Insr.Jlc•r at C / .-- ------ _�.................. .... . . . ... ..............-...------- has been installed in accordance with the provisions of TITLE- .of The State Environmental Code as described in he application fo"r Disposal Works Construction Permit No. ._�rr- .� 7���.. ........ dated ..._._..._............._...........__.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE�AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �����—DATE �—s ._.. _.....- Ins ect t''". �'./.. ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE : No... FEE...............'......... 0.? �tnttlrk C�rrtt�traxrtt>nnrrmit r-, Permission is hereby granted../ /.L/S.._ ...`----•----------------------•---------•----------•-------••--....... 1 {� t. to Construct ( ) or Repair (X) an Individual Sewage Disposal System at No..L2_S .... � '� rf� '`....... yam. --'------------- ---- �.. as shown on the application or Disposal Whorls Construction permit No. .................. a et d.._..��/���... ______ ------ ------ .s Board of4iealt DATE �..._.... •-- / r = � ; � FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS i � 4 M W„ go MEN cb ep _ EXISTING FIRST FLOOR PLAN EXISTING SE:.COND FL OOR PLAN SCALE vB° - I-O" SCALE: I/B' 1'-0 j _ O qa o° • r•y 35'-0v .Ibi_6v 52 $ 16'-0° 52 7'-6 ICY. T-2° 7'-Bvrs - .. FIREPLACE ... 7. M �1 M O .. .. BLUESTONE'SLABS IN GRA S SUN ROOM ... .. ... - ... .. .... .. ... ... ... S . .. 1 LATE) 4 DECK { .. ... ... - I.. .. .. IL 52. B 52 ld 2 � 3 NO ENCLOSURE _ - N LK R.O.Ro\�60 SHOWER OUTSIDE .. .. ... e $ i I , c o ilTc' 2$ s� 2$ 2¢ LAUNDRY W ry 0 MUD ROOM , .... _ .. ..-. .. .. ... ... o r TR .. - ( o q - T F(3)zno DR - :a ADD SWING � - pp (OAK) % _ KITGWEN PS DN b ..:(OAK) I .. .. 2 a g I Ill -- m .. - :. LLI 114 , o ________ - . - ..: m _ N-PI:._ WIO.l26 STEEL BEAM.ABOVE: N P6 :-I'W W1026 ST EL BE li. g Ep3. LAUNDRY RI'I .. .. .. .. ... - .. .. .. _. .. a. r � MASTER I 'I. I _f _ - NECE55ARY o MOVE COOP IF BEDROOM 2 6" TH 16'0° Q 243 .. ,- - II .- .. R. 30 1/6u46 7/6' "4'-2 I/2' 6'-I° - .. 17 A-Ill". ":5'- I/ 3 II Ill° I6-3 MANTLE _. ... _ "IOO W/TIE Env 11' M36�GAsSEAT 0 .. ml I -zR.O. 2x24 5/6° .: .. 2& RF - _ I 2' 0°.LIN '� II TWO CAR GARAGE': o z }yb LLAi1J . � II . Q�`i .p (OAK) N 0: ' cz - LINFW _ oQ . ry ---- -- — PST ON _—i—A 'E FLAT CEILING NG A I �I s� o � _m L° n _ O r 2 ... ❑ .. 1 ... �IC�1i1FQ 34 TW 24310 .. �a ' .�O 2& SOLID 2$ O� _ W ::. R.O.30 I/Bx40 7/e 7'-II I/ - "2Q MA NOG .. .. - .o .. ._ .. .. .. — .. .. .. " PANEL v UES II DINING ROOM @ TCp (OAK) .. N O .: ..W .... \. ..(OAK).. K n GUESTn L L� o I - m I] t :m - . IO 4'.(T�I �{ _ 1` .. 13:you .. U 32 �r i.< :. .. .. - .. ... TW441 .. LID R.O. /6x 6 7/6° I N S n ... ... _ I . PANEL E 5 a" a'B �p STEP m I N I SN ET 0" .41-0 a'-0""I a'-0" I .. - LEGEND/KEY: .. OAK ==U-j NEW WA ... ... .. .... On 4i_p"I I WALLS O EXISTING WALLS JOB:. LANE DRAWN HY. TFR A NEN FIRST FLOOR PLAN B IVIS/t2 _ ..... SCALE: I/4" m I'-0" - .- DATE: i • N b ..co Emil 1A UAL!. n - -__ 7 MEN LJ t193Iffi..Cl� pLAI 1 w EXISTING FIRST FLOOR PLAN ° EXISTING SECOND FLOOR. PLAN O - SCALE, 1/6 -On .- .. ._1 .. 1 ..: ..:. :. :. SCALE, 1/8" I'-O" .. �1 a .. ... .. .:36'-O°.. .. V-O _.. 14'_p° .. .. 6 6' .. .. .. .T,-6° .. .. - - . _ .. rs w. - :. ... cn o. GALLEY RAILS .GALLEY RAILS N 'N: .9 :. .. .. ... - 'Q BLACK RUBBER ROOF BLACK � F'K m W/ECOiB.FOR POTS W1 BOOTS FOR POSTS �f LU o l ..: o .. ...(2)TW 24310 .. :. Lu co O 'MOSTMG ROOF TO BE STRIPPED O.REPLACED z NURSERY ( LQ TILE) EH Q (REFINISH).. EiEDRGOM #$ EXISTING CUPOLA 0 : TO.REMAIN. .. n .. Z ... .. HVAC :(REFINiSH). .. .. .. ..10'061,41 7/El, .: ... .. .. Q D g (k q..IZ�.D RICKET32II, IIIIIII BEDROOM #2 nIXISTING ROOF TO BE STRIPPED 4 REPLACED 0 I/er48 7/8° '(REFINISH) 24.. TW 2432 BEDROOM #4 O BE:. .:' R.O.30 I/Bx48 7/B° .: - � Z ILACED .. (REFINISH) .. .. .. .. .. .24.. .. ... .. 2yI .. .. .. :. .. .. .: Q m 4 .. N ------------ EXISTING ROOF TO BE .. - Ri - STRIPPED 4 REPLACED -. .. .. r m.. ::. .. .. - ..�. EXISTING ROOF TO BE STRIPPED 4 REPLACED - 0 SHEET ct - PROPOSED SECOND FLOOR PLAN : .. .. .. SCALE: I/4' t JOB: LANE DRAWN BY: TFR DATE: I I/15/12 DIRECTIONS: ASSESSORS REF: From Hyannis - Take Route 28 towards Osterville; Map 140, Parcel 97 Take a left onto 5 Corners Rd, and continue to; Bumps River Road, Turn left onto old mill Road and Continue Straight Onto East Bay Street, OVERLAY DISTRICT. Turn Right onto Bates Street, Turn Left onto RPOD - Resource Protection Overlay District Manna Ave, Trurn Right onto Crystal Lake Road roec y and a Right onto Wianno Circle, Stay Right. House is on the Right # 175 FLOOD ZONE: Zone C Community Panel No. J250001 0016 D July Z 1992 LOCATION MAP (1-=2000 C- REFERENCES: ZONE: Certificate C198171 RC (RPOD) Land Court Plan # 2664-83 Area (min.) 87,120 SF n 20' WidthFrontage(min(mi) 10)0' Setbacks: Front 20' Side 15' SEPTIC NOTES PERC TEST: 13,702 4 Rear 10' 1.Location of Utilities Shown on This Plan Are Approx.At Least 72 Hours PERFORMED BY:CHARLES ROWLAND,EIT- SULLIVAN ENGINEERING Prior to Any Excavation For This Project the Contractor Shall Make SOIL EVALUATOR NO.13586 Z/ 39. 41 WITNESSED BY:DONALD DESMARIS,R.S.-TOWN OF BARNSTABLE N, the Required Notification to Dig Safe(1-888-344-7233). 11 July 26,2012 2.The Contractor is Required to Secure Appropriate Permits From Town 090 36, Lawn Agencies For Construction Defined by This Plan. G 3.Wherever Sewer Lines Must Cross Water Supply Lines Both Lines Shall TEST HOLE- I EL.32.0 TEST HOLE-2 EL.32.0 1 T x 9 Q Be Constructed of Class 150 Pressure Pipe and Shall be Water Tested to ......A•............................. ..... .. ...... .......... EXISTING PIT Assure Watertightness. In General,Water Lines Shall be Constructed in .-PAW-*0AAV$00k0.WN-V-'- U) ................ ............. ....... 81 ...............4D RGWW,9 Coordination With COMM Water,and Shall be in Accordance 611 ...............31.5 31.25 ........... With 248 CMR 1.00-7.00&310 CMR 15.00. ........... 511........... .........• .... ....... ................... .................. -I....I..... . ................. 4.A Minimum of 9"of Cover is Required for All Components. .SAN�..................31.1 121... ........ 31.0 5.All Structures Buried Three Feet or More or Subject 112 11-1.1-1.-111-111-1-1-1-111-1-1:-• 1-I� I- I X 32.04 B LAYER I OYR 6/8 B LAYER I OYR 6/8 to Vehicular Traffic to be H-20 Loading.It is the Engineer's BROWNISH YELLOW BROWNISH YELLOW t3 EXISTING SEPTIC SPRINKLER Recommendation that H-20 Always be Used. 511, COURSE SAND 27.5 51 COURSE SAND 27.5 TO BE ABANDONED CONTROLS VALVE 6.Install Watertight Access Risen and Covers to Within 6"of Finished C LAYER IOYR 7/6 C LAYER IOYR 7/6 OR REMOVED Grade Over SepticTank Inlet and Outlet,Pump Chamber Inlet,D-Box, YELLOW YELLOW PROPOSED ......... 27.5 MEDIUM SAND 511, MEDIUM SAND 51" 27.5 TIC TANK and One Leaching Chamber. PER TEST PERC TEST Lawn 0 7.Septic System to be Installed in Accordance With 310 CMR 15.00& 42 25 GALLONS IN<15 MIN 25 GALLONS IN<15 MIN -7.00 Latest Revision and the Town of Barnstable PERC RATE<2 MIN/IN(LTAR 248 CMR 1.00 '0" PERC RATE 0.74) 119.5 Board of Health Regulations. 150,11 <2 MIN/IN(LTAR=0.74) 19.5 150 NO GROUNDWATER ENCOUNTERED /51 Ile '100 NO GROUNDWATER ENCOUNTERED �S63 Lawn 8.All Piping to be Sch.40 PVC. 0 ................ 9.D-Box Shall Have a Minimum Inside Dimension of 12",and a Minimum ........ .. Proposed Deck Sump of 6". Proposed Sun Room 10.The Horizontal Separation Distance Between the Septic Tank,and Tank TEST HOLE- 3 EL.32.0 TEST HOLE-4 EL.32.0 . ........... Inlets and Outlets Shall be No Less than the LiquidDepth.Inlet Tees Shall ........ ............ ....... .......... Extend a Minimum of 10"Below the Flow Line.Outlet Tees Shall Extend --.%-.VERY-D QRAYJSH.BROWN-,-.. ............... I..."".......,..�...�.I.I.I..,Olko $1..........4M;0 ....... 31.5 6". 14"Below the Flow Line,and Shall be Equiped With a Gas Baffle. .......- .......31.5 . . ........... L.A.yu,).60. I.....I.... . . .......... .......... ................ .. . ...... ELEV. 32.87' ................... .................. SILL ...........31.2 1 31.1 B LAYER IOYR 6/8 B LAYER 10YR 6/8 Lawn BROWNISH YELLOW BROWNISH YELLOW 48" COURSE SAND 28.0 5211 COURSE SAND 27.6 C LAYER I OYR 7/6 C LAYER IOYR 7/6 YELLOW YELLOW PROPOSED 150111 MEDIUM SAND 19.5 150111 MEDIUM SAND--- 19.5 ADD17ION NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED LJ #175 Garage SITE PASSED2 S ty w1f d� Dwelling ON SILL ELEV. 32 87' La I-Finish Grade wn Driveway .3' Max. 9. Min Compacted Fill Filter 0 Fabric 'X SILL ELEV. 33.42 And/Or Lr- ---7020077- 118" - 112" LLJ Pea Stone 314- - 1 112- 3LEACHING Double Washed -31- CHAMBER Stone (b Lawn 4.83' \-31- 12.83' CROSS SECTION OF CHAMBER NOT TO SCALE <E DESIGN DATA Lawn Single Family 5 Bedrooms @ 110 GPD No Garbage Grinder Total Daily Flow=550 GPD Use a 1500 Gallon Septic Tank F*F* F"I TTA9 //71"See Note 6 ft)p.) LEACHING AREA EL. 29 52 F.0. EL. 32.O± vows Flow Equilizers F.G.-EL. 32.O± LJ 550 GPD 0.74(LTAR)=743.25 SF Required Install' As Required Sidewall 2(12'-10"+42')2'=209.7E Installer W Adjust as Require( OHW EL Bottom Area= 12'-1 0"x 42 539 SF 60 wr 1500 Gallon 28.40 Top EL 29,0 OHW Septic Tank EL. D-Box 0 ` OHW Provided 748.7 SF - � -� �E-is ti.ng Outlet Invert, le, 29.03' EL. Leaching Wi anno '4 LEACHING CHAMBER DESIGN Chamber 7, C=== To Be Installed 0n_1 Circle Stable Compacted 13ase got, EL 26.0 All Pipes to be Schedule 40. Redding,"T"s, ......................... Use 4-500 Gal.Leaching Chambers in Inspection Port, ............ ...................... .......... & Baffels .. .. IT-10"x 42'Double Washed Stone Fields as Shown. . ....... .......................... as Per Title 5 F'Ri ...............! ...................... ............................ .................................................. ....... EL. 19.5 No Groundwater Per Test Hole 2 DEVELOPED PROFILE OF SYSTEM EL. 2 Appox. Groundwater NOT TO SCALE Per T.O.B. Maps REVISTION: Update Building Addition and Move Septic Line 1012512012 NOTES: PREPARED FOR: PREPARED BY.• T/TL E.• Site Plan Legend: 1.) The structures shown were located on the ground by conventional Sullivan. Engineering, Inc.survey methods on 131JUL112. Proposed Improvements Perc. Test Holes Holly Tree 2.) The property line information shown hereon was compiled from Erin & Matthew Lone PO Box 659 Light Post available record information. Os tervill e, MA 02655 A LL- t Q)Hydrant (D- Hose Bib Deciduous Tree 3.) The datum used is Approx. NGVD 29' based on the town GIS data. (508)428-334.4 (508)428-9617 fox 175 Wianno CirVle Fl CBIDH Oak Tree -4 Guy Draft: C TR Field: Bamstable (osterville) Mass. LLJ -0- Utility Pole 10 0 5 10 20 40 CTR/WHK LJ-J Overhead Wires Maple Tree Pine Tree I -OHW- Review: PS Comp.: C TR DATE: SCAL -25- - Elevation Contour Project: 980002 July 26,2012 =10 ------------