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HomeMy WebLinkAbout0033 WOODLAND AVENUE - Health 33 Woodland Aveo� Osterville A= 140-135 E:SM E AD No.2-153L ON UPC 12134 smssd.co» + Med.in Uaa $,4r� ' w.usDa.MNaouair SFI mm � �� �� �`� � Y U � � G d � G. �' �.� �� i �9 J O4 OF BARNS bi .sL�►GE �� A�SEsssow. 1TtST�.LBIt'S M 8c [ C?MF NO ab g Yf fCS?lz� �g LEAGI3WQ PA-CII,1T - I7OFRRof)NdS u �BUILL1E9 OR dwM. Sepuratiau i1915Eauna6 86Eweep old ib�xlmum i}qBt 1 CnauudwaEe�Tsbleto tlae mtam oPLeaGhln�P�uiliEy :.�..., ,.... Pi'tvaEc:�1V'at±wr Sup ly `'Mo wid. aa6ung�+fic>�ty .�e�y�e1ls exist r` ' cif eits�ac:wlt�,n?AQ f eE of 04a ! lg f ty) gea > i exist urlti�lt�3a0 feet at ae�iins Pad a Furi1bbe(l b3 J biz . .. _r�. g1 T71-3 l �. 1 �W TOWN OF BARNSTABLE LOCATION '�3_�> vc �C-vim ���� SEWAGE# 2 02o —336 VILLAGE ®� -c�`�VLs ASSESSOR'S MAP&PARCEL ( O INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 15-04) //-/0 LEACHING FACILITY:(type)3—5W15 IY-20 (size) NO.OF BEDROOMS H, OWNER PERMIT DATE: J.O -20 COMPLIANCE DATE: '? Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland an c ili (If any wet nds exist within 300 feet o eaching facili Feet FURNISHED Y F1 �� �� � � �� c � '}' a � ��, C 5 � � .,, .r` t� ^� L /� .. �� � � I \ � 4�� ti y � � � � � � � � � -- � , �,.� � � � s � � -- � W 4, � � � No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS appuration for Misposal *pstem Construttion 3permit Application for a Permit to Construct f() Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.'33 W-&61>L0Vwb Owner's Name,Address,and Tel.No.CYAYT�I A Assessor's Map/Parcel )40 �- ��� L.dr Z2 p6 �L-E MA 0244e, )�,- � Installer's Name,Address,and Tel.No. )Z-A C.0 A6,r Designer's Name,Address,and Tel.No. Orh4e" -1 a 6-'I ' AW )06 6 Ox 3-11 0%&4$ '17 A-e-"f-•t4y A-^j r441w tiNl a z 54 6 c(C S- 1967 � 0a- /22�r Type of Building: /3s-/a 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) 441) gpd Design flow provided -44® gpd Plan Date aV-L Y.1 Z®1 a Number of sheets '1/ Revision Date Title PL,0-7- Pe-A-PJ 3 S W &,_ A *V'E- Size of Septic Tank /�'� Type of S.A.S. ppt"-f Description of Soil deg Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance o the afore described on-site sewage disposal system in accordance with the provisions of Title 5 nviro a and lace the system in operation until a Certificate of Compliance has been issued by this oard of He — Signe Date Application Approved by _ Date 16 — 2 G _ Xo Application Disapproved by Date for the following reasons Permit No. ®� r J�,� Date Issued �� A � :. .,•�.r..T.. ;+yf.,n t-♦.,•=t ,..:' iry *Tyr,, 4 }t.'r y ..i.Y �cn o. Fee`` s No / THE COMMONWEALTH OF MASSACHUSETTS Entered;ncomputer: r Yes . PUBLIC HEALTH DIVISION,- TOWN OF BARNSTABLE, MASSACHUSETTS 2ppYication•for ]Disposal 6pstern (Construction Permit Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) ❑Complete System :❑Individual Components `,{ Location Address or Lot No. , W oPsb LA/ nib DST Owner's Name,Address,and Tel.No.G�N `� /" ©�bVY 4,?3 -3899 Assessor's Mao/Parcel 40 ''J I4.S I•oT?..•;. A,Iq•aw s ns,6 -E AIA 02-641% Installer's Name,Address,and Tell No. )Z /� C e iv:7 Designer's Name,Address,and Tel.No.,4:.440WvTY/ P--V o/�ox �ii�,/?�/h2�Iss�,iccs a2toag f? f�C�� +y A. Fi4c/t�►�vl 0z546 ; Ste- G'7 k +9S• - /isr ' Type of Building: t j`� f' 1 _ Dwelling No.of Bedrooms,. 0 Lot Size's /3-5/0 sq.ft. Garbage Grinder( ) e Other Type of Building `-: No.of Persons Showers( ) Cafeteria( ) Other Fixtures �r✓"�, - -` Design Flow(min"requiired) � gpd Design flow provided .46 0 gpd Plan Date 1V 4y 1 Zo 1 y Number of sheets '' '' Revision Date Title ..t PE 67� P�fsJ' WYst. Size of Septic Tank / Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) t 4 F' Date last inspected: Aj.reement: 6 ' y f The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal,system•in r, accordance with the provisions of Title 5 of=the,Enviro e tal Gode and<no lace the system in operation'until a Certificate of r4 Compliance has been,issued by this Bard of He t . ��, P •ji :� i ..... W ,Signed - Application Approved bye �.�• (" Date I GG„? ��•• r Application Disapproved by bate 4 for the following reasons' w.'��'• .t", r, Permit No: a �•. 3.� Date Issued t7 , s .,- __,__. —_`—•——._�._.._a.._.., THE COMMONWEALTH OF MASSACHUSETTS ' BARNSTABLE,MASSACHUSETTS i §4. Zertificate of Coinpriance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( by l�'� 1y C071J 'at �3,- .( (J� G/�'V1� + d`^�'�/ ��� has been constructed in accordance 1 with the provisions of Title 5 and the for Dip sal System Construction Permit No. 7020 3'%dated Installer 11 /2 Co S??� � ✓AIC Designer ZWAJZI AA61A1 &%f0-9t-_44 #bedrooms ' Approved design flow 46 Q /-N gpd The issuan`cefofthisipermit s al not be construed as a guarantee that function the system will nction as designed.ft '' ,.,�y -' Date. Inspector No. Fee /� THE COMMONWEALTH OFMASSACHUSETTS PUBLIC HEALTWDIVISION� BARNSTABLE,MASSACHUSETTS Misposal.*pstrm (Construction Permit ' Permission is hereby granted to Construct(.4") Repair( ) Upgrade( ) Abandon( ) System located at /A/1P-V.AL-/j;PV;Q and as described in the above Application f Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. j �. Provided:Construction must be co m leted within three years of the date"of-f-tffis permit. ' rr c�1!9t jr; Date U l'1 :` kAPproved by �arnstab le Town of , ti I Regulatory Services Richard V. Scali,Interim Director annNsrnetr:. : MASS. Public Health Division. '°rfo ru<°i Thomas McKean,.Director 2001VMairrStreet,Hyannis .MA 02601 i i Office: 508-862-4644 Eav 4508-790-6304 Installer&Designer-Certification Form Date: i 21 Sewage Permit# Assessor's Map\Parcel tau l i f Designer: Installer: ,-}- -�- Address: a4 peconer =' Address:' • e On was issued a permit.to installea (date) (installer) -septic system at .VJ UOIDL.R�) based;.on a.design d awn by (address) :dated Z� l 74"9 M--\A:?� -l3 �O (designer) ' .LA)G. �( 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. Strip out (if required) was::inspected and the soils were found satisfactory. I certify'that the.septic-system referenced above was installed with major changes'(i.e. greater ihan 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. Strip out(if required)was inspected and the•soils. were found,satisfactory. I certify that thesystem referencea above was constructed in co liance-with the terms of th approval hers(if applicable) of _+i �• MIGiAE1.J. N " c, Li0R5Eili ��.. GVIL y nsta e S n TO iao•apt ISTS Affix Desi ner s,.tam Here ( ' gnet's Signature) ( g P.' PLEASE'RETURN TO BAR NSTABLE'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.ASepticADesignet,Certification'Fortn'Rev 8-14.-13:doc' c� �� �� � f Town of Barnstable Barnstable AF'iHE Tp� Inspectional Services , a CNV BARNSTABLF.� KAS& Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4988 2057 January 18, 2019 TARNOFF, PETER, TRUSTEE 45 WOODLAND AVENUE OSTERVILLE, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 33 Woodland Avenue, Osterville, MA was inspected on 12/15/2018 by Shawn McElroy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails",under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Discharge or ponding of effluent to the surface of the ground. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within'the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH c e n";"R.S., CH Agent of the Board of Health t Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\33 Woodland Avenue Osterville.doc oF� Town of Barnstable 1AiN8TABLE. Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the c,is the failure criteria and associated repair deadline -60 DAY DEADLINE CRITERIA V-1vischarge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe.. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool t ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within.50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc r `.. Commonwealth of Massacihusetts ,w Title 5 Official Inspection Form F :' ! C�'t Subsurface Sewage Disposal System Form -Not for,Voluntary Assessments 33 Woodland Ave Property Address Y George Padula Trust fit Owner Owner's Name _0 information is required for every OsteNllle ' MA 02655 12-15=18' ' '�` ' 4 page. City/Town State Zip Code Date of Inspection r�•} M a 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 Shawn Mcelroy Name of Inspector t Upper Cape Septic Services ' Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S 13971 Telephone Number License Number B. Certification j I certify that:l 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 theproperty 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 r maintenance of on-site sewage disposal systems.After conducting,this inspection'I have determined that the system: ' 1 `i. ,? ,,�,`' . is .', �.' 1, i •1 1. ❑ Passes 2. ❑ Conditionally Passes 3.. ❑ Needs Further Evaluation by the Local Approving'Authority f _ 4. ® Fails 12-15-18 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30-days of completing this inspection. If the system 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 Commonwealth of Massachusetts 3 Title 5 Official Inspection Form i'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Woodland Ave Property Address George Padula Trust Owner Owner's Name information is required for every Cisterville MA 02655 12=15-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: , ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist:Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ; ❑ One or more system components as described in the "ConditionalPass" 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 El ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Foam. .. ! i-l1 Subsurface Sewage-Disposal System Form -Not for Voluntary Assessments - 33 Woodland Ave Property Address George Padula Trust Owner Owner's Name information is a required for every OStervllle MA 02655 12-15-18, 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): El -obstruction is removed ❑ Y ❑N El ND (Explain below): ❑ distribution box is'leveled or replaced' ❑Y ❑. N 'El. ND (Explain below): Y, y • t L ❑ 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, r' safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form "i i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Woodland Ave Property Address George Padula Trust Owner Owner's Name information is required for every Osterville MA 02655 12-15-18 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: 4) System Failure Criteria Applicable to All Systems' : You must indicate "Yes"or"No"to each of the following for all inspections: Yes No I ® ❑ 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 r Commonwealth of Massachusetts ,w Title 5 Official Inspection Form T. M i,,, Subsurface Sewage Disposal System.Form,-Not for Voluntary Assessments e 41 . �:. ,> 33 Woodland Ave , Property Address George Padula Trust x Owner Owner's Name information is b required for every Osterville MA 02655 12-15-18.- .•_ page. City/Town r State Zip Code Date of Inspection C. Inspection Summary (cont.) , 4) System Failure Criteria Applicable to,All Systems: (cont.)., Yes No, , 'Static liquid level in ttie 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 Y2 day flow'' r, ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ` ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or ❑ " ® tributary` to a surface water supply. ' ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ®`` Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered..A copy of the analysis and chain of custody must be attached to this forrn j- ❑, ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ® �` E] 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.owrier should contact the Board of Health to determine what will be _ necessary to correct the failure 5) Large Systems:To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. ` For large systems, you must indicate either"yes" or"`no"to,each of the following, in addition to the questions in Section CA. 4 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 ❑ El Area— IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i�► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r_ ,> 33 Woodland Ave Property Address George Padula Trust Owner Owner's Name information is required for every Cisterville MA 02655 12-15-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section' CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant,'or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ '® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Wasthe 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.V26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 l r Commonwealth of Massachusetts - Title 5 Official Inspection-Form hG Subsurface Sewage Disposal System Form -Not forVoluntary,Assessments 'F ;. fir'' •' 33 Woodland Ave Property Address George Padula Trust Owner Owner's Name information is MA 02655 12-15-1.8 required for every Osterville ' ` page. Cityfrown State Zip Code Date of Inspection D. System Information �- 1. Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#.of bedrooms): 220 Description: Number of current residents: _ ,, , - Does residence have a garbage grinder? ,. ❑ Yes ® No Does residence have a water;treatment unit? ❑ 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? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 2018 Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 1 Commonwealth of Massachusetts Title 5 Official Inspection Form �i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,fsl 33 Woodland Ave Property Address George Padula Trust Owner Owner's Name information is required for every Osterville MA 02655 12-15-18 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 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: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? . Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 it Y Commonwealth of Massachusetts Title 5 official Inspection Form , i-a Subsurface Sewage Disposal System Form.-`Not for VoluntaryAssessments r .33 Woodland Ave t. Property Address George Padula Trust Owner Owner's Name information is Osterville " , required for every MA 02655 12-15.18 page. City/Town - State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® 'Septictank, disidbution box, soil absorption system ❑ Single cesspool w ❑ _ Overflow cesspool ' w ❑ 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 contracts I. ❑ Tight tank.Attach.a;copy,of the DEP.approval. ❑ Other(describe): Approximate age of all components,date installed (if known) and source ofiinformation: 1970's Were sewage odors detected when arriving at the.site?; ❑ Yes No 5. Building Sewer(locate on site plan): Depth below g 12"rade: feet` Material'of construction: ® cast iron ® 40•PVC ❑ other(explainj: Distance from private water supply well or suction line: feet Comments (on condition of joints, venting; evidence of leakage, etc.): Good condition. I t5insp.doc-rev.7/2 612 0 1 8 • Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments > 33 Woodland Ave Property Address George Padula Trust Owner Owner's Name information is required for every Osterville MA 02655 12-15-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 6"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ' ❑ Yes ❑ No ` Dimensions: - ' 1000 gal 12" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" - How were dimensions determined? Tape 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 is in good condition with baffles installed and no sign of leakage. t5insp:doc•rev.7/26/2018 Title 5 Official Inspedon Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official, Inspection Form ` it Subsurface Sewage Disposal System Form r Not for Voluntary'Assessments,.' 33 Woodland Ave Property Address George Padula Trust I Owner Owner's Name information is' required for every Cisterville MA 02655 12-15-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) A 14f 7. Grease Trap (locate on site plain): F 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 outletinvert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of i nspectio n)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 r Commonwealth of Massachusetts y Title 5 official Inspection Form M Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Woodland Ave Property Address George Padula Trust Owner Owner's Name information is required for every Osterville MA 02655 12-15-18 page. City/Town 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 N/A 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.): t5insp,doc-rev,7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal Systertl-Page 12 of 18 E r „� Commonwealth of Massachusetts Title 5 Official I nspection- f orm - ol Subsurface Sewage Disposal System Form-Not for-Voluntary`Assessments.� 33 Woodland Ave ' Property Address George Padula Trust .:•'" ,r, e,: ' Owner Owner's Name information is required for every Osterville ' �'' + r=- MA 02655 12-15-1,8 .. page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): t Pumps in working order 0'°=Yes El No* 'Alarms'iniworking order: , r.. w ❑ 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: .,.... <'® t'' leaching pits �+ . ' q . `t 'number:' 1-1000 gal ❑ leaching chambers number: ❑ leaching galleries number: - ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18- Commonwealth of Massachusetts y Title 5 Official Inspection Form hi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Woodland Ave Property Address George Padula Trust Owner Owner's Name information is required for every Osterville MA 02655 12-15-18 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.): Leach pit had obvious signs of failure with stain lines above inlet invert and into riser. 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 layer Depth of scum la p Y 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 f - f Commonwealth of Massachusetts ,. Title 5 Official Inspection -Form .' .i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Woodland Ave Property Address George Padula Trust Owner Owner's Name information is required for every Osterville , • '' %, }' MA 02655 12-15-18 page. City/Town ^• , State Zip Code Date of Inspection D. System Information (cont.) T 13. Privy (locate on site plan): Materials of construction: �'` " -_1 Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i t5insp.doc-rev.7/26/2018 ` Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts y Title 5 Official Inspection Form III Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 33 Woodland Ave Property Address George Padula Trust Owner Owner's Name information is Osterville MA 02655 12-15-18 required for every 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 40. rd C P i t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 I - r ''', Commonwealth of Massachusetts .� Title 5 official Inspection Form*- ' i-f Subsurface Sewage Disposal System Form -Not for,Volunta Assessments- ' 9 p Y rY 33 Woodland Ave 4 ' Property Address George Padula Trust Owner Owner's Name u'i f. information is Osterville " ' MA 02655 12-15-18 - required for every page. City/Town State Zip Code Date of Inspection D. System information (cont.) a; �g _• �- � - 15. Site Exam: ❑ . .Check Slope ❑ Surface water ❑ Check cellar - ❑ Shallow wells ' Estimated depth to high ground water: 20 feet• Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on.record If,checked, date of design plan.reviewed:.' Date ® -Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface'Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments T ,> 33 Woodland Ave Property Address George Padula Trust Owner Owner's Name information is required for every Osterville MA 02655 12-15-18 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked a ® 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 Form;Subsurface Sewage Disposal System-Page 18 of 18 33 (A)ond iand III �Ln •. • Im e ru CO 0 F F I C I A • ' --Sk cO Certified Mail Fee Er f i -r $ / Extra Services&Fees icheckbox,add fee as appropriate)-; r=1 0 Return Receipt(hardcopy) $ ❑Return Receipt(electronic) $ 9tmark O ❑Certifled Mail Restricted Delivery $ M e,-yI mark `� ❑AdultSlgnatureRequired $ �.��y, -P " ❑Adult Signature Restricted Delivery$ 'q� r3 Postage m $ t1 Total Postage and Fees - R $ TARNOFF, PETER_,TRUSTEE � Sent to 45 WOODLAND AVENUE M StiiifanifAp �PO ENo.,o §WI:` OSTERVILLE,MA02655 City State,ZIP+4®� � �-r :.. r r r rrr•r. Certified(Nail service provides the following benefits: •A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique Identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this. delivery. USPS®-postmarked Certified Mail receipt to the n A record of delivery(including the recipient's retail associate. f-.., signature)that Is retained by the Postal Service' Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or^ to the addressee's authorized agent 05 Important Reminders. Adult signature service,which requires the , ■You may purchase Certified Mail service with® signee to be at least 21 years of age(not First-Class Mail,First-Class Package Service, available at retail). or Priority Mail®service. - Adult signature restricted delivery service which ■Certified Mail service is notavallable for requires the signee to be at least 21 yQ of age international mail. and provides delivery to the addressee specified) ■Insurance coverage is notavallable for purchase by name,or to the addressee's authorized ageriti with Certified Mail service.However,the purchase (not available at retall). y of Certified Mail service does not change the a To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a I certain Priority Mail items. USPS postmark.If you would like a postmark on--.-, ■For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion e of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply ,_ You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece.t 2 electronic version.For a hardcopy.retum receipt, Z complete PS Form 3811,Domestic Return Receipt attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records. Ps For,3800,April 2015(Reverse)PSN 7530-02-000.9047 DELIVERY COMPLETESENbER:�COMPLETE THIS SECTION'. • ON ■ Complete items 1,2,and 3. A. Signature - �/ ■ Print your name and address on the reverse ►1 Agent so that we can return the card to you. ❑Addressee ■ Attach this card to the back of the mailpiece, B. Recei ed y rintediName). C. Df to of ell ery or on the front if space permits. � 1 1. Arti D. Is delivery address different from item 11 es If YES,enter delivery address below: ❑No NOFF, PETER,TRUSTEE WOODLAND AVENUE d9 A 1-b ez-. r STERVILLE,MA02655 tuESr��vl �� o,��10 �. II I IIIIII loll III I it I II II II III II II III II(III III ❑ dult Signaturre Restricted Delivery O Mastered Mce Type 0 Priority Mail ailRestricted ❑Adult Signature ❑Registered MajlTM I 9590 9402 4116 8092 9359 78 Herufied MailO eturn I Certified Mail Restricted Delivery �eturn Receipt for ❑Collect on Delivery Merchandise .,m(']pr rTM.ClSfpr f nm___tee.. -�-� ^ -Delivery Restricted Delivery ❑Signature ConfirmationTM 1 1 ➢il N 6 6� " t 1� {I f � f �'�1.'.it i I i 1 1 I � i� ❑Signature Confirmation 7 015 17'3 0 0 0 01 4r9 8 8 2 0 5 JR,- Restricted Delivery Restricted Delivery o I„ PS Form 3811,July 2015 PSN 7530-02-000-9053 w, Domestic Return Receipt l$ S Tt �'' t``" First-Class Mail Postage&Fees Paid USPS Permit No.G-10 9590 9402 411L 8092 9359 78 United States •Sender:Please print your name,address,and ZIP+4®in this box* Postal Service Town of Barnstable ' Health Division a �8 200 Main Street Hyannis,,MA 02601 -s —:-r ;�������_�� 1`iJ��1111)1,111 ,i1,il,li fill lit11l Town of Barnstable Barnstable Inspectional Services . "'e'Ca ` MAS& Public Health Division m 4'ArFn"�'y s 200 Main Street,Hyannis MA 02601 2007.- Office: 508-862-4644 -Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4988 2057 January 18, 2019 TARNOFF, PETER, TRUSTEE 45 WOODLAND AVENUE - -` OSTERVILLE, MA 02655--- ---- - ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 33 Woodland Avenue, Osterville, MA was inspected on 12/15/2018 by Shawn McElroy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Discharge or ponding of effluent to the surface of the ground. You are ordered to repair or-replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH '!ZReq, 4S c2, CHZ—� Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\33 Woodland Avenue Osterville.doc January 26, 2019 Mr. Thomas McKean, R.S., CHO Agent of the Board of Health Town of Barnstable Inspectional Services Public Health Division 200 Main St. Hyannis, MA 02601 RE: 33 Woodland Ave Osterville, NIA 02655 Dear Mr. McKean; I am writing regarding your January 18, 2019 letter regarding the above property at 33 Woodland Ave. Your letter notes that the 12/15/2018 inspection concludes that the septic system"fails." Peter Tarnoff passed away on March 29, 2018 and I have been appointed as the Personal Representative of his estate and the Successor Trustee of the Peter Tarnoff Trust. The Peter Tarnoff Trust,the owner of 33 Woodland Ave. Please find attached Peter's Death Certificate and the Letters of Authority appointing me as the Personal Representative for his estate assets. We are in the process of settling Peter's estate and have the property listed for sale, MLS #72436894. It is my understanding from the listing agent, Joan Witter of Compass,that there was no issue with the inspection so your letter informing me that the system "fails" is a surprise. I was also informed that we would not have to update the septic system prior to listing the house for sale. Please forward all future correspondence to my attention. My address is 28 Alder Rd. Westwood, MA 02090 My email is georgepadula,"yahoo.com and my phone# is 781-752-9005 if you need to reach me. Thank you for your kind attention to this matter. Best regards, George T. Padula, Jr. Cc: Joan Witter, listing agent, Compass ............................ ................................ ...........11.1....................­­............. ................................................ ........................... Docket No. Commonwealth of Massachusetts LETTERS OF AUTHORITY FORBA18PO698EA The Trial Court PERSONAL REPRESENTATIVE Probate and Family Court Estate of: Barnstable Probate and Family Court 3195 Main Street Peter Tarnoff PC Box 346 Barnstable, MA 02630 (508)375-6710 Date of Death: 03/29/201,8 To: George T Padula,Jr. 28 Alder Road Westwood,MA 0209.0 You have been appointed and qualified as Personal Representative in ❑ Supervised Unsupervised administration-of this estate on May 10, 2018 (date) These letters are.proof of your authority to act pursuant to G. L. c. 1906, except for the following restrictions if any: E] Pursuant to G. L. c. 190B, §3-108(4), the Personal Representative shall have no right to possess estate assets as provided in§ 3-709 beyond that necessary to Confirm title thereto in the successors to the estate and claims,other than expenses of administration, if any, shall not.be paid. E] The Personal Representative was:appointed before March 81, 2012 as Executor or Administrator of the estate. (Do Not Write.Below This Line-For Court Use Only) ■ C E.,R'TI-F'I CATION :1.certify that it appears, by the records of this Court that'....aid.apt ointmerif remains in full force and effect. IN TESTIMONY WHEREOF I have hereunto set my hand and affixed't he,,,seal of Said Col..Irt Date May 16, 2018 Anastasia W Perrino, Register of Probate MPC 751 (4/15/16) ............- ............... .................................................................... ..................................................... ................... ............ e NI III�I�I�� gLo yof italth wrdsandSadst Reg[toy ojYm!Records aed Statistics State File# 10I8 015948 CERTIFICATE OF DEATH Registered g 72 Fong&30108012015 PhtaeofDeah PLEASANT BAY NURSING&R120WATION CENTER,BREWS TER.MA DateofDeath MARCH 29,2018 Age 68 YES Sac MALE CWtrentName TARNOFF , PEIEYt SumameatBittharAdoption TARNOFF AKA F Birthplace NORWAIA CONNECTICUT m Residence 4S WOODLAND AVENUE, BARNSTABiF,MASSACHUSETTS 02655 mRace � � Education Y W/{1TE BACHELORS DEGREE ° AfadviStafta Oacupationllndmvry WIDOWED SCHOOLTFACMR/FDUCATION Lasr use—M,M.WfiiT&Monmeat Birth orA pt ) c ant:usYmmn onNemi) TARNOFF,DONNA.MARIB(L)MCOLL) NO 0 area ame- First A 1e(&?n=eat8i orA opda4 B pidce TARNOFF,BETTY(FERTIG) NEW PORK FathalPareatName—Lost First M1dd1e(Sumameat&r1h.orAda dvn) Birthplace TARNOFF,EDWIN(TARNOFF) NEW YORK , art.CattwofDooth—Si4WTWaHyUff immed4de caum then antecederacawast en unikifyigeaure awenwb ft-6 86"drak a[marctwa dump m,l Bonds' mateog in d") ' HYPOJQC RESPIRATORY DISEASE 2 WKS. hQuemaruoama�af -9 PULMONARY EMBOLISM 2 WKS. W r—Ontomua co"Squm . F METASTATIC LUNG CANCER- 3 YRS. m dDocmora�eocse0eeaceoh. � e PaH ersign' conditionsrn tftm butnotresu ginu iagcmue annero t r u " NATURAL. m Time ofDeath: 09:07 AM F Resulroflnjury: NO CerVer MIT GUPTA,MD Lic#Z26951 Addy. 1629MAIN STREET,CHATHAM, MASSACHUSETTS 02633 Funomf6icenaWDesignm W.CRAIG DOLAN #5030 FadM&lAddr. DOLANFUNERAL.HOME,MILTON,MASSACHUSETTS /mmedh=Dbpadtion CREMATION e DateofLmmedioreDlsposltioa APRIL 04,201S 2 P1aee1Ad&av ° SAINT MICHAQ.CREMATORY, 500 CANTERBURY �NtL l�i►�4d�1, STREET,BOSTON,MASSACHUSK[TS 02131 DateafRewrd APRIL 06,2018 DateojAmendme)t ._ CLEIK, TOWN OFBREQISTER I, the undersigned, hereby certify that I am the Town Clerk of the Town of Brewster; that as such, I have A TRUE COPY ATTEST: custody of the records of births, marriages, and deaths, required by law to be kept in my office; and I do hereby certify that the above is a true copy from said records.. Witness: My hand and SEAL OF THE TOWN CLERK TOWN OF BREWSTER,at Brewster,MA I o mo. wealth of Massachusetts `iit c- ubsurfac6,Se. a a )is osal S stem Form Not for VoluntaryAssessments ( y - f 33 Woodland Ave Property Address Barry Whitman Owner Owner's Name _ information is Qsterville. Ma 02655 8/5f201$, y required,forevery _ _ _._._ _.� page. Cptyl r own State Zip Code Date,, spectlOn a 4 Inspection results Mast be submitted on this fora,. Inspection fords may o be alters in way. Please see completeness checklist at the end of the form. --- ---- ._....... Important:When m �fi Information iling:out forms " on the eornputer � � M51 A -1 use only the tab - '" :a 9: Inspector: key to rhOve;y.OUt cursor-do not Sean M. Jones - "> usethe return _ _. ... ........ ... .... . ................................... ...................m_..................... key. Name of insp6ctor Capewide Enterprises rsb Company Name 153 Commercial St. ieazn Mash ee Ma_ _ ___ _ 02649 CityFrawn State Zip Code 508-477-8877 Sl 4522 ._..---- ....._. ......... _:.....__ _.�_.:._ ..... ........ ................. —=— Telephone Number License Number Certification I certify that I have personally inspected the=sewage disposal systern at'this address and thatthe - 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 aim a DEP approved system inspector pursuant to Section 45.340.of Title 5 (310 C R M00O).The system: M. Passes ❑ Conditionally Passes F� rails [� Deeds Further Evaluation by the Local Approving Authority _... 8/5/2013 Inspector's Signature Hate 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 owrter shall s' u'bm'it the report to the appropriate regional office of the DER 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 futureunder the same or different e iiditions of,usse, t5ins•W3 Title 5 Of€iaal Inspection arm. ubsurfiace Sewage Mposal'System-•Page 1 of 17� Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM , 33 Woodland Ave Property Address Barry Whitman Owner Owner's Name information is required for every Osterville Ma 02655 8/5/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of.Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The dwelling located at 33 Woodland Ave Osterville is served by a Title V septic system consisting of a 1000 gallon septic tank and a 1000 gallon leach pit. The system was found to be in proper working condition at the time of inspection. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form 4 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 33 Woodland Ave Property Address Barry Whitman Owner Owner's Name information is required for every Osterville Ma 02655 8/5/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 33 Woodland Ave Property Address Barry Whitman Owner Owner's Name information is required for every Osterville Ma 02655 8/5/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply,. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static Liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 33 Woodland Ave Property Address Barry Whitman Owner Owner's Name information is required for every Osterville Ma 02655 8/5/2013 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c�M 33 Woodland Ave Property Address Barry Whitman Owner Owner's Name information is required for every Osterville Ma 02655 8/5/2013 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 33 Woodland Ave Property Address Barry Whitman Owner Owner's Name information is required for every Osterville Ma 02655 8/5/2013 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: 2012=4,000 total 2011=8,000 total Sump pump? ❑ Yes ® No Last date of occupancy: vacant Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 33 Woodland Ave Property Address Barry Whitman Owner Owner's Name information is required for every Osteryllle Ma 02655 8/5/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined? size of tank Reason for pumping: routine maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 33 Woodland Ave Property Address Barry Whitman Owner Owner's Name information is required for every Osterville Ma 02655 8/5/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: original 1975 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1 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.): Joint were ok, no leaks, vented through the roof Septic Tank (locate on site plan): Depth below grade: 8„feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments oc^M 33 Woodland Ave Property Address Barry Whitman Owner Owner's Name information is required for every Osterville Ma 02655 8/5/2013 page. CitylTown 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 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 How were dimensions determined? Tank was pumped at inspection 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 was pumped after inspection, tank was structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: . Date � t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 33 Woodland Ave Property Address Barry Whitman Owner Owner's Name information is required for every Osterville Ma 02655 8/5/2013 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): . Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 33 Woodland Ave Property Address Barry Whitman Owner Owner's Name information is required for every Osterville Ma 02655 8/5/2013 page. Cityffown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert N/A Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: l5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 33 Woodland Ave Property Address Barry Whitman Owner Owner's Name information is required for every Osterville Ma 02655 8/5/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): leach pit was dry with no sign of past hydraulic overloading. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M e' 33 Woodland Ave Property Address Barry Whitman Owner Owner's Name information is Osterville Ma 02655 8/5/2013 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 50fflocial Inspection Form - Subsurface sewageispsasa! Sysferl� array -.that for Voluntary Assessments 33 Woodland Ave _ Property Address J �� Barry Whitman Owner Owner's Name information is required for every Osterville—--_ .............._. ._ ._.__ .._.... Ma. 02655 8/5........ ......... .. _... . page_ C ty/Town State Zip Code Date of Inspection- . System Information (cant.) 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 1 OO feet. Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below 0 drawing attached separately I t> i � < l 0 Pt'2 ` t5ihs•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 1.7 . I Commonwealth of Massachusetts Title 5 -Official inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c,M 33 Woodland Ave Property Address Barry Whitman Owner Owner's Name information is required for every Osterville Ma 02655 8/5/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: Checked with local excavators installers- attach documentation ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 33 Woodland Ave Property Address Barry Whitman Owner Owner's Name information is required for every Osterville Ma 02655 8/5/2013 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file ,Sins•1113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 LOCWT10N 5EVV&C4E• PERMIT UO. 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I J X 6' '- L l8 I/2' � � �, 2 t 8'-6" � L l'-e I/2" J K IN PROPOSED TWO STORY CUSTOM APPRO'o REVISION o CAPE WITH ATTACHED TWO CAR Barnstable Harbor Builders BARNSTABLE HARBOR BUILDERS N0: CDNNENTS DAIS GARAGE AND COVERED PORCH David Parrclln 33 WOODLAND AVE. s PO Box 483 OSTERVILLE, MASSACHUSETTS Barnstable,89 02830 2 - (7(50)246-1 Office t B/1J/YJ FRONT AND REAR ELEVATIONS 808)248-Bt85O t DRAWN BY:CED.DESIGN SCALE:A9 SHOWN bht&eharbor.com DESIGNED BY:CED.DESIGN DATE:L/28/19 wwa.Damstableharbor.com DATE: CHECKED.BY:OWNER LATEST REVISION:5/1/20 d 1'-8 1/2' 411- 4 s to ILIA =� a IA�O IO I° ImIA =�mm ImIA 2G-i MA LLOWABLE RIDGE HEIGHT I I ----------------- ; I I II I II ri-IT I I I p �; O m m 1!= „L714 m o < m O i' I I �`zm5Em x�A pmD I o l :.mzmPO 40°:3 z� m 11 I Z Z � ��o>x LL�r0$O A. I I �E.� ' 1 I I I �mS rmga -1> � Hv0li 'D �O=y I F-�♦TT� I 9i0A D w FO O� �ri�_'_ m�m? �>O i i �® d m i m T I-;r• � I I I = - `Lr° I T1� TAT - M. 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PU Bax 411 OSTERVILLE, MASSACHUSETTS a / Barnstable,tNA 02630630 2 1 ^ (774)521.3899-. v ■\ SIDE ELEVATIONS (508)246-6185 Cd DRAWN BY:CED.DESIGN SCALE:A8 SHOWN stableharbor.net DESIGNED BY:CED.DESIGN DATE:L/4B/19 voammm-�� vvdw.bamsta bleha rboccom DATE CHECKED.BY:OWNER LATEST REVISION:5/1/20 1 PROJECT. 9� LOCATION WOODLAND 6 AVE. q l � NAG O ti WIANNO - i GOLF CLUB a cob 4 PP 29.5 +29.9 CATCH WOO BASIN �D� � WOODLAND N D PAVEMENT (40' WIDE I 28.9 CATCH BASIN ) 0 LOCUS VENUE+30:4 RIM + 29.54 LEACHING : CATCH NOT TO SCALE 77 30�_ PIT BASIN pp \\�. f3SPL�D,�,cb G'�BLE EDGED �A ' .6 / DR/!gNAY �- ---_._30 NEW W,4TER CATCH CB .S£RNCE. 28.9 BASIN +30.2 FOUND + EIS NEG' CURB /'30 -- _ LAND 29.2 RIM 28.91 30.\ SCr4pEo/.SL A I ND G) TZI4 29.6 v BENCHMARK: S85*26 43� +30. ' +29.3 0 TOP OF BOUND % 120.43' 20"0 _� EL. 30.89' co CB I Z i FOUND w 3 6 + 30.3 :� n 12" PINE 1 1 , ,\O n¢ 12 PINE , BENCHMARK: + >O'41/N. 030.4 TOP OF BOUND " �"'� - EL. 30.12' o w w Arms F AREA O NEW G;AS O ' h 30.1 .S,rRtfGE ' w 15 w T.H. T.H. tM Z iGALLGII/ _ 0 31.0 31.3 oB s + tH;/3 LEGEND 0H,40BERs rFIny Q 4 G "STGWE x.�1.0 A[[ ARcr�No 0.s ( o ------------ --- EXISTING 2' CONTOUR LOT 1 /,&V cA[[av PARCEL 134 N F sEpnc rANK o N F 30-- EXISTING 10' CONTOUR ?s' Z CAR ESTATE OF PETER LAWN w ti GA�?gGE" o +29.5 EXISTING SPOT ELEVATION CARYL LOCKETT MILLER, TR. TARNOFF, TR. 32 r +30.9 M x O 0 SPOT ELEVATION • PROPOS ED E E PP \ n EXISTING UTILITY POLE LOT 2 O'*IN 29.9 O OAK O EXISTING TREE 13,51 0f S.F. ' 33.4 31.8 +30.6 _ T.H. EXISTING TEST PIT b r 3 r-32+ h I EXISTING CB - / 00 HOUSE FOUNDo CONCRETE BOUND iREp EXISTING "'o HOUSE ,M 10 .!1/N. Z ?S' 3 } APPROXIMATE AD LOCATION OF / EXISTING SEPTIC ^� PROPOSE SYSTE EXISTING 'GARAGE • cr ,' o ARPORT 3 GENERAL NOTES // 16x,32 3+ �� PROPO,SE'p 3 .o / POOL 10 1. ASSESSORS INFORMATION: MAP 140, PARCEL 135, LOT 2 31.8 N / 2. FLOOD ZONE: X (FEMA MAP 25001 C0757J) / / 3. ZONING DISTRICT: RC -FRONT 15', SIDE 10', REAR 10' / 1.s / 4. OVERLAY DISTRICT: AQUIFIER PROTECTION OVERLAY DISTRICT / EX/SMO s[-PnC r0 0 3 / BE puMpEo PRY 5. LOT COVERAGE BY: AND REA/04Fo A. EXISTING STRUCTURES: 939 S.F./13,510 S.F. 6.95% 31.5 B. PROPOSED STRUCTURES: 2,133.5 S.F./13,510 S.F. = 15.8% < 20% EXISTING SHED 31.7 31.ox � C. PROPOSED STRUCTURES (AND FUTURE POOL): 2,645.5 S.F./13,510 S.F. 19.6% < 20% 32.1 TO BE REMOVED oy D. FLOOR AREA RATIO = 2,768 SF/13,510 20.4% < 30% x.�1.0 PRIVACY � 6. STREET ADDRESS: WOODLAND AVENUE 41.77' FENCE h Ns1 � 7. HOUSE NUMBER:' 33 00�00 W 31.s 8. TOPOGRAPHIC INFORMATION COMPILED FROM AN ON THE GROUND SURVEY pROpOSEo NEW i UNOERG?a1No 9. ELEVATIONS SHOWN ARE BASED ON NORTH AMERICAN VERTICAL DATUM 1988. ELECTRIC C49LE TI/ 31.9 s0.10' i ANo TELEPHGWE 10. EXISTING SEPTIC SYSTEM TO BE PUMPED DRY AND REMOVED. N82"52'47" S£RNCE W � 30.8 PP #225/2 PARCEL 191 i N/F _ 5/13/20 REVISE FOOTPRINT, UPDATE LOT COVERAGE. TIFFANY SWAN - MARKOSKI DATE REVISION PLOT PLAN FOR #33 WOODLAND AVENUE PARCEL 132 PREPARED FOR N F CYNTHIA PARRELLA IN ROBERT M. SHEEHAN & ROSEMARY KOMENDA OSTERVILLE MA ,PLAN DATE: JULY 1 2019 - PLAN SCALE: 1" 10' -114 of CIVIL ENGINEERING M O WETLANDS PERMITTING �� icyL U T MKNA L �, WASTEWATER DESIGN 1 COASTAL ENGINEERING 90RSELU NO.35o54 TITLE 5 PLOT PLANS PIERS AND DOCKS �F�,�R�o �• 11rGj �1s 10 0 5 10 20, LAND USE PLANNING lr EER COMMERCIAL/RESDENTIAL 65 SWWng Cape Cod and Southeastern A/0.fs0Ch4lS*tts SCALE: 1 INCH 10 FEET 17 ACADEMY LANE, SUITE 200 FALMOUTH, MA 02540 508.495.122 ` V 1 PROJECT NUMBER: 19038 CAD FILE NAME: 19038SP DRAWN BY: L.M./K.B. SHEET 1 OF 2 �j i 1 SOIL TEST Date of soil test: JU N E 5, 2019 FINISH ORWOF SHALL BE 2X MINIMUM OILER ALL SEPTIC SYSTEM COMPONENTS USE 4"D/A. SCHEDULE 40 PVC OR CAST IRON PIPE Test taken by. Michael Borselli, P.E. 20'M/N1Y11,W SETBACK FROM EDGE OF STONE TO CELLAR WALL Results witnessed by: D. Stanton REMOI/ COVERS SET Percolation rate: < 5 M I N INCH 10 MIN/MUM SEZOWCK REMOVABLE CDIERS SET TO !Y )VIN TO WHIN J" OF FINISh' - " GRADE (,WIN. �3) Ground water NONE 6 OF FINISH GRADE (TOTAL OF 4� 7ELEI� =.31.0 ELEIi .31.0E ELEIi = 31.0E 7 I /' '/ % '/j'/j' • '/ /' / :j i/v/ . .• v v/ � v i / / y / i . ./ v / i ;j rj y/ ,/, ,/ i ./ i/ i i/ / / %/ j/''/ ° ELE1l = 29.0.E TEST HOLE #1 TEST HOLE #2 s = .02 MIN. .3'MAX. ! INII ELEI/. `s'.` = 27.17 2"LAYER OF 1/8" TO 1/2" 0 30.0 0 30.0 ,1500 GALLON of WASHED STONE �� SETFiRsr LOAMY SAND LOAMY SAND SEPTIC TANK ? 2'LEVEL ELEI/. f28.O 2» 10 YR 4/2 29.0 12 10 YR 4/2 29.0 a. h N ®®®® O ®000 �o '� ®®®®®®®®®®®®® B B as N N ®®®®®®®®®®®®® LOAMY SAND LOAMY SAND ,N 01ST. BOX SLOPE VAR/ES .1 -11 ELEI� _ 25.>7 \ » 10 YR 5 6 27.5 " 10 YR 5/6 27.5 d S = .01 MIN. 30 / 30 1� �H-20 L 04,01 O) MEDIUM SAND MEDIUM SAND � �+ W I� N 1 INSTAL[ J14" TO 1 1/2"DOUBLE �, SET SEPTIC TANK AND 01STi4 R1770N BOX I� WASHED, iP%1_WE0 STONE A[[ 66" 2.5 Y 6/4 24.5 66 2.5 Y 6/4 24.5 ON 6" LAYER OF C�?USHED STONE i i ARGY/NO CHA�t1BERS AN0 00lf9V - C2 C2 W 70 IHE BOTTOM 6F A/E iNAMBER ✓`Y LOAMY SAND LO%Y S ND � Z � � �_► SYSTEM. REFER TO LAYOUT OF l ) SYSTEN F�410fF DETAILS I CONTRACTOR SHALL��, go,, 2.5 Y 5/4 22.5 gp" 2.5 Y 5/4 22.5 PROFILE �' THE EXCAVATE 4'BELOW BOTTOM OF TEST HOLE ZZ-f-1 = 20.0 c3 c3 NOT TO SCALE SY57FM rO VERIFY SOIL COND1nONs MEDIUM SAND MEDIUM SAND I 132" 2.5 Y 6/4 19.0 132" 2.5 Y 6/4 19.0 TEST HOLE #3 TEST HOLE #4 0" 30.0 0" 30.0 I, A A LOAMY SAND LOAMY SAND 410 12 10 YR 4/2 29.0 12 10 YR 4/2 29.0 2 - OUTLETS .� - REMOVABLE 24"D/A. CDIiERS REMOVABLE 24"D/A. CDIi£R . A 1 3/4" •• 4 B B ,. LOAMY SAND LOAMY SAND 4 OUTLET INLET .,. TEE OPEN AT TOP SET 36» 10 YR 5/6 27.0 36" 10 YR 5/6 27.0 "o INLET TYPICAL OF 5 `- �3"M/N. FROM TANK CDI�ER N N INLET KNOCKOUT 01/IZET KNOCKOUT 8 L/ U/O LEI�EL C C 44 6„ 40� INLET TEE SET OUTLET TEE SET COARSE SAND COARSE SAND 1O"AIIN. BELOW 14"BELOW 2 - OUTLETS � .. 2.5 Y 6/4 2.5 Y 6/4 2411 LIIJU/D LEVEL [/!JU/D LEIi£L , GAS BAFFLE op - 2410 4 PLAN VIEW CROSS-SECTION j 120" 20.0 120" 20.0 DB-5 DISTRIBUTION BOX (H-20 LOADING. NOT TO SCALE �. a �.. .. ; • d : , ,•.., BASIS FOR DESIGN: ,o, 6� 50 _8. TOTAL DA/Z Y FL OW IS BASED ON 4 BEDROOMS, NO GARBAGE DISPOSAL TOTAL 0A1_1 Y FLOW = 110 GPD/BEDROOM X 4 BEDROOMS = 440 GPD 8' - 31/2" 1500 GALLON SEPTIC TANK H - 10 LOADING) BOTTOM AREA PROPOSED = 4.35.5 S.F. 6�, SIDE AREA PROPOSED = 186 S.F. NOT TO SCALE TOTAL LEACH/NG AREA PROPOSED = 6215 SF. ® ® ® ® O ® ® ® APPL/CA77ONRA7F = 0.746; 0/S.F. ® ® ® ® ® ® ® NEE' ® ® ® ® ® 34" DES/GNLEACH/NGCARA017Y 450GPD > 440GPD 24" 8' _ 6" CONSTRUCTION NOTES: CROSS-SECTION 1. INSTALLATION OF THE PROPOSED SEPTIC SYSTEM SHALL BE/N ACCORDANCE WN 77TZE 5 $. _ 6" AND THE BOARD OF HEAL 7H REGULATIONS. 2. THE CONTRACTOR SHALL DE7FRM/NE THE L 00A77ON OF IWE WA7FR SERl9CE AND e ° SLEFkF/N ALL AREAS ZESS IHAN 10'FROM THE PROPOSED SEPTC SY57FA.1. 5" KNOCKOUT 3 A COPY OF THE PLANS SHALL BE AVAILABLE ON S17F FOR REFERENCE AT ALL 77MES ° DURING THE INSTALLA7 ON OF THE SEPTIC SYSTEM. 21" DIAMETER COVER 4 NO CHANGES TD THE DESIGN SHALL BE PERFORMED Of 7HOLIr THE APPROVAL OF BOTH FALM0117H ENG/NEERING INC AND 7HE BOARD OF HEAL 1-H I 5" KNOCKOUT - 5" KNOCKOUT SEPTIC SYSTEM DETAILS .4 a FOR #33 WOODLAND AVENUE 5. THE SEP770 SYSTEM /S SUB.F07' TO INSPECAON BY FALMOV7H ENG/NEER/NG, INC a PREPARED FOR AND THE BOARD OF HEAL 7H a CYNTHIA PARRELLA IN 6. THE CONTRACTOR SHAll NOTIFY FALMOUTir✓ ENG/NEER/NO, INC AND THE BOARD OF HEAL TH a 5" KNOCKOUT OSTERVI LLE MA 70 INSPECT THE SEPTIC SYSTEM PRIOR TO BACKFILL. IN SOME INSTANCES, MORE 77IAN ONE INSPECAON MAY BE NEEDED. THE CONTRACTOR SHALL ONLY SACKFILL THE PORTIONS OF THE ° PLAN DATE: ,1U LY 1, 2019 PLAN SCALE: AS SHOWN SYSTEM 7HAT HAVF BEEN INSPECTED AND APPROVED BY FALMOUTiH ENG/NEER/NG INC AND a �H ofs CIVIL ENGINEERING S * O r T WETLANDS PERMITTING THE ARD F HEAL Th! PLAN VIEW ���` �' y,,lvl lJ r, 7. /F THE CONTRACTOR ENCDUN)FRS ANY VAR/ATIONS IN S17F CONDITIONS, SUCH AS DIFFERING �° ""'�' ` WASTEWATER DESIGN `7 COASTAL ENGINEERING SOILS, TOPOGRAPHY, `YE7ZANOS OR OTHER CDND/ADNS 7NT MA AY REOU/RE E RE- VALUAADN OF 500 GALLON LEACHING CHAMBER (H-10 LOADING g°avL"' ,} THE DES/GN, THE CONTRACTOR SHALL /MMED/ATEL Y CONTACT FALMDUTH ENG/NEER/NG, INC SCALE 1' 2' NO. � °TITLE 5 PLOT PLANS ��T ��� PIERS AND DOCKS • G/STER 101 YGI NEER 1` AL LAND USE PLANNING COMMERCIAL/RESIDENTIAL S&-mg Cope Cod and Southmstat" 4/vss04&1"tts 17 ACADEMY LANE, SUITE 200 - FALMOUTH, MA - 02540 - 508.495.1225 PROJECT NUMBER: 19038 CAD FILE NAME: 19038DT DRAWN BY: L.M/.K.B. SHEET 2 OF 2 - ----- --