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HomeMy WebLinkAbout0014 YORK TERRACE - Health 4 York Terrace} ',Osterville . P A 140 206 fl F l , i I. R t 6 �p E 1 I � 't I ' t _ e i I f. i ti S is D Commonwealth of Massachusetts a i Title 5 Official In p cii -mF .r Im - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments _ .� 14 York Terrace , a Property Address Christine.and Alex._Duhamal Owner Owners Name' .. information is "' required for every Osterville _ _ Mb 026S5 9/23/15 page. City/Town State Zip Code Date of Inspectiori � - - Inspection-results-must be submitted on this form. Inspection forms may not be altered in any way Please see completeness checklist at the end of the form. Important:When filling out forms A. Genara1 Lnformation on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono usethe return -- -- — ---------- - ------- -- ----- ----------- ---------- -- Name of Inspector`. key. - -- - - • — DiBuono Sewer and Drain raa Wompany,Name-,,, - 8 Johns path, r ` — Company Address --- -- - -— - - -- — ---- - I ---- iermn S Yarmouth MA 02664 City/Town State Zip Code 508-364-9587 S11r3522 -- ---------------------------------Telephone ----- ------------------- Number License Number B Certification r'tfilr'P/-"t.'t I certify that`I have pe.sonallyinspected the'sewage disposal system at this address and that the information reported below is true°accurate and"complete a's of-the time of the inspection.'The inspection was performed based on'my,training and experience in the proper function and maintenance of on site sewage disposal systems..I am a'DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 9/23/15 spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP: The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only descrilbes 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. oW.ge �s t5ins•3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal Systef 17 Commonwealth of Massachusetts Title 5 Official Inspection Forr Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14 York Terrace Property Address Christine and Alex Duhamal Owner Owner's Name information is required for every Osterville Ma 02655 9/23/15 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.cf 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 system contains a 1500 gallon tank as well as a concrete Distribution box. All tees and baffles are in place. The Distribution box is level and at normal level. The leaching is made up of a single H2O Leach pit installed_in 2005 under-driveway_ 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 Systen•Page 2 of 17 Commonwealth of Massachusetts Title fficial Inspection For ' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments - 14 York Terrace Property Address Christine and Alex Duhamal Owner Owner's Name information is required for every Osterville M_a_ 02655' _ 9/23/15 page. CityFrown 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 Conditionatly 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i— h Commonwealth.of Massachusetts :. Toff 5 Official 'Inspecfion Form Subsurface Sewage Disposal System Form - Not for Voluntary.Assessments 14 York Terrace Property Address Christine and Alex Duhamal _ Owner Owner's Name informaton is required for every Osterville Ma 02655 9/23115`"" 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 1/2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 it _ f Commonwealth of Massachusetts Title 5''Official Inspection For Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14 York Terrace _ Property Address Christine and Alex Duhamal Owner Owner's Name information is required for every Osteryille Ma 02655 9/23/15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required"pumpi,ng.more„than 4 times in the last year.N.O.T,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. El ® 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'i;'dicates ab'se:nt and the presence of ammonia nitrogen and nitrate:nitrogen i,s equal.to or less than 5 ppm, provided that no other failure criteria are triggered. A cop of the analysis Y . .. Y and chain of custody must be attacfied to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,00ogpd. El ® 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 Hof 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 urider Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts _ Title fficiall��-inspection r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 14 York Terrace Property Address --- -- Christine and Alex Duhamal Owner Owner's Name information is required for every Osterville _ Ma" 026" 5­ 9/2`3/15 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?(1f"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 outs... ® . ❑ 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,sl,udge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 5--- Number of bedrooms (actual): 5 — DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x.#of bedrooms): 550 f5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts TitleOfficial Inspection Form _ - Subsurface Sewage Disposal System.Form - Not for-Voluntary Assessments 14 York Terrace Property Address Christine and Alex Duhamal Owner Owner's Name information is required for every Osterville Ma- 026-55"' 9/23/15 page. City/Town State Zip Code Date of Inspection D. System Information Description: The'system'contains a 1500 gallon tank as well as a concrete Distribution box. All tees and baffles are in place. The Distribution box is level and at normal level. The leaching is made up of a single H2O,Leach pit installed in 2005 under driveway. Number of current residents: 2 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.) ry ysfem ihs p M `Yes ❑ No Laund: s, ected? Seasonal use? Yes No Water meter readings, if available last 2 ears usage d 2588 9pd g ( y 9 (gP ))� Detail: Irrigation in place Sump pump? ❑ Yes ® No Last date of occupancy: Date Cornmercial/lndustrial 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: !Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts _ W Tole ffieiai Inspection Forte Subsurface Sewage Disposal System Form - Not for Voluntary Assessments e 14 York Terrace Property Address Christine and Alex Duhamal Owner Owner's Name -- information is requited for every Osterville Ma 02655 9/23/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/user Date Other(describe below): General Information Pumping Records: Source of information: None provided recommended if not done within the last 3 years Was system pumped as part of the inspection?. El Yes ® No If yes;.volume pumped: gallons How was quantity pumped determined? Reason for pumping: - - -- Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection For s Subsurface Sewage Disposal System.Form - Not for Voluntary Assessments c� 14 York Terrace Property Address Christine and Alex Duhamal Owner Owner's Name information is required for every Osterville Ma 02655 " ` .9/23/15 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:- 10 years Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Bui'Iding Sewer(locate on site plan): Depth below grade: 18, feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): ..Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): System is vented throught the roof. Septic Tank (locate on site plan): Depth below.grade: 1 ft . feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ poi eth lene y y El other(explain) 1500 gallon if tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate). ❑ Yes ❑ No Dimensions: 1500 Gallon 3, Sludge depth: _ t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 OfficialInspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments \tip 14 York Terrace Property Address ---- -- -- Christine and Alex Du'hamal Owner ----- --------------=----------. Owner's Name --- --- information is required for every Osterville _-_ — Ma 02655 9/23/15 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge-to bottom-of outlet tee or'baffle 24 Scum thickness 3— Distance from top of scum to top of outlet tee or baffle 42 Distance from bottom of scum to bottom of outlet tee or baffle 1" Sludge stick How were dimensions determined? Tape Measure — Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): No evidence of Ieaking,Tees and or baffles in place at time of inspection. Grease Trap (locate on site plan): Depth below grade: NA _ 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 l5ins•3/13 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts i_ Title 5 Official , Inspection Form Subsurface Sewage Disposal System Form --Not for Voluntary Assessments 14 York Terrace Property Address Christine and Alex Duhamal Owner Owner's Name information is required for every Osterville — __— - -_ Ma 0.2655` 9/23/15 page. City/Town 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.): Tees are in place and levels are normal.— - --------- 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 i l5ins•3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts � - Title 5 Official Inspection Fr Subsurface Sewage Disposal System Form - Not for Voluntary Assessments >.. 14 York Terrace Property Address Christine and Alex Duhamal Owner —O wner's—Na'me Na m ------------- --- ------- ----------- - ---------- information is required for every Osterville---_.------._.---_------.---.--.----__.__-- -_-...- Ma 02555 9123/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above autiet invert At normal level Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution Box is level and at normal level with no signs of carry over or decay_ Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No' Alarms in working order: ❑ Yes ❑ Now Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: ---- ._.- ----- --- -----.._------------ - - - -- --- ---- - —-- t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form - Not for Voluntary.Assessments \ mot 14 York Terrace Property Address Christine and Alex Duhamal Owner Owner's Name - — --- information is required for every Cisterville — _ Ma 02655' "" 9/23/15- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching"pdts-., 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.): No signs of carry over and no signs of hydraulic failure_ Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): .. Number and configuration Depth —top of liquid to inlet invert ___-_.--____.__------ _.-____ Depth of solids layer Depth of scum layer Dimensions of cesspool _ _-.-_---_____.___:-_______,______.___..--. Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora ' — Subsurface Sewage.Disposal System Form - Not for Voluntary Assessments .,, 14 York Terrace Pr - ----- - ----- ------- — -— ---------- --Property Address ----- Christine and Alex Duhamal Owner ----— ------ ---- ----.._...-- -- Owner's Name - _------- --- ----- --- information is required for every Osterville _ _ _-- Ma _ 02555` _ 9/23/15 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.): No signs_of pond ng or hydraulic failure. Privy (locate on sife plan): Materials of construction: --- _ Dimensions ----------------_.__-- Depth of solids --- --- - - --- -- ---------—-------- -- Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of'Vegetation, etc,): t5ms• /1 3 3 Title 5 Official Ins pection Form:Subsurface Sewage Disposal System•Pa 4 9 P Y ge 1 of 17 Commonwealth of.Massachusetts a _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Y Assessments 14 York Terrace --- ------- --- -- - ---------- - -------------- ------- - -------Property Address --- ------------- Christine and Alex Duhamal Owner Owner's Name ------- —_-- -- -- information is required for every Osterville _ Ma Q265'5"' 9/23/15 _ page. City/Town 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Assessing As-Built Cards S/13115.5:14 PM ✓ !�I e J�TOWN OF BARNSTABLE LOCATION ! I y 0L 1 P rrA( _SEWAGE# VILLAGE D S�r"f 0"I ILL ASSESSOR'S DiAP R LW INSTALLER'S NAME$HONE NO. l SEPTIC'TANK CAPACITY I J UD L pT LEACHING.FACII fSY:(type) �T 6 X G' (size) NO.OF BEDROOMS BLUDER OR OWNER.. C C U/L!% � I o —kv PERMITDATE COMPLLM CZ DATE; � �—f f Separation DistaliCe Between the: Sye. Maximum Adjusted Groundwater Table to Lhe Bottom of f.eaehing Facility Feet ' i Private Water Supply Well and Leaching Facility (II any wells exist on site or within 200 feet of Iraching facility) Feet Edge of Wetland and Leaching Facility(If any wcdands exist within 300 feet of leaching acihry) Feet Furnished by l// 5t2 r 0o �ronT. I I f a 301 33 y i I htip://�Nwiv.towriofbarnstable.us/Assesslng/HMdisplay.asp?mappar-1 0206&seq=1 Page 1 of 2 it . Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Pr 14 York Terrace Property Address - — ----- Christine and Alex Duhamal Owner Owner's Name---------------- --..__._._..- -------- - ------ - ----- information is required for every Osterville _ _ _Ma _ 02655 9/23/15 page. City/Town State Zip Code Date ection_ __of Insp D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12+ ft — 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.--.,, Test hole data on plan dated 2005 shows NGE at 10 + ft Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins•3/13 — - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts ._� Title ' fficialInspection ®'r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14 York Terrace Property Address -- ----- Christine and Alex Duhamal Owner Owner's Name ---------------- ------ --- — information is required for every Oste.ryille - Ma 02655- _ 9/_23/15 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- completed` ❑ System Information— Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 15ins•3113 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 No. :;),W 5—OS Fee l©o THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Migool bpetem Construction Permit Application for a Permit to Construct( )Repair( i/)Upgrade( )Abandon( ) O Complete System Adividual Components Location Address or Lot No. Al All Owner's Name,Address agd Tel.No. > Assesso ' aplp ceI If)e� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. '7/% � Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 5 n .&&'�No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Renairs or Alterations(Answer when applicable) e_ 1e6 &—IO 7L © r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been i by is Board H lth. Signe Date 2- Application Approved by Date Application Disapproved for the following reasons Permit No. ( E) r 01; _25 Date Issued No, �� Fee /O� . - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH,DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Z[pprication for loiopozal *r5tem Cougtructiou Permit Application for a Permit to Construct( )Repair(Upgrade( )Abandon( ) O Complete System [Kdividual Components Location Address or Lot No. Owner's Name,Address a9d Tel.No. Assessoy'�Y Z_l (/rce / r+�5 A ff��°�/gyp Installer5''s-Name,,Address,and Tel.No. /t Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building /�'ras o.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type,of S.A.S. Description of Soil Nature of Re airs or Alterations.,Answer when applicable) reolwe -Z� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has be ' b is Board of7H lth. Signer �- Date Application Approved by Date a Application Disapp-oved for the following reasons Permit No. �c��� 5 -� Date Issued C) .5 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERT Y, that the On- up Se age Disposal System Constructed ( ) Repaired (�)Upgraded ( ) Abandoned( )byj at ,/I/ yOr x has been constructed�irnniaccordance with the provisions-of Title 5 and a for Disposal System Construction Permit No. a 5-053 dated a'Y �5 Installer � `T� 1 Designer ---- The issuance of this p rmit shall not be construed as a guarantee that t� says o�iYl"function a/s designed. Date r � �GS Inspector-_._ No. Fee 00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mi!6poal *p$tem n5truction Permit Permission is hereby granted /to1C itpgra /oust c ( lie, Rep Upgrade( )Abandon� ) / System located at k _ '5 .3 t fU// c and as described in the above;A�pllcat'onlfor Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5.and t Mowing local provisions or special conditions. Provided:Co s n mus be completed within three years of e date of this p t. Date:_ t�� �� ADbroved by._ \ � � \ 1 � � I °'� / �'°�� / • 'REFERENCES: Assessors Map: 140 Parcel:206 ZONE:RC - Setbacks: Fron t:20' Side: 10' 12.6' ,s �.. #14 Qola .16.6 46.0' .cr 6 T } t �- .�00 5 I certify trot the foundation.-. C9 Nh shown hereon conforms to, the setback requirements of'' + the Zoning Bylaws of the PLOT PLAN town of Bcrnstoble. 4 At 14 York Terrace BARNSTABLE Professional Land Surveyor Date (Osterville) NOTES: MASS. DATE:231JUL110 SCALE_:'1"=30' 1.) The structures shown were located on the ground 0 15 30 45 -60 FEET by conventional survey methods on 22/JUL/2010: PREPARED FOR: 2.) The property line information Ehown. hereon was AleX P. Duhamel compiled from available record information. PO.Box5001 Osterville MA 02655 3.) This plan is not 'for recording and is not to be used for construction layout or deed description PREPARED BY: CapeSury , purposes. 7 Parker Road Osterville MA 02655, DWG #• C267-4gl FIELD BY. RRL/MLL (508) 420-3994 / 420-3995fax' TOWN OF BARNSTABLE i LOCH'', ON I / 7 o/ I e,rrA CL SEWAGE # (O S' `VILLKGE 'eryi�lJl. ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY �� L aT LEACHING FACILITY: (type) 6 X C (size) /OZrD NO. OF BEDROOMS r BUILDER OR OWNER O C CJ CJ1 2/11 Cl C_r� r 1n t PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater,Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching acility) --� Feet Furnished by J IrDr�� . -7LpOnT 1 �4 A a _ as 13.E 3 3-7 33 y TOWN OF BARNSTABLE Iat+h N SEWAGE # " ,VILLAGE �S ��L ASSESSOR'S' MAP & LOT INSTALLER'S NAME & PHONE NO. !,,/ S= )It. - �y 'SEPTIC TANK CAPACITY LEACHING FACILITY:(type) i (size) /dam ONO. OF BEDROOMS J PRIVATE WELI:,-,OR PUBLIC WATER ;BUILDER OR OWNER QA/ DATE PERMIT ISSUED: DATE . COUPLIANCE ISSUED: VARIANCE GRANTED: Yes No � __ � �_ •.� _, m; � '` �. t� - �� � i ,,�: i fr r .T - y !, �. iSSESSORS MAP NO: 140 ` 'ARCEE NO.: -zoo THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TdW .................OF.....bA2,K�—..�MAs►�1�-f--- Alip iration for Bispsal Works Tonstrnrtion Prrutit Application is hereby made for a Permit to Construct (AO) or Repair ( } an Individual Sewage Disposal System at: - --• .................................................... Location-Ad ess or Lot No. --------•---------- ......................................................---............................. ._ caner Address - --- ---------------------------------- Installer Address UType of Building Size Lot..._ j._�a ...Sq. feet Dwelling—No. of Bedrooms............ ..........................Expansion Attic ( ) Garbage Grinder �`4 Other—Type e of Building _...... No. of persons............................ Showers — ( ) YP g --------------------- P ( ) Cafeteria dOther fixtures .----------••-----------------------------------------...------------------------..............------------------------------=--------.._....._..---_. W Design Flow..............(..�.Lr�_..................gallons per person per day. Total dail flow........ 9.�,.?-......................gallons. WSeptic Tank—Liquid capacity-.t.56 �allons Length....J.Q...... Width....e-.... Diameter-_-_--__-____- Depth_.�........ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No._-_____._I--------- Diameter......9. ..... Depth below inlet..... °C... Total leaching area..,-_3.l._�---s q. ft. • Z Other Distribution box (�(j Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date..------............................... Test Pit No0­4 . 1___---Z'-----minutes per inch Depth of Test Pit__---_t_f......... Depth to ground water N®T'�(p0a GT4 Test Pit No. 2....... ...._minutes per inch Depth of Test Pit...... 2' __ Depth to ground water_Pi..E4:AVL_> a -------------------------------------------------------------------•------------•--.....--•-•------•........................................................ 0 Description of Soil.............. _:.Aij ` _c> U ---••----------------------------------------------••--....._. ............................................................................................... x ------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable.______________________________________________________....... .................................. ...----•----------------------------------•----------------------------------------•--------......----.....------------------------......------------------------------------------------------...----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ii='!E of the State Sanitary Code—The undersigned further agrees not to place the system in ope ion unti �Cti` o mpliance has be sue by the board of h lth. o --- --- --------------------------•-------- -------- - -G ate eppficat�ionApproved By............................. -- -------------------- / ............ Date Application Disapproved for the following reasons:.............................................................................................................. ...................................................................................-.................................................................................... ............................... Date PermitNo.. ........ ------------- Issued....................................................... Date 140 w No ....f.� FEs....F: : ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH IG>..................OF....2)A2 ApplirFatiun for Diapos of Works Toustrnrtion Prrmit Application is hereby made for a Permit to Construct (k) or Repair ( ) an Individual Sewage Disposal System at: .....1-•C--r. ....... Location-Ad ress or Lot No. c -�,^'_ C ---•-•-•----------- (. (r�.LZ+Y� a..v....- �-`�":.�] 1 -----•-•--•-- ---•................^ ^---••--•--------- --------•--•---..................--.._.---- Owner Address . Installer Address d Type of Building Size Lot... ...Sq. feet U Dwelling—No. of Bedrooms.............,..?? _....Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ............... •-•------••--•--••....... W Design Flow..............1J_. ...................gallons per. person per day. Total daily flow____--_.-`7.5......................gallons. WSeptic Tank—Liquid capacity I t5k.)gallons Length....►__O...... Width-----'5...... Diameter________________ Depth.. ........ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..........I......... Diameter......I.:;;:...... Depth below inlet.......a:0.... Total leaching area._'3.,3.')...sq. ft. Z Other Distribution box (k) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I......2'-----minutes per inch Depth of Test Pit------t-•I-......... Depth to ground waterl�ar_i-2sk).. 44 Test Pit No. 2.....�'.....minutes per inch Depth of Test Pit....... ... Depth to ground water_Kk,-j_.F*,.j1J.i-_- W ••---•-•--•-----------------•----••--•------------••----•-•••--------•-•••••••••....---...----•••........••••-••--••-........-••-----•---............-•••-••. 0 Description of Soil.............. ... , � ----------- ...------•----------------------------------•------------------------------------....._......_.. x U ---------•------•-----------•---------------------------------------------••------•-•--------••--------------•---•---•------------------.•....------------------------------------•-•••---••-••-- W x -----------------------------------------••-••••-•--•-••-•-----•----•---•-•-•...•-•----•-•••---••--••-•--•-----------•--------•-----•-•-••••---•-----•-••••---•-••••-•-••-......---••---......-•••-•--•- U Nature of Repairs or Alterations Answer when applicable............................................................................................... --------------•-•--••--•-•••- ••-••-------.....---• Agreement: The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with 2pp h rovi?nA i of Ti T L of the State Sanitary Code— The undersigned further agrees not to place the system in tioa C yedB ompliance has ee�issed the boardit�gnerL.•.... .................... ' ._... _'. Dat capprov •---------------- ----- �.+� -- -- --- --- _ 1•b- `�- s C�l D to Application Disapproved for the following reasons:--•------------------------•----•-•---------•--------------•--•----------------•---------------------•--•••-••-- ........-•••--•--•-••-----•..............••••----•-••••••----•••-•----•-•-----•--•-•••-••-•-----------••. ��,� • Date Permit No. :-8......../_.C? Date THE COMMONWEALTH OF MASSACHUSET_7S BOARD OF HEALTH Cw°�f....................OF..... .. .....��.._...-?.... ........................................... Qrrtif iratr of TompfiFanrr THIS IS TaCERTIEY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) .. by.... ....... .... ............................................................(�-------------------------------------------- ( Installer has been installed in accordan with the provisions of T?�yt'ld'; j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No .Cz.......... dated--------I_QS 1.1 ............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................. .. -.1._:.. ..2.......---•---------------- Inspector... 1 dog ..._�._...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �� c� ...........j.....( .u-,J..........OF............ _... '! ..................................... a ....... �`...._7 FEE.. .r a..-........ Rapo,oAL :orku on ion rani# Permission is hereby granted------.....r.:... ' 1r ---------------------•-•------------.........-•------......................-- to Construct ( ) or Repair ( ) an Individu 1 Sewage Disposal System at No........... � Y. •v c.Fl G� � .................... Screet as shown on the application for Disposal Works Construction Permit I)ted...,.:�_/!!Z)��s .......... ---------------------------•--•------------••---•--• --•-------- -••------- --•------•-•---•---- Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS I ` ( 1 �•� TA 511J6ct.E 1-Ar()t_� 3f3�p�M5 (z6.1 I S b��S.F �' w1TN $E'PrGTArs�C : 33a x X=66G�Str?i ; �f 13 USE , 1 C�a.LL 01J s 1aFRL 1 a►a K ( _--- --- z4,r 7,sYosA�prT-�- use load Eza�,.i,o�"I�cr LN •�, - = v v!m4 .V C.ZU644CV ZAux 1 Tl. z� z Cwm-n (t t 133E C t.o OTA I za 41' o TAa k t... -pEgt�cr.f Fi..ows C-78 Ex"i � �� �' 4 -Fr- -riz>m rtov IN ZMu t.ozLs5sOF F"TAR yG�,• ..;�� !,,•-�_',�, zB.r. __ - ---�-2-._v.'v�- - . zv G o SLILLi','MN `' RtCriAR;� No- 29733 a 13AXTER A'r 4.� •�No.24043 vr, Tr-'sT N C.,Lr- SS/ JU L_Y z.Z,l�(8 6 ��Y`Zq•5 � ���"` T(a = 3o.5 . • • Tc�aF FN _tA z oIc loan C-sL ox �>Jv GAL. luv a NCH IN1/ �8.0 STAG 2:8.3 N RR Z'73 ►u� INY TAI.tIC v�11Tt+3'a� Z-7.b 179. 5 3q,o 1� 6N CERTIFIED pl-aT p1.A1\l q s-r:7uE Z1.3 b G EL I-OCATIDN: C>ST V►L.L p1-Au Rv-Fr-Rr=:NcG IZri 17.3 I t GF-ZT1FY -rHA-r7'4r- Hour e p `�Hcw EErI5� � `ty'R H>:=TEa14 cz,KP�` 5 W MA TT-4F- Al.i�t 5ET`�,�K ZiEnlIP,EMi✓NT'S �F�E : !_nCAM33 WIT141Q -rHF- FL.aZJQ'p1.h11,1. THis RAftj 15 NlS►$ASER DNAN INSTR�M� (lam 5U"EY ANO THE OFF5E1'S 5HOWN 5HZX4LU TgnT r3 E us Eq Ta EST&**L15 H Lr-1-T• L 1 N E:S. I COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECJDEP RECE OCT 2 TOWN OF B'TITLE 5 HEALT OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A _ CERTIFICATION `� � Property Address: 14 York Terrace Osterville, MA 02655 Owner's Name: Todd Chuma Owner's Address: Same Date of Inspection: October 19, 2002 Name of Inspector:(Please Print) James M. Ford Company Name: James M. Ford_ Mailing Address: P.O. Box 49 Map: 140 Osterville,MA 02655-0049 Parcel:206 Telephone Number: (508) 862-9400 Lot:2 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs Vyrther Evaluation by the Local Approving Authority %ai Inspector's Signature: Date: October 22, 2002 The system inspector shall submracotp)Zvyof this inspection report to the Approving Authority(Board of Health or w DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 14 York Terrace Osterville, MA Owner: Todd Chuma Date of Inspection: October 19, 2002 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced- ND explain: The system re pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced. obstruction is removed ND explain: 2 I Page 3 of 11 , OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 'Property Address: 14 York Terrace Osteroille, MA, E Owner: Todd Chuma Date of Inspection: October 19, 2002 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 3oard 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 within50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has aseptic 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 aseptic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well.". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia.nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE_ DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 14 York Terrace Osterville, MA Owner: Todd Chuma Date of Inspection: October 19, 2002 J D. System Failure Criteria applicable to all systems: You must indicate either`yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ ' Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a.design flow of 10,000 gpd to 15,000 gpd• You must indicate either`oyes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered`yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D-above the large system has failed. The owner or operator of any large system considered a' significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 r Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 14 York Terrace Osterville, MA Owner: Todd Chuma Date of Inspection: October 19, 2002 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS,located-on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any,of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)]. 5 I Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 14 York Terrace Osterville, MA Owner: Todd Chuma Date of Inspection: October 19, 2002 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a Number of current residents: 2 Does residence have a garbage grinder(yes orno): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Weekend Use COMMERCIAL/INDUSTRLM, Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: None on file-per treatment plant Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution'box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: May 29187-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 14 York Terrace Osterville, AM Owner: Todd Chuma Date of Inspection: October 19, 2002 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: Approx. 2' Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no):- (attach a copy of certificate) Dimensions: 1500 gal. Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: 29" Scum thickness: 10" Distance from top of scum to top of outlet tee or baffle: 9" Distance from bottom of scum to bottom of outlet tee or baffle: S" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There were no signs of leakage. Recommend pumping. 1 GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7. Page 8 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 14 York Terrace Osterville, M4 Owner: Todd Chuma Date of Inspection: October 19, 2002 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete _metal fiberglass L polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box was level and clean.. No solids were present. - PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 0 Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 14 York Terrace Osterville, MA Owner: Todd Chuma Date of Inspection: October 19, 2002 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 6'x 6'-1000 Qal. 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.): The pit was dry. The scum line was approximately 1'up from the bottom. There were no signs of failure. The bottom to was approximately 86". The cover was approximately 2'below grade. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil;signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 14 York Terrace Osterville, MA Owner: Todd Chuma Date of Inspection: October 19, 2002 Map: 140 Parcel:206 Lot:2 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. �rOnT a as JIG 3 3-7 33 y 10 u. • Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 14 York Terrace Osterville, MA Owner: Todd Chuma Date of Inspection: October 19, 2002 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25' +/- feet Please indicate (check)all.methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours maps . Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: The bottom of the leach pit to grade was approximately 8'6': Using Barnstable topographic map and the Cape Cod Commission water contours map the maps were showing approximately 25'+/ to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 I ASSACHUSETTS EXECUTIVE F TIVE OFFICE O E E NVIRONMENTAL AFFAIRS 4 DEPARTMENT OF ENVIRONMENTAL PROTECTI F T° ' d tiFq�To�I �007 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 14 YORK TERRACE OSTERVILLE,MA 02655 M140 P206 L2 Owner's Name: PAT FINNEGAN Owner's Address: 14 YORK TERRACE OSTERVILLE,MA 02655 Date of Inspection: 5/15/01 Name of Inspector: (please print). JOHN GRACI Company Name: SEPTIC INSPECTIONS Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes _ Conditionally P sses _ Needs Furth r valuation by the Local Approving Authority Fails Inspector's Signature: Date: 5/15/01 The system inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments THE SYSTEM PASSES TITLE V INPECTION. RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. ****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. Pagel 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 14 YORK TERRACE OSTERVILLE,MA 02655 M140 P206 L2 Owner: PAT FINNEGAN Date of Inspection: 5/15/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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: THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. n/a The septic tank is metal and over 20 years-old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup or break out'or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or Uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed ND explain: n/a Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 14 YORK TERRACE OSTERVILLE,MA 02655 M140 P206 L2 Owner: PAT FINNEGAN Date of Inspection: 5/15/01 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a:manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance n/a "This system passes if the well water analysis,performed at a DEP certified laboratory; for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: n/a 1 Page 4 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 14 YORK TERRACE OSTERVILLE,MA 02655 M140 P206 L2 Owner: PAT FINNEGAN Date of Inspection: 5/15/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped n1a. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.[ _ (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large 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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 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. a Page 5 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 14 YORK TERRACE OSTERVILLE, MA 02655 M140 P206 L2 Owner: PAT FINNEGAN Date of Inspection: 5/15/01 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection'? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out X _ Were all system components,excluding the SAS, located on site? X _ 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? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems'? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X _ Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 14 YORK TERRACE OSTERVILLE,MA 02655 M140 P206 L2 Owner: PAT FIINNEGAN Date of Inspection: 5/15/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 678 Number of current residents: 2 Does residence have a garbage grinder(yes or no): YES Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR,15.203): n/agpd Basis of design flow(seats/persons/sqft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) 'Tight tank 'Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1987 Were sewage odors detected when arriving at the site(yes or no): NO r. Page 7 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 YORK TERRACE OSTERVILLE, MA 02655 M140 P206 L2 Owner: PAT FINNEGAN Date of Inspection: 5/15/01 BUILDING SEWER(locate on site plan) Depth below grade: 16" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints, venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 16" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 150OG L 10' 6" H 5' 6" W 5' 8"" Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 33" Scum thickness: 0" 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: n/a 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.): THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): y n/a Page 8 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 YORK TERRACE OSTERVILLE,MA 02655 M140 P206 L2 Owner: PAT FINNEGAN Date of Inspection: 5/15/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a 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.): n/a PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 YORK TERRACE OSTERVILLE,MA 02655 M140 P206 L2 Owner: PAT FINNEGAN Date of Inspection: 5/15/01 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT HAD T OF WATER IN IT AT THE TIME OF THE INSPECTION.THE PIT HAS NOT HAD MORE THAN T OF WATER IN IT. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no):NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 YORK TERRACE OSTERVILLE, MA 02655 M140 P206 L2 Owner: PAT FINNEGAN Date of Inspection: 5/15/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. � � f PoQcn c � lDl qA �� ABA . c .0 k 3, P0 TA � 37 Ec GC 3� in f Page I I of H OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 YORK TERRACE OSTERVILLE,MA 02655 M140 P206 L2 Owner: PAT FINNEGAN Date of Inspection: 5/15/01 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: USGS MAPS AND CHARTS- 12+FEET Rwep-05—01 14: 27 BARNSTABLE HEALTH DEPT 5087906304 P_05 I I I t Town of Barnstable ff y I Regulatory Services HA MASSS Thomas F. Geiler,Director 1639. "rFD►�i' Public Health Division Thomas McKean,Director 367 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790.6304 DATE: 7 7o 6- c:E i f�lceT;, 11/14 07-S36 RE: /`r ycr k /�riatQ The Barnstable Health Division has reviewed the Title 5 septic inspection form for the above referenced property. The following comments listed below' are deficiencies according to 310 CMR 15.300 and the Town of Barnstable Health regulations. Please re- inspect the system, if necessary, complete a new report form or revise the pages pertinent to the deficiencies listed and resubmit the report to this office within fourteen (14) days: 40 bV AM >epdef.doc Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 YORK TERRACE OSTERVILLE,MA 02655 M140 P206 L2 Owner: PAT FINNEGAN Date of Inspection: 5/15/01 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: YES Obtained from system design plans on record-If checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: USGS MAPS AND CHARTS- 12+FEET/ENGINERED PLANS FROM HOMEOWNER 11 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 YORK TERRACE OSTERVILLE,MA 02655 M140 P206 L2 Owner: PAT FINNEGAN Date of Inspection: 5/15/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): BOX IS STRUCTURALLY SOUND. PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a R . ! s Commonwealth of Massachusetts Executive Office of Environmental Affairs Dept. of Environmental Protection One winter Street Boston Ma. 02108 ' John Grad ' D.E.P. Title V Septic Inspector P.O. Box 2119 Teat l QQ02536 WILLIAM F.WELD 7 Governor ARGEO PAUL CELLUCCI Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A o CERTIFICATION �9 Property Address: 14 York Terrace Osterville Address of Owner. �Q99NSlgglF 9� Date of Inspection. 10122/97 (If different) Name of Inspector: John Graci Patricia Finagen I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) e Company Name,Address and Telephone Number: §7 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X Passes This Inspection Is based on criteria donned In Title V Conditio fly asses code 310 CMR 16303.My findings are of how the system is performing at the time of the inspection.My Inspection does Needs rt r Evaluation By the Local Approving Authority not Imply any warranty or guarantee or the longevity of the Fails septic system and any ofits components useful life. Inspector's Signature: Date: 10123197 The System Inspector sh I submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 Department of Environmental Protection, l The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of — Co7hpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04@7)97) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 a Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 14 York Terrace Osterville Owner: Patricia Finagen Date of Inspection:10r22197 — Sewage backup or.breakout.or. hiah.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced —The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: — The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. — The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. — The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. — The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must Indicate either"Yes"or"No"as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or poiidiiig of effluent to the surface of the ulouiid of sill face waleis due to an overluaded vi cluuued cesspool. SAS is in hydraulic failure. (revised 04127ST) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 14 York Terrace osterville Owner: Patricia Finagen Date of Inspection:10/22/97 D]SYSTEM FAILS(continued) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. — — Any portion of a 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 wish no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: ' 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 0427197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 14 York Terrace Osterville Owner: Patricia Finagen Date of Inspection:10122197 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: _c_ — Pumping information was requested of the owner,occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal flow rates during that period. Large volumes of water have not been Introduced into the system recently or as part of this inspection. x As built plans have been obtained and examined. Note if they are not available with N/A. x — The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. -x— — The site was inspected for signs of breakout, x All system components, excluding the Soil Absorption System,have been located on the site. x The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on — — The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue,approximation of distance is — — unacceptable)[15.302(3)(b)] (revised 04127)97) I � r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 14 York Terrace Osterville Owner: Patricia Finagen Date of Inspection:10122197 FLOW CONDITIONS RESIDENTIAL: Design flow: 440 g•p•d./bedroom for S.A.S. Number of bedrooms: 4 Number of current residents: 1 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings, if available:(last two(2)year usage(gpd): rda Sump Pump(yes or no): No Last date of occupancy: Na COMMERCIAL/INDUSTRIAL: Type of establishment: n1a Design flow:o gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: n1a Last date of occupancy: Na OTHER:(Describe) Na Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has not been pumped In the test year. System pumped as part of inspection: (yes or no)No If yes,volume pumped:U gallons Reason for pumping: Na TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records,if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components, date Installed(if known)and source Information: 16 years Sewage odors detected when arriving at the site: (yes or no) No (revleed 04117)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 14 York Terrace osterville Owner: Patricia Finagen Date of Inspection:10f22197 SEPTIC TANK: x (locate on site plan) Depth below grade: +e" Material of construction:x concreate metal FRP Polyethylene_other(explain) If tank is metal, list age o . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: L+o's^Hs'r^ws'e^ Sludge depth:+" Distance from top of sludge to bottom of outlet tee or baffle: 26" Scum thickness:g Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle:U How dimensions were determined: Measured Comments (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Septic tank and all components are structurally sound.Recommend pumping system every two years for maintenance. GREASE TRAP: (locate on site plan) Depth below grade: nfa Material of construction: concrete metal FRP Polyethylene_other(explain) Dimensions: rda Scum thickness:-rda Distance from top of scum 10 top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle:rda Date of last pumpingn, Comments: (recommendation for pumping,.condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) rda BUILDING SEWER: (Locate on site plan) Depth below grade: 2- Material of construction:.. cast iron x 40 PVC_other(explain) Distance from private water supply well or suction MOO- Diameter: 4„ Qmments: (conditions of joints,venting,evidence of leakage,etc.) (revlaed 04f27197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 14 York Terrace Osterville Owner: Patricia Finagen Date of Inspection:10122/97 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rda Material of construction:_concrete_metal_FRP_Polyethylene_other(explain) Dimensions: rda Capacity: rda gallons Design flow: rda allons/day Alarm level:_nra Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) rda DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: rda Comments: (noted level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.) rda PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no)No Alarms in working order(yes or no)_Ye: Comments: (note condition of pump chamber, condition of pumps and appurtenances,etc.) rda (reylsed 0412757) Page l 1 of I'l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 YORK TERRACE OSTERVILLE,MA 02655 M140 P206 L2 Owner: PAT FINNEGAN Date of Inspection: 5/15/01 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: USGS MAPS AND CHARTS- 12+FEET i Z%ep-05-01 14: 27 BARNSTABLE HEALTH DEPT 5087906304 P.05 I P��T rgyo Town of Barnstable Regulatory Services BAMass LL Thomas F. Geiler,Director a�v� Public Health Division Thomas McKean,Director 367 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 DATE: rTC �V-\ rcGi 1-, 1114 O2S'36 RE: lY yt;�k /ef� e The Barnstable Health Division has reviewed the Title 5 septic inspection form for the above referenced property. The following comments listed below are deficiencies according to 310 CMR 15.300 and the Town of Barnstable Health regulations. Please re- inspect the system, if necessary, complete a new report form or revise the pages pertinent to the deficiencies listed and resubmit the report to this office within fourteen(14) days: I �a r & ` �( LiMSL '/5't ��L�n ' ��0L1 �'iL+7�` 1��� ✓3L(itli/r r Ovi uA T LPG ;epdef.doc Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 YORK TERRACE OSTERVILLE,MA 02655 M140 P206 L2 Owner: PAT FINNEGAN Date of Inspection: 5/15/01 SITE EXAM _Slope _Surface water _Check cellar _Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: YES Obtained from system design plans on record-If checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: USGS MAPS AND CHARTS- 12+FEET/ENGINERED PLANS FROM HOMEOWNER 6 11 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 YORK TERRACE OSTERVILLE,MA 02655 M140 P206 L2 Owner: PAT FINNEGAN Date of Inspection: 5/15/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches, etc.): n/a DISTRIBUTION BOX: X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box,etc.): BOX IS STRUCTURALLY SOUND. PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): n/a R FS Commonwealth of Massachusetts Executive Office of Envirolmiental Affairs Dept. of Environmental Protection One winter Street Boston Ma. 02108 ' John Grad' D.E.Y. Title V Septic Inspector P.O. Box 2119 Teatic 02536 WILLIAM F.WELD Governor ARGEO PAUL CELLUCCI Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM O PART A C 0 CERTIFICATION T 8 Property Address: 14 York Terrace Osterville Address of Owner. c9�9Ns19g( 9� Date of Inspection: 10/22/97 If different e P t ) Name of Inspector: John Graci Patricia Finagen I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name,Address and Telephone Number: It CERTIFICATION STATEMENT I certify that i have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: x Passes This Inspection Is based on criteria defined In Title V — Conditio Ily asses code 310 CMR 16.303.My findings are ofhow the system Is performing atthe time of the inspection.My Inspection does — Needs rt rEvaluationBytheLocalApprovingAuthority not imply any warranty or guarantee ofthe longevity ofthe Fails septic system and any of Its components useful life. Inspector's Signature: Date: 10/23197 The System Inspector sh I submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of CoThpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal, is cracked, structurally unsound,shows substantial infiltration or exfiltration, or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 007197) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 14 York Terrace Osterville Owner: Patricia Finagen Date of Inspection:10122197 _ SewaQe backup or.breakout or hioh.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced _The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: — The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. I — The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. I — The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. — The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR f5.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. _ Di9Gtarge or pouihng 0f effluent to the§u11ece of Hie ytGund oi'sul face walel s due to an overloaded vi clogged cesspool. SAS is in hydraulic failure. (revlsed 04127197) I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 14 York Terrace oslerville Owner: Patricia Finagen Date of Inspection:10122197 D]SYSTEM FAILS(continued) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped — — Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. — — Any portion of a 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 74 York Terrace osterville Owner: Patricia Finagen Date of Inspection:70122197 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: _c_ — Pumping information was requested of the owner, occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal flow rates during that period. Large volumes of water have not been Introduced into the system recently or as part of this inspection. x As built plans have been obtained and examined. Note if they are not available with N/A. x _ The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. _c_ — The site was inspected for signs of breakout. x All system components,excluding the Soil Absorption System,have been located on the site. x The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.` x The size and location of the Soil Absorption System on the site has been determined based on — — The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part Cis at issue,approximation of distance is — — unacceptable)[15.302(3)(b)) (revlsed 0491197) ! SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 14 York Terrace Osterville Owner: Patricia Finagen Date of Inspection:10f22197 FLOW CONDITIONS RESIDENTIAL: Design flow: 440 g•p•d./bedroom for S.A.S. Number of bedrooms: 4 Number of current residents: 1 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yea Seasonal use(yes or no): No Water meter readings,if available:(last two(2)year usage(gpd): rda Sump Pump(yes or no): No Last date of occupancy: Na COMMERCIAL/INDUSTRIAL: Type of establishment: nIa Design flow.o gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: rde Last date of occupancy: n1a OTHER:(Describe) Na Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has not been pumped In the last year. System pumped as part of inspection: (yes or no)No If yes,volume pumped:U gallons Reason for pumping: rda TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records,if any) . I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components,date Installed(if known)and source information: 16 years Sewage odors detected when arriving at the site:(yes or no) No pevlaed 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 York Terrace Osterville Owner: Patricia Finagen Date of Inspection:10/22197 SEPTIC TANK: x (locate on site plan) Depth below grade: 16^ Material of construction:x concreate metal FRP Polyethylene—other(explain) If tank is metal, list age o . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: t.10•6••H5•7^w5•e•• Sludge depth:1" Distance from top of sludge to bottom of outlet tee or baffle: 26" Scum thickness:o Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle:o How dimensions were determined: Measured Comments (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage. etc.) Septic tank and all components are structuralry sound.Recommend pumping system every two years for maintenance. GREASE TRAP: (locate on site plan) Depth below grade: nra Material of construction: concrete metal FRP Polyethylene_other(explain) Dimensions: nla Scum thickness:nra Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum 10 bottom of outlet tee or baffle:nra Date of last pumping;,r, Comments: (recommendation for pumping,.condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of'leakage, etc.) nra BUILDING SEWER: (Locate on site plan) Depth below grade: 2• Material of construction:_cast iron x 40 PVC_other(explain) Distance from private water supply well or suction MOO- Diameter: 4^ rygmments: (conditions of joints,venting,evidence of(leakage, etc.) (revlsed 0027197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 14 York Terrace Osterville Owner: Patricia Finagen Date of Inspection:10122197 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rda Material of construction:_concrete_metal_FRP_Polyethylene—other(explain) Dimensions: Na Capacity: r9a gallons Design flow: irda gallons/day Alarm level:_nla Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) We DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: rda Comments: (note if level and distribution is equal,evidence of sollids carryover,evidence of leakage into or out of box etc.) rVa PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no)No Alarms in working order(yes or no)_Ye: Comments: (note condition of pump chamber, condition of pumps and appurtenances,etc.) rda (revised 04127)971 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 14 York Terrace osterville Owner: Patricia Finagen Date of Inspection:110122197 SOIL ABSORPTION SYSTEM(SAS):x (locate on site plan,if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: rda Type: leaching pits, number: 1PW gallonleechptt leaching chambers,number:nra leaching galleries,number: rda leaching trenches,number,length: rda leaching fields,.number,dimensions:nla overflow cesspools number:nla Alternate system: Ira Name of Technology._rda Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) The leach pH s abucturaliy sound and functioning property.It had T of water In It,has not had more than T In It CESSPOOLS: (locate on site plan) Number and configuration: I've Depth-top of!liquid to inlet invert: Na Depth of solids layer: rda Depth of scum layer: Ma Dimensions of cesspool: nra Materials of construction: tva Indication of groundwater: rda inflow(cesspool must be pumped as part of inspection) ` rda Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) rda PRIVY: (locate on site plan) Materials of construction: rda Dimensions: rda Depth of solids: rda Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) nra (revlsed 04127)971 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 14 York Terrace Osterville Patricia Finagen 10122197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) Fro h arch A I 4 A; �6 (revlaed04127197) Page ! of 16 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 14 York Terrace Ostervllle Patricia Finagen 10122197 Depth of groundwater 12 Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property,observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers x Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS Maps and Charts (revised0427197) page 10 of 10 r . aol00Lg45 ?( FIELD ADJUST FOR �'�•. MAXIMUM WIDTH. . - ENGINEERS TO PIN L..ALL. � UNOIAL B!SGi FODATION FOR . PODUA4CRINIZ.FOUND. i'S%ACY BEFORE '�o upOia!°RSs orweRw Nv m NOTE: ic)6 0 " I:enoVe MOST B,ca+TRacTow sHALL vDxIFY oLL WINDOW ALL WINDOWS ARE TO BE - R000N OPFJIINGB FRIOR To ORDERING wNOwiB: ANDERSEN 400 SERIES wNDOW't ADD. 8 15E LITE FROSTED �oR r CONBTRLJGTb w/STORWATCH PROTECTION y� u - GLASS DooR—,L ASSUMES RtISPONSIBILTTY FOR ANY MISSING OR ! APPLIED GRILLES u SHIFT OPENING iLi I INCORRECT DIMENSIONS TW NOV, TO INSIDE AND OUTSIDE p p TNe ATTlNIRON or TNe DESIGNER TO Af.Gw'CDATE 1 L EXISTING SHELF IN CLOSET FLOOR n MASTER BEDROOM I _REMOVE EXIST. Arc ca+ASe FOR ® WALL KEY v+ -�-J CLOSETS UPPER BEDROOM . 1 A21 - O EXIST&4.WALLS vR •. ,. li NlMI it•VANITY +� - C_____7 WALLS TO BE REMOVE " u u✓STONE TOP - A21 if CABINET 1 A. 0 PROPOSE HALLS VANITY pID . ---9 NEW I n - p FLIP ®o ((•11 W.LG- DOOR �.J .. SWING DUSTING MASTER BATH BHavEs I ; ggW3"�p{ �� NDV FRAMD.l59 BUILT-IN NGR WC I - - f3� 3-'O# 151 . N54 F MEICINE CAB. --J I 2f SHOWER WALLS a✓MIRROR DR o ^_\I S P7UT_ I B y g` . INEW B•RA ��gg L 18 LITE PROS ¢ax. - CERAMIC.SUBWAY- SHOWER N �'\.BA /�'PANIt GLASS DOOR sK1�C1 p8p���U- r - TILE ON WALLSNEW Y _ ,yNFm0p7 ; LINEN 9HELVZS s--�w NIP RAFT a91 R ------ -I T cpi ici � DN . NEW SHOWER 4 CNRO'1E 1 W4 - - HEAD t VALV! THRU REMOVE WINDOW I 5 � ' LOCATX7N 421 P°R I / I A.3 . w � .0�. t ja�Iw Urn sylxa H Cw-' s)4•dc•�Keh ON o-"" C Cn C/� r I POs o TrP.2.8 HDR Z Q cn ' to ts• G I O• e _ gg A2 FIRST FLOOR DBL STUD PKTB ^ c� In - WALK IN CLOSET ADDITION 134 90. FT. - FLOOR BRACING ' - � FIELD ADJUST FOR - _ 4'O.C. FIRST .6V•� MAXIMUM WIDTH. T . . - - TWO TYPICAL T 9PAl:E4, _ .ENGINEERS-TO PIN N I -FOUNDATION BEFORE I\ ( - - _ o POURING FOUND: UFO H I g \ - I O w . - - PROVIDE s I R®ARS• --- 1 I I - � I a \ I V tY D.C.VERY IN - EXISTING FOUND.WALL % • \ I Z iLU a WW ANCHOR Q c _ _ — Q :^ BOLTS•76•O.C.G MAX. I MIN T E18W FLATS - uV9•I1911/4•FLATS WASHER 71I0 FLOOR R I 96•DIAM.CORRUGATE .. J .r _ Ili • .• - - JOISTS K•O. GALVANIZE STEM +•� Q• - I. ( AREAWAY W/GRAVE 3-'1fII0 HIP RAFTER �BED, Tmcw_ I.-1 � W V . Icl of �T CAP I I Q a _l J 1 t LI oW lu L SPACE BASEMENTI B T NEW ROOF FRAM I NU. PLAN w o o veRlPr LOC CRAWL I I NEWN SPACE I I ^ 0 ,— s s I I « QF ALIGN FLOORS I I y v a TWpc K 4'-8•CONCRETE CONTINUOUS IG"'&'%&°N ' cw+cRErE FoonNG , I e _ � PROVIDE oe REBARS• a_ tY D.C.VERT IN - DUSTING FOUND.WALL ,,,,, . , ,�::::� BASEMENT NOTES: t.WAIN FOUNDATION WALLS To BE t1• m CONC.W/2"s SAM 3 t BOTTOM REST FOUNDATION ON 9'XIi TRIP FOOTRJG. TYPICAL NOTES: T W,I"�AMM vDer.NE'�':�,y wDF'o"D�YIw d 6$ 8'i•MIN.�p�y�TOP Q FOOTI PROVID!!!/B•A1ICHOR 3 - 9TRUCTURAL W61NEE!/DMO ER TO F9•Jtf010.1 FRAMING Y INTERIM . WHOt FRAMING E Cw7PLETE AND PRIOR TO D�C1O9URE BY INTERIOR 80.TB•tIL O.G MAX.MIN 7•EMBmMRNT•V°Jb"uV4'PLAT!WA9HCR �^ ��� �� MALL PLASTER BOIARDVFINI^,H, 2 MOL!FLOOR JOISTS UNDER ALL PARALLEL PARTITIONS, tNO.ACra E,JEHALL SCHEDULE AND PROTECT FOP"WEATHER ALL _ AND DUD+uo uRes AS MAYBNG E 4 coNTRAeroR PRwIDE veNr�uTfaN ON COMPACTm FILL. . NECESSARY TO INBUR! m REOUIRm BY CODE(WINDOWS OR nIGIANICAL CONTRACTOR BH4LL SITE INSP[CT ALL DUSTING V0.PIROPOBm CONDITIONS PRIOR TO AND DURING CONSTRUCTION AND NOTIFY DC9tGNCR 11 T� LLL D�BIIRE THAT ALL FOUNDATION PLACES MAINTAIN . _ Q ANT DE9CREPANGEB AND/OR CNANYt9 THAT MAY BE DICOUNTERm. 4-0'MINITNM COVER. m . CONTRACTOR BWALL CONSTRUCT AND MAINTAIN TEMPORARY WALLS/ i.PROVIDE WES STIFFENING P'LATE9 AT ENDS OF STCt:1 BEAMS, TYP.BIIORING ETC-TO MAINTAIN/PROTECT DUSTING HOU9!AND STRUCTURAL . - INTEGRITY OF EXISTING HOUSE 7.BEE STRUCTURAL DRAWINGS FOR LOCATIONS OF ALL STRUCTURAL COLUMNS. 'co - CONTRACTOR 9LIALL SITE INSPECT/VERIFY ALL DUSTING VS. PROP09m 0.CONTRACTOR BNALL NOT SCALE DRAWINGS FOR DIMD1910N9. ANT MISSING,. CONDTONS PRIOR TO AND DURING CONSTRUCTION AND MAKE 4DJUBTMDJTB INCORRECT OR OUESTIONADLE DMFJJ91wL9 NOT BROUGHT TO TH!ATTENTION w .Z !�AS NECESSARY TO INSURE COMPLIANCE WITH DESIGN PARAMETERS AS OP THE DEIlIG/Et BECOME TN!RE9PiwESIB111T7 OF THE CONTRACTOR, lV WORK PACGRE9BlS. 'NILINTDtT OF DESIGN IS TO ALIGN NEW FIRST FLOOR BPAC�W DUSTING .�FOUNDATION PLAN NIFLmRToo �9HA~TL T TOP OP FONDATION WALL AS �, o N Q �i c J. I ®® I ® ® 1 it1 O ZFt rn D rn 7� rn < rn D rn -DI Z Z n�f ' 1 , -0` Es i p���� L r ' g 31 8 >e p8� 8� KY= Oil 2 0 N nQ (� . f�E�F d7r, a = BASEMENT °f nra _ cneT(N i 9EDRM. -=8Si3R .----- rn K-o Q F= € o (c .figg pill mr c = D J Z b 1� )4w >z w� y =7 F � w EE ol gg As 9dALE: 1 8�-1'—D. ARnTIp wruM �nmmE COPYRIGHT DATE REVISIONS z a e ,� ELEVATIONS NORTUDE NORTHSIDE HEREBYE%PRESLY DESIGN m "°" DESIGN �YRIGHT.THESE WCM ARE °R IQ �°A PROPOSED ADDITION NOT TO BE REPRODUCED DRAWN SHEET No. DATE a Nmall ASSOCIATES °OR D'"""Y °®°� °° DUHAMEL RESIDENCE 100.1�OR 11ANNER WHATSOEVER B/00/10 AT RBOO�`ua�° uw. DISTINUK RESIDWI&A COWMERCWI DESIGN WITHOUT PRiST oerAINDlc THE A.2 Ilo,"i°11.�nR 14 PORK TERRACE A�i°roREro�Ns�T pNTHsIo t4� 1WN sRiED•YARMOUTHPORT•W Ote�e CHECKED ascRoo(aaw.,wnuk OSTERVILLE, MA. coos)au-aato (ws)saa-ssm DESIGN DO NOT SACKFILL WALL UNTIL CONCRETE WA - BIT. IT.FILLER. . ASPHALT ROOF SNINGLFS ATTAINED 7 DAY STRENGTH TOP OFF W FLEXIBLE . MATCH HOSTING ' AND BOTH TOP'•BOTTTOM JOINT SEALANT . - T7VEK' HOUBEWRAP 1 OF WALL ARE PROPERLY. >lEIxCURED. _ SIDING SEE ELEVATION �•COX SHEATHING KoDx.PLYwoaD 2"•IV O.C. p 'TYVEK'NOUSEWRAP R30 GATT INSUL. R-tq - TOP 6 BOTTOM CONY. — 2'CONC.DUST CAP y� . �•GL.®u✓SKIM COAT PLASTER FIBERGLASS INSUL. IIII�III �" 13 W. Yj CDX PLYWOOD O}I fM STRAPPING 1 16'O.0 CARKT DAMPROOFING CL G CONY.RAFTER VENT 6 VENT BAFFLE' + / f.MIL. POLY VAPOR BARRIER OVER TOP Q =IIII=III n COMPACTED - FOOTING 2x6 1 16'O.C' / V G.W.B. -I III ICE AND WATER BARRIER MEMBRANE /. . CARRY UP 3'-O• PROM EAVE 'J7M KEYWAY N R-19 FIBERGLASS INSUL AL DRIP EDGE / GWE•MAIL M JOISTS 6 MIL,POLY VAPOR BARRIER AL. ICE t HATER BARRIER - // SIDING SEE ELEVATION ALUMIN.GUTTER _ RIM JOIST OR VOL.PERIMETER IIII — _ I IIII IIII � 1 1 - `T. IIIIII I t11�-I II 1111111-IIII-illl -1 I I I-1 I I I III-1 I I�I I I-111 I I I I�I i I-1 I i�111 I CORA-VENT STRIP VENT — — — — Ix TRIM 2x6 P.T. SILL 2xIO FLOOR JOISTS 16' O.G. Sg Wax T KCAL WALL DETAIL BIDING BLLL SEALER .. � � SCALE 1-1/2' • I'-OP TYP.WALL BOLTS W O.C.MAX �xwx�x OEM MIN 7'EMBEDMENT - - TYPICAL DUSTCAP FOOTING ® g 3=>nk� . x✓3b4U4'PLATE WARNER 61 - r" x o:�3 TAMP 5-OUT SCALE 1-1/2' 1'-0'FILL c¢¢ W ' �y� 1'/FT`SLOPE. PROVIDE 2 EAVE DETAIL WNNEBRE NO GUTTERS STONE 2•AR'OI�lND�ALL�OP#NIt�9 CONTI I I T I e DOL TOP PLATE iN 3 TYPICAL SILL DETAIL ,T ==cn _:4 SCALE 1-1/2' I'—O' 2x STUDS• Is' O.C. +A'Q I I _ RAFTER • 16' O.C. 2x STUDS 1.16' O_G. STM PLATE - s al 110 MPH WIND ZONE REQUIREMENT FOR 780 CIR 7th EDITION MA_ STATE BUILDING CODE ov H2s s EA. RAFTER Ak RIM JOIST 'ail JOINT DESCRIPTION NUMBER OF NUMBER OF NAIL SPACING.. � - ° TOP PLATE - 1'� COMMON NAILS 801(NAILS. W ROOF FRAMING - LOOK JOISTS Zr V - BILL PLATE LLI LLI BLOCKING TO RAFTER(TOE NAILED) a-Bd - 2-IOd EACH END - Q Q RIM BOARD TO RAFTER(END NAILED - 2-16d 3-tbd EACH.EIVD .. • _ - Z ea E O CONNEC ION o WALL FRAMING a.",".N.Ts ti ° ' Z mow/Q E TOP PLATES AT INTERSECTIONS(PACE NAILED) 4-16d 3-16d AT JOINTS 1/2' COX. SHEATHING • .t 0 LE,.W STUD TO STUD(FACE NAILED) 4-IBd 2-16d 24'O.C. BILL PLATE TO TOP PLATE Q a W- HEADER TO WEAVER(PACE NAILED) I&d 1" 24'O.C. ALONG EDGES - : _ SEE NAILING SCHEDULE ° Q J JU FLOOR FRAMING 2x6 DBL TOP PLATE S/B' ANCHOR BOLTS s 36' O.C. pj W to Y> JOIST TO SILL, TOP PLATE OR GIRDER (TOE NAILED) 4-Bd 4-tod PER JOIST MIN. 7' E16EOMENT L O W 91MPSON 8F'L(20 GA.j 1- BLOCKING TO JOIST(TOE NAILED) 2-6d- - 2-IOd EACH END uI/3'x3'xi/4' PLATE WASHER Q BLOCKING TO SILL OR TOP PLATE(TOE NAILED) 3-16d 4-16d EACH BLACK LEDGER STRIP TO SEAM OR GIRDER(FACE NAILED) '3-16d 4-ibd EACH JOIST .. V IL �-r JOIST ON LEDGER TO BEAM(TOE NAILED) 3-Sd 3-IOd PER JOIST BAND JOIST TO JOIST(END NAILED) 9-16e 4-16d PER JOIST - _ SILL TO LA E CONNEC ION w/ SH Z_ p BAND JOIST TO SILL OR TOP PLATE(TOE NAILED) - 2-16D. 3-16d PER FOOT IL/ SCALE'WT.S. U I" L ROOF SHEATHING 4 WOOD STRUCTURAL PANELS .- HEAD pQ RAFTERS OR TRUSSC9 SPACED UP TO 16'OX4 r - Sd tod 6' EDGE/6' FIELD FULL MGT.BTU NOR UPLIFT STRAP - o RAFTERS OR TRUSSES SPACED OVER li'O.C. Sd IOd 4' EDGE/6' FIELD --JACK STUD REFER TO TABLE 9 o GABLE ENOWALL RAKE OR RAKE TRUSS u✓o GABLE OVERHANG Sd lod 6' EDGE/6' FIELD SIMPSON o •`�\ .1i CAB�LENDBW4LL RAKE OR RAKE TRUSS w/STRUCTURAL Sd lod 6' EME/6' FIELD PNO.(14 GA. WINNDPLATOEW SILL o a ¢ ILS 6' O.C. GABLE KERB, LL RAKE OR RAKE TRUSS ul/LOOKOUT BLOCKS Bd IOd 4' EDGF/4' FIELD '2)16d COMMON CEILING SHEATHING 3/8' ANCHOR BOLTS • 361 o.c �q slth. a a a PND a GYPSUM WALLBOARD - 3d COOLERS - T EDGEAO' FIELD - Mw/'�J'x3'xt/4'EMBEDMENT! WASHER ``` o WALL SHEATHING p�$ � xa2 WOOD STRUCTURAL PANGS - Y la GA ANCHORS TYP. a a STUDS SPACED UP-TO 24'O.C: Ed lod 6' EDGEA2' FIELD JV AND 2W FIBERBOARD PANELS Ed - 3' EDGE/6' FIELD CORNER S U HO DOW V GYPSUM WALLBOARD 3d COOLERS - 7' EDGE/10' FIELD 'I - V SCALE.N.T.S. - yL Ot ao FLOOR SHEATHING 1 m WOOD STRUCTURAL PANELS 1'OR LESS Sd lod 6' EDGEA' FIELD GREATER THAN V Lod 16d 6' EDGE/6' FIELD S UDS 8 HEADERSC7 SCALE.N.T.S. 3 W - VERIPY(%1911NG GIMWl.91W ` ' 1 06 '�------ - II - ------ I ,I a c o I I LI n Z I I i co" b4 Og I I F� 'R D sa . 1 1� mpgrg� I I H ��' z m g i i uk I I I IoF A 1 1 uF I" pp ® Fia n — 16 H; -- - -- �� 2 4'. 9 p c: D . EXISIINO 2z 10 FLR JSTS. TTTTI - - - III11 I I I(t-t -------% iJ.-LLLJ I I • L, I 0 � p - M m PROJECT: REE VISIONS - DRAWN BY:- 142Bd218- FAX MM42B4298. '" DUHAMEL ADDITIONS MM fO YORK TERRACE,OSTERVILLE,MA .t, TITLE: .ARCHITECTURAL. INNOVATIONS • - - j A MASON OFAIFNTE)� PIC.4 y. FOUNDATION PLAN P.O.BOX20B8•c07U(T•MAO2SSB } . 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T - CG➢N — IQ---- -------- r ----------- �I i/-9'"IP 0.lUt WNL 10MTM t . - 4'-P YJlFP wNI fl - IL 6'_c ulI 1 I , O • I I a c., 3 , I cn n r O IF - OEl o r" e I I I I I , 1 , 1 " I I I I 1 1 O 1 1 1 3 1 I I 1 1 1 1 O 8 D P,ROJECT+ REVISIONS � � - DRAWN BY: � t m rn DUHAMEL ADDITIONS ' Z' °e 1O YORK TERRACE,OSTERVILLE,MA - \ TITLE: ARCHITECTURAL INNOVATIONS - �.. § SECOND FLOOR PLAN PoMMONO MU ozM nea