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0021 BLUENOSE LANE - Health
21 Bluenose Lane Marsions Mills A= 121 — 144—005 `� XIST. OUTDR. SHOWER EXIST. EXIST, EXIS . SINK r;- '- -- 00 -- EXIST. I L_- - TH E ETXIST.HEN III II BUILT-IN NEW CABS. REF. I I II I -------------- ------------ -- '� III _- ------- NE EXISTING n L VNG-RM. S EXIST. sr DINING St UP y h I' EXIST. FXIC;T Fvicr EXIST. c�naT NEW EX15T. EX15T. EX15T. D � NEW NEW 0� BATH LAUNDRY I OFFICE Ln EXI ST. � CABINET 0 SHELVES DN. N EXIST I 1 BUILT—IN BEDRM BENCH EXIST. REORM. NEw New NEW � I I ROOF BELOW . I ROOF BELOW � 1 I I I EX15T. EXIST N M (Exist' f ® } NEW c CENTER VIDEO M5T. BATH r— p SHOWE (ABOVE) too# x o� W ;� NEW UNDRY OFFICE ® NEW to BUILT-1 EW W.I. CLS. SI K CABINET NEW SEAL` '�'� L.IN. SHELVES R 9'-6" 6'-4" NEW MASTER BUILT—IN SUITE i BENCH �TVIE NEW ::.. .. :.... )RM,. . .. NEW NEW �. ROOF W ! BELOW ,ROOF 1 NEW. NEW NEW. NEW T. s 6" 15'-0" 5'-6" NEW GA LE-_ 8'-0" 26'-0° (NEW CONSTUCTION) i r No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppliLation for Mie-po8al 6pstrm Co nstruttiun 3permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No.C`/ Q ve-nose. (n, Owner's Name,Address,and Tel.No.Sob-937-` -94 Assessor's Map/Parcel /a/ 1q,1_S- o5 dac,-5S Installer's Name,Address,and Tel.No.34)FS- lgco o Designer's Name,Address,and Tel.No. 5b3-3GGl-�5 (3a� ola �' r,sfruc.�iov�,�r,c {�,v,fax�v� ,c7ow� ' r, �n -►'v g39 Ma;n sfi rs ills vaco -� t� Type of Building: _ Dwelling No.of Bedrooms Lot Size 0" `�ACr S sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures /o Design Flow(min.//required) 330 gpd Design flow provided �3`7' / gpd Plan Datel�b barU t 1, oV�//ls Number of sheets j // Revision Date Title I i � S � �(IJ11CC 64 00c_0), ©5kf4),�14 AdA y Size of Septic Tank UAO Type of S.A.S. tycap 83 Description of Soil Nature of Repairs or Alterations(Answer when applicable)�g/P- �G Ian 1p/jari Lbx -2 &6) Sop Sctf fErtAA ID ca la•n'w Y- 5' x 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 Environmen ode d not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt Signed Date o� / Application Approved by ,�/IN J 0� Date Application Disapproved by Date for the following reasons Permit No. G " Date Issued J Li A- No. Fee ,Mry THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS M1 01pplitation for Misposal �&pstem Construction permit Application for a Permit to Construct( ) Repair 411 Pgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. ,2/ QJve oase 6-), Owner's Name,Address,and Tel.No.S 0S-93�2- OA Assessor's Map/Parcel /al 1 q 4 -s ue` p5�e zuc CC" O SS Installer's Name,Address,and Tel.No.508- 4.�8-is`DG Designer's Name,Address,and Tel.No. (3vr-I•olo Cvns+r<x{i ou,� �:�c• s yr f�,x r>oq ,c7CX,on ' �c Cr 'MQUe rj'v Ql39 Ma r'Y! Si- ar kZ' s /iis. Type of Building: _ Dwelling No.of Bedrooms 3 Lot Size U^ AC V_e-S sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures / Design Flow(min.required) 330 gpd Design flow provided 13,12 gpd Plan Date Zk/ ( fZ,f t (, aC.l's Number of sheets_ / Revision Date / l Title r44e -3 Pe, r O-k. o02/ t31t cF 0/)1N4e r,LI A Size of Septic Tank /j' Iwo9--,_e Type of S.A.S. �rrr����� yx,c„-r��`YYf.,11(ifRd � �~ J Description of Soil Nature of Repairsor Alterations(Answer when applicable) i i;r�r /fao�o/%h?<ic�� 1k..k -? 641C.�) zo �-,e C k-Ct } 1f:'Y1 �r,sz/y,1Is1C1k N �Ir S�C�ttx n Ct (a•�y3 W X 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-Cod Band not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health.--' � Signed Date .Z r / 5— Application Approved by ��- �/ /��� /� Date 1 Application Disapproved by Date for the following reasons ^�^ Permit No. Date Issued ---------------------------------------7------------------------------------------------------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS ... --BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that ttthe 'On-site Sewage Disposal system Constructed( ) Repaired(4/0� Upgraded( ) Abandoned( )by ✓�v�,G Zt %,r ti�rc,c ->'Yii t -LY�� at D?/ / o In S LC(i74� �.S lr r'y,//� has been constructed in acco ce with the provisions of Title 5 and the for Disposal System Construction Permit N . O dated "� / 5� Installer >l �, b C .v7. r2.a` /G✓),--yr1C - Designer i/, �,� Y)aj- . "//R':�, t�� /� ^,, -•�i�L #bedrooms �j Approved design flow gpd The issuance of this permit It'll not bd construed as a guarantee that the system�i4lnlWassgned. 0 Date /. J Inspector f9 / / r V ---------------------------------------------------------------------------------------------------------------------------------------- No.,Q 0 (,5o3p Fee (012 , THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Voposal *pstem Construction 213ermit Permission is hereby granted to Construct( ) /Repair(� Upgrade( ) Abandon( ) System located at o?) f�� '1I)6 Se (i7/ �� `7't`77, / \ and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5.and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date ( Approved by V� I�SR-19-2015 00:47 From: To:15087906304 Pa9e:1,14 i FROM :down cape engineering inc rRX NU. :150�3629880 Mar. W 2015 12:16PM Pi TOWU Of Regulatory SeWices. Thm os F. 00&r,Dbrcctur ablfc Ties 10P Division ;7.00 maiu si:ct.,,1Hymlib,M&02641 (_)fro' 508-862 4CA4 pax' 508-790,-6304 .nWer &Dasitnoea�m a r�rtns�rb mr6es. I9a ai�eh: )0 LA)h (AU Inrp r: ,, / ,a S�lat>r y: ta�'Mo address: o D J '., ' � 6 — c1A. PO Il�l GL►- .1�1:r j�+1' On c way issued a pLmnit to irudkIl a ( e'1te) l ilLRfB)1,8r SE"pt1G Ry3tEriz;it d l tc.�lL�t1'E' '`� __oared r r�dcaiga drAwn'by - (aclilrese) 2-3 dated _ ..- 1S 1;eFjjtify ftL the. se c. sysfpa.referenced al Tie waq ius-4L [ed'sub8tMtially ar.•rorriind to the cieaigp, whit.h,Xa r inclu&-MiD.0y aJT,109t-J. aha) -Ps Sit.cjL z9]ei e1 relacaCion of thy: clistn'bution bnX a WOX geptLo,tank I crxot, 'LL"p the septic: sy'aun refcv.,m4ed P-bove wits iuRta7 ul with muior (boupes -'a cr than 10' laternl rruacation.e -iw SAS or any wrfical relocs flal.of any cvo.'1pernrnt Of.•1j1,C'BPptiG yyS"ti=�01 ]Il Afi.G�CC�411GC`N7.E StI r..021 Regnlud=. 'E'lan reASion.ur CeTt c.(t a.R-JAILf 7-de to fallow y �N bF Mq q • - ,gv��DAN��LA.� (Ivstalter'y SiAt<ve) CIVIL f° a No.465CC � �Qr s rep`o� ONAL 1]�Fiit'ner39 1�XN p eTPJ PT, rEzmTO .aARNr9 �PUBI. g , 'c,']•g.. D, >c>, ".r zr� ._ Clf �R-19-2015 00:47 From: To:15087906304 Pa9e:2/4 TOWN OF BARNSTABLE i LOCATION �;�:`.,ram"-! LOL SEWAGE# -� -rf o3 i VILLAGE _ASSESSOR'S MAP&PARCEL INSTA.LMUS NAME&PHONE NO.s!�z.':Z�zc^i t - SEPTIC TANK CAPACITY _ trA'f(_;mot hoc tdp,6-,f0L-- .Al-le LEACHING FACILITY:(type) i• (size) r I - X J-t NO.OF BEDROOMS ..OWNER 61u. I. Cft. PERMIT DATE: i COMPLIANCE DATE: Separation Distance Between the: r Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Watcr Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) eet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) tk-- Feet FURNISIWDBY T'L- Jf L i . II1 • II i . . Print Page Page 2 of 4 • Sales History -Map/Block/Lot: 121 / 144/005 -Use Code: 1010 History: Owner: Sale Date Book/Pa e: Sale g Price: NOVACON, PETER K& KAREN B 1998-09-28 C150265 $140000 PERRON, WILLIAM& JOAN 1997-07-30 C145307 $130000 DACEY, WILLIAM E III TR 1989-10-30 C118878 $242500 FIZELL, WELDON R&NORWOOD-FIZELL, WENDY 1989-03-15 C119996 $117900 ARCHIBALD, WILLIAM 1986-04-16 C 101010 $1 ARCHIBALD, WILLIAM 1977-08-24 C71580 $0 • Photos 121 / 144/005 - Use Code: 1010 �t ,w • Sketches -Map/Block/Lot: 121 / 144/005 - Use Code: 1010 17 2, 1 'WDK'. 12. __... 0 : z , r OIT As Built Cards:Click card#to view: Card 41 • Constructions Details -Map/Block/Lot: 121 / 144/005 - Use Code: 1010 Building Details Land http://www.townofbamstable.us/Assessing/printl5.asp?ap=0&searchparcel=121144005 2/23/2015 Print Page Page 1 of 4 Print this page • Owner Information - Map/Block/Lot: 121 / 144/005 -Use Code: 1010 Owner Map/Block/Lot GIS MAPS NOV ACON, PETER K& 121 / 144/ 005 Owner Name as of KAREN B Property Address 1/1/15 21 BLUENOSE LN 21 BLUENOSE LANE Co-Owner Name OSTERVILLE, MA. 02655 Village: Marstons Mills Town Sewer At Address: No GIS Zoning Value: RF • Assessed Values 2015 -Map/Block/Lot: 121 / 144/005 - Use Code: 1010 2015 Appraised Value 2015 Assessed Value Past Comparisons Building $ 111,600 $ 111,600 Year Total Assessed Value: Value Extra $ 17,600 $ 17,600 2014 - $ 272,500 Features: 2013 - $ 272,500 $ 5,400 $ 5,400 2012 - $ 265,500 Outbuildings: 2011 - $ 271,500 Land Value: $ 137,900 $ 137,900 2010 - $ 273,400 2009 - $ 310,300 2008 - $ 332,100 2015 Totals $ 272,500 $ 272,500 2007 - $ 392,000 .Residential Exemption Received= $87,192 • Tax Information 2015 -Map/Block/Lot: 121 / 144/005 -Use Code: 1010 Taxes C.O.M.M. FD Tax $ 422.38 (Residential) Community Preservation $ 51.70 Act Tax Town Tax(Residential) $,723.36 Fiscal Year 2015 TAX RATES HERE 2,197.44 http://www.townofbamstable.us/Assessing/printl5.asp?ap=0&searchparcel=121144005 2/23/2015 Print Page Page 3 of 4 Building value $ 111,600 Bedrooms 3 Bedrooms USE CODE 1010 Replacement Cost $124,039 Bathrooms 2 Full Lot Size 0.5 (Acres) Model Residential Total Rooms 6 Rooms Appraised $ Value 137,900 Style Cape Cod Heat Fuel Gas Assessed $ Value 137,900 Grade Average Heat Type Hot Air Year Built 1990 AC Type None Effective 10 Interior CarpetHardwood depreciation Floors Stories 11/2 Interior Drywall Stories Walls Living Area sq/ft 1,267 Exterior Wood Shingle Walls Gross Area sq/ft 2,678 Roof Gable/Hip Structure Roof Cover Asph/F GIs/Cmp • Outbuildings & Extra Features - Map/Block/Lot: 121 / 144/005 - Use Code: 1010 Code Description Units/SQ ft Appraised Value Assessed Value BMT Basement- 768 $ 17,600 $ 17,600 Unfinished WDCK Wood Decking 374 $ 5,400 $ 5,400 w/railings • Sketch Legend Property Sketch Legend B2N Barn-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only BAS First Floor, Living Area FTS Third Story Living Area SOL Solarium (Finished) BMT Basement Area FUS Second Story Living Area SPE Pool Enclosure (Unfinished) (Finished) BRN Barn GAR Garage TQS Three Quarters Story (Finished) CAN Canopy GAZ Gazebo UAT Attic Area(Unfinished) CLP Loading Platform GRN Greenhouse UHS Half Story(Unfinished) FAT Attic Area(Finished) GXT Garage Extension Front UST Utility Area(Unfinished) FCP Carport KEN Kennel UTQ Three Quarters Story (Unfinished) FEP Enclosed Porch MZ1 Mezzanine, Unfinished UUA Unfinished Utility Attic FHS Half Story(Finished) PRG Pergola UUS Full Upper 2nd Story (Unfinished) FOP PRT Portico WDK Wood Deck http://www.townofbamstable.us/Assessing/printl5.asp?ap=0&searchparce1=121144005 2/23/2015 Print Page Page 4 of 4 Open or Screened in Porch PTO Patio http://www.townofbamstable.us/Assessing/printl5.asp?ap=0&searchparcel=121144005 2/23/2015 gap p f 0 m o ' LfI M Postage $ O L Certified Fee `, Z Retum Receipt Fee Q BV Postmark, C3 (Endorsement Required) :� N Here O Restricted Delivery Fee 13 (Endorsement Required) O �0�}� rU Total Postage&Fees r-a goo Mr. & Mrs. Peter K. Novacon 21 Bluenose Lane Osterville, MA 02655 Y Certified Mail Provides: o A mailing receipt O 1 n A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. c For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT-Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 F Town of Barnstable Barn Regulatory Services Department MA bs� `9. Public Health Division Q 0 D D �,� 2007 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7014 1200 0001 0358 0307 January 19, 2015 Mr. &Mrs. Peter K.Novacon 21 Bluenose Lane, Osterville, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5. The septic system located at 21 Bluenose Lane, Osterville, MA,was last inspected on 12/16/2014 by Troy Williams, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails"under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: O Backup of sewage into facility or system component due to overloaded or Clogged SAS You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system with in the deadline period will result in future enforcement action. PER ORDER OF T BOARD OF HEALTH omas McKean, R.S. CHO Agent of the Board of Health QA.SEPTIC\Letters Septic Inspection Failures or Future Ev1\2I Bluenose Ln Ost Jan 2015.doc Q � Parcel Detail x f ' i55g12�in���n�t propdata,'ParcelDetail,aSD 0=7624 r , 4tA�Sid , 7 i3 , I - • Parcellnfo . Parcel ID 121.144.005 Developer Lot LOT43 �% Location 21 BLUENOSE LANE Pri Frontage 135 + ASec Road Sec Frontage A Village MARSTONS MILLS Fire District C-O-MM Town sewer exists atthis address No Road Index 0142 Asbuilt Septic Scan; ', t l Interactive Map ? � I 121144005 1 . t , - V Owner Info = +l owner NOVACON,PETER K&I c0 � Owner ' streett 21 BLUENOSE LN Street2' city OSTERVILLE state MA Zip 02655 Country 3 . # a� + land Info h� Acres 0.50 use Single Fam MOL-01 Zoning RF Nghbd 0106 is Topography Level Road Paved Utilities Public Water,Gas,Septic Location F� t :. t FV Construction Info a1 ' SEPTIC letters Se ti 483 ElliottRd Cent Jan 2 1�Start E Q1 1 p � 'Parce�IDetad Goo42 T1 ® � � Il,i)AM le Ch� 1 Flicker Lane MM;doc Computer name : HEALTH899JF User name : flvnni Operatinq Svstem : Windows NT(5.1) "i�� l) J ��)t�`�� i;�0 _J7�N1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Bluenose Lane, Marstons Mills M - 121 P - 144/05c~s Property Address Peter Novacon " �- Owner tm� Owner's Name information is MA 02655 December 16, 2014 =r required for every 21 Bluenose Lane, Osterville page. Cityffown State Zip Code Date of Inspection tW .. 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 A. General Information filling out forms I ca on the computer, 11 use only the tab 1. Inspector: (J key to move your cursor-do not Troy Williams use the return key. Name of Inspector Troy Williams Septic Inspections Company Name 19 Hummel Drive Company Address ram, South Dennis MA 02660 City/Town State Zip Code (508) 385- 1300 S1682 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: J- ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority December 16, 2014 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of'Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspactio r : ubsurface Sewage Di spo al System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 21 Bluenose Lane, Marstons Mills M- 121 P - 144/05 Property Address Peter Novacon Owner Owner's Name information is required for every 21 Bluenose Lane, Osterville MA 02655 December 16, 2014 page. Cltyrrown State Zip Code Date of Inspection B. Certification (coot.) 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. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 Bluenose Lane, Marstons Mills M - 121 P - 144/05 Property Address Peter Novacon Owner Owner's Name information is required for every 21 Bluenose Lane, Osterville MA 02655 December 16, 2014 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N El 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 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 21 Bluenose Lane, Marstons Mills M - 121 P- 144/05 Property Address Peter Novacon Owner Owner's Name information is required for every 21 Bluenose Lane, Osterville MA 02655 December 16, 2014 page. Cityrrown 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/z day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 21 Bluenose Lane, Marstons Mills M - 121 P - 144/05 — Property Address Peter Novacon Owner Owner's Name information is required for every 21 Bluenose Lane, Osterville MA 02655 December 16, 2014 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 1 0,000g pd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ti 21 Bluenose Lane, Marstons Mills M - 121 P- 144/05 Property Address Peter Novacon Owner Owner's Name information is required for every 21 Bluenose Lane, Osterville MA 02655 December 16, 2014 page. di Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example,'a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 15ins-3113 Title 5 official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Bluenose Lane, Marstons Mills M - 121 P- 144/05 Property Address Peter Novacon — Owner Owner's Name information is 21 Bluenose Lane, Osterville MA 02655 December 16, 2014 required for every page. Citylrown State Zip Code Date of Inspection D. System Information Description: 4 _ Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No 13=78,000 gals. Water meter readings, if available (last 2 years usage(gpd)): 12=65,000 gals. Detail: Sump pump? ❑ Yes ® No occupied Last date of occupancy: Date Commercial/Industrial Flow Conditions: N/A Type of Establishment: N/A Design flow(based on 310 CMR 15.203): Gallons per day(gpd) _ Basis of design flow(seats/persons/sq.ft., etc.): N/A Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No N/A Water meter readings, if available: l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 21 Bluenose Lane, Marstons Mills M- 121 P- 144/05 Property Address Peter Novacon Owner Owner's Name information is 21 Bluenose Lane, Osterville MA 02655 December 16, required for every 2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: N/A Date Other(describe below): N/A General Information Pumping Records: Source of information: No pumping info was available. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 21 Bluenose Lane, Marstons Mills M - 121 P - 144/05 _ Property Address Peter Novacon Owner Owner's Name information is required for every 21 Bluenose Lane, Osterville MA 02655 December 16, 2014 -- 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: Tank d-box and leaching were installed on 2/15/90 per compliance. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 18"+ Depth below grade: feet c 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.): Lines were found clear at the time of inspection. Septic Tank(locate on site plan): 16" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5'X9'X6' 1000 gallon _ 4" Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 21 Bluenose Lane, Marstons Mills M- 121 P- 144/05 Property Address Peter Novacon Owner Owner's Name information is required for every 21 Bluenose Lane, Osterville MA 02655 December 16, 2014 page. Cityrrown 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 2' $„ Scum thickness 6" Distance from top of scum to top of outlet tee or baffle 2" Distance from bottom of scum to bottom of outlet tee or baffle 8„ How were dimensions determined? probe/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.): Pvc inlet and concrete outlet tees were found present and in working order. No evidence of leakage or damage was found. Tank was in need of pumping. Grease Trap(locate on site plan): Depth below grade: N/A feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 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 Date t5ins-3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 21 Bluenose Lane, Marstons Mills M - 121 P - 144/05 Property Address Peter Novacon --- Owner Owner's Name information is required for every 21 Bluenose Lane, Osterville MA 02655 December 16, 2014 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A --" Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): N/A Dimensions: N/A Capacity: gallons N/A Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: N/A Alarm in working order: ❑ Yes ❑ No N/A Date of last pumping: Date Comments(condition of alarm and float switches, etc.): N/A *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 21 Bluenose Lane, Marstons Mills M - 121 P - 144/05 Property Address Peter Novacon Owner Owner's Name information is required for every 21 Bluenose Lane, Osterville MA 02655 December 16, 2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert above Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was found level and in working order. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No' Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): N/A 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•3113 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 21 Bluenose Lane, Marstons Mills M - 121 P - 144/05 Property Address (Peter Novacon Owner Owner's Name information is required for every 21 Bluenose Lane, Osterville MA 02655 December 16, 2014 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: 1 -6'X6' pit with ® leaching pits number: 2' of stone ❑ leaching chambers number: -_- ❑ leaching galleries number: ❑ leaching trenches number, length: -- ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit was found full and in hydraulic failure at the time of inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A -— N/A Depth-top of liquid to inlet invert N/A Depth of solids layer Depth of scum layer N/A Dimensions of cesspool N/A _--- Materials of construction N/A ---- -- Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °wM 21 Bluenose Lane, Marstons Mills M - 121 P - 144/05 Property Address Peter Novacon Owner Owner's Name information is required for every 21 Bluenose Lane, Osterville MA 02655 December 16, 2014 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.): 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 15ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 21 Bluenose Lane, Marstons IMills M - 121 P- 144/05 Property Address Peter Novacon Owner Owner's Name information is 21 Bluenose Lane, Osterville MA 02655 . December 16, 2014 required for every — page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to .at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 101 t5ins•3113 ` Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts -- . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Bluenose Lane, Marstons Mills M- 121 P - 144/05 Property Address Peter Novacon Owner Owner's Name information is required for every 21 Bluenose Lane, Osterville MA 02655 December 16, 2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 13.0'+ 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: SDW 253 Zone C 50.0' 5.6'adjustment You must describe how you established the high ground water elevation: USES maps show ggound water at approx. 20'+. Groundwater adjustment at the time of inspection was 5.6'. Bottom of leaching at 9.0'was found not to be located in the high groundwater elevation at the time of inspection. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 21 Bluenose Lane, Marstons Mills M - 121 P - 144/05 Property Address Peter Novacon _ Owner Owner's Name information is required for every 21 Bluenose Lane, Osterville MA 02655 December 16, 2014 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist i ® Inspection Summary: A, B, C, D, or E checked 1 ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE ,r OCATION �{ t +e srylG Lam' [�P[. SEWAGE# Q�� VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY CSC L1 Ic7GY�-C-sEI-L ��� � v , LEACHING FACILITY:(typ (size) A I J �3 NO.OF BEDROOMS 51 b06AL_ t C'1A v� /D OWNER_ 1�I0 VGct PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility $.5 Feet ` Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) N 1& Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) pA Feet FURNISHED BY ��G�/ /''t L� 74//.,+s�iy 33�. �a `V Lg(i TOWN OF BARNSTABLE LOCATION 4-0 NWNOU lx )Aa-e- SEWAGE # S VILLAGE T-f,lC V i 11 ASSESSOR'S MAP Cz LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) 140wti Pi T (size) �� G NO. OF BEDROOMS 3 PRIVATE WELL OR UELIC ATE BUILDER OR OWNER green j6r° eA j)F j DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No C!r 1� w Ue- W � �hy� AJa✓aeon Town of Barnstable y� Departi rent of Regulatory.Services arZ. , ]Public Health,Division Date � 15 Pin Al 200 Main Street,Hyannis MA 0260 Date Scheduled Tzm 0br e k+e'e Pd. !Q� d d U l Sol Suitability AssesSment for Sewage .,Disposal Perforrrred-By: _ tit e Goy��l(/P Witnessed By: LO ATION&GENERAL INFORMATION Location Address C &Atri oft ",%C Owner's Name /Vo✓a eo•1 / Address Assessor's Map/Parcel: JCLI/191 /S Engineer's Name W d�� NEW CONSTRUCnON REPAIR Telephone# �U�J 6 d �� Y/ Land Use: La u/t7 �j' _ e Slopes(%) Surface Stones Nan Distance's from: Open Water Body;>��C/ ft Possiblc Wet Area ,IQG ft Drinking Water Well��DG ft Drainage Way,��ft Property Line ft Other ft (Street name,dimensions of lot,exact locations of test holes&pare tests,locate wetlands�n proximity, to holes) ZO 5.,g 1' Parent material(geologic) G W<q t 6G{7Wa s" / Depth to 13edrgclt , �G Depth to Groundwater. Standing Water in Hole:_AZA. Weeping from Plt Fnce /mil fQ` Estimated Seasonal High Groundwater�j /'T • D i RXWATIO�T FOR.SEASONAL HIGH WATER TABLE Method Used: _� ' a� w E_ _ Depth Observed standing in obs.hole: lu. Depth to sell mottles: Itt, Dcpth to weeping from side of obs,hole: In, Groundwater Adjustment Index Well# Reading Date: Index Well level Adj,factor— Adj.Growidwaterbevel , Observation PER.COLATZON TEST Daie _, Tn a r , Bole# l _ TImu at 9" Depth ofPerc. J ' TlmeAt6" Start Pro-soak Time @ Time(9"-G") End Pre-soak / /J' Rate Min./lach Gl�;17z ��CI? Site Suitability Assessment: Site Passed tI Sitp Failed: Additional Testing Needcd(X/N) /" Original: Public Health Division Observation Holt;Data To Be Completed on Back—-------- ***If percolation test is to be conducted within 100' of Wetland,you must first notify the Barnstable Conselfvation Division at least one(1)Week prior to beginning. Q:ISEPTlW13RCPORM.DO C IDEEP.OBSER'47ATYON HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Sd1l Color Soil•. Ot1ior Surface(in.) (USDA) (Munsell) Mottling (Structure,Stoned;Boulders, aTisisten;y,%.nravel) 10 y0-/32 C. �lC 7 IDEEP OBSER_ ` .&T[ON BOLE LOG Hole'# 2 Depth from Soil Horizon Soil Texture Soil Color ` '` Soil Other Surface(in.) (USDA) (Munsell) • Mottling (Structure,Stones,Boulders. consistency,90 Greve yra 3-- 3Z ,y 6 DEEP OBSERVATION ROLE LOG H®le#. Depth from Soil Horizon Sall Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stricture,Stones,Boulders. Co i to c Gravel) ]DEEP OBSERVATION HOLE LOG Role# Depth from Soil Horizon Soil Texture Sall Color loll Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stoacs,Boulders, Co si tan ' P +G Flood Insurance Rate Map:. / Above 500 year flood boundary No— Yes Ij Within 500 year boundary No Yes ' Within 100 year flood boundary No. yes-4— Depth of lr1'attitraTly Occurring Pervious Matorial Does at least four feet of naf urally occurring pervio�u�material exist in all areas observed throughout tho area proposed for the soil absorption system'If not,what is the depth of naturally occurring pervious matdrtal? Certification I certify that on /� (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me,consistent with . the requited training,expertise and experience described in�10 CUR 15.017. Signature Datb Q:=PTlaPE 2CP0RM.D0C THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ---------------------------------------------- Alip iration for Mipasal Works Tomitrnrtiun Frrmit Application is hereby made for a Permit to Construct (K) or Repair ( ) an Individual Sewage Disposal System at: _ ..•-------------_--•--....---......-----....................------........•---.................-- --...•••--•-•••--------------.............---••---- •....--------- Location r/ o far er y Addres$ r C _27 Installer Address Type of Building Size Lot 9/- 8`��..-..__Sq. feet U Dwelling—No. of Bedrooms................3.......................Expansion Attic (/✓) Garbage Grinder (�) Other—T e of Building No. of persons............................ Showers — Cafeteria PA Other fi tures -----•------------------------ .....................gallons per person per day. Total daily flow.._..._.._._-_.__..........._..___.__..._.__gallons. - ------- ------------ - ----- W Design Flow.................. . g P P P Y Y 9 Septic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter................ Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------_----_--- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( E Percolation Test Results Performed by.......................................................................... Date......../.......... �+ Test Pit No. 1____ _`___minutes per inch Depth of Test Pit--0i............. Depth to ground water.__ ................ fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ---•--•---------------------------------•••---••...•-•-.........-•-----------------------------•----------------------------------------••------•-•--------- O Description of Soil...�'lF[�tv'�_ �Cdo-4 6— 57 x .................•...•••---------•-----------------•••-•-----•------•--•--•---•••••••-•---•--•-----......•-•---------------... V -•-----•-•--•--•-•••---•---•---•------------•._.........-••-•-----------•-•---••....-----•---•-••-••--.....-•-------•--••--•--•-•-•-------•----------••-•-•---•--•-••-----------•---•---•--•-----•---••. W UNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Ind ideal Sewage Disposal System in accordance with the provisions of'THE 5 of the State Sanitary de— The dersigned further agrees not to place the system in operation until a Certificate of Compliance has b n ss e by board of lth. Signed ,.....: ../Date ...- .. Application Approved BY •`•.1^- G� ........................••--- Date Application Disapproved for the following reasons---------------••----•-•---------------------------------------------------------------------------------......-- ----------•-----•-•-••••---------------•--•-••-•--------••-••-------------••-•----------•--•---•-•------•--••-•-------------•-••-•--•-•----••••-----------------••-•-•------•-----------••--•........... Date PermitNo.........a.`r........—Y(..................... Issued-------------------------------------------------------- Ds to No..........:....`.� .... F>l s. ; :..................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH -------------------------------------------------- ---------- Allp iratiun for Dhip ,sal Works Tomitrurtion "jaunt Application is hereby made for a Permit to Construct (,, -) or Repair ( ) an Individual Sewage Disposal System at .. ._. _......_... _. . - �..71.. ...._.. .. --------•_.. Location-Add ess i or Lot No. _ . tom`� � C s .�.b,k.......CZ: O ner Address Installer Address Type of Building Size Lot�.l._f�................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic (A ) Garbage Grinder ( ) '04 4 Other—T e of Building No. of persons............................ Showers — Cafeteria 04 Other fixtures _______________________________ __ W Design Flow.............. ......................gallons per person per day. Total daily flow..........................................._gallons. Ix Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( < F / Percolation Test Results Performed by-___:__-_-..__...'---------------------------------------•-•--------------- Date.....____...._.a._.._..---- � p p p N Test Pit No. 1................mmutes er inch Depth of Test Pit___._,:_..._________ Depth to ground water---- 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_._______-__-___---..___ O Description of Soil !1Ff �� C off"S ......._ r�A.!� U •-•------••-••-•-••--•----•---•----------•--•••--•--•--•-•---•-•----•---......-•----... W UNature of Repairs or Alterations—Answer when applicable.___________________________________________•-•-----__-•---------__-------_•-__•----•--••--•-__. -----------------------------------•------•-----•-------------------------------------•-------------------------------------------•-----------------------------------•-----------------......--••--•--- Agreement: The undersigned agrees to install the aforedescribed In idual Sewage Disposal System in accordance with the provisions of'TTa of the State Sanitary (f de—The dersigned further agrees not to place the system in operation until a Certificate of Compliance has been�iss e, bye; e board:of i lth. g ¢ � = _. ....... ........... Date Application Approved By .. ...cv.,.-.ua •- - Application Disapproved for the f o lowingreasons:--•---•-•••---_••-••....•-•.----------•-••----•-•-•••-••••---•-------------------------•----........• •--•--. •.................••-•--------•-•-----•-•••--•--•-•-••--•--•--------•---••••-----------------•-............-----•------------•-••-•--•-••---•••-•--•-••-•••--------------••--••-•--------•--••----------- Date PermitNo......... -r...L1 ---------------------- Issued----------------•--------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF........I........................................................................... (Inrtifiratr of Tompliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (Y) or Repaired ( } by J. .•'r. ►� 41 S C o a-.t.. & S C-.%/ ----- •-----.---•--------------------------•---------------------------------------•---•----------------------•-----------------•-•--------------------------- o I' .r/3 y r G S t.#4*V at 3 S has been installed in accordance with the provisions of TIT IE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-------- �__�r ____-•-_•- dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �s DATE.......�1 . ..... ,/ ::!� .._._. Inspecto - .- . ---- .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... .a'u^!................OF.........�5.. .............. ....................._............._............ iVO._.`a. ... ..���o.-. FEE.-- -l i::::... UWpoual Works Tonstrnqion Vrrmit Permission is hereby granted...... :✓._,....---_----rz- [ o to Construct (4) or Repair ( ) an Individual Sewage Disp sal System at No. �- --`-IN------------------- =mac<�. S f`.-••-----•------�:....., -- -- .--•--- -- Street as shown on the application for Disposal Works Construction Permit No. " .:J .._ Dated.......................................... -•----•----................................ ... DATE_ I .................................. Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 1 9 NOTES:, MARSTONS MILLS 0 1- ALL .WORKMANSHIP AND MATERIALS SHALL .CONFORM TO D.E.G.E. --!Y 1w M*Amum ON AS INDICATO Aw TITLE 5' 'THE T D OWN, OF- ,- , BARNSTASLE RULES AN REGULATIONS FOR THE 'SUBSURFACE DISPOSAL OF-SEWAGE; LOCUS 10, Mel. AND 'THE REQUIREMENTS OF THIS PLAN., Oum 28 OUT-E 28 2. ALL COVERS TO 'SANITARY,UNITS SHALL 'Bt BROUGHT- TO ............7. BLUENOSL, VAIH T.O. FOUND WITHIN 12'* -OF FINISHED GRADE. AlIONN 80 MIN. 3.� ALL MASONRY ,UNITS �USED To BRING COVERS TO' GRADE PLACE. 'SHALL BE MORTAREDIN 4.. ALL -COMPONENTS OF THE -SANITARY SYSTEM SHALL, BE -CAPABLE r UK,40 TCH mk .'OF WITHSTANDING H-10 LOADING'. UNLESS THEY ARE 'UNDER OR PER �H-20 LOADING /4" P0 WTHIN '10,-FT." OF'ORIVES OR PARKING AREAS. t* LAM OF PLOW LINE SHALLBE USED UNDER 'OR. WI`lHIN 10 FT.- Or.:DRIVES.'OR WASHED .PARKING. r >T' APF 6. EFFLUENT PIPING FROM DISTRIBUTION BOX SHALL ENTER LEACH PIT oi$TkiguION LIMAP THROUGH SDEWALLIrOR .TO -ONLY. 'ENTRANCE- THROUGH MASONRY , P .,Box :,�_EXTENSION ILL ,NOT .BE ALLOWED DEED NATION BEtA MA E, AS ,TO COMlPLIANCE' WIT-H NO DETt Z RMI ;HA§ 1000 CALLON SP'WC TANK,. ONING REGULATIONS. 6WNER/APPLICANT r SHALL RESTRICTIONS OR Z OBTAIN SUCH �bi:TERWNAVN FROM APPROPRIATE-AUTHORITY. 6^0 A SYSTEM PROFILE "HOR "AND, VERTICAL BOTTOM ��OF TEST HOLE 0 IZONTAL -CONTROL� SEE LEVY, ELDREDGE NOT 7).SCALE &' WAGNER fItLD .NOTE5O0K .#, OR USGS PROBABLE �HIGH WATER LEVEL DESIGN CALCU LATI ON 8 CURRENT. ZONING INTERPIRETATIOW MIN. 'FRONT SETBACK FEET NUMBER OF:BEDROOMS MIN. SIDE GARBAG -SETBACK FEET�� E DISPOSAL 'UNIT TIMATED -FLOW FEET- MIN. REAR .SETBACK GAL /DAY , ( 10 GAL/6R./DAY X BR') REQUIRED �SEPTIC TANK CAPACITY 4 AL. GAL ACTUAL SIZE, 'OF .SEPTIC,TANK LEACHING AREA REQUIREMENTS REA SIDEwALL: 2.5 AL,/S.F. -0 GALS.F.,, TTOM'. AREA' GAL, - TEST CAPACITY 0 PERCOLATI ON SOIL ALL) LEACHING BOTTOM + IQ )(2.5) :44T -0) DATE OF SOIL . EST' , ' LEACHING CAPACITY RESERVE WITNESSED BY - SAME PERCOLATION RAtt'-` 2 -r IN �H'OLE,' TION HOLE OSSERVATION 1 OBS ERVA . ELEV.w 5tD,0 .............. ATION ' -000 K Tr* E- 0 LEGEND. LEVATIO EXISTING SPO N 0oXo EX CONTOUR---"- ISTING FINAL,8POT ELEVATION ,' 00.0 FINAL CONTOUR ��MD 'AT LEV, 4 P7-2 WATER AT ;ELEV. 140 WATER E 57 'SOIL TEST PIT LOCATION —W —W TOWN WATER S EPTIC TANK 0 DISTRIBUTION BOX' ADJUSTMENT: WATER LEVEL PRIMARY,LEACHING PIT RESERVE LEACHING PIT WATER' LEVEL TEST DA INDEX WELL IN111AL :ISSUE WATER LEVEL RANGE -ZONE By DEPTH TO WATER LEVELrOR INDEX WELL' . 0. , DATE N DESCRIP11ON ''FOR THIS'MONTH ' DESIGN SITE PLAN , SEPTIC WATER LEVEL. ADJUSTMENT L DEPTH -To ,HIGH WATER IN L6 I , ASSACHUSETTS FOR OF Ad INC. GREENBRIER. DEVELOPMENT CO 0 A VED.' BOARD Or.'KEALTK" JOB NO. 1472 SCALE: 40' _ 'LEVY, ELD REDGE -,& :WAGNER ASSOCIATES..INC RCM "Jpl aL - -SITE -,-TAN &M siftoRs AGENT 889 WES, ENTERVM MA '02632- 777 T -MAIN SMEET -c A-7 'WAS40 STONE j ALL SYSTEM COMPONENTS SHALL BE NOTES SYSTEM PROFILE MARKED WITH MAGNETIC TAPE OR (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS ASSUMED ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE orllsle 2. MUNICIPAL WATER IS EXISTING \ TOP FOUND. EL. 58.4' � FILTER FABRIC OVER STONE 3. MINIMUM PIPE PITCH TO BE 1 8" PER FOOT. 56.0 MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 56.3 Route 28 BLOCKS OR PRECAST H-10 NOTE: MIN. WALL THICKNESS 2" PRECAST RISERS 4. DESIGN LOADING FOR ALL PROPOSED PRECAST Bluenose Ln RISERS (7YP.) UNITS TO BE AASHO H-M so 2I 0 PVC PIPES LEVEL1ST 2' COMPONEN s INVERT IN 52.47' 4' Qo 4fh co a tH ENDS ( �') [-SIDES 53.3' S. PIPE JOINTS TO BE MADE WATERTIGHT. od v�y � �e5ti� •\�d 10 EXISTING 14" E '°°`'°``°`' CD �-77=7 � �� qFn � � �����•��� 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE Locus � 5> ° ° ° ° .: ,:� .. Bo°g°°° a >Lo TEE TEE ° ®®®® ° WITH 310 CMR 15.000 TITLE 5.SEPTIC TANK** 54.27 * o o a o 0 6" MIN. SUMP - °o°a10.0. ®®®®®®®® FA®®®®®®®®®® °°°°°o° ( )GAS BAFFLE:: °°°°°°°°°°°° 12" MIN. INT. DIM. o�o�o ®®®®®®®® ®qq®®®®®®®®®® 000aoo'-Oo�o9�°�°' N o ° ® o 0 0 0 `I II ry� 4 _ o°o°o °o°o°o °o°g°o° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND53.17 53.0 °_° ° ° 50.47 LIQ LEVEL ACME OR EQUALNOT TO BE USED FOR LOT LINE STAKING OR ANY ( WATERTEST D'BOX OTHER PURPOSE. oke a r> . ° c,..:....:•.:. ..•;:- :: ..::• :~...,...: . FOR LEVELNESS 5t� r a cus o°o°a°o° o° o °o°a°S°o°o°a°o°o°o °o°o°o'a '.o°°,°^°o0o°o„ogogo°o°o°o°o°o,.o�o°°�o„o°o°o°o. 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. H-10 500 GAL. LEACHING CHAMBERS BY ACME PRECAST OR EQUAL Q�ley BU/77 s (2) UNITS REQUIRED 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. V i'ite� r ALL AROUND PRECAST STRUCTURES 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00 X 12.83' / OR OMPACTION. (15.221 [2]) h CONCOEALOEDENTS WITHOUT INSPECTIONNOT TO BE BY YL BOARD OF a %e oii0 HEALTH AND PERMISSION OBTAINED FROM BOARD moo (9.2 9. SLOPE) ( 5 9 SLOPE) OF HEALTH. FOUNDATION- EXIST. SEPTIC TANK 12' D' BOX 15' LEACHING 45.4' BOTTOM TH-1 10. CONTRACTOR SHALL BE RESPONSIBLE FOR FACILITY NO GROUNDWATER FOUND _ CALLING DIGSAF)= (1-888-344-7233) AND VERIFYING THE LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF / **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT *THE INSTALLER SHALL VERIFY THE LOCATIONS of ALL - WORK. LOCUS MAP ✓ 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 11. ANY UNSUITABLE MATERIAL ENCOUNTERED WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM CONDITIONS IF NOT SUITABLE SHALL BE REMOVED 5' BENEATH AND AROUND THE NOT TO SCALE PROPOSED LEACHING FACILITY. 1 ASSESSORS MAP 121 PARCEL 144-5 1 12. EXISTING LEACHING FACILITY SHALL BE PUMPED / s.66 AND REMOVED OR PUMPED AND FILLED WITH CLEAN ✓ / 5 9 55.32 LEGEND \ •' 51,11 99 - EXISTING CONTOUR X 99.1 EXIST. SPOT ELEV. E&P \ 99 PROPOSED CONTOUR \ / s .5 7�76St0- / L UEVoSE SYSTEM DESIGN. .55 ] PROPOSED SPOT EL. mrr X / 55.82 / TH1 z� / F , . \ 4 GARBAGE DISPOSER IS NOT ALLOWED Z. TEST HOLE / \ 38 x 5 56- EOP YYY / 5 5 EXISTING 3 BEDROOM DWELLING 2� SLOPE OF GROUND / F / / x5 .', 1. _ DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD UTILITY POLE �° s6.'z BENCHMARK USE A 330 GPD DESIGN FLOW Q� c� 56.70 EATER SHUTOFF **RE-USE EXISTING 1000 GAL. SEPTIC TANK FIRE HYDRANT MAP 121 / / 02 o6.74 � I SEPTIC TANK: 330 GPD (2) = 660 NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING O PARCEL 144-6 H 1 ,-- / goo / � �./ / N EXIST. F x 56.96 TH 56.90 PAVED �, LEACHING: �� / DRIVE 56.99 56. s TEST HOLE LOGS / ��� / \ I I SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD `11 q7°4 x 52 569 , x57.15 ��, BOTTOM 25 x 12.83 (.74) = 237 GPD ENGINEER: DANIEL E. GONSALVES, SE #13587 $7 57.06 ti TOTAL: 472 S.F. 349 GPD WITNESS: DON DESMARAIS, RS / �P 9 55.35 575 (5 USE 2 500 GAL. LEACHING CHAMBERS ACME OR EQUAL) 2/1 1/15 . 8 DATE. 7 5 7 -/ST/Nc WITH 4 STONE ALL AROUND O MIN 2 INCH �� Tpe<</NG PERC. RATE _ < / 0 5920°.,824 56.33 CLASS I SOILS P# 14628 / / �. ELEV. ELEV. / MAP �2 � X. CAUTION GAS LINE IN THIS AREA MA °» 4 °' � 56.4' < PARCEL �44-5 x56.49 56 APPROVED DATE BOARD OF HEALTH 56.4 ° 56.47 701 0.5 ACRES �, °E°K TITLE 5 SITE PLAN SL SL o SF.67 (�. O OF 10YR 3/2 10YR 3/2 56.42 �; 1°» 9» � ��B 55.87 121 INOFMgs 21 BLUENOSE - \ SL S L \ x .34 x56.25 -4 ' DANIE ��' p U OSE LANE OSTERVILLE MA o L 10YR 4/6 53.1 ' `� 10YR 4/6 53.2' yG, o A. `'a �iDANiELA. . OJALA OJALA PREPARED FOR 40 38 CIVIL �' No.40980 F�O/S6E°��\��� q°oFssN �o� BORTOLOTTI CONSTRUCTION J ,ems \ X. x5 25 C C x55.7.3 G UR NOVACON \ / PERC x �AOF'fgs ���HOF4fq DATE: FEBRUARY 11, 2015 M/CS M/CS / DANIELAS9 N � ti o�� G � 9c REV: FEBRUARY 23, 2015 (S/T NOTE) / OJALA �� DANIEL �Nm CIVIL N .o A. i 2.5Y 7 4 2.5Y 7/4 / No.46502 OJALA / No.40980 A off 508 362 4541 fax 508-362-9880 SIONAL EN lgNO sUR\6- downcape.com / / down cape englneering, Inc. 132" 45.4' 132" 45.4' / / , civil engineers NO GROUNDWATER ENCOUNTERED Scale: 1"= 201/ / -2_(-� �I? / land Surveyors J 939 Main Street ( R to 6A) / f 1 DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 D CE # / 5-Q / / 0 10 20 30 / 50 FEET 15-011 BORTOLOTTI-NOVACON.DWG