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HomeMy WebLinkAbout0155 SMOKE VALLEY ROAD - Health 155 Smoke Valley Road Marstgns Mills A= 097-006 7 S C a 1 w �.er -76 V yk wFl -fir 3 �QC.�Po��nS sp c F n Gg ���` CQ ��''' �� la ' I00 Npl �or p- v� tenor✓' JvM4) -Fora IlIg _3-740 s� d � � grnrn n. Sevier 4D Puv �.V�t� JddJH, I n l lh S'I4..eP`7 Q� P�H� -tn.n �v:�(��n�j S[�.I,,f SQwe✓ e Jec�u+ P"f e TM �� ulopiQ i 2 . 11 ,q�,el (�r�-SSe3y�^y ('tc�,+•tAt) � �octi�( �h � Z,d,G, L.F� InvM2. U,p�u {7e�J2v+�nJ ' 1 Ao p��3I(7- w�11�-+hN� � G� p n^�i t(1" Ul4r.Q � t1�c,�rrQ,,,y �,,C,� Nd,,k� �1i�eGf�m,•}'`^y� 6b „�,Q �.�{,d I�Q„�(� c���� fi"��� � r�r)• L�y� ���QrNi�nL ,�,��� -� e'� c�LO' "a`'1 / 1 � f� l'�,ry 54�1►z��t�j^ „d r Ir e r sot ua , v M� 8 30 I I 1 - J �a"I�t.1' T���p�,`� an s�I►�^ �"��d9 �,'rw �n r�, G�e-& ��,,L4^0-) 155 Smoke Valley Road Marstgns Mills A= 097-006 i K r f I i I i f S M EAD No.2-153LY UPC 12934 smead.com • Made in USA a�Y .gam F 0 USSR 14 TH S PRODUCT IRE S FI #wM nE SOURCING REQu dABfif OF THE SPI PROGRAM CFRTIRED . SOURGNG MIWWWROGRAMORG I i ,L I� TOWN OF BARNSTABILE LOCATION SS SMO nl'� V SEWAGE# VU LAGE— ri SE SOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �' PST.!' (size) 10M NO. BEDROOMS r I S �e OWNER A PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet. Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within Feet 300 feet of leaching facility) . FURNISHED BY S ;M S G r y 33 I la _ CArA C a CPS a l 3 a$ as 3-T a ' f 3 00 s _ _......... __ __ I� COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Main House P ,Add sr 155 Smoke Valley MAN I I s ---A,—kr r&e.MA 02655 Owner's Name: Beth Shea Owner's Address:_ Date of Inspection: Juh;2, 2012 Name of Inspector:.(Please Print) James M. Ford Company Name Jaynes M.Ford Mailing Address. P.O Box.49 - Osterville,MA 02655-0049 +'f; y ' Telephone Number: (508) 862-9400 . .-. CERTIFICATION STATEMENT � �r 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 ani.a DEP approved system inspector.pursuant to Section:15.340 of Title.5(310 CMR 15.000). The system: =a Passes Conditionally Passes eeds Further Evaluation by the Local Approving Authority ailS. .. Inspector's Signature: . ,Date: Juh;8. 2012. The system inspector shall s i it a copy o£this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of comp ting this inspection. If the system is a shared system or has a designflow 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 Guest House systent was not inspected ****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 tinder the same or different conditions of use. Title 5 Inspection Foi7n 6/15/2000 page 1 � �� i Y Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 155 Sinoke Valley Osterville.MA: Owner: Beth Shea Date of Inspection: July 2, 2012 Inspection Summary: Clieck A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure.criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements: If not determined",please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance: indicating that the tank is less than 20 years old is available. . ND.explain. . Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection_ if (with - approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced < obstruction is removed ND explain: 2 . Page 3 of 11 t : OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 155 Smoke Valley Osterville,MA Owner: Beth Shea Date of Inspection: v Jul 2 2012 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 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 a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance *This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform' bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and:. the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3 Other: - 3 a Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM' PART A CERTIFICATION (continued) Property Address: 155 Smoke Valley Oster-ville,MA Owner: Beth Shea Date of Inspection: July 2, 2012 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 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 100feet but greater than 50 feet from a private water supply well with no.acceptable water quality analysis. [This system passes if the well water analysis; performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is.equal to or less than 5 ppm,provided that no.other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility`with a design flow of 10,000 gpd to 15,000 gpd You must indicate either"yes"or"no"to each of the following: ;(The followin' criteria applyto large systems in addition to the criteria above) Yes No' the.system is within400 feet of a surface drinking.water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped. " Zone 11 of a public 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 , - 4 ` Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 155 Smoke Valley Osterville,MA Owner: Beth.Shea Date of Inspection: July 2;201.2 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 they 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,aplan 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 As unacceptable) [310 CMR 15.302(3)(b)] ,t ' 5 Page 6 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION:FORM PART C SYSTEM INFORMATION Property Address: 155 Srnoke Valley Osterville.'MA . Owner: Beth.Shea Date of Inspection: July 2. 2012 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents: 4 Does residence have a.garbage grinder(yes or no): N/a Is laundry on a separate sewage system(yes or no): N/a [if yes separate inspection required] Laundry system inspected(yes or no): no Seasonal use(yes or no): no Water meter readings;if available(last 2 years usage'(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: CurrentlV COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sq/ft etc:); Grease trap present(yes or.no). .. Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to,the Title S,system(yes or no): Water meter readings;if available: Last date of occupancy/use: OTHER(describe): . GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection:(yes or no): If yes,volume pumped gallons--How was quantity pumped determined? .Reason for pumping: 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): Approximate age of all components,date installed(if known)and source of information: Date of installation app. In 1976 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: 155.Srnok-e Vallee Osterville;MA Owner: Beth Shea Date of Inspection: July 2. 2012 , 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: 20" 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 Qal. . Sludge depth: 2„ Distance from top of sludge to bottom of outlet tee or baffle: 30 Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 6", Distance from bottom of scum to bottom of outlet tee or baffle: 10" 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.). The tees were Present. The liquid level was even with the outlet invert There did not appear to be an sins of leakage GREASETRAP: None.(locate on site plan) y Depth below grader 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 Iasi pumping:, Comtiients(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): i Page 8 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 155 Smoke Vallev Oster-ville,MA Owner: Beth Shea Date of Inspection: July 2, 2012 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions`. Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 'Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-Box was,broken down.A new D-Box ivas installed. The cover is to parade. PUMP CHAMBER: None :(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): { 8 Page 9 of 11 OFFICIAL INSPECTION"FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 155 Smoke Valley Osterville,MA Owner: Beth Shea Date of Inspection: July 2. 2012 SOIL ABSORPTION SYSTEM(SAS): ! ✓ (locate on site plan,excavation not required) If SAS not located explain why:, Type ✓ leaching pits,number: 3- 1000 gal. leaching chambers,number: leaching galleries, number: leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number: Innovative/alternative system". Type/name of.technology: Comments(note condition of soil, signs of'hydraulic failure, level of ponding, damp soil; condition of vegetation, etc.):'. The nits had 2'of water on the bottoin. -There was no sign offailure'frorn the Pits A camera was used to inspect 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.): i ' Page 10 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C .SYSTEM INFORMATION(continued) Property Address: . 155 Smoke Valley Osterville.MA` Owner. Beth Shea Date of Inspection: July 2, 2012 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties tout least two permanent reference landmarks or.. benchmarks.. Locate all wells within 100 feet.. Locate where public.water supply enters the building. 133 -- --- 3 a 40 , ag a1 �3a�k k .. 10 - .. v Page 11 of 1 T OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 155 Smoke Valley . Oster-ville,MA Owner: Beth Shea Date of Inspection: July 2, 2012 SITE EXAM Slope. Surface water Check cellar Shallow wells Estimated depth to ground water 20+1- 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 propertylobservation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic and ivater contours ntaps Checked with local excavators,installers=(attach documentation) Accessed USGS database-explain; You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps the maps were showin-a approximately 20 +/-to ground water at this site. t. This report has beers prepared only for the septic system and components described herein.. This septic system has been inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system.ivill f rriction properly in the fntture..There have been.no warranties or guarantees, either expressed, written or implied, relating to the septic system,the inspection; this report andlor any components of the septic system which have not been located and inspected.. i 11 i I too, M ;wo To moke Valley Road rile, MA '02655 : f � vl ��� 5r il'I 1 � -. \ ��`_' �] d � � � t � -- v �� COMMONWEALTH OF MASSACHUSETTS EXECUTIV:E.OFFICE OF ENVIRONMENTAL AFFAIRS r` DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE S OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Main House&Guest House Property Address: 155 Sinoke Vallev A ?2655 V VS 'Y Owner's Name: Beth Shea M' Owner's Address: Date of Inspection: July 2, 2612 Name.of Inspector: (Please Print) James M Fond Company Name: James M. Ford Mailing Address,: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the.informa ion 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: Lama DEP approved system inspector pursuant to Seption.15.340 of Title 5(310 CMR 15.000). The system: y j �M Passes - gnditionally Passes a Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: July 8, 2012 The system inspector shall su it a copy o 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 Guest House.systent pumps up into the inain house septic tank this was verified on 8127112 ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address hovv the system will perform in the future under the same or different conditions of use. Title 5 Inspection Forin 6/15/2000 page 1 ,:; �� Page 2 of 11 OFFICIAL INSPECTI014 FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 155 Smoke Valli Osterville,MA Owner: Beth Shea Date of Inspection: July 2, 2012 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 r�g p or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed ND explain:'. 2 Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO RM PART A CERTIFICATION (continued) Property Address: 155 Smoke Valley Osterville.MA Owner: Beth Shea Date of Inspection: July 2. 2012 _ 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 5 feet of a surface p p vy 0 s face water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than.100 feet but 50 feet or more from a private water supply well**. Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3 K, 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: 155 Smoke Valley Osterville,MA Owner: Beth Shea Date of Inspection: July 2, 2012 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►he 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 syster" 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 system.;in addition to the criteria above) t 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 ha's 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 • Page 5 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 155 Smoke Valley Osterville,MA Owner: Beth Shea Date of Inspection: July 2, 2012 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 detennined 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 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 155 Smoke Valley Osterville,MA Owner: Beth Shea Date of Inspection: July 2, 2012 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents: 4 Does residence have a garbage grinder(yes or no): N/a Is laundry on a separate sewage system(yes or no): N/a [if yes separate inspection required] Laundry system inspected(yes or no): no Seasonal use(yes or no): no Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): _ gpd Basis of design flow(seats/persons/sq/ft etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or"no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system.pumped as part of the inspection(yes or 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: Date of installation app. In 1976 Were sewage odors detected when arriving ai;the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARVASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: I55 Smoke Valley Osterville,MA Owner: Beth Shea Date of Inspection: July 2, 2012 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.): fi SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 20" 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: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30 Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" 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.). The tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage Note. The Quest house pumps up into the tank.. GREASE TRAP: None (locate on site plan) r 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 oatlet 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: 155 Smoke Valley Oster-ville,MA Owner: Beth Shea Date of Inspection: July 2, 2012 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete. _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping`. Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-Box was broken down.A new D-Box'was installed. The cover is to Qrade. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms.in working order(yes or no) Comments(note condition of pump chamber„condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 155 Smoke Vallev Osterville,MA Owner: Beth Shea Date of Inspection: July 2, 2012 SOIL ABSORPTION SYSTEM (SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 3- I000 gal. leaching chambers,number: leaching galleries, number: leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number: _ Innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The nits had 2 of vvater on the bottom: There was no sign of failure from the Pits. A camera ivas used to inspect 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: r` Dimensions: i Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 i Page 10 of 11 • OFFICIAL TNSPEC"I UN FORM-NOT,FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15S Smoke Valley Ost&vilL MA Owner: Beth Shea Date of Inspection: Julu2. 2012 SKETCH OF SEWAGE DISPOSAL SYS':fElVI Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or bencluuarks. Locate all wells within 100 feet:. Locate where public water supply'enters the building: AB ------ GAr/i - 3 &k La� 13-7 a2 3` 00 . A3C Or GUeST' tpV rA Mouse P 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM, PART C SYSTEM INFORMATION(continued) Property Address: 155 Srnoke Valley Osterville,MA Owner: Beth Shea Date of Inspection: July 2, 2012 SITE EXAM Slope - Surface water Check cellar Shallow wells Estimated depth to ground water 20+1- 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: Using Barnstable topographic and water contours maps, the maps were showing approximately 20 +/-to Around water at this site. _. This report has beeii prepared only for the,septic system and components described herein. This septic system has been 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 septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 Ekxk IT.ir x-W-W 'fit�c I s :40 At*& a tR�isrOr Etednoom #�ara + , 19'-W x 1;3'.4" e K N C y a uw ROM 0&r iY4r iT-4" f`�•�4` Vv"Ro" / / FROM 214rx ow 11 12'a'x 15.r x WO Ems, nq noight 55 Smoke Valley Road o )sterville MA 02655 t � _ f - I 11 _ r E X- 1115n 1271 =; 1 71 i - - . f � n . f � .. ;� .. -. -. _ —•.-sue � .. w s x .: �ytAin I�ousc, SY.r�e,M TOWN OF BARNSTABLE =LOCATION �S SMO� SEWAGE# VILLAGE i f" t SE SOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY.(type) 3" PiT' (size) OM NO.OF BEDROOMS J OWNER Sea PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY S !M A B 133 I(O 3 � O S 3°I S 1 yap .`1 5 LOCATION /: l � SE &C,E PERMIT UO. �J �a !1�►STQLLE •5 IJ�NIE � ADDRESS BUILDER 5 Q &M ADDRESS DIaTE PERMIT ISSUED =— — — — — — — — DATE COMPLI &MACE ISSUED ; " � ,.� a �� ���� 4,. M1. /` I� ��, 1 f -1 No. ���... a Fa$... 1�................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 t 7TLo-1...........OF.....�6.. > Appliration -for ]iopoiitt1 Works Tonfitrnrtion Prrniit Application is hereby made for a Permit to Construct ( 4/or Repair ( ) an Individual Sewage Disposal Sys at: --------------------------------------------------------------------------------------- Loeation-Address y or Lot No J Owner Address � Installer Address VType of Building ize Lot............................Sq. feet Dwelling—No. of Bedrooms-_-_-___---3--------------------_-------Expansion Attic ( Garbage Grinder (/,I- p�, Other—Type of Building ............................ No. of persons..._.Gc�_.._............_. Showers (, — Cafeteria ( ) G.I Other fixtures --•--------------•--------------------------- w Design Flow...............�6-.--------.----•__--gallons per person per day. Total daily flow........--.-----.-..------.-..--.--.gallons. WSeptic Tank—Liquid capacity/,)_!�Ugallons Length---------------- Width.......... ..... Diameter__.:-........... Depth._-_-.--_--- x Disposal Trench—No- ___________________• Width-------------------- Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No......... Diameter....lvDD---- Depth below i let.................... Total leaching area------------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) Q; -PC1;:h - r/- `]tl aPercolation Test Results Performed by------_------------- --•---•----------------------------•------•--------- Date-.-.----------------------- ----------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-.._----__--._-._------- fJ Test Pit No. 2----------------minutes per inch Depth of Test Pit-.--__-____________- Depth to ground water--.--_--_--_-._.-_-... �� --- -,-,�-------------• -••--•--•----------•-------•-------•----:......._......................------ O Description of Soil----.-... Fig - = ==* .....��' ....................it - -------------�-t --------� -------- zf� �==. �� ............../_2 ----- -r--------------- w z -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------.. -----------------------•-----.-.--.--------------------------------------------------------•------------•----------.--------------------------------------------- ---------- -------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by,the board of health. ned---- `f l `a / liv------• •-?/_ �/t✓' Date r Application Approved B Date Application Disapproved for the following reasons------------------ =� ' --------•----•----•-•-----------------------------------------••-----------•----•------------------------------------ ..--•-------•-•------•-----•-•-----....---•-----------------------•------.-•.•.... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............OF............�/� �:.ic............. .................... T'Drrtif iratr of f�omplianrr THE,, TO CERjI'IFY, hat the Individual Sewage Disposal System constructed ( or Zpaired ( ) InstallerZ" .................................... r 7 has been installed in accordance with the provisions of AjfVglee)1I of T-le State Sanitary C le as_described in the L-i ��L� dated..-..-- -- '`�-1����' application for Disposal Works Construction Permit No.--........... .... .. TIME ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE---------- -- - -- . ............. Inspector---- ------ --._ ----- THE COMMONWEALTH OF MASSACH G BOARD Ojj HEALTH / .........\. .....lf 2f�Z..........OF...........I'll.. � -------------- No.--------���--•- FEE..../4�............. �i:��o�ttlrk� nn�trnrtion �rrntit Permission i h reby granted - -- . �.---- c%cz'.Q •----------------------- ; ----•----- --•-•---_-_-----•• ...... to Construct ( Repair ( an Individual Sewage,,i4pos SI m at No. ,` � �'��1 =, . "I. ------, ---t----- -� f ------------------------ Street as shown on the application for Disposal Works Construction Permits /._ ._. D id---._�__-Z..---__�.�- ... ol ---------------.-- .................... (/ C1�o_ard o ealth DATE-------------------------------------------------------------------------------• FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H E7ALTH I (•=�� /Z-1 h............OF....f ................................... `J Appliration -fur UWVosal 10orkii Tomitrurtion Prrniit Application is hereby made for a Permit to Construct ( _�or Repair ( ) an Individual Sewage Disposal Sys at -- -_..... •-_ ........_ ---•--------••-•_•.. --...................................................... �ryL�oeation•AddresswA or Lo o. ......• Owner dress t • -_--_-_-_-----------•- Installer Address Q Type of Building ize Lot............................Sq. feet U Dwelling—No. of Bedrooms..-._---. .._..Expansion Attic (X Garbage Grinder Other—Type of Building ___________________________ No. of persons._-.&--_______-_--__-.-- Showers ZO l Cafeteria ( ) ------------------------------- -----•••••----•------------------- Q Design Flow................. .Z--------------.-.----gallons per person per day. Total daily flow... ..... -------------- •-•ll -- ' Other fixtures ________________ _____ ___ W ..-- ---------------------------gallons. WSeptic "Dank—Liquid capacity,(,_ .gallons Length.............>.. Width................ Diameter------------------ Depth................ x Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area...............-----sq. ft. Seepage Pit No_______ __________ Diameter__./vQ.0-_-_. Depth below i let-------------------- Total leaching area._-_-_.-_._._---_sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ��� ly-- •z 7 aPercolation Test Results Performed by---------- ---------------------•---------•-------------------- Date........------.----------------------- a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water-------._-.__.-.-------- fz, Test Pit No. 2----------------minutes per inch Depth of Test Pit.-__-___-_-__.___:__ Depth to ground water.-.--.-.-__-----.___-. G •------ . .__. ..__... -----Z Description of�oil-------- Y60 ........ •--- ..- `J. Wx Z......... � ----- l Y r.. 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by e board of health. ned. ------.�. , C� Y Application Approved By---.... l.!/t �.•.'- natU.-- �. Application Disapproved for the following reasons------------------------------------•--.-•-••---.._._....-----•--•-----------------•-..------ �._._---------- ---••-•-•---••---•---•--------------------------------------•-•----------•--•--------- ---••---------•---------•------------------------------------------------------••-•-•----•----•-------------- Date PermitNo......................................................... Issued..................... ---------------------------------- Date --------------------------------------------- -man------- -- ---------=------------------- - - ------- ------- LOC&TIOt,A : l SE OC4E PERMIT 1U0. IILIS-T1%LLE 5 QNN AE F, ADDRESS ' iBUILDER 5 Q ADDRESS DATE PERNAIT 15SUED - - - - - - - ,j ® ATE CONAPLI &&ICE ISSUED I - --- -- - II� � i i I x j rv� No.ZO I Z-- I Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for Mig ga[ *pgtem Cougtruction Permit Application for a Permit to Construct Repair ! Upgrade Abandon 0 Complete System ❑Individual Components PP ( ) P ( ) Pg ( ) ( ) P Y P Location Address or Lot No. 5 5 /v�®NntL VA Owner's Name,Address and Tel.No. Assessor's Map/Parcel 4, ; V, _ ' .0' ®91 006 g Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Gof&l n� Type of Building: A � Dwelling No.of Bedrooms /y6 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 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 Repairs or Alterations(Answer when applicable) i ,1T 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 TityV of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu by ' Bo of Health. Signed Date Application Approved by Date Application Disapproved 5/the fol ing reasons I Permit No. so i-2-- Date Issued �Z Zee Z l_- : = No.�1Z-- - Fee �Ma uo a THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 6 Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS . 0(ppYication for Mizpogor 16p0tem Construction Permit Application for a Permit to Construct( )Repair(Xpgrade( )Abandon( ) El Complete System O Individual Components al Location Address or Lot No. /S'S' 5 fv\Qkp V AI IZ;y Owner's Name,Address and Tel.No. tTv Assessor's Map/Parcel _ «+rv-,�� 091 r (7b�o/1J ��� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 60j -tS _ Type of Building:Dwelling No.of Bedrooms 06 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures kx Design Flow A 9 gallons per day. Calculated daily flow N 1'� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil, nn Nature of Repairs or Alterations(Answer when applicable) 1J \' 1 - - i 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 of the Environmental Code-and not to place the system in operation until a Certifi- cate of Compliance has been issued by V Bo of Health. Signed '�� � ,na_.•- Date 1- I Y Application Approve&by Date Application Disapproved the fo tng reasons Permit No.?o 12 -1 RQ Date Issued Ln 1 Z --------------------------- ----------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired Abandoned( )by //// at /.>S S�aFj A ���f�.11 has been construct d in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. r J RS dated 6 17- Installer Designer The issuance of this permit sha1L not be const ued as a guarantee that the syst nction as designed. Date a Inspector -. —---——————————————————————————————— /-- No.� 1Z^ 198 Fee 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migpo!ml *pMem Construction Permit Permission is hereby granted to Construct )Repair(�pgrade( )Abandon( ) System located at /s.S SM v k>8 o'sa rv;IL and as described in the above Application for Disposal System Construction Permit. The applicant re nizes 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 a Date:_._[ Approved by - ( V E �_ � ___-- Z577 } oT cn Q �I I - / a / 93ry \ .� � �, E�c►ST�►:1� SHE© -3 s�no�.►s ��N 88__ , 7 is I?.E LI 1< FENCE. . SGS All D T'"t'I!l%E_T` . r. PIZ, di=sly, Qs. I TE 8� He Itil� 'Stzraa 12D. 13c�ZZ4RP�� �..� . MIS. 4.._.l%�, ;mar,)j -.—�j . . ..1r. '°� • . 0 5'SZ 14 i r-rc �,n Tom!s�os� o THE- l '-�cZ���,.,r� r,-►� ,Z1�x.i�5" w ��M r= �►-IUD`� �-r 5 I DE .�,�.�o 1��� - C��= '400!-t-1�N. ^NC3, Hen l tW 7Z--> 51 US E �K. l�ri� T I Id�f- rt�"�.�-- �- � 7 �PO�ED ,��,-;-• -�� TInN J TD F_ J A�IL _ffdx4.P EL F-(-oo R, Tex-W N_ % Fxir�i ..al. �FlED- N I*,+l-.F'n5-r--S- r 5d 4,; y� - E�IET-4 SI-1EA,, TE 24Co N I,�,►-+AID 5`{' a , �PX�H OF , gss9�y �.. k Arch'oeerlOre O T. VAR NL'•M g PkIL6RQQK . .{ _ MECHANICAL 0. i 0 X. PB Be• I)) 4'-2' 65'-0' B'-10' fear Falm°u rn, Oi511 I I STRUCTURAL SYMBOL LEGEND, Gjl� C_ - I ___EXTENT OF BHEARWALL SIGNAL ---------- -=l —REMOVE EXISTING ' Jr I` �e �. STAIR ® STANDARD 5 BLOCKED B;1/2 W/1 W BD RING-SHANK®6 ------------- COMPOSITE , AND SOLID BLOCKED SEAMS W/1/2 GWB/PLASTERBOARD ON INSIDE H VIIL NEW PVC/ RAILING SYSTEMAP4 N4RROW WALL PORTAL FRAME(SEE DETAIL'BPOSITE DECKING-__.--.-_----- ON EXISTING FRAME DIMENSION LEGEND DIM. I3 DIMENSION TO EDGE OF STRUCTURE I I I / \ i II i m_ .2 ND EDEXPA I' DIM I DI MENSION TO CENTER OF OBJECT DECK E.2 NEF2LINE OF WALL LEGEND: EENED PIORCN I — I I I Ifl NEWEXISTING OVERHANG I I / ABOVE O EXISTING WALL TO REMAIN v I I 1 --I .—D—O —O--�_—`—__O___-1' _—— —_----- _______—_ ---------------------------------- g I NEW WALL CONSTRUCTION 'J x 4 0 —ACK , A3.1 24'-0° - VSTUDS OVE ' 5- EX! EXISTING GARAGE FOUNDATION GARAGE ADDITION WINDWTR O` O 'COSS N'�+ W FWH905b -- 'm I EXIST. I FNG306B �—'�---- / I \ iI. NEW F.G I RE=_.acenENT �r CLAMSFIE L° ,y j` 1/1 FAMILY ROOM t 11 S AK TUB / (`�I_ m I I / BVLKHEA DR. I I C 2668 PKT. - NEW BEAM POSTS/EACH END): I I w I.1 BREAKFAST 6 x 8 aI DOUG-FIR FOR FULL -- J _ D 0 S SUPPORT. LAG BEAM TO TOP F I--F.F.LVL ABOVE J� -- u I I AREA � I I, I I bb0 I (SEE SI.3 2ND FLR. pf�•. ¢ I I o I STUDS. RUN SISTER 2 x 4 KING *.�, FRAMING PW/SIDE LAN) r iI .y�'q�. REMOVE EXISTING I I DE =I O f _ SLEEPER SAM EACH E HEIGHT AS TOP ."� 9 NEW F-'p��%� - - CASEWORK U I I I 1 WALL PLATE. TIE THE KING STUDS L-r Vl 1 1.1STR. BATH '' TO THE POST W/3°TIMER-LOK ~ o O I I --------r BENCNI J,`�\�. (F AL LAYOUT BY ' a I SCREWS SPACED 16'^O.C. O NEW I 1 \ _EXISTING CASEWORK ], - V•1'I'G' I ��, TO REMAIN B.I.ScAIING �\ A3.1 M1 / spy 1p� - /. / - ____ 11 __fca -_-LOWW EXST. / \ _ULL 4T L� ON. / : CABINET OVEN NEW 0 DOOR 84 2'-", �—�— IN EXPANDED IXI SAW CUT CONC. FDALL ILL RSTOm EXPANDED DPE SLAB HEIGHT STAL IIV 4eMSTR. BEDROOM SIN 10'- HALL SMOKE � Y_ 3068 C.O. F.-P.SURROUND 4065 TRACK DR. DET. Ka II1I EXISTING N • --__ III I \ �/'•. // CAB_WORK 2'-a• I 1 III I I 43.2 i TO REMAIN i O S/-AL 'TYPE%G7P.BD. ON ALL COMMON HOUSE I I WALLS AND CEILING III I I -'.• EXISTING CASEWORK F- NEW TO REMAIN /' EXFOYER E](PANDED Ii I___I' MUD V I STEEL BEAM LIVING/ DINING ROOM II r I 00 'I N�TYF'EI"X'GTPD.BD. III ---- I I, i L'1 L� m (SEE 51.4 ROOF FRAMING+ I r--- ----- 1 Q0 I I BUILDING SECTION'D'A3.1) I 1 NEW BALUSTER S, II II CUTTING 6D. I III I - /' I HANDRAIL AND II II NEW G I I I II I I:- rc I N hcL POST E P II II KITCHEN N EW Qv HIGH SHELVES ..� :. `:.,.\ 4—6-D--FIR --IST-ER -—---� `-r:..D1•I,(FINAL LAO7e_0 UT BY EXISTING DOOR 2 4 K D STUDS. OTHERS) r ——J I 1IIII 1III 1IT1I II II pppOo z OUGH OPENINGBEAM F¢wo >9Ewa OEXPANDED C2 CFUp LN SOLID BLOCK LOAADD a z 9 0TOGIRTPOINTS ABOVE SILL PL (SEE 51.3 2ND (TTP. 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