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Home My WebLink About0010 ADMIRAL'S LANE - Health 10 ADMIRALS LANE OSTERVILLE A = 119 066 l i 0 3 TOWN OF BARNSTABLE �L ®o L� LOCATION SEWAGE# a C VILLAGE 0'3 k U_, ASSESSOR'S MAP&PARCEL - O(p(� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ' 1 C�yC� C�0A 2.x i S-k LEACHING FACILITY:(type) (size) iQ NO.OF BEDROOMS OWNER M; cy n e 2A\p PERMIT DATE: A" 13 COMPLIANCE DATE: Separation Distance Between the: _ Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �' S 1 fi Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) /Jo4, Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Pf Feet FURNISHED BY c,r;s Toir 4\ No. -DTI / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s` Ygs� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplitation for Misposal *pstrm ConstrUrtion permit Application for a Permit to Construct( ) Repair'Upgrade( ) Abandon( ) ❑Complete System RIndividual Components Location Address or Lot No. 10 fz4AwN,C-ck,_\S L 4 Owner's Nam ,Address,and Tel.No. 11 - (o i, Assessor's Map/Parcel .�'„it Installer's Na e,Address,and Tel.No. Designer's Name,Address,and Tel.No. 1lype of Building: SZ y. -- l i Dwelling No.of Bedrooms L t Size sq.ft. Garbage Grinder(0 pi c Other Type of Building lQ A No.of Persons Showers( J Cafeteria(L. Other Fixtures � �qq Design Flow(min.required) N J Tl' d Design flow provided r°'{ gpd Plan Date Number of sheets Revision Date Title ll f Size of Septic Tank 15T I , b Type of S.A.S. fl4- Lenc'k" Description of Soil �� 1 Nature of Repairs or Alterations(Answer when applicable) aT' Date last inspected: Agreement: The undersigned agrees to ensure the co truction arldmainteriance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of t Enviro en -C e d not to place the system in operation until a Certificate of Compliance has been issued by this Board f Healt Signed Date 3 p Application Approved by — ► Date t T� Application Disapproved by Date I for the following reasons ' Permit No. •l iki /o a _ Date Issued Y u.-„ No. O` U o Fee• —,7 ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE; MASSACHUSETTS 1'es" f li Rppfication for Misposal *pstrm Construction Vermit;, Application for a Permit to Construct( ) Repa r \Upgrade( ). Abandon( )` ❑Complete System ; &Individual Components Location Address or Lot No. Owner's Name,Address,and Tel:No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel:No. Type of Building: Dwelling No.of Bedrooms . -',Lot Size sq.fl. Garbage Grinder Q-) fN w ,, r Other Type of Building No.of Persons g Showers( U),Cafeteria(tom Other Fixtures l Q-w �c.� k n j f� �C:, . Design Flow(min.required) J °~ d 1 Design flow provided l� �"P4 O# gpd t T Plan Date Number of sheets Revision Date t Title f � Size of Septic Tank q') 4 6-T 1 606 Type of S.A.S. � � t�� f Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1?3 c 6e -- Date last inspected: +fit Agreement: f The undersigned agrees to ensure the construction d;maintenance of the afore described on-site sewage disposal system'in ,,� accordance with the provisions of Title 5 of the Enviro en� C1de 'and not to place the'system in operation until a Certificate of Compliance has been issued by this Board�of^Heal r 1 Signe /I . ,. - Date Application Approved by Date ---f k v Application Disapproved by ? Date for the following reasons Permit No. 2-U f f(i d d Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired O Upgraded( ) Abandoned( )by .. __ . .. - (� � --- - .t at r�y��C;��`� �-•vJ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Utl dated Installer Designer P- #bedrooms U Approveddesign ii`ow gpd The issuance of this permit• hall fiot✓b~e�cconsffued as a guarantee that the systl will function—designed. + Date '" ) Inspector•��\` ' / C/° No- 1 l5 1(1(l Fee 12 THE COMMONWEALTH OF MASSACHUSETTS - -. PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS €+ Misposal *pstem Construction permit Permission is hereby granted to Construct( )rr Repair Upgrade( ) Abandon( ) System located at % 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.. i Provided:Construction must be completed within three years of the date of this permit. ld , Date ` Approved by L� L� e�/� e- VE Town of Barnstable Barnstable ° Regulatory Services Department AgAme`��j BA"5CABIX, 6 9 ,.� Public Health Division P. jFDAA°�� 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1730 0001 4988 0268 April 20, 2018 ELIO, MICHAEL A 10 ADMIRALS LN OSTERVILLE, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 10 Admiral's Lane, Osterville, MA was inspected on 04/11/2018 by Chad Hathaway, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Distribution box must be replaced with H2O component or relocated. You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH v omas cKean, R.S., Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mai ling\Conditionally Passes Letters\10 Admirals Lane Osterville.doc Town of Barnstable snxivsrABLE. Regulatory Services Department rfD MA'S A Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ,kAny"conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER e Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 0 10 Admiral's Lane Property Address M.Elio Owner Owner's Name information is Osterville ✓ Ma 4/11/18 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Chad Hathaway use the return Name of Inspector key. H.P.S. r� Company Name P.O.Box 151 Company Address Forestdale Ma 02644 City/Town State Zip Code 774-274-2581 12866 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: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 4/11/18 Ins s ure Date The system inspector shall srdr-greater, Iof this inspection report to the Approving Authority(Board of Health or DEP)within 30 eting this inspection. If the system is a shared system or has a design flow of 10,000 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 Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form 7 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 Admiral's Lane Property Address M.Elio Owner Owner's Name information is required for every Osteryille Ma 4/11/18 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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 Forth:Subsurface Sewage Disposal System•Page 2 of 17 L Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Admiral's Lane Property Address M.Elio Owner Owner's Name information is required for every Osterville Ma 4/11/18 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 E Y ❑ N ❑ ND(Explain below): H10 Dbox located under paved driveway was camera inspected and rotted out ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless-Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 10 Admiral's Lane Property Address M.Elio Owner Owner's Name information is required for every Osterville Ma 4/11/18 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 mannei 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 El Liquid depth in cesspool is less than 6" below invert or available volume is less ® than Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 10 Admiral's Lane Property Address M.Elio Owner Owner's Name information is required for every Osterville Ma 4/11/18 . page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 Admiral's Lane Property Address M.Elio Owner Owner's Name information is required for every Osterville Ma 4/11/18 page. Cityfrown 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+ l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 10 Admiral's Lane Property Address M.Elio Owner Owner's Name information is required for every Osterville Ma 4/11/18 page. CitylTown State Zip Code Date of Inspection D. System Information Description: Number of current residents: seasonal Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail Sump pump? ❑ Yes ® No Last date of occupancy: seasonal part time Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 10 Admiral's Lane Property Address M.Elio Owner Owner's Name information is required for every Osterville Ma 4/11/18 • page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: 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 M 10 Admiral's Lane Property Address M.Elio Owner Owner's Name information is required for every Osterville Ma 4/11/18 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: 1978 Were sewage odors detected when arriving at the site? ❑ Yes Z No Building Sewer(locate on site plan): Depth below grade: 2.25 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line. 10+feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 2'feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) H10 1000 gal septic tank at working level. 2 PVC lines enter tank with tees in place. concrete baffle on outlet pipe If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Sludge depth: 6" 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 10 Admiral's Lane Property Address M.Elio Owner Owner's Name information is required for every Osteryille Ma 4/11/18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28 11 Scum thickness 4 Distance from top of scum to top of outlet tee or baffle 3" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is due for pumping. Tees and baffles in place. no visable cracks or leaks Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Titles Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Admiral's Lane Property Address M.Elio Owner Owner's Name information is required for every Osterville Ma 4/11/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 I— Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ,•''p 10 Admiral's Lane Property Address M.Elio Owner Owner's Name information is required for every Osteryille Ma 4/11/18 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 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): H10 Dbox camera inspected under paved driveway. box is rotted out. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: leaching pit was dug up. 6x6 pit with stone water level was 44" below invert pipe with no staining above current level to indicate past failure t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 12 of 17 r— Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 10 Admiral's Lane Property Address M.Elio Owner Owner's Name information is required for every Osterville Ma 4/11/18 page. City/Town State Zip Code Date of Inspection D. System Information (cost.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number:. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): none Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 10 Admiral's Lane Property Address M.Elio Owner Owner's Name information is required for every Osterville Ma 4/11/18 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M s•'� 10 Admiral's Lane Property Address M.Elio Owner Owner's Name information is required for every Osterville Ma 4/11/18 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 A � � O 4 ® 3 l� l �9 33 ? 13 t5ins•3/13 Title 6 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 M 10 Admiral's Lane Property Address M.Elio Owner Owner's Name information is required for every Osterville Ma 4/11/18 page. CityrFown 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: 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: town GIS septic area el.44' You must describe how you established the high ground water elevation: low el in area is 4' Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I_ Y Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 10 Admiral's Lane Property Address M.Elio Owner Owner's Name information is required for every Osteryille Ma 4/11/18 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ❑ System Information—Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on`page 15 or attached in separate file 4 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 I COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION tO TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 10 Admirals Lane Osterville, MA 02655 Owner's Name: Norman Fertruson Owner's Address: Same ' Date of Inspection: November 5, 2001 RE GEE� Name of Inspector:(Please Print) James M.Ford r �Ov 2.6 2001 Company Name: James M. Ford Mailing Address: P.O.Box 49 of aARNSTpgIE Osterville,MA 02655-0049 1oWHEA,TH�EP1 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage-disposal`system at this addres's and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes . . Conditionally Passes Needs Further Evaluation by the Local Approving Authority. Fails Inspector's Signature:;. Dater ' November 11. 2001 The system inspector shall subm' a copy of this inspection report to the Approving Authority(Board of Health or a DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority: , Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form i36/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 10 Admirals Lane Osterville, MA Owner: Norman Ferguson Date of Inspection: November 5. 2001 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system 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 FORM PART A ' CERTIFICATION (continued) Property Address: 10 Admirals Lane Osterville, MA Owner: Norman Ferguson ; Date of Inspection: November S. 2001 . C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. , 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS'is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and,SAS and the SAS is within a Zone l 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 Tess than 5 ppm,provided that no other failure criteria are triggered; A,copy of the analysis must be attached to this form. 3. Other: -- 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 10 Admirals Lane Osterville, MA Owner: Norman Ferguson Date of Inspection: November 5. 2001 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'/2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered`yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 r Page 5 of 11 OFFICIAL INSPECTION:FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM f PART B a CHECKLIST Property Address: 10 Admirals Lane Osterville, MA ` Owner: Norman Ferguson - . Date of Inspection: November 5, 2001 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? - - ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection'? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out ✓ Were all system components,excluding the SAS,located on-site ✓ Were the septic tank manholes uncovered,.opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems?' The size and location of the Soil Absorption System(SAS).on,the site has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is atissue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)]. Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 10 Admirals Lane Osterville, MA Owner: Norman Ferguson Date of Inspection: November S. 2001 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): Yes Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): 1999-111,000 gals.; 2000-80,000 gals. Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): upd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: None on file-per treatment plant Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy -- Shared system(yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Sept 22178-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTIONFORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART-C SYSTEM INFORMATION (continued) Property Address: 10 Admirals Lane Osterville, MA ' Owner: Norman Ferguson Date of Inspection: November S.2001 _ BUILDING SEWER(locate on site plan) s, , 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: 2' Material of construction: ✓ concrete =metal fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: 10" Distance from top of scum to top of outlet tee or baffle: 9" Distance from bottom of scum to bottom of outlet tee or baffle: S" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle cohdition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present The liquid level was even with the outlet"invert. There were no signs of leakage. Recommend pumping 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 outlet tee or baffle. Date of last pumping: Comments(on pumping recommendations,inlet and-outlet tee or baffle condition,;structural integrity;liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 10 Admirals Lane Osterville, AM Owner: Norman Ferguson Date of Inspection: November 5. 2001 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 Ll-box was level There were no signs ofsolids or leakage. 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: 10 Admirals Lane Osterville, MA Owner: Norman Ferguson Date of Inspection: November S. 2001 }' SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: TS'Pe - ✓ leaching pits,number: 6'x 6'with 2'stone-per design plans 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,edamp soil,condition of vegetation, etc.): The pit had 6"ofwater on the bottom. The scum-line was 2'up from the bottom. There were no signs of failure. The bottom to garade was approximately 10'. The cover was Y below grade. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: r 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.): a PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,•condition of vegetation,etc.): 9 s . Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 10 Admirals Lane Osterville, MA Owner: Norman Ferguson Date of Inspection: November S. 2001 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. i PJ1 . is Ca Aa- 3q t3a- ao• � J^y. A3_ 3 83- 0 , Ay - 3 � y 13�1 - 39 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: 10 Admirals Lane Osterville, MA Owner: Norman Ferguson Date of Inspection: November 5, 2001 SITE EXAM Slope Surface water Check cellar - Shallow wells Estimated depth to ground water . 25' +/ feet (Adjusted High Ground Water Level-is 20.3) . Please indicate (check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: The bottom of the leach pit to grade was approximately 10'. Using the Barnstable topographic map and the Cape Cod Commission water contours map the maps were showing approximately 25'+1-to ground water at this site. :Using the Cape Cod Commission Technical Bulletin the high ground water adjustment for this site(MI W 29, Zone C, 9/014 was 4.7' k This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. ` 11 r 4t r G A k 6ro,,,4waTc. l e ue y A c jus+i►'%f,A " I 05' 0 i TOWN OF BARNSTABLE L(?CA'bON IO ACM)rX)IS I /i Ak- SEWAGE # YMLAGE STrer✓. { ASSESSOR'S MAP & LOT-1 I 1 O INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /CM (,A�• LEACHING FACILITY: (type) I�i� (4�(� (size) C9 NO. OF BEDROOMS 3 BUILDER OR OWNER /td/✓► Ae4 �CrQASOn PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 1n ri0tc,-{-t 0� rroi lea- 3y A3- 3�• Ay- 3 ray- 3� LOCTION �i l SEWAGE PERMIT N0. -HVE V@ILAGE I N S T A LLER'S .loyb � t & ADDRESS TO BACKHOE SERVICE 150 ,Walnut street Wea-Bamstable, Mass. 026.68 BUILDER OR OWNER GATE PERMIT ISSUED DAT E COMPLIANCE ISSUED ��_�� . /JG rY!//'q�3 �ay 7� -. No......................... - Fms.......:..:.J............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _Town _ _. ..... 0F.....!Barnst.abbe.................................................... Appliration -for Uhipasal Workii Tomitrurtion Vanfit Application is hereby'made for a.Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: .............................?]�-x a1s._.1ane.,.0stexvi11e- --------------------------Lot--#1 d ral-s---.La e-----------.- Location.Address or t o. Fl oyd j._anal-Donald.--J-.---S ilyia--------------- ...............5 6-1inda..pane.,...Iiy_annis------......•-•----- Owner Address w John Alto Marstons---Mills....--- ='; =--------- a -----•-------•------------------•------...----•••-------••-----•--••--.......------•---------- Installer Address Q Type.of Building Size Lot....1_,22...acr(2q. feet U Dwelling—No. of Bedrooms..-._-_3---------------------- .Expansion Attic ( n)0 G,rbage Grinder ( 40 Other—Type of Buildin W0.0d----------------- No. of ersons._._________.___.__________. Showers Cafeteria a YP g. P ) - l( ) Other fixtures Design Flow '�-_____--_-__-g __--.___-__-__-_-.-gallons per person per day. Total daily flow -gallo ......................S s. W ..f` WSeptic Tank—Liquid capacity-.,a --__gallons Length................ Width................ Diamet r..............._,J)e)tli- :- xDisposal Trench—No.:................... Width.................... Total Length---______-__•.____-- Total leaching area---------- ---------sq,<ft. � PSeepage Pit No.-------_-_-_______ Diameter-------------------- Depth below 'nlet____ .-_____. .--.Total leaching�wea--._._._.: ._ --..spit. _ Z Other Distribution box ( ) Dosing n ) (� '�� - 7� Percolation Test Results Performed by -------------------------------------- Date... - ---- 7 aa Test Pit No. 1----------------minutes per inch Depth of Test it.-..._.............. Depth to ground water...:..-.- --:.-.---... Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water--------:_.---.--._ a+' / = O _ - a f J ... Description of Soil-------- � y2 1 .�1-.._. l .:.._ ------------ x W -----•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- UNature 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 oissuZeyhe boar of health.Si d- a4D le A roved B .-..--------- _'�/' -If----------- Application PP Y � Date Application Disapproved for the following reasons----------------------------------- ........................................................ Date PermitNo.........................................=.............. Issued........................ ................................ Date �.4b NO......................... YuE.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _... .... .. ................OF..................................... .........................--1...................... . Application -fur IN-4vlaiittl Workii C omitrurtion Vrrttiit Application is hereby'made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: •----•----------------------•---•---------------•-••--......---------------------------........•-- ••----•...--------•-------•-•-------••-•-------••••••••--••-------•-•---------------•-•-......•-- Location-Address or Lot No. -•--•-••--------------------•-...........---•-•---.............--------•------•--•---------•----- .....................-............................................................................ Owner Address W Installer Address d Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................. Showers ( ) — Cafeteria ( ) p' Other fixtures ............................................d -----•------------•----------------------------------•-----•----------------- w Design Flow----------------------------------_.........gallons per person per day. Total daily flow-------------------7........................gallons. WSeptic Tank—Liquid capacity__----_-_-_gallons Length---------------- Width................ Diameter--------- ...... Depth.--_---_------ x Disposal Trench—No. ...................• Width........._---------- Total Length__--_____--_-.____-. Total leaching area--------------------sq. ft. Seepage Pit No..................... Diameter.................... Depth below 'nlet_...�_______. otal le�hin_ area-_-----._._---____sq. ft. Z Other Distribution box ( ) Dosing n ) (J,C�' j �" �� Percolation Test Results Performed b : J...................................... Date.._?-.—S�._._ � Y a Test Pit No. 1................minutes per inch Depth of "Pest it.................... Depth to ground water.........--------------- (s, Test Pit No. 2----------------minutes per inch Depth of Test Pit.-__-__-_________-- Depth to ground water-....... ............... P4 - - 4-S -- D ------- - --y � (- ------ � r Description of Soil_..._____ ---- a - ----- -- --- kill U -------------------------- w UNature 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 the board of health. Sied- ------------------------------- ------------------------------f -- - - -• ?at � Application Approved B ! _ .�/ PP PP Y '` , Date Application Disapproved for the following reasons-------------------•-------------------------------------------------.------------------------------------------- ------------------------•----•------.....----........---------.............--- ------•-•----------------=--------------------------------------------------------------------- ------------------ ---- Date PermitNo......................................................... Issued..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH/ Trrtifiratr of Tlimp aurr TRIS IS TO R IF , That„the tIndividual Sewage Disposal System constructed ( or Repaired ( ) by....... o f f' ..................... ----------•-------•--------- /! E/rcJ �� %J r has been installed in accordance with the provisions of.'fir X of The State Sanitary C le as described in the application for Disposal Works Construction Permit: No.-:" :� _C............... /f R dated............. ............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 7 . DATE. ^. y:-:`----•---------... Inspector - -----1 ''` ..... ...... THE CO�Iy1MONWEALTH OFIMASSACHUSETTS BOARD 'OF HEALTH �J1 . ..........?..... .........OF......... �^G'��'� ` No. ......... FEE.'_'- ........... �i>��o�ttlo �,� .�tr�xrx,tioii �rr�tit Permissionis ereby granted.------ --------4---- - ----------- �G. .� ...............................J............................................. to Constr ctor Repair ( �)Xdnf/dividual Sew Di osa System % at No._.7dJ;---/ -- �4-�' - G�FsConstruction — � �' ��"�`1 --- - --------- as shown on the application for Disposal Wor. Per treet o - 7s .............. / �i / . ... .... .............. 1( �ll -------------•----•-•----------- oard of Health DATE........ ----------------------------=------ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 4 V/ E C.48 G FL.476 . Mp � n 0 4 1, �G 48 •8 n� g9 a _ U "�v G EL.S/S �Tiv yfq 3. o.A! �►SS✓QED DA-r�./`� CERTIFIED PLOT PLAN ,q - s 6 LOCATION OSTEt?ViGL� /�r95s. SCALE DATE ! EDWARD E. KELLEY PLAN REFERENCE . . . .. . . CUMMAQUID, MASS. 02637 wA/ on/ ,qOf EDWARD , �!t E. , " 1 CERTIFY THAT THE ... . � No 2�10� .J EXIST/NG.... �or�eiLi9TliOt� O SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT CONFORMS TO THE SUV'<4�'{ SETBACK REQUIREMENTS OF THE TOWN OF fa'ye ��rtiv'ct. . . . . . . . . WHEN CONSTRUCTED. S1L V1A DATE />. 78 PETITIONER: ,, ��y�riw- MASS, dam,. REGISTERED LAND SURVfi+fO!? • v I r SNEET 2 of .2 S�✓E-E7'S TOP OF FOUNDATION ; CONCRETE COVER CONCRETE COVERS 4"CAST ON e° 12°MAX. 12"MAX. "f3/4 PIPE (OR 4"ORANGEBURG(OREQUIV.) 2"PIITCH 1/4"PER.FT. PIPE MIN. LEACHPITCH 1/4'PER.FT. PIT ASTINVERT . HINGEL.4,..es INVE f INVERT o . ( OR.SEPTIC TANK c DIST. ELgsJ j= UIV.INVERT BOX.. .. GAL. INVERT .ELINVERT ;• ww 11/2EL9 00 '` ED wE �c �--- ¢ --s- lo PROR LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM ' NO SCALE M SOIL LOG WITNESSED BY DATE !7uG. 4; TIME Xo;ISA .191. G•,.,/1� e::�9�/• BOARD OF HEALTH TEST HOLE I TEST HOLE 2 Ttk?M�►.5. 4c, ��e � PE". ENGINEER ELEV. . 'z.os. . . ELEV, S2.6o. . . . / 1 wuuOCogyy ., woaDGoAy ti �,' DESIGN DATA : �., spa;so,L 3 \� ' ,,�.: NUMBER OF BEDROOMS _._ 3o' 30". TOTAL ESTIMATED FLOW . . 330 . . . GALLONS/DAY 4Z~ BOTTOM LEACHING AREA 78:5 SO.FT. /PIT Mt�u.-� �iEDiu•� eoruiT C°oTui�- SIDE LEACHING. AREA . . �B�..Sv . SQ.FT./ PIT GARBAGE DISPOSAL IYPN.L' . .(50% AREA INCREASE) TOTAL LEACHING AREA . .:�C7,.PO SQ.FT .Z. PERCOLATION RATE �:�s ?7/ . MIN/INCH . N�. WATER ENCOUNTERED LEACHING AREA PER PERCOLATION RATE .- -' 9.. SQ.FT. i . . '' NUMBER OF LEACHING PITS !a(r)1vi7}! 7WO.'5-z-r APPROVED: . . . . : . , . BOARD OF HEALTH 7'HOMAS•E.KElLEV fib. S7aw� Pg f?iT,DATE . . . ENGINEERS-S.URVEYOR$ . . . . . . . . " `. 346 LONG POND DRIVE AGENT 'OR INSPECTORWVT11 YARM® OF Mgssq THO EDrN�, 42 cn SiL I/iA rq,vP. -SiL V/•9 . . . ff[.. .ter O u r� /.EMIFG/ST. ,100 �, sIONAI PETITIONER �[/a/ .vIJi S /�ff15S, `/ AR STABLE TOWN OF ►, - - " �_ �Qj got ATTACH e2n tO HEADERS TO(9)1-va �LYL WITH a c ) V ' SIMPSON:4ONG-TIE I j GONG@AL@D JOIOT -.: . pp TYPICAL HANGERS < (� 9u OPEN TO BELOW ,Q M)D°IO JOI0T6 - • 45 '4 •:A o . n. ..a. € Y 5:, UNDER EXISTING�... 94 0! rHt/4 r 8 ATTACH-RIM.b187 TO.. • A. IT 4" •w V . { ,E ., <�-3 PROPOSED WALLS- S� 3 y FOR,JOISTS WITH BY_lOx3" +. - r } RIDGE BEAI'1:BPAN m 0 ,.. - 0 MIN.WOOD SCREWS F - } UN F I 1014 ED 'H-4s � MJ3x10 HEADER TO .:: BEAR UPON EXISTING a� O T t G a .. WALL TYPICAL 36"HIGH RAILING cl s RaaE - M)DAO HEADER f� ecurn,ur,oewxmea ra1' --- -I �' C . _ _ III ✓ " roaumee."°`i+xs .I UNFINISHED - - =B A L.C O N Y Q b EXISTING 2xt0 FLR JDIST I Q I. .. .. _ 1 ATTIC L AT B"O,C. I. "d - 3o''MIN. ... ryF i: CHIMNEY i "STORAGE„ z . - •. ,� .r . - rod rw 'I. _ 42J1?)Sxt4 LVL RIDGE BEAM (2)9x10 HEADER ` l _.. _ HEAD. DENOTES TYPICAL S N wec Ar• a "L„ _ DENOTES PDOWN ` TYPICAL STARS TO FOUNDATION - _ • - 80"MM. � .. .. - ., } : .. - Q x r.. . !Q�, ♦ _ _ 'OPEN TO t 6'-6"HEADROOM(MIN.:' ! N x, pOBt DOWN S. . -. MAX.RISER HEIGHT 0-V4 F I df - - ¢s TO FOUNDATION DESIGN T-X".RISBi HEIGHT ! ay X _ i� ACTUAL RISER HEIGHT FIELD DETERMINED _ ¢' ,r .J - P y • MIN.TREAD DEPTH 9° D ? j ¢L _ .. 3 CATI�AL : .. iELI ' - R DESIGN 9 TREAD DEPTH - 333 _ CEILING" I"NOSING 0-1/Y MAX,). - oI 4 4 'MAX.OPENING BETWEEN RAILS SALLUSTBi3 SHALL NOT EXCEED 44NCRM(CLEAR OPENINW _ � - g'-O' . I :.O j. WALL - . .. .. ... ,. OF tBALGONT ~O • - OF. F ELD DETERMINED . -I � END A =tOP OF•HANDRAIL SHALL BE MINIMUM '" .' �C--•— a . m - .✓ .. .' TO I O • , ... .. ' <. •Q - .4-INCHES AND d MAXIMUM OF 9B-INCHES ABOVE .__—.._ MIN, ri • - I BASF9.UPON LOCATION OF L} I ! . THE FLOOR _ - _ .. = .... - - q, .. HANDRAILS ADJACENT TO WALl3 SHALL BE NOT •. — _..-:-,._ .__----. !. tDUSnNG DORMER . } LESS THAN I-Ifl'FROM WALL ° ,, l ..I _ . m - HANDRAILS BNdLL BE BETWEEN HI/4"TO 1" x 'a _ ; 1! .. , -.•, _ .. A o- F W W.N 1. u .!._._ .. ...,.. EXISTING WALL: ., L O - SEE DRAWING i/A4 FOR'. - ", z PROPOSED Y RELOCATED "2FLALLY COLUMNS M ' a. y EXISTING BASEMENT .. n 0 a , b lu yt 3 PROPOSED 2ND FLOOR'PLAN.. 0 4 PROPOSED FRAMING PLAN _ SCALE: 1/4'.I'-0" SCALE. - - GALE:I " • , i M eD r , - - - u tu 4 ." .. . . - ..a,. - , F• - _EXISTING- .. .. - v O - FAMILY ROOM _ '.FAMILY T'ROOM C W SAL60NY ABOVE'. 0 j . i a. ' lQu¢7��• e_ ' .. A - ' 0.0 B O I 11 N a rill ., ., .- FOTER LIY'NIB TROD Z :LI V'NI G T.R OM } —' EXISTING. .Q - .. EXISTING ALILNG FOYER j " I Q 1 , O ENTRY S H E E T • t PROPOSED IST FLOOR PLAN z EXISTING 1ST FLOOR PLAN Az ALE:v4"s I'-0" SCALE. 1/4".x t'-0" _ SC vERBiON I;1 J e. . t t d) u Jig g p( FXISTIRG RIDGE .. } [ = s l2)I-Vxl4 LVL OTRUCTLIRAL - - ..��0> INSTALL 3x6 COLLAR TIES _ - .. ., RIDGE BEAM' AT EACW OF F` • - R SET UNDER LVL RIDGE F -EXISTING 7xb RAFTER S AT - - t E (3)Bd COMMON NAILS TO ATTACH .. -COLLAR TIES TO RAFTERS - _ PAD OUT TO%4Y DEPTH FOR R30 FIBERGLASS MATT INSULATION STICH 7x 6=6 TOGETHER WITH (2)16d COMMONS AT 10"O,C. 1 VERTICALLY I /� jm • I i I] REMAI IG ROOF t0 EMAI_ 'RN _ IyY i ILA 4" .CLEAR OPENING 4 - Q? _k— i m a QU EXIST --.. - - - o.c KNME • - F}—•Wg FIN.FLR, WALL. _ N 2. T ___ ______ _ al ADD T_bO_G________y 0OC I 0A � ._ CEILING HEIGI411 N F . 4"MAX.CLEAR OPENING _ a CEIL.HEIGHT TYPICAL STAIRS } - 4,•O° - I MAX,RISER HEIGHT S-1/4" , Y} a DESIGN`I-X%RISER HEIGHT } W a�Q•' - -. ACTUAL RISER HEIGHT FIELD DETERMINED MIN.TREAD D DESIGN 9°TREAD DEPTH I'N05NG(H "MAX.) Z pQp�( - CASED R 2x4 MAX.OP"NG B GHA�NOT"GEED 4•INCHES (\ 'OPENING WALL OPEN TO(CLEAR HANDRAIL SHALL BE A MNIMUM OF ' Z - @ SS@ EXISTING r ABOVEEB AND THE MAXIMUM OF 90-INCHES 9 BRICK.FIRE PLACE - NOT LESS THAN 1-1/2 FROMT TO WALL SHALL BE,e - d) - HANDRAILS SHALL BE SETWFEN W4°TO 7' .. - - .. r EXISTING]xl0 FJ AT 16"O.G, EXISTING 7xi0 FJ AT 16°O,C, FULL HEIGHT - . BLOCKING 3: m .. ` 80 ID BLOCKING UNDER EXI m x10 CENTER.SEAM-'. � « L BL _ STING � W •U - _ - WOOD COLUMNS TO SUPPORT - O STRUCTURAL RIDGE �m mWW LL EXISTING LALLY COLUMNS .. "- u• yJ �' `� m uj SEE FOUNDATION PLAN vAa 7 y FOR ADDITIONAL LALLY EXISTING COLUMN LOCATIONS ' .. BASEMENT EXISTING Y - CMU FND. FOR FIRE PLACE ci PROPOSED FOOTING TO BE - ' �r 74°x24"xl0"'WITH 1-'5 REBARS AT 11"O.C.EACH WAY BOTTOM 4 (S"UP FROM BOTTOM) I { cl BNEET ,43 TYPICAL SECTION VERSION 1.1 : _ xl: