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HomeMy WebLinkAbout0040 BRIDGE STREET - Health ff fBridge stre 9t tervillF P- - A e 116 006 1 c ' r THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I A , m / �C(�'J IL DATA COMMONWEALTH OF MASSACHUSETTS lugEXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS' DEPARTMENT OF ENVIRONMENTAL PROT.,ECTION , TITLE 5 Y OFFICIAL INSPECTION•FORM-NO T FOR VOLUNTARY.ASSESKMEN;'FS SUBSURFACE SEWAGE DISPOSAL SYSTEMcFOtM . PART A _. , CERTIFICATION ; Property Address: 40 Bridge Street Osterville, MA 02655 Owner's Name: Louis Vinios Owners Address: ti Date of Inspection: June 15:2009 ' i Name of Inspector: (Please Print) James M Ford Company Name: James M. Ford. Mailing Address: AQ.Box 49 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT arr I certify that I have personally inspected the sewage disposal system at this address aird,'thaf ffi ��r� -tnan�n ,�o,te� below is true,accurate and complete as of the time of.the inspection. The-inspection)`as performed`based on my training and experience in the proper function and maintenance of on site sewage disposai`systems. I am a,DEP s- approved system inspector pursuant to Section 15:340 of Title 5(31-0 CMR 15.000) .l e system:.. ' ✓ Passes . Conditionally Passes Needs:Further Evaluation.bythe.Lo.cal Approving Authority~ . Fails ti t Inspector's Signature: Date n June 29.-2009' .The system inspector shall s nit a.cop of this inspection report to the''Approving'Authority(Board of Health°or . DEP)within 30 days of completing this inspection. If the system is a shared:system or;has.a design flow.of.10,000.:;. gpd or greater,the inspector and the system owner.shall submit the report to the-appropriate regional office of then ' DEP. The original should be"sent.to the sysle.I m 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;th:e conditions'of'use at,-that,. t e same or different t address how thus`stem will. erform in the future--under h . time. This.mspechon does no y p conditions.of use. Title 5 Inspection Form 6/1'5/2000 page I v l`� Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION, (continued) Property Address: 40 Bridge Street Osterville, MA: Owner: Louis Vinios Date of Inspection: June 15, 2009 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: i 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 detennined(Y,N,ND)in the for the following statements. If"notdnined",please explain. y�� 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 inuninent. 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. ,r 0 Page 3 of I 1 OFFICIAL INSPECTION.FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 40 Bridge Street Osterville: MA Owner: Louis Vinios Date of Inspection: June 15, 2009 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to detennine 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 CM 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 fPer f�f a`, surface water supply or tributary to a surface water.supply. y` 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 forn. 3. Other: 3 r Page 4 of 11 OFFICIAL INSPECTION.FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 4.0 Bride Street Ostervllle, MA Owner: Louis.Vinios Date of Inspection: June 15, 2009 D. System Failure Criteria applicableito 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 acesspool 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 detertnined 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 gp& 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 1l 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 Page 5 of I 1 . OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 40 Bridge Street . Osterville. A M . Owner: Louis Vinios Date of Inspection: June 15, 2009 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 nonnal flows in the previous two week period? . Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ ` Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for-signs of break out? ✓ _ Were all system components,excluding the SAS, located on site? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction;dimensions,depth of liquid,depth of sludge and depth.of scum? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil.Absorption System (SAS)on the site has been determined based on: Yes : No ✓ _ Existing information. For example.,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.3020)(b)]. 5 Pag e 6 of 11 OFFICIAL INSPECTION FORM . NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 40 Bridge Street Osterville. MA' .Owner: Louis Vinios Date of Inspection: Ane 15, 2009 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: 2 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/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): +- Water meter readings,if available: Last date of occupancy/user ICI OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: Qallons---How was quantity pumped determined? Reason for pumping: 1 : 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 51712001 per as-built card Were sewage odors detected when arriving at the site(yes or no): No 6 : Page 7 of 11 OFFICIAL INSPECTIONYORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 40 Bridge Street Osterville,MA Owner: Louis Vinios Date of Inspection: June IS, 2009 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: Conunents (on condition of joints,venting,'evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 10 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 dimension's 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.). Ceinent tees were present The liquid level was even with the outlet invert. There did not appear to be any signs of leakage. GREASE TRAP: None (locate on site plan) Depth below grade:: Material of construction:._concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: - Scum thickness: Distance from top of scum to top of outlet tee.or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: - Comments(on pumping reconunendations, 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: 40 Bridge Street. Osterville, MA Owner: Louis Vinios Date of Inspection: June 15 -2009 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 normal PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarns in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 i Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) . Property Address: 40 Bridge Street Ostetrville, MA Owner: Louis Vinios Date of Inspection: June 15, M09 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why:• Type leaching pits,number: ✓ leaching chambers,number: chambers 12'x.44'z.2'.per as-built 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.): There did not appear to be any signs of failure from the Chambers.A camera was used for the inspection. 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: Commments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 . Page 10 of I 1. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) . Property Address: 40 Bridge Street Osterville, MA Owner: Louis Vinios Date of Inspection: June 15. 2009 SKETCH OF SEWAGE.DISPOSAL SYSTEM Provide a sketch of the.sewage disposal system including ties to at least two pennanent reference landmarks or benchmarks. Locate all wells within 100 feet.'Locate where public water supply enters the building. Ab- 33 --- . /4{ A ab 3 E E F pElf,k C O 0 10 r Page I el I of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 40 Bridge Street Osterville: MA Owner: Louis Vinios Date of Inspection: June 15, 2009 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 10 +/- 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 eater contours maps the maps were showing Uproxiinately 10'+/=to ground water at this site This report has been prepared only f6r the septic,systenz and components described herein._,This septic system has been inspected and passed as of the date of inspection. This report is not a warrant)or�guarantee that the systenz will function properly in the future. There have been no warranties or guarantees, either expressed,written or inzplied, 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 r COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRON 'F �, ON RtECE JUN 1 G Z003 TOvv,',: -i BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 40 Bridge Street Osterville, MA 02655 Owner's Name: Robert Moran Owner's Address: f ;VIAP Date of Inspection: May 30, 2003 PARCEL ; �(3 t� Name of Inspector: (Please Print) James M. Ford LOT Company Name: James M. Ford Mailing Address: P.O. Box 49 OsterviUe,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 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 FtInspector's Signature: Date: June 2, 2003 The system inspector shall sub ' a copy,of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 40 BridZe Street Osterville MA Owner: Robert Moran Date of Inspection: May 30, 2003 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: 40 Bridze Street Osterville, MA Owner: Robert Moran Date of Inspection: May 30, 2003 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(l)(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 I 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 Page 4 of I I �. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 40 BridQe Street Osterville, MA Owner: Robert Moran Date of Inspection: May 30, 2003 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 gpd• You must indicate either`yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) - Yes No 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 Page 5 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 40 Bridge Street Osterville, MA Owner: Robert Moran Date of Inspection: May 30, 2003 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ Were all system components, excluding the SAS, located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)]. 5 • Page 6 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 40 Bridge Street Osterville, MA Owner: Robert Moran Date of Inspection: May,30, 2003 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: n/a Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system (yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): pd Basis of design flow(seats/persons/sqft,etc.): Grease trap present ryes 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: New system-not pumped Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a.copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: May 7/01 -per as built card Were sewage odors detected when arriving at the site(yes or no): No 6- Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 40 Bridge Street Osterville, M4 Owner: Robert Moran Date of Inspection: May 30, 2003 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: 10" 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: 0" Distance from top of sludge to bottom of outlet tee or baffle: 32" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 8 Distance from bottom of scum to bottom of outlet tee or baffle: 15" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,-etc.): Tees were present. The liquid level was even with the outlet invert. There were no signs of leakage. Scum/sludge were minimal. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 40 Bridae Street Osterville, AM Owner: Robert Moran Date of Inspection: May 30, 2003 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: allons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box,etc.): The D-box was level and clean. No solids were present. There were no signs of backup or failure from the leach field 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 f • Page 9 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 40 Bridge Street Ostervitle, MA Owner: Robert Moran Date of Inspection: May 30, 2003 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ` leaching pits,number: ✓ leaching chambers,number: Chambers- 12'x 44'x 2'-per design plans 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 leach field was located but not due up. There were no signs of failure in the D-box. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 i Page 10 of 11 h OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 40 Bridze Street Osterville. MA Owner: Robert Moran Date of Inspection: May 30, 2003 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. /gyp- 34 . / 1 GN ac 0 E I C N Z 10 Page I I of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 40 Bridge Street Osterville, MA Owner: Robert Moran Date of Inspection: May 30, 2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 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: 1115101 Observed site(abutting property/observation hole within 150 feet of SAS Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You mast describe how you established the high ground water elevation: According to the design plans, no water was observed at 96"when the system was installed. 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 `, 2 TON" OF BARNSTABLE LOCATION 7 O, 3 f C CC ST SEWAGE# VILLAGE O sleiryi k ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY SW LEACHING FACILITY.(type) �c.�.f (size) NO.OF BEDROOMS OWNER V i A 1 oS 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�SiOt,GT on �J. Foe Ab_ AE - yY A QE E � O O � S • TOWN OF BARNSTABLE `.LOCATION L/U 13", c5'e- r SEWAGE # o�UD SCJ Y-,LACE OS CrJ,IGI. ASSESSOR'S MAP & LOT //6" 006 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) C�Aih LW (size) /aX �/y X o1 NO.OF BEDROOMS p BUILDER OR OWNER ``O�4-f - lk OfAr1 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 leach' g facility) Feet Furnished by 1/1 S,Pt t,I 10A FO r� r�1A- 3aq �, C. 3gto A • yy• a F14 - QY.- / FI - a7:t0 Ac - So.9 G:r ------------ Y� ► TOWN OF BARNSTABLE � W #_ SEWAGE.LOCATION �U ti) �. l y � Va,LAGE f� 8 GPiL Q, C e ASSESSOR'S MAP & LOT 116 INSTALLER'S NAME&PHONE NO. rC)bIA4C"64 6AO L4 1�1_ SEPTIC TANK CAPACITY / 6-b LEACHING FACILITY: (type) ( e4S (size) K i' NO. OF BEDROOMS BUILDER OR OWNER //11 PERMITDATE: � ��5�� _COMPLIANCE DATE: �� � 'V 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 fu Feet within 300 feet of leaching facility) Furnished by 44 2,� F H - I -log `� 1 - 21' 4 22 _3;r E / 6 O No. I J i f Fee V V THE COMMONWEALTH OF MASSACHUSE TTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Migooal *p5tem Congtruction 3permit Application for a Permit to Construct(>Q Repair( )Upgrade( )Abandon Complete System ❑Individual Components Location Address or Lot No. AO Orc 5i— Owner's Name,Address and Tel.No. Assessor's Map/Parcel 30 Gr1CQ1-1A 6t, MM%0- 1i6 u lv 0skcv-viTia vrtn 00 1 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ~ 5 ,trk... A. e1g. Hcalvv�9rc.+� o l 612- sr Ice- a N Type of Building: Dwelling No.of Bedrooms Ftw- Lot Size Z"7,014 sq.ft. Garbage Grinder( ) v Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow //o yvc/ ga4effs-per-day. Calculated daily flow 5750 gallons. Plan Date Number of sheets c)ru Revision Date Title ,,aes� Size of Septic Tank !boo a.lt Type of S.A.S. kcaci. C kc-"­ VZ A.44'r`21 L"L, Description of Soil t^c ltr- Jt; so I I I O V 0­1 01645 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensurA the cons ction mainte a ce of the afore described on-site sewage disposal system in accordance with the provisions o tle 5 of nvi mental a and not to place the system in operation until a Certifi- cate of Compliance has been issue t ' B d Sign 1 Date Application Approved by Date 3 CD Application Disapproved for the following reasons Permit No. 0� Date Issued s CO/n ,,.... . r, 9d- 5'� ,ax Fee r i Entered in computer: VN THE COMMONWEALTH OF MASSACHUSETTS - ' Yes PUBLIC HEALTH DIVISION,7 TOWN OF BARNSTABLES MASSACHI S�T'fS (pplication for Migpogar 6p! tem Congtruction Permit r Application for a Permit to-Construct()�)Repair( )Upgrade( )Abandon( ) X Complete System ❑Individual Components r t Location Addressor Lot No. � Owner's Name,Address and Tel.No. � 'gr�0%Ft V v it _ Ru be.-4- 0V rre+n Assessor's Map/Parcel '-30 St yv�rj�P 1 I(o (�.1. !9 C)Sb'zr u i /¢ 1'V1�1 � � lb) Installer's Name,Address,and Tel.N Designer's Name,Address and Tel.No. '4'Z�W.?� �t/3 ICZ 5 ttw A . LI3 i I Sv- P1- Pkit -"Q Type of Building: 4k Dwelling No.of Bedrooms we Lot Size ___7 014 sq.ft. Garbage Grinder( ) ' Other Type of Building No.of Persons Showers( Cafeteria( ) Other Fixtures Design Flow ��� 1.od/6�� penay. Calculated daily flow S5o gallons. g�aibrrs Plan Date Number of sheets Revision Date, Title '+ Size of Septic Tank 1?500 ��tl Type of S.A.S. ktctc , C koH,hc- I F 44 Description of Soil r c.An-- 10 3�2 Pic-is P' F 6 41 2 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees!to ensu31the cons ction d mainte ance of the afore described on-site sewage disposal.system{ in accordance with the provisions o itle 5 of t Envi nmental 6e and not to place the system in operation until a Certifi- cate of Compliance has-been issu b t ' Bo d fa e �/ O Sign Date Application Approved by %'� Date , Idol' Application Disapproved for the following reasons Permit No. CJ 1 Date Issued— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS �{/•rLe� C�a� eertif irate of Compliance } THIS IS TO CERTIFY,that the On-site Sewage-Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )b , 1-1at ` d 'l- C> V F W -has-been constructed in acc7dance with the provisions of Title 5 and the for Disposal System Construction Permit No.o9Q Z �j�—dated.- //(/© Installer Designer oe ;- The issuance of this�enpiit �l not be construed as a guarantee that the syste 11 f as desig d. _ n Date �3 ��7 n Inspector ` No. )not—I—�r�------- �6v—006 ---------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS ligogal *pgtem Congtructton Permit ,fern fission is hereby granted to C struct( )Re )Upgrade(, )Abandon( ) (� /oft c ©� c System located at �' , and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with.Title 5 and the following local provisions or special conditions. '£ Provided:Constru`ccttio ,must be completed within three years of the date of thi p t. Approved b� r Date: A V t Y''�� ,TOWN OF BARNSTABLE F�L LOCATION SEWAGE #. VILLAGE 8 GB2 cam` e ASSESSOR'S MAP & LOT 116 INSTALLER'S NAME&PHONE N0. - 4 C& SEPTIC TANK CAPACITY !'6b C� G o' LEACHING FACILITY; (type) _��d� �ettc (size) NO. OF BEDROOMS n BUILDER OR OWNER 1 04 PERMITDATE:3 Wo Vol" 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 F s 44'- 2" P H 17° 16 D „ 1 it aE 34 11 GH - 22! 3,` C / i � c c _ . r v co - I - r x! to �f4 gy u r� 40 44, I �luIrJ :. i taN. Wed i {f Rbl c- �CSJchr E+c�'t2n4� � f F r I a i G� jl��F MpHc�. n - I cs2a-� d' e8 I�lcl 1 li©V I�`212 N Gig'k�i I2��� •. : ` -. , •% j aH�l.o}. z � ��p I � �° GENET �X• -�`Tp• ,. _. . ' ;.:::. � .,— — F/1�- " ? �+Y�'� ' y � z I tcH l z 24� Toyy/�ua` . • � u h Iz 40 A IV to ar I'� �� 5�9�a"' I I�%a _-�� •7=`0.. �' I��.lo T�V. G0'g�eu _ a. l� �brG�� �" c� � � m j �� �1�' � I � i' !=bM i_L.`f FGceot—t• � FPl.t� i: Ra : w/TruM- : I I1 I:k fist 6Nob V4 L� �-• • , . . Town of Barnstable r# Fy L rtment of Health,Safety,and Environment, arvices �1►+E Public Health Division Date Q, 367 Main Street,Hyannis MA 02601 BARNaTABLK It MA99. ATfDMKt"`� Date.Scheduled /2,14. Z� Time 16:odR'1 Fee Pd. I dQ°o Soil Suitability Assessment for Sewage Disposal Performed By: =jAr_VL . W l S 0n Witnessed By: DohY1a Mors.v\4 4 :LOCATION Bc;GEN;ERAL INFORMATION . Location A m ddress � S}. Owner's Nae 1/2.brad• I'V1orw.� g0 Cis. os tro,IL Address 30 Gam. V t OS�w ui Iti 8 Assessor's Map/Parcel: M�1a� 1 t(o na( �o Engineer's Name 13 o.,.6. tjp J Meft"ptti uO NEW CONSTRUCTION ✓ REPAIR. Tele hone# ;W—,i.. 1 "'"j- 1 tnd' p 9 Z8-9 t 31 cat Land Use Res cckj«+I�S Slopes(%) Surface Stones Y10 rtq Distances from: Open Water Body ` SQO ft Possible Wet Area ft Drinking Water Well ft Drainage Way It Property Line ft Other ft SKETCH: (Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 001 4-1 T. - 129.50 �fr pis r A m i2 STORY W F�DWE•WNG%. I o I Iol ti ipl TPI Iml 137 so. a _ 'bt4 e Siaru_-6 } Parent material(geologic) G L0 otel Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETETZIVTTNATYOl�t +OR��r SONAT,JUG �VATE1t TA:::: Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment il. Indcx Well#_ ..... ,__ Reading,Date: ___.__._ -Index Well level Adj.factor Adi.Groundwater.Level PEItCOLATI+t2N'I'EST Uate T1me Observation Hole# Time at 9" °`- Depth of Perc Time at 6" Start Pre-soak Time c(✓t 10'• o Time(9"-V) End Pre-soak . uhGbl. L. Soak , Rate Min./Inch IGta 4w, ZM n1a It- Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant . I)Eh✓P:OBSERVATIOON HOLE LQG Depth from Soil Horizon Soil Texture Soil C olor Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,l3oulderes. Consistency.° Gravel) 6 —/0 ��o Sa ev+l i_o a n.l I U YZ VIA fit. rA�j is CoGste 0 G. Ca tt9 U C Sdwam, wcQ I o qY.? �d}, DEEP;;OBS]CRVATION kIOL;]G LOG Hale# Depth From Soil Horizon Soil'rexture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.%Gravel) O- q +rAp �Jy3e3 hhcct, `IGN.oO 66, CAW 0 Ut.�'e r1 ZO�r e 1�6u C 4rz. a u t lU Lek 6/4 r^"m { DEI'PbBS.ERVATrON IIOg E LOG Bole # Depth from Soil Horizon Soil Texture Soil Color Soil - — -Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. _. -Consistency,%Gravel AEEP 013SRVATION:I30L LOG Hcle# . Depth from Soil Horizon soil'rexture Soil Color Soil Other Surface(in.) (USDA)• (Munsell) Mottling (Structure,Stones,Boulderes. +' Consi ten c % 'ravel Flood Insurance Rate Man: Above 500 year flood boundary No V"' Yes Within 500 year boundary No Yes ✓ Within 100 year flood boundary No— Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Y6�-, If not,what is the depth of naturally occurring pervious material? Certification ' l certify that on Agri 1. 119,5 (date) 1 have passed the soil evaluator-examination-approved by the Department.of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature Date THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ............. ..........................OF.......................................................... Appliration for Uhipuml Warkii Tonotrnrtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair (AIT an Individual Sewage Disposal System at: Location-Address a or Lot No. 11................................... ••- . ......4'7..--........ Owner Address Installer Address d Type of Building Size Lot............................ q. feet U Dwelling—No. of Bedrooms........ .....Expansion Attic ( ) Garbage Grinde� ) Other—T e of Building No: of persons............................ Showers W YP g ---=---------------------•- P ( )._...__Cafeteria-(--- ) Otherfixtures ------------------------•-----------------------------•••------•-•--•...-•-•-•-•---••-------•---•-----........--.... w Design Flow.............................................gallons per person per day. Total daily flow............................................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 inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................mmutes per inch Depth of Test Pit.................... Depth to ground water........................ (X, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water............-._......... a+ •---•-----•..-•--------•--••--------•-•-------•----------------•-----.....•....-•---...-•--•----...-........................................................... 0 Description of Soil........................................................................................................................................................................ w 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the systemiin operation until a ertifi t�ee Com li .ce has been issued by the board of health. _ fined---•r��., ."�'�kt�...._. ="---.-� .---•-----......-•--- ••------•--•--ate .._...._.... Appli anon Approved BY ��' '` ..._..••••.. ^?��Z 8�----- ------------ ate -•------ Application Disapproved for the following reasons-----------------------------•-••----•--•---------------------------------------•----------------.......•--.... ......................................•--•-----------------•------------------------------••------....----••-•-•--=-•-.._..-----•------•--••--•-••-----• ...............be-- 9 ---.......................... Date Permit No......-- •----•-- --------------------- Issued....... - - - --. .............. Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) IM A DATA i NJ FEJ ------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............................---.----.....O F............................._.........._..._.:.......... Appliratiun for Disposal Works Cfunutrurtinn Frrmit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at ,• �P Location-,�Awddre s �f /� F p yip /Jf/tea ..'............E:C./.� .......................... .. .s ..• •�•4f e�t.�..pa'�`.......Ya..Oi Lot NO. .a!Z'n���:Pb�4'✓y l.+'$. + ............ ......... ................... Owner Address W Installer Address TypeDwellinNo. of Bedrooms____.__ Size Lot............................Sq. feet Building of ,., g— ........_•....................Expansion Attic ( ) Garbage Grinder ( ) a04 Other—Type of Building No. of persons............................ Showers YP g --------------------•------• P ( )--- Cafeteria•( ) � Other fixtures -•------•------------------------------------------------•--------------------•••---•-•---•------•------•--•-•----. ---•-- W Design Flow............................................gallons per person per day. Total daily flow............................................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 inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) . Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date................ --------------------- ... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.........._-_-__-._..__- f� Test Pit No. 2................minutes per inch Depth of Test Pit.........:.......... Depth to ground water........................ ---•----•-------------------------••------------•--•----•--•------------••----...._.......................................................................... ,b 0 Description of Soil.........................................................................................................................•---------------•------------------------.------ W UNature of Repairs or Alterations—Answer when applicable._.............................................................................................. ...-----••----•---------------------------•-•-•-----•---......-•--•---••---------------•-•--•-•--•----------------------------------------------------•----.............. ......................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance wi+ the provisions of TITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the sy operation until a Certificate of Compliance has been issued by the board of health. '..fined.... ZZ14ie. Application Approved By..__...` _ � Application Disapproved for the following reasons:.................................................................. ---•-•----------- --------------•-•----- ............. Permit No............ ..........i-_ ................. Issued............ THE COMMONWEALTH OF MASSACHUSETTS BOARD =.OF HEALTH OF.................... .... ..................................................... (9rruf txttt.r of :TontpliFaurr THIS IS TO CER//T�I-�F``Y,,That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.......1Utt �l........ •... ------. ------------------------•---- ------••-•••------•--....-•••---•-•....-•-•-•--•---••-••-•----........_......--•-----------•••- t Installer � 1' /fly Cam' at has been installed in accordance with the provisions of TIT; 5 0 The State Sanitary Code as,described in the application for Disposal Works Construction Permit No.__... _��..-...... . ............. dated__.._____---=' �_ : _ '............. ... TIME ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO TRIBE® AS A GUARANTEE THAT THE SYSTEM WILL FUPCTIOJ4 SATISFACTORY. DATE...... .....3.. .l.%5 A ........... ...Q�4, .. ..... ........... r THE COMMONWEALTH OF MASSACHUSETTS BOARD" OF HEALTH No. _l ................................ ........OF......................................................................---•--......... Dispos al Works Tonu#rnr#ion rrnni# Permissionis hereby granted................................................................................................................................................ to Construct ( ) or.\Repair.._( ) an Individual .ewa a Di s o al S stem at No................ zA C,o ` ------------------ - --- Street .a as shown on the application for Disposal Works Constructiont- Ta__ Date �-- •--------------••-----•-••--••-----•-••------------•----•.............................................. Board of Health DATE................ .. FORM 1255 A. M. SULKIN, INC., BOSTON L.O CATION — SEWAGE PE R IT NO. VILLAGE — Ile INSTA LLER'S NAME 6 ADDRESS B U I L D E R OR OWNER DATE PERMIT ISSUED n DATE COMPLIANCE ISSUED �. �. __..... off.•, �� 106 o rk " LOCATION SEWAGE PER IT NO. ' VILLAGE I N S T A LLER'S NAME i ADDRESS B U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED VI C4 �\ /p 6 0 Ol( i7l rla -a-0 IL As— Built Plan 40 Bride Street Osterville Mass. . ,4y II Pre ored For: Louis Vinios Assessor's Mop: MAP: 116 PARCEL: 006 Baxter, Nye & Holmgren, Inc. Community Panel Numbers: 250001 0016D & 0018D Registered Professional F.I:R•M. Map Zone: A13 Engineers and Land Surveyors Plan Reference: B, N & H Inc. 81 X Pion. - Bridge Street Town Layout 812 Main Street Deed.Reference: Deed Book 17047 Page 64 Ostervilie, MA., 02655 g Phow — (508) 428-9131 Fax — (508)-428-3750 i Owner: Louis Vinios Job Number• 2003-054 Scale: 1" = 40' Date: July 28, 2003 IP FND . ffi(1L L�G�Nn — UkA I LIT ?rt-L L IA YL1R VI DAT11) - I- i S•U 4 w I TU Ta %TIZf-£T� o� W j W - IV.. TQ %CL47, �.� ���' Lr- o Inal TO L_FT a rp � (n -J pp i2' TT1 El LIAT ry�'`� ,iy' N 3Q' M S�[TIL 'TV\RV, w ° 0 • p m AD TO LURC-1kiMtr FLfLD B/DH FND � � Z G h n X 11L111BY113LE Ffk&K_ ;�°j '� i tiC S BRB/FND 9 IRON AXLE - � '� fkv Sz FOUND DECK =ti0 WMRM PIPER '` LANDING a ` UND • Op! o S!, CL D-BOX IP FND :\ PARCEL AREA 4V b!� Q� S�� 0 CB 27,0131 SQ. FT. �,�q��' \ 0.62t ACRES y� O 4 C2 OG \ IP FND / \` L LOCATION OF EXISTING \ / SEPTIC SYSTEM 05-08-2001 BRB/FND i± � A=160.'01 / R 1111 01 -0- / OF � I CERTIFY THAT t0 THE BEST OF MY KNOWLEDGE THE FOUNDATION SHOWN HEREON ��H kq_ IS IN COMPLIANCE WITH THE APPLICABLE BARNSTABLE ZONING DISTRICT SIDELINE AND SETBACK REQUIREMENTS, IS LOCATED IN RELATION TO THE MONUMENTS JO SHOWN, AND IS LOCATED WITHIN A SPECIAL FLOOD HAZARD AREA q N . 298 GIST GISTERED PROFESSIONAL LAND SURVEYOR DATE rfOHAL L µ J f _ ;i T 15 to M _ � s r`�'LeW S-Taw1C 4 i r�+� �/'' --_` '--•----• ter- .'• "�} � Z i� � '�l�r.,,� �,. -, h.�F �.:lir-. � ^"�*+�".�F..:�:awk't. - �a.C,� �• ',-�,(.,r- ��1�..- f..1 i�-'� ©� ��F'P�'>� ZOy�Kr h•�7�j aV.S_Tt GF.���t� r ��<Y.1 I��� •..a l�,J K ?. ��e�� ._.s ',s' / ® �D�' ok--_ .�� �•-MLd+I 1�.CR.S,L.!1� -�..) T�'r���1� J•.�'� � ��.:, �.. ��� ���`_ ;�Z �"��-' �4 -, LA �...mf'_ --•s• 'CTz'OOI,d_"tom-.e5►��.;.t�.,3, ,� CS ...__., .. .. ..._ _�. Y �„!` Z"�' t w�► "-" P.G tJ nl,_3 Z A 77 1 ti Z h- K_X =>-Z Lam_5 a i fy r7W . - - + � �4'�•� __.. _ � __._ 4 ,�T?+. '�-. `� j � A_`7�L� �9 l tea'*'t-l"�,�rt..,���1..�•�..1'J'l. Td 'E�14,;`�� ��'�aA.lj Lam'` ._..... _ .._,...,�,. ,,,� _._,..�.�,. _ � • .` "' G.C�l�t'C.`1' �� '�, tT t,i N'! 1,U C3 r,� +��a►+c ,, t14 4 t114 fv po m 1 77 7 1 IL t L tip fit_ >✓ra ic,P "Tb-r>E 3 t£� a ,br # ?a5 /-- 7 c�x04 n+ S"r'*A/ei Cir 2 L v 4. 3-1 ,k. ". ►•n R s` • N C� C?�E N !�j �J 1 I�-s 1�J+J(�1r4 '." f�1 'fit 'raw- � 2 79 �rA1✓�_ �ELow �E� tit•O - -t- ILeaching Area Requirements N WEST (BAY ST- � 1 5 BEDROOMS AT 110 GPD/BI=DROOM = 550 GPD B A P� II ADDITIONAL 50% FOR GARBAGE DISPOSAL N/F NICHOLAS A. ABRAHAM, ET UX. I 1 I PERC RATE _I _2- MIN. / INCH (CLASS 1 ) QRIDGE Sr \ O cL PLAN BOOK 96 PAGE 25 I LTAR = 0.74 GPD S.F. LITTLE I ISLAND LOCUS \ � I � MIN. LEACHING AREA OF S.A.S. : ' I 550 GPD/ 0.74 GPD/S.F. = 743 S.F. MIN. WEST BAY I IRON AXLE ' N/F JEFFREY CAMERON, ET UX. FOUND ' N/F E PROPOSED SYSTEM LEACHING GALLEYS _ _ PLAN BOOK T191 PAGE 37 I L BOTTOM : 12'x44' = 528 SF LOCUS MAP - �- - - CB/DH FND - - I PLAN BOc SIDEWALL: (12'+44')x2'x2' = 224 SF i TOTAL 752 SF SCALE 1 25,00 I S 50'17'31 E - ASSESSORS 16.27' 1 N 39'21'19" E - -261.46' TD - - - - _ N Design Schedule ELEVATION MAP 116 PARCEL 006 CB/DH FND 130.97' -CB/DH FND TOP OF FOUNDATION 12.0 RC & AP r HOMEMADE CB BENCHMARK MINIMUMS r '"� � �%- ' • W/IRON PIPE FINISHED CRAWL SPACE FLOOR 7.0 - ) CB DH ELEV. 8,-.a 4 NGVD FRONTAGE = 20 FOUND FINISHED GARAGE FLOOR 10.5 "A I w - WIDTH = 100' r,,. -, 9 SEWER INVERT AT FOUNDATION 10.5 ' ' x FRONT SETBACK = 20' r GARAGE SEWER INVERT INTO SEPTIC TANK 10.3 2 SEWER INVERT OUT OF SEPTIC LANK 10.0 '� r - ,•,� ,;' ,�� t -�, � : , �, --- SIDE SETBACKS 10' DISTRIBUTION BUILDING HEIGHT = 30 - -- ' SEWER INVERT INTO DISTRCB BOX 9 8 O� h REAR SETBACK 1 9- DH FND ,> -- `� -�- -- zo SEWER INVERT OUT OF DISTRIBUTION BOX 9.6 CO n C7 P L�• D SEWER INVERT INTO LEACHING `"YSTEM 9.5 G��O����Q : 'RQPCSED ,�,. BOTTOM OF LEACHING TRENCH _ 7.5 GENERAL NOTES �O 69 O`1- I I%;;< y GARAGE n WATER TABLE 2.5 ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE WITH ~",PROP ED 2' TITLE V OF THE STATE SANITARY CODE DATED MARCH 31, 1995 & ANY LOCAL RULES APPLICABLE. IVE C\ ANY CHANGE TO THIS PLAN MUST BE APPROVED IN WRITING BY THE I o \ VSTK S T a,,,, 1 s _ DESIGNING ENGINEER. w .g Ir ,C OD WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BACKFILLING, 1 `< L4 �' v� 12' _ NOTIFY THE ENGINEER & BOARD OF HEALTH AGENT FOR INSPECTION. I _ _o ; ;.1 s o FOUNDATION ELEVATION MUST BE CHECKED WHEN COMPLETED. FINISHED GRADE 1 z \ \ \ THESE ELEVATIONS MUST NOT BE CHANGED WITHOUT WRITTEN APPROVAL ...�� i 36 MAX.- 12 +IN. /\\/\\\\Ln \\/\\/\\/\\\\/\�//� ,\\\/� // / COMPACTED FILL BY THE DESIGNING ENGINEER. I 't f M PIPING TO BE 4 PVC. n� :.y I; j n 'PROPOSED r '� I o z � PEASTONE I DISPOSAL SYSTEM' \ n a ALL SANITARY D S OSAL S S E 1 cn w �_�: y Z HOUSE co r<. a ° EXCAVATE AND REPLACE ALL UNSUITABLE MATERIAL SURROUNDING THE R E R G Y s 30-5" Q ° ° 3/4" TO 1 1/2 " LEACHING FIELD FOR A DISTANCE OF 5', PER 310 CMR 15.255. s I rn DOUBLE ed 1 ' co � (7 /''�"�� 'I• `" ' .-f • ,' `..J ,•S O 3 1 °d --- ° ° WASHED STONE WITH TICLEAN SSAND,LOR REMOVED.PUMPED, LIDS DEMOLISHED AND FILLED KK . i �j.l. l ° I ,. I SECTION HOU-`E i`io. 51 1`'" i } %%; t '' DATUM: NGVD 00 �,, PROJECT BENCHMARK PK ELEV 7.96 LYI `° NO SCALE N/F MAXINE J. BORNSTEINCn fi Z 6 li t ti I v H CB/DH ELEV 8.14 MIN biUU � h p !y o FRAM �,I r •. CULTEC RECHAT""ER 330 0 v, � FLOOD ZONES Al (EL 11.0) r I}lJ.a r,;. )•`_F 41 F.I.R.M. PANEL 250001 0018 D ALL PIPES TO BE SCHEDULE 40 PVC DATED JULY 2, 1992 IQ LOCATION OF UNDERGROUND UTILITIES ARE APPROXIMATE AND BY THE APPROPRIATE � No i , ��� • SHOULD BE VERIFIED IN THE FIELD R_.._I xt 1 �p r - Y I f - UTILITY COMPANY PRIOR TO ANY CONSTRUCTION. .•. -� z" r JU i 3 h'. 3 - D ' w 1 i NF• 1 1 5' WASHED STO N/F DAVID B. CROSBY t ' I 1 • I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE PROPOSED HOUSE y " I PROPOSED I r.. :,''. SHOWN HEREON IS IN COMPLIANCE WITH THE APPLICABLE BARNSTABLE RESERVE I - , ZONING DISTRICT SIDELINE AND SETBACK REQUIREMENTS, IS \ 1 I - _ LOCATED IN RELATION TO THE MONUMNENTS SHOWN, AND IS 7 �� 60 TP #2 - - - - - -P -1 44, LOCATED WITHIN A SPECIAL FLOOD HAZARD AREA. O 1 I.- -- THIS PLAN IS NOT TO BE RECORDED NOR IS IT TO BE USED TO ESTABLISH PROPERTY-LINES. � --> >• � ' �' � _-._- z o N E A 1 3 , PLAN OF LEACH CHAMBERS O O 1 I PARCEL 2 (EL 11) ti - a 1 - I s- 2 a o 1 1 27,014 S. F-". NO SCALE 0.62 _Acres t REGISTER D PROFESSIONAL LAND SURVEYOR DATE �� I _ ; T 0 P O V ` 81.83' 137.50' DEED IP s E:RED'FND _ e 39'30'40" W 53, \ ----- -- ---------------------------------- -- POLE #4 � 40 BRIDGE STREET B R I D G E S T R E T 'b 1 ' Osterville, Massachusetts r PK/NL FND BENCHMARK ' �: PK ELEV. 7.96 NGVD :'ts 662.97' PREPARED FOR Id 39'30'40" E o1 - s �� � .,; ,� Robert Moran TITLE Sanitary Disposal System FINISHED GRADE = 11.0 TYPICAL SYSTEM P20FILE BAXTER, NYE & HOLMGREN, INC, BAXTER NYE & HOLMGREN INC. NOT TO SCALE SOIL LOGS `E'61`i TOP of DATE:OCf. 12,2000 > > FOUNDATION = 12.0 ENGINEER: BOARD OF HEALTH AGENT: Registered Professional sTEPHEN WILSON DONNA MORANDI Engineers and Land Surveyors FINISHED GRADE OVER TANK = 10.8 FINIS,r=D GRADE OVER D. BOX = 10.8 FINISHED GRADE OVER LEACHING TRENCH = 10.5 TEST PIT 1 TEST PIT 2 812 Main Street, 0sterville, MA 02655 8"MIN. 3" (mi . 4" SCH. 40 PVC FIRST 2' (TO BE LEVEL) G.S.E. = 9.5 G.S.E. = 9.8 Phone - (508)428-9131 Fax - (508)428-3750 (TYPICAL) 4" SCH. 40 PVC 12" (min) Cover 2 min 36" (max) Cover 0 0 PVC or 10" Cl TEES P P GAS BAFFLE 6" SUMP 4' SCH. 40 PVC SANDY LOAM SANDY LOAM FINISHED � CONSTRUCT ACCESS j 2"Layer 1/8"tot/2" 10 YR 10/4 10 YR 3/3 0' 20' 40' 60' CRAWL MANHOLE OVER INLET T.._( Peostone LEACHING CHAMBERS 10" g" SPACE = 7.0 TO TANK TO AT LEAST _.. WITHIN 6" FINISH GRA L,�. Slope = 0.005 min 6" CRUSHED REINFORCED CONCRET _. . B B STONE FOOTING 4" PVC • O • O • O • O O • O SANDY LOAM SANDY LOAM SCALE:1 "=20' DATE: 01/15/2001 O O O O O O O O O O O 10 YR 4/4 10 YR 5/6 O O O O O O O O O O O 21" 20" REV. DATE: REMARKS BOTTOM ELEV. = 7.5 C C NOTE: OBSERVED GROUND WATER MEDIUM TO COARSE SAND MEDIUM TO COARSE SAND col 1500 GALLON SEPTIC TANK _ DISTRIBUTION BOX 5' MIN FROM OBSERVATION WELL AT 53 10 YR 6/7 10 YR 6/4 TO BE INSTALLED ON A LEVEL STABLE BASE r0 BE���ISTALLED ON A LEVEL STABLE BASE BRIDGE STREET, ELEV. 2.4 120" 120" SEPTIC TANK 70 BE INSPECTED & CLEANED ANNUALLY 3 OUTLETS REQUIRED � Groundwater Observed � EL �.5 (PERMIT # 2000-487) DRAWING NUMBER WATER ENCOUNTERED WATER ENCOUNTERED H: 2000 2000-68 SURVEY worksht 200068se .dW PERC @ 84" PERC © 96" ELEV 2.5 ELEV 1.8 JOB 2000-68