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HomeMy WebLinkAbout0101 BRIDGE STREET UNIT #A - Health 101 Bridge Street a' Osterville P 411111,� A 093 033 - „ u 5 k , ° ^ Y E �r I TOWN OF BARNSTABLE L._OCATION / 0 -,( g-e Sir e e I SEWAGE# VILLAGE 0 s i er v j /1 P ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. To L S12 r T I C SEPTIC TANK CAPACITY f S"0 O LEACHING FACILITY:(type) C A P'Y7 f3 e-7 P S (size) NO.OF BEDROOMS OWNER T v i1 PERMIT DATE: COMPLIANCE DATE: IrV V I Separation Distance Betwe n 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 �J o OT 00 At (312 /3 )L 7-f- ►:: ' J TOWN OF BARNSTABLE f� L&ATION 101 I3r► �qe. Sl SEWAGE# VILLAGE 0 ST-efyi ASSESSOR'S MAP&LOT 09*3 033 INSTALLER'S NAME&PHONE NO. �I�:iEPTIC TANK CAPACITY SOM 4016 (type) (size) LEiACHING FACILITY: �' G/JIIGys' '`NOi OF BEDROOMS —t-� BUILDER OR OWNER t^JJ 'O/Y 0 YAC,I••1 G iu� 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 leachi�]8 facility) Feet ` Furnished by 7i1 TQftG a 3I 30 �rOAr . A't � �`�� Coves 'T'b S.,AJt. No. 00� 2_. L Fee. Uv THE COMMONWEALTH OF MASSACH SETTS Entered in computer.: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes !application for ]Disposal Opstem Construction Permit Application for a Permit to Construct( ) Repair(4--Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No./ �j^p i2t�' STrr'C'?' Owner's Name,Address,an el.No. / Assessor's Map/Parcel 93— -5 OSrrYYifl� { 64-Yoc Imtaller's Name,Address,and Tel.NosY/$'4/XIO•-Q'73g Des64</i er's Name,Address,and T 1.No. ✓OS•�j�'��J-G�j�/�.S' � �c,� Type of Building: Dwelling No.of Bedrooms Lot Size kC^e/ sq.ft. Garbage Grinder( ) Other Type of Building QQ)'�f�e�1 ti f No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.req sired �0 gpd Design flow provided gpd Plan Date Number of sheets ,Z Revision Date j 114 Title Size of Septic Tank S UJ Type of S.A.S. 2 Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o Health. Signed � Date Application Approved by 1441.2 Date t l Application Disapproved by Date for the following reasons Permit No. �Q s /) Date Issued v l �ej Fee UV THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: r PUBLIC HEALTH DIVISION - TOWN OF BXRNSTABLE, MASSACHUSETTS Yes Application for -isposal 6pstern Construction Permit t Application for a Permit to Construct( ) Repair(lXUpgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No./ ��"/ (�'F svrr,g/ �' Owner's Name',Address,and Tel.No. / QSTGi Yi/�„� ..�.; S!9/ ��G/C6AT/bN �p(/NA1471 Ut'T Assessor's Map/Parcel '7 33 t In taller's Name,Address,and Tel.No.�I' -41.2,4 3g Designer's Name,Address,and Tel.No. 7as��h d�1,� �s 1471 ��prS'�/ot�c Lcc l .� r'-Ie al-Srati � -2 uri sr 17 v Type of Building: �J Dwelling No.of Bedrooms /'"' Lot Size ?J H c rrt sq.ft. Garbage Grinder( ) Other ; Type of Building Do /1 Fn a J No.of Persons Showers( ) Cafeteria( ) —, Other Fixtures I Design Flow(min.req fired) a D gpd Design flow provided �`/ gpd -Plan Date �� (o Number of sheets Revision Date r I Title / J Size of Septic Tank S UJ Type of S.A.S. .� < .��, he CC X Description of Soil AAA s Nature of Repa'rs or Alterations(Answer when applicable) , 9 121/4,�7 i ya . Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o Health. Signed ,.c `�% � Date Application Approved by l Date I f Application Disapproved by Date for the following reasons Permit No. a o I !-j Date Issued t( L/ 7 / THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO FERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded Abandoned( .)by 45-GPol 12G ,a r vw_ ' at t//j/ 6 / .has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. . . p/ . - �J tdated I InstallerJAy.e lj /�!! S144'`0_5 Designer #bedrooms Approved design flow '),) o gpd The issuance of this permi shall not be construed as a guarantee that the system will nctio desigried1l. Date �� Inspector t ' --------------------------------------------------------------------------------------------------------------------------------------- No. + b qV 1 Fee Ivy THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal *- pstrm Construction permit Permission is hereby granted to Construct( ) Repair Upgrade Abandon( ) System located at l Ql , and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date ► / Approved by I l V Town of Barnstable Regulatory Services Richard V. Scali,Interim Director snnxsrnsBt�. � Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Desi ner Certification Form Date:-- Sewage Permit# 211A q Assessor's Ma \Parcel �3 3 g P Designer: �� C-(%l .� I)Staller: Address: ��r _" __ Address: On was issued a permit to install a (date) (installer) septic system at /Ul �r� -� S �f�d�f� based on a design drawn by (address) ,�n /r`G dated , I (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. s 4 I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the r of the I\A approval letters (if applicable) ; , v`.. �sVA o` Mgss (I staller's Signature) cCn 4 ]d 6 14'..5 224kA \q�' 1."•` .., 'SST No�P4 (Degilne-Ols Signature) (Affix Desigi erN.Stamp`Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 101 BRIDGE STREET —'+ Property Address Wianno Yacht Club Owner information is Owner's Name •equired for every page. s Osterville✓ MA 02655 10/24/16 Cityrrown 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 filling A. General Information 9U 0 gut forms on the -omputer,use only the tab key to move your 1. Inspector: -ursor-do not use the •etum key. Robert Paolini Name of Inspector Robert Paolini Septic Service Company Name n� 17 Playground Lane Company Address Yarmouthport MA 02675 Cityrrown State Zip Code 508 362-3555 S14454 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: M Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Furt er Evaluation by the Local Approving Authority -� 10/24/16 Inspector's Signatur -" Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 ,(a �S Commonwealth of Massachusetts i Title '5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 BRIDGE STREET Property Address Wianno Yacht Club Owner information is Owner's Name •equired for every page. Osterville MA 02655 10/24/16 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: ❑x 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. 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-3113 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 BRIDGE STREET . Property Address Wianno Yacht Club Owner information is Owner's Name ,equired for every page. Osterville MA 02655 10/24/16 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(cunt.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form: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 101 BRIDGE STREET lug Property Address Wianno Yacht Club Owner information is Owner's Name •equired for every page. Osterville MA 02655 10/24/16 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: . ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ 0 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 0 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ 0 Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 BRIDGE STREET Property Address Wianno Yacht Club Owner information is Owner's Name j equired for every page. Osterville MA 02655 10/24/16 City/Town State Zip Code Date of Inspection B. Certification (cunt.) Yes No ❑ ❑x Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ❑x Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ❑x Any portion of a cesspool or privy is within 50 feet of a private water supply well.. ❑ ❑x Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for 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.] ❑ 0 The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ El The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes" to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 BRIDGE STREET Property Address Wianno Yacht Club Owner information is Owner's Name •equired for every page. Osterville MA 02655 10/24/16 Cityrrown 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 ❑x ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ❑x Were any of the system components pumped out in the previous two weeks? ❑ ❑x Has the system received normal flows in the previous two week period? ❑ FX-] 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) ❑x ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑x ❑ Was the site inspected for signs of break out? ❑x ❑ Were all system components, excluding the SAS, located on site? ❑x ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ 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: ❑x ❑ 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): 4 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5in3•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 BRIDGE STREET Property Address Wianno Yacht Club Owner information is Owner's Name equired for every page. Osterville MA 02655 10/24/16 Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: na Does residence have a garbage grinder? ❑ Yes R No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes 0 No information in this report.) Laundry system inspected? O Yes ❑ No Seasonal use? ❑x Yes ❑ No Water meter readings, if available last 2 ears usage d na 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ❑x No Last date of occupancy: NA Date Commercial/Industrial Flow Conditions: Type of Establishment: clubhouse Design flow(based on 310 CMR 15.203): 440Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): 3256 Grease trap present? ❑ Yes 0 No Industrial waste holding tank present? ❑ Yes 0 No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑x No Water meter readings, if available: na t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 17 I <.n Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 BRIDGE STREET Property Address Wianno Yacht Club Owner information is Owner's Name •equired for every page. Osterville MA 02655 10/24/16 Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 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 ❑x No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: x❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract p Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Ttle 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 101 BRIDGE STREET Property Address Wianno Yacht Club Dwner information is Owner's Name •equired for every page. Osteryille MA 02655 10/24/16 Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes 0 No Building Sewer(locate on site plan): Depth below grade: 1' feet Material of construction: ❑cast iron 0 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.): Joints appear tight No evidence of Ieakage.System vented through the building vents. Septic Tank(locate on site plan): Depth below grade: 1.5' feet Material of construction: 0 concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Sludge depth: 3" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form u Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 BRIDGE STREET ,p Property Address Wianno Yacht Club Dwner information is Owner's Name •equired for every page. Osterville MA 02655 10/24/16 Citylrown State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 43" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 811 Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every 2 years.Inlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. 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 Title 5 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 101 BRIDGE STREET Property Address Wianno Yacht Club Owner information is Owner's Name equired for every page. Clsterville MA 02655 10/24/16 City/Town State Zip Code Date of Inspection D. System Information (cunt.) 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 BRIDGE STREET Property Address Wianno Yacht Club Dwner information is Owner's Name equired for every page. Osterville MA 02655 10/24/16 Cityfrown 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 No 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.): Bow is Ievel.Box has one outlet Iaterals.No evidence of Ieakagge.No evidence of solids carryover. 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: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 BRIDGE STREET Property Address Wianno Yacht Club Owner information is Owner's Name •equired for every page. Osteryllle MA 02655 10/24/16 Citylrown State Zip Code Date of Inspection D. System Information (cunt.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑x leaching galleries number: 4 galleys 12x20 ❑ 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.): Sandy soil.No signs of hydraulic failure. 6"of water in galleys at time of inspection. 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 Tile 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 •''�� 101 BRIDGE STREET Property Address Wianno Yacht Club Owner information is Owner's Name •equired for every page. Osteryiille MA 02655 10/24/16 Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 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 101 BRIDGE STREET Property Address Wianno Yacht Club ° Owner information is Owner's Name equired for every page. Osterville MA 02655 10/24/16 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 31 8 A l l sn'J cover �s g�h ° 1 of 1 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 BRIDGE STREET Property Address Wianno Yacht Club Owner information is Owner's Name •equired for every page. Osterville MA 02655 10/24/16 Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ❑X Check Slope n Surface water ❑ Check cellar. ❑ Shallow wells Estimated depth to high ground water: Bottom of leaching 4' 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: As-Built ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS observation well data.USED:Technical bulletin 92-0001 annual ranges of groundwater elevations. 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 BRIDGE STREET Property Address Wianno Yacht Club Owner information is Owner's Name •equired for every page. Osterville MA 02655 10/24/16 Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ❑x Inspection Summary: A, B, C, D, or E checked ❑x Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ❑x System Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file N w I t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of Barnstable P 4t t�J gyp' Department of Regulatory Services BMWSUBM : Public Health Division Date >, �OTeucc��°$ 200,Main Street,Hyannis MA 02601;� Date Scheduled ' • Time Fee Pd. /C� 4_..r, C,/�la' . Soil Suitability Assessment for Se ge Dispo al Performed By: Witnessed By: ��(/ �1/, 2 LOCATION& GENERAL INFORMATION Location Address Owner's Name W IAA/NC C-6 101`- �r I �cJ a �p ���Y�'{- Po I'3c�x 9 2�{q � Address �S�r�r1tl� AM.0.Z65'S, Assessor's Map/Parcel. q'b 1.31 ` _-.Engineer's Name -jGe,t 1t1G G 4^W 4' NEW CONSTRUCTION REPAIR V✓ , -,Telephone 588 Land Use _ t° slopes(90) .1 Surface Stones `r r Distances from: Open Water Body -11>0 --ft possible Wet Area ft. Drinking Water Well {t Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 4. LJ t I �, - I Ti P z 50 - t Parent material(geologic)6wfl5 Depth to Bedrock u Depth to Groundwater: Standing Water in Hole:_��IJ� Q6 Weeping from Pit Race_ 1 Estimated Seasonal High Groundwater jal DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottle.s: in. Depth to weeping from side of obs.hole: in, Groundwater AdJustment fI. Index Well# Reading Date:_ Index Well level_. , Adj,factor Adj.Groundwater level PERCOLATION TEST . bate x'tme 'U Observation Hole# Depth of Perc 5y" Time at 6" " start,Pre-scakTime @ 'R'^� ,. Js1.�2.� Time(9"•6") End Pre-soak Rate MinJInch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) , Original: Public Health Division' a Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one (1) week prior to beginning. Q:\SEPTIOPERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency,% ravel P-3 'S SAIJC4 a R614, �o N6-I!D 14,e . ZtAtJ DEEP OBSERVATION HOLE LOG Hole#_ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) 'Mottling (Structure,Stones,Boulders. Consistency,% ravel a-l Sk a Q 3 L � 6 3 o 6se DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) k DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%GrayeI Flood Insurance Rate Map: Above 500 year flood boundary No_ 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 � 4.. area proposed for the soil absorption system? --- If not,what is the depth of naturally occurring pervious material? Certification " I certify that on � a (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,p)xperfisoand experience described in 310 CMR 15=017. Signature Date Q:\.S.EPTIOPERCFORM.DOC l 9c) COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS lugDEPARTMENTIOF ENVIRONMENTAL PROTECTION ' ALL D ti 2004 [JAN `N OF BH, �,;,E EALThi D�r'T, TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 101 Bridge Street CHAP Osterville, MA 02655 PARCEL, Owner's Name: Wianno Yacht Club LOT Owner's Address: Date of Inspection: December 21, 2003 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Ostervi!!e,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 Fail Inspector's Signature: Date: January 3, 2004 The system inspector shall 4submiaof 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: 101 Bridge Street Osterville, MA Owner: Wianno Yacht Club Date of Inspection: December 21, 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: C 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: 101 Bridge Street Osterville, MA Owner: Wianno Yacht Club Date of Inspection: December 21, 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(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "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: I 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 101 Bridge Street Osterville, AM Owner: Wianno Yacht Club Date of Inspection: December 21, 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 M 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: 101 Bridge Street Osterville, AM Owner: Wianno Yacht Club Date of Inspection: December 21, 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)]. I 5 f Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 101 Bridge Street Osterville, AM Owner: Wianno Yacht Club Date of Inspection: December 21, 2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system (yes or no): [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use(yes or no): Water meter readings, if available(last 2 years usage(gpd)): Sump Pump(yes or no): Last date of occupancy: COMMERCIALANDUSTRIAL Type of establishment: Yacht club Design flow(based on 310 CMR 15.203): -- gpd Basis of design flow(seats/persons/sgft,etc.): -- Grease trap present(yes or no): No Industrial waste holding tank present(yes or no) No Non-sanitary waste discharged to the Title 5 system (yes or no): No Water meter readings, if available: Unavailable Last date of occupancy/use: Summer 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: Installed Jun. 14190-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: 101 Bridge Street Osterville, AM Owner: Wianno Yacht Club Date of Inspection: December 21, 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: 12" 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. H-20 Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: S" 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: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. There did not appear to be any signs of leakage. The inlet cover(steel)was to grade. 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 I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 101 Bridge Street Osterville, MA Owner: Wianno Yacht Club Date of Inspection: December 21, 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: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box,etc.): The D-box was level. No solids were present. r 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 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 101 Bridge Street Osterville, MA Owner: Wianno Yacht Club Date of Inspection: December 21, 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: ✓ leaching galleries,number: 4- 12'x 20'(per as built card) 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 galleys were dry and the insides were clean. There did not appear to be any signs of failure. The bottom to grade was S' The steel cover was to grade. x: CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth -top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.): I 9 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 101 Bridge Street Osterville, AM Owner: Wianno Yacht Club Date of Inspection: December 21, 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. a 31 3o A g 0" 1 A I D STwI C Omn'i1 Tb 5�acic, 10 f Page 11 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 101 Bridge Street Osterville, AM Owner: Wianno Yacht Club Date of Inspection: December 21, 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: ✓ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: The bottom of the galleys to grade was 5'. 1 hand au-aered down on the bottom to 7.5'below grade and no water was observed There is no hi-ah-around water adjustment at this site due to the distance to a tidal bay. 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 TOWN OF BARNSTABLE LOCATION /4,i f ��St �� SEWAGE # VILLAGE ASSESSOR'S MAP & LOT ®13 OR- INSTALLER'S NAME PHONE NO.AQ / / -S 1.3 41�' �' SEPTIC TANK CAPACITY/---y 6 LEACHING FACILITY:(type)c�() �A�/�Y1 (size) a NO. OF BEDROOMS ! PRIVATE WELL OR PUBLIC WATER,;�ug/� BUILDER OR OWNER /v!� DATE PERMIT ISSUED: /S DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No c/ a Gv�� w,� � 'a0 9_3 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH i.. .................. .! l .!ar..ti� Lt---..-................._.............. Allp irFa#iun for Uiipuua1 urk,i C�ualutrurtiun ranfit Application is hereby made for a Permit to Construct ( ) or Repair (�) an Individual Sewage Disposal System at: ...............................................................................•-••. Loc ti Address . LuB •101 �2 . . ...o.r...L_.o J�ZIo..: LL............ ....... .........7------ Owner Address W / Installer Address 1 7 � �C Type of Building Size Lot.......:....................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder �) Other—Type of Building _-- C«� No. of persons............................ Showers Cafeteria �) p' Other fixtures _________________________________ _ W Design Flow............................................gallons per person per day, Total daily flow...... .700.__...._._.............._gallons/-P� ( WSeptic Ta k—Liquid capacitv►5W_..gallons Length-_tiJ0:::.Q. Width._. '. Diameter___________----- Depth..S._ x DisposaLIrench—No..................... Width..... �c..._...... Total Length_____r's. ....... Total leaching area__'4 ?_.....sq. ft. Seepage Pit No____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Other Distribution box (�) Dosing_tank (1 z , \ Percolation Test Results Performed by.__ irk"L ��- __I�}`�-S ._� C............. Date... _' ......... Test Pit No. I_..Az.....minutes per inch Depth of Test Pit... .t3......_... Depth to ground water...`-'i----.-----. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water................_....... P4 ------------•--------------------------•-------.---- -•--••--............---------•- ---•-------......................................................... O Description of Soil...0-`-..... .....--C—0 LS4 I—�D U ------......•--------------------------'---------------------------'--...--'---------------------......-----------------------------------...... W x ------------------------------ ................... ...................................................... -•------------------------•----------------------------------------------------------••------- U Nature of Repairs or Alterations—Answer when applicable_________________________________________________________________________________.------.-.-__. ---------------------------------------•--------•----------------------------------........._'----------•-----------••-•--•-•••-----------------••-----••-•------••••••-••---•----------•._............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia ce has been issue - y the boar f he lth. Signed<' -. ------- - .... --------------- --------------------------------- ---- "ate ZP Application Approved By = -G �'" �� .. Dace Application Disapproved for the following reasons: ........................................................ ....... ........................... . ate-------------- ........................ ......... .................................................................. ....... .. .... .. ..... ... .. .. ... .......... ....................... ....................................... Date Permit No. ........... .r' /�------------------------ Issued ---....�....�� �.� --- - -- -- --------- -- ----------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OV.I.!�...................OF !i��h.��..1-�....i3.L.,F..................................... Appliration for Disposal Works Tonstrnrfion 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair (}() an Individual Sewage Disposal System at: !� Locatio -A dr Adr or Lop-No. lot Owner •Address W a ----•.................•-••---- --......•-•---.. _.._.._......:..............------....---*- -•••r'-----^-•-------•_..._,.._....••••--_......____..._•-•---p^-••----•--•-----.....,-•-•---- Installer Address 9 y p QType of Building Size Lot...._t_._-_.t___l'_-------------str: mq Dwelling—No. of Bedrooms............................................Expansion Attic ('') Garbage Grinder (�) Other—Type of Building Gj ` No. of persons............................ Showers (-'") — Cafeteria (— ) Q' Other fixtures --------------- •--•---•------• . W Design Flow............................................gallons per person per day; Total daily flow........f ___............_.._......g_allonns f�,° 1 9 Sufic T-aZnk—Liquid capacity-�_��_._...gallons Length--.).Q. _�? Width....`a J� Diameter__.""____- De�Pth_.. 1 DispblvHrench—No. .................... Width.....'(-,..____._.. Total Length.......-_.-�_....._ Total leaching area---:'�tJ-�.....sq. ft. Seepage Pit No..................... Diameter------------------_ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (\/) Dosing lank (log IH -� Percolation Test Results Performed bY___5 �.�_.._�_.. ��'....z 1___ .............. Date...___ _'Z6 .___:_9 ..______.. Test Pit No. I____4.Z------minutes per inch Depth of Test Pit-- ' .......... Depth to ground water. .`.__l........._. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -••-••- -----• - - - - ...... 0 Description of Soil...Q- ............................. . ... ..................... -------------- x x ------------------------------------------------ -------•--------------------------------------------------------------------------------------------------------------------••-•-•-•••••-------•---••-- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -------•---•----------•--------•-----•---•---•-•----•••-----•------•-----•---•---------------•----••--•-•-••----••-••-•--•----__..-._.._.....------------------........................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia ce has been issue -by the boar of a alth y. S>gn - .... .............. • Date c Application Approved By ------------- ................................................... - . Date Application Disapproved for the following reasons: .......... .... ................. ........................... .. .... -------------------------- ----------------------------------------------------------------------------------- -- -- ------ - ------- ---------------------------------------- -- ---------------------------------- ---------------------------------------- • Date Permit No. �' �1.............................................. Issued ....... ............, . Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ®4WN................ OF ........................................................ C�e>rttftcttte of C�ontylia re THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ......................................................----------- ------------ ---------------------- ------ -------------------------------------------------------- Installer at --------------------------------------------------------------------------------------------------------------------------- --- -------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE,5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..� .----- -#. Z.......... dated .... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT HE SYSTEM WILL FUNCTION SATISFACTORY. DATE . ... ...................................................... ...... .... ............. .... Inspector .................------------------------------------ ---------. ---- ------- -------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH vr..............OF... ...... ................'"...... ............. .................. � No..............° .._� FEE.r ...:. ;Disposal Works Tonotr ion- amif Permission is hereby granted-------------------- ' -------------------------------------.--------------------------------..... .................... to Construct ( ) or Repair ( 4'Tan Individual Sewage Disposal System � Street' . as shown on the application for Disposal Works Construction Permit �1 "�' _ Dated..... �----- _ ------------------ .. ................... _ Board of,Health DATE---------------1�---- d�--'l.'.��...................................... . -------a----------- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS THE ro�o TOWN OF BARNSTABLE OFFICE OF DsaslTAIM i BOARD OF HEALTH rnr k�e� 367 MAIN STREET HYANNIS, MASS.02601 i June 18, 1990 Peter Sullivan Baxter & Nye, Inc. 7 Parker Road Osterville, Ma 02655 Dear Mr. Sullivan: You are granted permission, on behalf of your client, Wianno Yacht Club, to install a replacement onsite sewage disposal system at Bridge Street, Osterville, listed as parcel 33 on Assessor's Map 93. The permission is granted because no variances are needed from any State or local health regulations. Also, the existing cesspool appears to be located in close proximity to groundwater. Therefore, the replacement system may alleviate a source of pollution. Very tru ours, Grover C. M. Farrish, M.D. Chairman BOARD OF HEALTH TOWN OF BARNSTABLE GF/bs d TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ID 093 Parcel =_ 033 Permit# Health Division ,,�r. Date Issued Conservation Division Fee Tax Collector Treasurer SEPTIC:YSTEri 1 FOU T U Planning Dept. INSTALLED IN COMPLIANC" Date Definitive Plan Approved by Planning Board WITH TITLE 5 WITH CODE AND Historic-OKH Preservation/Hyannis TOWN REGULATIONS Project Street Address 101 Bridge Street Village Osterville, Massachusetts 02655 Owner WIANNO YACHT CLUB (TEL: 508-428-2232) Address Same as above Telephone Rotary Club of Osterville/ contact, Robert J. Smith, Jr. (508) 428-9700 Permit Request The tent will be used the afternoon and evening of Saturday, 13 July 2002 for the shelter auction/supper of Osterville Rotary Club's annual FISHING.TOURNAME;NT. The. dimensions of the tent are: 32' z 60' Sperry Pole Tent. UP: 12 July 2002 DOWN: I Jul y 2002, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 0 Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: 0 Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Easement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric 0 Other Central Air: 0 Yes 0 No Fireplaces:Existing New Existing wood/coal stove: ❑Yes O No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attachedrgarage:❑existing-O new size Shed:❑existing 0,new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ CommercL ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �oFIMEA� 'Town of Barnstable 1 � 39. REGULATORY SERVICES CMS. i63q. ♦0 PTFD MA'S A PUBLIC HEALTH DIVISION l MAIL TO:TOWN OF BARNSTABLE ` PUBLIC HEALTH DIVISION 367 MAIN STREET P.O.BOX 534 HYANNIS,MA 02601 PLEASE INCLUDE A CHECK FOR S20.00 DOLLARS AND A COPY OF YOUR FOOD SANITATION TRAINING (E.G.ServSafe)CERTIFICATE APPLICATION FOR TEMPORARY FOOD SERVICE PERMIT DATE March 26, 2002 NAME OF SPECIAL EVENT Rotary Club of Osterville I s --Annual is ins ournamen NAME OF PERSON(S)REQUESTING PERMIT Robert J. Smith, Jr. Tournament Committee TELEPHONE# (508) 428-9700 727 Main Street, Apt. F-1 Osterville, MA 02655 HOME ADDRESS VILLAGE Rotary u o s erville ecre ary: NAME OF ORGANIZATION TELEPHONE Bob Smith: .(508) 428-9700 ADDRESS Post Office Box #705, Osterville, MA 02655 Hot dogs, hamburgers, condiments, potato chips, FOOD TO BE SERVED(LIST EXACT FOODS)_m ,i �i 71 e. chi e , o� agusages, water- melon, a;kan gri 71 d melon, cookies NAMES OF TRAINED FOOD HANDLERS (ATTACH COPIES OF CERTIFICATES) Wianno Yacht C1ub/101 Bridge Street ADDRESS WHERE TO BE SERVED Osterville, MA 02655 Saturday, 13 July 2002 none DATE TO BE SERVED RAIN DATE Heavily-insulated ice chests HOW WILL FOOD BE KEPT BELOW 45 DEGREES F HOW IS FOOD COVERED In ice chests, SARAN wrap, metal foil HOW IS FOOD SERVED With spoons, tongs, etc!. Hamburgers wi a spatula Men and women's separate bathrooms in Club House TYPE OF HAND-WASHING FACILITY Hand—washing sink in Club House kitchen (all available both before, during, and after supper) (SIGNATURE OV AP ANT) a i Q/I-IEA.LTH/W PF'ILES/TE YIPFOO D Existing N33°47'40"E 330't o --------o North OSTERVILLE 101 Cesspool �.--�'O�- ---"_" Bay MA .5 $ See Noe#19 I Two Bedroom Unit n�� . 12 Bat Sill El 11.8 .. W.Bay R C STONE ACCESS DRIVE (e� 10 CONC.RA _ ....� 10.1' 5T 1 �i + LL 210't toTop of Ban 9.Q 11.5•, ° O 12.3 t Q '--- 12.1 eS � ublic _ B.0 grJ9 Landing � LOTUS y 000 242.s,11 M.H.W, ."r-" 8.1 11.0 o -7'� - Paved D/w West Bay ,a ' DOCK o • ..`� \ TP Gravel Parking Area. 'SITE LOCUS 0 226'#to Top of Bank BENCHMARK: ® e TOP OF CORNER STEP 12.3 pg NOTTO SCALE o ` 6 EL.= 11.87 Q o 'T 6ZT LEGEND o O G.' W . p �q� °- .° 11.2 g, Q O °'`�'Fa 1.. w. 32' a` 12.3 EXISTING SPOT GRADE ©° e�ly4 1i.3 3.3 5A5 ?i Vi 24x5 PROPOSED SPOT GRADE Lawn Area. 9.2 w+ - 10 -- EXISTING CONTOUR Po S -24 - PROPOSED CONTOUR 11 FENCE WOOD FRAMETP Gravel Parking Area W TEST HOLE LOCATION BUILDING 1 SEPTICTANK TOF 1 S.3t \ 8 7. � ST Lot 3 '� - � / DB DISTRIBUTION BOX ,�� 10.5 f SAS SOIL ABSORPTION SYSTEM ° 1.73$ Ac's oP � hoc Uj 0 0. 12.7 Q i / C3F °® W------- ° EXISTING 1500 GAL. o SEPTICTANK O 1 1.2 IS FF � ®Q APPROX.LOCATION OF o 1.5 0 EXISTING LEACH CHAMBERS -�.Q `rTl I �t-lir-llo 19.4- S33047'40"W 350,22' o 12 10 10 12 Bridge Street Proposed Sewage Disposal.System . _ � -. ,.,1 Assessors Map 117 101 Bridge Street INSPECTION NOTE. Bdr 1 Kit SH H Bdr2 Parcel120 Oste9 ille, MA PRIORTO FINAL INSPECTION BYTHE ENGINEER,SYSTEM NEEDSTO BE COMPLETE INCLUDING BUILDUP FOR COVERS. Prepared for:dt p WYC Sailing Education Foundation 1.)Assessor's Map 93 Parcel 33 Mashpee, MA 2.)Sk 29249 Pg 143 FLOOR PLAN . Prepared by: 3.)PI Bk 22 Pg 19 N.T.S. GRAPHIC SCALE 4.)This property is not in a 30. a 15 so � 120 All Cape Septic LLC Zone II of a Public Water Supply 618 Route 28 5.)Flood Zone:AE EL 12 West Yarmouth, MA 02673 Flood Zone:VE-Velocity Zone FL.Map 25001 C0757J Dated July 16,2014 (IN FEET) (508)771-4200 Email allcapeseptic@gmail.com 1 inch=30 ft. Date:8/11/16 Sheet 1 of 2 By:MA Ch SM Project No.AC-15 Rev.Date:os/3o/16 Chance SAS.Design Cafes Rev.Date:11/10/16 Revised Scale CONSTRUCTION NOTES TOP OF FOUNDATION 220"DIAMETER CONCRETE COVERS EL=11.8± RAISEDTO WITHIN 6"OF FINISH 1.)ALL WORK SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE,TITLE 5(310 CMR 15.000): GRADE(OR AS NOTED) STANDARD REQUIREMENTS FOR THE SITING,CONSTRUCTION,INSPECTION,UPGRADE,AND a •C.O. EXPANSION OF ON-SITE SEWAGE TREATMENT AND DISPOSAL SYSTEMS AND FOR THE TRANSPORT EL-1 t.5t E1m12.1 t El=t 2.3� El=t 1.7t AND DISPOSAL OF SEPTAGE,ANDTHE LOCAL BOARD OF HEALTH REGULATIONS. ; 2.) ANY SEPTIC SYSTEM COMPONENT INSTALLED IN A LOCATION WHERE THERE IS POTENTIAL FOR VEHICLES OR HEAVY EQUIPMENT TO PASS OVER IT SHALL BE DESIGNEDTO WITHSTAND AN•H-20 LOADING. IF UNDER AN IMPERVIOUS SURFACE,SYSTEM SHALL BE VENTEDTO THE ATMOSPHERE 10.5* 8.9, GEOTEXTILE FABRIC 3.)TO MINIMIZE UNEVEN SETTLING,SEPTIC TANK AND D-BOX SHALL BE INSTALLED ON A STABLE (IN PLACE OF 1/4"-1/2"PEASTONE) MECHANICALLY-COMPACTED BASE ON SIX INCHES OF CRUSHED STONE. 70 rn 4.)COVERS OVER THE INLET AND OUTLETTEES OF THE SEPTIC TANK,THE DISTRIBUTION BOX,AND THE SOIL ABSORPTION SYSTEM SHALL BE RAISED TO WITHIN W OF FINAL GRADE. LEACHING 10 3 9,32 g 07° 8.67 8.S as ;� 3/4"to FIELDS,TRENCHES,AND OTHER SOIL ABSORPTION SYSTEMS WITHOUT ACCESS MANHOLES SHALL Prop.Min. A!, ' a t7.4 K s,x 1-1/2"STONE HAVE AT LEAST ONE(1)INSPECTION PORT CONSISTING OF PERFORATED 4"PVC PIPE PLACED Elevation & DB-3 "' ` -A VERTICALLYTO THE BOTTOM OF THE SOIL ABSORPTION SYSTEM WITH A CAP,TIED WITH MAGNETIC GAS BAFFLE H-20 Rated THREE(3)SHOREY PRECAST CONCRETE H-20 MARKINGTAPE,ACCESSIBLETO WITHIN 3"OF FINAL GRADE. ( _BOX LEACH CHAMBERS(08'x1.51)WITH 4'OF STONE ON 5.)PIPING SHALL CONSIST OF 4"SCHEDULE 40 PVC OR EQUIVALENT PIPE SHALL BE LAID ON A � ENDS AND SIDES 5 t' MINIMUM CONTINUOUS GRADE OF NOT LESS THAN2%FROMTHEBUILDINGTOTHESEPTICTANK, 46' ­4 SEPTIC TANK ��40, �� Langes�R�un LEACH CHAMBERS AND NOT LESS THAN 1%OTHERWISE. 6.)DISTRIBUTION LINES FOR THE SOIL ABSORPTION SYSTEM SHALL BE 4"DIAMETER SCHEDULE 4o 1500 GALLON •FLOW PROFILE (END VIEW) PVC(OR EQUIVALENT)LAID AT 0.005 FT/FT.UNLESS OTHERWISE NOTED.LINES SHALL BE CAPPED H-20 Rated NOT TO SCALE EL=2.3 Bottom Test Hole AT END OR AS NOTED, 7.)LINES FROM THE DISTRIBUTION BOX TO BE LEVEL FOR THE FIRST TWO(2)FEET BEFORE 4' 8,0' &0. 8.0' 4' PITCHINGTOTHE SOIL ABSORPTION SYSTEM, DISTRIBUTION BOX SHALL BE WATER TESTED TO, TEST HOLES ASSURE EVEN DISTRIBUTION. +.,. 8.)GROUT TO BE USED AT ALL POINTS WHERE PIPES ENTER OR LEAVE ALL CONCRETE STRUCTURES. tia ro LA a IN ORDER TO PROVIDE A WATERTIGHT SEAL k Test Hole#] (EL=12 3t) 11 9.)HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS OF THE SEWAGE Depth Elev. Layer Soil Class Soil Color• Comments k Chambers DISPOSAL FIELD DURING THE COURSE OF CONSTRUCTION OF THE SYSTEM. O ,tea 10.)IN ACCORDANCE WITH 310 CMR 15.221,ALL SYSTEM COMPONENTS SHALL BE MARKED WITH W-12" 11.3 A Sandy Loam 1 OYR 3/1 Friable 12"-36" 9.3 B Loamy Sand 1 OYR 5/6, Loose MAGNETIC MARKING TAPE �s= 36"-120" 2.3 C Medium Sand 2.SY 3/1 Loose 11.)THERE ARE NO KNOWN WELLS WITHIN 100'OF THE PROPOSED SOIL ABSORPTION SYSTEM. �y 12.)FROM THE DATE OF THE INSTALLATION OF THE SOIL ABSORPTION SYSTEM UNTIL RECEIPT OF THE CERTIFICATE OF COMPLIANCE,THE PERIMETER SHALL BE STAKED AND FLAGGEDTO PREVENT. Test Hole#2(EL=12,34 ' USE OF THE AREA THAT MAY CAUSE DAMAGE TO THE SYSTEM. D-Box 13.)THE DESIGNER WILL NOT BE RESPONSIBLE FOR THE SYSTEM AS DESIGNED UNLESS Depth Elev. Layer Sall Class Soil Color Comments CONSTRUCTED AS SHOWN ON PLAN. ANY CHANGES SHALL BE APPROVED IN WRITING BYTHE SYSTEM DE51G N CALCULATIONS DESIGNER, W-12" 10.7 A Sandy Loam 1 OYR 3/1 Friable. 12"43" 8.7 B Loamy Sand 1 OYR 5/6 Loose SEWAGE DESIGN FLOW REQUIRED:2 BEDROOM DWELLING 0 110 GPD!BEDROOM=220 GPD 14J THE BOARD OF HEALTH REQUIRES INSPECTION OF ALL CONSTRUCTION BY AN AGENT OF THE REQUIRED BOARD OF HEALTH AND THE DESIGNER.THE DESIGNER SHALL CERTIFY IN WRITING THATTHE 43"-120" 2.3 C Medium Sand ISY 3/1 Loose SEWAGE DESIGN FLOW PROVIDED:THREE(3)4'x8'x1.5'DEEP LEACH CHAMBERS WITH 4'STONE ON ^ SEWAGE DISPOSAL SYSTEM WAS INSTALLED IN ACCORDANCE WITH THE TERMS OF THE PERMIT THE ENDS AND THE SIDES AND THE APPROVED PLANS. 48 HOURS ADVANCE NOTICE 15 REQUESTED. Vt=((32.0 x 12.0)+2(32.0+12.0))x J4=349 GPD PROVIDED '-.` IS.)LOCATION OF UTILITIES IS APPROXIMATE AND CONTRACTOR SHALL BE RESPONSIBLE FOR DATE OF TESTING: 11/05/15 ,Z t?- DETERMINING THE LOCATION OF ALL UNDERGROUND AND OVERHEAD UTILITIES PRIORTO SOIL EVALUATOR: SCOTT MCGANN 349 GPD PROVIDED>220 GPD REQUIRED COMMENCEMENT OF ANY WORK.THIS INCLUDES,BUT IS NOT LIMITEDTO,REQUESTSTO DIGSAFE, BOARD OF HEALTH AGENT:DAVID STANTON RS SCOT lawn r `� :,• . ANDTHE LOCAL WATER DEPARTMENT SEPTICTANK CAPACITY REQUIRED:220 GPD X 200 45=440 GPD REQUIRED � �.�,,L.. j r ANY PRIVATE UTILITY COMPANIES, PERCOLATION RATE: LESS THAN 2 MINANCH IN"C"LAYER AT 54" SEPTICTANK CAPACITY PROVIDED 1500 GALLON PROVIDED(MINIMUM ALLOWED) 16.)CONTRACTOR SHALL VERIFY THAT ALL WASTELINES ARE CONNECTED BY WATER TESTING NO GROUNDWATER ENCOUNTERED A GARBAGE DISPOSAL IS NOT PERMITTED WITH THIS DESIGN FLOW �0 'u'Oar/1'�¢ WITHIN THE DWELLING PRIORTO INSTALLATION OF ANY SEPTIC COMPONENTS. , .--4-1 17.)CONTRACTOR SHALL VERIFY EXISTING INVERT ELEVATIONS PRIOR TO INSTALLATION OF ANY 1:1 , SEPTIC SYSTEM COMPONENTS. I CERTIFYTHAT I AM CURRENTLY APPROVED BYTHE DEPARTMENT OF PrOpOSeCI Sewage D1spOSal System . VARIABLE AND HOLE DATA IS NO GUARANTEE OF SOIL CONDITIONS IN OTHER AR TEST HOLES COMPLETED PER STATE ENVIRONMENTAL CODE,TITLE 5. SOILS CAN BE AREAS. IF ENVIRONMENTAL PROTECTION PURSUAMTTO 310 CMR 15.017 TO CONDUCT BY M SOIL EVALUATIONS AND THAT THE ABOVE ANALYSIS HAS BEEN PERFORMED 101 Bridge CONSISTENT WITH THE REQUIRED TRAINING,EXPERTISE,AND EXPERIENCE g Streetery a OSti i Ie, MA VA SOILS DIFFER FROM THOSE SHOWN IN THE SOILS LOGS,DESIGN ENGINEER IS TO INSPECTTHE Prepared b SOILS PRIORTO PROCEEDING WITH INSTALLATION OF ANY SEPTIC COMPONENTS. DESCRIBED IN 310 CMR 15.017.1 FURTHER CERTIFY THAT THE RESULTS OF MY Prepared for: p y: 19.)EXISTING SEPTIC COMPONENTS TO BE LOCATED,PUMPED DRY,FILLED WITH CLEAN SAND AND SOIL EVALUATION,AS INDICATED ON THE ATTACHED SOIL EVALUATION FORM, WYC Sailing Education Foundation All Cape Septic LLC ABANDONED IN PLACE OR REMOVED AS REQUIRED.AREA TO BE COMPACTEDTO MINIMIZE SETTLING. ARE ACCURATE AND IN ACCORDAN WITH 310 CMR 15.100THROUGH 15.107. 9 648 Route 28 Mashpee,MA West Yarmouth,MA 02673° (508)771-4200 alicapeseptic@gmail.com SCOTT MCGANN,CERTIFIED SOIL EVALUATOR Date:8/11/16 Sheet 2 of 2. 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