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HomeMy WebLinkAbout0120 BRIDGE STREET - Health 120 Bridge Street Osterville A = 116 - 005 No.2-153LON UPC 12134 smsad.com • Made In USA jOFl a umim iii mu m C .../ � n � � _ I ,+� ._ � ` �"�� �-�--� i '' '� col- f Commonwealth of Massachusetts Title 5 Official In Form Subsurface Sewage Disposal System Form'- Not for Voluntary Assessments 120 Bridge Street $ y. Property Address Richard Callahan Trust 41 Owner Owner's Name / information is ✓ required for every Osterville MA 02655 11/16/2015 a$ page. City/Town State Zip Code Date of Inspection e Inspection results must be submitted on this form. Inspection forms may not be alte way. Please see completeness checklist at the end of the form. y red in any . Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not ,fames Ford use the return key. Name of Inspector „b Company Name P.O. Box 49 Company Address Osterville MA 02655 Cityrrown State Zip Code 508-862-9400 S 12482 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Furthe Ev luation by the Local Approving Authority 11/16/15 Insp rs Signature Date Th Sys em inspect r shall submit a copy of this inspection report to the Approving Authority(Board of H 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 V's Title 5 Official Inspection Form:Subsurface Sewage Disposal Sys te age 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ..A,.•y'�r 120 Bridge Street Property Address Richard Callahan Trust Owner Owner's Name information is required for every Osterville MA 02655 11/16/2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please exp►ain. 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 Title 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 120 Bridge Street Property Address Richard Callahan Trust Owner Owner's Name information is required for every Osterville MA 02655 11/16/2015 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ 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 l5ins•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 uM a 120 Bridge Street Property Address Richard Callahan Trust Owner Owner's Name information is required for every Osterville MA 02655 11/16/2015 page. Cltylrown 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 P certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered: A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 120 Bridge Street Property Address Richard Callahan Trust Owner Owner's Name information is required for every Osterville MA 02655 11/16/2015 page. Cityrrown State Zip Code Date of Inspection B. Certification (Cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ , ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 7 Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary'Assessments 120 Bridge Street Property Address Richard Callahan Trust Owner Owner's Name information is required for every Osterville MA 02655 11/16/2015 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 i l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 s Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments '�M a •`'�r 120 Bridge Street Property Address Richard Callahan Trust Owner information is Owner's Name required for every Osterville MA 02655 11/16/2015 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: unavailable Sump pump? ❑ Yes ® No Last date of occupancy: unknown Date Commercial/Industrial Flow Conditions: i Type of Establishment: i Design,flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? El Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 120 Bridge Street Property Address Richard Callahan Trust Owner Owner's Name information is required for every Osterville MA 02655 11/16/2015 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: never pumped Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ,❑ Single cesspool f ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. Ij �' ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 120 Bridge Street Property Address Richard Callahan Trust Owner Owner's Name information is required for every Osterville MA 02655 11/16/2015 page. City/Town � State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: system installed -4/2013 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 3' feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ® other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal. H-20 Sludge depth: 1 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 i Commonwealth of Massachusetts H Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 120 Bridge Street Property Address Richard Callahan Trust Owner Owner's Name information is required for every Osterville MA 02655 11/16/2015 page. Cityrrowm State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 29 Scum thickness 0' Distance from top of scum to top of outlet tee or baffle 5 Distance from bottom of scum to bottom of outlet tee or baffle 14 How were dimensions determined? measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): The liquid level was u to the outlet p pipe. No sign of leakage. The inlet steel cover was 3" below facie. Grease Trap (locate on site plan): Depth below grade: n/a feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El 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 l5ins-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 120 Bridge Street Property Address Richard Callahan Trust Owner Owner's Name information is required for every Osterville MA 02655 11/16/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): N/a 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 15ins-3113 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 a 120 Bridge Street Property Address RichardCallahan Trust Owner Owner's Name information is required for every Ostervillle MA 02655 11/16/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert even Comm ents 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(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.): The pump chamber is in new condition * 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-3/13 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 pw M 120 Bridge Street Property ertY Address Richard Callahan Trust Owner Owner's Name information is required for every Osterville MA 02655 11/16/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 6 Inflitrators ❑ 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 infiltrators were dry and clean and there was no sign of failure A camera was used to inspect Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 120 Bridge Street Property Address Richard Callahan Trust Owner Owner's Name information is required for every Osterville MA 02655 11/16/2015 page. City/Town State Zip Code Date of Inspection D. System Information (Cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): N/a 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 120 Bridge Street Property Address Richard Callahan Trust Owner Owner's Name information is required for every Osterville MA 02655 11/16/2015 page. City/Town 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 QA� � i a C `1 �9 80 3 O 3 '?G 91 . qs 1016 vGATT-' sga93`' t5ins•3/13 ' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection_ p n Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 120 Bridge Street Property Address Richard Callahan Trust Owner Owner's Name information is required for every Osterville MA 02655 11/16/2015 page. City/Town State Zi Code Date of Inspection P D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10'+/- 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: To o and water contours map ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: see above 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 C Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 120 Bridge Street Property Address Richard Callahan Trust Owner Owner's Name information is required for every Osterville MA 02655 11/16/2015 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file (Sins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION I a 0 1�> . 06-a SEWAGE# 0,0 13 - o VILLAGE \e�v 1 (e ASSESSOR'S MAP&PARCEL //Z- OOS INSTALLER'S NAME&PHONE NO. , �Q G , �. - �SbB-41 of 9 SEPTIC TANK CAPACITY LEACHING FACILITY..(type) F/OC,) 7, FW�2S is (size) NO. OF BEDROOMS S OWNER A,412/,V4 ZoM A-CC H PERMIT DATE: -(q-(3 COMPLIANCE DATE: Afei/a o i3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and LeachingFeet Facility(If any wells exist on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Feet • g Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY ry . r 'Me�+�l Fr�r9tvtc��-Cov�Qs ot\ 80 o a 967, If l0� 6 VZ-AT" I TOWN OF BARNSTABLE LOCATION Q O )5Qi p6 r S l SEWAGE# olo f 3/- CO S J' VILLAGE O 'S\et t I le ASSESSOR'S MAP&PARCEL OOS INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /�06Gf?l�"���o�U1--� /i0606Pj��vlh� C�f}►it LEACHING FACILITY:(type) floc.) zltfilujc23 (61 (size) NO.OF BEDROOMS S OWNER �VAJ7_1 Ct,3 /%,4)2/�14 L(Jn , hQC H PERMIT DATE: 3 — (R`(3 COMPLIANCE DATE: a 01.3 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 �.7 vv\teraA 'P-ps itCo(,e2s ox tj &3 Li S 2"4SP, pa IT O qs'3 -4], 8 � 8 ve4w-- No. (� �j " V / _ ! Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -'TOWN OF'BARNSTABLE, MASSACHUSETTS Yes Zfpphrafion for Misposal *pstrm (Construction Vermit Application for a Permit to Construct Repaix�Upgrade X Abandon Xomplete System ❑Individual Components Location Address or Lot No. 126 ar' c cf. Owne 's Name,Address,and Tel.No. Assessor's Map/Parcelj f QB;'" Installe,&Name,Address,and Tel.No. 5-68-yag. Designer's Name,Address,and Tel.No. �a �t �[(��T $saq ark�� R� Po Bok cc O �a�l s�• �s y OB--(/2 8-3 3 Yel o s4,prY,,Ile 14.4 ez6 6'S Type of Building: Dwelling No.of Bedrooms /` Lot Size l sq.ft. Garbage Grinder( )✓t,40 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 5576-V gpd Design flow provided gpd Plan Date /'Z R-Z (2,, 7—ot3 Number of sheets > Revision Date Title Size of Septic Tank !S©0 &A con S Type of S.A.S. Floc,, P,A(Ils e, S Description of Soil ,='h tesf A,_4 1 0-9"' e4dee /L /11,_CG4A/ /'4, SA.40I 0 P/l �'S' 32_-1ot ' 6 ;yes C (-,&ae .sand 10r2 l6 Nature of Repairs or Alterations(Answer when applicable) U ((-&_jNe A J � J 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 f Health. Signed �% Date Application Approved by 1�l " ��G' �(. j Date Application Disapproved by Date for the following reasons �{ Permit No. i r © �� Date Issued . ,. �. y�w `f r. .�..� ,•r;., _. �...,.x w� Y< •w,**__F- ,nor »«v .. c....•.R o — .�ti ". No. 410o-o 711Fee THE COMMONWEATH'OF MASSACHUSETTS Entered;ncomputer: PUBLIC HEALTH DIVISION =TOWN OF BARNSTABLE, MASSACHUSE-'TTS -'Yes Oration fo_rf Mispos.aY` psteitt Construction Permit Application for a Permit to Construct f Repair-0 Upgrade) Abandon ) iXfCom lete S stem i`/ % p p y ��I'ndividual Components Location Address or Lot No. �Z D 5,-, j c -+ Owner's Name,Address,and Tel.No: x /S�'CAa r� P. Cei//a ti a r Assessor's Map/Parcel Installer's Name,Address,and Tel.No. - r, f Designer's Name, ddress,and Tel.No. Type of Building: ' Dwelling No.of Bedrooms %j / Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria(, ) Other Fixtures Design Flow(min.required) 5 5 0 gpd Design flow provided 5-6 6•G gpd Plan Date i`1. �/ , LG/3 Number of sheets( / Revision Date Title Size of Septic Tank l S-00 (ram lon S Type of S.A.S. ��a w D,��vS er S Description of Soil .Zh La Vr� Nature of Repairs orAtterations(Answer when applicable) i 41, Date last inspected: Agreement: f 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 systemm operation until a Certificate of Compliance has beX issue&by this Board of Health. ) l Signed icy / �� .� Y t Date Application Approved by Yi°l 4t` -�rC•� Y� Date 5 11 7 yApplication Disapproved by Date. for the following reasons ` Permit No. �d (3 — ® $�> Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance ~ THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded Abandoned( )by at has been constructed in accordance with the provisions"of Title$;and the for Disposal System Construction Permit No. �U r C��> dated a f t l t Installer k t c �(CIA I �,� \ _ _ Designer_ ...•� i`��.i- �=vac„icy--,-�i #bedrooms q7— r Approved design flow gpa The issuance of is permit khall not be construed as a guarantee that the system will fulnct*io asl designe . ' Date LT I I Inspector ! , -- No. aU _;" Q a 6- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION=BARNSTABLE,MASSACHUSETTS MIsposal &psi Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade(✓) Abandon( ) System located at 120 -3C,df P S,-Z. 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 �j M r/3 Approved by C�464-L l,/ �� a nvwm tn uu=auc -- ---_- 200 Main Street,Hyannis,MA 02601 ge/t' INV. Office: 508-862464# Fax: M8-790.6304 Installer&Designer Certification Form Date: 4-I g,- Sewage Permit# aO c 3-O 86- Assessor's Maplparcel /M OO S ..r Designer: �� UWn "�✓1Sl c�M InstaReri �" o vi c t e 1 1 c d Address: �.y, k °S`� Address: W-I To or Si, 6L� k LP, W1A7 ,6z�sS O sTe��:`�e rlA _ 0a65f pn 3—I a' i3 was issued a permit to install a .(date) (installer) teat AI R;• 6,asi- Osi«�,%� septic system � based on a design drawn by (address) S.,Ilwr EA Lf\ccc L!s dated hAkCjj t4 jao t3_ (desiaaerj. I certify that the septic system referenced above was installed substantially according to the desism, which may include minor approved changes such as lateral relocation of the distribution box andior septic tank. I certify that the septic system referenced above was installed with major changes (Le. greater than 101 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. 'H Of Moss 9 JOHN C. cyG (Installer's Si�,IIatttre) o O'DEA CIVIL No.48168 Cn 9 90� FG/STEJAI Ulk Fss G�� (Designees m- (-Affix Desire. Here} PLEASE RETURN TO BARiVSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL 130TI-1 THIS FORM AND AS-BUILT CARD_ARE. RECEIVED BY TIE BARNST-ABLE PUBLIC HEALTH DIVISION THANK YOU- Q:Health/Sep[is/Desisna Cerfificadoa Form 3=7b dac a BATH r ROOM ENTRANCE • BA TH KITCHEN ROOM BED :#5 OOM DEN BED ROOM #4 BED SUN HALL . . ROOM HALL - #1 1 DINING ROOM BATH BED BED I ROOM ROOM ROOM ROOMI L #3 - #2 1st FLOOR 2nd FLOOR FLOOR PLANS SCALE. 1 2- - 20 0 10 20 40 FLOOR PLANS A T 120 BRIDGE STREET RICHARD P. CALLAHAN TR. J J�G -OF TESTS: OCTDBER 5, 2006 XA,TION RATE : LESS THAN 7 MINUTES PER INCH DROP IN THE C HORIZON IN DOH 2 AND DOH #4 BY : JOHN G. SCHNAIBLE, CEC Sr DONALD DESMARAIS, BARNSTABLE BOARD OF HEALTH IDWATER: ENCOUNTERED AT ELEV=1.9 IN DOH #4 _ 1) ALL CO 2) FLO CON GROU*WAERNITORING WELL (GWMW) LOG 3) � DATEREADING DEPTH EIDATION 11-271.'43pm 7.59 1.89 11-271:55pm 7.58 1.90 11-27-07 2-08pm 2:10pm 7.57 1.91 FLOW 11727-07 2-08pm 2:25pm 7.56 1.92 SEE P< 11- 27-07 'gyp 2 m 2: Mee��II 40pm 7.55 1.93 .`"y 6 11-27-07 25pm 7.54 . 1.94 11-27-07 2:04m 3:10pm 7.63 1.95 11-27-07 2'08pm 3•.25pm 7.53 1.95 11-27-07 2-08pm 3:40pm 7.53 1.95 11-27-07 2:08pm 3:55pm 7.53 1.95 11-27-07 2*Q8pm 4:1 Opm 7.53 1.95 11-27-07 2'08pm 4:?.5pm 7.53. 1.95 11-27-07 2:08pm 4.40pm 7.54 1.94 11-27=07 2tBpm 455pm1,93 DEPTH MEASURED IN FEET FROM TOP OF WELL. CASMG AT ELEVATION=]48 HIGHEST OBSEIM GROW07ER 6 ELEVATION 1.95 YARIANCE.• SEI HOW MEASURED GROUNDWATER FROM TEST HOLES S SHAM 19 . t 310 WR 15,000 (TI F 5); —INLET.AND OUTLET INVER INCHES ABOVE HIGH GROUN OVAL N (11 INCH VARIANCE REQUES 07F MATERIAL WITHIN 5 OF LEACHING FIEID .=3.3f — SEE DOHIZ AND BELOW EL=28f fH SAND FILL IN ACCORDANCE WITH NOTE #9 1^ z §� S4 7 56 59 E R k � wa Peaks Drive 61. 6 ❑ 345 032'37„E 30' Private Rd " �� x� x ,•�� e�I. � oc a e ence ,r .> ❑ /l �-� 4 Mark C. Curley Tr. Z 0 _`1 f S48 11 00 r M & P 116129 r i._.� �/ � � v ❑ ❑ 4 Ice ence ❑ Gorden Garden 0 A 9 A ' V 4, #120 Q (o 2 Car Garage 10.1 NSF IWIVl ' \) C!31�" �� 10,3 Bushes � Oyster Harbors Yacht Basin 01i 40.0 10 10.5 Gate Lawn /� ("� Garden 0 Lawn Lawn ��•y 1 2,0 O (/ � Lawn 28.0 Location �� 4' Picket 4' Picket n Fence / // Gorden O Fence 1"=2000'f 7 ❑ Stone Walkway Cv/ p 28,0 � C►•1 O N ASSESSORS REF.: �a O O 16,o N Map 116, Parcel 005 .� \ TH-1 150o cal an loco canonO Chimney Septic Tank Pump Chamber Q o \ �t✓ town UJ OVERLAY DISTRICT: o,`�`� �, p Gorden AP -. Aquifer Protection District �j�` stone Driveway v 12,0 10,0 �Q Estuarine watershed stone Padla �~-� Lo otp Paz \ to be :::P \ F. F. Elev. 10.95 "- -- _ 1---_�Dete ined Bushes o \ (Bench Mark) 0 0) -h y FLOOD ZONE: \ Lawn Lawn Bushes En 77 Zone A 13(EL 12) Z Community Panel No. #120 �""" 4' Picket Fence ❑ #250001 0018D ��� ~`cr, 2 sty w/f Re Plumb ° Jul 2 1992 Septic Line Concret and y , Dwelling for Invert at (Entire Property ev. s.58 Elev. 7.50 99. 41 N/F /is in Flood Zone) i ~' cote Nicholas Lawn M P 11 A& E11 N Abraham 6002 i PERC TEST: 13,874 1 PERFORMED BY:CHARLES ROWLAND,EIT- SULLIVAN ENGINEERING ZONE: ~., ti\ `•�. SOIL EVALUATOR NO.13586 WITNESSED BY:DONALD DEMARiAS,R.S.-TOWN OF BARNSTABLE `! \� MARCH 1,2013 MB-A2 - ❑ �__.._ _��. + SITE PASSED Area (min.) 10,000 �` + + - - ---_ 1 4' Picke DESIGN DATA _ _ Frontage (min) 20 Existing Septic (,,,� #88 TEST HOLE 1 EL.10.0 TEST HOLE 2 EL.6.5 i 9 P Fence Single Family .,,.................... ...... ... . .. .. Bridge St. 8 y ;AaYEI:.i,a€ti: ii:.:..:.:::: :`;:: A ............................. Width min 0 to be Removed �I g ............ (min) 6� -5 Bedroom @ 110 GPD :1 ARi€.iRA€:;::::.:..;:`;:::: uBRY3ARi€. 7€..::.:.:..::.... J e .. ........................................................ c9 I or Abandoned c_) Garage Setbacks: - -P No Garbage Grinder 8";:i::;::?r;. :rz;;;;i i� 714fiSAt D' 9.3 8" :.:;:: ED t%IyT:Si tt73;::::::; 5.8 g B I itkYEli 1CtIYIt b1&.;:`.`.:;.':'t i:(:' t:: $LAYS... 11}I'..... :.:;'::..:.:.t: Front D r� ❑ N Total Daily Flow=550 GPD _. , .. , >:BRQ�i�l+7l;r1I:.XFxI;I:Q�S?::::.:.:::::.:c. p�Is� :�:.c��: Use a 1500 Gal Septic Tank "i`;:'.'?'?:°:`:::">;i;. 'It7ii °.i:"`' `?, ,,.i r.::..;;:;c.::.:::... Side 0 z C.,.1 32 ......... 13..... 1a6!►lYl.......... 7.3 32 ..... l #111�1I i ::2 2::: .'::: .':3.8 �j� �\ C LAYER IOYR 6/6 C LAYER 10YR 6/6 Rear 0' -.. LEACHING AREA BROWNISH YELLOW BROWNISHXELLOW `o Q+ \ COURSE SAND 60" COURSE SAND 1.5 ::FE 550 GPD/0.74(LTAR)=743.2 SF Required 48" PERC TEST 6.0 GROUNDWATER ENCo RED TH-2 Abutters Sidewall .91(136.0)=123.8 SF 25 GALLONS IN<15 MIN. one Driveway � Lawn y Bottom Area 72.0 SF 108,, PERC RATE<2 MNAN(LIAR=0.74) 1.0 Total Provided=795.8 SF GROUNDWATER ENCOUNTERED V ~�. hl Gorden Y ti.. _ _.�_ - LEACHING CHAMBER DESIGN � •• All Pipes to be Schedule 40. Use LocateJunctionOutsid oi yBox LEGEND. 6-Flow Diffusers;a an L shape,With a P Lawn i �`�,. 4'Washed Stone Field as Shown. Cables Installed In Accordance Pum Power& Float Control EM Electric Meter Picket � thBldg&'Eetctc deSaaal ❑ Fence (^ Alarm To Be On Separate v J Service From Pumps QS Sewer Manhole ❑ r(.� 1/2"0 Gale Pipe ® Catch Basin �a� Lot #3 "1 - For noaf Support El ee ant a .Veet f 31465 2 SF 5' o a o- ax 5' R �d9e DH Light Post 8t •A 24"0 Opening Above A Guy �0 _ 0. �22 Acre y p For Manhole � 4"0 Sch. 40 PVC V Utility Pole + From Septic.Tank Frame & Cover i ; ` Com artment '6P Wood Post OHW- Overhead Wires ❑ ` - 25 Elevation Contour - SEPTIC NOTES PUMP COMPARTMENT PLAN VIEW DETAIL moo" „`A' (��^ ' -- 1.Location of Utilities Shown on This Plan Are Approx.At Least 72 Hours -� "3 2 y Y Z f Prior to Any Excavation For This Project the Contractor Shall Make NOT TO SCALE Weeping Willow Tree ^i / oo 4 the Required I V f N + / 2.The ContractorNotification s R ahuired to Secure l-88Appropriate From Town 5 • 8-344-7233). YT r J r Conduit Thru Chamber For Frame Manhole over �✓'1 / Power&Float Cables e 1 Agencies For Construction Defined by Thus Plan. Finished 9"Min. Maple Tree 0 J < ' 3.Wherever Sewer Lines Must Cross Water Supply Lines Both Lines Shall Grade cover N/F Be Constructed of Class 150 Pressure Pipe and Shall be Water Tested to Anne T. Moran (n 1 2 6.O 5 Assure Watertightness. In General,Water Lines Shall be Constructed in 4"0 Sch. 40 PVC M & P 093032 Coordination With COMM Water,and Shall be in Accordance From Septic Tank } Cedar Tree 0 Compartment Drill 1/8"0 Hole N/F Galy. Choi r. With 248 CMR 1:00-7.00&310 CMR 15.00. For Drain Canzano JR 4.A Minimum of 9"of Cover is Required for All Components. Emergency Storage Inv To D-Box Francis W. eq lm 9 Y l. En Min. 2' Cover M g� p 116001 5.All Structures Buried Three Feet or More or Subject Volume s3s cal. to Vehicular Traffic to be H-20 Loading.It is the Engineer's Alarm On EL 4.30 Holly Tree F Access Cover (typ.) Recommendation that H-20 Always be Used. Pump On El. 4.00 ,t F.G. EL. 10.of (See Note 6) 6.Install Watertight Risers and Covers to Within 6"of Finished Grade Pumps Off El. 3.50 w o Pump Y o F.G. EL. 10.0t Over Septic Tank Inlet,U,and Outlet,D-Box,and Two Leaching Chamber. a 2"0 Sch. 40 PVC d 7.Septic System to be Installed in Accordance With 310 CMR 15.00& Threaded Pipe See Note 10 0 248 CMR 1.00-7.00 Latest Revision and the Town of Barnstable Check iValve Flow Equilizers As Required Board of Health Regulations. Bottom of Chamber El. 2.50 PROPOSED EL. 5.85 EL. 8.0 Finish Grade 8.All Piping to be Sch.40 PVC. Bottom of Tank El. Z25 EL. 7.50 ' Filter 9.D-Box Shall Have a Minimum Inside Dimension of 12",and a Minimum Secure Pipe h rap _ _ Bottom of Chamber 'rv- ====$ Stable Comp, 1500 Gallon Fabric Sum of 6". Base Buoyancy Ca1C11J<a110riS Installer To EL. 6.1 Se tic Tank f 000 Gallon D-Box CompactedV Fill AND OR or Approved E u Confirm Prior P EL. 5.80 Too El. 8.45 N � p 4/10 H.P. Myers Pump H-20 Pump Chamber H-20 EL. 7.90pp q al$ 1500 Gallon Tank To Any.work EL. 6.5o / 10.Septic Tank Shall be a 1,500 Gallon with a Department Approved Effluent , Waterproof/Seal with 2 coats H-20 Prior to OrderingPumps the Contractor Buoyancy=vol.oftank in water x unit weight ofwater of Approved Sealant Waterproof/Seal with 2 0 0 0 0 0 Bo t. .95 �p 0 1�8" - 1�2" Tee Filter on theOutlet. Must confirm te Compatibility of the =(1.95-1.60)10.5'x5.67x62.4 .r oats of Approved Sealant EL. 7.87 Flow Diffusor I ® ® 8 ® 8 ® Pea Stone Existing Electrical Service To Be Installed On H-20 ;._ ® ® ® ® �Z= 11.The Separation Distance Between the Septic Tank Inlets and 13001 bs ��able oompac e ase �, Outlets Shall be No Less than the Liquid Depth.Inlet Tees Shall Extend Tank Weight=11,480 Lbs EL. 1.60 „ . 314" 1 112" Bedding, T's, & Baffels "' " "' "' a Minimum of 10"Below the Flow Line.Outset Tees Shall Extend 14" Tanks Sinks EL. 1.30' as Per Title 5 REiitby�.8c:f2 pltnc ?: :.::.:......:... N 4' -Double Washed All.:Unsu%tattle:Soilscif: EL. 1.95 Stone Below the Flow Line,and Shall be Equiped with a Gas Baffle. PUMP COMPARTMENT SECTION DETAIL 1000 Gallon Pum Chamber .. .. .. ............................. Estimated High Groundwater 12' P the.::Qut�r:POrirrrster.:.of';i'fi* :.$!"f Ri: Per Monitoring Well Buoyancy=vol.of tank in water x unit weight of water r� s e' For Sep tic Permit #2008-211 N SCALE ....: ... _(1.95-1.30)8.5x4.83x62.4 1665.2 Lbs NOT T� �i ��5 t-8,240Lbg DEVELOPED PROFILE OF SEPTIC SYSTEM CROSS SECTION OF FLOW DIFFUSOR NOT TO SCALE TO SCALE Title: PREPARED BY: PREPARED FOR: Notes/Revision: Site Plan 11 sUlI1Va1 Engineering, Inc. Callahan, f�IChard P TR 1.) The property line information shown was ,,1compiled from available record information. Proposed Improvements PO Box 659 c% Oxbow Corporation �20 Bridge Street.L. - Osteryille, MA 02655 West Palm Beach FL 33401-8104 2.) The topographic information was obtained gfrom an on the ground survey performed on (508)428'3344 (508)428-9617 fax 11/MAY/12 Barnstable (Osterville) Mass 3. The datum used is NGVD '29 a fixed Field: JOD, CTR Review: JOD 10 p 5 10 20 40 ) mean sea level datum. Dater •/ { Comp.: Pro: 97_038 Koch , March 1�, 2� 13 rr 1 Or Drafty :CTR Drawing # 120 Bridge Existing 9