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HomeMy WebLinkAbout0215 BRIDGE STREET - Health 215 Bridge Street, Osterville A ®q3- 031v oD1 y � l i d I e s SCHULZ LAW OFFICES, LLG- THE SAMUEL ISHAM HOUSE 1340 MAIN STREET OSTERVILLE, MASSACHUSETTS 02655-1542 TELEPHONE_(508)428-0950 FACS[M1LE i508)420-1536 ALBERT J. SCHULZ MICHAEL F. SCHULZ aschulz@schulzlawoffices.com mschulz@schulzlawoffices.com September 12, 2017 Thomas McKean, Director Health. Department Town of Barnstable 200 Main Street Hyannis, Massachusetts 02601 Via Email: thomas.mckeanR town.barnstable ma us Re: 215 Bridge Street, Osterville, Massachusetts 02655 - Dear Mr. McKean: This letter serves to confirm our discussion this morning regarding the septic system serving the main house at 215 Bridge Street, Osterville, Massachusetts 02655 (the "property"). ' The septic system for the main house was designed with a flow ofr495 gallons per day. See Exhibit 1. As I represented to you and evidence with the attached photograph, the'garb_age� 'disposal unit has been permanently-removed. See Exhibit 2 (showing existing sink and underneath). Kindly confirm by acknowledging below that without a garbage disposal unit in the kitchen, the main house may have four(4) bedrooms which is supported by the daily flow of the septic system. As always, please do not hesitate to contact me should you have any questions. s Very truly yours Michael F. Schulz Thomas McKean., Director 1 � 1' a e L. L V I I IL. Juiin i No. UUZI r. 1 f .M THE COMMONWEALTH OF MASSACHUSET'rs BOARD OF HEALTH �t ct,,�►�........................O F... A;Ipfiratinn for Bigpugal 19urk5 Tnn�f rftn f rrUtif Application is hercby made for a Permit to Constrict ( ) or Repair ( ) an Individual Sewage Disposal System at: oT. _Zp........... 1P�� �...�.�7RGE7'�...... sJ"�rrr��� Lo7�, moo_ Location.Addre- :.... or Lot No. ��i,CU!-R._- __ �6-- --�!cy/J..,�--- `,p.•.y.F ,�..h.`.1.e�,ti,.ar.!.,�....... nee n drus ...................:................................ �....:. .� _ -............. aq loatallcc Addresa Type of Building Size Lot_ �.9..Y .........Sq. feet U Dwelling—No. of Bedrooms-__:__. ....._........................F— ansion Attic 6- '� IcL o�•E Garbage Grinder jy�n. a Other—Type of Building _x4e.e L2.............. No. Of Persons....,3_._-._..___ Showers Other fi.Ytures ( ") —�'Cafeteria -. .._..-- -•--- - _... -- Design Flow_______.........._-..........:.........gallons per person per day. Total daily fio _�?��12� gallons Septic Tank—Ly uid'ca aci / •--•-,...., q P ty�----gallons Length, Width ... iameter--.• ....... ----.,--- x Disposal Trench—No._____—.,_._ Width.................. Total Length........ Total leaching area............:..sq. ft. Seepage Pit No......_............. Diameter.._......_.......... Depth below inlet...._ ._...:._:_. Total leaching area._. .............sq. ft. z Other Distribution box ( ) Dosing tank ( ) - , '-' Percolation Test Results Performed by.._.............. .:_. Date.__,_.....__:_..._ ........:................-------- -----•- _ Test Pit No, I.........7..minutes per inch Depth of Test Pit...............____ Depth to ground water___---_. V� Test Pit No. 2....__........minutes per inch Depth epth of Test Pit....... ...... Depth to ground water....—.......__... - .._._—........_...........--- • 0 Description of Soil___!_..a�' _�_ o _ _.�1L -•----°�z--- .-'- .. 41..... �o�� ;� ai0..---....__.._.._ ....___................_....—.................................__.......-._.......--.........._............................................._-----_...__._......... U Nature of Repairs or .Alterations—Answer when applicable. ...... .........................—_:_..............._........ ..............................................w.._„..........__ .. ---- _.................................................... Agreement: The tuidersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of IITI , 5 of the State Sanitary Code---The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed. .......... _ �� __ __. _.... ,l .. �.. ..... DaEe Application Approved PY------------- - ......-......................... ......lv Dzke Application Disapproved for the following reasons:..............................................,......................._.._._...-----•----...:__._____ .. ...........— ....... .-- Issued..: .._....... ..w...... �� ..... - -,-•., __ -' •Date THE COMMONWEALTH OF MASSACHUSETTS _ BOARD HEALTH ................ Trrfifira#r of t THIS,d.F TO CERTIFY,That the Individual Sewage Disposal System constructed ( ) or Repaired by - - .........._.._-__-. ._ .._.,_.....__ .. _ _... ......... -..... -— ....... ---_..... _ has been installed in accordance with the provisions of TI IF 5 o The State Sanitary Code as described in the application for Disposal Works Construction Permit No...._.___..___._. dated .....---- THE ISSUANCE OF,THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY, .-� � . . , ..< ._.r ... ......_. ,.,,,�,._.,_._,�_d... .._.: � �. ,.. r. �, �. _ r�, ,,' E yz � •`� __�`"`�. _nf' =. `� 3 r �'. `� ,�p��l 4.f.e iY J . =�* sL •� ��. �.. .- Y�U.�K_'. +�d S�GHULZ I:A. V (Df ,TCES, LI:G TH.E SAIMUEL,ISHAM IiOtT5E. 3 1 4, MAIN` STREET OSTERVILLE MASSACHUSETTS 0i C665 1_:542 r'.` .. - '; TELEPHONE(506)428=0950:, :: z FACSIMILE(508)420"153C3 ALBEAT J SCHULZ MICiI'AEL F-.:SCHULZ; psehuizC�sciiulzlawoff ces com msehulz@schulzlawoffices.com 1 ,.. .. September 12 2017 '' l Thomas McKean,Director Health peparement I Town of Barnstable ! 200 Main Street _. , Hyanni , Massachusetts 0201 Via Email thornas Inckean(a7town bainstable maul Re 215 Bridge Street,Ustervi""lie,Massachusetts 02655 tr,z' Dear Mr McKean x j - ..w 1 z : This letter serves to confirm our discussion this;rnornmg regarding the septic system serving the main house at 2 i 5 Bridge Street, Osterville,Massachusetts 02fi55 (the"property") The septic system for' he main house was designed with a flow of , gallons per day See 1 Exhibitl As'I represented to you and evidence'with the attached photograph,the;garbage s dsposal:unrt has been permanentlyremoved See Exhibit 2(shown existing sink and:_ j underneath) 'Kindly confirm by acknowledging below that without%4 garbage disposal unit in the kitchen,the main house may hav�four;(4}bedrooms which is supported,by the daily flow of the septic system 'fig S c��uo^sfd� w,�sv,« �.s��ee d ..-. As always, please do not hesitate to contact me should you have any questions :'': ' Uery truly..yqurs . ::;. /�`/ � �'' . ;_ Michael F SchuTz � .. ..� ` l �.�—� �- f .' Thomas McKean, Director � : 1, u (� � to t I 60t Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessme't`s 0 215 Bridge Street-Main House Assessor's Map: 93 Parcel: 36-1 ha Property Address I,,j Glenn G. Wattley Owner Owner's Name ­J information is -n required for every Osterville MA 02655 Icy 5, 2017 page. 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 A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not David D. Coughanowr use the return Name of Inspector key. Eco-Tech Rapid Response r� Company Name 155 George Ryder Road South Company Address Chatham MA 02633-1621 City/Town State Zip Code 508 364-0894 1328 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 � jNOFM,4 qc El Conditionally Passes ❑ Fails ❑ Needs Fu - v619 n Local Approving Authority - CO HANOWR No. l 28 `p May 5, 2017 Inspector's Signature FM INSPEG 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 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 �0 �s t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c�M 215 Bridge Street- Main House Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Owner Owner's Name information is Y Osterville MA 02655 May 5 2017 required for every , page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Inspector's Notes==> The septic system described herein is deemed to pass this Real Estate Transfer Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4- 5, or specified by local regulations. The scope of this inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. 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* o6the,"septic=tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exflltrdtton.o-r 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 thane-20 years old;is,available:*` ❑ Y ❑ N ❑ ND (Explain below t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 215 Bridge Street-Main House Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Owner Owner's Name information is Osterville MA 02655 May 5 2017 required for every Y page. City/Town 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 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 215 Bridge Street- Main House Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Owner Owner's Name information is Osterville MA 02655 May 5, 2017 required for every y page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a 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 co_liform 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 Y2 day flow t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 215 Bridge Street- Main House Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Owner Owner's Name information is Osterville MA 02655 May 5 2017 required for every Y 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 eoua.l to or less than 5 ppm, provided that noAother failureVcriteria 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. l 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. l5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M ,•'' 215 Bridge Street- Main House Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Owner Owner's Name information is Osterville MA 02655 May 5, 2017 required for every y 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? ® ElWas the site inspected for signs of break out? z ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9c°M 215 Bridge Street-Main House Assessor's Map: 93 Parcel: 36-1 Property Address , Glenn G. Wattley Owner Owner's Name information is Y Osterville MA 02655 May 5 2017 required for every , page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry-on a separate sewage system? (Include laundry system inspection 0 Yes ® No information in this report.) Laundry system inspected?. ❑ Yes ❑ No 4 Seasonal use? - _ s fz ❑ Yes N No Water meter readings, if available (last 2 years usage(gpd)): 484 gpd Detail 2015: 178,000 gallons 2016: 175,000 gallons This represents the flow for both the garage apartment and the house and the irrigation system. Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203) Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 215 Bridge Street- Main House Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Cwner Owner's Name information is Osterville MA 02655 May 5, 2017 required for every y page. Cityfrown 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: owner Was system pumped as,part of the inspection? _a:f. ,. .:: _. ...F❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 215 Bridge Street-Main House Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G.Wattley Owner Owner's Name information is Osterville MA 02655 May 5 2017 required for every Y page. CitylTown State Zip Code Date of Inspection D. System Information (cont.)' Approximate age of all components, date installed (if known) and source of information: Age: 34+ years Certificate of Compliance for a new system was issued 5/30/1982 (Permit#81-638 at Health Department). Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 1 feet -- Comments.(on condition of joints, venting, evidence.of;leakage, etc.): Sewer line appears structurally sound with no evidence of leakage or backup into dwelling.. Septic Tank (locate on site plan): Depth below grade: 2.5 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: 8.5'x 5'x 6'-1000 gallon Sludge depth: 6 inches t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 215 Bridge Street- Main House Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Owner Owner's Name information is Osteryille MA 02655 May 5 2017 required for every Y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 28 inches Scum thickness 8 in Distance from top of scum to top of outlet tee or baffle 6 inches Distance from bottom of scum to bottom of outlet tee or baffle 10 inches How were dimensions determined? Design Plan Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping is recommended at this time. Maintenance pumping is recommended every 2-4 years with year round occupation. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. 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.doc a rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System a Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 215 Bridge Street- Main House Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Owner Owner's Name information is Osterville MA 02655 May 5, 2017 required for every Y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: El-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'): i *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts 4 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 215 Bridge Street- Main House Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Owner Owner's Name information is Osterville MA 02655 May 5 2017 required for every y + page. City/Town 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 at outlet invert 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.): no adverse conditions observed. 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 215 Bridge Street-Main House Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Owner Owner's Name information is Cisterville MA 02655 May 5, 2017 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 1 ❑ 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.): No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. A hole was dug into leaching gallery stone and no effluent was observed in the stone or overlying soils. 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 215 Bridge Street- Main House Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Owner Owner's Name information is Osterville MA 02655 May 5, 2017 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids . Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 215 Bridge Street- Main House Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Owner Owner's Name information is Osterville MA 02655 May 5, 2017 . required for every Y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately DRIVEWAY NOT z LUW QC' -TO Cr cc or SCALE �a Ln I THIS SKETCH IS 0 BEST VIEWED IN T; O COLOR FORMAT ` u <u D V�I1 ELF UPI G 0 215 508 364-0894 A B p I L�OoC AT§O V��pp 1000 GALLON —OF SEPTIC COMPONENTS SEPTIC TANK —DISTANCES IN DECIMAL FEET A B C I --- 14.5 18 Q3 D—BOX 2 --- 27 30 3 34.5 27.5 --- LEACHING GALLERY t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 215 Bridge Street- Main House Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Owner Owner's Name information is Osterville MA 02655 May 5, 2017 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 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: 10/23/81 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Previous inspection report ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Approved design plan on file with the Board of Health shows bottom of system to be 5 feet above groundwater.Previous inspection report o 9/24/97 indicates high groundwater is 10 feet below the surface. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 215 Bridge Street- Main House Assessor's Map: 93 Parcel:.36-1 - Property Address Glenn G. Wattley Owner Owner's Name information is Osterville MA 02655 May 5 2017 required for every y page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information-Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file SEPTIC INFO AT us EC® TE GEOHYDROLOGICAL PROFILE - NOT-TO SCALE--, :- - - Z Q a Z FLOW DIFFUS.SOR ¢e. • sae °. BOTTOM OF a LEACHING � PER DESIGN � PLAN LEACHING IS ABOVE HIGH GROUNDWATER N-- O ' U7 GROUNDWATER OBSERVED ON 9129181 t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth of Massachusetts 9 U`3�" ly W Title 5 Official Inspection . Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 215 Bridge Street-Garage Apartment Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Owner Owner's Name information is Osterville MA 02655 May 5 2017 required for every Y page. City/Town.. State Zip Code Date of Inspection MAY 22 n0spectildn'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 out forms A. General Information r� cc7�� /eX c��� •on the computer, c use only the tab 1. Inspector: key to move your cursor-do not David D. Coughanowr use the return Name of Inspector key. Eco-Tech Rapid Response r� Company Name 155 George Ryder Road South Company Address ,ems Chatham MA 02633-1621 City/Town State Zip Code 508 364-0894 1328 Telephone Number License Number B. Certification 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 �vSNOFkA ❑ Conditionally Passes ❑ Fails V ❑ Needs f to o vl��aon ;t ,e Local Approving Authority COU ANOWR o..1 28 D May 5, 2017 Inspector's Signatu TFM DNS?SG' Date oo The system inspector s a 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 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.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 ,b00 ' Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 215 Bridge Street-Garage Apartment Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Owner Owner's Name information is Osterville MA 02655 May 5 2017 required for every y page. Cityfrown 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: Inspector's Notes==> The septic system described herein is deemed to pass this Real Estate Transfer Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4- 5, or specified by local regulations. The scope of this inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. 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 septictank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration'o—r;taank.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 arid if a Certificate of Compliance indicating that the tank is less than'20 years oldjs available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments. ;M 215 Bridge Street-Garage Apartment Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G.Wattley Owner Owner's Name information is Osterville MA 02655 May 5, 2017 required for every Y 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'rtis 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M s•'' 215 Bridge Street-Garage Apartment Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Owner Owner's Name information is Osterville MA 02655 May 5 2017 required for every Y page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a 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. ElThe s tic tank and SAS and the SAS is less than 100 feet but 50 feet or system has a septic more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow l5ins.doc•rev.6/16 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 215 Bridge Street-Garage Apartment Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Owner Owner's Name information is Osterville MA 02655 May 5 2017 required for every Y page. City/Town State -Zip Code Date of Inspection B. Certification (cont.)- Yes No t ❑ ® 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`tfiat ri6dtl4er failure criteria4te-triggered.'A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D., Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes' in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the, system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 215 Bridge Street-Garage Apartment Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Owner Owner's Name information is Osterville MA 02655 May 5 2017 required for every y page. 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 ® ❑ 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): 1 Number of bedrooms (actual): 1 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): not indicated t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 215 Bridge Street.-Garage Apartment Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Owner Owner's Name information is Osterville MA 02655 May 5 2017 required for every Y page. City/Town State Zip Code Date of Inspection D. System Information Description: Space on permit application for design flow was left blank. No enginneered plan for this system was found in town files. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No ' information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? _44 ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): 484 gpd Detail: 2015: 178,000 gallons 2016: 175,000 gallons This represents the flow for both the garage apartment and the house and the irrigation system. Sump pump? ❑ Yes ® No Last date of occupancy: last summer Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 215 Bridge Street-Garage Apartment Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Owner Owner's Name information is required for every Osterville MA 02655 May 5, 2017 page. City/Town 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: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ® Other(describe): Septic Tank and Leach Pit t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 215 Bridge Street-Garage Apartment Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Owner Owner's Name information is Osterville MA 02655 May 5, 2017 required for every Y page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Age: 22+ years Certificate of Compliance for a new leaching system was issued 5/3/1995 (Permit# 95-967 at Health Department). Were sewage odors-detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting,.evidence of leakage, etc.): Sewer line appears structurally sound with no evidence of leakage or backup into dwelling. Septic Tank(locate on site plan): Depth below grade: 2 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: 8.5'x 5'x 6-1000 gallon Sludge depth: 4 inches t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 215 Bridge Street-Garage Apartment Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattle Owner Owner's Name information is Osterville MA 02655 . May 5, 2017 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Winches Scum thickness none Distance from top of scum to top of outlet tee or baffle 10 inches Distance from bottom of scum to bottom of outlet tee or baffle 14 inches How were dimensions determined? As built card Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping not required at this time. Maintenance pumping is recommended every 2-4 years with year round occupation. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 215 Bridge Street-Garage Apartment Assessor's Map: 93 T Parcel: 36-1 Property Address Glenn G.Wattley Owner Owner's Name information is Osterville MA 02655 May 5 2017 required for every Y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form =' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 215 Bridge Street-Garage Apartment Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Owner Owner's Name information is Osterville MA 02655 May 5 2017 required for every Y page. CityrTown 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 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.): 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.doc•rev.6/16 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 215 Bridge Street-Garage Apartment Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Owner Owner's Name information is Osterville MA 02655 May 5 2017 required for every, Y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches - number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system - - Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. No effluent contact staining was observed above the normal operating level of the septic tank. 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 215 Bridge Street-Garage Apartment Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Owner Owner's Name information is Osterville MA 02655 May 5, 2017 required for every _ Y 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.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 215 Bridge Street-Garage Apartment Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Owner Owner's Name information is Osterville MA 02655 May 5, 2017 required for every Y page. Cityfrown 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 THIS SKETCH IS INFO fag BEST VIEWED IN SEPTIC ����.�� COLOR FORMAT GCo- BROGE STREET NOT pp nn LEACH TO SCE L�OC A T§ NNS —OF SEPTIC COMPONENTS ' B —DISTANCES IN DECIMAL FEET A B 13AG AGE 1 17 24 APARTMENT 2 18 15 �I OF 2115 1000 GALLON A SEPTIC TANK lyq TF. P; FS DRIVEWAY 508 364-0894 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 215 Bridge Street-Garage Apartment Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley Owner Owner's Name information is Osterville MA 02655 May 5, 2017 required for every Y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 16 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: Previous inspection report ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Previous inspection report o 9/24/97 indicates high groundwater is 16 feet below the surface. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 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 GSM , 215 Bridge Street Garage Apartment Assessor's Map: 93 Parcel: 36-1 Property Address Glenn G. Wattley. Owner Owner's Name information is Osterville MA 02655 May 5 2017 required for every y page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary (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 GEOHYDROLOGICAL -PROFILE — NOT TO SCALE 1� II PRECASTS LEACH e PIT 4_1g ,o BOTTOM OF LEACHING PIT LEACHING IS ABOVE HIGH GROUNDWATER GROUNDWATER ELEVATION PER INSPECTION OF 9124197 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C `SYSTEM INFORMATION Property Address: 215 Bridge Street Osterville Mai' Owner: Markey Date of Inspection: 9/2 4/9 7 FLOW CONDITIONS RESIDENTIAL: '1� Design flow: �40 R.p /bedroom for S.A.S. Number of bedrooms: Number of current residents: Garbage grinder (yes or no):_a Laundry connected to systt;m (yes or no): Seasonal use (yes or no): d Water meter readings, if available (last two (2) year usage (gpd): Sump Pump (yes or no):m Last date of occupancy:-f°& _ COMMERCIAUINDUSTRIAL• Type of establishment:I)A Design flow: A14 Rallons/day Grease trap present: (yes or no)-AY Industrial Waste Holding Tank present: (yes or no)" Non-sanitary waste discharged to the Title 5 system: (yes or no)2 Water meter readings, if available:" NIA Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPIN�ysteom OR S nd ourc!,of informs o pumped as part of inspection: (yes or no)_ If yes, volume pumped: A 6) gallons Reason for pumping: TYPE OF STEM 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) I/A Te�,hnology etc. Copy of up to date contract? Other �JOf� APAOXIMATE AGE of all compon nts, date installed (if known) and ource of information: Sewage odors detected when arriving at the site: (yes or no)ZO (revised 04/25/97) Page 5 of 10 FRO I�6 � St! III a� Nt l� 19 . a .23 A19 /77 1r i i LOCATION SEWAGE 1' � IIIYf11u. , V I L L A G E QS!`rvf��P iriaf� INSTALLER'S NAME & ADDRESS JOHN A. AALTO BACKHOE SERVICE , West Barnstable, Mass. 02668 S U I L D E R OR OWNER con DATE PERMIT ISSUED DATE COMPLIANCE ISSUED TOWN OF BARNSTABLE LOCATION ,�� %�� � ZG�2g6E) SEWAGE 093• VILLAGE /' ASSESSOR'S MAP & LOT O O� INSTALLER'S NAME & PHONE NO. �c7ROan �`D��� fag S6yo r SEPTIC TANK CAPACITY zoocc4l LEACHING FACILITY:(tYPe) I1'^^''ice` �. / (size) 6X8 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER.OR OWNER DATE PERMIT ISSUED: DATE COMPLUINCE ISSUED-_.-- t7 VARIANCE GRANTED: Yes No �� - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:21 5 Bridge Street Osterville Ma Owner: Markey Date of Inspection: 9/2 4/9 7 BUILDING SEWER: (Locate on site plan) Depth below grader Material of construction: �ast iron L140 PVC _ other (explain) Distance from private water supply well or suction line /wg _ D,ameCer y,r Comments: lc ndition of joints, vent in evidence of leaka e, etc.) r SEPTIC TANK:&I-tviM44v,y (locate on site plan) 1 Depth below grader Material of construction:4concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age A40 Is age confirmed by Ceniificate of Compliance 41oY(Yes/No) Dimensions: Sa"6�%�rac �l4a�G ��7��12'9GA Sludge depth: Distance from top of sludge to bosom of outlet tee o>tbaflle:� Scum thickness D Distance from top of scum to top of outlet tee or baffle:,_ Distance from bonom of scum to bosom of outlet t or baffle: How dimensions were determined: Comments: trecommendation for pumping, conditi n of inlet and outlet tees or baffles, depth of liquid level to relation to outlet invert, structural integnty, evidence of leakage, etc.) a GREASE TRAP�� (locate on site plan) Depth below grader Material of con struct ion;4Atoncrete/Ametal,{ Fiberglassolt�Pol yet hylene4-44ther(explain) .41,1 Dimensions: /1l/F Scum thickness: " Distance from top of scum to top of outlet tee or baffle:_ Distance from bonom of scum to bottom of outlet tee or baffle:�[/� Date of last pumping: 414 Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural ntegriry, evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATIO1`4 (continued) Property Address: 215 Bridge Street Osterville Ma"' Owner: Markey Date of Inspection: 9/2 4/9 7 TIGHT OR HOLDING TANK:Aa)—Clank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade:&� Material of constructionAAoncrete4Wmetal f4iberglass VAolyethylene 4JAther(explain) Al Dimensions: AJA Capaciry: A)A gallons Design flow: gallons/day Alarm level: Alarm in working order"Yes;/VA No Date of previous pumping: _J2 Comments. (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:Z1711*k /l ose (j111k1 (locate on site plan) Depth of liquid level above outlet invert: /0 Comments: in to if vel a d distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER:AhNi (locate on site plan) Pumps in working order: (Yes or No)-A2& Alarms in working order (Yes or No)dj/, Comments: (note condition of pump chamber, condition of pumps and appunenances, etc.) r L; 407- 6&r (revi.ad 04/25/97) Pnge 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 215 Bridge Street Osterville Ma Owner: Markey Date of Inspection: 9/24/97 _ SOIL ABSORPTION SYSTEM (SAS):--,,,/� ;locate on site plan, if possible: excavation not required, but may be approximated by non intrusive methods) If not determined to be present, explain: Type: � leaching pits, number: / J leaching chambers, numbe leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: (2 Alternative system: Name of Technology: Comments: (note condition of soi , s� ns of hyd auli failure, level ponding, condition of v getation, etc.) CESSPOOLS: /M)6 (locate on site plan) Number and configuration: IV19 r Depth-top of liquid to inlet invert: /V16 Depth of solids layer: Depth of scum layer: /iliq Dimensions of cesspool: Materials of construction: lL Indication of groundwater: i inflow (cesspool must be pumped as pan of inspection) y,e Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: '&�Zve_ (locate on site plan) Materials of construction: Allf Dimensions: Depth of solids: 44W Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/35/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM IN FORMAT ION'(continued) Pro ddress: 215 Bridge Street Osterville Ma Own�;r: Markey Date of I spection: 9/2 4/9 7 j) SKETCH N SEWAGE DISPOSAL SY$TE nclude ties to at least two permVe ,referer7ces la�dmarkXor benchmarks ocate all.wells within 100' (Lpc �ublic oZer supplycomes into house) .._ ...'.I.._._.... ..�.... N o 1. op 61 o . (revised 04/25/97) page 9 0f 10—_~ I SUBSURFACE SEWAGE DISPi L SYSTEM INSPECTION FORM r C SYSTEM INFO):. . .!ION (continued) Property Address: 215 Bridge Street Osterville Ma Owner: Markey Date of Inspection: 9/24/97 �Vr 'V40 ha5 Depth to Groundwater Feet Sd-e3-eoe� Please indicate all the methods used to determine High Groundwater EIC-ation: Obtained from Design Plans on record bservation of Sit (Abutting property, observation hole, basement sump etc.) 4:,n-�etermine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in our own words how you established the High Groun�a*erElevation. Must be completed). Y Y g �— i Used CAPE Cod Commission Map Dated September 95 Cape Cod Water Table Contours and Public Water Supply WellHaed Protection Ares (revised 04/25/97) P&C. of 10 n rr^Try .+r.-rr.r�rrnn re-.,m r:•.�.+++�.r.•.r�+r.+nm�u r.►�r.v.nm �*'*..�.-em-v r.--'ram-r-.- _ ._ TOWN OF Barnstable- WARD OF HEALTH SUHSURFACF, 9FWA(;E DISPOSAL SYSTF,M IN9I1FCTION FORM - PART D CFRTIFICATION `• �'•.•T T .•. .��..I..��T.�'�.1•n:1T1TT.'QTIIT.P'TI'1'.r•71VTR.'Y RTI•f�1�IIR�..�fT'.►/•T. IfT r^ITT'r1n .�. �.r- -TYPt OR PRINT C UARLY- PROPERTY INSPECTED STREET ADDRESS 215 Bridge Street Osterville Mass. ASSESSORS MAP , BLOCK AND PARCEL # OWNER ' s NAME Markey ' PART D - CERTIFICATION NAME OF INSPECTOR Joseph P. Macomber Jr . COMPANY NAME Joseph P. Macomber & •'ion , Inc . COMPANY ADDRESS Box 66 Centerville , Ma . 02632-0066 5 L r e v t Town or City Stet• LIP COMPANY TELEPHONE (508 I 775 -3338 FAX ( 508 ) 790 -1578 CERTIFICATION STATEMENT I certify that I. have personally inspected the sewage disposai7 system nt this nddress and that t)1e information reported is true , accurate , and complete as of the time of .inspection . The inspection was performed and any recoininendaLions regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , Check one : (XXXXXXXX.2LX9yste(n PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public healLh or the environment as defined in 310 CMR 15 , 303 . Any fail(Ire criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . 0 System FAILED The inspection which I have con acted has found that the system fn ! 1s to Protect the *public health and the environment in accordance with Title 5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . ,Inspector Signature Date 9/25/9�7 )ne copy of this certification must be provided to the OWNER , the BUYER ( where applicable ) and the 130ARD OF 112AL1'll. • Zf the inspection FAILED , the owner or oporator shall upgrade the eyatem wir.hin one year of the date of the inspection , unless allowed or requires; otherwise as provided in 310 CMR 15 , 305 , partd . doc —X- W U7 �C7 ti THE COIV MONWEALTH OF MA.SSAC14USETTS DEPARTA4 ENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualificatiqns as required and is hereby authorized to use the title CERTIFIED 'TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. June 8. 1995 Acung Director of the c ion u[ W11cr �PoU �nControl ' c� COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF:ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION e ONE WINTER STREET. BOSTON, MA 02108 617.292.5500 WILLIAM F.WELD TRUD1'COXT Govcmor Sc`rcw ARGEO PAUL CELLUCCI DAVID B.STRUR' Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissionc PART A CERTIFICATION Property Address: 2;5 y$ qge Street Osterville Address of Owner: Date of Inspection: / 4 (If different) Name of Inspector: Joseph P.Macomber Jr. 1 am a DER af�pr ve(� ystem nspector p rsuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: " • •1'laeom�er & on Inc. Mailing Address: BOX 66 Centerville,Mass . 02632 Telephone Number: 508-775-3338 CERTIFICATION STATEMENT I cenify 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails A Inspector's Signature: Date: ��� The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 god or greater, the inspector and the system owner shall submit the repon to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: AI SYSTEM PASSES: Ihave not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR t S.303. Any failure criteria not evaluated are indicated below. COMMENTS: Bl 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. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not. Q The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:1twww.magnet.state.ma.us/dep {'j Printed on Recycled Paper t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (cohfinued) Property Address: 215 Bridge Street Osterville,Mass. Owner: Markey Date of Inspection: 9/24/97 B) SYSTEM CONDITIONALLY PASSES (continued) A124C Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstruc7ed pipe(s) or due to a broken, senled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipets) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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(sl are replaced obstruction is removed C1 FURTHER EVALUATION 15 REQUIRED BY THE BOARD OF HEALTH: WV Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: &tO Cesspool or privy is within 50 feet of a surface water A.d 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 APPROPRIATE) DETERMINES THAT THE SYSTEM 15 FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: *6 The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well 6 The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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. Method used to determine distance (approximation not valid). 3) OTHER �i (revised 04/25/97) ➢age 3 of 10 DATE: . 9/24/97 PROPERTY ADDRESS: 215 B-ri•dge Street Osterville,Mass . 02655 On the above date, I Inspected the septic system at the -above address. This system consists of the following: 1 . 1 -1000 gallon tank and two Flowdiffussors. This is for the main house. 2 . Garage cottage. HAS 1 -1000 gallon pit and 1 -1000 gallon pit. Based on my int ct action, I certify the following conditions: 1 . This- is a title five septic systetn.­ ( 78 Code ) ' 2 . Both septic systems are in proper working order . at the present time. SIGNATURF`: Name : J . P . Macomber Jr•• i ---------------- Company:* J . P_Macoa)ber &- Son'_Inc , , Address __Cente_rvi11e , Mass__024632 ` Phone:___548..:Z7 �338______ • I THIS CERTIFICATION DOES NOT CONSTff UTE A GUARANTY OR WARRANTY ?ii N H le LJOSEPH P. MACOMBER. & SON, INC.Tanks-CeupoolrLeschfieldsPumped & InstjllydTown Sewer Connectionsx 6G ' Centerville, MA 02632 0066 �'` F � eu 775.3335 775-6-012 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION"(continued) Property Address: 215 Bridge Street Osterville Owner: Markey Date of Inspection: 9/2 4/9 7 D) SYSTEM FAILS: You must indicate ei;• er "Yes" or "No" as to each of the following: V I have determined that the system violates one or more of the following failure criteria as defined in 310 CmR 15.303 The bass for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an 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 5A5 or cesspool. Static liquid level in the distribution boxLabove outlet invert due to an overloaded or clogged SAS or cesspool i�t Liquid depth in 64iu61 d is less than 6" below invert or available volume is less than 112 day flow _ Required pumping more than a times in the last year NOT due to clogged or obstructed pipe(s) Number of limes pumped _. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation Any portion of a 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 qualiry analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 god or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 ll of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CmR 5.00 and 6.00. Please consult the local regional office of the Department for further information )revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 215 Bridge Street Osterville Ma Owner: Markey Date of Inspection: 9/2 4/9 7 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes N Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. ZThe system does not receive non-sanitary or industrial waste flow. ,V _ The site was inspected for signs of breakout.e _ All system components, luding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of TTT baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. —The size and location of the Soil Absorption System on the sitethas been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance'of Sub-Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [I5.302(3)(b)) (revised 04/25/97) Pegs 4 of 10 TOWN OF BARNSTABLE LOCAT10t SEWAGE # %2 VILLAGE QSf ASSESSOR'S MAP 6z LOT INSTALLER'S NAME & PHONE NO. C` 0(2_bo- rrn us- LG-b-56 9'0 3SEPTIC TANK CAPACITY /,©oo c,y/• kLEACHING FACILITY:(type) 9,7 (size) 6X$ NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER A 2h!? DATE PERMIT ISSUED: 3/2 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No I k . Q ASSESSORS MAP NO- 10 "No: P �� PARCEL NO: �2� Fiza. ............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH =:Y TOWN OF BARNSTABL.E Appliration for DiinvniiFal lVadw Tomitrnrtion rnmit Application is hereby made for a Permit to Construct ( ) or Repair (4/ran Individual Sewage Disposal System at: iOJG�c�C� ��j� may► .............!!IC.�M�Cl !_[.,.t ca tioY,:h. -![ - ------•---------,------ •-•---------------•- or Lot No. -------------••-•-......•-•--•-----•----•--•------......_...._..........•----- O+aner Address V. .................. •--•---------------••------....--•...---•----••--•...------....--•-•-...............•••....._•--•- a Iust ler Address Type of Building Size Lot............................Sq. feet Dwelling 1o. of Bedrooms.-/---------------------------------------Expansion Attic ( ) Garbage Grinder aOther—Type of Building ---------------------------- No: of persons_-_-__.__._-_--___------_- Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------ ------------------------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length________________ Width---------------- Diameter---.------------ Depth................ x Disposal Trench—No. .................... Width.................... Total Length-------_............ Total leaching area....................sq. ft. Seepage Pit No.---_-_--_--- ...... Diameter------------------ Depth below inlet.................... Total.leaching area..................§q. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I--------=-------minutes per inch Depth of Test Pit.-.___--_____---_-- Depth to ground water-.--__.--_--_-___----... Gi, Test Pit No. 2...................minutes per inch Depth of Test Pit.................... Depth to ground water.._...-._-_-___---___--. 04 ------------------------------------------------------------------------------------•--•------------ ........................................................ 0 Description of Soil............................................-------•----------------------•---------------------------------------------------.._....------------------............._.. x ----------------------------------------------------- --------=------ ------------------------------------------------------------------------------- ----- ----------��--- � /�/. ...... 000_ U Na e q�R airs 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 Compiia has been i ! d by t and of health. Signed'. �',..L...`d � -----------:---------------------------------- ...... e Application.Approved By :.:.: i . De - Application Disapproved for the following rearonr- ----------------- ..............................---------------------------------------------------------- . 7 .............................................. ... ---------------------------------------- Permit No. ...."P... `" Issued ........%�J'�..�.....��...... .:,��-------------- Dare No................-��� (S;'6 �.ta� F�s. O............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diij-p .gul Work.6 Cgumitrnrtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (kl<an Individual Sewage Disposal System at,', . ,, - 0 Locat io -.1dd rs or Lot No. /ice. / l Owner Address a --•-•-......----G n�" Uz �s------------------- -------------- � Instf ler Address UType of Building Size Lot............................Sq. feet Dwelling 2No. of Bedrooms._/------------------------------------_-Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building -------------_--_--.---__- No. of persons---------------------------- Showers ( ) '— Cafeteria ( ) dOther fixtures f --------------- W Design Flow--------------------------------------------gallons per person per day. Total daily flow........ ..................................gallons. WSeptic Tank—Liquid capacity.-----------gallons Length---------------- Width---------------- Diame ter---------------- Depth------_--_-_ x Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No........... ......... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~" Percolation Test Results Performed by.......................................................................... Date........................................ a 14 Test Pit No. 1................minutes per inch Depth of Test Pit--.--._-__-_----_._. Depth to ground water-:_.__._.-------____---- f14 Test Pit No. 2................minutes per inch Depth of Test Pit--.--.-.--_--_-_.-_- Depth to ground water........................ 04 ----------------------------••-----------------------------------•-------•-----••-•---------.................•-•••---•-----------------...---......•--.----- 0 Description of Soil....................................................................................................................................................................... ---------------"---- --------------- --------------.-.------------------------------------------------------.------------------.....------.._......._�-- -------------------------.•--- U Na e qf.R�a^irs or Alterations—Answer when applicable_-.-.--. .______._.__..__ �s� /j...-- DD �,� • 0 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 untiLa Certificate of Complia has bei�n i s. ed by t e and of health. c ., Signed - �,� r ......... - - - ..�-- r - Application Approved BY --------- - - -�— . ............................`...-...................... Da[e ..- .. Application Disapproved for the following y'easons .... .............................. .. ........................................................?........... t Permit No. �... •;J.. fS ------------ Issued -----c Q ........... ...Da[e.. Dare t J" THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C�Ertifirate of Q-11ontyliance i� TljjS A TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired U/ by ------------ �. � :v ./K.............. >----------------------------------------------------------------- ----------------------------- ----- ---- at . Q� . _. .. - -- ^--- has been installed in accordance with the provisions of TITI: 5 ohe Sate Environmental Code as described in, the application for Disposal Works Construction Permit No. -------- dated ------ .-�- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT-BE CONSTRUED AS A GUARANTEE-THAT THE SYSTEM WILL FUNCTION SATISFACTORY. -� = DATE...... .. �'......... ........ .. ...._.... Inspectc�r\..-..t ----- ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 0 FEE ............ �i��r�a��t1 nrk� �un�tr�rtuan rrntit Permission is hereby granted o2D0�1__ _i )� t/.5------------------------------------------------------------•--......-----... to Construct ( ) or Re ®air-(�n Individual Sewage Dispdsal System atNo.............. •' --•i`r •`, -------. -----------_---------- St .1 �� as shown on the application for Disposal Works Constructi errry �o'. D ......� .... � -� .. ------------------------- Board of Health / DATE-------------------- ............................................... (/ FORM 36508 HOBBS&WARREN.INC..PUBLISHERS , L0CkTION� s"� SEWAGE PERMIT NO. 15W®c1 �e V L L'AG E I N S T A LLER'S NAME a ADDRESS JOHN A. AALTO BACKHOE SERVICE 250 )Wdinut Street West Barnstable, Mass. .02668 0 UILDE R C OR OWNER .Ji/fvr�r �o/rrsu 'DATE PERMIT ISSUED DATE COMPLIANCE ISSUED y/_7v/�� o mT i i J. NO THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ .....OF... U, T.Q�BLe ............................................ Appliratiou for Uhipoiittl Morkii Tontitrurtiou Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at L:....T.?..../.o...........Q!Pll1 F.....�7R�E .......4...st6.i��/ Lo�i� io Location-Address .1 ............. .............. ti .......h` .�-ti !.t' ...- -- O ner A dress ........................................................... .. !..f.}.zST ti,� 111.1................................................ a Installer Address Qa Q Y _.._......Sq. feet Type of Building Size Lot��!_____ V Dwelling—No. of Bedrooms._..._%3................................Expansion Attic f yo,L E Garbage Grinder W A r 04 Other—Type of Building ..Le.eoa.............. No. of persons....2.................... Showers Cafeteria (.V� Q' Other fixtures ................................. . _ W Design Flow............................................gallons per person per day. Total daily Ions. g g P P P Y Y 9. ........... . WSeptic Tank—Liquid capacity..M..--gallons Length................ Width---------------- Diameter..--..--.---.... Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.--..--............. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.................................•---...---------------------------------- Date---------------------------------....--. aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-----..---.........----. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-----.................. Rai ----------------------------- ----------------- ---- ...........--......................................................... 0 Description of Soil.....d-- -a.f- ......L o�4,� ,.�1115.....---"Z 2------- --99--'-3-..... 05 ------------------------ W ----------------------------------•------------------------------------------------------------------.....------------------------------•--•-_•---- UNature of Repairs or Alterations—Answer when applicable--------.--- ----------------------------------------------------------------------- ----------------------------•------••----------------------•--------------...........--•---•--......----•--------------------------------------------------------•--•-------......--------•-.......----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T T__EE p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed.. . ----------------•-----•--- I� .....��....------ �� Date Application Approved BY..............,.--. -'- .r_1.1 ........---•-•----•- ............ ..L � Date Application Disapproved for the following reasons:----•--•...................•-------••----••---------....---......---•------•-----------.........._--------_..._ ---------------------------•--------•---....-•---••--•-----••-•------•---------------.........................---------•--------•-----------------------------------.....------------......._-------•-- Date PermitNo......................................................... Issued_....................................................... Date > 0 y , r �., THE COMMONWEALTH OF MASSACHUSETTS 4 BOARD OF HEALTH U.w.. _................OF... ! ............................................. Appliration for UWpog al Works Tontitrnrfinn rprutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: off'- vt /g Q.P/U�rF„_•S7 CE r Os rur.�� L o 7`v /o ................•- -•......_..--.•.... --•------------------ ..........•-••••......----•••••---•••----•--•----------------•----------•-...............-----••-- Loca ion_Address or Lot No. IR s��v.ti ��`6 �N�,9 ���� A/ A.,,�i - � .. ._.. .. . - -- ..... ............ .-- V o N/✓ /%A`T4 O ner 1�ress ---------------------------------------------------------------------------------------- ---•-------•..... •••-•-•-•-•-----••----•----••-.......-........••••--••----•----------•-•---.•. Installer Address UType of Building _ Size Lot .r� ..........Sq. feet Dwelling—No. of Bedrooms..... ...................................Expansion Attic (tiO3-E Garbage Grinder p-, Other—Type g p ( ) — Cafeteria Other—T e of Building _.w 4a:�.............. No. of persons ____.__._______.__._ Showers "� (��) a' Other fixtures .................................. ----•-�------------------ Design Flow............................................gallons per person per day. Total daily flo 3 k......<-- - s.- .y ...._._._gallons. W - WSeptic Tank—Liquid capacity 0D.._.gallons Length---------------- Width---------------- Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.............._----- Total Length.................... Total leaching area____-_-_--__-_._-.sq. ft. Seepage Pit No--_---------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water...................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground.water.._.._.............._... a ...................................................... •.•••..ti..r..�.-•-•--••••---•-•-••.......................•••............------••- O Description of Soil-----�r �-�'... .1-0�44'1 sU'� ° •--• i4�1<1...... r U •--�o✓c5---------SAN,O----•----------------------•------------.......-----------------•----------•---------------------------------------------------------------------------- W ---------------- -----------------•-• ------•---•---•----------.--------------------•----------------------------•-----._.... ..................................................................... U Nature of Repairs or Alterations—Answer when applicable............. -------------------------------------------------•-______---_-•.----__. •---------------------------------------•-•---------------------------------.................---...------------------------------------------------------------=----------------...........•-•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'11 y g g p y 5 of the State Sanitary Code—The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued by the board of health. Signed--------- --�==-%�--�-- ----•-••----•----•---------------•------------------- �� `�.... Application Approved By............... --•----•----------- ------------------- Date Application Disapproved for the following reasons---------------------------------------------------------------•------------------------.. .----------........... --••-------------------------•------•----••-•------••----•--•--------------------.....-•------------......----------------------------------------------- ------......--•••-............•--- Date PermitNo......................................................... Issued-........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH .� �✓ ................OF............................. ........ .?.........................._.............. Trrtif iratr of Tomphaurr THIS�A TO CERTIFY That the Individual Sewage Disposal System constructed (�r Repaired b r_�:n_... G:�`. at----------------=..'................................ ' ----------'---------------�J----`a--`-----------------------------------------------------------------------._.._..----------------- has been installed in accordance with the provisions of TITLE j of he State Sanitary Code as described in the application for Disposal Works Construction Permit No---- �._ _�•-__-___-___- dated---.._----__-_----•_. ------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFAC OP_,Y. DATE.......................................... f ............. Inspector......... .A CM.,------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD ®,�,HEALT„ ,OF.. . .................. tr.?'!�: .. --------..................--......------.._.................................. No...c -.:�..... FEE...................... Disposal nrk9non trudinn Vamit Permission is hereby granted to Construct or Repairr��� ) a Indiv4uaI Sewa D' posal System at No........... • .�1.�_...� �... 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