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HomeMy WebLinkAbout0227 BRIDGE STREET - Health 227 BRIDGE STREET, OSTERVILLE A=093.038 > o It i 0 ire` 1. II J ' c s Y TF4E tp� Town of Barnstable w + IARNSfABLE, . Inspectional: Services Department �Ar fa�ti A Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO 2 YEAR DEADLINE CRITERIA Single Cesspool ❑ Any "conditionally passed systems" (broken cover-, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Cl Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc t. Town of Barnstable Barnstable oFt�r� . Pam' ti Inspectional Services Department "' ca�'y BARNb'TABLE: 1 ►. 63 Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 9729 July 8, 2019 SOUSA, LORRAINE A & TOOMEY, LISA M TRS 143 TOPSFIELD ROAD WENHAM, MA 01984 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic systems located at 227 Bridge Street, Osterville, MA was inspected on 06/24/2019 by Frank Nunes,111, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic systems showed that the system "Fails" under the guidelines ypof 1995 TITLE V (310 CMR 15.00) due to the following: j �j� kU A 0 System 1 of 2 • ystem 2 of 2 (Main House) — Single Cesspool. It is the basement laundry �f,` , system. You are ordered to repair or replace the septic system within two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period`will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters MailingTailed or Needs Further Evaluation Letters\227 Bridge Street Osterville.doc Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �- 227 Bridge St. (1 of 2 systems at the property this is the main house) `? Property Address wner Sousa iinnformation is Owner's Name 4.Q required for every Osterville MA 02655 6/24/19 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. Inspector Information Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ® Fails 6/24/19 Inspectbrlg Signatur Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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 form should be sent to the system owner and copies sent to <?/V d f the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts ,ig Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments. 227 Bridge St. (1 of 2 systems at the property this is the main house) Property Address Sousa Owner Owner's Name information is required for every Osterville MA 02655 6/24/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 227 Bridge St. (1 of 2 systems at the property this is the main house) Property Address Sousa Owner Owner's Name information is required for every Osterville MA 02655 6/24/19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with,Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts . �a ,ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 227 Bridge St. (1 of 2 systems at the property this is the main house) Property Address Sousa Owner Owner's Name information is required for every Osterville MA 02655 6/24/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: ***There are 2 sytems to the main house. One of the main house systems"Fails". It is the basement laundry sytem. It is a single cesspool which is not allowed in the town of Barnstable. The primary system is the other sytem it serves the main house, the guest cottage, and the dock building. It does not"Fail". Also the dock building has a pump chamber. It pumps to the 2000g septic tank 4) 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 227 Bridge St. (1 of 2 systems at the property this is the main house) Property Address Sousa Owner Owner's Name information is required for every Osterville MA 02655 6/24/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ® 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 ❑ ® 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 water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ® ❑ 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. j 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts (o Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 227 Bridge St. (1 of 2 systems at the property this is the main house) Property Address Sousa Owner Owners Name information is required for every Osterville MA 02655 6/24/19 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: 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)] r t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts i Title 5 official Inspection Form I' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 227 Bridge St. (1 of 2 systems at the property this is the main house) Property Address Sousa Owner Owner's Name information is required for every Osterville MA 02655 6/24/19 page. Cityfrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 8 Number of bedrooms (actual): 8 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 8 bed rm Description: Owner provided engineering plan from 1977 that shows it as a 8 bedroom design but the as built on file shows it as a 3 bedroom.There were no engineering plans on file at the BOH Number of current residents: 0 Does residence have a garbage grinder? Yes ❑ No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ® Yes ❑ No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: Single cesspool for the laundry. Sump pump? ❑ Yes ® No Last date of occupancy: seasonal Date .. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form I' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 227 Bridge St. (1 of 2 systems at the property this is the main house) Property Address Sousa Owner Owner's Name information is required for every Osterville MA 02655 6/24/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: n/a Design flow(based on 310 CMR 15.203): Gallons per day n(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No + Y If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/user Date Other(describe below): 3. Pumping Records: Source of information: Pumped 2018 per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 I , Commonwealth of Massachusetts ro Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 227 Bridge St. (1 of 2 systems at the property this is the main house) Property Address Sousa Owner Owner's Name information is required for every Osterville MA 02655 6/24/19 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known)and source of information: 1977 per owner provided info Were sewage odors detected when arriving at the site? ❑ Yes ® No. 5. Building Sewer(locate on site plan): Depth below grade: 18feet Material of construction: '❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet feet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 227 Bridge St. (1 of 2 systems at the property this is the main house) Property Address Sousa Owner Owner's Name information is required for every Osterville MA 02655 6/24/19 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 1• Depth below grade: feet Material of construction: ' ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) Inlet cover to grade If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 2000g Dimensions: 6„ Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle >12 Scum thickness trace >2" Distance from top of scum to top of outlet tee or baffle ` >2,.' Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3yrs to prolong the life of the system t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts ro Title 5 Official Inspection Form 11. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 227 Bridge St. (1 of 2 systems at the property this is the main house) Property Address Sousa Owner Owner s Name information is required for every Osterville MA 02655 6/24/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: n/a 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: n/a Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 227 Bridge St. (1 of 2 systems at the property this is the main house) Property Address Sousa Owner Owner's Name information is required for every Osterville MA 02655 6/24/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 01, 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.): D-box is 1'6" below grade, average condition for its age, no adverse conditions ,f t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 227 Bridge St. (1 of 2 systems at the property this is the main house) Property Address Sousa Owner Owner s Name information is required for every Osterville MA 02655 6/24/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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.): Pump chamber has cover to 6"of grade, it is located at the boat house building and pumps up to the main house 2000g septic tank * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: " 4 ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 I Commonwealth of Massachusetts Iio Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 227 Bridge St. (1 of 2 systems at the property this is the main house) Property Address Sousa Owner Owner's Name information is required for every Osterville MA 02655 6/24/19 page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The pert pipe trenches were video inspected and are damp at this time, there was no indication of past hydraulic failure, approximately 18" below grade 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration single, for the basement laundry Depth—top of liquid to inlet invert 2'6" Depth of solids layer 011 Depth of scum layer trace Dimensions of cesspool 20"x20"x3' Materials of construction block Indication of groundwater inflow ® Yes ❑ No Comments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts w - Title 5 Official Inspection Form � p w Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 227 Bridge St. (1 of 2 systems at the property this is the main house) Property Address Sousa Owner Owner's Name information is required for every Cisterville MA 02655 6/24/19 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: n/a Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 I Commonwealth of Massachusetts ,9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 227 Bridge St. (1 of 2 systems at the property this is the main house) Property Address Sousa Owner Owner's Name information is required for every Osterville MA 02655 6/24/19 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 14. 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 � ) r a d O� QpA't ZL G LP —" c 5 G;gt1L L 1z'PVjV_ AJ M't t5insp.doc•rev.7/26/2018 Title Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts �n P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 227 Bridge St. (1 of 2 systems at the property this is the main house) Property Address Sousa Owner Owner's Name information is required for every Osterville MA 02655 6/24/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (coot.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar r ❑ Shallow wells Estimated depth to high ground water: 7,feet Please indicate all methods used to determine the high groundwater elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 r 4 A Commonwealth of Massachusetts 9 Title 5 Official Inspection Form w Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 227 Bridge St. (1 of 2 systems at the property this is the main house) Property Address Sousa Owner Owner's Name information is required for every Osterville MA 02655 6/24/19 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8:Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 r , I I/►'1 i 17� f e r���c f��j� cc Jf ��l No. l 0l � J�. Fee T COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppliLation for Disposal 6pstem Construrtion Permit Z Application for a Permit to Conact(, ) Repair( ) Upgrade( ) Abandon( ) Oomplete System ❑Individual Components Location Address or Lot No. �jjZ/,Qb� �`j. 7 Owner's Name,Address,and Tel.No. im 941vLrf Assessor's Map/Parcel I staller's Name dress,and Te No Designer's Name,Address,and Tel.No. i� 6✓I�G ` c�r� ' � 99 &Z OAN .6496 -,5�V6• YAKA ,0 Z7_1V0)0'ZT Type of Building: `Q Dwelling No.of Bedrooms , / Lot Size ..J y1 sq.ft. Garbage Grinder( ) Other Type of Building GAA 4 bb / ONa iW No.of Persons Showers( ) Cafeteria( ) Other Fixtures .Design Flow(min.required)) //40 gpd Design flow provided <7� gpd Plan Date / / ` /9 Number of sheets Revision Date Title Size of Septic Tank /,500 SAjjZL &0—? /7 6QA&k'ype of S.A.S. P/jAi,03Md /a PFLD Description of Soil ' c _I1 l�� 2� n V Nature ofgRepairs or Alterations(Answer when appl' able) vA �� N IdAST1�►L4, �L MYS A W ,C 24 N-a_n� e,�� o -� �v w I fit y - r � E���1���� NS SSi��--t= t� l �.�� Date last inspected: /`e Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 e Environmental Code and not to place the system in operation until a Certificate of ;- 4 Compliance has been issued by this Bo d o e lth. o /gyp ig Date t� ' 1 Application Approved by Date Application Disapproved by Date �� for the following reasons Permit No. l j Date Issued - 3/ 1- THE COMMONWEALTH OF MASSACHUSETTS 1 15 All n�� BARNSTABLE,MASSACHUSETTS (Certificate Of Com YIatire THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded) Abandoned( )by PA�r"02�i &X 64VATI W at 1QS SZIJD&'G J4 MZ2U) L4Z has been constructed in accordance l with the provisions of Title 5 and the for Disposal System Construction Permit No;2 -4 -�C(%ated Installer Pj!gZT_wG efC A!tnNMZW Designer Dowk) -1c �IS6i"L51 �yy.Sy #bedrooms Approved design flow gpd The issuance of this perm t shall not be construed as a guarantee that the system wil n 'o . desi Date Inspector ------------------ No. Fee ; THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS VspoSaf 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade(:°"') Abandon( „� System located at and as described in the above Application for Disposal System Construction Permit. The applicant Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. z Date Approved by x TOWN OF BARNSTABLE LOCATION_fZj &,lmE ST SEWAGE # 6 . VILLAGE 0M rtV l4L fr, ASSESSOR'S FLAP G LOT O 3 O 3$ + INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY© �r��- LEACHING FACILITY�tnm) WMAS 100-i (size) f NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER JpSrH cpilSl� DATE PERMIT ISSUED: DATE COZIPLIANCE ISSUED: VARIANCE GRANTED: Yes No. &it i6m Loam re 4 (off 144 i ' ',zhs"ct,an 6/24/2019 147zi 1� p1�i�„� . 4 Number T Inspection Date Inspector Result 1 1391'0 � Gr24�°2'Oi9 Numes III, frank F«R ( aiVRepair The following conditions)"are occurring: , discharge: or ponding of effluent to the surface of the ground f I pu,irnping,more than 4 times during the last year NOT due to clogged or obstructed pipe. . :. # {rbackup of sewage into facility,or system component due toan overloaded or clogged SAS or cesspool static liquid level in the: distribution box above outlet ins+e:rt due:ao an overloaded or clogged SAS or cesspool 0 any portion of the SAS, cesspool, or privy below high groundwater elevation ` any portion of the cesspool within a'Zone 1 to a public well (--I 'any portion of a cesspool within 50 feet of,a private water supply well with no acceptable water quality a-nalysis Keceived Date comments - 6d27 2019 1 of 2 systems Garage u^� �. belete IraSpe Save Septic'Changes I'eturn to Lookup 1 / 3 l l TOWN OF BARNSTABLE LOCATION 15I ► . 5T SEWAGE # VILLAGE T 12V(LLB ASSESSOR'S MAP & LOT 09 3 ®36 { INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY Cy LEACHING FACILITY:(type) I (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER JOS&PH SOVS& DATE PERMIT ISSUED: p DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No . ItA• P.W. Owm F-0604 io 2 A 1 �vcPd►�151 s�1�1 �'' iNo.__.... Fma.......N..................... HE COMMONWEALTH OF MASSACHUSETTS P c� a.� BOARD =AL Z HTT�OF........ . Appliration -fur Bitipaiial Vorkfi Tonfitrurtion Vrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst t. ation• dress or Lot No. ..........:.................... a caner Address Wlot- ..•• •-• - -------- ------------ --•-•------....-•-------•---••--•--•-----•---............................---••--- nstaller Address- d Type of Building Size Lot_._.Z�'.........__...... Dwelling�-No. of Bedrooms.......................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building -------.�'�..'U_._�Ti_._...... No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------------------------------ ---------------------------------------------------------------------------------------------- W Design Flow-------------- ............. ...... gallons per person per day. Total d'ily flow................ __-----.-..-.--. i lions. Septic Tank Liquid capacity ..gallons �Length...If:- �..... Width.--(a.�._.. Diameter__............. Depth. 1.'�--. Disposal Trench Y—/ No._..__ ._ -- Width______ ___________ Total Length....140.-...... Total leaching area-. 615; -----Sq. ft. x Seepage Pit No..................... Diameter-------------------- Depth below inlee... _.._._..___ Total leacliii f area------------------Sq. ft. z Other Distribution box ( ) Dosing tank ( ) �'�` ' � /?-/- 7 / '-' Percolation Test Results Performed by._�. X7&4_4_ !%�.. ® :.� �.��'' Date.... a Test Pit No. 1...... per mch Depth of Pest Pit...... ....... Depth to ground water...6.#Z------------- (� Test Pit No. 2._9.110W minutes per inch Depth of Test Pit,-Z&W.-ff... Depth to ground water.s!.!Y_l&-_--.--. - --------------------------------------------------------------------------------------- O Description of Soil �6t"Z.A9•rn__s V, D_ P✓ .5�®�• 'D._i?�> .._,S.4�tl j--------------------------- x ------------------------------------------------------- ................ -- ---- --------------------------------- ----•-- W --------------------------------------------------------------------------------------------- -- -° ..... fi.6 ( :.' -----------_------- V Nature of(R epairor Alterations Aner when appli 1 ..._ . �0 _--_---- .- _... . ...__ / _--.--.. ---•- ---- --- .... ..... --------- ---- ---- -------- Agreement: -.. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned rther agrees not to place the system in ` operation until a Certificate of Compliance has b -n sued by the boar ealt E Sign ---------- :... .•-----•------------•))........................-----"--------- 7•�-----•----.... " Date Application Approved B ��'� 7 7 ------ -- -------- - ----- --- ----------- Date Application Disapproved for the following reasons------------- ----- -------------- ---•------....... . ..:_..._..._._....._._......._..._.........._..._. } --•-•-.......--•-•----------------•-•------......---•----••----•---. -• .............................................................. Date PermitNo. -••••••-----------------••-•-••--•••--••----_. i Iss'tied---•--•..... ............. Date ... ... _ ................ ................................ .......,................................................... .s.•.•.•.i..•� a , THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH .........OF............. �....... Trrtif iratr of 0,11mphaurr T I 0 CERT T e Individual Sewage Disposal System constructed (k) or Repaired ( ) by .. -•..... .... .... -------------- -----• ---•-------•-----------------------•-•----••-------•-------•--- S X all / has been installed in accordance with the provisions of Ar X o The State Sanitary Code as described in the application for Disposal Works Construction Permit No.._ ..... �_.7__.._._._.-. dated.... -...7.-77..............:. THE ISSUANCE OF THIS CERTIFICATE SHALL, NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................-•-•---•--•--•--•. ...=°-=....... Fas.....`4ST_"w ..... 4 1 THE COMMONWEALTH OF MASSACHUSETTS 'BOAR® F HEALTH E .w, Apli irtttinn -fur 13i11.puiittl Works Tomitrnrtion Prrniit Application is hereby made for a Permit toConstruct ( ) or Repair ( ) an Individual Sewage Disposal §teat. /+ .__ _ _•<_ ..._ __!_....._ ___. .___f_. _..___... ............................................................................ J ��jcation- dress I or Lot No. astaller r Address -------•••--. ( -•--• --•- '-' ...................•... Address Q Type of Building Size Lot......------------------------Sq. feet Dwelling—No. of Bedrooms---------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building .............................. No. of persons----------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ---------- -------------------:7°-............. _-------------------------------------------------------- ------------- ------------------------------ W Design Flow............................................ per person per day. Total daily flow---_........................................gallons. WSeptic Tank—Liquid capacity-------------gallons Length---------------- Width-----.-------_- Diameter................ Depth_...._.......... x Disposal Trench'—No._.-___`______________ Width------ -__- Total Length____.___._-_._____-- Total leaching area_-_---_--___--___-__sq. ft. Seepage Pit No..------------------- Diameter-------------------- Depth below inlet_____,______.._-_-_• Total leaching area........----------sq. ft. z Other Distribution box ( ) " Dosing tank ( ) 6 A- Ac _ ��"�' 77- aPercolation Test Results Performed bY.......................................................................... Date._------------------------------------.. Test• Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_--,__-_,_-__-__-__-__--- (4 Test.Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__:-------------- -----------------------------------------------------------------------------------------------------•--•----•_---.-•_-------.------•-•----------••---------- GDescription of Soil.................................................................................--------------------------------------------------------------------------------------- U -----==------------------------------ -------------------------------------- -...• •. x , ��° �----- - - ------------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable.-__•____________________________--------------------------------------------_,__--_______. -- --------------------------------------------------------------------------------------`-- -----------------------` Agreement: y` The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned urther agrees not to place the system in operation until a Certificate of Compliance has ba�eri` sued bythe boar heal Sig non_�l -- l r j 7 7 - Date Application Approved BY / - - --• --------------- I �� 1�^ Date Application Disapproved for the following reasons:----------------------•-----------------•----•-----------------•-••••---•---•-------------------•------_•.-------- .....--•-•-----------------•---••-•-•--•--....._...... ---'----••--.....--•-'•---•-••••••-•'•-----•-'-.......••-•---•-•-••'•------•._....'••.....-'••----'------•---------•----.......__...------------•- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH . ..........OF............ ..... .. ............................................. Uprrtiftrtttr of 109NImphanrr CERT Y, he,:Individual Sewage Disposal System constructed (�or Repaired ( ) by �, ' " r stall r --=- � - at 7 1•L. '� - 6 ---' -------j --- ----------------------- --------------------------•---------•--------------------- has been installed in accordance with the provisions of :Art'I XI of The State Sanitary Cole as described in the application for Disposal Works Construction Permit No._(_1.,7 �p.. ............ dated__ -;!-4_:X�-7-________•._------•. THE ISSUANCE OF THIS CERTIFICATE SHALI.`�NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................''.................................... Inspector------------------------.......------------------------•----•-••'--•---••......--•- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7 OF........ .................... •9 Permission is hereby granted ../ ..---... x..-•-------------------------------------'-----•......---••-•...--•...... to Construct ('_ r epair ( . ) an tldivid r 1 Sev4age Di,5posal ystem -- at No.... ... �! -------------------------------------------- as shown on the application for Disposal Works Construct on Permi No _._�_____._,___. Dated___-�. .n_.;7 .__7.l�_........ ( '. �a d oI)�eaith .�( r DATE J 7d FORM 1255'•Hoees & WARREN. INC.. PUBLISHERS - - k r Ai It Y } � = -r �/ 10GCy t \It 1V\ , �� �i I?.o r�� +f ` �✓' ' =-- �' 1 "` .. !T"�_ ISLIAt 17 / L i 1 ., --,►J -� ..� Ix 47> Lc ziz-A, tsj EL �04557 ,4. Aca. 1 1 5 `- 19 64G 3H •'1 ar i ,4/2 a•4 Y Qe T4 r J Xt 9 • ,`�cCL< �, 4 1 �1 � r 1 41 � ► �;i,l:t,u C., - Q �71' . 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