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HomeMy WebLinkAbout0324 BUMPS RIVER ROAD - Health 324 AD, Osterville � '� � A -ti.120 038 =00F i S No. 4210 1/3 BGR ESSELTE 10% O ® 0 0 L _ __ __ �_ �� �" �c�- � � �� ��'-� "(� v U � G �-,,, � . rr � � i �f �uv� �� ' -_'_"' � � ��� ���J,2 -- may P� // g � �-( �� � : o �. �' '� r u u. , 9 Commonwealth of Massachusetts /,20-dig Title 5 Official Inspection Forme Subsurface Sewage Disposal System Form-Not for Voluntary Assessments R 1 M 324 Bumps River Rd h K Property Address Curth K"' Owner information Owner's Name is required for every page. Osterville MA 02655 6/29/18 -I '= Cityrrown State Zip Code Date of Inspection • lea 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. General Information 1. Inspector: Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes • ❑ fails ❑ Needs Further Evaluation by the Local Approving Authority 6/29/18 Inspec&A SignJ9 Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DER)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 brld V* f Commonwealth of Massachusetts t Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 324 Bumps River Rd Property Address Curth Owner information Owner's Name is required for every page. Osterville MA 02655 6/29/18 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: New D-Box and Chambers 2013. 3 i B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 324 Bumps River Rd Property Address C Curth Owner information Owner's Name is required for Osterville MA 02655 6/29/18 I every page. I CitylTown 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 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 324 Bumps River Rd Property Address Curth Owner information Owner's Name is required for every page. Osterville MA 02655 6/29/18 Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning.in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® 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 %day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 r— Commonwealth of Massachusetts Title 5 Official Inspection Form1 . Subsurface Sewage Disposal System Form-Not for Voluntary Assessments, 324 Bumps River Rd µ " Property Address Curth Owner information owner's Name is required for every page. Osterville MA± 02655 " 6/29/18 City[Town 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. 1 ❑. ® Any portion of,a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy'is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is icesspool 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, ❑ F1 , 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 ❑ 0 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 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 - F . f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 324 Bumps River Rd Property Address Curth Owner information Owner's Name is required for every page. Osterville MA 02655 6129/18 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: f 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. El ® 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): 41 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 ' I r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yy< 324 Bumps River Rd GM Property Address Curth Owner information Owner's Name is required for every page. Osterville MA 02655 6/29/18 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 information in this report.) El Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage(gpd)): Detail: 1 1 Sump pump? ❑ Yes ® No Last date of occupancy: occupied _. Date I 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 324 Bumps River Rd Property Address ' Curth Owner information Owner's Name is required for every page. Osterville MA 02655 6/29/18 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: 4 Source of information: No pumping 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: 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.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 324 Bumps River Rd Property Address Curth Owner information Owner's Name is required for Osterville MA 02655 6/29/18 every page. , Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Septic tank per age of home and new d-box and chambers 2013 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan):. Depth below grade: 18"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): >10 Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): r , Septic Tank(locate on site plan):, w 12„ Depth below grade: feet t - Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) H-10 tank appears to be structurally sound If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000g Sludge depth: 4" t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments' y 324 Bumps River Rd Property Address Curth Owner information Owner's Name is required for every page. Osterville MA 02655 6/29/18 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 >12 1,t 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 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 3 years to prolong the life of the system 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments" M 324 Bumps River Rd Property Address Curth Owner information Owner's Name is required for every page. Osteryille MA 02655 6/29/18 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 324 Bumps River Rd Property Address Curth Owner information Owner's Name is required for every page. Osterville MA 02655 6/29118 Citylrown 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 0" 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 2' below grade, cover to 12", no adverse conditions 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): t 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 324 Bumps River Rd Property Address Curth Owner information Owner's Name is required for every page. Osterville MA 02655 6/29/18 City/Town State " Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: f ® leaching chambers number: 3 ❑ 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.): Chambers were video inspected and are damp at this time, they are approximately 3' below grade, cover raised to 18 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 Title 5 official Inspection Form 5 o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 324 Bumps River Rd Property Address Curth Owner information Owners Name is required for every page. Osterville MA 02655 6/29/18 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.): Soils are compact and dry 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.): r , t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ' 324 Bumps River Rd Property Address Curth Owner information Owner's Name is required for every page. Osterville MA 02655 6/29/18 City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately C 0 IF per► � � s�{�-L� t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 usetts Commonwealth of Massach Title 5 Official Inspection Form Subsurface Sewage Disposal System Form =Not for Voluntary Assessments M 324 Bumps River Rd Property Address Curth Owner information Owners Name is required for Osterville MA 02655 -6/29/18 eve page.every 9 Citylrown 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: >138"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: 2013 NGW 138" Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: 2013 compliance per BOH ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping, site is at 43'msl and nearby surface water is 10'msi You must describe how you established the high ground water elevation: see above f 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 M 324 Bumps River Rd Property Address Curth Owner information Owner's Name is required for every page. Osterville MA 02655 6/29/18 City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file M t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 L y ( $ f'. L�'g. ..I•_ _A�t+ ri I.r 5+. �. I- I' ! 1 I 7.1 i t ¢' �! 'R.Z I 1 41 (<; '.Y`ZPZ >'U�N�bA U� -1 ice"_�, �'(-- ,-- O- - I N --rt— 2kX2Y• ---t-- = � :_ _ ., _. 1��af4.Te'--�;s5— -- �d � � � 6 ..1 as 4 } «. .- . -•a .`.. i.; 1.. ln. (� �� I 1' i I ', ��. a "� t• G{ �y a- I . .J, d,. 4,1 M , .I ,,• yY i i -{ .. _ 2 H 1 _ L. �_ - I - ?a► 1�- - ---- - - I j l3u� O ' : t:f Kcw 32- fee . 4 y ' G,�!1 5~.^•� f�l sY Cc*) _ TOWN OF BARRNSTABLE LCATION a 3 V vd- l C SEWAGE#`��/3— I93 VILLAGE C�)5 1 erV (lie I ASSESSOR'S fMIAP&PARCEL /o O -00/ INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY //o v o G A(• (( C e x�s i It t5 LEACHING FACILITY. (type) ,SODGAI C fJA-MJ0(3I (size) /.2.5. X 33• S NO.OF BEDROOMS OWNER PERMIT DATE:- t3 COMPLIANCE DATE: (. o'lb(3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY c 30 , 3 � C Y t � No. � 2 c I J — � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _X� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftpiication for ]Bisposal .pstem Construction Permit Application for a Permit to Construct( ) Repair tr) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.3pIL f `' P s 2`Vr4a Owner's Name,Address,and Tel.No. 0 STerNdic Pk%,16.Zess a eta. vt Assessor's Map/Parcel I QC> 3 -U pl 3oZy ��m a�c�aQ jlp/ C��STcn i Installer's Name Address,and Tel No. Designer's Name,Address,and Tel.No. '3 'Bmcc RCGI�.s�"cr S�c9-yda` 04rr� tfcero/z aka po,aaa R8t t7S4.4Lstir as5-3 > Type of Building: Dwelling No.of Bedrooms Y Lot Size Q S;.S6oZ sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) yob gpd Design flow provided yy6 gpd Plan Date llFW-at Q6 13 Number of sheets a Revision Date Title Size of Septic Tank /000 . �F_xt,r n Type of S.A.S. S'O0 G61 C[JRM c4S C3It Description of Soil ors-`gSAY'� 31/ 8 y 96 't /09/11 y &Vv L160' "i38 K rh .3,�n�.5X 7/3 Nature of Repairs or Alterations(Answer when applicable) 1� -r��l e Jt t g i�► I cAc 1►A 4-K ✓ ., s .bo t( 3 //`tSZoarc 33,5`A IJ. S- z d' Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Nov. Application Approved by Date t Application Disapproved by Date for the following reasons Permit No. f Date Issued f �!�j --------------------------------------------------------------------------------------------------------------------------------------- No. a Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: , PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for Disposal 6psteln,Cons trUction Permit Application for a Permit to Construct( ) Repair a4 Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.3 Ll 0) Owner's Name,Address,and Tel.No. g�8 �6-q 91g ' US'I-NfVi�(c l"�4v�Q y'7e55N ai r,'.Sr? _. Assessor'sMap/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.3�uce 1`tGC�Il s��3 yaL' �r�trcn /7e rrl ;��o?a Type of Building: Dwelling No.of Bedrooms Y Lot Size 9 IV S"Z_� sq.ft. Garbage Grinder(-`/� Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures , Design Flow(min.required) 'NO gpd Design flow provided Ll Ll,S gpd Plan Date Nuu• a(,_:ab 13 Number of sheets 'Revision Date �.. Title T r Size of Septic Tank _1-060 ��� I /r s r rc Type of S.A.S. Jo C,,Al. ('FIr1 rl I r6 Description of Soil C)"- / ,y, , 5,J,+,J/ /v t? 3j// p '- 416', 16�m Jl y ,Ai l,z Nature of Repairs or Alterations(Answer when applicable) � ,\\a T L F'x 5 i c (�• c rl �)� r 1 ( 1 t.� Q i sT. L x Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Alou. 3G,,,1 o 13 Application Approved by , Date i. Application Disapproved by Date_ Date . for hollowing reasons •Yr Jy` Permit No.go Date Issued 19 ! /3 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance - THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(V Upgraded( ) Abandoned( )by 'J k U rL A(,.\ e at E,3q R U t 16 S f R+V<, 124_ G t r v<<(� has been constructed in accordance tj with the provisions of itle 5 and the for Disposal System Construction Permit No.A5r �dated /-7 77( - Installer 3�I vc t c eu I( , �,1 c-r Designer �Dqia,?i v /F yr 2 #bedrooms Approved desgnflow �/ 6 gpd- The issuance of this permit shall not a construed as a guarantee that the system l fun Rio 'jas�p/olesigned.� JU `- Date Inspector / �'.i"// I � -- - --------- - -. - - r _ _ - - - } :. _- t= - -------j--- - No. °27j L/0 Fee /v y THE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair —(✓� Upgrade( ) Abandon( ) System located at 32 y (- S E7 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. P� Date a / ?7 Approved by ` 1 Town of Barnstable . WE r Regulatory Services Richard V. Scali,Interim Director • BARNSrABL& 9� 6& Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 416113 Sewage Permit# (200 —L1f33 Assessor's Map\Parcel Q0/39-0o/ Designer: g �L.1 Inc, Installer:��Vj.p Address: Pa 801C qil Address: t7 Rpn_�_l t' - C_ 5074 w i&P ✓/tf A On `C �3 ��Z� � `�%tom was issued a permit to install a (date) (installer) septic system at 3 2-� ld�^'��S XLy�.f 91/ OS f-based on a design drawn by (address) L dated h �//% (designer) . I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was'installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in kp�a nce with the terms of the IAA approval letters (if applicable) or i�qS o� O c (Installer's Signature) fftt�� (Designer's Signature) (Affix Desig ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc i I Town of BAAnstabie. r# Department of RekWatory Services Public Rl ealth Division Bate , _ t63w �e� g 200 ain Streeb Hyannis MA 02601 $y .i Date Scheduled �" ' =i E T . . Time Fee Pd. n oil Suitability Assessment for Se Performed By: tJti`J �tiJ\_'� - `� `"• ! Witnessed By: ' . )`1 }�✓ LOCATION & GENERAL INh'ORMATION (� Location Address . � `�j Pin PS (�YV `�d- Q_ Owner's Name tJl�� - Address: Assessor's Map/P4tcel: I L.V 3� _ I Engineer's Natne ''ll NEW CONSIIM�rION REPAIR � Telephone# � V �y� I Land Use ►`-��� Slopes('Yo) 9 Surface Stones A el 12 ft Distances from: Open Water Body. ft Possible Wet•Area ft Drinking Water Well _ Drainage Way >"IT 6 ft Property Lme � I o ft Other ft k SKETCH:($treet name,dimensiods'of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) t rig ; C,'2 7 "L co r ! Parent material(geglogic) / � 1 Depth to Bedrock Depth to GroundwaW Standing Water in Hole: i Weeping from Pit Faee Estimated Seasonal Nigh Groundwater N Dft- ERUN . TION FOR SEASONAL HIGH-WATER TOLE- Method Used: Depth dbserved standing in obs.hole: In. Depth to sulk mottles: ft i in. Groundwater Adjustment Depth toiweeping from side of obi.hole: i Adj.ACtor,,.,._:.� Adj•fhtlundwater Level ,o Index Well# _ Reading Date: index Well level - ¢ PERCOLATION TEST . D$tt 'xc Observation -- Role# _ L _ � ,Time at G':w Depth of Pere Time:&41)1 . Start Pre-soak Time-@ End Pre-soak Rate MinJInch „ c° x Additional Testing Needed(YIN) Site Suitability Assessment: Site Passed Site Failed; F r - Observation Hole Data To Be Completed on Back original:,Public klc'lth Division — ***If percolaibn testis to be conducted within 100' of wetland,you must first notify the Barnstable e4oservati0n Division at least one(1) week prior to beginning. DEEP OBSERVATION HOLE LOG Hole# I Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel S DEEP OB SERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) a tlJ � Ln til -27 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consist enc 3'o Gravel DEEP OBSERVATION HOLE LOG Hole# fA Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface•(ia.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. ra I Flood Insurance Rate Map: Above 500 year flood boundary No Yes Within 500 year boundary No V Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist.in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the requir d inin ,exper ise and experience described in 3.10 CMR 15.017 Signature Date 1� Q:\SEPTICIPERCFORM.DOC I N First-Class Mail Postage&Fees Paid USPS UNITED STATES POSTAL SERVICE Permit No.G-10 •Sender: Please print your name, address, and ZIP+4 in this box • I � I M I I Town of Barnstable Public Health Division N 200 Main Street I Hyannis, MA 02601 I -401141,till,ill,Ifln 3 a n- 'fir. Ram""", � e Complete items 1,2,and 3.Also complete A. Sig r re item 4 if Restricted Delivery is desired. ❑Agent ® Print your name and address on the reverse X ❑Addressee so that we can return the card to you. B. Received by(Printed Name) Da f D livery m Attach this card to the back t the mailpiece, e55i e � �� //Mz or on the front if space permits. � 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes d I If YES,enter delivery address below: ❑ No ✓ Paul J. & Dessie A. Stringer { Po Box 31 MA 02655 3. Service Type i M . Ostervllle, ❑Certified Mail ❑Express Mail I ❑Registered ❑Return Receipt for Merchandise A !` ❑.Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Ye 2. Article Number 7 0112 1010 0000 2851 1043 (transfer from service label) 1 PS Form 3811..February 2004 Domestic Return Receipt 102595-02=an-1540,� m n. Q '\ r co Postage $ru O Certified Feer - O r r !Postmark Retum Receipt Fee �/ Here O (Endorsement Required) fn O G Restricted Delivery fee ti O (Endorsement Required) (n r M Total Postage&Fees Is • ���� d Q 4 z fl.Jr C ' Paul J. & Dessie A. Stringer PoBox 31 - ------------------------- Osterville, MA 02655 Certified Mail Provides: .,:._ .` o A mailing receipt n A unique identifier for your mailpiece o A record of delivery kept by thelPostal S & ice for two years Important Reminders: n Certified Mail may ONLY be combined with First-Class Maile or Priority Maile. o Certified Mail is not available for any class of international mail. e NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. n For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. e For an additional fee, delivery may be restricted to the addressee.or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". n If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT-Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000.9047 r 'Town- of Barnstable Barnstable aq SFIE Tp� P� tip MQ AmmjcH Cdp Regulatory Services Department , 1 + BARNSCABLE. MAC- Public Health Division ArFD""p� 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Acting Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2851 1043 November 12, 2013 Paul J. &Dessie A. Stringer PO Box 31 ' Osterville, MA 02655. ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 • The septic system located at 324 Bumps River Road, Osterville, MA was inspected on 9/24/2013, by James Ford, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system needed further evaluation under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • System is in hydraulic failure • Pit is in failure You are ordered to repair/replace the septic system within sixty (60) days 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 E BOARD OF HEALTH Thomas McKean, R.S.; CHO Agent of the Board of Health _ Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\324 Bumps River Rd Osterville Nov 2013.doc i Parcel Detail http://issgl2/intranet/propdata/ParceiDetail.aspx?ID=7311 71 MASS t1 td P7, Logged In As: Parcel Detail Thursday, November 7 2013 Parcel Lookup Parcel Info Par ID 120-038-001 ( DeveloLot{LOT 1 Pri Location F324 BUMPS RIVER ROAD - �� Frontage Sec t - Sec Road'' Frontage J Village JOSTERVILLE FireIC-O-MM District Town sewer exists at this Road. 0194 address N Index o -- Asbuilt Septic Scan: Interactive 120038001_1 Map �1 x Owner Info Co- Owner STRINGER, PAUL J&DESSIE A owner Streetl jP O BOX 31 Street2 j City OSTERVILLE _....._I State MA Zip * 5 Country Land Info _ Acres 0.56 Use;Sid ngle F.am MDL-01 I Zoning IRC r Nghbd;0105 Topography lLevei Road Paved Utilities Public Water _ Location F Construction Info Building 1 of 1 YearBuilt 85 Roof ExtGable/Hip all!Wood Shingle Built' Struct Wall' Living�076 � Roof Asph GIs/Cmp AC ,,Area I2 - Cover[As—ph, Type° w fl Style[CapeC Wall jDrywall Rooms 4 Bedrooms ( , Model lResidential IntlCarpet Bath 13 Full Floor Rooms Grade Average Plus Heat,------Hot Air Rooms 18 Rooms ie - ation Stories F1/2 Stories ' Heat Fuel Gas 'Found-(Poured Conc. , — Gross i http://issgl2/intranet/propdata/ParceiDetail.aspx?ID=7311 11/7/2013 Commonwealth of Massachusetts Title 5 Official Inspection tiOn Form - Subsurface Sewage Disposal System Form Voluntary Assessments M 324 Bum s River Road Property Address Paul Stringer Owner Owner's Name information is required for every Osterville MA 02655 page. City/I own State 9/24/2013 Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in an way. Please see completeness checklist at the end of the form. y Important:When F ,. filling out forms A. General Information. r' on the computer, r" use only the tab 1 Inspector: key to move your cursor- not use the return James Ford key. Name of Inspector % w Company Name P.O. Box 49 - - Company Address reaw Ostervllle City/I own MA 1 02655 State 508-862-9400 S 12482 Zip Code Telephone Number - License Number B. Certification ' u I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,;accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes Fails ❑ Needs Further E al ation by the"Local Approving Authority Inspec s Signature 10/3/13 Date The em inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer; if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 I I /�e Title 5 Official linpacorm:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 OfficialAnspection Form - Subsurface Sewage Disposal.System Form-Not for Voluntary Assessments 324 Bumps River Road Property Address Paul Stringer 't Owner Owner's Name information is required for every Osterville MA page. City/Town 02655 9/24/2013 li 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: ❑ 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or ir1.310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: i t B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section n 1.eed 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 substantici[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 1 Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): - 4 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official. Inspection Fora' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M v 324 Bumps River Road Property Address Paul Stringer Owner Owners Name information is required for every Osterville I MA 02655 9/24/2013 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 sewagelbackup or break out or high static water level in the distribution box due to broken or obstructe6pi.pe(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) am replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑-Y ❑, N ❑ ND (Explain below): ❑ distribution boxis 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): d ❑ 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 waterEl , Cesspool or privy.is within 50 feet of a bordering vegetated wetland or a salt marsh Y -.t5ins 3/13 h Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments % . 324 Bumps River Road Property Address Paul Stringer Owner Owners Name information is required for every Osterville MA 02655 9/24/2013 page. City[Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that'the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well ❑ The system has a septic'tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. y , 3. Other. i 1 ' f, D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No z ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® Discharge or ponding of effluent to the surface"of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static.liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than '%2.day flow t5ins•3/13 } Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i r Commonwealth of Massachusetts H ; Title 5 Official' Inspection Form Subsurface Sewage Disposal'System Form - Not for Voluntary Assessments 324 Bumps River Road Property Address >. t - Paul Stringer Owner Owner's Name information is u; required for every Osterville MA 02655 9/24/2013 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: is ❑ ® 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. El Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a,private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,01D gpd. ❑ ® The,system fails. I have determined that one or more of the above failure criteria exist as described in 3.10 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--1WPA)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 Departmeht. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 't ;i i Commonwealth of Massadlhusetts- W Title 5 Official Inspection Form Subsurface Sewage Disposal.,System Form - Not for Voluntary Assessments wM 324 Bumps River Road Property Address Paul Stringer Owner Owner's Name information is , required for every Osteryille MA 02655 9/24/2013 page. Clty/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: 1 r 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) tR ❑ ® Was the:facility or dwelling inspected for signs of sewage,back up? ® El Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? 4! ® ❑ 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)] s ' D. System Information' Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110'gpd x.#of bedrooms): 440 :I t , I • t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I Commonwealth of Massachusetts Title 5 Officials Inspection Fora, Subsurface Sewage Disposal system Form Not for Voluntary Assessments 324 Bumps River Road Property Address Paul Stringer Owner Owner's Name information is required for every Osterville MA 02655 9/24/2013 page. City/Town State Zip Code Date of Inspection D. System Information' ' Description: a. Number of current residents. 'r 3 Does residence have'a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? # . ❑ Yes No Seasonal use? r.: ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: e. unavailable , fi Sump pump? ❑ Yes ® No Last date of occupancy: currently Date Commercial/Industrial Flow Conditions. Type of Establishment: `F Design flow(based on 310 C(MR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? e ❑ Yes ❑ No Industrial waste holding tankipresent? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if avaiable: �• a l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposali System Form - Not for Voluntary Assessments ;M 324 Bumps River Road I Property Address Paul Stringer Owner Owners Name information is required for every Osterville MA 02655 9/24/2013 . page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/usq,:d'Y. Date Other(describe below): r ' . • r. General Information Pumping Records: Source of information: _ last pumped in May 2013 = per owner Was system pumped as pah`of the inspection? ❑ Yes ® No 1 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 i% t s ,. s . Commonwealth of Massachusetts Title 5 Official ,lnspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 324 Bumps River Road Property Address ol Paul Stringer Owner Owner's Name r information is required for every Osterville MA 02655 9/24/2013 page. City/Town State Zip Code Date of Inspection D. System Information,(cont.) Approximate age of all components, date installed (if known)and source of information: installed - 11/4/85 per as-built Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate ons.ite plan): Depth below grade: 27 3 - feet Material of construction. ❑ cast iron ® 40 PVC ❑ other(explain): f Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 1 a _ t; r Septic Tank (locate on site fIan): ^ Depth below grade: 15" feet Material of construction: , ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: 1 : years Is age confirmed by'a Certificlate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal. Sludge depth: 2" i t5ins-3/13 { Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 'F L i ; Commonwealth of Massachusetts m W Title 5 Officiat Inspection Fora Subsurface Sewage Disposar,System Form - Not for Voluntary Assessments 324 Bumps River Road Property Address t . Paul Stringer Owner Owners Name information is , required for every Osterville MA 02655 9/24/2013 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 24" Scum thickness 1 ". 6 Distance from top of scum to top of outlet tee or baffle Distance from bottom of sc ;to bottom of outlet tee or baffle 10" 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.): The tees were present. no sign of leakage Y" Grease Trap (locate�on site:plan): Depth below grade: feet Material of construction: r, ❑ concrete ❑ metal. ❑ fiberglass ❑ polyethylene ;. ❑other(explain): N/a t; a - Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scud to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3113 ;j Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official .Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments o U wM 324 Bumps River Road Property Address Paul Stringer Owner Owners Name information is required for every Osterville MA 02655 9/24/2013 page. City/Town State 0 Code P 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.): t ; Y : i; @ J' Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): N/a .: Dimensions: a: Capacity: gallons Design Flow: gallons per day Alarm present: v El Yes ❑ No t Alarm level. Alarm in working order: El Yes ❑ No a 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 r . t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•IPage 11 o/17 ,r Commonwealth of Massachusetts W Title 5 Official 'Inspection Form Subsurface Sewage Disposal',System Form -Not for Voluntary Assessments 324 Bumps River Road ` Property Address , Paul Stringer Owner Owners Name information is reg wired for every Osterville MA 02655 9/24/2013 page. City/Town State Zip Code Date of Inspection D. System Information,i(cont.) Distribution Box(if presentmust be opened)(locate on site plan): rr Depth of liquid level above outlet invert even i< Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The D-box was normal S 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.): N/a i, * 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: I : r t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-'Page 12 of 17 t 4, Commonwealth of Massachusetts W Title 5 Officiatinspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a,•• 324 Bumps River Road Property Address Paul Stringer Owner Owners Name information is required for every Osterville MA 02655 9/24/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type. 1 ® leaching pits , number: 1 - 1000 gal. ❑ leaching chambers number: ❑ leaching galleries number: El 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 pond'ing, damp soil, condition of vegetation, etc.): The pit was full.The liquid was up to the inlet pipe The pit is in failure The cover was 2' below f Cesspools (cesspool must,be pumped as part of inspection) (locate on site plan): Number and configuration, }; N/a Depth—top of liquid to inlet'ipvert - Depth of solids layer Depth of scum layer. Dimensions of cesspool Materials of construction Indication of groundwater inflow. ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 ' rl 1 l Commonwealth of Massachusetts u Title 5 Official= inspection For Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 324 Bumps River Road Property Address Paul Stringer Owner Owner's Name information is required for every Osterville MA 02655 9/24/2013 page. CitylTown it State Zip Code Date of Inspection D. System Informati ' (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: (i Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/a 4, d : I ; t s t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 s ' a Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M a 324 Bumps River Road Property Address Paul Stringer Owner Owners Name information is required for every Osteryille MA 02655 9/24/2013 page. City/Town y, 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 t t o a 311 a �a� 3 O y 3 /,V 33 ' i t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 1 ?i r V ' Commonwealth of Mast'sachusetts u W Title 5 Official, Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 324 Bumps River Road Property Address Paul Stringer Owner Owner's Name information is required for every Osterville MA 02655 9/24/2013 page. CitylTown 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:. 20' feet Please indicate all methods°used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date Hof design plan reviewed: Date ❑ Observed site('a&tting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: 'I Using topo and water contours maps ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database -explain: You must describe hour you;established the high ground water elevation: see above a . . „t Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 _ t Commonwealth of Massachusetts ` - Title 5 Officials Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 324 Bumps River Road Property Address Paul Stringer Owner Owners Name information is ° required for every Osterville MA 02655 9/24/2013 page. City/Town i 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)completeda ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file u C its - II, n 1 l" t 4 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 1. I_ , 3 L 0:C k T 10 N r /Sa/E W A G E PERMIT NO. VILLAGE - - INST.jLL , R'S � ME i ADDRESS :4 OR OWNER DATE PERMIT ISSUED - DATE COMPLIANCE ISSUED t = � 1U � ti ............... THE COMMONWEALTH OF MASSACHUSETTS � BOAR® Off` HEALTH •::.--�...O..wi x.--............... .................... App ira#inn for Disposal Works Tunstrnrtinn Prrmit Application is hereby made for a Permit to Construct ( K) or Repair ( ) an Individual Sewage Disposal stem at: , \ ` „ � ................ l�lo...�.............�-`....PS..�t.V.eiL 7_.... �.R.1���......................................... Lpr, iQn-Addre s I or Lot No. ------------------htp 1 .. ........----.............. ------------------------- . ... ....---------......-•----..............--•--.. -- - -- ------ Owne��_ Address a ........ ............ ........ .......... ........... ._...--- ----_. Installer Address U Type of Building Size Lot.2. �5 .Sq. fpet .-� Dwelling—No. of Bedrooms._Z�------------------------...........Expansion Attic �d6 Garbage Grinder Other—Type of Building ............... No. of persons_...._...........•.......... Showers — Cafeteria 04 Other fixtures ............................ . Design Flow........:....... .agallons per per on el da . Total it w._._...__ w g 5. ...................g P P � '�' Y Ap $30....................gallons. WSeptic Tank—Liquid capacity CM.gallons Length_: __._G_._ Width'q-t ... Diameter'............... Depth._ . .. x Disposal Trench—No......... ..... Width.................... Total Length.................... Total leaching area.....................sq. t. Seepage Pit No..............I.. ._ Diameter....... ........ Depth below inlet.....:......... Total leaching area...` 0.sq. ft. Z Other Distribution boxes Dosnk ( b Percolation Test Results Performed by... 1_' ._. `4.G_L1•-_C.............. bate..lao. ,,,, tt Test Pit No. 1...—._minutes per inch Depth of Test Pit-__--t......... Depth to ground waterALT- u@.T6Mj (s, Test Pit No. 2_4!42 ....minutes per inch Depth of Test-Pit......1Z........ Depth to ground water_____1.`..•......._.. � .----- - ._. O Description of Soil....... .^` -..... 2 n !.4_.... -_----�_'Z------.....1- ..- 0 x 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 iI'LU 5 of the State Sanitary Code— The rndersigned further agrees not to place the system in operation until a Certificate of Compliance ha e dtbyard of hea% l //S. DateApplicati n Approved BY---•---•-•-•----•--------------Qom.•------------- •..............--------•- =•-- . 1 . .9...5__ Date Application Disapproved for the following reasons-----------------•----------•----•-------•--------------------•--•--------------••----••----••-•------•......--- .............•------•---•-....••••......-••---•••----•-•-...._..._•---•--•--•--•-••.........-•-•••-•----•...•••--•.........---••--•--•-•••--•••-•----------•--•--••-••----•----•••-•-•-••-----•••------•- Date PermitNo. ......•............................... Issued-....................................................... Date Tw -W No...................... F�s... � . .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1.--Q .-----......OF................. �.+ :1.`~�-" C.::C=`..-----------....----- ApplirFa#ion for Disposal Works:Tnnntrnrtinn umit Application is hereby made for a Permit to Construct ( K) or Repair ( ) an Individual Sewage Disposal';' System at ............_...... •....... .................... ---•--......_.--_... ...... - -----•.......---•-•...... _.L -Addres or Lot No .... �lj[X3', t� .................... ..... ------ Own Owner-•-..�..:, ..........................Address Installer Address Type of Building Size Lot..Z�_y .G.�___Sq. feet �., Dwelling—No. of Bedrooms......................................Expansion Attic Oa Garbage Grinder AR)) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ----------------------------------------------------r•----•-•---•-•••-----•-•-••-•------•-••--•-•--•--•--------•-------..........•-•---•-----------. w Design Flow................`?..`��...............___._gallons per person per day. Total daily flpw........ r .....................gallons. 9 Septic. Tankf,.. Liquid capacity_V-`=:A..!gallons Length... Width.-'!_... Diameter.-...:.......... Depth_..`' '. Disposal Trench- No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.................I-___. Diameter.......a------- Depth below inlet........ _..._... Total leaching area....�� DK zsq. ft. Z Other Distribution box(,.�)� Dosing-tank ( Q)© Percolation Test Results Performed by._ '.1kI�' _?__:.�.... !.`� �,_ _C-_____________ Date... .�_2-n'� `a r ------------ --- Test Pit No. 1....-4-:_ '..minutes per inch Depth of Test Pit.....!.L......... Depth to ground fs, Test Pit No. 2... .<~'=__...minutes per inch Depth of Test Pit.......1!.......... Depth to ground water....... .............` i --- •-••'-•--•-----••-....... ••...---•------•-.....----•-....-••------.....-•--••--.. .---•--------------------- Description of Soil------. ...........� ? cox `� ,�_� ----•--•••------•------------------•---------- -----=......-•-•-----•----- ----------- . U ----•----•••-••----•---------••----•-•-._...•--------•---•---•--------••-••-•-----------•--••-•••---•....--•-•-••-•-••---------•-=..----•----•--••----••---••-•......................... ---------------- 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 TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of ompliance has ty/been /issued �bby/the board of health el S•gned6n-:--`!`l.'//G6:!_f/i`t�<'s2'E�`�-'�-��f' -.FrX'`- =,C.`r'" (�''�i�= G� -- •'-_ N-_'..`:14�_.__ J Date /9S Applicati n Approved BY ......... G?.. `•- ..-------------------- ......... *�lea ✓Date Application Disapproved for the following reasons-----------------------------•----•---------------------•-----------------------------------------------•-------- --•...............••----•-...•-••------•----••----...--------•--••-••-•---------•---------••-•------...--•••----•-------•-•-----•---•-••--•---•••••••-----------•-••-•-•--•-•--•---•-----••.•-----.----- Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH. ..........................................OF............................ ............. ............. (Irdifirtttr of (1 utpliFanrr THI,S�I� 0 CERTIFY That the Individual Sewage/Disposal System constructed ( ) or Repaired ( ) - =by ---••- ... -•-- }) Installer •---------------•-•-•----...... ._.......--- has been installe in accordance with the provisions of TIT 5 of The State Sanitary Cod as described in the application~fm4bisposal Works Construction Permit No: -_._..__" T_ {_...... dated------- --1 �1Ys ........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST UED AS A G ARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........ ..... ...................... Inspector ............ THE C0 4MONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................................OF....................... ......................._......._............................ No....... `.... ( FEE....-................... Mops nrks T nntra uan unfit Permission is hereby granted. .....� --•---------------------•----------........------......--------•---...........---•--........ 4 to Construct ( ) or Repair ( ) Individual Sew e Disposal System atNo....J...... .2- ... _ 1-• . ........•---------•---- -•--••---•---•--••-••-••---•--• .........•.. Street as showron the application for Disposal Works Construction Permit No.�6'S_....�7..Dated.._.* ._vp'�--- ,S ................:.. . : ....... ;' - 3 Board of Health DATE---...--•.--,-•-- ........................................... =- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS i ., G•A iZ6/�IGG G��iJ D C R:. � DAI Roo t_Y F-Lc J . = u oC i, 3 33 0 G. P. D. %!c v o�/G/• r3 1 TAMK .336 X . 1567 /21 L-cn.c.vi?� _ �.�I OEV�IAU` /'�iZEA ' 150 . 5, r, %> •9 /�� o Q �- � 66161110 t4 A R1r A = So 5-F. _.�✓ <, �g.7 %- Ili �!� Cyr S"o. G. P. l�. 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'a. - . ..c.,• y � - e , .. _. +..>•J S -Q ., - : , o ,. - r - , _ , , r n' • L , < , r PARCEL ID: CENTERVILLE 120/036 43.8 I I I r , e f UPOLE '- 44 Ssr9. � N PARCEL ID: t 120 037 o ► , EXIST 1 ,000GI 43.9 - TREES Oft LEACH PIT ' LOT 2 �. ••� ' / CBR B HD / �° i ' 1,054 eet •hh1� ' �'� I` I LOCUS, MAP 'S 44 �h LOT 1 I LOCUS INFORMATION AREA=24,562f S.F. i 7 PLAN REF: 393/7 6�O TITLE REF: 4452/328 PARCEL ID: MAP 120 PAR. 38-001 EXIST �1 , OOG Jy I s I ZONING: "RC" vP ` o SEPTIC' TANK �° , FLOOD ZONE: "C" `� TOF=45.0 �I a , COMMUNITY PANEL: 250001—OOi6—D DATED:07/02/92 - 43.6 _ � ---- 4:4 SEPTIC SYSTEM °0; _u REPAIR PLAN `� 1_ I g I LOCATED AT: 43 —__ �� #324 � ' 324 BUMPS RIVER ROAD \GPI ------- °�� z o I CEN TER VI LLE, MA. PREPARED FOR D m(A m PAUL J. & DESSIE A. sR STRINGER 9• Z NOVEMBER 21, 2013 2�/ `' , 0Dip FRREN OF 'yqS V No. 11 Py S4NITAR\1`� I ,2L _t 3 I I ,\ G� LEGEND Q �\ % ��ti LOT 2' , - , SON S INC. PROPOSED CONTOUR MEYER �C ' ® PROPOSED SPOT GRADE �.` 4 + i i ' P.O. BOX 981 EXISTING CONTOUR EAST SANDWICH, MA. 02537 + 96.52 EXISTING SPOT GRADE - - I W— EXISTING WATER SERVICE �„� 0 8 —2 9 2 2 5 ® TEST PIT _. --- - - ----. - _ SCALE: 1"=20' SHEET 1 OF 2 J 1609 NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS I T.O.F. EL=45.0 NOTE: PLACE RISERS OVER.ALL COVERS W/IN 6" OF GRADE I FINISHED GRADE (44.0) F.G.EL: 44.0 F.G. EL: 44.0F.G.EL: 44.0 b MAINTAIN 2% MIN SLOPE OVER LEACHING AREA A i ' • .a 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2" TOP TANK=EL. 43.30 t. • 1 STONE OR FILTER FABRIC = z DOUBLE WASHED STONE 6„ '. 4 4" SCH 40 PVC tO"I �6a\_OS ®®®®®®®®a®®= 1% (MIN.) !' TEE'S ARE TO BE t4 INV.41 :' 5 2' EFF. DEPTH ®®®®®EM®®®®® 4" SCH 40 PVC -� INV.42.05 INV.41 .45 , GAS t - 4 2X8.5 4 OUTLET ELEV. BAFFLE PROPOSED DB 3 EFFECTIVE LENGTH 25' .. ..,, .,;. . . 177 DISTRIBUTION BOX INV. '42.30 aim INV. ELEV.= 40.0 EXISTING GALLON SEPTIC TANK OF S G 1000 LL S k GAS BAFFLE TO BE INSTALLED ON �. BREAKOUT s Q" 9� . ti OUTLET TEE AS MANUFACTURED BY DA N M. � - E - 41 . 0 s LEV._ P CONC. ELEV.= 41 .50 TUF-TITE ZABEL OR EQUAL TO ME Q M ..NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING No. 1140 "' INV. ELEV= 40.50 E E33PIPE INVERTS PRIOR TO CONSTRUCTION ®®®®®®2) D-BOX SHALL BE SET LEVEL AND TRUE TOG/$TE ®®®®®®GRADE ON A MECHANICALLY COMPACTED SIX Sq a BOTTOM EL.= 38.50 ®®®®®®INCH CRUSHED STONE BASE, AS SPECIFIED IN NI TARS 1 3,75' 5 FT. 310 CMR 15.221(2) tl ,Z� - i 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK # SEPARATION 6.1 O FT. ��PTI� SYSTCIV' EFFECTIVE WIDTH 12.5' WITH 1500 GALLON SEPTIC TANK IF FAILED, _ SYSTEM � -PROFILE DAMAGED, NOT H2O LOADING, OR UNDERSIZED. S I 4) INSTALL INLET & OUTLET TEES W/ BOTTOM -OF TESTHOLE EL: 32.40 _ SOIL ABSORPTION SYSTEM (SECTION) GAS BAFFLE AS REQUIRED (500 GALLON LEACH CHAMBER) GENERAL NOTES: ' 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL" LOGS P#: 14176 DESIGN CRITERIA BOARD OF HEALTH AND THE DESIGN ENGINEER. NUMBER OF BEDROOMS: 4 BEDROOM DESIGN 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE DATE: NOVEMBER 14, 2013 LOCAL RULES AND REGULATIONS. SOIL EVALUATOR: DARREN MEYER, CSE 1614 DESIGN PERCOLATION RATE: <2 MIN/IN' 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR WITNESS: DONNA MIORANDI, BARNSTABLE HEALTH DAILY FLOW: 110 G.P.D. X 4 BR = DESIGN FLOW: 440 G.P.D. TO NSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. GARBAGE GRINDER: NO (not designed for garbage grinder) 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING SEPTIC TANK- 440 gpd x 200% = .880 gpd, RE-USE EXIST. .1,000 GAL. SEPTIC TANK FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN _ Elev. TP-1 Depth Elev. TP-2 Depth ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 43.90 A 0" 43.90 A O" LEACHING AREA REQUIRED: (440) = 594.59 S.F. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF I LOAMY SAND LOAMY SAND .74 - IOYR 3/1 1OYR 3/1 THE CONTRACTOR ER OWNER TO NOTIFY THE LOCAL TION. OF 43.23 B 8" 43.23 8" USE THREE (3) 500 GALLON PRECAST LEACH CHAMBERS W/ 4' HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY PUBLIC WATER. LOAM 6/6 Y B LOAMY S/Io STONE ON ENDS & 3.75' STONE ON SIDES: 33.5' L x 12.5' W x 2'D 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED 40.57 40 40" 40 J TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. C 11 .57 C ' BOTTOM. AREA: 33.5' x 12.5'= 418.75 SF 9. IT SHALL BE THE RESPONSIBIUTY OF THE CONTRACTOR TO VERIFY THE d THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING MEDIUM $ MEDIUM SIDE AREA: (33.5 t 12.5) X 2 X 2 = 184 SF CONSTRUCTION. SANG ' 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND REMOVED PER TITLE 5. SAND TOTAL SQUARE FEET PROVIDED = 602.75 vs. 594.59 REQ'D PERC ® EL 38.25 2.5Y 7/3 2.5Y 7/3, DESIGN FLOW PROVIDED: 0.74(602.75 S.F.) = 446.0 G.P.D. vs. 440 G.P.D. req'd 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY PROPOSED ADDITION/SEPTIC SYSTEM UPGRADE PLAN AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 13. NO ABUTTING PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. -32.40 138" 32.40 138" 324 BUMPS RIVER ROAD, OSTERVILLE, MA 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. 15. ALL PIPING TO BE 4" SCH 40 0 1/8-/FT (UNLESS SPECIFIED) PERC RATE <2 MIN/IN. ("C" HORIZON) Prepared for: Strin er NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN t MEYER&SONS,INC. Maepouffall�Slurve� N.T.S. DMM • I,:Darren-M._M".er,,R.S.._CSE,.,hereby_.ce_rtify_that_1. am currently.approved_by._MADEP.:.pursuant,to_310 CMR .15.01.7_. to conduct soil evaluations and that the above analysis has been performed me consistent with the POBQXf7Bf ) DATE CHECKED pe �Y (508 419-1086 SHEET N0. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Eval. Exam in October, 1999. EAST SANDWICH,MA02537 ' 3 50e.362--2922 1 1/21/13 DMM 2 of 2