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Home My WebLink About0140 BUNKER HILL ROAD - Health '140 Bunker Kill Road ®sterville 119 069 ° ° ° 0 , a ° ° 0 d' - ° • ° F, , ° ° , o 99 U t ° ° *a. is -sae+.... . .ken_a3c. .....m..a'r:.f- �at"Fa •�.f -min , ... .��—.° - ��.. -^._. -.:sies•.a.,,.ter,:�.,RL� � . =� i 6 MAIN STREET )o3epk J. anwa02601 y •�I• (b , I .C. I�IYANNIS.MASS. -728 7ELEPr+on�(sob)771-728a GYNECOLOGY - i August 11,2020 3 j Dear Mr. McKean,R.S.,CHO As you recall Mr.Frank Nunes III Inspected the septic system at 140 Bunker Hill Road,Osterville,MA on 6/3/2020 in anticipation of selling the property. Mr. Nunes issued a conditional pass based on the fact that the D-Box needed to be replaced. The leaching pits were found to be working correctly and in good condition. The original to be built plan called for H-20 pits if located within a driveway. On September 23, 1987 Jerome Dunning inspected the system and a certificate of compliance was issued. Under your direction and letter of June 18,2020 Bortolotti construction replaced the D-Box with a H-20 t box. The work was inspected by David Stanton and a certificate of compliance was issued that the work was completed on 7/9/2020. j In compliance with.31 CMR15.301 the buyer was informed that it is unknown whether the septic pits were H-10 or H-20. i This was done prior to Bortolottts work and that the buyer did communicate with Bortolotti construction before the work was done on 7/9/2020. The home was purchased on May 30,2020.Money was withheld from the sale and placed in escrow pending the issue of an Unconditional Title Five Certificate. The escrow money will not be released to me until the Unconditional Title Five Certificate is issued. In that I have complied with your directive as stated in your letter'of June 18,2020 and also the requirements of 310 CMR 15.301, 1 am asking you to issue to me an Unconditional Title 5 Certification at this,time. A copy of the certificate can then be given to the buyer's attorney and the escrow monies can be released to me. Thank you for your help in this matter. If there are any questions for me feel free to call me at my office 508-771-7284 or my cell phone 508-776-1961. Sih erey, osep J.Co way,M.D. { i 6/1Wn2u septic system at m burocer nm Koaa 1 From:Thomas.Md(ean@town.bamstable.ma.us, To:jeonway50@aol.com, Subject: Septic System at 140 Bunker Hill Road Date:Thu,Jun 18,2020 5:32 pm Good Afternoon Dr. Conway, { The septic system located at 140 Bunker Hill Road, Osterville was originally inspected by Health inspector Jerome Dunning on September 23, 1987. The system passed the inspection and a certificate of compliance was issue at that time. I On June 3,2020,the septic system was inspected by Frank Nunes III, certified DEP inspector, as required while the property is offered for sale,prior to a real estate transaction. Mr.Nunes discovered the distribution box is of"H-10 construction and is in a paved driveway." He further noted the distribution box is"in poor condition....with excessive corrosion." jOnce the distribution box is replaced with a new H-20(heavy duty loading)distribution box,it will pass inspection and a new certificate of compliance will be issued This will satisfy the requirements of the Health Division,MA DEP and the buyer- for the real estate transfer. I , Sincerely, Thomas McKean httpsJ/mail.aol.comANebmaiistd/erwsfPrint Oessage 1/1 No. O " " ' Fee C w THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftphLAtion for MI8p08a.Y *pstrm Coneftuttiun 3permlt Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. NO n er 1441 Owner's Name,Address,and Tel.No. iS8$_��(o. /94 Assessor's Map/Parcel % ('� Osiuo; col t✓, ( /�/�� Installer's Name,Address,ak Tel.No._4;6# $'_a?OX2 Designer's Name,Addd"ess,and Tel.No. 46Z-A1.tshry lA A)/A E) C On l Type of Building: Dwelling No.of Bedrooms ►v Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) N ' 14 a-) Aj, WmAi tCX1 6 x i f el y f?174 600e, +0 p�( 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 Environm e d not to place the system in operation until a Certificate of Compliance has been issued by this Board of Signed - Date ,-.6 6V Application Approved by �, 1 Date �p '� c� Application Disapproved by Date for the following reasons. �„ Permit No.' �� Date Issued 50 �� No. Fee 111 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �"'` Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Misposal 6pstent Construction i3ermit Application for a Permit to Construct Repair ) Upgrade Abandon( ) El Complete System ®'Individual Components Location Address or Lot No. ty�() j";��f- a Owner's Name,Address,and Tel.No. /96 tt r 4 Assessor'sMap/Parcel 9 /)44 �% !' Installer's Name,Address,and Tel.No. 41A—&Y Xp Designer's Name,Addr"ess,and:Tel.No. ��J -'' ( r �at G'arzSFft.� i � �l5i to ' j 1 6n� Type of Building: " Dwelling No.of Bedrooms /y Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures �r •'' Design Flow(min.required) gpd Design flow provided l' gpd Plan ` Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. v , "Description of Soil t Nature of Repairs orAlterations(Answer when applicable) . ., . ,., . , c < .z,i kek,,h kcx l e i�{{ / ftr l tt . Date last inspected, Agreement: The undersigned agrees to_ensure the construction and maintenance of the afore described on-site sewage disposal'system in i accordance with the provisions of Title 5 of the Environmental Code grid not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health Si ede._`�,_ r --� ✓' Date e_, S Application Approved by 16• (��,,� �y Date ( ^3ci —2U Application Disapproved by Y �� Date for the following reasonsF " Permit No. "t "1 * " Date Issued 6, ' }O .+�G3 ra - - -._--....--------------- - -- _. _-.--- -• -_ - _- - ------- - ---00 _ .. THE COMMONWEALTH OF MASSACHUSETTS y VvV ,,^ d4u T) BARNSTABLE;MASSACHUSETTS Certificate of Compliance o �� ,.• T �� L f�L Qw. THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaire� Upgraded( ) Abandoned( )by &,r�t3(v� '*lh-1,AltAuAA(0r_) , IN-NC t ii r at Pta n VNI-s> 14,U. �� ()ai2Yt fa�j{e has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Oa4 "' dated EC1'' �rt Installer! t��t7flc ( nCk�t��C yc�1� ,.i,.l� Designer ,�1,yiA �s5 nh,a lCrb7_ xi`C l''t� '({.• {' t�f v #bedrooms Approved design flow ~ gpd The issuance o this permit shall not be'construed as a guarantee that the system will fun/'ction as desig�ed. Inspector �./('J ti/ ar�, 4 No ---- _ - -- - - -- -- - - ---- -- -- � C� T -- Fee � - _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS t ' Disposal 6pstem Construction J)Prmit Permission ig"hereby granted to Construct 1( ) Repair(o Upgrade( ) Abandon( ) System located at I0 A f ( -,�_,,� ;all - 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.n Date tM — 3 0 o 2-0 Approved by McKean, Thomas From: McKean,Thomas Sent: Monday,June 22, 2020 4:58 PM To: 'Maureen Sudbey' Subject: RE:Title V Inspection results Good Afternoon, Below in red, are responses to your questions/comments: In the letter from your office to the seller,the only thing required for seller to be issued a certificate of compliance is to replace the D box with an H-20. The required action does not address the issue the inspector brought up regarding the 2 leaching pits being unaccessible. The distribution box must be replaced.,However,Ian inaccessible leaching pit is not listed within the.failure criteria within Section 310 CMR 15.303, of the State Environmental Code Title V. Of course, as.a buyer,I am concerned that the leaching.pits are not accessible for inspection now and in the future. Are there no requirements that in order to receive a certificate of compliance, all components of the septic system must be accessible and able to be inspected?ANSWER: An inaccessible leaching pit is not listed within the failure criteria in Section 310 CMR 15.303, of the State Environmental Code,Title V. The report also states that the tank couldn't be inspected and no levels were able to be taken because the tank is under a brick walkway. Does the tank not have to be inspected and levels taken to pass? ANSWER: The inlet of the septic tank was.accessible according to the inspection report dated June 3, 2020. This will suffice. The scum_ and sludge levels were inspected and were not found to be excessive according to the submitted inspection report. Does Barnstable require the system to be pumped for the Title V inspection?ANSWER: The Town of Barnstable does not require every Title V system to be pumped for real estate transfer inspections. The Town of Barnstable Health Division does follow 310 CMR 15.302(4)(b)of the State Environmental Code,Title V which requires each cesspool to be pumped. Does the company installing the new D box need to be licensed to install.septic systems?ANSWER: Yes,the installer must be licensed. I hope this answers all of your questions.. If you should have any additional questions, I can be reached by telephone at 508 862-4644. . Sincerely, Thomas McKean From: Maureen Sudbey [mailto:msudbeysa)icloud.com] Sent: Monday, June 22, 2020 8:19 AM To: McKean,Thomas Subject: Title V Inspection results Good morning Mr McKean 1 I would like to make an appointment to meet with you regarding a Title V inspection at 140 Bunker Hill RD. I have attached the report. I am the buyer of this property. The inspector, Frank Nunes III, indicates that the system only Conditionally Passes because the D box is of H-10 construction, in poor condition showing excessive corrosion and is located under an asphalt driveway and the 2 leaching pits are under the driveway without an accessible steel cover to grade. In the letter from your office to the seller, the only thing required for seller to.be issued a certificate of compliance is to replace the D box with an H-20. The required action does not address the issue the inspector brought up regarding the 2 leaching pits being unaccessible. Inaccessibility to leaching pits is not listed as a failure criteria during a real estate transfer inspection according to Title V, the State Environmental Code. Of course, as a buyer, I am concerned that the leaching pits are not accessible for inspection now and in the future. Are there no requirements that in order to receive a certificate of compliance, all components of the septic system must be accessible and able to be inspected? ANSWER: Inaccessibility to leaching pits is not listed as a failure criteria during a real estate transfer inspection according to Title V, the State Environmental Code. .The report also states that the tank couldn't be inspected and no levels were able to be taken because the tank is under a brick walkway. Does the tank not have to be inspected and levels taken to pass? ANSWER: The inlet of the septic tank was accessible according to the inspection report dated June 3, 2020.. The scum and sludge levels were not excessive according to the submitted inspection report. Does Barnstable required the system to be pumped for the Title V inspection?ANSWER: No, Barnstable does not require the system to be pumped for the real estate transfer inspection. The Health Division does follow the State Environmental Code,Title V requirements. Does the company installing the new D box need to be licensed to install septic systems? ANSWER:Yes. We are due to close on this home on 7/1 and the sellers already have a construction co set up to begin the D box replacement, so I be very grateful if I could get an appointment as soon as possible. (I know, am sure everyone says that!) Best Regards, Maureen Sudbey 781-789-9560 CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! 2 McKean, Thomas From: McKean, Thomas Sent: Thursday,June 18, 2020 5:33 PM To: 'jconway50@aol.com' Subject: Septic System at 140 Bunker Hill Road Good Afternoon Dr. Conway, The septic system located at 140 Bunker Hill Road, Osterville was originally inspected by Health inspector Jerome Dunning on September 23, 1987. The system passed the inspection and a certificate of compliance was issue at that time. On June 3, 2020,the septic system was inspected by Frank Nunes III, certified DEP inspector, as required while the property is offered for sale, prior to a real estate transaction. Mr. Nunes discovered the distribution box is of"H-10 construction and is in a paved driveway." He further noted the distribution box is "in poor condition.... with excessive corrosion." Once the distribution box is replaced with a new H-20(heavy duty loading) distribution box, it will pass inspection and a new certificate of compliance will be issued. This will satisfy the requirements of the Health Division, MA DEP and the buyer- for the real estate transfer. Sincerely, Thomas McKean 1 Town of Barnstable • • Inspectional Services BARNSTABLE, MA 99.039. Public Health Division i6 10� 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4987 7848 June 16, 2020 CONWAY, PATRICIA A TR 140 BUNKER HILL ROAD OSTERVILLE, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 140 Bunker Hill Road, Osterville, MA was inspected on 06/03/2020 by Frank Nunes III,certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • The distribution box is rotted. • It is still Conditional Pass, as it is unknown if H-20 leaching pits are under the driveway. See policy attached. You are ordered to replace the distribution box within one (1)year 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, HO Agent of the Board of Hea Q:\SEPTIC\Title V Inspection Report Letters Mai ling\Conditionally Passes Letters\140 Bunker Hill Road Osterville.doc f THE rpm Town of Barnstable Barnstable i BARNSrABLE, • AFAmaiceCdy MA� r Board of Health i639 pTfo �s 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 FAX: 508-790-6304 October 9,2012 Revised November 20,2013 Public and Environmental Health Program Policies,Procedures, and Guidelines H-10 Components Discovered Beneath Parking Areas and Driveways During Septic System Inspections Conducted Under 310,CNM 15.301,State Environmental Code,Title 5 No.2012-005 When a DEP certified inspector discovers an H-10 septic system component located beneath a parking area or driveway during a septic system inspection, conducted under 310 CMR 15.301 State Environmental Code Title 5,the system shall be deemed as a "conditional pass." The system owner will then be ordered, by the Board of Health,to correct.this problem within two(2) years and will be provided several options to rectify the issue, including by: a.) replacing the septic system component with a new component relocated into another area of land which is not beneath any parking area or driveway, and properly abandoning the discovered H-10 component; or by b.) replacing the septic system component with an H-20 component beneath the parking area or driveway, and properly abandoning the discovered H-10 component, (or in the case of leaching pit, replacing the top of the leaching pit with an H-20 slab top); or by c.) relocating the parking area or driveway in such a way that no vehicle will have access or the ability to drive over the existing H-10 septic system component. If it is unknown whether or not a particular system component which is located beneath a parking area or driveway, is H-10 or H-20 (for example: a leaching pit is located beneath a paved driveway without an accessible steel cover to grade and there are no records on file indicating whether the system component is H-10 or H-20),the system shall also be deemed as a "conditional pass". In this case,the seller must make the potential buyer(s)aware of the "conditional pass" status,the unknown construction of the septic system component(s), and it's safety concerns. Wayne Miller, M.D. Paul Canniff,D.M.D. Junichi Sawayanagi QAPOLICIES\H I KomponentsBeneathDriveways&ParkingAreasRevised2013.doc ,9 Town of Barnstable HARNSPABM �A b� ,m� Inspectional Services Department rFa ru►ti" 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 is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone l to a public well ❑ A portion of the cesspool is located 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) I QKT 16y) 0 ER J- "X �, �► ��4� Re airdeadline: Qp! • ��1v�w� r 7 .-- Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts �� 0 Title 5 Official Inspeption Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 Bunker Hill Rd. Property Address r R 4 Conway ' Owner Owner's Name / information is I/ required for every Osterville MA 02655 6/3/20 page. City/Town State Zip Code Date of Inspection ,ar 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 S'/4r- NSLf� 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); I 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 » 6/3/20 InspeWsIgignature 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 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 'L r - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •.� 140 Bunker Hill Rd. Property Address Conway Owner information is Owners Name required for every Osterville MA 02655 6/3/20 page. City/Town 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): The D-Box is of H-10 construction and is in the driveway The leaching pits are in the driveway without an accessible steel cover to grade t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 r Commonwealth of Massachusetts ,F Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Bunker Hill Rd. Property Address Conway Owner information is Owner's Name required for every Osterville MA 02655 6/3/20 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): , I ❑ 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 El (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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Bunker Hill Rd. Property Address Owner Conway information is Owner's Name required for every Osterville MA 02655 6/3/20 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: 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 r Commonwealth of Massachusetts �. ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 Bunker Hill Rd. Property Address Conway Owner information is Owner's Name required for every Osterville MA 02655 6/3/20 page. CityrTown State Zip Code Date of Inspection C. Inspection Summary (coot.) 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 Y 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. 5) 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 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.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 Bunker Hill Rd. Property Address Conway Owner information is Owner's Name required for every Osterville MA 02655 6/3/20 page. City/Town 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) ® i❑ 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts �e l Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Bunker Hill Rd. Property Address Conway Owner Owner's Name information is required for every Osterville MA 02655 6/3/20 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 6 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 990 Description: 5 bedroom permit and 5 bedroom per 1987 compliance, 1985 plan shows 990gpd provided to accommodate a 6 bedroom home with a garbage disposal Number of current residents: 2 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 it Commonwealth of Massachusetts �. ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments v 140 Bunker Hill Rd. Property Address Conway Owner information is Owner's Name required for every Osterville MA 02655 6/3/20 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: i Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No 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/use: Date Other(describe below): 3. Pumping Records: Source of information: pumped last summer 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 h Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 140 Bunker Hill Rd. Property Address Conway Owner information is Owner's Name required for every Osterville MA 02655 6/3/20 page. Cityrrown 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: 1987 per compliance on file Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): 3,611 Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: <10'feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 Bunker KII Rd. Property Address Conway Owner information is Owner's Name , required for every Osterville MA 02655 6/3/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cost.) 6. Septic Tank(locate on site plan): 3' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) Tank appears to be structurally sound, inlet cover is raised to 12" of grade, outlet cover is under brick paver walkway and is inaccessible, because outlet cover is inaccessible scum and sludge measurments were not taken, scum and sludge levels at the inlet end were not excessive If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 2000g Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 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? 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 140 Bunker Hill Rd. Property Address Conway Owner information is Owner's Name required for every Osterville MA 02655 6/3/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. 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 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: 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 140 Bunker Hill Rd. Property Address Conway Owner information is Owner's Name required for every Osterville MA 02655 6/3/20 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 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.): _ The,D-box:is of H=10.construction.and-is in::the'paved driveway, it is 2',below.grade and in'poor " condition at this time with excessive corrosion _ t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 I Commonwealth of Massachusetts Title 5 Official Ins ection Form p Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 140 Bunker Hill Rd. Property Address Conway Owner information is Owner's Name required for every Osterville MA 02655 6/3/20 page. Cityrrown 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.): * 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: 2 ® leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 I Commonwealth of Massachusetts lia Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 Bunker Hill Rd. Property Address Conway Owner information is Owners Name required for every Osterville MA 02655 6/3/20 page. City/Town 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 leach pits are in the paved driveway with no access, they were video inspected, Pit"C" had appoximately 1'6"of effluent in it and pit"D" had approximately 2' of effluent, no indication of past hydraulic failure at either pit, top of pits are approximately 3'6" below grade 12. 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 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 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 140 Bunker Hill Rd. Property Address Conway Owner information is Owner's Name required for every Osterville MA 02655 6/3/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): '� t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts re Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Bunker Hill Rd. Property Address Conway Owner Owner's Name information is required for every Osterville MA 02655 6/3/20 page. Cityrrown 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 a A v. �r c�o� CL Sad t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 140 Bunker Hill Rd. Property Address Conway Owner Owner's Name information is required for every Osterville MA 02655 6/3/20 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: >13' 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: 1985 NGW 13' Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: 4' seperation per 1987 compliance ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping shows the site at 22'msl and nearby surface water at 2'msl 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Bunker Hill Rd. Property Address Conway Owner information is Owner's Name required for every Osterville MA 02655 6/3/20 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist F 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 t 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 Crocker, Sharon From: Crocker, Sharon Sent: Wednesday,June 03, 2020 2:19 PM To: McKean, Thomas Subject: Phone Call - Dr. Conway 140'Bunker.-Hill Rd.Ost / Dr. Conway spoke with Dr. Guadagnoli inquiring about our policy septic components under driveway and he directed him to you. Please call Dr. Conway '(hm 508-420-0887) (cell 508-776-1961) Office after today: 508-771-7284) 1 put street file on your desk. Septic Inspector, Nunes, did inspection today and will be sending in a conditional. D-Box and leaching are under drive, Plan wording to be reviewed. #6 says under drive.will be H2O. Nunes said the D-Box was H10 and diidn't determine if leach is H2O. No damage, working fine. Thank you. Sharon Crocker Office Manager Town of Barnstable—Health 508-862-4739 The information contained in this electronic transmission("e-mail'),including any attachment(the"Information"),may be confidential or otherwise exempt from disclosure.It is for the addressee only.This Information may be privileged and confidential work-product or a privileged and confidential communication.The Information may also be deliberative and pre-decisional in nature.As such,it is for internal use only.The Information may not be disclosed without the prior written consent of the Director of Public Health and/or the Town Attorney's Office of the Town of Barnstable.If you have received this e-mail by mistake,please notify the sender and delete it from your system.Please do not copy or forward it.Thank you for your cooperation. - 1 ' N No. I OW — Fee--- - ----------- BOARD OF HEALTH TOWN OF BARNSTABLE App[icat ion f or V el[ Con$truct ion-Vermit Application is hereby made for a eka rmit to Cons1ru ��"� ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel l \011 ��_— S .Y��2V — Owner n Address 7— Installer — Driller Address Type of Building Dwelling — -- — —---— Other - Type of Building----------- - - No. of Persons----------------------- - Type of Well VC' -- — ----—-- Capacity—�d------- l---- Purpose of Well— Agreement: `r � - L =---- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a erti 'cate pflComplian has been issued by the Board of Health. l Signe — --- — — �a / -- te Application Approved By — --- date Application Disapproved for the following reason ------ - - ----— - ---- ----- ---------------- - — date Permit No. -- Issued----- -— - -------- ----— date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate Of ComPfiance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by-----------------—-- - —=------ ---- -- --- - -- --- --- --------- Installer at- -— --------- ------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ---------Dated----- ----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------- -- - -- Inspector---- —-- -,- - -- --------— s o� �/4 �\J� ` - -------- Fee _-- ----- - No. J BOARD OF HEALTH ` TOWN OF BARNSTABLE Applitat Congtruct ion Permit Application is hereby made for a ermit to Constru t .-), Alter ( ), or Repair ( )an individual Well at: - --1 c_1 d 9 vtn l c$v ( ICJ. 7n ll. �q►d - .` a Location Address Assessors Map and Parcel —E— Own r Address I S1�G � 'Installer — Driller Address Type"of Building $ Dwelling -=---- - —---- i Other - Type of Building /--+ -------------- No. of Persons------------------ ------ ----- �U L — --- - Capacity-Y--=��-- -Q Type of Well----�-- P �----- — - Purpose of Well_ `�-�- i Agreement: . The undersigned agrees to'install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate f Compliance has been issued by the Board of Health. ��/� - Signe —�� — — — date 1 — - - r/ Application Approved By _ t - ` _-----J ----- -------- date _--_ (J , Application Disapproved for the following reason ------------- -—----— - ; ------- D � Issued -------------- date Permit No. _ --� — date i BOARD OF HEALTH TOWN OF BARNSTABLE C ertif irate ®f ComPliante THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) -------—--— - ------------------- - - -- - — --- ---- --by_____ Installer at- -- ------- -- ------- -- ---------- F. has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ----------Dated---- ----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------- - -- Inspector-- --- -- ---__——--- BOARD OF HEALTH TOWN OF BARNSTABLE ell Construct ion Permit No. , --- -------- s UA C' � Fee Permission is hereby granted 4' to Construct ( ,, Altea ( ), o Repair,( ) an nd vidual ell at: , / t' �v r //-Y, 120 I ( street'-' 12 —1 F as shown on the application for a Well onstruction Permit " v Y�}r No. U- lu— %W Dated- , �- _ ---- _------ r sP Board ti Health DATE A TOWN OF BARNSTABLE r " LOCATION/y� �NC� /�i�L SEWAGE # "VILLAGE ASSESSOR'S MAP & LOT l l 069 INSTALLER'S NAME PHONE NO. I�,sty�yZ >, , . 'SEPTIC TANK CAPACITY 2Oem LEACHING FACILITY:(type) : Z (size) I ' NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER_ BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: T- 2 ) $ 7 VARIANCE GRANTED: Yes No �� e Z/ ,. � � I 2a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -----./'(w .........OF............... 6.��.......... ApplirFation for Disposal Works Tnnstrn.rtinn Vrrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: A. .........4-lenll� ,� _ Location-Address ,v No. er Address Installer Address d Type of Building Size Lot.._1.12'•_(0-11-_Sq. fee Dwelling—No. of Bedrooms......... ..........................Expansion Attic ( ) Garbage Grinder (/ a`4 Other—T e of Building ............... No. of persons............................ Showers YP g -------------------------------------------P ---- ( ) Cafeteria ( ) Otherfixtures -----------------• ---------------------_------------------------•---• • ... w Design Flow........./J6........................gallons per person per qay. Total dail flow____..... .._.._.............gallo . ir W Septic Tank—Liquid capacity/,50Vgallons Length-_/d...... Width..�j.__...... Diameter---------------- Depth.63....... x Disposal Trench—No..................... Width..... Total Length........... Total leaching area------------ sq. ft. Seepage Pit No...... Z--------- Diameter..../oP........ Depth below inlet...&............ Total leaching area PP. ft. Z Other Distribution box (1,�` Dosing tank WO Percolation Test Results Performed by................................................. r--.----------v--. Date................. _.,,_,,._jr__ �' Test Pit No. 1-__._4-----minutes per inch Depth of Test Pit_....`� ..... Depth to ground water.!_! �f/t.(�✓Vdt�-1- (z, Test Pit No. 2...... .....minutes per inch Depth of Test Pit....../,,4�....__.. Depth to ground water Al,�_ �l2eojl �,e•• a . �x ...... ..........!. O ,,// Description of Soil 11�4�' ! �!---------------�5` ----�t� M w UNature of Repairs or Alterations—Answer when applicable----------------------------------------------------------_..................................... .....................................----------------------------------------------...--•---.......•••---•••-••------------••••••••••••••---••-•••••--•-••-••••••••••••.........-••-•-•-----•....•.-•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewa e Disposal System in accordance with the provisions of i I=s , p 5`of the State Sanitar Code— The undersigne urtl ; agrees not to place the system in operation until a Certificate of Compliance h s b en issued y the b and o ieal o - g Si ned_ •••• •••• - Date Application Approved By................. ... .... . . Date Application Disapproved for the follow' g reasons:................................................................................................................ •-•...........................•-••------...-•------...--•----------•----------•--•--------...---•--....----....••---•--•••-••••••-••----•••••--••••••••---•--•••••••••••••-----•••......--••............................... Date Permit No......_7.m_A 4r;L'.3..-. / Date No.... 1:.J3 Fes$•- � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........oF................ 1�•............... Allp iration for Dispngaal 10ork.5 Tanstrurtiun Vamit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: _ �.�..��..�.!�!-/ - ....... -7 ................................................ Location-Address Lot No. Address . ................ ........0...... Installer Address Type of Building Size Lot___J __ ,_,1 ..Sq. feet Dwelling—No. of Bedrooms_________ .............................Expansion Attic ( ) Garb�ge Grinder a`4 Other—Type of Building No. of ersons____________________________ Showers YP g ---------------------------• P ( ) — Cafeteria ( ) Otherfixtures -------------------------------------------•------••--------••....---•---------------•-----•----. DesignFlow_______..__/�?........................ allons er erson er da Total daily flow_._._____ W � g P P P , Y• Y ��----------------------gall'"�• WSeptic Tank—Liquid capacity/.574OVgallons Length__/,0...... Width_42..... Diameter________________ Depth4c,�,,?_ .. x Disposal Trench—No_ ____________________ Width..... ,------------ Total Length....._________.___ Total leaching area....................sq. ft. Seepage Pit No.......Z......... Diameter-__/P_-____-__ Depth below inlet... _________.... Total leaching area//P 6 "sq. ft. Z Other Distribution box (1,�" Dosing tank 0-4 Percolation Test Results Performed by_________________________________________________ ___ __ Date...................... ___ a /t� .�vunT' Test Pit No. 1-----Z___.__minutes per inch Depth of Test Pit_.__.,l____.......... Depth to ground water_ _ G14 Test Pit No. 2......Z.....minutes per inch Depth of Test Pit------ ,X........ Depth to ground - - _ � water/_�a.tvn�� n --•----•_. . . (7 _•-- ---_-••---•---• OJ ----------- •r-•-----------------•••-•••...----_----- � D 10.--- tj Description oSol_. -------J - ---- ----T U -----•-------------------••-------------••---------------------------------•................................................--••--•--------•--...------------...-•------.......---•-------...--_------ 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'TT�� p of the State Sanitary Code— The undersigne urth agrees not to place the system in , operation until a Certificate of Compliance h s b en issued by the ar o �ieal t • Signe Date Application Approved B PP PP Y :ar_�-:.. ---------------------------------------- Application Disapproved for the follow g reasons:-----••--------•----•-•4---...-----•--------•------------------------------------•--._...__•Date----...•••••- -•-----•----•----------...............--------------•--•--•------------.....-----------•-••---------------•-------------------------•----------•---------•---------------•-----------................ Date PermitNo. 7- ----�-.................-- Issued....................................................... - Date - -- ,THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /.. �.c.:z. ._......OF........A)x3m v: a: --(...................................... Qwrtifiratr of Toutpliancr THIS IS TO CERTIFY That the Ind vidual Sewage Disposal System constructed ( ) or Repaired ( ) bY............... ---------------------•--------------.....------•--....----•--------.._..----------.._..-----........-•-------•-••----- I G �' -} Installer � ---------------------------------------- has been installed in accordance with the provisions of TTTIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No ��_�_`__3�-_:�?.......... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL KNCTION SATISFACTORY. .. DATE.....................' )_3-_'1).......................... Inspector..............._-...... w THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No... ...... FEE..-___-_. �............ Raposat Workii onitrnrtion rrntit Permission is hereby granted .................. ...................... to Construct (xj or Repair ( J.an Indivi� ual SeDisposal System atI�To. l!_� `.y. t 7 S ................ - -----------------------------------------------•------------------------._......•-- Street as shown on the application for Disposal Works Construction Permit No.P.- ___ Dated__________________________________________ .............................. - of Health DATE................................................................................ Board FORM 1255 HO$bs & WARREN. INC.. PUBLISHERS AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION/yd �1� � SEWAGE #__g)-,3z► "� VILLAGE �S �f�� ASSESSORS MAP & LOT I O 69 INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY Zpc LEACHING FACILITY:(type) - Z (size) n NO. OF BEDROOMS .5 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED_ VARIANCE GRANTED: Yes No Zi http://issgl2/intranet/propdata/prebuilt.aspx?mappar=l 19069&seq=1 2/19/2014, i 20 F T � SOIL TEST TOP OF FOUND. ' EL = 97.5 _ 10 FT. MIN /�- f OBSERVATION HOLE I OBSERVATION HOLE 2 OBSERVATION HOLE 3 CONCRETE - - DATE OF TEST _ JULY 3, 1985 DATE OF TEST DULY 3, 1985 pgTE OF TEST COVERS PIPE _ WITNESSED BY _ JjC. _ WITNESSED BY .-__ J.C. �MN R#WITNESSED BY � � i! a�"� PEft F'1' PERC RATE ___ `2 MIN / INCH PERC RATE _`2__ MIN /INCH PERC. RATE MIN./INCH - 0VEItS ! 0 4 CAST IRON (OREL El = __93.1 ELEV = _ 95.0 ELEV. = EQUAL) PIPE- MIN. �12"MAX _ r PITCH 1/4" PER FT - 2% MIN TOP 8 SUBS Ali TOP 8 SUBSOIL 24.. LEVEL „ �� I 24 FLOW LINE_ ,,1.._. � 17'— EL= _92.3 10 _ ------ � _- _. - - � 'C MIN. EL- 91,3 ,[ .-- .. ^ .__ . - • EL I CLEAN MEDIUM SAND CLEAN MEDIUM SAND EL= 91.5 I EL= �4.�_ EL ` �_rl& �' o 0 I _ EE 1 DIST 6 ` I I EL, 80J 136" EL = 82.0 -- BOX I LOCATION MAP WATER ArT - Ems- - WATER ArT ------ E t.. JVAT E R AT E L = 1 1500 GAL ° — ----------_ ----- -- n - NO WATER ENCOUNTERED -- SEPTIC PRECA�; ` LE ACHING I EI_ _ 841 L_EG E N D TANK E3ASIN OR E: U131V. EXISTING SP5T t_LEVATION OOx0 10' I EXISTING CONTOUR - - - 00 - - - - - FINAL SPAT ELEVATION FINAL CONTOUR 00 PROFILEOF - ________.._�.__-_._ —__ ._ _ _ --_-__-- - _. - A� BOTTOM OF TEST ROLE Off -OBSERVED ---W"ER TABLE- ABr EL = 80.1 SOIL TEST LOCATION SEWA( DISPOSAL SYSTEM ADJUSTED-&ROL#40- WATER TAKE �- �---L- -}- €�__-- TELEPHONE POLE NOT TO SCALE -. HYDRANT �° I LOT 31 TOWN WATER CATCH BASIN i®, FRAME 8 COVER SHALL BE 4 SET WITH MASONRY UNITS a CLEAN SAND WHICH ARE TO BE MORTARED IN PLACE GENERAL NOTES \ -- 2 LAY ER OF I. ALL WORKMANSHIP AND MATERIALS SHALL f F 1/8 - 1/2 WASHED I I STONE CONFORM T:' D E Q E TITLE 5 AND THE p , - L .4 TOWN OF-BARM TALE RULES d REGULATIONS - N ` G2�'� + ---' _ { FOR THE SUBSURFACE DISPOSAL OF SEWAGE u 3 r" 2.ALL COVERS TO SANITARY UNITS SHALL BE 't•- \ \ �, _ _._. �l_ — a BROUGHT TO WITHIN 12" OF FINISHED GRADE LOT 40 ► 60,710 ft2+ I w �-- - 3/4"- 1 1/2" 3.EXISTING AND FINAL GRADES SHALL REMAIN i 1.394 A.+ I 1 = 61 >= v G WASHED STONE ESSENTIALLY THE SAME LT 3? / ,� 0 r 6 ww 4 NO DETERMINATION HAS BEEN MADE BY HIS �. h �G OFFICE AS TO COMPLIANCE_ WITH TOWN LL_ _. . _ PRECAST LEACHING t---- � ZONING REGULATIONS. OWNER / APPI, (CANT 24� I d TO M''`,,, !din; t `; / ;� OBTAIN SUCH DETER BASIN 4 �' A D A APPROPRIATE AUTHORITY 5. THIS PLAN IS VALID ONLYIF T IS STAMPS D PLAN VIEW AND SIGNED IN RED. THIS OFFICE ASSUMES s 2! NO RESPONSIBILITY FOR INFORMATION CONTAINED ' FRAME., a COVERS SHALL 10, ON COPIES WHICH DO NOT HAVE ORIGINAL . ._ / --- BE SF WITH MASONRY UNITS 96� ��' WHICH HRE TO BE MORTARED - - - --- --- - _1,� STAMPS AND SIGNATURES IN PL��CE 6. ALL COMPONENTS OF THE SANITARY SYSTEM 1 _ _ .T SHALL BE CAPABLE OF WITHSTANDING H-10 I 10' DIA a. . c. "�. — - LEACHING PIT DETAIL LOADING UNLESS THEY ARE UNDER OR WITHIN l_EAC-Hft PI! �4 / INLET y' { 3MIN. OUTLET NOT TO SCALE 10 FT OF DRIVES OR PARKING AREAS, H - 20 '• '� _' ` i csT w C 8 0) +"�►` 6 MIN. FLOW LINE LOADING SHALL BE USED UNDER OR WITHIN E nir.►r Lx- ` i D-� 100� ° 2 MIN. -- P /--REMOVEABLE COVER 10 FT OF DRIVES OR PARKING AREAS q�►.,►�, OUTLET PIP E S �- = rn 10"MIN. I OUTLET TEE Al V ►00% RESERVE n� ��O �,'z � �-' �� / � LIQUID DEPTH TEE . DEPTH �+ SQUIRED ` — — - ! BELOW FLOW LINE -- - F v5 ` , c 4 FT 14 INCHES - --- ° MIN FRONT SETBACK 3G 6. 0" INLET �p� I, 11 M, TUP OF C.H, LEACHING P / 5 FT 19 INCHES _ , °FLOW . OUTLET 1`0IN REAR SETBACK 11 ► IUD;)cJ ( SUMED) I / 1 4 FT MIN .__�y _/ - - �` LIQUID 6 FT 24 1NCHES rj -'LINE I MIN SIDE SETBACK 7 FT 29 INCHES 10• i �cV DEPTH c. 31 • \ �'> 1` 8 FT 34 INCHES - 6 APPROVED BOARD OF HEALTH f� INLET TEE PROVIDED DATE AGENT 1 CX7 \ �. ----- - --- ------ PER SECTION 15.10.2 \ �' .`. TITLE 5 PROJECT I. ^CATION 1 Z 1 #I �...__ 31 � `� I v LOTS 43 8 75 BUNKER HILL ROAD I Tri 95 NO OF OUTLETS' MARSTONS MILLS, BARNSTABLE + \ CROSS SE__C' -N VIEW i 1 \ I = } \� APPLICANT SEPTIC TA`� DETAIL DIS-�. BOX DETAIL NOT TO SCALE McPhee / Conway N ter Tt 0 \ \ a � 1 D ADDIT{( NAL NOTES -- R. J. O HtA/?m hNc \ 1 ` Rey. Land Surveyors - Reg SanitoreGns i ~ DESIGN CAL ' L AT IONS 1. SOIL TEST NUMBER P I (SOIL TESTS E3'% OTHERS). p �' 'S ROUTE /34 - UNIT 2 - Po 0, BOX 237 HY?RANT �� \ i 1 NUMBER OF BEDROOMS _.__ 6 SOUTH DENNIS, NA . iii GARBAGE DISPOSAL UNIT __ YES -- ------ 1 TOTAL ESTIMATED FL011V 20 GAL./ GAY 10 x9 ` / ^\ LOT 75 1 ( �1Q__ GAL/BR /_)AY �_BR )x 150% --990 --------- ``\ 58 901 ft2+ , REQUIRED SEPTIC TANK ,PACITY .....-,GAL. ` L &Gc 1.352 A.+ ACTUAL SIZE OF SEPT+�, T,A K - 1500 ___GAL -- ------ `"-�., LEACHING AREA REQUIREMENTS r �\ XO� 31p 49 ___ _... . SIDEWALL AREA -_2.�._ GAL./S.F f I BOTTOM AREA ____LQ.____ GAL./S.F. /� - "------_ I LEACHING CAPACIT'` ( BOTTOM SIDEWALL) — IIOQ___.__. GA._ -- _ 2 12.5(3.14-GAO) + I.O(3.14x25)J REVISIONS _ LOT 76 SCALE: DATE RESERVE LEA' RING CAPACITY —_1100 —GAL f11CHARD "� 1 , RICHAR 5 -' EARN �(�0 69 DR. BYE J APPD BY: <A , 2 12.5(3,14x6x10) I.O(3,14x25)) _ O'HEARN �o. 278 1 1 `'ss�oNCIS `v ` I � JOB NO I v SHEET ' OF tic., i. -� - -L -1 - I - - / FORM 11/6/ 85 l F