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HomeMy WebLinkAbout0044 CURRY LANE - Health 44 Curry Lane Osterville A= 140—072. , i f 4 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 44 Curry Lane Property Address Edward Migdelaney Owner Owner's Name information is required for Osterville MA 02655 June 17, 2013 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any Way. Please see completeness checklist at the end of the form. Important:When filling out A. General Information forms on the (� computer,use 1. Inspector: �1 only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name raa PO Box 1487 Company AddressF Marstons Mills MA �'Q�!648 return City/Town State (Zi'Code C) 508.428.1779 S112855 - s Telephone Number License Number ^"= V B. Certification ' ='t _ 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 Evaluatio by the Local Approving Authority 9i4 _"_i June 17, 2013 Job# 13-49 Iq ector's Si ature 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 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 un ;r 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 Title 5 Official Insp io rm Subsurface 1/gelsbposa�S!temPage 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 44 Curry Lane Property Address Edward Migdelaney Owner Owner's Name information is required for Osterville MA 02655 June 17, 2013 every page. City/Town State Zip Code Date of Inspection B. Certification (cont) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Tank was not in need of pumping at time of inspection, Area of SAS was probed with no signs of saturation found. 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 44 Curry Lane Property Address Edward Migdelaney Owner Owner's Name information is required for Osterville MA 02655 June 17, 2013 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments e 44 Curry Lane Property Address Edward d and Mi delane 9 Y Owner Owner's Name information is required for Osterville MA 02655 June 17, 2013 every page. Cityrrown State Zip Code Da`.;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 l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts D. Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 44 Curry Lane Property Address Edward Migdelaney Owner Owner's Name information is required for Osterville MA 02655 Ju,ie 17, 2013 every page. 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. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply ❑ ® well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, theret�,re the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 r Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 44 Curry Lane Property Address Edward Migdelaney Owner Owners Name information is required for Cisterville MA 02655 June 17, 2013 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous tvo 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 3f scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 44 Curry Lane Property Address Edward Migdelaney Owner Owner's Name information is required for Osterville MA 02655 June 17, 2013 every page. City/Town State Zip Code Date of Inspection D. System Information Description: I Number of current residents: 2 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d N/A Irrigation g. ( y g (gp )) system. Detail: Sump pump? ❑ Yes ® No Last date of occupancy: CurrentlyOccupied. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM •'' 44 Curry Lane Property Address Edward Migdelaney Owner Owner's Name information is required for Osterville MA 02655 June 17, 2013 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Tank pumped when leaching system was installed. 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•3113 Title 5 Official Inspection Form:Subsur` ,�e Sewage Disposal System•Page 8 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 44 Curry Lane Property Address Edward Migdelaney Owner Owner's Name information is required for Osterville MA 02655 June 17, 2013 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Leaching system installed April 2011 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 2'feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10.5' long x 5.8'wide- 1500 gal. Sludge depth: 2" t5ins•3/13 Title 5 Official Inspectio-i Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessment; �M 44 Curry Lane Property Address Edward Migdelaney Owner Owners Name information is required for Osterville MA 02655 June 17, 2013 every 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 30" Scum thickness 1, Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 13 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.): Recommend pumping in 18-24 months. Liquid level was found at bottom of outlet invert and tees were intact and clear. 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 Di stance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ec G 44 Curry Lane Property Address Edward Migdelaney Owner Owners Name information is required for Osterville MA 02655 June 17, 2013 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 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.): f *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 44 Curry Lane Property Address Edward Migdelaney Owner Owners Name information is Osterville required for MA 02655 June 17, 2013 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert oil Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: l5ins•3113 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 44 Curry Lane Property Address Edward Migdelaney Owner Owner's Name information is required for Osterville MA 02655 June 17, 2013 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4 Infiltrators. ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovativeialternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soils and stone surrounding SAS were probed with no evidence of saturation found. 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 44 Curry Lane Property Address Edward Migdelaney Owner Owner's Name information is required for Osterville MA 02655 June 17, 2013 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of pondinr, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 r Commonwealth of Massachusetts - ,� � Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 44 Curry Lane Property Address Edward Migdelaney Owner Owner's Na-We information is required for Osterville MA 02655 June 17, 2013 every page City/Town Slate Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage dispose 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 ❑ drawinq attached separately 20 i Back Yard 54 38 .................................... ................................... .................................... k�ti'A1�Rz Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 44 Curry Lane Property Address Edward Migdelaney Owner Owner's Name information is required for Osterville MA 02655 June 17, 2013 every 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 of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database-explain: You must describe how-you established the high ground water elevation: Low areas of abutting properties are considerably lower than SAS. 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 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 44 Curry Lane Property Address Edward Migdelaney Owner Owner's Name information is required for Osteryille MA 02655 June 17, 2013 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION qC� �t�f�Z� �►�, SEWAGE# 4(s VILLAGE ujr- ASSESSOR'S MAP&PARCEL 14iS-- 74, INSTALLER'S NAME&PHONE NO. Z-G. l - -7-71 - 9;5" SEPTIC TANK CAPACITY /-.5-co =,A-L LEACHING FACILITY. (type) o0 oZ 2rN e-k- (size) .-7p 1 X 36 NO. OF BEDROOMS -3 mil-`3nS7D I NS OWNER a&L.L PERMIT DATE: -Imo- t1 COMPLIANCE DATE: a 4 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) /`fi , Feet �y�FURNISHED BY o�®z s w w Ab O O M1- 0 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered;ncomputer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppficatiou for Zisposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(.,,)"'Abandon( ) [:]Complete System ❑Individual Components Location Address or Lot No. v i. 'Pe— Owner's Name,Address,and Tel.No. n i� a j�fe f�r-u i I,e S/t, hr'ren 5F�: LJ9-6 f�o�M A O 6 s/ Assessor's Map/Parcel 1t/,)./"j �� - 6 1 Instal r' Na a Address,and el.No. 5'd `�'� �� es�gner's Name,Address,and Tel.No. Sod•, (bn��a�--, ns+- ,Ucf-&n P.v E3o x 'w y +:ail 2 Er, ire—i' =,Mrk, 1l A- vat Ff a,' 1WA-0XW Type of Building: Dwelling No.of Bedrooms 3 Lot Size .746g 9 / sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ,3 C) gpd Design flow provided ���� gpd Plan Date Ao,,n4- 1 g, _aOaq Number of sheeets , Revision Date Title / /grin- dS ' Q. Size of Septic Tank Type of S.A. I0.. ` 30.VL Description of Soil o Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maim ce of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environme Cod nd not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Dated/G/ Application Approved by Date ��12 "<l Application Disapproved by Date for the following reasons f Permit No. �L7'' -- �/ Date Issued No. 't 0/1- 0 _ ^e'4N•re�/t' Fee ` — 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: z PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es \ `- - ? c 01ppYication for Disposal *pstem Construction permit Application for a Permit'to Construct( ) Repair( ) Upgrade(!Abandon( ) ❑Complete System ❑Individual Components' Location Address or Lot No. l/l,/t4t,._CL Owner's Name,Address,and Tel.No. Assessor's Map/Parcel u-L- S�6 IVI►� U!S$/ / �' � ti Installer'ss Name,Address,and Tel.No: SOS 'T)/ � �`T Designer's Name,Address,and Tel.No.A 1�Aor�o1a- -� t'lari # utl��GY UP�•UCo a -owy JO&;)6 � 1 Sf 6 � Trc i mill"Type of Building: Ma 34. � & ` J i Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.-required) 3 3[) gpd Design flow provided gpd Plan Date Aj�, )—�07 Number of sheets / Revision Date - Title Llau no- Size of Ta Septic nk , f t P S r, Type of S.A.S. y 1{-)6 . , . 3a(It- Description of Soil 4 Nature of Repairs or Alterations(Answer when applicable) i i a v; Date last inspected: Agreement: , It{, The undersigned agrees to ensure the construction and mainZdnot ce of the afore described on-site sewage`disposal system in accordance with the provisions of Title 5 of the Environmental-Cod to place the system in operation until a Cdrtificate of Compliance has been issued by this Board of Health. may " 11 Signed f, Date W///�"` Application Approved by Date .- = Application Disapproved by Date for the following reasons ,f Permit No. 490 Date Issued 1/ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS` Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgradedl(_l Abandoned( )by Xb(I 40 Jn � eqh ` 8.^ , at `-r-t t Lsi ��S ,C�, p has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. p� /(•61 5 dated Installer Designer #bedrooms Approved design flow /1 3 5(.) gpd The issuance of thi permit shall not be construed as a guarantee that the system wi functi b n/as designed. (' Date Ll (I Inspectorjv / > --------- - ---_-------------------------------------------------------------------------------------------- No. a0u- (Jt 1- Fee l THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE, MASSACHUSETTS Disposal 6pstem Construction J)Prmit Permission is hereby granted to Construct( ) Repair( ) Upgrade / Abandon( ) System located at Y 7 {toA on_^ 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.,--'i� - c Date y—( Approved by APR-20-2011 08:47 From:BORTOLOTTI CONST 5084289399 To:15087906304 P.2/2 FROM !rJcun cape angin"ring ine FAX NO. 'ISO 6298M Apr. 19 2011 eM!,l5PM P2 S t �• aasewnxKA �• /�i f°teblia^!�e�a��1.�j➢bWW'ISIkt1Q1 r1bliman McKean, m ADO Milin Stmt,llvam mu.blik 01601 Uffies' 508-961464 .'cx g)R-1�11 69tla ►nAteDlar��Ybr;.►i nea�.�ri'�a; d'u��.sar 7C;'ra¢r; 4 /q f� ��ayta FrrLtuui� �Ull' D!� At<a�9�r'`fI tt!Ilsp��ti�'nxrrra �� '�a 1)Dd9A�,91�LC', fj� ._ �Il rjef+c4 hasifluear. /1,� �° o. rya �i,[11�lakSarA. A,� r,._ _U,4-. � .#.�liixe�fl; � r t3ss �Jfa't�l� el`rfee '7aT 71 Cam. l'• was 1.4mad u nt:rlaii lei immE It aeptia aystsm at T GWi'4 Q.KX 'ba5Gd or,a.dr-gi rn drawn T•y (altar.se ti x remit. 111u1 lhu W-Ptio systm r'tfrrennzrl above. Wns in:stdod iabmWntially t3CCt:3tilUlr; � rF ille dR$.eK;ti,wlljtlt Tn v jxi�lur e.wiai r dppxuvr d ::luu,ga such m 10cral relrmadon al thn cdi�i>a�rlrtiatl L'o��ud/c�r�e�rti,e panic. 1 celrify ftt eht: sgiti4 symez,u r6wamwe, itbovu wria ina lied with -nujQT uhunsas (Le. yit)ltC: SbAC1WMIMIM10CWilmul°them.S'ASteruvlyvEYCiell.re.10Mi1Mof41MIPcrmptut91 of tbe qcr tics . )11iIC I]x accordalere,with Sinn T,.oerd rlesvulmim.q. Plrtits ravi9io :r>r cent iecl ail dat 1poa to bUlum qN OF DANINLA. } OJALA -� CIVIL �a �No.4ti4Q2 � 19•i1 a$�ownt�l`� i'`i il itnT�r} (J1.Tii?t D- iKri�T'f Stitulp i"m) [JBASY, R11VITA T qjM�r J.�1r C,'R,w1 LL N" rbr,=,D Mrr, a= =g FQ,C 0-9 ca . Q,tt�+iinll,inpcicl.h�q �r C aMinoon Fortin?-JC•94 44-- Town of Barnstable Barnstable ti¢ A&MCft Regulatory Services Department Ica HAPN$T"M Public Health Division 200 Main Street, Hyannis MA 02601 2007 I Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 70081830000205009656 June 15, 2009 Esther S. Baker Estate PO Box 269 Osterville, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 44 Curry Lane, Osterville, MA was last inspected on May 11, 2009 by Robert Polselli, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to an overloaded or clogged SAS. You are ordered to repair or 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. ER OF THE B 0 OF HEALTH o c e ;R.S., CHO Agent of the Board of Health Commonwealth of Massachusetts ,? Title 5 Official Inspection Form 'Subsurface Sewage Disposal System Form -Not for Voluntary Assessments mg Property Address Owner Owner's Name information is' ©r�ti!� required for e, C e��ery page. Citvlrown tad bS, g State Zip Code Date a6 ins ection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms the computer, r,use 1: Inspector: only the tab key to move your r /0 cursor-do not , use the return Name of Inspector key. i iv�i o Company Name i C°0 Qax /a �S Company AddressC Z/ � i/ 002 64f oZ Etnn Clty/Tow•n /y y State Zip Code , Telephone.Number ' License Number B. Certification lA I certify that 1have 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 CM 15.000). The system: ❑ Passes ❑ Conditionally Passes Fails ❑ Needs Further Evaluation by the Local Approving Authority _ 0D a , Inspect s Signature Date The system inspector shall'submit a copy of this inspection report to the Approving Authority(Board of Health or DEP�I 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. i /off t5ins•09/08 - Time 5 Omcial Insoecion Forth:Subsurface Sew c,-a _ r Commonwealth of Massachusetts Title 5 Official Inspection Form =�^7 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address. o� e Owner Owner's Name information is f/ required for 's7�✓l�1 every page. City/I own V J State Zip Code Date of spe tior. B. Certification (cont.) Inspection'Summary:Check A,B,C,D or E/always complete all of Section D A) System Passes: I{ 1. ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the'`Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved,by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined,"please 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 o . Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-09/pa rtle 5 Official Inspection Form:Suosu-.-=S=sl-a t)is^csa;S• _e__.q;7 commonwealth of Massachusetts Title 5 Official Inspection Form � WmM ; g Subsurface Sewage Disposal System Form Not for Voluntary Assessments 4 Property Address Owner Owner's Name / information is �S Yy! le required for I e. ,/�/ every pa City/Town 9 State Zip Code Date or Ins6ectAn B. Certification (cont.) j 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. Svstem 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): ik C) Further Evaluation is Required by the Board of Health: 01 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 wetiand or a salt gars^ t5lns•09108 Title 5 Omdai Inspec5on Form: ce.S=.•rc=Oisv .1 Sy,ie^•?_-_:.;,;; f Commonwealth of Massachusetts IMM Title 5 Official Inspection Form — 21 Subsurface sewage Disposal System Form -Not for Voluntary Assessments Property Address lz��� Owner Owner's Name information is required for of 4Kvl Ile every page. City/Town State Zip Code Date Ins ection . B. Certification (cont.) i 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. [IThe 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 e 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: i*This system passes if the well water analysis, performed at a DEP certified laboratory; for 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 I attached to this form. - !9 3. Other: I . D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: l l . ❑o Backup of sewage into facility or system component due to overloaded or Yes clogged SAS or cesspool ❑ [2, 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 overloud d or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6"below invert or available v lu me is less than isms•ewos Titl=5 Ofid21 insoec5on Form:Suosur_ce S_,.r_ Oise;S.,:- i Commonwealth of Massachusetts _ Title 5 Official Inspection Form i' t Ic! Subsurface Sewage Disposal System Form -Not for Voluntary Assessments (4✓."r r Property Address Owner Owner's Name information is // � / required for asp-G/ Ile,!(G ,41"4 0.)63- ��7 every page. City/Town State . Zip Code Date�ection B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Any portion of cesspool or privy is within 100 feet'of a surface water supply or tributary to a surface water supply. ❑ .Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply Weil. ❑ 1 "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.] F The system is a cesspool serving a facility with a design flow of 2004gpd- 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. it 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 supoly ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area.—IWPA)or a mapped Zone II of a public water supply well If,you have answered"yes"to any question in Section E the system is considered a Significant t^relit; h 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 contaci the appropriate ' regional office of the Deparment. t5ins-09108 Title 5 Official Inspection Form:subsu:�'ce,SewGo=DIsoo==i 9s=s-.P- c cl-;7 f it Commonwealth of Massachusetts mr Title 5 Official Ins ection Corr p ' ; Subsurface Sewage Disposal System Form Not for VoluntaryAsses sments ;\,3-K7 Garr Property Address K Owner Owner's Name information is ,,//�� II -- -- / l • required for V�TG✓�l I�� XY. OaS �/ OC� every page. City/Town State Zip Code Date o'Ins bon C. Checklist �1 Check if the following have been done. You must indicate`yes" or-no" as to each of the following: I� Yes o Pumping information was provided by the owner, occupant; or Board of Health ❑ ze, Were any of the system components pumped ouf'in the previous two weeks? ❑ L/7 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) 2 ❑ Was the facility or dwelling inspected for signs of sewage back up? L� ❑ Was the site inspected for signs of break out? t 1� ❑ Were all system components, excluding the SAS, located on site? L�' ❑ 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? Ly" ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has — / been determined based on: ❑ Existing information. For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part C is at Issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: t Number of bedrooms J (design ) Number of bedrooms (actual): DESIGN flow based on 310 CM 15.203 (for example: 110 gpd x n of bedrooms): 4 t5ins-09108 Title 5 official insoec:,'on Form:suhcur ac�- Se•n_e=pis sal �;._ ,�__ Commonwealth of Massachusetts z Title 5 Official Inspection Form icl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address 97 �►�!�/ Owner Owners Name information is //,�.,, le required for ©.STG✓l//�(t Aw every page. City/Town State Zip Code Date of Inspection D. System Information Description: Dumber of current residents: Does residence have a garbage grinder? ❑ Yes 1-1-fl No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes No Laundry system inspected? r Yes � No � Seasonal use?_ ❑ Yes ! No -Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? Yes 1 ; Io Last date of occupancy: Date Commercial/Industrial Flow Conditions: It Type of Establishment: Design flow(based on 31.0 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? 'es F1 No Industrial waste holding tank present? — ' Yes i iNo Non-sanitary waste discharged to the Title 5 system? — 1 Yes I No Water meter readings, if available: t5ins•oS/o8 1-We 5 Offidaf Inspection Form:Sub;urace SW- a, __, Commonwealth of Massachusetts 1gp Title 5 Official Inspection 'Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address /7A Owner Owner's Name information is ©.S /_w,Ile, required for 7� every page. City/Town State Zip Code Dat,o f inspection D. System Information (cont.) Last date of occupancyruse: Date Other(describe below): I�rY. General Information Pumping Records: . Source of information: Was system pumped as part of the inspection? ❑ Yes If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping:. Type of System: t ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records; if ar t vl) ❑ Innovative,'Alternative technology. Attach a copy of the current operation and . maintenance contract(to be obtained from system owner) and a copy of!atest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the pEP approval. ❑ Other(describe): �� t5ins•09lQ8 , Title 5 of ci2l Insp=otion Form:Subsr:---cr S=u2ae Commonwealth of Massachusetts. Qmw Title 5 Official al Inspection dorm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments C61 r� Property Address G�,G✓ Owner Owner's Name information is ©,S�G•i��{� Q required for �/� DoZ(e,�- .S/// every page. City/Town State Zip Code Dai o n pection D. System information (cont.) _ Approximate age of all components, date installed (if known) and source of information: Y Were sewage odors detected when arriving at the site? ❑ Yes o Building Sewer(locate on.site plan): Depth below grade: feet Material of construction: cast iron 40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass = 9 polyethylene ❑ ocher(explain) If tank is metal, list age: yea,-- Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) I Yes ! No Dimensions: Sludge depth: t51ns•osros Title 5 omgal Inspection Form:SLbsL.,ece S__=trc= Commonwealth-of Massachusetts R NO rf Title 5 Official Inspection Form Subsurface Sewage Disposal'System Form -Not for Voluntary Assess,nents Property Address Owner Owner's Name i information is J� �✓�/ required for ©ST"✓ ` �i Q�jr 5' �� ��' every page. City/Town State Zip Code Date&Ins ecfion D. System Information (coat.) Septic Tank(cont.) 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.): I Grease Trap (locate on site plan): Depth below grade: feet Material of construction: i� ❑ concrete ❑ metal ❑fiberglass e 9 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: tSirns•OS108 Date Title 5 OSaal Inspection Fomr-Subsu ace Se rae=Dise0321 sys`e-•=_., -__;:7 Commonwealth of Massachusetts � , Title 5 Official Inspection Form _, I - bi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments A Property Address Owner Owners Name information is required for V s1�li/�I� /"i�/f 47���/O� every page_ City/Town State Zip Code Date of Inspection D. System Information (Cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, Liquid levels as related to outlet invert, evidence of leakage, etc.): I� 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: q Capacity: Li gallons Design Flow: gallons per day II Alarm present: El 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 d t5ins•09108 Title 5 Omcial Inspection Form:Subsur;ce Pace 4 I Commonwealth of Massachusetts ► � Title 5 Official Inspection —�-� pect�on Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owners Name . information is oS�v, � required for _ ll � ('�� s- /l 0 every page. City/Town State Zip Code Date or inspection D. System information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 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.): Frump Chamber(locate on site plan): i. Pumps in working order: ❑ Yes J No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (:SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsu,- =S Fr_eo Discos 2f S}Ss:.•_. 2,-,i 7 J i , Commonwealth of Massachusetts Title 5 Official Inspection Form 113, '. F Ir.-i l_1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address �A Owner 1: Owners Name information is O� v/// required for �P✓ AR every page. City/Town State Zip Code Date of nsoection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: El !leaching galleries number: ❑ ' leaching trenches number,length: ❑ leaching fie'ds number, dimensions: overflow cesspool number: it Ej 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.): I# 4j I Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert -71 Depth of solids layer e M Depth of scum layer �211— -e t,.,,a Dimensions of cesspool Materials of construction �pL h/ /J �d G�✓ Indication of groundwater inflow tsms•osroa ❑ Yes ( :: No Title 5 Official InsPec6on Form:Suescra�S_x__o C�sxs=_;g,•;.=_., °_.__ __.;7 Commonwealth of Massachusetts C Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments v } Property Address Owner Owner's Name information is required for OS ✓Y!�h /%/� /� �� 0/ every page. City/Town State Zip Code Date Inspec cn D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,; etc.): 'J� �'I (.e.s t7U S �T�r H�� � �N✓i�✓��. ply 63, I0 /✓►i���`S l+� ��/C� �t.✓, 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.): I i t5ins•09/08 - Title 5 Dfficfal Insr?C50n Fc rn:Subs!!fan S�;�_�Dic,_Ge Commonwealth of Massachusetts 1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address Owner information is Owner's Name /'- required for �J 7 ,"// �� ©p��r' k l every page. City/Town State Zip Code Date of.nsp ction D. System Information (conf.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including 9 p yst g ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet'. Locate ;�hre p Ic water supply enters the building. Check one of the boxes below: and-sketch in the area below ❑ drawing attached separately t I i i } 1 >� I I A'A j ' 1 t. I a v I Aa E i f I i I i t5ins-05/o8 - Tithe 5 Official Inspection Forrn:Suosunsce Sewage pis osai Svsler,:. Commonwealth of Massachusetts Title 5 Official Inspection Form `` �1, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - l Property Address Owner Owner's Name information is 0 S ✓yt required for It � ��b� SA �= every page. City/Town State Zip Code Date o lns; eceion D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells c;,2-o / Estimated depth to high ground water: feet Please indicate all methods used.to determine the high ground water elevation: �F ❑. Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of th - xpia ❑ Checked with local excavators, installers-(attach documentation) (] Accessed USGS database-explain: You must describe how you established the high ground water elevation: it I� Before filing this Inspection Report,please see Report Completeness Checklist on next page.15irs•09/08 - Title 5 Official tnsneciion Form:Subsurface Sewoe D+=crsal SYSter.? -•=c„-; Commonwealth of Massachusetts W. Title 5 Official Inspection Form iy z i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s�q Property Address c Owner Owner's Name information is required for V f 7z1Z///G� O.;-6ss every page. City/Town State Zip Code Date of./Inspection E. Report Completeness Checklist Inspection Summary:A, B, C, D, or E checked Inspection Summary D (System Failure Criteria Applicable to All Systems) completed Sy m Information-Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file �Y t5ins•09108 Tice 5 offltlal inwecion Fom:Subsij, &Avr.-�y,y,:a�:,s= .p,.,;%c 17 V r 176 Town of Ba.lrnstabllle Pit- Department of Regulatory Services Public Health Division gate - - + gARNBTABLE, " 7� M� 200 Main Street,Hyanuis MA 02601 163 Date Scheduled 0c, Time t) Fee Pd. D o y Soil Suitability Assessment for'Seipage. ispos�114` Perfonned By: Witnessed By: LOCATION & GENE,RAL INFOR ATION � Location Address ( ! n, , �Q (, Owner's Name !0/j v wvvjy/` Address 6 Assessor's Map/Parcel: l�t�/ ?O� Engineer's Name !! hone It SOd- NEW CONSTRUCTION REPAIR Telephone� pp Land Use Slopes(°/o) —� 70 Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way It Property Line �� ft Other ft SYX,4'TCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) . ti CV U A , 1�0 , y Parent material(geologic)C "f Depth to Betb•ock Depth to Groundwater: Standing Water in Ilole: /`, U(V Weeping _.,__ 1'l-on)fit Face (NV f `1 Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL kIIOII WATER TABLE Method Used: Depth Observed standing is obs.hole: In. Depth to soil nwttles; Depth to weeping from side of obs.hole: .,,._,.e.In, Grouadmiter Adjusiment _,—ft. Index Well# Reading Date: Index Well level K AdJ,factor— Adi,Gr(Atndwater Level m PERCOLATION `IES'I' Observation Hole# C irce at 4" ,r Depth of Perc �J" 1 j N 1 A� Time al 6" y Start Pre-soak Time @ 7AtM Time(9"-6") End Pre-soak, " U Rate Min./Inch �Z Site Suitability Assessments Site Passel , — Sit.-Failed:- Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you naaast first Dotlty tile. Barnstable Conservation Divisioll at least one (1) week prior to beginning. QASEPTIC\PERC FORM.DOC 7 DELP.OPSERVATTON HOLE LOG Depth from Soil Horizon Hole# Soil Texture Soil Color Soil Surface(in.) (USDA) Olher ) (Munsell) Mottling (Structure,Stones;Boulders. �-- /4-' Co isle cy.% ravel 3&-/32 DEEP OBSERVATION HOLE LOG Depth from Soil Horizon Soil Texture Hole# Z Surface(in.) Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consis enc %Gravel 41 .00 DEEP OBSERVATION HOLE LOG Depth from Soil Horizon Soil Texture Hole# Surface(in.) Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cc siste c O vel Depth from SEEP OBSERVATION HOLE LOG Hole# _ Soil Horizon Soil Texture Surface(in.) Soil Color Soil Other (USDA) (Munsell Mgttling (Structure,Stones' Boulders, Consi ten a I Flood Insurance Rate Klan• Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year hood boundary No Yes — Depth of Naturally Oecurrin I'ervio� us Material Does at least four feet of naturally occurring pervious material exist in all areas observed bserved throw proposed for throughout the p p r the soil absorption system? g If not, what is the depth of naturally occurring pervious material? Lertl----ification I certify that onQ (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 required training,expertise end experience described -n Y1'0 CIAR 15.017. Signature x . ' --"-- Date Q:1SBFTICVERCF0RM.DOC I I SYSTEM PROFILE NOTES ALL SYSTEM COMPONENTS SHALL BE PROVIDE 20" MIN. DIAM. WATERTIGHT (NOT To SCALE) MARKED WITH MAGNETIC TAPE OR 1. DATUM IS APPROX. NGVD �� ACCESS COVERS TO WITHIN 6 OF FIN. GRADE COMPARABLE MEANS FOR FUTURE LOCATION. TOP FOUND. EL. XX.X' PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADE 2. MUNICIPAL WATER IS EXISTING11 47.0' MINIMUM .751 OF COVER OVER PRECAST 2% SLOP REQUIRED OVER SYSTEM 47.0 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. �Q Locus O PRECAST H-10 8" MIN. DIAM. 4. DESIGN LOADING FOR ALL PROPOSED PRECAST RISERS (TYPJ UNITS TO BE AASHO H-M I urry 2'0 4"OSCH40 PVC c� PIPES LEVEL 1ST 2' 2" DO WAS PEASTONE 5. PIPE JOINTS TO BE MADE WATERTIGHT. o so' OR GEOTUTILE FABRIC , \*45.6' 10■ 1500 GAL H-10 }4" 44.25 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE Sou h 44. 4' TEE SEPTIC TANK TEE , n NTH $ 44.59 0 `0 0'0 6" MIN. SUMP SSA o o 00 310 CMR 15.000 (TITLE V.) 00000 43.75 GAS BAFFLE::' 1?001°0,0 °00 12" MIN INT. DIM. `� 2M- 000 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND 4' LIQ. LEVEL (ACME OR EQUAL) 4.3.92' 43.75' So 2' 8 NOT TO BE USED FOR LOT LINE STAKING OR ANY ;.....:. „_, . .. oog �`bo 41.75 OTHER PURPOSE. aoo 0 0 0 0 0 0 o`o 0 0 0 0�o�o 000 0 0 0''� H-20 3050 INFILTRATORS !y. o � � � � � � � � � � � � � � � � - 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4 PVC. ono O. O O O O O O O O O O O O O O O O o 0 0 0 00 0 0000000000000,,0�000000000�0�0�0�0„o�0)00000. " 09� 6" CRUSHED STONE OR MECHANICAL 3/4" TO 1 1/2" DOUBLE WASHED STONE 9. COMPONENTS NOT TO BE BACKFILLED OR COMPACTION. (15.221 [21) CONCEALED WITHOUT INSPECTION BY BOARD OF OVERALL DIMENSIONS TO OUTSID1= OF STONE: 30.4' X 10.25' HEALTH AND PERMISSION OBTAINED FROM BOARD ( 2 X SLOPE) ( 1.7X SLOPE) ( 1 X SLOPE) 5.65' OF HEALTH. LOCUS ��� 10. CONTRACTOR SHALL BE RESPONSIBLE FOR FOUNDATION 38' SEPTIC TANK 39' D' BOX 2' LEACHING CALLING DIGSAFE (1-888-344-7233) AND FACILITY VERIFYING THE LOCATION OF ALL UNDERGROUND do NOT TO SCALE *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS BOTTOM TH-1 & TH-2 WORK' ASSESSORS MAP 142 PARCEL 72 NO GROUNDWATER FOUND 36.1 PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED 5' BENEATH AND AROUND THE LOCUS IS WITHIN AP AND ESTUARINE PROTECTION PROPOSED LEACHING FACILITY. DISTRICT 12. EXISTING LEACHING FACILITY SHALL BE PUMPED (NO CONSTRUCTION PROPOSED, UPGRADE ONLY) LEGEND- AND REMOVED OR PUMPED AND FILLED WITH CLEAN x 47.27 SAND. 99- EXISTING CONTOUR X 99.1 EXIST. SPOT ELEV. 99 PROPOSED CONTOUR 46.99 198.41 PROPOSED SPOT EL. 1 .05 TH, 1 2'0'3s° SYSTEM DESIGN: TEST HOLE YYY .46 GARBAGE DISPOSER IS NOT ALLOWED 2� SLOPE OF GROUND UTILITY POLE PAVED DRIVE DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD X 46.9 3 USE A 330 GPD DESIGN FLOW y, FIRE HYDRANT 47 47.53 .93 NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING p 19. 47.71 0 2 SEPTIC TANK: 350 GPD (2) 660 w 47. 47.99 .85 87 9 USE (1) 1500 GAL. H-10 SEPTIC TANK N 4, " 64.09 48.19 . 1 46 47.49 1 q� x x 7.94 3 48.27 04 / / 47.29 TEST HOLE LOGS LEACHING: x 7. 48.27 x �.1 48.19 47.83 SIDES: 2 (30.4 +10.25) 2 (.74) = 120 GPD � ENGINEER: ARNE H. OJALA, PE, SE TH1 x 47.19 X 7. 2 0*`�/ / 7.s647 18 BOTTOM 30.4 x 10.25 (.74) = 230 GPD I;cP WITNESS: DAVID W. STANTON, RS 47.2o x 7 8 GARAGE / 0J�Et��/ TOTAL: 473 S.F. 350 GPD DATE: AUG. 6, 2009 18 TH2 6'� 51 / / 4 o USE (4) H-20 3050 INFILTRATORS, PERC. RATE _ < 2 MIN/INCH / o 47.10 4 /47.03 '44 WITH 1' STONE AT ENDS AND 3' AT SIDES 74 1 LRG. 46.84 CLASS I SOILS P# 12658 ,\ OAK g x 47.9 47'27 RHODYS 51 W�� �57 46.79 V ELEV. ELEV. 46.42 4 B FLAG. EXISTING DWELLING PATIO TOP FNDN, EL W � W O / o„ 4 47.1' 0" 4 47.1' A6 CP 49.82 49.2 .98 A A SL SL 45 .37 � \ 0/4 74 " 1OYR 3/2 " 1OYR 3/2 5 32 �6 7 LOT 71 I C� APPROVED DATE BOARD OF HEALTH MA 6 4 � 44 45.22 � � � 26629 SF f 6.49 �46.31 B 43.57 4 TITLE 5 SITE PLAN SL MS 439 RHODYS AN �S \ OF 42.53 HOLLIES 4 44.5 BENCH MARK - TOP OF I 36" 1OYR 5/6 44 1' „ 1OYR 5/2 � 4 PATIO ELEV. = 49.8 6 _ x 6.01 4 134 CURRY LANE B 42 STEPS TO SL 42 BASEMENT SLIDER OSTERVILLE .56 PERC PREPARED FOR C 41 36" 10YR 5/6 44.1' 41 ' X .51 MS a -�- ESTATE OF ESTHER BAKER 180.16' 2.5Y 7/4 qqo x 39.10 AUGUST 12, 2009 x 40.10 _ ' MS � y(w OFMgSo. ��Sw of jw of Mgss �Fp` ygssgc ��zw OF4fj off 508-362-4541 °� DANIELA ti 9cti °� DANIELA ti� $� sfo I fax 508-362-9880 DANIEL �° DANIEL downca OJALA -+ g m pe.com o OJALA � A. � CIVIL N o A. � • • 2.5Y 7/4 CIVIL OJALA No.46502 OJALA `� down cQ**e eng1Aeeriag Inc. 132" 36.1' 132" 36.1' �No.46502Q No.40980� a �� NO.40980 IFS E���? ��°,�FS ,° °IFS ��ST� G. P°� 0 civil engineers NO GROUNDWATER ENCOUNTERED Scale: 1 = 20 / s�oNAt S10N ��' qN s �o� land surveyors / 939 Main Street ( Rte 6A) 09- > 76 0 10 20 30 40 50 FEET 66 � DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 09-176.DWG(SBO) -