HomeMy WebLinkAbout0019 EAST BAY ROAD - Health 19 East•-Bay Road, Osterville
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. Commonwealth of Massachusetts lql-009—Doc;,
�- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments tr a
19 East Bay Rd t J
Property Address `.'I
t.�
Spiotta
Owner Owner's Name/ n
information is required for every Osterville ✓ Ma 9/10/19 }
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. Inspector Information
on the computer,
use only the tab Chad hathaway
key to move your Name of Inspector
cursor-do not H PS
use the return key. Company Name
P.O.Box
151
rab Company Address
Forestdale Ma 02644
City/Town , State Zip Code
774 274 2581 12866
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my ,
inspection; and the inspection was performed based on My training and experience in the proper function
and maintenance of on-site sewage disposal systems. After conducting this inspection 1 have determined
that the system:
1. ® Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
9/10/19
Ignat Date
The system inspector shall mit a c py of this inspection report to the Approving Authority(Board
of Health or DEP)within 3 days o ompleting this inspection. If the system has a design flow of
10,000 gpd or greater, the ctor 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.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18
ti
r '
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
19 East Bay Rd
Property Address
Spiotta
Owner Owner's Name
information is required for every Osterville Ma 3 9/10/19
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. '
1) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
M
Comments:
This inspection is not a guaranteeand applies no warrantyof the described septic components in this
report including but not limited to piping structual intergrity of components and life exspectancy of
leaching and described components: This inspection is to describe conditions witnessed at time of
inspection only. Regular tank maintenance and water conservation can prolong life of septic systems
Information on care and do's and don't's can be found at town health dept or mass.gov
J
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" (N, 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. r
*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): r
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
' Commonwealth of Massachusetts
Title 5 Official Inspection Form
1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
19 East Bay Rd
Property Address
Spiotta
Owner Owner's Name
information is required for every Osterville Ma 9/10/19
page. Cityrrown 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. g
❑ 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):
El 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):'
+ - 4,;
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.7/2 612 0 1 8 ' Y; + Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 ,
Commonwealth of Massachusetts
Title 5 Official Inspection Form
1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
19 East Bay Rd '
Property Address r ; 'A" '
Spiotta .. ,
Owner Owner's Name
information is
required for every Osterville Ma 9/10/19
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.) y "
0 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. I I '
❑ The system has aseptic 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:
I
4) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections: f
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,
• E -
t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18
_.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
19 East Bay Rd
Property Address
Spiotta
Owner Owner's Name
information is
required for every Osterville Ma 9/10/19
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (coat)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No °
El ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/2 day flow
❑ ® 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.7/2 612 0 1 8 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
Y 19 East Bay Rd
Property Address
Spiotta t F
Owner Owner's Name
information is required for every Osterville Ma 9/10/19
page. CitylTown 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
s
❑ ® Were any of the system componentspumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined?(If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
❑ ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
t i
P
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
19 East Bay Rd
Property Address
Spiotta
Owner Owner's Name r
information is required for every Osterville Ma 9/10/19
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms (actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
Description:
3) 500 gal H2O Chambers 35x13x2
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
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage(gpd)):
Detail:
public ,
Sump pump? ❑ Yes ® No
'Last date of occupancy: current
t
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
Commonwealth of Massachusetts
1= Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
a 19 East Bay Rd
Property Address
Spiotta
Owner Owner's Name
information is Osterville Ma 9/10/19
required for every '
page. Cityrrown State ,Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
Type of Establishment:
.F .
Design flow(based on 310 CMR 15.203): canons 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
. t
Non-sanitary waste discharged to the Title5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: bate
Other(describe below):
3. Pumping Records:
Source of information: unknown
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
j•
Commonwealth of Massachusetts a:
0
Title 5 Official Inspection Form '.
1' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments'-., `
19 East Bay Rd y,
Property Address
Spiotta 6
Owner Owner's Name _
information is required for every Osterville Ma ' 4 9/10/19 '_ '*
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
lip-
t :
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 1/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP.approval. :<<;
❑ Other(describe): rf'
Approximate age of all components, date installed (if known)and source of information:
2001
Were sewage odors,detected when arriving at.the site? , ': •J❑ 'Yes ❑ No
5. Building Sewer(locate on site plan)'; ,
T
Depth below grade: feet "
& ,t. ,
4-
Material of construction;
❑ cast iron }®40 PVC y ❑other(explain):
Distance from private water supply well or suction line-- u;Y 1 feee
t`
Comments (on condition of joints, venting, evidence of leakage, etc:):
no signs of leaks or poor venting,70
• ;�. ='
t5insp.doc•rev.7/26/2018 ' f�'`' ! r , Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form r..
Subsurface Sewage Disposal System Form.- Not for Voluntary Assessments
19 East Bay Rd a
Property Address
Spiotta
Owner Owner's Name
information is required for every Osterville Ma " 9/10/49
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
25
Depth below grade:" feet"
Material of construction:
® concrete ❑ metal' El fiberglass El polyethylene V ❑ other(explain)
h20 1500 gal. steel covers at grade on both covers
If tank is metal, list age: e - yearn
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ •No.
Dimensions:
• ' � '106 x56' •
3"
Sludge depth: s `. r
31"
Distance from top of sludge to bottom of outlet tee or baffle ,
"
' Scum thickness Y less then 1
- � - - .
Distance from top of scum to top of outlet tee or baffle J
k 18„ ,
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined? tape and stick
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
teen in place tank in good condition ,
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
1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
19 East Bay Rd
Property Address
Spiotta
Owner Owner's Name
information is required for every Osteryille Ma 9/10/19.
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
19 East Bay Rd
Property Address
Spiotta
Owner Owner's Name
information is required for every Osterville Ma 9/10/19`
page. Cityrrown State Zip Code, Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached? , ❑ Yes ❑ No
9. Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 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.):
H2O Dbox solid in good cond. no carry overs no decay visable
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 ,
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
19 East Bay Rd
Property Address
Spiotta
Owner Owner's Name
information is required for every Osterville Ma 9/10/19
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-, El Yes ❑ No*
s
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:
❑ leaching pits number:
® leaching chambers number: 3
❑ leaching galleries number:.
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
1 Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
19 East Bay Rd
Property Address
Spiotta
Owner Owner's Name
information is required for every Osterville Ma 9/10/19
page. Cityrrown 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.):
3) 500 gal L.0 located under paved driveway. end chamber cover is undeer driveway but end of
chambe past pavement post hole dug down to stone. probed stone clean and dry
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 n
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments `
19 East Bay Rd '
Property Address ,
Spiotta
Owner Owner's Name
information is Osterville Ma 9/10/19
required for every -
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
i
13. Privy(locate on site plan): , .
Materials of construction:
Dimensions t.
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
r `41
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
19 East Bay Rd
Property Address
Spiotta
Owner Owner's Name '
information is required for every Osterville Ma 9/10/19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System: g
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 x
• s .., �,.. V V V i a v I• A
Y t_ A.�
{
_ t '
t5insp.doc•rev.7/26/2018 ,_r Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 - `
C Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
19 East Bay Rd
Property Address
Spiotta .
Owner Owner's Name
information is required for every Osterville Ma 9/10/19
page. Cityrrown 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: 10' in low area of septic
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:
town GIS mapping {
You must describe how you established the high ground water elevation:
low wetland area across street is el. 4' area of septic el. 14'-16' bottom of leaching is 4'6"deep
leaving 4'of seperation to ground water
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
cam, Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
19 East Bay Rd
Property Address
Spiotta
Owner Owner's Name
information is Osterville Ma W10119
required for every `
page. CitylTown State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
® A. Inspector Information: Complete all fields in this section. y
® B. Certification: Signed & Dated and 1, 2, 3, or checked
® C. inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria)and 6 (Checklist)completed
® D. System Information:
For 8:Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t
a .
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System"Page 18 of 18
TOWN OF BARNSTABLE g7C-
LQCATION /% 14�R 5 �i� KC41 SEWAGE O�00 7 X-//
VILLAGE �s /Irv.Ile f ASSESSOR'S MAP & LOT I' -Oval-00';
INSTALLER'S NAME&PHONE NO. 7 S�-" ?7 4
I SEPTIC TANK CAPACITY ®ti
LEACHING FACILITY: (type) 3 - (size)NO.OF BEDROOMS
BUILDER OR OWNER ,5 v,jd �A
PERMIT DATE: l`Z-" I l"G 1 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist.
on site or within 200•feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by,
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b
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60. ® F4 5 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Ye
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ZippYication for 33igpooal Opotem eon!gtruction Permit
Application for a Permit to Construct( . )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
19sso s`R.. PBce�y R , Oster ille41 Q�? Ca_, Joseph & Colleen Spiotta .
Installer's Name,Address,add Tel.No. Designer's Name,Address and Tel.No.
Wm. E. Robinson Septic Service Glen Harrington
P O Box 1089 Centervilkle
Type of Building:
Dwelling No.of Bedrooms—4 Lot Size 1:7 sq.ft. Garbage Grinder( )
Other Type of Building e s; e e t; _, No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 440 gallons per day. Calculated daily flow 440 gallons.
Plan Date 1 1 —1 8—01 Number of sheets 1 Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) replace failed l e a e h i n g with
�H 20 500ga1 chambers with 4 ' of stone all amunrl
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 En ironmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been' sue y this d Health
Signe e 1 Date
Application Approved by Date
Application Disapproved for the following reasons
Permit No. Date Issued
Diu: V ✓ a t` ..- -M P Fee$5 0
a �,s, THE COMMONWEALTH OF MASSACHUSETTS F � y Entered in computer: Ye f�
PUBLIC,HEALTH DIVISION - TOWN OF BARNSTABLE,. MASSACHUSETTS
y t ;..
2ppltcation for &.5pooal *pgtein Construction Permit
Application for a Permit to Construct( . )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
19 East B$y R . , Osterville Q Joseph & Colleen Spiotta
Assessor's ap/F
Installer's Name,Address,add Tel.No. Designer's Name,Address and Tel.No.
Wm. E. Robinson Septic Service Glen Harrington
P O Box 1089 Centervilkle
i
Type of Building:
Dwelling No.of Bedrooms Lot Size 1 ,3 0 sq.ft. Garbage Grinder( )
Other Type of Buildin 4 No.of Persons Showers( ) Cafeteria( )
Other Fixtures hr
Design Flow 440 gallons per day. Calculated daily flow e A n gallons. '.
Plan Date 1 1—1 8—01 Number of sheets 1 Revision Date
Title
Size of Septic Tank' Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)� rain1 ace f ai 1 6d leaching wi th 33')R H 20 500ga1 chambers with 4 ' of stone all around
_ 13' X 25" X 2'
Date last inspected:
Agreement: f
The undersigned agrees to ensure the construction and maintenance of the afore described - " sewage disposal system
in-accordance with the provisions of Title 5 of the En iromhental Code and not to place., e stem in operation until a Certifi-
cate of Compliance has been ' sue y this d Health'
Signe 1 �'' Date j�rf
Application Approved by Date Zr =/I/
Application Disapproved for the following reasons 61
Permit No. r Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
l
BARNSTABLE, MASSACHUSETTS
Spiotta r.
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(X )Upgraded( )
Abandoned( )by Wm. E. Robisnn Septic Service 0
at 19 East Bay Rd. , Osterville has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit N . ' "" '" dated i 2. 11 h l
Installer Wm. E. Robinson Sr. _ Designer
The issuance of thi permit shall not be construed as a guarantee that the system will unction jde 'ggned.
Date 7Q Inspector 5
1 �
1
— ff
— —————— ————— —— ———————————
No. ` Fee $50
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Spiotta tspOsaY *pstem Congtruction Permit
Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( )
System located at 19 East Bay Rd. , Osterville
1 ,
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Cos uc on st b completed within three years of the date of t s J
Date: Approved by
r%jxklYl 11 •TViu L Trauv�aa v►� va► .a
Page 1 of 3
No.
Date:
Commonwealth of Massachusetts
f?C,.o )i-e-W e- , Massachusetts
Soil Suitability Assessment,for On-site Sewage Disposal
✓-
S
Performed By �r/�zC/
t. t-� ry .v, ate:
...
Witnessed By: ....... .
Lamian Address or �, �, g ��yes 1 °, `►� . S ;act
Address,and
ew Construction ❑ Repair
Office Review
Published Soil Survey Available: No ❑ Yes ❑
Year Published .................. Publication Scale Soil Map Unit .. .
Drainage Class - Soil Limitations .........
Surficial Geologic Report Available: No ❑ Yes ❑
Year Published Publication Scale -
Geologic Material (Map Unit) ............................................................................................... .
.
Landform ................................................_...................
Flood Insurance Rate Map:
Above 500 year flood boundary No ❑Yes ❑
Within 500 year flood boundary No ❑Yes ❑
Within 100 year flood boundary No El Yes ❑
Wetland Area:
National Wetland Inventory Map(map unit) ............I....
Wetlands Conservancy Program Map(map unit
....................................................................
C Current Water Resource Conditions (USGS): Month
O
Range :Above Normal ❑Normal ❑Belc�.v Normal
Other References Reviewed:
DEP APPROVED FORM-12/07/95
Page 2 of 3
> Q
Location Address or Lot No. Y
On-site Review
�_ Date•,...1�//Z / %C�=071.,�y!
Deep Hole Number ,._ Time: Weather
Location (identify on site`plan) :. ._.,. ....... ,.�.. ..... ..:.: ....
Land Use :..- �d+ .... ... Slope t°rb) S-7`i�a Surface Stones 'n.....
Vegetation
Landform ... Dluv�
Position on landscape (sketch on the back) . ... .
Distances from:
Open Water Body IS feet Drainage way Z&0 feet
Possible Wet Area . /-570. feet Property Line .. feet
Drinking Water Well -A-1/A. feet Other
DEEP OBSERVATION HOLE LOG*
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface Ilnches) (USDA) (Munsell) Mottling (Structure.Stones,Boulders, Consistency, %
Gravel)
:L
�� t� Yxs/ do
,2 6 ` r a 0 L j S �Yr��Y4, trn C
MINIMUM UP RED AT EVERY PKUIrUbtU WWUbAL AKtA
Parent Material(geologic) DepthtoBedrock: .>/ Z 0
Death to Groundwater: Standing Water in the Hole: , YX Weeping from Pit Face: ✓Vf
Estimated Seasonal High Ground Water:
DEP APPROVED FORM-12/07/95
Page 3 of 3
Location Address or Lot No.
Determination fo�onal high Water Table
Method Used:
❑ Depth observed standing
gin observation hole................... inches
❑ Depth weeping from side of observation hole................. inches
Depth to soil mottles .:.: inches
Ground water adjustment ................... feet
Index Well Number .................. Reading Date .................. Index well level ... ..
Adjustment factor .................. Adjusted ground water level .....................................................
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas
observed throughout the area proposed for the soil absorption system?
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on (date) I have passed the soil evaluator examination
approved by the Department of Environmental Protection and that the above analysis
was performed by me consistent with the required training, expertise and experience
described in 310 CMR 15.017.
Signature_ Date
4`
DF;P APPROVED FOW%l-12/07/95
,s •a ar a aJa%�VLA l iVl•
Location Address or Lot No. / 49,
COMMONWEALTH
O WEALTH OF
ASSA M
_ CHUSETTS
Massachusetts
Percolation Test*
Dater Z. / D 5
Time: / .,. 1...:._.....
Observation Hole #
Depth of Perch
Start Pre-soak
End Pre-soak
/D ` Zr � ,
Time at 12"
Time at 9"
Time at 6"
'Time (9"-6")
Rate Min./Inch
" Minimum of 1 percolation test must be performed in both the primary area AND
resei ve area.
Site Passed Site Failed ❑'
Performed By:
Witnessed By:
Comments (J ,b 6_ t� S'au &.. Wf
DEP APPROVED FORM-12/07/95
TOWN OF BARNSTABLE 67 C_
LOCATION '4! XT SEWAGE #�0 /a 7 A/1
VILLAGE S ��<v.ljQ ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
� -7 F 7 7 �
SEPTIC TANK CAPACITY :�`�
LEACHING FACILITY: (type) ' ` '�0 L 5J& (size) �'-
NO. OF BEDROOMS
BUILDER OR OWNER
�A
PERMITDATE: 22-- )9-6 ` COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility). Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
N"n
1
Z 3
� b
Commonwealth of Massachusetts
Executive Office of Environmental Affairs ✓ /QFCf%�
fQ
Department of q N 8
Environmental Protectio 1%, 19g,
William F.Weld ® ��ly�pTlAB�F Trud e
Governor
Argeo Paul Celluccl Do uhs
u.oowrnor �e
9
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A -
CERTIFICATION
Property Address: 19 East Bay Rd, Osterville Address of Owner. Ed Spiotta
Date of Inspection: 1 2—31 —9 6 (If different)
Name of Inspector. W.E. Robinson SR
Company Name,Address and Telephone Number. ( 5 0 8 ) 7 7 5—8 7 7 6
W.E. Robinson Septic Service
P.O. Box 1089 Centerville MA
CERTIFICATION STATEMENT
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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sew disposal systems. The system:
-g
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature: &t) t Date:
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, , C,or D:
A) SYS PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
Bl SSYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes
inspection.
.w
Indicate ,no,or not determined(Y,N,lor ND). Describe basis of determination in all instances. If"not determined",explain why not)
The septic tank is metal,cracked, structurally unsound, shows substantial infiltration or ex5ltration,.or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved
by the Board of Health.
(revised 3/95) 1
One Winter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292.5500
i Printed on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(oontinued)
Property Address: 19 East Bay Rd, Osterville
Owner. Ed. Spiotta
Date of Inspection: 1 2-31 -9 6
B]SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four tunes 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
obstruction is removed
C] THER 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 the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A
MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
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.
2 SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)
DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system and'is within 100 feet to a surface water supply or tributary to a
surface water supply.
The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and.is less than 100 feet but 50 feet or more from a private water
supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.
3) THER
(revised 11/03/95) 2
r -
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 19 East Bay Rd, Osterville
Owner. Ed Spiotta
Date of Inspection: 1 2—31 —9 6
D) SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for
determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged 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 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I 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. If the well has been analyzed to be acceptable,attach copy of.well water analysis for
coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
El LARGE SYSTEM FAILS:
e following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
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 U of a public
water supply well)
The owner o operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.,
(revised 11/03/95) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Addrom 19 East Bay Rd, Ostervill&-
Owner. Ed Spiotta
Date of Inspection: 1 2-31 -9 6
Check if the following have been done:
-umping information was requested of the owner,occupant,and Board of Health.
(None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
dying that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
_As built plans have been obtained and examined. Note if they are not available with N/A.
facility or dwelling was inspected for signs of sewage back-up. ,
-L✓iae system does not receive non-sanitary or industrial waste flow
'he site was inspected for signs of breakout.
_All system components,excluding the Soil Absorption System, have been located on the site.
1,Vhe septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffies or
' tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.
Lelfhe size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods. '
facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 11/03/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 19 East Bay Rd, O s t e r v i l l e
Owner. Ed Spiotta
Date of Inspection: 12-31 -9 6
FLOW CONDITIONS
RESIDENTIAL:
Design flow:< <�L7�allona
Number of bedrooms: /
Number of current residents
Garbage grinder(yes or no): -
Laundry connected to system: or no):Y�Z3
Seasonal use(yes or no):_
Water meter readings,if available: 1994 116 , 000 ca 1 q
1995 1 1 $., 000g ' G 1996 — 1 20 000 gal G
Last date of occupancy: /2—3/—41
COMMERCIAL/INDUSTRIAL:
Type of establishment:
Design flow:_,gallons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or no)_
Non-sanitary waste discharged to the Title 6 system: (yes or no)_
Water meter readings,if available:
Last date of occupancy:
OTHER(Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS d source of information:
System ppluped as part of inspection: (yes or no)_
If yes,volume pumped: gallons
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)
Other(explain)
APP XIMATE AGE of all co ponents,date'installed(if known)and source of information: S
8 7 p V7 4
Sewage odors detected when arriving at the site: (yes or no)
(revised 11/03/95) S
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 19 East Bay Rd, Osterville
Owner. Ed Spiotta
Date of Inspection: 1 2-31 -9 6
SEPTIC TANK_
(locate on site plan)
Depth below grade: ;L,,
Material of construction: _metal_FRP_other(explain)
Dimensions:
Sludge depth: 40 '
Distance from top of sludge to bottom of outlet tee or baffle:, 0
Scum thickness: A '
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle: eS e
Comments:
(recommendation for pumping,condition.of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.) ,S"a cJ T� ,L c0 S, (!!, s,g,
L. oe,
G!AF SE TRAP:_
(loca on site plan)
Depth low grade:
Material of construction:_concrete_metal_FRP—other(explain)
Dime
scum
from top of scum to top of outlet tee or baffle:
Distal from bottom of scum to bottom of outlet tee or baffle:
Cc nts:
(reco endation for pumping,condition of inlet aad outlet tees or baffles,depth of liquid level in relation to outlet invert,otructural integrity,
eviden of leakage,etc.)
(revised 11/03/95) g
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 19 East Bay Rd, Osterville
Owner. Ed Spiotta
Date of Inspection: 1 2—31 —9 6
TIG OR HOLDING TANK:_
(locate site plan)
Depth be grade:
Material construction:_concrete_metal FRP_other(explain)
Dime
Capaci gallons
Design ow: gallons/day
Alarm 1 1:
Common
(oonditio of inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if leveYand distribution is equal, evidence of solids carryover,evidence of leakage into or out of box,etc.) 6 K/
PUMP HAMBER:
(locate o site plan)
Pumps in rking order:(yes or no)
Comments
(note co n of pump chamber,condition of pumps and appurtenances,etc.)
(revised 11/03/95) 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(oontinued)
Property Address: 19 East Bay Rd, Osterville
Owner. Ed Spiotta
Date of Inspection: 1 2—31 —9 6
SOIL ABSORPTION SYSTEM (SAS):
(locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods)
If not determined to be present,explain:
Type:
leaching pits,number:_
leaching chambers,number: 4'1
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number, dimensions:
overflow cesspool,number:
Comments:(note condition of soil,signs of hydraulic failure, level of 4,1
� G � `Ydr�`�� ponding,condition of vege�atiYoa,etcJ
G M L/1 S � T U 1 V�r Ka'N-1 A
D.
C POOLS:_
(loca on site plan)
Numbs and configuration:
Depth. p of liquid to inlet invert:
Depth o solids layer.
Depth of layer:
Dimensio of cesspool:
Materials of construction:
IndicatiA of groundwater:
inflow(cesspool must be pumped as part of inspection)
Co ta: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
PRIVY:
(locate site plan)
Mate ' of construction: Dimensions:
De of solids
Co ate: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
(revised 11/03/95) g
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 19 East Bay Rd, O s t e r v i l l e
Owner. Ed Spiotta
Date of Inspection: 1 2—31 —9 6
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all v ells within 100'
le.on, l
A
?4l
� L ,
f
DEPTH TO GROUNDWATER
Depth to groundwater: /O � feet
method of determination or approximation: b b
(revised 11/03/95) 9
TOWN OF BARNSTABLE
'Ile LOCATION v SEWAGE #
VILLAGE ASSESSOR'S MAP LOT
t INSTALLER'S NAME PHONE NO.)I�e-)
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type)
C!57 (size)
ONO. OF BEDROOMS PRIVATEWELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:.
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No t,.,/
AA
�
-4
TOWN OF BARNSTABLE
9
LOFATION V' SEWAGE
VILLAGE ell l ASSESSOR'S MAP & LOT /`7'l^ CG
t INSTALLER'S NAME & PHONE NO. -
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
dNO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER [ �j,�/ f jic Jam.
�
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED• 7-1C), S -)
. .ti
VARIANCE GRANTED: Yes No .�
b-�
7r
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4 SEWAGE
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SITE an
PLAN
-
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•
, FELCO PREPARED FOR:
No -
CONSTRUCTION ENGINEERING
,. A DIVISION OF FELCO, INC. " 1J_
'F80N!W�p, 5U�—D— This plan is for Sewage Design only and is not Intended , P.O. BOX 1366 scA� ti �O -61957(EXISTING)----•-•••... to be a survey plot plan. Verify zoning and Utility Set- ORLEANS MA 02653 4' D—
CONTOURS(PROPOSED)—o—o=o—o— back dimensions prior to construction. (gib 255.8141 ��J7
FT7
, »
w SHEET 1 of 2 '
SECTION - SEWAGE x TEST HOLE LOG
pO — SEPTIC TANK— — "D" BOX— —LEACH CIA" 9S4t TEST BY R,FA1715Mi- d. Ul)IJ�ll�1`1(� �64dv4
�0O ` TOP OF FDN TEST DATE Jc II Z WITNESS
........(MSy t _
r T.H. #1. T.H. #2
E - ELEV._
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y D. -fl?e 5U8 • l QO 1oV 4 S�1(3 �S8 €.
M
r L CAZAV
�.lr-117 NASNsp omE -
G1, �
SAAIV
IN G OUT IN OUT ---11�- M r
M ® �._. . � , ::;;. GLEAN ! l7
IG.So SEPTIC :. r
TANK � �
WS
ELEV. ELEV. ELEV. ` 1 IZ o O
E/EV� ELEV. tclG�/ �teU — N p 7i5
w y, 4,4 >rNco�nlSIE4� �Z
vJA�I#EQ 5T0 �op
DESIGN BEDROOM HOUSE
- TEST RESULTS
t '. ff %_Z with requirements of the state sanitary code(title V)&is
1. Lot meets
NO considered "BUILDABLE". ,
DISPOSER DISPOSER x
PERC RATE G2 MIN/IN. 2. Percolation Rate Is LZMIIJ�I>`1 In
7 art. E�1ZT(1Y�D 3. VAS _Water encountered
FLOW RATE (GAL./DAY) 4-
SEPTICTANK �
REO'D SEPTIC TANK SIZE
NOTES: (UNLESS OTHERWISE NOTED)
LEACH FACILITY
SIDE WALL CL4�0� ( 2.� ) = 235.7.E GrD. �,� 1 2.MUNICIPAL WATER 905T1AW i IiFQ,. 1.DATUM(MSy t TAKEN F�19MI�7�PJL-� QUADRANGLE MAP
77 AVAILABLE
BOTTOM 4 ealb•OO ( (� ) _ •OOG/D. 3.PIPE PITCH: 1/4"PER FOOT
TOTAL = �7/,S 20 fj�� �MAP - 1-5W- V��i 4.DESIGN LOADING FOR ALL PRE-CAST UNITS:AASHO- 44 -
G a
=t 5.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:(1)FT.
{� 8.PIPE JOINTS SHALL BE MADE WATER TIGHT
�^ 'J 1 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS.` `
/•'` A p,tn ��iIIJ��GV� Q,� STATE ENVIRONMENTAL CODE TITLE V
US y� / DJ�DI�-JfML,ZS4� EACHING (i�1R�Vl'Y 8.VERIFY SOIL CONDITIONS TO INSURE PROPER INSTALLATION.
7� )� + NOTIFY FELCO IF CONDITIONS DIFFER.
,
ALL '*-WAGS COMF+ooejTs, 1250L)Q N2o wAPI►6 1" DRIV AV A
t�AZt( Ash -- 8E 24 �6) x zo' W►0 6 K .4(a" P to. I�t15T�f2L rc r�rF�ua F.�vD .¢c.� vni1 nos ,c�'tii v Feuer_
- - -- - � •� �w. ��! ANC-•s'C'f' ��. ���# ,,, . : •. ,
O+ N � Xx-•wt 4 '`$- ?'c.. ".fry' z�,f6n ..,. - _• ., .:. -
GI S1
�
�FESSI014 t A,
FELCO
CONSTRUCTION ENGINEERING
P.O. BOX 1366
BOARD OF tLF-ALTH
APPROVED DATE T'J�Q.1�rf•P�PiL.l MA _uG.aS . •_�_�_o_t� ORLEANS, MA02653`
,a� 61 255.8141
REG.PROFESSIONAL ENGINEER I
SHEET 2 OF 2
1-20"DIAM,ACCESS MANHOLE \J
hI SITE PLAN 5f
Design Calculations
SCALE; 1 "=20'
.I +• o a
BENCH MARKON CONCRETE BOUND !;' Number of Bedrooms: 4 0'
Main
ELEV.= 17.50' NGVD `j -1, Garbage Grinder: No C}
® ® EM 24„ 34" Leaching Capacity Requirec: 440 GalODay
j ® ® Leaching Area Required: 440 Gal./(0.74 Gal./Sq.Ft.)=595 Sq.Ft
Proposed Leaching Structure: 1-33.51 X 13'W X 2.0'D Leaching Trench Y JI ��
STEEL REINFORCED PRECAST CONCRETE 3 H-2 0 500 gal. chambers '•- �
PLAN VIEW Leaching Area Provided: 621,5 Sq.Ft,END-SECTION Proposed Leaching Capacity: 460 gpd > 440 gpd. req'd. LOCUS
H-20 1500 GALLON CHAMBER 4' S 4, NO CCALE
NOT TO SCALE
'
USE ACME PRECAST OR EQUAL 2" OF 1/8" TO 1/4"
PEASTONE (WASHED)
rM
T,H, #1F
14:90r 1 LOT 9 - 1
11,27' 10,95'
° 6 9 � 3 H-20 500 gal. chambers
3/4" TO 1 1/2" WASHED CRUSHED STONE
LOT 9 - 2 GENERAL NOTES
O AREA = �,300± SQ.� T. �Q� O� TRENCH CROSS-SECTION 1, ADDRESS: 19 East Bay Road
NO SCALE 2. ASSESSORS NUMBER: Map 141 parcel 9-2
70 T.H. #2F
\ T 0 15,HO' ��\ O� 4. DEVELOPER'S
INFORMATION 2 ATIONWAS COMPLIED FORM AN
/O (90. 0 s ON THE GROUND INSTRUMENT SURVEY.
7 �Q 13,98 0 5. MUNICIPAL WATER IS PROVIDED TO SITE AND
0- SURROUNDING PROPERTIES.
N0 Q� do 6. REFERENCE PLAN: PLAN BOOK 236 PAGE 107
�/� C e S S o L S Ln x B V W REFERENCE PLAN: "Site and Sewage Plan, Lot 9-2, East Bay Road
coO" O 79 18 �J 8' X BO� , f o r o 13-1 � � O/ Osterville, MA", prepared for John Hauck, Brewster, MA,
O //�� prepared by Felco. Inc„ Orleans, MA, scale 1"=20', dated 6/3/1987.
c S/ab / 0 0 g � � 8. NO POTABLE S ARE LOCATED WELLS ARE LOCATED WITHIN 100 F0 FEET OF SAS.
EET OF SAS.
Rq0 F�.,00 � G o
o / c�-- O
1 1® i7"i1#1 ele Oo tterl2 6 11,39' Cli BUW CONSTRUCTION NOTES
0 1 21' ,O (D \ / 1. Contractor is responsible for Digsafe Notification
1 1g O �L and protection of all underground utilities and pipes.O
G 2. The septic tank and distribution box shall be set
-• 3/4"-1
7 - - , existing _�___O 3. son a w o
2 Backfll should be clean
•- O \ I � level on 6" of 1/2" stone
` '..... SAS
O � I •I ul d or gr v� with n
un er roun utilitie .
stones over 3" in size
O g 4. n during installation
2 '-�--._-•_ This system is subject to inspection du 'ng
-1 5-9. --
--_ by Glen E. Harrington, R.S.
----- - -�7,63 5. The contractor shall Install this system in accordance
- 3 3° cJ9 � X 39� X 2 q 17, -- Code
- O with Title V of the Massachusetts Environmental
. 0D un0 G - - --G -- - --- BVW and the Regulations of the Town of Barnstable,
leaching trench using round ut, tie_ 6. Provide a Acme Precast H-20 D-Box and 500 gal. chambers
x 11,76' 0 or equal.
3 I - 2 O 500 gal • chambers with 7. No vehicle or heavy machinery shall drive over the
4' septic system unless noted as H-20 septic components.
of stone on sides & ends. 8. Install gas baffle or equal on septic tank outlet tee end.
OO 9. Existing SAS, D-Box and leachate contaminated soil to be removed
7 and disposed of properly off site.
P E R C TEST & SOIL EVALUATION / 6 9 G 10. All existing inverts and site conditions shall be verified by contractor.
Date of Perc. Test & Soil Evol.: November 12, 2001 O O / 11. Contractor to remove soils considered to be unsuitable or impervious
Test Performed By: GLEN E. HARRINGTON, R.S., CSE and replaced with soil according to 310 CMR 25,255, as necessary.
Witnessed b Donna Z. Miorandi, R.S. 12, Utilities shown were located and marked b DIGSAFE and C-O-MM
Excavator: Wm Robinson, Sr. PERK TEST @ T.H. ##1 0
Y
Test Hole Test Hole Test Hole PERK DEPTH=30"-48" GB 12.42, Water Department.
No. 1 No. 1F(P6464) No, 2F(P6464) BEG. SOAK @ 10:20 AM Inc!
END SOAK @ 10:26 AM 1 7,1 1
DEPTH SOILS ELEV. DEPTH SOILS ELEV. DEPTH SOILS ELEV.
Unable to pre-soak with 24 gals. of water
USE PERK RATE <2 MPI FOR DESIGN PURPOSES
0 17.11' 0 14.9' 0 15.8' O
aamAsand top & sub top all 0
sub Water Table Adjustment @ TH-2F
11" torR3/2 16.19' 24" 12.9' 24" 13.8 Map: TSW-89
Byw clean
Zone: Zone B
26' ov R5 8 14,94' 60" med. sand 9 0• Adjustment: 0.3'
clean clean v 1
C 1 fine med, sand
sand
sand ADJ. H2o 7.6'
t02" H20 6.4' ---------------------
10YR6/6 - -------- ------
102" Hzo 7.3•
120" 7,11' 1 1 0" 1 4.9' 120' 1 1 5.8'
NO Gw ENCOUNTERED Date of Test Holes 1F & 2F.: May 11, 1987
Test Performed By: R. Fairbank ���t14FMgS,S, PROPOSED SEPTIC SYSTEM UPGRADE
Witnessed by: Jerry DunningPREPARED FOR
1 JOSEPH & COLLEEN SPIOTTA
A R AT
LEGEND
o'1070 19 EAST BAY ROAD
o
*NOTE: ALL PIPES ARE TO BE 4" DIA• SCHEDULE 40 P.V.C. OSTERVILLE, MA
*NOTE: INSTALL GAS BAFFLE OR EQUAL ON SEPTIC TANK OUTLET TEE. O o O EXISTING 1500 ^/(7 AR`
10' min. from H-10 SEPTIC TAANKNK
house to septic tank Finished grade over system=2% slope away
Existing 24" gig. 5 HOLE X 104.46 DENOTES EXISTING PREPARED BY:.
Existing House cast Iron covers at grade PREPA
Gar, slab Elev.=19.09' DIST, BOX SPOT GRADE R
\\ EXISTI ADE Existing Grade Etev.=16.1 \\\
, . . GLEN E HARRlNGTON
CRAWL V 95. ---- EXISTING CONTOUR
s = aa2' 12" min 9 LEDA ROSE LANE
Min. 2-1/8'-1/2" 36" max.
SPACE EXISTING 5.at Level for 2' S-01 washed stone Too Pea;;tone Elev.=75.11' O DEEP TEST HOLE
1500 GAL, MARSTONS MILLS, MA 02648
SEPTIC TANK N n 18' Invert Elev.=14.61'
v H-10
INSTALL " o ® c o 0 0 24"MIN. PERCOLATION TEST
.- - � _ Bottom of Leach TEL: 508-428--3862
GAS BAFFLE n u u co Trench Elev.= 12.61'
OR EQUAL 33.s Approx. location FAX: 508-428-3862
v LEACH TRENCH 5.0
6" OF 3/4"-11/2" STONE > = a II V existing water service
yAdr. GW @TH # 2F Elev.=7.6' MSL SCALE: 1 =20 DRAWN BY: GEH NOV. 18, 2001
SYSTEM PROFILE c
6" OF 3/4"-11/2" STONE
Not to Scale c � -
FILE: SPIOTTA.DWG SHEET 1 OF 1