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Home My WebLink About0289 EAST BAY ROAD - Health (2) E289 East Bay Road , C r 163-017 Osterville;I Town of Barnstable Inspectional Services Department B"" MAS&` ' Public Health Division i0rfp A 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4988 0466 November 10, 2020 WALSH, LAURA F TR 289 EASY BAY ROAD OSTERVILLE, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 289 East Bay Road, Osterville, MA was inspected on 10/13/2020 by Nicholas Geneseo, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. ER OF THE BOA OF HEALTH 4 Th as Mc ean, R.S., Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\289 East Bay Road Osterville.doc Town of Barnstable EBLA M s ,A i639• ,�� Inspectional Services Department rfo Ma's" Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A. McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An "x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS O 1 YEAR DEADLINE CRITERIA tatic liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc TOWN OF BARNSTABLE LOCATION �� C G• SEWAGE # VILLAGE OrrervAL ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 16VO LEACHING FACILITY: (type) 444-� 6"a (size) NO. OF BEDROOMS---. BUILDER OR OWNER PERMTTDATE: 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 /1 SDc �n 17- oe(l A Fro�-r a3 ao 3 '3 3 a l3rive-w1-0 `1 3 � ' i r Commonwealth of Massachusetts �Q3 . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 289 East Bay Road Property Address . Owner Laura Walsh information is Owner's Name , required for every page. Osterville MA 02655 October 13,2020 City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. A. Inspector Information 1. Inspector: Nicholas Geneseo Name of Inspector Wind River Environmental Company Name 46 Lizotte Drive Suite 1000 Company Address Marlborough MA 01752 City/Town State Zip Code (973)830 6126 SI 13988 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection;and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: ❑ Passes ❑ Conditionally Passes ❑ Needs Further Evaluation by the Local Approving Authority Q Fails October 13, 2020 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original 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. t5ins.doc 9 rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ° 289 East Bay Road Property Address Owner Laura Walsh information is required for every Owner's Name page. Osterville MA 02655 October 13, 2020 City/Town State Zip Code Date of Inspection C. Inspection summary Inspection Summary: Complete 1,2,3,or 5 and all of 4 and 6. 1)System Passes: ❑ I have not found any information which indicates that any of the failure criteria described t in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 2)System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair, as approved by the Board of Health,will pass Check the box for"yes', "no"or"not determined"(Y, N, ND)for the following statements. If"not determined,"please explain. The septic,tank is metal and over 20 years old"or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration'or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. " A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. Y N ❑ ND(Explain below) t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 19 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 289 East Bay Road Property Address Owner Laura Walsh information is required for every Owner's Name page. Osterville MA 02655 October 13, 2020 City/Town State Zip Code Date of Inspection C. Inspection summary (cont.) 2)System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational.System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3)Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a.System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: r Tide 5 Official Inspection Form:Subsurface Sewage Disposal System 9 Page 3 of 19 I Commonwealth of Massachusetts 8 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 289 East Bay Road Property Address Owner Laura Walsh information is required for every Owner's Name page. Osterville MA 02655 October 13, 2020 City/Town State Zip Code Date of Inspection C. Inspection summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b.System will fail unless the Board of Health(and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4)System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No [J1 ❑ 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 t5ins.doc 9 rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 19 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments " 289 East Bay Road Property Address Owner Laura Walsh information is required for every Owner's Name page. Osterville MA 02655 October 13, 2020 City/Town State Zip Code Date of Inspection C. Inspection summary (cont.) 4) System Failure Criteria Applicable to All Systems:(cont.) Yes No Q ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Q Liquid depth in cesspool is less than 6"below invert or available volume is less than'/a day flow ❑ [Jf Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped:_ ❑ Q Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ Q Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ Q Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ 0 Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Q 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.] ❑ [J1 The system is a cesspool serving a facility with a design flow of 2000gpd-10,000gpd. Q ❑ 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 11 of a public water supply well t5ins.doc rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 19 Commonwealth of Massachusetts Title 5 'Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments " 289 East Bay Road Property Address Owner Laura Walsh information is required for every Owner's Name page. Osterville MA 02655 October 13, 2020 City/Town State Zip Code Date of Inspection C. Inspection summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"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 aH inspections: Yes No Q ❑ Pumping information was provided by the owner,occupant,or Board of Health ❑ Q Were any of the system components pumped out in the previous two weeks? Q ❑ Has the system received normal flows in the previous two week period? ❑ Q Have large volumes of water been introduced to the system recently or as part of this inspection? Q ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ Q Was the facility or dwelling inspected for signs of sewage back up? Q ❑ Was the site inspected for signs of break out? Q ❑ Were all system components,excluding the SAS,located on site? Q ❑ 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? Q ❑ 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: Q ❑ Existing information. For example,a plan at the Board of Health. Q ❑ 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)] t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System 9 Page 6 of 19 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface s dace Sewage Disposal System Form Not for Voluntary Assessments I 289 East Bay Road Property Address Owner Laura Walsh information is required for every Owner's Name page. Osterville MA 02655 October 13, 2020 City/Town State Zip Code Date of Inspection D. System Information 1. 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 GPD Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes Q No Does residence have a water treatment unit? ❑ Yes Q No If yes,discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes Q No information in this report.) Laundry system inspected? ❑ Yes Q No Seasonal use? ❑ Yes Q No Water meter readings, if available(last 2 years usage(gpd)): 24 GPD Detail: Usage: 18,142 gallons/730 days=24 GPD.Some water bills showed no gallons used. Sump pump? ❑ Yes Q No Last date of occupancy: Current Date t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System 9 Page 7 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 289 East Bay Road Property Address Owner Laura Walsh information is Owners Name required for every page. Osterville MA 02655 October 13, 2020 Cfty/Town State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes,discharges to Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): General Information 3- Pumping Records: Source of information: Wind River Environmental—see attached. Was system pumped as part of the inspection? . d Yes ❑ No If yes,volume pumped: 1000 gallons How was quantity pumped determined? Quantity measured by pump truck Reason for pumping: Check structural integrity of the tank t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System 9 Page 8 of 19 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 289 East Bay Road Property Address Owner Laura Walsh information is required for every Owner's Name page. Osterville MA 02655 October 13, 2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components,date installed(if known)and source of information: 1977 Were sewage odors detected when arriving at the site? ❑ Yes d No 5. Building Sewer(locate on site plan): Depth below grade: 1.5' Feet Material of construction: Q cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments(on condition of joints,venting,evidence of leakage,etc.): The main line was clear and there was good flow.Unable to enter the house due to COVID-19. t5ins.doc rev.7/26/201 B Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 19 Commonwealth of Massachusetts Title 5 official Inspection Form "o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 6" 289 East Bay Road Property Address Owner Laura Walsh information is required for every Owner's Name page. Osterville MA 02655 October 13, 2020 Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 8" feet Material of construction: 2 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: 8" x 5" x 5' Sludge depth: 8" Distance from top of sludge to bottom of outlet tee or baffle 27" Scum thickness 2" 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 14" How were dimensions determined? Tape Measure Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The liquid level in the tank is normal and both baffles are in place.The tank appears to be in good condition and there are no leaks present. t5ins.doc a rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' 289 East Bay Road Property Address Owner Laura Walsh information is required for every Owner's Name page. Osterville MA 02655 October 13, 2020 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 t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 19 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments " 289 East Bay Road Property Address Owner Laura Walsh information is required for every Owner's Name page. Osterville MA 02655 October 13,2020 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 1 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box,etc.): The distribution box is under the driveway and has a single outlet.A visual inspection by camera found the liquid level 1"into the outlet pipe.The box has extensive corrosion. t5ins.doc 0 rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 19 Commonwealth of Massachusetts N s Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Y 289 East Bay Road Property Address Owner Laura Walsh information is required for every Owner's Name page. Osterville MA 02655 October 13,2020 City/Town State Zip Code Date of Inspection D. System Information (conf.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order,system is a conditional pass. 11. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located,.explain why: Type: ❑ leaching pits number: z leaching chambers number: 4 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Dispcsal System 0 Page 13 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r� 289 East Bay Road Property Address Owner Laura Walsh information is required for every Owner's Name page. Osterville MA 02655 October 13, 2020 Cityfrown 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.): Opened the chambers and found the liquid level to be high and starting to run back into the box.The system is in hydraulic failure and must be replaced. 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.): t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 19 Commonwealth of Massachusetts i Title 5 Official Inspection Form ra Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4 289 East Bay Road Property Address Owner Laura Walsh information is required for every Owner's Name page. Osterville MA 02655 October 13, 2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): t5ins.doc rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposar.System Page 15 of 19 Commonwealth of Massachusetts a W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 289 East Bay Road Property Address Owner Laura Walsh information is required for every Owner's Name page. Osterville MA 02655 October 13, 2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: �✓ hand-sketch in the area below ❑ drawing attached separately 60,yt1- A (FRONT) � A � t5ins.doc rev.7/26/2018 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System Page 16 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 289 East Bay Road Property Address Owner Laura Walsh information is required for every Owner's Name page. Osterville MA 02655 October 13, 2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: Q Check Slope Q Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 6' feet Please indicate all methods used to determine the high ground water elevation: CJj Obtained from system design plans on record If checked,date of design plan reviewed: 10/28/1977 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: Groundwater information came from the soil logs on the design plan. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 17 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 289 East Bay Road Property Address Owner Laura Walsh information is Owner's Name required for every page. Osterville MA 02655 October 13, 2020 City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: d A. Inspection information: Complete all fields in this section. d B. Certification: Signed&Dated and 1,2, 3, or 4 checked Q 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 15: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 16: Explanation of estimated depth to high groundwater included t5ins.doc rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 18 of 19 Commonwealth of Massachusetts o- W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments " 289 East Bay Road Property Address Owner Laura Walsh information is required for every Owner's Name page. Osterville MA 02655 October 13,2020 Citylrown State Zip Code Date of Inspection Pumpinq Record Work orderp0217080732 Cust91281157 Customer Since:2003 Tax:6.2500 $ Job Comments Tech Comments 10/23/2020 AM TS Sospactlen Wo clodlo data) HYC 1000 Cevmrtbi A*=**. Olaas are avaLLable OMLr»tbrCugb Goon Gallop Clpmtoenr will be,Dn Oita with dgrao4 al thtor acboito.. Roeamandad rro Ractaoaodatiom. ••Plan arc in taro Race L.Pain t a100 Chock aoa11 nor plans- CC On Ma -RC account JL•- Coverts) secured. Prcparty Clear by October 9 after ILASaa, tacxat.Q 2020-010-6u2. Bacoaoaoaaci so RaceroandatiOn. eternal rater level. 1(adorate top m01142. Modarato bottom sludge..Main Its=Clear. Plates to presact and has bona C2020ad as naadad. RaCa:mandod Bacot addittva, COLS addltivo..Coverts) 4000M0. RoCama"A punping every.24 mOntba. System Owner System Location Laura Dialers Primary?Am 289 Bast Bay Road 209'Beat Bay BoW notorvlllo, Ma 02GS5 o3tortillo. NA 026SS tso8) 426-15os Halos Laura s (Son) 428-LSOS Service Date: Tao 10113/2 0 2 0 07D4s Ass Frequency: Call to Confirm: service Toe: Seaadord Previous service: 10/a6/2o20 Approx. Oats: Loos CCLS: 11/20/2013 Loc3ti0oomts: Depth Below Grade: Custom Clean: Cust Nome: HD Filter. Township. Bespection/IS: County: Bai7reieablo ._ ,.- "Build Up ton, urM,..,.: ,.,,, w ! .. :..,._ .. rt Q Unittrrice :.z ,8ctprloe osp ct3cm rLGlo 5 IDOL l0CXUdLn%punp 2.00 a'r39S.0000 395.00 rj' LnmputSm (Labor/Hrpoourn Paesjpoz sr *.Do 8t"150 0000 9 >'0.00 LaopoCeaam rltlo s BOM Pool 1 00 9 i'2s.0000;$ 7S.00 Punpinq 2000 -.,'' 0.00 8;'27S.Poo.<;8 Hovirommactal complLaaOa - HoaidOntial },�- 1 00'91.�`.3.0000 81 —3.00 - Fuel/ =Orgy Racorory .. `'�- l:oo- 79:6250 $•u^".29.6J _.. .^ - - tAft9d:0 452.43 wesugpothesel keys steps mkeepyausysteiheaWrr. To :9 0.00 'Rep/sr meMCbv •Use COS bacteria additive Tad :8 As2:6J .ilst*flow spodal Site: 0kpo6at Volume: Payment Detall: Site Code: 0.0000 3uota,raa000acm2201 09/2024 Sales Rep; l:H_Haparss rmtalla CSR: eyan Councli Duo an Bocoipt Truck: Techntdan:Mickolao cemoaca On Site:09Fsa AM 1PONurr6er. Tech Notes: system not operating PLrao. frorraal water level. Hadorato top 0021ds. Molerate bottom alvogo. Both tattLos are intact. Main 210a Clear. BLLter 10 prelS=t and. has be=c2000a0 an hao0od. Onvar(s) occur". System falls title,S. Trio task Customer not on site rod sign ore to Cewgged raltmr, in u**=tba drlvevw at a also level: OpoOed the ebanbare sod the chambers are at a hlgb level and,running bad to X the boos. System rill sot pans title 5 . No pnaplogg at tuts tiao. Tb=k you MG. Bee011120,44011 Mm RacObmaodatlm me. ••Ba000 did amr1LOO tba tank by miataao later C-to—Siva"- in"a day. no Macgo.. .WIND RNER ENVIRONMENTAL t5ins.doc a rev.7/26/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System a Page 19 of 19 i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS kip DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED APR 0 8 2003 TOVvN ur bAkNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION. Property Address: 289 East Bay Road MAP 3 Osterville, MA 02655 PARCEL 0 Owner's Name: Laura Walsh LOT Owner's Address: Date of Inspection: March 18, 2003 Name of Inspector: (Please Print) James M Ford Company Name: James M. Ford Map: 163 Mailing Address: P.O. Box 49 Parcel: 017 Osterville,MA 02655-0049 Lot:9 Telephone Number: (508) 862-9400 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 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 eeds Further Evaluation by the Local Approving Authority ils Inspector's Signature: Date: March 19, 2003 The system inspector shall s ritopy 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. Notes and Comments '****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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 289 East Bay Road Osterville, MA Owner: Laura Walsh Date of Inspection: March 18, 2003 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: 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. Answer yes,no or not determined(Y,N,ND)in the 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. ND explain: 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 obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 289 East Bay Road Osterville, AM Owner: Laura Walsh Date of Inspection: March 18, 2003 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 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 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,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 289 East Bay Road Osterville, AM Owner: Laura Walsh Date of Inspection: March 18, 2003 D. System Failure Criteria applicable to all systems: You must indicate either"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 'h 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 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 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,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gPd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 CNM 15.304. The system owner should contact the appropriate regional office of the Department. 4 i Page 5 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 289 East Bay Road Ostenille, M4 Owner: Laura Walsh Date of Inspection: March 18, 2003 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 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: Yes No ✓ 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(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 289 East Bay Road Osterville, MA Owner: Laura Walsh Date of Inspection: March 18, 2003 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents: 2 Does residence have a garbage grinder(yes or no): Yes Is laundry on a separate sewage system (yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): Yes . Last date of occupancy: .Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Never pumped-per owner Was system pumped as part of the inspection(yes or no): 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) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Dec. 1178-per as built card Were sewage odors detected when arriving at the site(yes or no) No 6 Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 289 East Bay Road Osterville, MA Owner: Laura Walsh Date of Inspection: March 18, 2003 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below,grade: Approx. 2' Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: 15"+/- Distance from top of scum to top of outlet tee or baffle: 4" Distance from bottom of scum to bottom of outlet tee or baffle: 5" How were dimensions determined: Measuring 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.): .Tees were present. The liquid level was even with the outlet invert. There were no signs ofleakage. Recommend pumping. GREASE TRAP: None (locate on site plan) Depth below grade: 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 289 East Bay Road Osterville, MA Owner: Laura Wdlsh Date of Inspection: March 18, 2003 TIGHT or HOLDING TANK: None (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/day 'Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box was level. No solids were present. There were no signs of failure or backup from the leach field. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc): 8 Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION (continued) Property Address: 289 East Bay Road Osterville, MA Owner: Laura Walsh Date of Inspection: March 18, 2003 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: ✓ leaching chambers,number: 4 leach chambers w/stone -per as built leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): I dug down in the stone beside the chambers and there were no signs offailure. The bottom to grade was approximately 3. CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 289 East Bay Road' Osterville, MA Owner: Laura Walsh Date of Inspection: March 18, 2003 Map: 145 Parcel: 081 SKETCH OF SEWAGE DISPOSAL SYSTEM Lot: 9 Provide a sketch of the sewage disposal system including ties tout least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Fron-V /P /y a 3 ao 3 5-7 60 �rtvcw,� i ro 13Ay 10 F I Page 11 of 1 i OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 289 East Bay Road Osterville, AM Owner: Laura Walsh Date of Inspection: March 18, 2003 SITE EXAM Slope . Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate (check) all methods used to determine the high ground water elevation: ✓ Obtained from system design plans on record- If checked, date of design plan reviewed: ✓ 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: The bottom of the leach chambers to grade was approximately 3. The drywell next to the septic system was dry. The bottom to grade was approximately 5. According to the design plans, water was observed at 72". There is no-round water adiustment for this site(within 300'of a tidal bay). This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied,relating to the system, the inspection and/or this report. 11 G•ice ,- �= Fss..:f2._............... � THE COMMONWEALTH OF S�ACHUSETTS„ BOARD ALTH `.SUBJECTRTO=APPROVAL OF ------......oF....... . .. �� .........................................13ARNSTABLE CONSERVATION cl� ISSION� ,��tr�#ila�c �n� �t��n��a1 �� C��r�.c�Uan � � s� f Application is hereby made for a Permit to Construct ( ) or Repair ( ).h an Individual Sewage Disposal _7417 System at: - ...................... ...... Location-Address or IQt�No. .... -�5r��' D•�Jf .._._..._ 5 / 9 ._�.......----�-----O-SSE, ! /G-c --............................. Owner Address ......................... •••---•....._._....__...... .••--------•---------•'-••••••---•----••--- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms._._ ..................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria, Other fixtures ------------------------------- � W Design Flow_...1� ..................... gallons per�ersex p r day. Total daily flow............. _;-_ •_........._......gallons. .,.<f, � Se c Tank—Li id acit _.�! allons Length................ Width....................... Diameter--------- ._._.__ Depth................ i—No.................�jl. Width...._...__. ....... Total Length....:Z1r`........ Total leaching area____Y4 ....sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet..................... Total leaching area..................sq. ft. z Other Distribution box ( &-r- Dosing tank ( ) a Percolation Test Results Performed by... o !J:;, !�Q __.. �./ ___._.__.__ Date. .... .................. Test Pit No. 1................minutes per inch Depth of Test Pit.__:_`'______.__.__ Depth to groun _ _f---•----77' fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.. __._ ....... --------•--------------------------------------------------------------- ---•.........•-•--••_...._..... _- --------____---••••---•---____-- Descriptign of.Soil `gam------ --�--.----� - y _'.... _- ,/f .7 U Nature of Repai" or a tions—Answer when applicable.____-/_-.•_______________tz ^............. _ _ _ ..___.___._...__.._____.. __ / b��... /..�...................... .� �.VI �/ �, Agreement: o%y�� The undersigned agrees to install the faforedescribed Individual Sewage Disposal System in accordance with the provisions of iITIE 5 of the State Sanitary Cod —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b� n iss ed b he bo d of)iealth. Date Application Approved BY � 2 Date Application Disapproved for the following reasons------------------------------------------------------------------•-•---------------------•• ----= .- ...............•-----------...---•--------------...------.....--••--.......----------------------------.....-------------------------------•--------------------------------------•--D{:......�-� ate PermitNo:....................................................... Issued......----•-------•--- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........OF.......... ��A_ _k................................................... Tatifiratr of Toutpliatta THZ C ZI—;�'1 0 RITIFY, That the Individual Sewage Disposal System constructed ( or Repaired ----------------- ------------.............. ............... ------------------*....... ------------------------------ Instaler.., 7 ......_/............................ ............. ...... ... Je� hash een installed in accordance with the provisions of T. ' .6 71 of The State Sanitary Code as described in the application for Disposal Works Construction Permit ............... dated----7`/f-_ !................. THE ISSUANCE OF THIS CERTIFICATE SHAkL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION ON SATISFACTORY. DATE............................ Ins pector...... ........... - -------------------- ------------- --------- 7 THE COMMONWEALTH OF MASSACHUSETTS BOARD 9f HEALT . .............. No._-_.... '2.7.... FEE...A_ J . ....... ton 'prrmit Permission�i�_Jiereby granted. ...... ... ............................................................................ 1., a or Repair an InA Q d I Sewap,D g ya ispo al-system to Cons ............................. ----------- Street . as shown on the application for Disposal Works Construction�P ��/NNo, pDated..... ........... .......... .....j7 ................................ DATE....................................................................I............ Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS AIL �•v THE COMMONWEALTH O CHUSETTS,, BOARD . F ALTH ApplirFatinq for RUipwiFal Works Tonstratr#inn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal .r,. . System at. Location Address + or t No . ..................... J.. i . ....�'.? -- ...- C S?. I+G....�...._ Owner Address- Wr �5,.. .. ,. ..__' ..� .......................... ......................_....................................._.._......................._........_. Installer,,- r Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms____ .........._....._._.._..___Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building _____...:__. No. of persons........................... Showers — Cafeteria W yP g ----•---•-• P ( ) ( ) a Other fixtures _..--------•••• $ W Design Flo�v____.�' gallons per-pemeR per day. Total daily flow..__._._ r - ................gallons. WSe c Tan —Liquid*ca acrtyZ�M-gallons Length................ Width_.. _ Diameter................ Depth x �1 No. :. Width_._ ._._._.. Total Length .__,�.`___.___ Total leaching area____ 1. sq. ft. Seepage Pit NO.*.................... Diameter................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (4o�' Dosing tank ( ) �� Percolation Test Results Performed by._AVPM?- .___�'^ ___ _F�=_____________ Date.t'�0___.��.9/_:�!�....__. aTest Pit No 1 .___.mmutes�per inch Depth of Test Pit____________________ Depth to grouno�watep�._._ �. Teit Pit No ,2...... _.._minutes'• er inch Depth of Test Pit____________________ Depth to ground water._ .__. ....... a �t •---• p -••••-•-••••....... --•- _ .. .••--- .................••••--_..._ O Descr<pti n o Soil.... � -- �.�'� ._ -• �. _`"'. .... .. --• y. _.. w ----•- UNature.of Re s o It ations—Answer when applicable._____ _______________________________ Agreement: The undersign e e t instaIl th .afo escri e idea ewage Disposal System in accordance with I ' the provisions of TI';IE '5 of the.State Sanitary.Code'—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b iss ed b he b • d of health._ Sigri+' ..._•...............•..... -----•.. --................ ......••••-• ........ Date _.... ! { r . . glow Approved B � :.. Da e Application Disapproved for the f ollowing'f1i ons___________________________________________________Y___...________.__,_____ _____--- ••------- -•----.._ ............................................................) ............... .........................................................Da......--.--- PermitNo x.... ................................................. r Issued_....................................................... a Date ,J THE'COMMONWEALTH OFMASSACHUSETTS BOARD O �HEALT,H .. ........OF...... . ...: A4e .................................................... &rtifirate-of Toutph aatrr THIS IS TO CERTIFY, That the Individual-Sewage Disposal System constructed (,e-br Repaired ( ) by., . _...., ..............................••------••-••••.._..---•••......-----__.._ •----•------......_.._.._. .•••................_._.... __........-••-••-•--•----•--•--•-- ��/�,,,�� .-4I IT n. at- -!- � -'r' Install . �•rPar, + h been installed in accordance with the provisions o L. of he State Sa ode as described in the a lication'for Dis o al Works Construction Permit 1 _ da.ted__ .a.:' ,,_ _.._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA ANTEE THAT THE zSYSTEM WILL FUNCTION SATISFACTORY. DATE::...:........ ..._......-----•-•--...... Inspector.................................................................................... N"Pi THE COMMONWEALTH OF MASSACHUSETTS BOARD nF HEALTH .. ........:.....OF.. ......_._..:... FEE" S. Dis'pos ai torks Tonotrwffot.,,, uti# Permissi n. 's hereby granted..------•--------------------- -•-----• ........••-•-- :_: .............................................. ...._. .........._._.._........--=• . to Co truc> ) or Repair ( ) an I iv' ual SewageDIs osal System (� ....... AW, ______.. F. - as shown on the application for Disposal Works Construction Pe N ____________________ Dated« -.� _* ________•___.._. ��!! ��.o. � -................................ a !•i4e DATE............................................................................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS r' I 14" 14° I ..: .. Oa W,LG. O V 3 REPLACE IX. DR__I MATCH TO EX. V 'i N REPLACE EX. BEDROOM DR. I MATCH TO EX. 0 90 m it s \ SITTING/READING N e x - a k7 ( F � h CQ m — — E—+ EXISTING 312'-O' •Y 312'-0" ►4 t��++ ADDITION - EXISTING ADDITION " INDICATES NEW WALL CONSTRUCTION FIRST FLOOR PLAN ��SECOND FLOOR PLAN e - CONTINUOUS 2x6 P.T. SILL PLATE/SILL INSUL 2x3 R.0 • 12, O.G. w/1/2' DIA GALV. A.B. ®W-O" O.G. MAX --} - CONT. 2x10 -- 2x4 R.C. HORIZ. SUPPORT - � - RIM JOIST I i SHAPED 2x6 R.C. SUPPORT BM. O a' % E-' Ix6 R.0 BACKING BOARD ' I DRILL 6 GROUT BEHIND 2x6 BRACKET - - �,' 2-,t4 DOWELS 0 12" OC 2x6 R.0 SHAPED 0 E_ �� .. BRACKET > . �14' F V En CRAWL SPACE CA / = L 5 1/2' CONC. SLAB OVER _ t 6 MIL POLY VAPOR • i - .. BARRIER OVER 6" COMPACTED GRAVEL A TRELLIS DETAIL SCALE:1 v2^ar-o• " IO" CONC. WALL WINDOW SCHEDULE O".2204""x1 o CO NC- FTG .. _ SYM. MANUFACTURER'S UNIT ROUGH OPENING REMARKS `.., DRILL t GROUT- A ANDERSEN CW14 2'-4 7/8"x4'-0 1/2" �`" 2-#A DOWELS® 12' O.C. i DATF 04/P6/Of f3 ANDERSEN CXW16/P3560/CXW16 TO MFR SPECS TEMPERED GfA55 � /� -i""� --'--�'- ?FVISI(_;W, EXISTING - ' _..._ _. i ExISTING 312'-O" - ADDITION NOTES: TYP FLOOR FRAMING PLAN _ i r ��ra, 1a. gCp,E,,,•_,-0 FOUNDATION PLAN t. ALL ANDERSON WINDOWS TO BE 400 SERIES-WHITE - � SCALE:,I"•=r-a ` 2. ALL ANDERSON WINDOWS TO HAVE APPLIED GRILLES. w SEE ELEVATIONS FOR GRILLE PATTERNS. I i NEW FOUNDATION PROVIDED � G.C. TO ADJUST 4 I. - EXISTING IS NOT TOP OF WALL TO ALLOW 3. PROVIDE INSECT 5CREEN5 REL AB O N W Al LE FOR E ALIGNMENT OF NEW F L. COR 4. HARDWARE TO BE DETERMINED BY OWNER - - ., � � -CONSTRUCTION. TO EXISTING _ \ �\ � r ROOF SHINGLES TO MATCH EX. _ rr ALUM. GUTTERS ON Ix FASCIA TO - ..—MATCH EX. - i N Lr LLLJ m PERGOLA �� l.a— a \d✓ 10 - - Ix12 CORNERED .. ,. I,. N .•. - FEE W coo I . Q a H.C. SHINGLES WOVEN CORNERS ., .,. r .;: .. TO MATCH EX. • - - p ADDITION EXISTING EXISTING E"xcli ol61( SIDE ELEVATION-OPTION#2 , U REAR ELEVATION FRONT ELEVATION SCALE:,l,•-,'O . SCALE:,/,-=,•O• 1►+I Z a TYPICAL ROOF CONSTRUCTION ---_-� - _ .. ASPHALT SHINGLES ON - -� BUILDING FELT ON •\. - •• CDX PLYWD. r PROP-A-VENT BAFFLE '\ WO RAFTERS N.'O.C.uJ/ 54MPSON 142.5 CLIPS O*W O.G. 9a(R-BO)FIBERGLASS BATT —CON RIDGE VENT KRAFT FACED INSUL- - 1 11 T/B'LVL 12 ,\•� —RIDGE BD. .i.. - 4 • MATCH EX.r 2xH'/Ib'O.C. 2x4 OUTRIGGERS . O W O.G. e _ � • _ / ALL TRIH TO MATCH EXISTING 'f w .. E'I W ALUM.GUTTERS ON .h 1 x S STRAPPING AT ib'O.C. Ix FASCIA BD6 . • • - IMGOAT PLASTER SYIOO I4 I . a • W a . Ix SOFFIT W COPT VINYL - SOFFIT VENT . TYP.2rrU FLOOR CONSTRUCTION ' 9/4'T1f.PLYWD SVBFLCM - - (/] GLUED•NAILED OVER _ 2x,ds 1 M'O.C, - [P TYP • TRL TIOII • M •' EXPOSURE • x - �. d TYVEK HOUSEWRAP V2'CDX PLYWOOD 2x4 STUDS Ni'O.C. 1 5 STRAPPING AT 16'O.C.� 3 I/2'URIS D UNFACFD FIBERGLA56 _ BWEBOARD WITH BATT INSULATION F - - I - SKIM COAT PLASTER-SMOOTH - I2'BLUE BOARD ' uV VEN.PLASTER(BHOOTH) a _ + TYP IST OOR CONSTRUCTION 7 4 6 PLYWD SUBFLODR -'--GWED b NAILED OVER J t - r •. 2x10'R• FIBERGLASS b'(R19)FIBERGLASS GATT INSULATION � InI l— FOUNDATION. - -111� - CRAWl 6P_ illl_ — --- BITUMINOUS OAHPPRPOFING F:.4TF 04/2ON o-CONC 6104 - a 3 1/2'CDNC.SLAB OVER �j FOUINDATION WALL u✓ .. b MIL POLY VAPOR BARRIER ON 20•x10•DEEP F.'F I'. ON b'COMPACTED GRAVEL KEYED CONC. FOOTING U GROSS 8ECTION A2, r. r 4 � ' GA. ,r.. � \ ',--'• - - _. ... 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