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0095 EEL RIVER ROAD - Health
95 Eel River Road _ Osterville / A= 116-121 i r ' s r F i ;a I� u Commonwealth of Massachusetts �(p- ♦ a-� +n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c !% 95 Eel River Rd u— Property Address William & Christina Stout Owner Owner's Name information is Osteryille ✓ Ma. 02655 6-8-21 required for every page. City/Town State Zip Code Date of Inspectiori. 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 S I t- IS44C I on the computer, use only the tab Michael Sears key to move your Name of Inspector cursor-do not . Robert B Our Co INC. use the return Company Name key. 363 Whites Path Company Address South Yarmouth Ma. 02664 City/Town State Zip Code 508-477-8877 S114430 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: 1. ® Passes �N OF 2. ❑ Conditionally Passes MICHAEL '.N 3. ❑ Needs Further Evaluation by the Local Approving Authority ='0. SEARS No.SI14430 r�' 4. ❑ Fails FRTIF� nn o 6-8-21 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 form should be sent to the system owner and copies sent to the buyer, If applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc.rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 1 of 18 c Commonwealth of Massachusetts �n p Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Eel River Rd Property Address William & Christina Stout Owner Owner's Name information is Osterville Ma. 02655 6-8-21 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 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: System is in working order 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 c Commonwealth of Massachusetts w Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 95 Eel River Rd Property Address William & Christina Stout Owner Owner's Name information is required for every Osterville Ma. 02655 6-8-21 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. ❑ 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 cam, Commonwealth of Massachusetts �u Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form Not for Voluntary Assessments .......... 95 Eel River Rd Property Address William & Christina Stout Owner Owner's Name ill information is Osterve required for every Ma. 02655 ' 6-8-21 page. 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 ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �- II; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 95 Eel River Rd Property Address William & Christina Stout Owner Owner's Name information is Osterville Ma. 02655 6-8-21 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary cont.) p rY 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '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: ❑ E 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 11 of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form li Subsurface Sewage Disposal System Form Not for Voluntary Assessments 95 Eel River Rd Property Address William& Christina Stout Owner Owner's Name information is required for every Osterville Ma. 02655 6-8-21 page. Cityrrown 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 ❑ Z Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N!A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information.. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 c Commonwealth of Massachusetts p .Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments u 95 Eel River Rd Property Address William &Christina Stout Owner Owner's Name - information is Osterville Ma. 02655 6-8-21 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 6 Number of bedrooms (actual): 6 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 Description: 0 Number of current residents: 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 readin s, if available last 2 ears usage d NA 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No NA Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Eel River Rd Property Address William & Christina Stout Owner Owner's Name information is required for every Osterville Ma. 02655 6-8-21 page. Cityrrown 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): i 3. Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 c , Commonwealth of Massachusetts Title 5 Official Inspection Form �I. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Eel River Rd v Property Address William &Christina Stout Owner Owner's Name information is required for every Osterville Ma. 02655 6-8-21 page. 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: 4-20-88 #87-681 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 5' 10" Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Ck Commonwealth of Massachusetts �w Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Eel River Rd Property Address William & Christina Stout Owner Owner's Name information is Osterville required for every Ma. 02655 6-8-21 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 5' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 2500 gal If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 2500 gal 1.. Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 0 8" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Sludge judge, tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 2500 gal tank tee in baffle out outlet cover at 18" below grade t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 C Commonwealth of Massachusetts Title 5 Official Inspection Form _ I� Subsurface Sewage Disposal System Form Not for Voluntary Assessments 95 Eel River Rd V� Property Address William &Christina Stout Owner Owner's Name information is required for every Osterville Ma. 02655 6-8-21 page. Cityrrown 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 Farm:Subsurface Sewage Disposal System-Page 11 of 18 cam, Commonwealth of Massachusetts a Title 5 Official Inspection Form I1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Eel River Rd Property Address William & Christina Stout Owner Owner's Name information is required for every Osterville Ma. 02655 6-8-21 page. City/Town 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.): D Box is H2O with 2 outlet pipes box is 2"' below grade t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 cam, Commonwealth of Massachusetts �n Title 5 Official. Inspection Form I, Subsurface Sewage Disposal System Form Not for Voluntary Assessments M � 95 Eel River Rd Property Address William &Christina Stout Owner Owner's Name information is Ma. 02655 6-8-21 required for every Osteryllle page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): i * 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: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 c Commonwealth of Massachusetts ,p . Title 5 Official Inspection Form �i; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r; ............ 95 Eel River Rd V Property Address William &Christina Stout Owner Owner's Name information is Cisterville Ma. 02655 6-8-21 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): SAS is 2- 1000 gal pits both are clean and dry with no sign of failure 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 Farm:Subsurface Sewage Disposal System-Page 14 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form I, Subsurface Sewage Disposal System Form Not for Voluntary Assessments 95 Eel River Rd Property Address William &Christina Stout Owner Owner's Name information is required for every osterville Ma. 02655 6-8-21 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 1 Commonwealth of Massachusetts Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Eel River Rd _ Property Address T William &Christina Stout Owner Owner's Name information is Osterville Ma. 02655 6-8-21 i required for every -- - — — ---- -- page. 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 C o 54 P -G3 -71 y_/06 OF Aq,9/����i GJ ``�.���.••.......• q�'y•. M I C H A E L '.N"s_ =o: SEARS No.SI14430 y '��;f5f 1 N Sp`�G�`�```�� t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts L Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Eel River Rd V� Property Address William &Christina Stout Owner Owner's Name information is Osterville Ma. 02655 6-8-21 required for every page. City/Town 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: 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: 7-16-86 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ h ex Checked with local Board of Health - plain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Plan, no ground water Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 r c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Eel River Rd Property Address William &Christina Stout _ Owner Owner's Name j information is required for every Osterville _ _ Ma. 02655 6-8-21 _ page. City/Town 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. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached .For 15: Explanation of estimated depth to high groundwater included f?o4+o* q- I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 No. Fee /6— i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es 01ppritation for -Misposal *pstem Construttion permit Application for a Permit to Construct( ) Repair()0 Upgrade( ) Abandon( ) []Complete System �Zidual Components Location Address or Lot No.Ot Rt. d ITC R-j%1 e Owner's Name,Address,and Tel.No. Ct*&kSt1r4A r v.4x tM S`fAODT' Assessor's Map/Parcel t I b 12-1 l i3tmb Army >AJoke , NY l 01 a 2 Installer's Name,Address,and Tel.No.$o$ - '( 1 l - 8 01 l Designer's Name,Address,and Tel.No. KpIIef-r- B 6UR Co . Z 3 t,,aV„1v1 Twii4 S. YA,,-At-ni , MA, 0 2(o G`4 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided JU gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ly%S+A I l N U,3 A$3 1120 g a x L0. l C o r,c r,k l�zo I��ac.� w��►,h 6' o>; Gr�aE Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar of Healt Signed Date 9 Z Application Approved by �jl6A Date a f Application Disapproved by Date for the following reasons Permit No. 1 ©-2-0 a 2 Date Issued 0 it I �-Q y s �kNo. 2a .° i 4 Fee 70 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es application for Mispi sal *pstetn Construction Permit Application for a Permit to Construct( ) Repair( Upgrade O Abandon( ) ❑Complete System /ndividual Components Location Address or r Lot No. $ EF 1 R1 uc r <r ts, � 'f e�",j t lle Owner's Name,Address,and Tel.No. CN,L,Jr•jtjA r v41111r}svi STAvDT Assessor's Map/Parcel I I (o I •I -'- 1 Ti t_{u r h C>t N� �,rvn�c.t i 11 E , N Y 1 01 o g Installer's Name,Address,and Tel:No.5 3 - y l l $011 Designer's Name,Address,and Tel.No. 3to3 WV,k PA TO S.`M-t1AU1-R4 MA 02Cn&`4 Type of Building: a* Dwelling No.of Bedrooms i� Lot Size sq.ft. Garbage Grinder( ) s Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ,,(( Design Flow(min.required) oU d Design flow provided AJ i 1 d gP g P gP Plan Date I Number of sheets Revision Date• - Title Size of Septic Tank Type of S.A.S. Description of Soil —Nature of Repairs or Alterations(Answer when applicable) Jh S A N tLo D 8 3 I4 2 J f> [ m rt�t� R1\C� 1`.�s1V1rh bn C� CrAaE Date last inspected: Agreement: } The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. _ - —.-. _. Dale -- �- . NZ T Application Approved by -IJ _ Nlar r Date Application Disapproved by Date for the following reasons Permit No. r,.R ra 2 Date Issued to Ap s ��p -t THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(,/} Upgraded( ) Abandoned( )by at cf 1� .c• X"-,-tf .�t has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ,?010-24r dated g��r A 6 Installer Designer #bedrooms 1��,Q Approved design flow AAA gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date t„( �^� Inspector 4:_4( V,, No. ')o'to r? Fee THE COMMONWEALTH OF MASSACHUSETTS �— �,j r- PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction 3permit -----,-Permission is hereby granted to Construct( ) Repair(�) Upgrade( ) Abandon( ) System located at ( n r /2d. and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date q f,� I 2c) Approved by e (1,/ (e f + j v �TTti Town of Barnstable Inspectional Services BARNSfABLE. 9 MASS. ,�� Public Health Division BONA 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4987 7992 September 17, 2020 STAUDT, WILLIAM W & CHRISTINA R 1 RETURN BEND BRONXVILLE, NY 10708 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 95 Eel River Road, Osterville, MA was inspected on 08/27/2020 by Michael Sears, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • The distribution box is an H10 and underneath the driveway. See attached policy about H-10 components discovered beneath parking areas and driveways during septic system inspections. You are ordered to replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mail ing\Conditional ly Passes Letters\95 Eel River Road Osterville.doc Town of Barnstable Barnstable �B"M j j Board of Health 1639.A� Dm Fp� 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 FAX: 508-790-6304 October 9,2012 Revised November 20,2013 Public and Environmental Health Program Policies,Procedures,and Guidelines H-10 Components Discovered Beneath Parking Areas and Driveways During Septic System Inspections Conducted Under 310 CMR 15.301,State Environmental Code,Title 5 No.2012-005 When a DEP certified inspector discovers an H-10 septic system component located beneath a parking area or driveway during a septic system inspection, conducted under 310 CMR 15.301 State Environmental Code Title 5,the system shall be deemed as a"conditional pass." The system owner will then be ordered, by the Board of Health,to correct this problem within two(2) years and will be provided several options to rectify the issue, including by: a.) replacing the septic system component with a new component relocated into another area of land which is not beneath any parking area or driveway, and properly abandoning the discovered H-10 component; or by b.) replacing the septic system component with an H-20 component beneath the parking area or driveway, and properly abandoning the discovered H-10 component, (or in the case of leaching pit,replacing the top of the leaching pit with an H-20 slab top); or by c.) relocating the parking area or driveway in such a way that no vehicle will have access or the ability to drive over the existing H-10 septic system component. If it is unknown whether or not a particular system component which is located beneath a parking area or driveway, is H-10 or H-20 (for example: a leaching pit is located beneath a paved driveway without an accessible steel cover to grade and there are no records on file indicating whether the system component is H-10 or H-20),the system shall also be deemed as a "conditional pass". In this case,the seller must make the potential buyer(s)aware of the "conditional pass" status,the unknown construction of the septic system component(s),and it's safety concerns. Wayne Miller,M.D. Paul Canniff,D.M.D. Junichi Sawayanagi QAPOLICIEST 1 OComponentsBeneathDriveways&ParkingAreasRevised2013.doc 'THE Town of Barnstable Inspectional Services * HAIMSMILE. i 9q� "`39. ,�� Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4987 7992 September 17, 2020 STAUDT, WILLIAM W & CHRISTINA R 1 RETURN BEND BRONXVILLE, NY 10708 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 95 Eel River Road, Osterville, MA was inspected on 08/27/2020 by Michael Sears, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • The distribution box is an H10 and underneath the driveway. See attached policy about H-10 components discovered beneath parking areas and driveways during septic system inspections. You are ordered to replace the septic system within two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\95 Eel River Road Osterville.doc Town of Barnstable Barnstable MAW sARNSTABLE, � AlEflmatcaary Board of Health 639 Al 0 Dm 200 Main Street, Hyannis MA 02601 2007 Office: 508-8624644 FAX: 508-790-6304 October 9,2012 Revised November 20,2013 Public and Environmental Health Program Policies,Procedures,and Guidelines f H-10 Components Discovered Beneath Parking Areas and Driveways During Septic System Inspections Conducted Under 310 CNM 15.301,State Environmental Code,Title 5 No.2012-005 When a DEP certified inspector discovers an H-10 septic system component located beneath a parking area or driveway during a septic system inspection, conducted under 310 CMR 15.301 State Environmental Code Title 5,the system shall be deemed as a "conditional pass." The system owner will then be ordered, by the Board of Health,to correct this problem within two(2) years and will be provided several options to rectify the issue, including by: a.) replacing the septic system component with a new component relocated into another area of land which is not beneath any parking area or driveway, and properly abandoning the discovered H-10 component; or by b.) replacing the septic system component with an H-20 component beneath the parking area or driveway, and properly abandoning the discovered H-10 component, (or in the case of leaching pit, replacing the top of the leaching pit with an H-20 slab top); or by c.) relocating the parking area or driveway in such a way that no vehicle will have access or the ability to drive over the existing H-10 septic system component. If it is unknown whether or not a particular system component which is located beneath a parking area or driveway, is H-10 or H-20(for example: a leaching pit is located beneath a paved driveway without an accessible steel cover to grade and there are no records on file indicating whether the system component is H-10 or H-20),the system shall also be deemed as a "conditional pass". In this case,the seller must make the potential buyer(s)aware of the "conditional pass" status,the unknown construction of the septic system component(s),and it's safety concerns. Wayne Miller,M.D. Paul Canniff,D.M.D. Junichi Sawayanagi Q:\POLICIES\H 1 OComponentsBeneathDriveways&ParkingAreasRevised20l3.doc Town of Barnstable BARNSPABLE, ' b 9. ,�� Inspectional Services Department ArfD MP'i A Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360,44 and Title V: 310 CMR 15.000) An "x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located within 50 feet of a private water supply well I 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• ❑ Si gle 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 t , r/ r a i Commonwealth of Massachusetts �n Title 5 Official Inspection Form '•_ I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments t II 95 Eel River Rd 4' V� Property Address < , ft') William &Christina Stout Owner Owner's Name 44 information is required for every Osteryille Ma. 02655 8-27-20 . 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 /Ly__M3 on the computer, Michael Sears use only the tab key to move your Name of Inspector cursor do not' Robert B Our Co INC.use the return Company Name ' key. 363 Whites Path Company Address South Yarmouth Ma. 02664 City/Town State Zip Code ietea 508-477-8877 S114430 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: u 1. ❑ .Passes �� so 2. .❑ Conditionally Passes �u� �` �—� 4j ;`��• Cy'o � � ' MICHAEL SEA '•.N 3. „® Needs Further Evaluation by the Local Approving Authority . _0- RS �' No.SI14430 c �y :* : a ' 4.' ❑ Fails - A �' �%Ar��FRrIF��•:�o��. INS? SP 8-27-20 Inspector's Si ure Date The system inspector shall submit a copy of this inspection report to,the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to.the system owner and copies sent to the buyer, if applicable, and'the•approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 • N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Eel River Rd Property Address,, William & Christina Stout Owner Owner's Name.;:. information is, Osterville Ma 02655 8-27-20 required for every } State Zip Code Date of Inspection City/Town/Towne P page.` Y P . C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of,4 and 6, ` 1) System Passes: I ❑" 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: ' t. 2) System Conditionally Passes: ❑ One ornore 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-septictank 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): - t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface.Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts ry Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Eel River Rd u� Property Address William &Christina Stout Owner Owner's Name' information is required for every, Osterville Ma. 02655 8-27-20 page. City/Town State. Zip Code Date of Inspection C. Inspection Summary (cont.) ' 2) System Conditionally Passes (cont.): ❑' Pump Ctiamber 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 t ❑ 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)(4)that the:system is not functioning in a manner which will protect public health, safety-and the environment: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 r Commonwealth of Massachusetts rn Title 5 Official Inspection Form i1; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Eel River Rd u Property Address William &Christina Stout Owner Owner's Name . information is Osterville Ma. 02655 8-27-20 required for every page. 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:: El The system has.a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water isupply or tributary to a surface water supply. ❑ The system has aseptic tank and SAS and.the SAS is within a Zone 1 of a public water supply. t' El The system has a septic tank and'SAS and-the SAS is within 50 feet of a private water supply well. ' El 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: **Thls system passes if the well water analysis,Fperformed 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: D Box is H10 under driveway, it is also 6' below grade 4 System Failure Criteria ApplicableY to All Systems:ms: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No El _ . Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 'Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth'&Massachusetts # . Title 5 Official inspection Form l i . tiI Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Eel River Rd Property Address William &Christina Stout. is Owner Owner's'Name 4 information is =" required for every Osferville` #; Ma. 02655` 8-27-20 pager City/Town" - State Zip Code Date of Inspection , C. Ifnspedion•Summary (cont.) 4)-_-System Failure Criteria Applicable to All Systems:(cont.) Yes No. Static liquid level in the d'istributionbox.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 thanTM*%.day,, low .K Required pumping= ore than 4 times in the last year NOT due to clogged or ® m obstructed pipe(s). Number of times'pumped: ❑ Z Any portionof 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. g _. ® Any.portion.of a.cesspool or privy,is within a Zone 1 of a public water supply EI: 41 well. El ® 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,forfecal 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 s-stem is a cess ool servin a facilitywith a desi gn n flow of 2000 d- Y p 9_ 9 9p ® 10,000 gpd f The system fails.`I have determined that one or more of the above failure. r therefore the system fails. The criteria exist as described in 310 CMR 15 303 Y system owner'"should.contact the Board of Health to determine what will be necessary to correct the failure. Y 5) Large Systems: To be considered a large system the system must serve a facility with a , design flow of r10000 gpd to 15,000 gpd: For large.systems,syou must indicate either_"yes" or, "no to each of the.following, in addition to the questions:in Section'CA,} , Yes No ❑ ❑ the system'is with(n 400 feet of a surface drinking:water supply i , ❑ ❑ the system is withiin 200 feet of,a tributary to a surface drinking water supply the system'is located in a nitrogen sensitive area (Interim Wellhead Protection ❑ Area—lWPA)"or a mapped Zone Il of a public water'suppfy well t5insp.doc•rev.7/26/2018 Title"5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 18 { f cam, Commonwealth of Massachusetts rn Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Eel River Rd' V Property Address William &Christina Stout Owner Owner's Name information is required for every Osterville Ma. 02655 8-27-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the.system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? tg ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) Z ❑ 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: Z ❑ Existing information. For example, a plan at the Board of Health. � ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 c Commonwealth of Massachusetts Title 5 Official 'Inspection Form �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Eel River Rd Property Address William &Christina Stout Owner Owner's Name information is Osterville Ma. 02655. = 8-27-20 required for every - page. Cityrrown State Zip Code Date of Inspection D. System Information 1.. Residential Flow Conditions: { Number of bedrooms (design): 6 Number of bedrooms (actual): 6 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 Description: Number of current residents: Does residence have a garbage grinder? _ ❑ Yes ® . No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: I Is laundry on a separate,sewage system?(Include laundry system inspection , ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d NA 9 ( Y 9 (gP ))� •, Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 nZ Commonwealth of Massachusetts �n Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Eel River Rd Property Address William &Christina Stout Owner Owner's Name information is required for every Osterville Ma. 02665 8-27-20 page. City/Town State Zip Code'" Date of inspection D. System 1'nformation (cone,) 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):, 3. Pumping Records: Source of information: NA 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.7/2 612 0 1 8 Title 5 Official Inspection Form-Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I) Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Eel River Rd Property Address William &Christina Stout Owner, Owner's Name information is required for every Osterville Ma. 02655 ' 8-27-20 page. 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: 4-20-wH #87-681 Were sewage odors detected'when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): .. Depth below grader 5 10feet Material of construction: Y ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting; evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 1 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �C, � 95 Eel River Rd u Property Address William &Christina Stout Owner Owner's Name information is. required for every Osterville Ma. 02655 8-27-20 page. City/Town State F. Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete. El metal ❑ fiberglass ❑ polyethylene ❑ other(explain) i 2500 gal If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 2500 gal Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 0 811 Distance from top of scum to top of outlet tee or baffle ' 18„ Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Sludge judge, tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid°levels as related to outlet invert, evidence of leakage;etc.): 2500 gal tank tee in baffle out outlet cover at 18" below grade t5insp.doc•rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts +� _ ,,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 95 Eel River Rd Property Address William &Christina Stout Owner Owner's Name information is required for every Osterville Ma. 02655 8-27-20 . page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: El concrete• ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness I 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 inert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grader _ Material eri I of construction: r ❑ concrete ❑ metal ❑'fiberglass ❑ polyethylene ❑ other(explain): Dimensions: ` Capacity: gallons Design Flow: gallons per day t t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Eel River Rd V� Property Address William &Christina Stout Owner Owner's Name information is Osterville Ma. 02655 8-27-20 required for every page. City(rown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) t 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.): D Box is 16x16 with 2 outlet pipes box is 6' below grade under driveway t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 16 c Commonwealth of Massachusetts " �� is Title 5 Official Inspection Form k 15 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments `G � 95 Eel River Rd Property Address William & Christina Stout Owner Owner's Name information is Cisterville Ma. 02655 8-27-20 required for every page. Cityrrown State Zip Code Date_of Inspection D. System Information (cont.) 10. Pump Chamber(locate.on site plan): .Pumps in working order: ❑ Yes- ❑ No* Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps-and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass... . 1.1. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: , Type: ® leaching pits number. 2 ❑. leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches- number, length: ❑ leaching fields. number, dimensions: ❑ overflow cesspool number. ❑ innovative/alternative system Type/name of technology:. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 r Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - 95 Eel River Rd Property Address William & Christina Stout Owner Owner's Name 'information is - required for every Osterville Ma. . 02655 8-27-20 page. Cityfrown •State Zip Code. Date of Inspection D. System Information (cunt.) t 11., Soil Absorption System (SAS) (cont.) Comments (note,condition of soil;signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc.): _ SAS is 2- 1000 gal pits both are clean and dry with no sign of failure 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth-.top of liquid to inlet invert d Depth of solids layer .Depth of.scum layer Dimensions of cesspool Materials of construction y 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/M8 Title 5.0fi cial Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 95 Eel River Rd Property Address William &Christina Stout Owner Owner's Name information is required for every Osterville . Ma. 02655 8-27-20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 1f 13. Privy (locate on site plan): Materials of construction: Dimensions' Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 C- Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 95 Eel River Rd Property Address William &Christina Stout . Owner Owner's Name Information is Ma. _ 02655_ 8-27-20._ .__.. required for every Osterville — state Zip Code Date of inspection t_ Oltyffown page +, D. System Information (cont.) 4R; 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 o 0 A l � � w I•� -6'? 3-7" q�to1.l t5lnsp.doe rev.712612M Title 5 Official Inspection Form:Subsurface Sev+age Disposal System•Page 16 of 18 f - Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 95 Eel River Rd Property Address William & Christina Stout Owner Owner's Name information is required for every Osteryille Ma. 02655 8-27-20 page. Ciiy/Town State Zip Code Date of Inspection D. System Information.(cont.) 15. Site Exam: i Check Slope .g ® Surface water ® Check cellar ® Shallow wells 20' Estimated depth to high ground water: feet Please indicate all methods used to determine the,high ground water elevation: z Obtained from system design plans on record 7-16-86 If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole-within.150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe.how you established the high ground water elevation: Plan no ground water Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 cam, Commonwealth of Massachusetts +n _. Title 5 Official Inspection Form 1; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Eel River Rd Property Address William &Christina Stout Owner Owner's Name information is required for every Osterville Ma. 02655 8-27-20 page. City/Town 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. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed D. System Information: For 8: Tight/Holding Tank Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included Bo how, o� sxs "or `y"u nW Z Rom{' III t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 NoF.7® Fps.............. ~— THE COMMONWEALTH OF MASSACHUSETTS / BOAR® qF HEA T ---------.../. ..._........... .....OF.......... ... .. ..............---- . ------..................... Appliration- for M-4posal parks Tun�.rn Finn rrntit �,q5 Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal -System at: ... ..o.. l . ..-... ... ��fit... ........ �avI dell&.--------------- ------------------------.............----- o ation-t%ddr s / or Lot No. 1#.r), - EL T.•------------------------------- ------------------•-------------------------- O Address W Installer Address Q Type of Building Size Lot.................... .....Sq. feet V Dwelling—No. of Bedrooms__._...___ Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ��j p, yp g �yp �T! No. of persons... l.................. Showers Cafeteria ( ) a � Other fixtures ----------------------------------------------------------------------------------------------------------------------•--••----•-------..__....------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter---------------- Depth................ Disposal Trench—No. .................... Width......._............ Total Length......._............ Total leaching area....................sq. ft. � Seepage Pit No-------------_------ Diameter.................... Depth below inlet.................... Total leaching area........_.........sq. ft. Z Other Distribution box ( ) Dosing tank ( ) - �" Percolation Test Results Performed by.......................................................................... Date........................................ 1 Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water_.-__._-_____-__-----_-. r%, Test Pit No. 2._.---•-----____minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -•-•-••••-••-•---•------•-•--•-------------•••-•-•-•....------------•-•-•-•-••••....-------------•--.........•--...•-••-----•-•......--••----••-••--•-•--_... 0 Description of Soil.......................................................................................................... W ---•••••--------------------•--••-•-•-•••-----•--••••-•--•-•--------•------------------•-•-••---••----•-••••-••-•--•-••--•••-•------••--•--•--•--•----•--•------•--••-•••----•......---•---------•-•••-- UNature of Repairs or Alterations—Answer when applicable............................................................................................... •--------------------------•---••----•-•••-•••----•---•--•---••••-•-••••----•...._.........------•----••-------------•••-•-•-•--• --•-•-----•-•••-•-----•----•-•-----......-------•----•-•-•-••--•----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TT LE '- of the State Sanitar ode— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ee issu/ bXtoardl of health. Si-ned D Application Approved By..... a - - - -----•----•----------------------------•---- ........ PA ate r� ------ Application Disapproved for the following reasons----------------------------••-------------•-------------------•---------------------------...--••••••.....------ .............-................................ •--•--............•--------•-----••------------------...------------.........----------------------------------------------------------•--------••---•--- Date Permit No..... .��.l�l..-f?.-r...............•---..... Issued.-------------•--= ®. 'Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. ------------------OF............... ........................ -_ 4A .� �ir�aii ` i o��a �rtion rrntit ./an Application is hereby made for a Permit to Construct ( ) or Repair ( Individual Sewage Disposal System at: Locat:on-Addres7 / or Lot No. . (0 er Address bd Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms. .Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building /'No. of persons..................... Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------- . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ _ Disposal Trench—NTo- -------------------- Width.......-............ Total Length.................... Total leaching area....................sq. ft. �<.. Seepage Pit No------_------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. :y Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed b ....................................... Date........................................ . µ,. Test Pit No. l----------------minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.................... a ----------------------------------•----------------•----............----- --------------•----- ODescription of Soil............................................................/)......---•--. 4--•------F�---�g7 rS,---------- U •----------------------------------------•----•--------------------------------------------------........--•---•-------•---•--••---•-----------------------------------•----------------------------•-- W ------- ---------------------•-----.....---••---•••------------------•••---••-----•--••-----•------•------•-•---------------------•---••••--•-•------•--•------•------•••--•-•---•-----•---.............. U Nature of Repairs or Alterations—Answer when applicable----------- ...............................................................-........................................................................................................................................ Agreement: The undersigned agrees to install the fo edeDed • 4bythe idual Sewage Disposal System in accordance-with P T` g P 64 the provisions of �: : of the State Sani o further agrees not to f � operation until a Certificate of Compliant been board of health. Signed.........................•------.......-•---•-----•--•-••---•-•......•-----••••-•-••. Date " Application Approved By..... o ......................•----•-------••------. ...•.... ' -7-------- f fl 1 A t Aj,A :" pplication Disapproved foraJ1e�: -•-------•---•-•-•---------••-••----••---------•--•-••--•-••-••••••-•••-•---•------•---•----•--•-----••••-- ------•-------------•--------------•-•--...-----....------------------------......----......----------•-.-••-•--•-••-•------------------------•---•----------•-----•-------•-----•••••-••••-•-•••••...._ �f Date PermitNo..... ....................... Issued........................................................ Date I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ir..........OF....... ........................ Trrtifirate of TontpliFanr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) �r Repaired ( } by------------------------------------------------------------------------------------------ ----..-.-------.-•--------------.--..-..........------.........-----°-/-----------------------------.._-- / r // Installer _ 't at hS�-f.- � Il-1Q L 1f-��'C { �'tT'f has been installed in accordance with the provisions of Ti T T2 j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.......l..Imn . /......... dated_-------__................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE............... .."._3.__ 2.2f-...........-•-•---•------•-•-•-•--.. Inspector.............. J.D........................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �-� n O._ ...��.... t'EE. Disposal Vorkv Taonotr ion rrmit Permissionis hereby granted.............................................................................................................................................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at \'o. C. t 'r �... .........629-f `M 5 ' t�et f as shown on th( Pglida*P f isposa1 Works Construct • �rmit No. . Dated.......................................... ..............•••-•-----••--------•------------•-------------•-•-•-•...------•••-•----------------...---- Board of Health DATE................................................................................ FORM011255 HOBBS & WARREN. INC.. PUBLISHERS t �� OWN OF BARNSTABLE LOCATION /D?/ /d� G�"L &neaEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. �� 1lj✓a,/�1p � � SEPTIC TANK CAPACITY ,SDo LEACHING FACILITY:(type) (size) gA NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER iG BUILDER OR OWNER �fy ' �P� �� �Q`/1�"� • DATE PERMIT ISSUED: p DATE COMPLIANCE ISSUED: ZD O VARIANCE GRANTED: Yes No I �p� � r 9� . i ., i i q � �� � � ._ - - 7/28/2020 ShowAsbuilt(1700X2800) OWN OF BARNSTABLE LOCATION /od/ 116 C6L K111—m19EWACE � VILLAGE ASS OR'S 'MAP&LOT 1.� t INSTALLER'S NAME&PHONE NO. y —6 /g rlALrlo SEPTIC TANK CAPACITY DO LEACHING FACILITY:(tppe) NO.OF BEDROOMS /) C oPRIVATE WELL OR PUBLIC WATER iG BUILDER OR OWNER ?H, ��154/L pl,T'• DATE PERMIT ISSUED: p DATE COUPLIANCEISSUED: ZO r0 VARIANCE GRANTED: Yes No fyhd3C rA%AlT 1 ,y i -- q https://itsqldb.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=116121&sq=1 1/1 195-c S�cA �a � " s � -7 �� �I Living Kitchen Room -- 15'x2'�' Dining 27'x16' I Room 14'x17' 0 o Master 01 Bedroom 0 15,x17, Office 12'x1O' Foyer 0 '�'� 8'x1g �' Cu�e u 6'x , C 7 10'x6' --- -- Mild � Room Garage 24,x23, MING DEPT. DATE IRE DEPARTME DATE L0 .; s;���n rF r�FSAREREO ED FOR PERV TING Total Spa feet _ Qv- } i i Master Bedroom Bedrooms. 13ax17' Y Bedroom 12'X15' 151X12' Bedroom 12'X2®° wic l - 8'x5v Landing Office 5'X10' 7'X12' Total sq. feet = 1390 � euk - BA RNS 7,` ILDI G T. I J E�21 Q i V 2iZ I�G GP , OS+R-"� (Le- FIRE DEP DATE ESAREREQUIREDFORPERM)TINGNG i Entertainment `'4;�' Play Room 1 �X14�' Room 14tx23v 26'xl7'. ec� oom Utility R I Doom 115'x:t6' 16 7 81xiov SIVICIKE B BARNS". �` BUILDING DEPT. lDATE Total sq. feet= 1612 FIRE DEPARTMENT -- DATE _ a lH ``/Y rRFSARF RFGUIRFDF PERM,�TING _ REVISIONS: NO. DATE . 7 y4 13 49 i 4 GRAVEL DRNE N REFERENCES: .P.*39 22 , o cy In / /\ �'{I PROJECT TITLE: 44 B.M ` '� �' / U.P.• lIl/38 AG DISPOSAL — q, / NL.IN POLE SEW // i \2� 13 \� �/ \6 EL=21.35 N.G.V.D. SYSTEM DESIGN 6 OF - LOT 8 EEL RIVERROAD — — — 6 — — ' _f - _ " '-� — .;,- T.P. IN '00♦, ..— /l / / it• act l / ,° _ BARNSTA �+ � 9 BLE, MA. �� ♦. � is ' �'' ' .B ' ND. � ` a !�8 2 OSTERVILLE BE//R "2 Igo' ' 1 �/.�'% �, �� YMOO �) U.P.*38A % �j / � i j/ / �� - l // - 66 .� o/ PREPARED FOR : %.?/ 1 %00 t\ ,� ELEC.METER . �,, /:=� �, / WILLIAM STAUDT -- -. U.P.#T/37 / k"llool l / C.B.FND.\�oo ' OBSERVED HIGH WATER 118166 ;F��• 00 Il 1 ' I �' r -' ' r •`��' •49 �' / 6 N, T ,( / / ,� •' ' 1 ' 23 e ZONE : RF-1 The BSC Group i �� — _ ,,=' / // �,a ��/ /� // // / ,/ 1 i I ,/ / �, SETBACKS ,' Nz l / ;/— __ _ , / �! / / / // FRONT 30 / SIDE /5 REAR /5'' 45 Cape Cod Survey Consultants I, I1 2 52E o �/ / / _ \ I F�1�' • �� cr loll / // / / / / HYD.TAG BOLT 6/ =EL 24.34 Route 6A Street N.G.V.D. Barnstable V111age MA / r / / ♦ `// 02630 617 3102 8133 23 20 MAIN ST. I) PROPERTY LINE INFORMATION WAS ;OMPILED WRACK LINE ,FROM L.C.C.3(45Z AND DOES NOT REPRESENT AN ACTUAL SURVEY ON THE GROUND. / w 2) TOPOGRAPHY AND WATER LOCATION LOCATED BY STADIA SURVEY. LOCUS' '_✓,, o� N 3) l00 YEAR FLOOD ELEV.=12.00 ELEV.TAKEN FROM FLOOD INSURANCE RATE MAP COMMUNITY PANEL NUMBER 2900/ 00/6C WEST BAY ��; REVISED AUGUST 19,1986 c Q CL ALt,I SCALE: I� a 30' } PUL y FEET nyY L.�`y o No. 32443 y . LOCATION MAP o 5 /o Po METERS � 1'77t� s ;;s '�l;IS1EgE?i y' SCALE : I.-2r083' DATE: J U L Y 16, 1986. "t rzAtiy COMP./DESIGN: DATE PROFESSIONAL ENGINEER - CIVIL DATE PROFESSIONAL LAND �URVEEYOR CHECK: DRAWN: J.H.C. ; e, FIELD: D.J.B. FILE NO: DWG. NO: 1064 SHEET JOB NO:03J704.0 1 OF 2 SOIL TEST PIT DATA. INDICATES INDICATES SEPTIC TANK DETAIL: _ :F Y DISTRIBUTION BOX DETAIL: REVISIONS PERC. -�- OBSERVED NOT TO SCALE NOT TO SCALE LEACHING PIT DETAIL. No L,ArE (c rJ TEST - GROUNDWATER NOT TO SCALE TP _ TP " TP NOTES: I. SEPTIC TANK SHALL BE STEEL 4. INLET AND OUTLET TEES TO BE CAST IRON, NO. OF OUTLETS: 3 REINFORCED CONCRETE. SCHEQ 40 PVC OR CAST-IN-PLACE CONCRETE. TEES MANHOLE COVER LOAM 81 SEED GRD. EL. -i . =� GRD. EL. ��•t} GRD. EL. TO BE CENTERED UNDER MANHOLE COVER. NOTES- BROUGHT TO FINISH tiVADE OR PAVEMENT 2. SEPTIC TANK TO WITHSTAND H-10 LOADING r_-'�-J---� i/I. DIST. BOX TO WITHSTAND H-10 LOADING l, 1'r. , GW. EL. - GW. EL, =- GW, EL, �' UNLESS UNDER PAVEMENT, DRIVES OR I 1 TRAVELED WAYS,WHEREIN H-20 LOADING I I UNLESS UNDER PAVEMENT, DRIVES OR "MIN OF 1/8' ` l ToN v' -,__ z,y�+/ 1 TRAVELED WAYS WHEREIN H-20 LOADING ' Tor: . SHALL APPLY. J PRECAST F_ 0 1/2� 12"MIN. FILL I SHALL APPLY. ASHED 3. ALL PIPE CONNECTIONS AND CONCRETE MANHOLE COVER I I DIST. I 1 TONE Ur-,T% 'yD�L BROcu.t/ ^'�'�'ti CONSTRUCTION TO BE WATERTIGHT. BROUGHT TO FINISH GRADE -� BOX 2. PROVIDE INLET TEE OR BAFFLE WHERE SLOPE OF : y5 ,e�• „- :;„,�, I I INLET PIPE EXCEEDS 0.09 FT/FT. OR IN .7po�e I I .PUMPED SYSTEM PVC INLET PIPE .. - o 0 0 o CM o 0 o p / 12'MIN. L---r-y---J GENERAL NOTES: COVER 3. FIRST TWO FEET OF PIPE OUT OF DIST I �d p ff1ELs�tn1 PCK'` BOX TO BE LAID LEVEL Q C=I o CID 0 0 0 • r/ NOTE: I THIS PLAN I S FOR_"._, iw�c. >t 4 ,: __ .:.. .: • PLAN VIEW = N AND e I o/, �, �. . ' C IT TO CONSTRUCTION OF HEIGSEWAGE Teo "SJ a e Do �' ' b WITHSTAND AND H-10 LOADING REMDVEABLE a c o 0 0 o ca a s DISPOSAL FACILITY ONLY. NORMAL WATER LEVEL COVER +�' •� �,. l.' UNLESS UNDER t i r __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _, PRECAST .� PAVEMENT, RIVE 2. ALL CONSTRUCTION METHODS AND O OR I 3/4•Tp I-I/2 a c o 0 o Q o o a TRAVELED WAY WHEREIN MATERIALS SHALL CONFORM TO MASS. P+, plvlr. I : PROVIDE +. , ;:, ,, F 7 /, DOUBLE LEACHING PIT •oo H-20 LOADING SHALL D.E.Q.E. TITLE 5 AND LOCAL BOARD INLET TEE -Sib/ , ZAP .c ,Cp 1 1 WATERTIGHT u WASHED a t3 o Q o Q a o a p► °� APPLY. OF HEALTH REGULATIONS. �,,:/Nf✓u.?M T L`R� I — M[CAST (DI I,_ _ S(tYR) ,� I. .'.1 I'; STONE °JOINTp d 4'-0" MIN. OUTLET 1/G`�.__ L. I ,. _ t- 1i }; L) (no ftnell 8O 'TAN IC �`• LIOUIU OEETN TEE NOTE 2 1 i� 1 w . ( 0 3. ALL PIPES LOCATED UNDER PAVEMENT _ 4" INLET _ a o o CM c� cc o C3 o Q1. OR TRAVELED SHALL BE SCHEDULE '�l'�J r`I 4"OUTLET •I 1�i oo �j 40 OR EQUAL. r Pi1 i ..I L., o 0 0 0 o cl C1 a o - - - - - - - - - - - - - --_J 'L------1J �--- -� .. •' .: : :, :. ' o.. ,' . . .' �: l-.-. '• oo -BOTTOM ON QiT BOTTOM ON LEVEL STABLE BASE 0iir � oo. 01 A o o !/� /e LEVEL STABLE ( ' t/otsFTiryw CROSS-SECTION BASE y o PLAN VIEW CROSS-SECTION VIEW . - i 1 4{ DI A CONSTRUCTION NOTES: DATE: DATE: DATE: I INVERT ELEVATIONS- TEST BY: TEST BY: TEST BY: 40 INVERT AT BUILDING WITNESSED BY: WITNESSED BY: WITNESSED BY: 4" INVERT AT SEPTIC TANK(in) T: 4" INVERT AT SEPTIC TANK(out) PERC. RATE: PERC. RATE: PERC. RATE:MINJINCH MIN./INCH MINJINCH 4" INVERT AT DIST. BOX(in) 141 4" INVERT AT DIST. BOX(out) /2. 97 DATUM: INVERTS AT LEACHING FACILITY: VERTICAL DATUM: N,<:;, v c. INVERT A T L EACHING PI T 5 BOTTOM OF LEACHING PIT -1 2 BENCHMARK USED: ��.-_�,�.►.� 1�1,i,.1c -,-/_►f:�t�+ t=�a�-:I � 1�,-E- r- U. S. G. S. MA XIMUM GROUND F'G� ��-,e•�rzr C: 9r.ie.�...re 07/ es-7r WATER ELEVAT/ON _43— EN„pINA'G°!c".3 /IIlY�'4/•,r i:.! OBSERVED GROUNDWATER ELEVATION _ o HIGH GROUND'.PATER LEVEL COMPUTATION STEP 1• Measure death to water table to nearest 1/10 ft__..__._. 7bST P/r '�3� Date !�e�tr�. 7.S ..._.—_.. T011rn/CaY/Vaal STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: GAcoropnate index CI Water-level range zone....�—._� t__J DESIGN CRITERIA:STE? 3 Using monthly repo "Current Water Resources Ccnoitions" determine current depth to DESIGN FLOW: I 86 12 3 -L/G.P.B./D - - G.P.D. - water fevei for index well ' I - ^' `^'Y•x I _BEDROOMS AT � �� STE° 4 Using Table of Water-levei Aoiuvtments for index well ISTE?2A1,current dearth to water level for mcex well (STEP 3). and water level zone(STEP 29) The BSC Group determine water-level adjustment_-----•--_........_.._----.._-..__..--......----.._-......_.... REQUIRED SEPTIC TANK: STE? 5 Estimate depth to h,ah water by subtracting the water GAL. level adjustment(STEP 41 � ^ from measured de-cm,to water 11 � ( sb' SEPTIC TANK PROVIDED: _ 25 GAL. levelat site ISTE? 11 ..............- -..............._.................... _.....................................<..._........ I SIZE OF LEACHING FACILITY REQUIRED: Cape Cod Survey Consultants DESIGN PERC. RATE: r MINJINCH 6- ' _ �- .,ram rt! __:�,.•r 3261 Main Street Route 6A Barnstable Village MA 1.c LL f _ c. 02630 _ g 9c P1✓� 617 362 8133 GPD SIZE OF LEACHING FACLITY PROVIDED: PROJECT TITLE: rot.7E SEWAGE DISPOSAL SYSTEM DESIGN ern. LOT 8 EEL RIVER ROAD II14 ar IN BARNSTABLE OSTERVILLE far y to •� PREPARED FOR: William Staudt PROFESSIONAL ENGINEER-CIVIL DATE DATE: 3 19 st, COMP/DESIGN: aw CHECK: DRAWN: 5/a W FIELD FILE NO _ .----------- -- f _ DWG. NO. ^G 4 - Z SHEET JOB NO: 2 OF A ,