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0059 FIRE STATION ROAD - Health
59 Fire Station Road Osterville A = 118 - 114 1 o Commonwealthof Massachusetts �" li7 Title 5 official InsMIETMpection Form , Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a,. 59 Fire Station Road Property Address Jaxtimer _ Owner Owner's Name / v Information is Osterville ✓ Ma: 02655 2/19/2020 %. required for every ' page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When A. Inspector Information /,h"i 11�3g63 filling out forms on the computer, Sean M. Janes use only the tab — --- --- key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Beldan Lane Company Address --..._._.._. Centerville Ma 02632 _ IL AV Cityrrown State Zip Code I 774-248-4650 smjonestitle5@gmail.com, SI4522 sean@s onestitle5.com__ _ _._....._..�__...._ 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 l have determined that the system: *r x>sv 1. ® Passes 2. ❑ Conditionally Passes zF 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails f'k 2/19/2020 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 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. t51nsp.occ,•rev:7/2612016 Title 5 t7MC121 inspection Forth;SUDSUMaCe 50w3ge 016p0531 System•Page 1 0/18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Fire Station Road Property Address Jaxtimer Owner Owner's Name information is Osterville Ma 02655 2/19/2020 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: The property located at 59 Fire Station Rd Osterville is served by a Title V septic system consisting of a 1500 gallon septic tank, 1000 gallon pump chamber, distribution box and a 28'xlVx6"4 lateral leach field. The system was found to be in proper working condition at the time of inspection. 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 ray.7126=18 Title 5 Official Inspection Form:Subsurface Sewage Utsposal System•Page 2 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Fire Station Road Property Address Jaxtimer Owner Owner's Name information is required for every Osterville Ma 02655 2/19/2020 page. Cityrrown state Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(coot.); ❑ 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(1j(bj that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.MUMS Title 5 Official Inspection Form!Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Fire Station Road _ Property Address Jaxtimer _. Owner Owner's Name information is Osterville _ Ma 02655 2/19/2020 required for every Ci fTown page ty 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 151nspAoc•rev.7120=18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Esimim Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for'Voluntary Assessments 59 Fire Station Road Property Address Jaxtimer Owner Owner's Name information is Osterville Ma. 02655 2/19/2020 required for every page. Cityffown state Zip Code Date of Inspection C. Inspection Summary (cont.) 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 El ® Liquid depth in cesspool is less than 6"below invert or available volume is less than Y day flow ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ® Any portion of cesspool or privy is within 100 feet of a.surface water supply or tributary to a surface water supply. ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. 0 ®, Any portion of a cesspool or:privy is within 50 feet of a private grater 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 C.4. Yes No 0 (l 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 15insp doe•rev.7126/20i8 Title 6 official Inspection form Subsurface Sewage Disposal system•Page s of i8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Fire Station Road Property Address Jaxtimer Owner Owner's Name information is required for every Osterville Ma 02655 _ 2/19/2020 page City/Town State Zip Code Date of Inspection C. Inspection summary (coot.) 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 am inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ 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. ® o 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)] t5incp.doe-rev.712W2018 Title 5 Offimal inspection rorm'.0ub3urfaco Gerwage Oiepa l 3yMem-Page 0 of 10. Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Fire Station Road Property Address Jaxtimer Owner Owner's Name information is required for every Osterville Ma 02655 2/19/2020 . page City Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 220 gpd Description: Number of current residents: 0 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 0 No information in this report.) Laundry system inspected? ❑ yes No Seasonal use? ❑ Yes Z No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes No -Last date of occupancy: unknown Date- lSinsp.doc•rev.712W018 Title 5 Mist Inspecdon 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 59 Fire Station Road Property Address Jaxtimer Owner Owner's Name information is required for every Osterville Ma 02655 2/19/2020 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: pate Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? _ — Reason for pumping: t5insp.®oc•rev.7l260118 Title 5 Official inspection Forma Subsurface Sewage Disposal System•Page 8 of 18. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Fire Station Road Property Address Jaxtimer Owner Owner's Name — information is required for every Osterville Ma_ 02655 2/19/2020 page. CitylTown State Zip Code Date of Inspection D. System Information (cons.) 4. Type of System: ® Septic tank, distribution box, soil absorption system Q Single cesspool Q, Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes,attach previous inspection,records, if any) ❑ Innovative/Altemative 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 t/A system by system operator under contract ❑ Tight tank.Attach a copy of.the DEP approval. Q Other(describe): Approximate age of all components, date,installed (if known) and source of information: system installed 5/2/2016 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 1.5 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.): Joints in good condition, no leakage,vented through roof. t6 nsp.iroc•m.MUM Title 5 OTripal inspection Form:Subsurface Sewape Disposal System•.Page 9 of,18. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Fire Station Road Property Address Jaxtimer Owner Owner's Name reformation is required for every Osterville Ma 02655 2/19/2020 page. Cityrrown State Zip Code Date of inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons Sludge depth: 5" Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 2" T' Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Opened covers and took measurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking_and,was structurally sound. t5IMPAW-rev.7YAQ018 Title 5 official Inspection Form Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Fire Station Road Property Address _ Jaxtimer Owner Owner's Name information is Osterville Ma 02655 2/19/2020 required for every --- - 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 0 polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: ---- gallons per day 1.5rny,ebtr;•rev 717r9Pln R Title 5 Official Insisacilan Form:Subsurface Sewage Disposal system•Page:1 of 16- Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form•Not for Voluntary Assessments 59 Fire Station Road Property Address Jaxtimer Owner Owner's Name information is required for every Osterville Ma 02655 2/19/2020 page. Cityfl own 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: 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 011 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.): Distribution box was level and in good condition with no rot. Water level was even with outlet invert with no signs of past backup. t5lnep.doc•rev.71=2018 Title 5 Dffidal Inspection Form,Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts -� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Fire Station Ro®d Property Address Jaxtimer Owner owners Name information is Osteryille _ Ma 02655 2/19/2020 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: Z Yes ❑ No* Alarms in working order: Z Yes ❑ No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber was in good condition, pum�ar d alarm functioned when triggered manually "If pumps or alarms are not in working order, system is a conditional pass. 11. toll Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: = i Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: IT leaching trenches number, length: ® leaching fields number,dimensions: 1 28'.x16'x6" overflow cesspool number: ❑ innovative/alternative system Type/name of technology: - tginsp,doc•rw.7/2612018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 10 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Fire Station Road Property Address Jaxtimer Owner Owner's Name information is OStervllle Ma 02655 2/19/2020 required for every page. Cityy/rown 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.): no lush vegetation, soil and stone dry with no signs of past saturation. 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.): I r5in6p,duc•rev.71M018 Title 5 Official Inspection Form'Subsurface Sewage Disposal System•Page 14 or 18 Commonwealth of Massachusetts Title 5 Official Inspection Form _ s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Fire Station Road Property Address Jaxtimer Owner Owner's Name information is Osterville Ma 02655 2/19/2020 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions T Depth of solids ._. Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.dec•rev.Mfiote T)tte 5 Official Inspection Forth:Subsurface Se"golhsposel System•Page 15 Of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 fire Station Road Property Address Jaxtimer Owner Owner's Name 'information is OSteNille Ma 02655 2/19I2020 required for every page. CitfTown 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 Iry � I 33 _�- Al -? 2 �3 q0 w76 3 C) ?6.b t5insp.doc-rev.70MIS Tills 5 OKciat Inspection form Subsurface Sewage Disposal System-Page 16 of 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Fire Station Road Property Address Jaxtimer Owner Owner's Name information is Osterville Ma 02655 2/19/2020 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. 91„ 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: 3/26/2015 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: Design plan dated 3/26/2015 indicates that groundwater was encountered at 91 and system is designed to have 4'+sel�erat!on between bottom of s.a.s. and adjusted high groundwater elevation. Before filing this Inspection Report,please see Report Completeness Checklist on next page. WrispApc•rev.726W18 Title 5 Official Inspedian Form.Subsurface Sawage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Official Inspection Form Title 5 0 p Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Fire Station Road Property Address Jaxtimer Owner Owner's Name Information is Osterville Ma 02655 2/19/2020 required for every page. City/Town Ci /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 I5in3p.doc•rev.W28 MS Title 5 Official Inspection Form Subsurface Sewage 01sposal System•Page 18 of 18 MAY-04-2016 21:3e From: To:15oe7906304 Pa9e:1,'1 Town.of Barnstable Regulatory.Services i sxenersMM F Richard V.Scab,Interim Director :RAM .� Public health Divisimi Thomas McKean,Director 200 Main Street;Hyannis,MA 02601 Offs e: 508-862 4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: Sewage Permit# 268-2 Y? Assessor'9 MaplPnrcel 119 10 H Designer: lv Installer: 80r�6L�o tonstt/ �+ 1�nC- ' Address: -7 'PQ.�.z Gro Address: 'VS— ZU(US4.r_ea( — �9s .h,4- ^'16 m2f $ Pa aovi 6 5'4 On 012- "/4 6.r-A.l ei 6mft x, was issued a permit to install:a ate (installer) -septic system at. S 7 F%ram 5 4e wn ke6 based on a design drawn by (address) „),`6q, � '1v/+�i dated 8 4/a!�/ R��. I a p 1 designer) certify that the septic system referenced above was installed substantially according to the design,which may include minor approved changes such as lateral relocation of the :distribution box and/or septic tank. Strip out (if required) was inspected and'the soils were found-satisfactory. -Pa J�,_tr,,er c..a 5 r;4 C,'r+ a A Qr jt-t 4 r Q s PeYd,,-_-(a I certify that the septic system referenced above was installed with major changes ti.e. g=ter than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Regulations. Plan revision.or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. c I certify that the system referenced above was constructed ' ianee with the terms ofthe 11A letters(if applicable) (Installer's Signature) V.. estgner's Signature (Affix Desfg'hiFr31.Stamp Here PLEASE RETURN TO BARNSTABL)Ev,PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLMCE WILL NOT BE ISSUED UNTEL BOTH THIS FORM AND AS;.. BUILD'CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTD DIVISION. THANK-YOU. Q.1*tic DcsigwCertificntion Form Rev&14-13.doC l' Chuck Rowland From: McKean, Thomas <Thomas.McKean@town.barnstable.ma.us> Sent: Tuesday, January 19, 2016 8:44 AM To: chuck@sullivanengin.com; Stanton, David Subject: RE: EJ Jaxtimer - Fire Station Road Ground Water Adjustment I have no objections with your methodology for determining high groundwater-as described in your e-mail. From: Stanton, David Sent: Friday, January 15, 2016 8:22 AM To: McKean,Thomas Subject: FW: EJ Jaxtimer- Fire Station Road Ground Water Adjustment -----Original Message----- From: Chuck Rowland fmailto:chuckta)sullivanengin,com] Sent: Thursday, January 14, 2016 3:55 PM To: Stanton, David Subject: RE: EJ Jaxtimer- Fire Station Road Ground Water Adjustment David, John& I did a level run at the property and think we came up with a good high water mark. The wetland abutting the property drains into a river and would not crest very much more than the standing water since it would just run into the river and drain to the ocean. The bank that the wetland would flood to during a large rain event or very wet season is 6.3' Elev. The difference between the standing water in the well at the property and the water level in the wetland is 0.9' higher in, the well. This leads me to a conclusion that a high water table would be about 7.2'elev. And to confirm this during the past year the water level reading in the well have reached a maximum elevation of 7.1'. Using this method,the high ground water elevation at the site is 7.2'. Could you confirm that you and Tom agree with how I came to my conclusion before I start designing a system. Thanks Chuck From:Chuck Rowland [mailto:chuck sullivanengin.com] Sent:Wednesday,January 13,2016 2:09 PM To: David Stanton<David.Stanton(c@town.barnstable.ma.us><David.Stanton!2town.barnstable.ma.us> Subject: EJ Jaxtimer-Fire Station Road Ground Water Adjustment David, 1 Did you get a chance to review the ground water adjustment diagram that I gave you. Thanks Chuck Chuck Rowland, E.I.T. Sullivan Engineering&Consulting, Inc. P.O. Box 659 Osterville, MA 02655 508-428-3344 508-428-9617 (fax) E;1ICl c . S'U1, 1 OUS lti� t 2 JFM14 MJJA SOND Elevation LO d- � "� "' o 0 0 O N a o 1 D' 9' 8, 7' 6' 5' C correction to water reading o B correction to water reading p A correction to water reading Seasonal High Water Line Grade River Wetland Ground Water Correction High 59 Fire Station Road Observed Groundwater SULLIVAN ENGINEERING, INC. Ground Contour Sketch OSTERVILLE, MA Not to Scale TOWN OF BARNSTABLE LOCATION �� � j Q�_f� SEWAGE# @�tF��q VILLAGE v 7L.Z ASSESSOR'S MAP&PARCEL Sz INSTALLER'S NAME&PHONE NO. � SEPTIC TANK CAPACITY I LEACHING FACILITY:(type) �Fjj ts'Z, (size) 'A'7,1c 1 NO.OF BEDROOMS OWNER PERMIT DATE: - COMPLIANCE DATE: s 2 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) 1 Feet FURNISHED BY zo y )� 1 0 Z44 L y 6d d I f I I I I I _ I i � i F � I r No. /� I � Fee THE COMMONWEALTH (0 MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Rpplitation for ]Disposal 6pBtem Construction i3Prmit Application for a Permit to Construct(<epair( ) Upgrade( ) Abandon�< omplete System ❑Individual Components Location Address o Lot No. Fie- $k Owner's Name,Address,and Tel.No. Asses sor's Map/Parcel r l ��Y Installer's Name,Address,and Tel.No. r-c)3 q9 Designer's Name,Address,and Tel.No.Sul 7 t Wort 2r /eoI Type of Building: Dwelling No.of Bedrooms 2 Lot Size 2 97 5 sq.ft. Garbage Grinder( ) Other Type of Building 5,nA 2eS, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required)��/` 220 G PD gpd Design flow provided 7171' ft'h Dp-$,I ^ �30 gpd Plan Date g'�9^/y Number of sheets Revision Date Title 5".t,e 10*,_ Ptb,Gb34 lb Size of Septic Tank JE&O Gp��®�fA c Type of S.A.S. te-QQ4%, P� Description of Soil M d /i �' Lo4� ,f "�� er Nature of Repairs or Alterations(Answer when applicable) 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-nort-6 ce the system in operation until a Certificate of Compliance has been issued by this Board of Health. ed Date Application Approved by `'mod Date b--1 � q Application Disapproved by Date for the following reasons Permit No. Date Issued l ----------------------------------------------------------- --------------------------------------------------------------------------- �j •i i .. N, i0�� s' j r• '"f, q __wee /Entered in computer: THE COMMONWEA7�TF�=�11E'MASSACHOSETT_S--- Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS l�l�ILatIOTY for �I8�J08aY- pBtPtYC CDnstrUttionPrIYCIt Application for Permit to Construct(Repair( ) Upgrade( ) Abandon Complete System ❑Individual Components Location Address o Lot No, G C f-f .$ Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.Now �r 71 (—9 3 9 Designer's Name,Ad ess,and Tel.No. ��a �--a wT -7 �r1 er R Po BvK 5oY-Yz8-31Y`� C4'S'4•-=4 9 va^fit 05�e r L,1IR 41 A -�` Type of Building: _ Dwelling No.of Bedrooms 2 Lot Size 2��, 97 5 sq.ft. Garbage Grinder( ) Other Type of Building ( No.of Persons Showers( ) Cafeteria( ) r Other Fixtures. Design Flow(min.required)2(�j/' 220 G PD gpd Design flow provided M;,h Des, 11 310 gpd 1 Plan Date �ry Number of sheets Revision Date j 5 Title S �'C (Jio 4 e-0 04 --` Size of Septic Tank_(S 00 64//pr S Type of S.A.S. // Description of So' Tf t '.:L. a—�� G� e Lo4.r, fin '�� t3wL0 Pr; Nature of Repairs or Alterations(Answer when applicable) , f 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-nof of face the system in operation until a Certificate of ( Compliance has been issued by this Board of Health. ed Date Application Approved by Date � � 'a 1 � � t Application Disapproved by Date for the following reasons Permit No. S�G L-) ' Date Issued �a 1 -- ------------------------- -------- -- - - - -- - -------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of CoMpliante THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed(1r Repaired( ) Upgraded(✓� Abandoned( )by -06 A-:c1 w v't "1 �,Q S l ��at S`1 f,(•e f�-q i�:o^ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No ''�y' dated y Installer Designer f cr '� #bedrooms '6r Z Z 0 &PD Approved design flt�w -33o G AD 3 g� 7) y5^ gpd The issuance o thi permit shall not be construed as a guarantee that the system ill etion as des ed. v Date in Inspector u ------ --------------------------- No.. L "1 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS i Zispo aY *pstem Construction Permission is hereby granted to construct( ) Repair( Upgrade( ) Abandon System located at s� �� f . d^ g,' )�" 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 spe"cial conditions. � 3 Provided:Construction ust be o pleted within three years of the date of this pe Date T T `1 L Approved by ' Commonwealth of Massachusetts Title 5 Official Inspection For'm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 FIRE STATION RD • , Property Address f LEVINE ROSALINE K Owner Owner's Name information is OSTERVILLE _ MA ' 6-15-14 . required for every page. Cityrrown 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: A. General Information, - When filling out forms on the computer,use only the tab key 1. Inspector: to move your s I y DOUGLAS A BROWN cursor-do not ' use the return ame of Inspector key. ZLIGLAS A BROWN INC Company Name � P.O. BOX 145 ` c' Company Address CENTERVILLE MA 02632 fe0°" Cityrrown State ' Zip Code 508-420-4534 S14297 Telephone Number License Number B. Certification - I certify that I have personally inspected the sewage disposal system at this address and that the s 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,Mm intenance of onite sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ? ❑ Passes ❑ Conditionally Passes ® Fails El Needs Further Evaluation by the Local"Approving Authority ' t 1_j a r '5-15-14 Inspector's nature Date- The system inspector Shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection'. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the'system owner shall submit the, 'report to the appropriate regional office of the DEP. The original should be'sent to the system owner -and copies sent to the buyer, if applicable, and the approving authority: ****This report only describes conditions of 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•3/13 Title 5 Officitsion Form:Subsurface Sewage Disposal System•Page 1 of 17 ` r f . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments M 59 FIRE STATION RD ' Property Address LEVINE ROSALINE K Owner Owner's Name information is required for OSTERVILLE ' MA' 5-15-14 every page. CitylTown State Zip Code Date of Inspection 3 B. Certification (cont.) Inspection Summary: Check-A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.' Comments: B) System Conditionally Passes: - ❑ One or more system components as described in the"Conditional Pass"section need to be ' replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health;will pass. Check the box for"yes", "no"or"not determined"'(Y, N, ND)for the following statements. If"not determined," please explain. t. 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-3/13 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 , ` a. I • Commonwealth of Massachusetts Title 5 Official Inspection Form' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments. 59 FIRE STATION RD Property Address LEVINE ROSALINE K 4. Owner Owner's Name information is required for OSTERVILLE MA 5-15-14 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cost.) t, ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health):. ' ❑ broken pipe(s)are replaced ❑ Y e ❑ 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): .; 4 , ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):.. ❑ obstruction is removed ❑ Y ❑ N- ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health:' Condition$e�lst which require further evaluation'by the Board of Health in order to determine if the system Is falling to protecf public heath, safety or the environment. 1. System will pass unless Board of Health determinesin 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 iswithin 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 a r _ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 59 FIRE STATION RD ` Property Address LEVINE ROSALINE K Owner Owner's Name information is required for OSTERVILLE MA 5-15-14 every page. City/Town State ,Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic,tank and SAS and the SAS.is within 50 feet of a,private' water supply well ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: " **This system passes if the well water analysis, performed at a DEP'certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are,triggered. A copy of the analysis must be attached to this form. 3. Other: r D) System Failure criteria Applicable to All Systems: You must indicate"Yes or"No"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® - 0 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El El or 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 Y2 day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 5 59 FIRE STATION RD Property Address • LEVINE ROSALINE K Owner Owner's Name information is OSTERVILLE MA 5-15-14 required for every page. CityfFown a State Zip Code Date of Inspection B. Certification (cont.) ' Yes _ . No Required pumping more than 4 times in the last year NOT due to clogged or El Z 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.. 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,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5ppm, provided•that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with'a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that-one or more of the above failure criteria exist as described in 310 CMR 15.303, 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 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. r For large systems,you must indicate either"yes"or"no"to each of the following,,in'addition to the questions in Section D: , Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El, Elthe 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 R above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the,Department. t5ins•3r13 ' Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspectionform' a Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments• 59 FIRE STATION RD Property Address ' 'LEVINE ROSALINE I< x Owner Owner's Name information is ` required for OSTERVILLE MA 5-15A4 every page. Cityfrown State Zip Code' Date of Inspection . C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ❑ ® Pumping information was provided.by the owner, occupant,or-Board of Health ❑ ® ` .-" '- 'Were'any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal.flows in the previous two week period?.. El' ®' Have large volumes of water been introduced to the system recently or as part of this inspection? a 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? v ® ❑ 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 tfe 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design), 2 Number of bedrooms(actual): 2 DESIGN flow based on 310'CMR'i 5.203 (for example: 110 gpd x#of bedrooms): 220 •. b t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form + Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 FIRE STATION RD` Property Address LEVINE ROSALINE K Owner Owner's Name information is required for OSTERVILLE MA 5-15-14 every page. City/Town State Zip Code Date of Inspection D. System Information - Description: ACORDING TO AS-BUILT CARD SYSTEM CONSISTS OF A CESSPOOL AND 2 INFILTRATORS WITH STONE THERE WERE ALSO AT LEAST ONE OTHER PIPE COMING INTO OR EXITING THE MAIN CESSPOOL ' Number of current residents: 0 - Does residence have a garbage'grinder?, ❑ Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ❑ No information in this report.) } Laundry system inspected? ❑ Yes ❑_ No Seasonal use? El Yes ❑ No Water meter readings, if available last 2 ears usage d , VACANT 9 ( Y 9 (gP ))� Detail VACANT Sump pump? .❑ Yes ❑ No Last date of occupancy: - UNKNOWN M Date Commercial/Industrial Flow,Conditions:' Type of Establishment: , r Design flow(based on 310_CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present?. - ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑' Yes ❑ No Water meter readings, if available: t5ins-3113 TRIe 5 Offi ial Inspection Form:Subsurface Sewage Disposal System•Page 7 of.17 J =Mas Commonwealth ofsachusetts - Title 5 Official Inspection Form' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 59 FIRE STATION RD t Property Address LEVINE ROSALINE K-• Owner Owner's Name information is required for OSTERVILLE MA`' 6'15-14 every page. Cityrrown - State Zip Code, • Date of Inspection D. System Information (cont.) r Last date of occupancy/use: Date + Other(describe below): General Information Pumping Records. Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped:' gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank;distribution box, soil absorption system r Single cesspool ❑ Overflow cesspool _ ❑ Privy. ❑ Shared system (yes or no) (if yes, attach p eviou's 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): CESSPOOL AND 2 INFILTRATORS AND APPEARS TO BE SOMETHING ELSE AS WELL(COULD NOT DETERMINE) k . t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 A. f } : Commonwealth of Massachusetts = Title 5 Official Inspection Torm, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 59 FIRE STATION RD Property Address LEVINE ROSALINE K Owner Owner's Name information is required for OSTERVILLE MA 5-15-14 every page. City/Town State Zip Code Date of Inspection D. System Information cont: Approximate age of all components, date installed (if known),and source of information: - APPEAR TO BE ORIGINAL 5 Were sewage odo�s'detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): ' t Depth below grade: . feet Material of construction: ❑ cast iron ❑,40 PVC ' ❑ other(explain): Distance from private water supply well or suction line; _ feet Comments(on condition of joints,'venting,evidence of leakage, etc'): Septic Tank(locate_on site plan): r, y Depth below grade: feet Material of construction: ❑concrete '❑ metal ❑fiberglass ❑ polyethylene El 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: Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts S F Title 5 Official Inspection Form"' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 59 FIRE STATION RD Property Address LEVINE ROSALINE K Owner Owner's Name information is required for OSTERVILLE MA 5-15-14 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom'of scum to bottom of outlet tee or baffle How were dimensions determined? ' Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to,outlet invert, evidence of leakage, etc.): Grease Trap(locate on site plan): Depth below grade: y 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 t5ins•3/13 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17« Commonwealth of Massachusetts ' Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 FIRE STATION RD Property Address ` LEVINE ROSALINE K Owner Owner's Name information is OSTERVILLE `' MA 5-15-14 required for every page. City/Town 'State Zip Code Date of Inspection D. System Information(cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Y ' Material of construction: ' ❑ concrete El,metal. . ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons ' Design Flow: gallons per day Alarm present:" ❑ Yes ❑. No Alarm level: Alarm in working order: ❑ _Yes ❑ No Date of last pumping: Date, P Comments(condition of alarm and float switches, etc.): ' ' Attach copy of current pumping contract(required). Is.copy attached? ❑ Yes ❑ No t5ins•3113' r Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary'Assessments M 59 FIRE STATION RD . Property Address •,_ ,; LEVINE ROSALINE K Owner Owner's Name - information is required for OSTERVILLE MA 5-15-14 every page. Cityrrown State Zip Code Date of Inspection, D. System Information (cont.) Distribution Box(if present must be opened) (locate on site.plan): : k Depth of liquid level above outlet invert W . f 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.): a Pump Chamber locate on site plan Pumps in working order. '`' ❑,-Yes E] �No* Alarms in working order: ❑ Yes ❑ No*. Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): *If pumps or alarms are not in working order, system is a"conditional pass. Soil Absorption System(SAS) (locate on site plan, excavation not required): ' r If SAS not located, explain why: `. . VIEWED BY CAMERA . t5ins-3/13 + Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 FIRE STATION RD Property Address LEVINE ROSALINE K. ' Owner Owner's Name information is required for OSTERVILLE MA 5-15-14 every page. City/Town State Zip Code_- Date of Inspection D. System Information (cont.) a Type: ❑ , leaching pits number: ® , leaching chambers number: 2 INFILTRATORS ❑ 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.): _ Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration AT LEAST ONE Depth—top of liquid to inlet invert Depth of solids layer,w Depth.of scum layer Dimensions of cesspool w •. Materials of construction Indication of groundwater inflow ® .Yes ❑ No ` t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System'•Page 13 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form k Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 59 FIRE STATION RD . Property Address LEVINE ROSALINE K Owner Owner's Name information is required for OSTERVILLE MA 5-15-14 every page. CitylTown State_ Zip Code Date of Inspection D. System Information (cost.)'. Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): THE MAIN CESSPOOL APPEARED TO HAVE A SMALL AMOUNT OF GROUND WATER IN THE BOTTOM , OWNER STATED.THAT BASEMENT GETS WATER AT TIMES OF HIGH GROUND WATER 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.): S t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of.17 Commonwealth of Massachusetts Title 5 Official Inspection Forme _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 59 FIRE STATION RD' Property Address , LEVINE ROSALINE K Owner Owner's Name information is OSTERVILLE MA 5-15-14 required for ' every page. City/Town State Zip Code Date of Inspection D. System Information (cont:) 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 f ® drawing attached separately r r. • r t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 r A Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal'System Form -Not for Voluntary Assessments 59 FIRE STATION.RD - ` Property Address LEVINE ROSALINE K Owner Owner's Name information is required for OSTERVILLE MA 5-15-14 every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) . Site Exam: > ' ® Check Slope -' ® Surface water` da. ® Check cellar ® Shallow wells Estimated depth to high ground water: 7-10 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ¢+ ❑ Observed site(abutting property/observation hole within 150 feet of.SAS) ❑ Checked with local Board of Health-'explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed.USGS database-explain:. You must describe how you established the high ground water elevation: MAIN CESSPOOL APPEARS TO HAVE GROUND WATER IN THE BOTTOM NEIGHBORING HOUSE HAS RAISED SYSTEM( SITES ARE SIMILAR IN ELEVATION Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 ` - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments x M ,Y 59 FIRE STATION RD Property Address LEVINE ROSALINE K Owner Owner's Name information is required for OSTERVILLE h MA 5-15714 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D,'or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System'lnformation-Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file • max. • { t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Assessing As-Built Cards '`' - Page 1 of 2 TOWN OF BARNSTABLE LOCATION SEWAGE VILLAGE OS%ew�I� ASSESSOR'S MAP 6z LOT', INSTALLER'S NAME si PHONE NO.COCPA•a GC/Jc� yd8-S6yO .. S PTIC TANK CAPACITY l 00 6A-15/of ACHING PACILITY:(type)n2,,,fr/T•a%sltl (size)_ STn c NO.OF BEDROOMS oZ PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER �tael� LTC,% e DATE PERMIT ISSUED:. / /.l-9/ DATE COMPLIANCE ISSUED-_ VARIANCE GRANTED: Yes No . .4 ` • �a�y�j e at. http-//www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=118114&seq=1 5/15/2014 .. ':Gown of Barnstable: P# DepArtiment of Regulatory Services M Public health Division, HateM ASS `•.a ' �3 " �`�' 200 Main'Street.Hyannis MA 02GOf Fb MAt i / Date Scheduled Try as b f Time- Fee Pd. ! d�'00 _ 2 {x g 14 So S r�abtiii Assessment for Sewage Disposal Performed B : l V�h "� h I C F_rj%"7 PLC Y Witnessed By: NJ CATION'c& GENERAL INFORMATION Location Address. ' Cl"�7 071, rei{ Owner s Name Kos aui;nE � k4 ��7 e Address 59 F re sf7a►i I Uskerv,'llr, m+ 0a.G55 AsscasorsMap/Parcel:kf� / Engineers Name a NEW CONST®RU&IOBN REPAIR , Telephone#„ * Land Use es. O � p•.,M.) „Surface Stones Distances from:..Open Water Bddy. / S4 � _ft Possible Wet ` l -. Q. Drinking Water Well ff Drainage Way! ��� �_ft Property l the 2 S^ — ft Other. ft 4 i SIM,TcM,(Street name,di inerisious of lo� exact locations of test holes&pert tests,locate wetlands{n.proximity to holes) �r « 11$�! 'r .� Pareaf material(geologic) �.Q S�l Depth to Deli �OOi t r Depth to l3roundwater.,Standir�A;V�ater m Hole 6 Weeping from hit Race 1. A I q d EsUmated Seasonal High Groundw'iter —�e /� 3 DFTIial A'1'ION IE OR SEASONALRIGH WA.T +R T'ABI.r�+' Method Used: . Fr,���+C:i I 3 R?co!►,P,,q Depth Observed sta�tfir g mobs;hole 0 1ti; Depth to sgll mottles. N°ne— in ' Depth to weepmg from rdg of bs hot 7 (v ln, Grnundwatee Ati�uatment •> ':' it. Index Well#MzW ReadmglD to rtndeaWelllevot��r Ac{� thctor. AdJ Oroundwuter].eXel„ 7 I '1CRCOLATION.T +'ST Data tzi�.'xttue ' Observation Hole# Tiute at rl" .... ...., ._. t I I I r: - I :.ev..-•.-,- ;:�y A t ter,,. a +' .*.,.� ..^>� _. ._ - _-. Depth of PercTM ..Tliite ttt G Start Pre-soak Time @ d End Pre-soak Rate:Mrn/hrcit,Y F t 2M'In;h {2 •�i%1' .. Site Suitability Assessment Si Pat ,Site Failed:'.. - Additional Testing Needed(Y/N) e .. t. Original: Public Health Division" Observation Hole Data To Be,Completed on Back---------- ' t: ***If percolation test is to be conducted within 100' of wetland,you must first notify the. , Barnstable Conselrvation Division at least one(1) week prior to beginning. Q:\SEPTICVERCFORM.DOC DEEP.;OBS 1 RvA.7CION HOLE LOG Hole# _ Depth from Soil Ho�izou Soil Texture Soil Color Soil Other Surface(in.) ([1SDA) (Munsell) Mottling (Slnucture,Stones;Boulders. isistencys 96 t3�yel1 te LAI i KEEP OR$ERVATION HOLE LOG Mole# Depth from Soil Florim Soil'rexture Soil Color : soil Other Surface(in.).. �. (USDA) (Munsell) . Mottling ' (Structure;Stones,Boulders. i en o roM,� 119 to�Ie DIM O :SERVA'CIbN HOLE LOG Hole# � Depth from !Sol[Horizo Soil'dxiure Soil Color Soil Other Surface(in.) (USDA) (Munscll). Mottling' (Structure,Stones,Boulders. i to tid �'�9 �w '� : ��s-o� Q r/�' sly • 3 C II �s . 0 to /z sly DEEP O �SEIIVA 'ION MOLE LOG' Hole # Depth from Soil Horror Sotl''exture Soil Color Soil Other Surface(in.) (u$bA) (Munsell) Mottling (Structure,Stones;Boulders, 101 Flood Ilistirauce.Rate,�t>< 2/ Above S00 year�flood bbpndnry No ! , Yes __- o.Y/. 1-4a1 f 1 1 j - l� of ( f+�v 'Within 500 year bound'ry No I Yes Within l00 year flood 'bundaiy_No Yes _ De tl> of Naturall Oc rrin Pervious Ma erial ' Does at least.four.feet of_I afurally occu�lring or in exist in all areas_ observed throughout the: area propose If the soil a sorption syt�tett7 1 -- If not,what is the.depth 0, ii atarally,occurring pervious material'? Certification I card that on /`�- i (date)I have passed the soil evaluator examination approved by the certify Department of Environmental Protection and that the above analysis was performed by me consistent with the required training;cxpertis4:and experience described in 10 CMR 15.017. Signature Date 7 8 l Q:\S.l?P'riC\PERCFORM.DOC ': HIGH GROUND—WATER LEVEL COMPUTATION' a' n ` Date: ° 7 9/ Site Location: �9 ��� S�a+10 ';,\OG�'. Permit: ° Owner: k ,Phone: jxx ;niel Cons = yYp8 ,. Ilk Contractor: S'vll,'✓gn'_F >�ec�;nr, C'� k Ro:+a�un�/ 6 ` Phone: Notes: p:. ,e , STEP 1 Me'asure�depth to water table _. to•nearest 1/10'ft. r ' (depth is in feet below:Iand'surface)- Date. 7 t; 0 rnmtdd/yy,;, feet'below is { STEP 2 Using Water-Level Range Zone and Index°Well x //:3o Map locate site.and `determine l - A) Appropriate index .ugs�P`e B) Water-level rang e zone, ` 41 rs ' ,• T STEP 3 Using monthly"Current Water Resou`rces'. _ Conditions" determine'current depth to,water. " level for index well.. } 20 mrn/YX STEP 4 Using Table of Potential 1Water,Level Rise for, index well (STEP 2A) `current depth to.water: ' level for index well (STEP 3); and water-level`. - zone (STEP 213) determme water-level - 4 adjustment. ; s :�• �* 0 STEP 5 Estimate depth`to thigh water,by subtracting,the4 water-level 1adjustment (STEP 4) from', �': 3 7 0 measured depth to•water"level at site,(STEP 1) . NOTE* Tables 1-9 "Potential£Water-Level Rise" are attached asEworksheets to this,file: _ * xi :s - Z monthly index well data: www.capecodcommission.org/wells.html t,, UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid p USPS Permit No.G-10 Sender: Please print your name, address, and ZIP+4 in this box • p Town of Barnstable Regulatory Services Department Public Health Division 200 Main Street Hyannis, MA 02601 I i i� h SENDER- COMPLETE,THIS SECTION . e Complete items 1,2,and 3.Also complete A_ ignat r ell I item 4 if Restricted Delivery is desired. ❑Agent I ■ Print your name and address on the reverse essee so that we can return the card to you. B.Received.by(P fed me) Date T livery.I 'i ■ Attach this card to the back of the mailpiece, or on the front if space permits. D, Is delivery address different from item i? ❑Y 1. Article Addressed to: If YES,enter delivery address below: O.No Rosaline K Levine I Katherine J Levine 59 Fire'Station Road 3. se ice Type Osterville, MA 02655 Certified Mail ❑Express Mail Registered 9Return Receipt for Merchandise. --- ❑Insured Main ❑C.O.D. ,i 4, Restricted Delivery?(Extra Fee) p Yes 2. Article Number (Transfer from serylce label) 7 012 1010 0000 2851 3603 PS Form 3811.,February 200d Domestic,Return Receipt 1.02595-02=M-1540 • D I LVJ V-Aj`I( ! LCI:U�T1 . . . . O .A M F IAl NPostage $ /=:1"11 �Certified Fee ✓/� PostmaO Retum ReceiptFee Here ON O (EndorsementRequired) 1 �4 Restricted Delivery FeeQ (Endorsement Required) p Total Postage&Fees $ ' I" rI F59 � saline K Levine r % Katherine J Levine Fire Station Road erville. MA 0965.9 Certified Mail Provides: o A mailing receipt 'W o A unique identifier for your mailpiece e A record of delivery kept by the Postal Service for two years Important Reminders: o. Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. a For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". n If a'postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry.. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 Town of Barnstable Barnstable Regulatory Services Department S. ' Public Health Division I' �• 1639. 1 N�A�A 200 Main Street, Hyannis M 0260-1 200? A Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2851 3603 June 10, 2014, Rosaline K Levine % Katherine J Levine 59 Fire Station Road Osterville, MA 02655 The septic system located 59 Fire Station.Road, Osterville,MA was last.inspected on i 5/15/2014 by Douglas A Brown, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Single cesspools automatically fail in the Town of Barnstable: • There are indications of groundwater inflow; must be attended to. You are ordered to repair or replace the septic system within sixty(60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH omas McKean, R.S. CHO Agent of the Board of Health • Q:\SEPTIC\Sample Failure Ltr\59 Fire Station Rd Ost Jun 2014.doc f> TOWN OF BARNSTABLE LOCATION SEWAGE # 9/-�0/ A � I1g I1� VILLAGE DSlr2�,f/e ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. ®CeA-/! C'�✓l�r�/— L/s�$-S 6�D SSEPTIC TANK CAPACITY �0Q d 6�1/f✓l r � i TEACHING FACILITY:(type) -Tn /ol j (size) P/ o7 STD NO. OF BEDROOMS o2 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED; VARIANCE GRANTED: Yes No i 1 �,. q 3s,.��<r . �, :\ , , � \. �. ��, (� � w e ` �'1 x s�, 1i . � aJ . —� `1 , _ .� ,. ", d r' Fus... �d 6z? THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works Tnnstrnrtion Fumit Application is hereby made for a Permit to Construct ( ) or Repair �l an Individual Sewage Disposal System at ...-- fzd ..5.. � I..W.........Rd:..................... ............................................. .........------................ Location-Address - - —SotiN l���J/dV�. ..1iRF s r_oW°r v' °Qo,�l ................ Owner dresF UInstaller........................................ ...... .� ....w_f��.....�dress'�S PZ ji..X. I 1 I£---.............. UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.......................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers a —Type g ---------------------------- P ( )--- Cafeteria ( ) Otherfixtures -------------------------------------------•---------------•--------•--------------------•-----•--•---------•------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x 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........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_-___-__--_-__-_-------. 44 Test Pit No. 2..........:.....minutes per inch Depth of.Test Pit---:................ Depth to ground water........................ a' •----------•-----------------------•----••------•---------•-------..............•---••......-----•--......................................................... 0 Description of Soil............................................................................... --------------------------------- ...................................................... x U W --------------- ------------------------------------------------------------•---------•---••--•--------------. �r /q+ Nature of Repairs or Al�rations—An�wer when applicable -. U� d.___ !. /0/zR 0_.- _.__._- U P PP . ............................ ------Sri' c.......................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. j Signed - ...................��-'y'�`�' �..� 9 4/ ........ ------------- .Date Application Approved Bye...-- /t�_---- ��?-,l? r..- Date Application Disapproved for the following reasons: ................................. . ----........ -- --.:.--------------: ...---------------.-.......---....... . .................................... . ................................./.------....-----------..............------------........---------...................---------------...........--------- .................................... Permit No. .. -:.r1�.--1-------------------------------- Issued .------------. . . e ., Date V It , — No................r.... .........�.CS✓ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou for Dispnsa1 Workii Tonstrnrtinn runfit Application is hereby made for a Permit to Construct (. ) or Repair ( an Individual Sewage Disposal System at -----....... -Location-Address or Lot No. 0.�n� (J i ry 5. ..f� S Ar t?.w..1�o� U: fit„ //� _.... - ------•... .......... Owner A¢dress W '01idor� /ylFAc/vwIAM.1� /!v. t?UI ------------------------------------------------ ._........... Installer Address d t'_Type of Building Size Lot............................Sq. feet /a Dwelling—No. of Bedrooms___-_. .................................Expansion Attic ( ) Garbage Grinder ( ) aOther—,,Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------------------------------------•••....--•-•-•--....--••-•--------------------••-----•----------•---...........-•-------_-•---- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x 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 ( A Dosing tank ( ) Percolation Test Results Performed by.................... ---------•------••-•---,--••-•--•--•--•----••-•--••--- Date-----------------........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' ----•-•---------•------------------•••---•-••-•-------------••••••••--------••......-•---••-•-------......................................................... 0 Description of Soil....................................................................................................................................................................... x U -••--•••••••-•--•----------•-••----••••--•-----...--••---•-----•-••--•-------••-•-•..._.......-•-•--•--=----•---•••••--•---•---------------•-•--•--•-----•......--••-•-----•......•--••-•--•._..__...... W -•--••----• -- ------------- --- ----------•----- = iy U Nature of Repairs or Al rations—Anrer when applicable____T�_....... .................................................._............ ..-•--•-••----••----......--�Y�is/l�L(7....--S �J rn. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed -._a tOr�+� c ------� 9 �°l CJ� ` � - - ------------------ Date Application Approved B .......... ........... --------------- ------------------------- -- ........------------------------- Dae Application Disapproved for the following reasons: ......-.. ................. ----------------------------------------------------------------------------------------------------------- -- ---------------------------....................--------------------- -----------.... ------------ 4 -- - /� D PermitNo. .. Issued -------------------------------------------------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ter#tfira e of C11ontylia n.ce j THISW TO CERTIF J, hat the Individual Sewage Disposal System constructed ( ) Or Repaired ( v) by..... r^ 1... ` OiuFi .1....GvA .............. ....................................... Installer - _ p at ................. .. ......... s 5.?i.t .a ���t.........---...------------------..............---......------...... ----.------------------------....: has been installed in accordance with the provisions of TITLE 5 of he State Environmental Co g as desc ibed in. the application for Disposal Works Construction Permit No. ..... ..........._ ......�.... dated ........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE... ............................................................... Inspector � �/t!. -------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 3o No...�/.... ........� FEE........................ �i��r�a��1 nrk,s �n n rrmi� gam. Permission is hereby granted-------- 6 to Construct ) oepair ( �n Individual r ewag is os System D L. at No....... .....4-'..5�7-�Y v% ... -------------------•-••---•••. Streetc as shown on the application for Disposal Works Construction Permit N.J_/l'"f���fDated__ _-;. '7//7'-"'5y ��-•- --• --- Board of Health I DATE------------------ --•-------- - -��----------••-•-•--------•---..... v FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS Miorandi, Donna From: John O'Dea [John@sullivanengin.com] Sent: Wednesday, August 13, 2014 3:10 PM To: Miorandi, Donna Subject: RE: Firestation road We had over 7 ' to groundwater, but we were a little higher on the property. I would put it maybe 6' down. By the bottom of the existing cesspool acting as septic tank. The existing infiltrators probably are not 5' above water - but shouldn't be in water - unless the adjustment putting water above the road is correct. -----Original Message----- From: Miorandi, Donna [mailto:Donna.Miorandi@town.barnstable.ma.us] Sent: Wednesday, August 13, 2014 2:29 PM , To: john@sullivanengin.com Subject: RE: Firestation road Oops! Ok-didn't realize that. How deep did you find groundwater on that perc. I will consult with Donny and others when they get back in office this afternoon. But, for now, keep planning -on full plan. Donna -----Original Message----- From: John O'Dea [mailto:john@sullivanengin:com] Sent: Wednesday, August 13, 2014 9:45 AM . To: Miorandi, Donna Subject: RE: Firestation road we have already done the perc test. . . . .Donny filled in that day. The adjusted groundwater comes up above the road, which we know is not true. we knew the groundwater across the street didn't make sense at the time, but their system was backing up and they couldn't wait to study it more. That's why we wondered if a tank would by us some time to review. We will work on a full plan - unless the above changes your minds. John O'Dea, PE Sullivan Engineering Inc. 7 Parker Road / P.O. Box 659 Osterville, MA 02655 508-428-3344 508-428-9617 (fax) t -----Original Message----- From: Miorandi, Donna [mailto:Donna.Miorandi@town.barnstable.ma,.us] - Sent: Wednesday, August 13, 2014 8:56 AM To: John O'Dea Subject: RE: Firestation road Hi John: Funny you should ask as I was just going to email you regarding this. You will have to do a perc test to determine actual groundwater because it is too close to #50 that had a groundwater issue. They have a pump 1 chamber and mounded system and if I recall that lot is higher than #59. This house will need the whole package-sorry! ! Donna -----Original Message----- From: John O'Dea [mailto:john@sullivanengin.com] Sent: Wednesday, August 13, 2014 8:40 AM To: Miorandi, Donna Subject: Firestation road Donna, Have you had a chance to run the idea of a septic tank and d-box only to immediately remedy the failure and give us time to try the existing field and study the groundwater? And if so is this just a permit that can be pulled by installer without engineered plans? John Sent from my iPhone A 2 Miorandi, Donna From: John O'Dea [John@sullivanengin.com] Sent: Wednesday, August 13, 2014 9:45 AM To: Miorandi, Donna Subject: RE: Firestation road We have already done the perc test. . . . .Donny filled in -that day. The adjusted groundwater comes up above the road, which we know is not true. we knew the groundwater across the street didn't make sense at the time, but their system was backing up and they couldn't wait to study it more. . That' s why we wondered if a tank would by us some time to review. We will work on a full plan. - unless the above changes your minds. John O'Dea, PE Sullivan Engineering Inc. 7 Parker Road / P.O. Box 659 Osterville, MA 02655 508-428-3344 508-428-9617 (fax) b , -----Original Message----- From: Miorandi, Donna [mailto:Donna.Miorandi@town.barnstable.ma.us] Sent: Wednesday, August 13, 2014 8:56 AM To: John O'Dea Subject: RE: Firestation road Hi John: Funny you should ask as I was just going to email you regarding this. You will have to do a perc test to determine actual groundwater because it is too close to #50 that .had a groundwater issue. They have a pump - chamber and mounded system and if 2 recall that lot is higher than #59. This house will need'the whole package-sorry! ! Donna -----Original Message----- From: John O'Dea [mailto:john@sullivanengin.com] Sent: Wednesday, August 13, 2014 8:40• AM To: Miorandi, Donna Subject: Firestation road Donna, h . Have you had a chance to run the idea of a septic tank and d-box only to immediately remedy the failure and give us time to try .the existing field and study the groundwater? And if so is this just a. permit that can be pulled by installer without engineered plans? John Sent from my iPhone ' 1 Page 1 of 1 Miorandi, Donna From: John O'Dea [John@sullivanengin.com] Sent: Wednesday, August 06, 2014 11:32 AM To: Miorandi, Donna ° Subject: 59 Fire Station Road Donna, As a follow up to our discussion I spoke with Doug.Brown yesterday. His recollection was that there was clear water in the bottom of the pit which is now serving as the septic tank before infiltrators. He believes the house was unoccupied, so assumes it was ground water—which is the failure. We have not dug up the infiltrators, or confirmed the size. My question is can an installer pull a permit without engineered plans to replace the septic tank and add a d- box, and would this meet the upgrade requirement for the time being. We have performed a perc test. The adjusted groundwater using the Frimpter is 2' above the road. We would like to study our well longer before committing to a full upgrade. We also believe that the site will be redeveloped in the 3-5 year time frame anyways. If you could review this with Tom at your earliest convenience I would appreciate it. There is a closing scheduled for the 26th, and we need to have a permit for something before that. John O'Dea, PE Sullivan Engineering Inc. 7 Parker Road / P.O. Box 659 Osterville, MA 02655 508-428-3344 508-428-9617 (fax) 8/7/2014 Miorandi, Donna From: John O'Dea [John@sullivanengin.com] Sent: Wednesday, August 13, 2014 8:40 AM To: Miorandi, Donna Subject: Firestation road Donna, Have you had a chance to run the idea of a septic tank and d-box only to immediately remedy the failure and give us time to try the existing field and study the groundwater? And if so is this just a permit that can be pulled by installer without engineered plans? John Sent from my iPhone 1 Miorandi, Donna From: Miorandi, Donna Sent: Wednesday, August 13, 2014 8:56 AM To: 'John O'Dea' Subject: RE: Firestation road Hi John: Funny you should ask as I was just going to email you regarding this. You will have to do a perc test to determine actual groundwater because it is too close to #50 that had a groundwater issue. They have a pump chamber and mounded system and if I recall that lot is higher than #59. This house will need the whole package-sorry! ! Donna -----Original Message----- From: John O'Dea [mailto:john@sullivanengin.com] Sent: Wednesday, August 13, 2014 8:40 AM To: Miorandi, Donna Subject: Firestation road Donna, Have you had a chance to run the idea of a septic tank and d-box only to immediately remedy the failure and give us time to try the existing field and study the groundwater? And if so is this just a permit that can be pulled by installer .vaithout engineered plans? John Sent from my iPhone 4 1 Map Page 1 of 1 Town of Barnstable Geographic Information System New Search Home Help Parcel Custom Map Abutters Map Size ® � Zoom out a®l fl a l d a D In Viewer ® >,r 71 RAB=JPG 11R [ 1/ �f X %9 X 924 X 7 14.81 r Turn map layers on/off by ®. ' • selecting check boxes below f Refresh . 12.89 - .. X 14_4 1 © Town BoundariesEM -A a ❑ Road Names a 8.73 ❑ Voter Precincts Q o X ,. 07,39 ❑ Map&Parcel Numbers (] `F-ee. � Parcels ❑ FEMA Flood Zones - - - Set Scale 1" = 109 Aerial Photos v MAP DISCLAIMER ; �_ � � Effective July 16,2014 _ Velocity one Copyright 2005-2010 Town of Barnstable,MA All rights reserved.Send uestions or Mae iol®lS year flood - BarnstableMA v1.2.5122[Production] , 131 AO-100 year flood - ❑0.2%Annual Chance Flood ❑Open Water ❑/ Neighboring Towns k 13 [J Water ❑J Streams " © Jetties - { ❑J Edge of Water - - v ' r http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=118114 8/13/2014 . Miorandi, Donna From: Miorandi, Donna Sent: Wednesday, August 13, 2014 8:56 AM To: 'John O'Dea' Subject: RE: Firestation road Hi John: Funny you should ask as I was just going to email you regarding this. You will have to do a perc test to determine actual groundwater because it is too close to #50 that had a groundwater issue. They have a pump chamber and mounded system and if I recall that lot is higher than #59. This house will need the whole package-sorry! ! Donna -----Original Message----- From: John O'Dea [mailto:john@sullivanengin.com] Sent: Wednesday, August 13, 2014 8:40 AM To: Miorandi, Donna Subject: Firestation road Donna, Have you had a chance to run the idea of a septic tank and d-box only to immediately remedy the failure and give us time to try the existing field and study the groundwater? And if so is this just a permit that can be pulled by installer without engineered plans? John Sent from my iPhone 1 n . UNITED STATES POSTAL SERVICE First-Class Mail - Postage&Fees Paid USPS_ Permit No.G-10 Sender: Please print your name,address, and ZIP+4®in this bo� Town of Barnstable Public Health Division �6 200 Main Street I v� Hyannis, MA 02601 ' ri����111�tillr�:l1�!'II�Il,t1ldll"�t���ifl�lt'!!'i{i1{l�l�ria�#� i _ SEN• • • • • • • e Complete iterr)A 1,2;and 3.Also complete 'A °igria re item 4 if Restricted Delivery is desired. ❑Agent 0 Print your name and address on the reverse ❑Addressee so that we can return the card to you. p B. ece by(P d Na Jroe� C. Dat Qf. livery 0 Attach this card to the back of the mail iece, �V / 3 ` or on the front if space permits. 1. Article Addressed to: D. Is very address erent from item 1? Yes If YES,enter delivery address below: ❑No .. l r�3 Sam Y. Jaxtimer 350 Main Street 3. Service Type Ostervilie, MA 02655 ❑Certified Mail® G Priority Mail Express' ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (transfer from service►adeq ? 7 014 °12 0 0 000110358 0 4 3 7 PS Form 3811,July 2013 Domestic Return Receipt 0 OPostage $. DEB Certified Fee r� Retum Receipt FeeO (Endorsement Required)O Restricted Delivery Feela (Endorsement Required) O uTotal Postage&Fees t ram. c. Sam Y. Jaxtimer n 350 Main Street r Osterville, MA 02655 Certified Mail Provides: e A mailing receipt + e A unique identifier for your mi it iece r c A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. e For an additional fee,a Retum Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form'3811)jo the article and add applicable postage to cover the fee Endorse mailpiece"Return Receipt Requested'.To receive a fee waiver for" a duplicate return receipt,a LISPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. " IMPORTANT:Save this receipt and present It when making an Inquiry. ` PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 ^ Town of Barnstable Barnstable I IN '� Regulatory Services Department "" BAPMNA"B`E ' 11 Public Health Division 639 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7014 1200 0001 0358 0437 February 24, 2015, °'' �� C�- i Sam Y. Jaxtimer 350 Main Street"' Osterville, MA 02655 The septic system located 59 Fire Station Road, Osterville,MA was last inspected on 5/15/2014 by Douglas A Brown, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed"under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Single cesspools automatically fail in the Town of Barnstable. • There are indications of groundwater inflow; must be attended to. You are ordered to repair or replace the septic system within sixty(60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future i enforcement action. PER ORDER OF THE BOARD OF HEALTH — :� Q Q cKean,R.S. CHO Agent of the Board of Health _ Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\59 Fire Station Rd Ost Jun 2014.doc #ij� �. <n o ��, s4 s a ► .. .p }-aka K � r--.:.. c� � j -a� x f'�•�� ..+"�',t -y o r CD CYD cry' i— o - a zp a CDCIO r o 7 i rn cn oo -�-4 I T � oo b c- - rnI � z CD rn ' -� a s rn C rn C s — CD m U7 0 t + f 4 131 00 A t 1 p�l ...«tea CJL.,`r_ -d 1 g C) zu- C i •-1-1 j 'w f 1 00 CD l Y h m 4 N ro _ it iry co CL qb r. Jo-a 'rty r-r Pe CDD cn if CD l f z` .t O •m CD '' - '' m ", z i v; �n � ,Vµ ly_+• r Jp'Cld $ n d. r. v a o ti Town of Barnstable Barnstable Regulatory Services Departments i "'RN Public Health Division I I 039.A1� 2007 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790.6304 Thomas A..McKean,CHO CERTIFIED MAIL# 7012 .1010 0000 2851 3603 June 10, 2014,' r Rosaline K Levine o y % Katherine J Levine 59 Fire Station Road Osterville, MA 02655 The septic system located 59 Fire Station Road, OSterville, NU was last inspicted o, i 5/15/2014 by Douglas A Brown, a certified septic inspectorfor the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the followings • Single cesspools automatically fail in the Town of Barnstable. • There are indications of groundwater inflow;must be attended.to. You are ordered to repair or replace the septic.system within sixty.(60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH omas McKean,R.S. CHOo-- Agent of the Board of Health Q:\SEPTIC\Sample Failure Ltr\59 Fire Station Rd Ost Jun 2014.doe No...........y`• - •• FE$.$5...Q-............ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH _.. .Town- ...or.....Barnstable - ApplirFation for Di-spo5 al Workii Chan rudiuit Orrmit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: ...........52_F.'ir.e... -------•--------------------- ...............-------------•------•------•-•----_...-----...------------------.......------...._ Location-Address or Lot No. JackLeY_lrAe....................................................... .............Qat.eruilla......................................................... W J. P. Macombe(�"ne& Son Inc Centerville Address .................................................................................................. ............................................................................,h..............._..__. ` Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( } Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons....................._------- Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------- - --------------------------------------------------•----..---•-•------- .._.. W Design Flow............................................gallons per person per day. Total daily flow............................................ WSeptic Tank—Liquid capacity............gallons Length.............__'Width.........------- Diameter................ Depth.................. x 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........................................ . as Test Pit No. 1................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........................ ----------------------------------•-------------•-----......_._...::----------.......--•-------••---............................ .............. Description of Soil..........Sand- & ..GraV.el---------------- x W --------------------------------------------------------------------------------------•-•---------------------------------- :... U Nature of Repairs or Alterations—Answer when applicable.--1-1000 gallon. tank -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-•--_-•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iiT 1-;u. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in . operation until a Certificate of Compliance has*re , dth oa health. Signed m" x ..................................... Date ApplicationApproved By--------------------------------------------------------------------------------------------•-•- Date Application Disapproved for the following reasons:................................................................................................................. •-•-•--•-•----------------•------•-----------------------------------•--.....--------•----------------------•••....................................................................................... nn Date Permit No......................................................... Issued...�T_.'z=•-S �7 ._...__. Date i ,'1 • t No.._... _........ ;q5...�. ._ \ THE COMMONWEALTH OF MASSACHUSETTS yr}�'yt B�yOAF DQ. -OYyy��}'j HEALTH OF-...... ....-............- ................................ 1 1 hip t �trila �un �g1rk1xr# nrt Ap lication is hereby made for a' Permit to Construct ( ) or Repair ( ) an Individual Sewage Dissp' SyStetT1 St fi 1•i � S €�t ntcail . ... 5 � .. ..... 9.. __ . Location-Address t,-or Lot No a � ..... J ..ck Levine .• ........ . ..._........Q . �.. � .-•---•-- �T -� w ---- W 4 . P s Macomb tit Sqn Ina 4�E�.ntervill 6 Address f' a .................... •-•-••-•-••-• ................ •••-•-•••.......-•--•--••••..._ 1 Installer X Address d Type of Budding . ,. Size Lot__________________ _' _____Sq feef`- U � Dwelling . No. of Bedrooms f j _______________Expansion,Attic ( ) Garbage,Grinder s OPL4ther T e of Bu1ldiil No. of ersons__ _ Showers — Cafeteria k. Q' tr Y x Other'fixtures W `Design E1ow gallons per person per day. Total daily flow __.______ _gallons 1:4 Septic Tank--Liquid capacity gallons Length _______________ Width Diameter__-____._.___:_. Depth ,• Disposal Trencli "No ___.____.___ 'Width ._ Total Length Total leaching area______ sq ft;' x See page PIt No; _____. Diameter �?______________ Depth below inlet__._..__ Total.leachin area____ s ft P g - P g q zi Other Distribution box ( ) Dosing tank ( ) Percolation Test.Results Performed by.. ............................ ....... ......... ..:... Date................................... Test Pit No I________________minutes per inch Depth of Test Pit.................... Depth to ground water...........:............ `_ Test.'PitNo 2_______ ......nunutesper�mch Depth of Test Pit.___:__._..__ Depth to ground water.............. O . fife SC ( tP _ 4 ___________________________ Description of Soil _••--- 4 . U ....................... ...............................................= .................................................... ---- ----- ------------- - W , ; U Nature of Repairs or Alterations Answer when applicable.__�-11 g 11 fll1 tank ..................... . Agreement.: < The"undersigned agrees to install.:the aforedescribed Individual Sewage Disposal System in accordance with the.:provisions of TITLE 5 of,the State.:Sanitary Code— The undersigned further,;agrees not to place the system:in. i. operation until a CertificateAof,,Compliance has �ee' issued by th oa health Si ned .k. ........... -•• PP PP A lication A rov ......................................................... Date .` - Application Disapproved for the following reasons-----------------------------•---••-••-•-•-------- ---- -- f ..--------•-••. -----•-------------•---------.....---•-••••-•--•-._....... ' Date % .Permif No......................................................... . Issued: ---------•--- ••--•--- ` } Date r ' THE.COMMONWEALTH OF MASSAC:H,USETTS ¢' t BOARD OF `HEALTH v.. Barnstable ...................................... OF.......-.-........ .......................................... _.............._... °{ IIIS 1� TO CERTIF' , That the..Individual Sewage Disposal System constructed ( ) or Repaired (X b ti 1Oseft P. Macomber & Son ��c. - S Installer at. �S9 Fire ;StaticSn Road ••asterville - i hasfeeh installed m accordance with the provisions of T 5 of The State Sanitary ode as described in the. apple rion for Disposal Works Construction Permit No. __ X-Y�__________________ dated_- ". °_!$f'': ._.__._._____.:. E 51 t`,TH 'ISSUANCE OF THIS CERTIFICATE SHALL.NOT-BE CONSTRUED AS A GUARANTEE THAT THE SYSt�Et *ILL FUNCTION SATISFACTORY. z E � DATE` •-•-_____...... p�. ...m � nsgegtor r a> + a W. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Barnstable No ... PEE, i Pefm sI rijis hereby granted----=tjOAd h P Macomber -`� �a�...In . k, ._.. _-•-.... to Constr ct ( � ) or-`Repair ( an.Individual Sewage Disposal System of No_.5 ' _etAtlon ad, Ostrul2e, t k q m t 14= Street as shown on the�a�pplication for Disposal Works Construction Pe it ___ Dated....�``_��"%�� _..._.... a:r ax*, ,: *d-of H 7 DATEy i i J Y.7 .......................... --.._..... FORM 'I25,4 \aBBS & WARREN, INC., PUBLiSHE § LOCATION SEW_ G PERMIT NO. VILLAGE S - INSTA LLER'S NAME & ADDRESS// '8UILDER OR WNER� DA T E PERMIT ISSUED - - -L . DAT E COMPLIANC'E ISSUED �G�-zs - �� v y 04- --- -- --- - - L____ - - -- ion ASSESSORS REF■.x oa Map 118, Parcel 114 Proposed Inspection Port F■ stal ''1 Fill Material Shall Be Comprised.of Clean Granular Sand Meeting (See Cross Section) the Requirements of 310 CMR 15.255 (3). 'r � j A Sieve Analysis Shall Be Performed by the Design Engineer 0 Prior To Installation. Septic to be Pled in Vent - Charcoal Filter OVERLAY DISTRICT. ' 3 ' " • ' N85� �' 2„E / Fill to meet s ecs Final Location to be See Note 1.1 Determined at Time of Installation so as 106.00 DEVELOPED PROFILE OF SYSTEM Min. F.G. EL. 14.8 F.G. EL. 13.95 Min. to be as Inconspicuous os Possible GP - Groundwater Protection District ■ / EL. Splash Plate tI Perforated i e to 1 > r� Flow Equalizers PP 10' br n NOT TO SCALE As Required be pihed I FLOOD ZONE: #� .>.. •• 0.005'per LF k� F.F. EL. 13.25 Too EL. 13.2' M, See Note 6 (typ.) _ EL. 12.70 \ Zone AE & 8 ro ! F.G. EL. 11.8t IF C. EL. Min. 12.15 EL. 12.9 =EL12.2' Community Panel NO. ; EL. 1 84 y �o 1, .............. #250001 C0776J ' \ See note 10 .. 2:;2:......' `' Jul 16 2014 Approved Filter y , fPequlrAd x, 4 9 €l. f0.55 Installer To ° A: • `' U. ' \ Confirm Prior EL H-20 Plastic or Rubber �••'7'� i r+ a 11'' \ �► To An Work EL 10.10 Remove & Replace ZONE: 4 • c ~} Y 1500 Gallon H-20 Impervious Barrier to EL P All Unsuitable Soils Within 5' of o n Septic Tank 1000 Gallon prevent Breakout ■ �s- Lo f Arec 1 W t.M-f d/s.d d Pump Chamber As per + i I 310CMR15.255 2 T The Outer Perimeter of The System n RC iwo(Yj Coats o1*pplOvd Sealant 249 75f �F \ "/ w ea'ot.of Ate•° To EL. 12.2 Adjusted Groundwa er EL. 7.2' ,�T•� 'G / ` ./r■o!z)coots of nvprowd Sedsnt ( ) YP• ' # sy \ / EL 5.40 N ) Area (min.) 87,120 SF (RPOD) E • EL. 5.93' �Ad Lstment Per Frontage (min) 20 Observation- ( ) , N ) Bedding,"T"s To Be Installed Onp F Encountered rounG dwater= Width (min) 100' Inspection Bon Port, a e Compacted Base Setbacks: f W (TyP•) Location Plan: as Per Title 5 Fron t 20 to Side 10' S001 1 WZ0W* #59 i N Rear 10' a 1 Sty w/f ~�2 �" o / CAPACITY LITERS P� MI1�IUTE^ Dwelling \ cni , r•� 0 40 80 I20 160 200 240 280 320 360 D-Box ! ` % o W �... 9 t: c? i o l ;. _._�_._• 30 cG I 25 -5 _ 7 W Existing Septic System W # +- N,F to be Removed Judith E Souza Tr. 20 : s Approx. Location Per Tie Card W 28' Paved Parking Area 0 15 < < Vent - Charcoal Filter `} tt! 4" Perforated Final Location to be `7•74 T Pipes Determined at Time of Installation so as to be as Inconspicuous as Possible Ins ection Port Proposed I 3 < ent 4"0Perforated PVC Pipe Placed p J l 0 h --*---716' Vertically Down Into The Stone 1J�o0 Gallon 1\ Bench Mark p Finish Grade To The Soil Below W/Screw Cop Septic Tank f' CB/DH '^ Q To Within 3" Of Finished Grade M El e v. 13.2' 2Inspection t \ ....... - - Port Proposed k m s p f fj "-min. Compacted Fill Filter Fabric 1000 Gallon Book 103-121?i ' i - I Leach Field Deta11 3'-max. Pump Chamber Shed Plan..6 1g4-�d t _. i - -Plan s°°k Proposed 7u'. I w c 2, _ � a 1„ 10, - - -� Garage ted Pe on r0 so,- ��; �� �-(� : "' t`y(} `�l) ��� 4"k7 Perforo z 8 1 2 0 t PVC Pie 1 a Stone Thrust blocks , r _ , Ott CAOAGITY GALLONS PER "MINU`T•E 2' 4low 4 "111 4 on pressure lines r 3 4"-1 1 2" where required Strip out unsuitable 6" q Material Within 5' of outer Double Washed Stone Perimeter of System 200' River Pump Power & Float Control PERC TEST: 14 391 Front Buffer / -1 !L Cables Installed.In Accordance 16' Locate Junction Box 0 O With Federal, State & Local M Outside of Tank Bldg. & Elec. Codes PERFORMED BY: CHUCK ROWLAND,EIT SULLIVAN ENGINEERING CROSS SECTION OF LEACHING BED / 28'\ TH-2 ir) Alarm To Be on Separate SOIL EVALUATOR NO. 13586 Y TH-3 a) LO Service From Pumps 10.0 '� M WITNESSED BY:DONALD DESMAR AIS,�R.S.-TOWN OF BARNSTABLE Y f ..�0"SC �O 7001 ` _ v �7 i/2"0 Galy. Pipe BVw eUf 9 Vc'/1t �~ TM-4 N For Float Support DUNE 12,2014 f ` \ SITE PASSED - lr . Z •� Proposed 40 Mil �' 4'-0" p a Field \ Water\ Tight Barrier toy TEST HOLE - I EL. 13.50 TEST HOLE - 2 EL. 13.50 16 / \ Preyent Breakout ; 24"0 Opening Above A/E.LAYER . . . . . . . . . . . . ..'.'A/E.iAYER - \ For Manhole . . . . . . . . . . . .. . . .'. . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . \ \ 10' \pff_ _Sys-tem 14 Frame & Cover . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... . . . . . . . . . . . . . . . . . . . . . . . .......... „ LOAIY> SAND: : :: :':':': :': :':':' \� --- _-- - / ` \IN, \ f Ott . . 13.2 6 13.0 w; VERY PALE.BROWN VERY Pt?�I,E.BtQW '; . . ... . . . . -- Existing Barn --_ ---� . . . . . . .. . . . . . . . . . . .. . . . .. . . . . to be Removed PUMP PLAN VIEW DETAIL 16" M nIUI 'SAND. .'.'.'.'. .'.'.'.'.':'. 12.2 18" : l..D.. ..-$AND:':':':':':'. . . . . .'. 12.0 16 104.03 \ C LAYER 10Y 8/8 L 1 Y 8 50, 579� p0'40"W y \\ NOT TO SCALE LIGHT YELLOWISH BROWN 1t LIGHT YELLOWISH BROWN SEPTIC NOTES B Vw Bu f fed _ MEDIUM SAND 91 MEDIUM SAND 5•9 1.Location of Utilities Shown on This Plan Are Approx.At Least 72 Hours N/F \\ 20" PERC TEST 15.9 GROUNDWATER ENCOUNTERED Prior to Any Excavation For This Project the Contractor Shall Make 24m & ore 25 GALLONS IN< 15 MIN. the Required Notification to Dig Safe(1-888-344-7233). Richard P. Callahan Tr. \ \ Conduit.Thru Chamber.For Frame & Cover \\ \ Finished Power & Float Cables 9" Min. 91 tt PERC RATE<2 MINI'1N(LTAR=0.74) 5.9 2.The Contractor is Required to Secure Appropriate Permits From Town °\ Grade Cover \ \ , _ GROUNDWATER ENCOUNTERED Agencies For Construction Defined by This Plan. \ 3.Wherever Sewer Lines Must Cross Water Supply Lines Both Lines Shall 200' River Front Buffer 4"0 Sch. 40 PVC Be Constructed of Class 150 Pressure Pipe and Shall be Water Tested to From Septic Tank p Inv. 10.05 Galy. Chaff Drill 1 8"0 Hole Assure Watertightness., In General Water Lines Shall be Constructed in Emergency Storage For Drain TEST HOLE - 3 TEST HOLE 4 s y s To Pressure Dose EL. 13.70 EL. 13.70 Coordination With COMM Water,and Shall be in Accordance Volume 607 Gal. � System Min. 2' Cover . . . . . . . . . . . . . . . . .'.'.'.'.'.':'.'.".'.'.'. A/E.LAYER With 248 CMR 1.00-7.00&310 CMR 15.00. Alarm On El. 7.56 E " " " " " • ' ' PUMP SELECTION DATA s .':': : :.: : : :.:':':':':':':':':':':':':': ....: ' 4:A Minimum of 9"of Cover is Required for All Components. Pump On El. 7.25 ..LOAMY.SAND.. . . . . .'.'.' ':':' '... .OAMY- -SAND 5.All Structures Buried Three Feet or More or Subject Single Family One Pump Needed 6 13.2 8 12.9 -Head Loss 13.0E-6.80'=6.2'Using 7' Pumps off El. s.8o Pumpto Vehicular Traffic to be H-20 Loading.It is the Engineer's w o Bw LAYER.i0YR.5/8. . . .'.. . .'.'. Bw'L .YER.I0YR.5. . . . . . . . . . . g g -Pipe Friction Loss ° 3"0 soh. 4o PVC :. . . ...:...:VERX PALE.BROWN::::: :.. . .....' VERX' A .B.$ROWN'. .'. . . . .'.'. Recommendation that H-20 Always be Used. . . . . . . . . . a Threaded Pipe „ . . . MEDIUM SAND. . . . . . . .. . . . . 6. Install Risers to Within 6"of Finished Grade 4 Required)over Hazens-Williams Equation Iv 19 12.1 18" ' ' lt'aDI[JM'SAND'.'.'.'. .'.. . . 12.2 ( q ) Assumed 2" Smooth Plastic Pipe Bottom of Liquid El. 5.80 l C LAYER 10Y 8/8 C A 1 Y Septic Tank Inlet and Outlet,Pump Chamber Inlet,and D-Box. Bottom of Tank El. 5.30 LIGHT YELLOWISH BROWN LIGHT YELLOWISH BROWN Install Risers to Grade over Pump Chamber Outlet. F= 1.52' Using 2' P MEDIUM SAND 93" MEDIUM SAND 7. Septic System to be Installed in Accordance With 310 CMR 15.00& Total Head Loss T+2'=9' Secure Pipe of To & � 5.9 Bottom of Chamber Stable cam oared 24" PERC TEST 11,7 GROUNDWATER ENCOUNTERED 248 CMR 1.00-7.00 Latest Revision and the Town of Barnstable 4/10 HP Myers SRM 4 Pump Recomended 4/10 H.P. Myers SRM4 Pump Base Prior to Ordering Pumps the contractor 25 GALLONS IN< 15 MIN. Board of Health Regulations. For Permitting Only or Approved Equal* Must Confirm the Compatibility of the 93�� PERC RATE<2 MINAN(LTAR=0.74) 5.9 8.All Piping to be Sch.40 PVC. Existing Electrical Service Draft t GROUNDWATER ENCOUNTERED 9.D-Box Shall Have a Minimum Inside Dimension of 12",and a Minimum Sump of 6". PUMP CHAMBER DETAIL 10.The Separation Distance Between the Septic Tank Inlets and BOUYANCY CALC S Outlets Shall be No Less than the Liquid Depth.Inlet Tees Shall Extend DESIGN DATA a Minimum of 10"Below the Flow Line.Outlet Tees Shall Extend 14" ��PL�N ar f,14 1,500 Gallon H-20 Septic Tank NOT TO SCALE and Shall Be Equipped with De Department Approved Effluent Tee Filter and a w Single FamilyP Pp J� Dry Dead Weight=21,230 LBS -2 Bedroom Design Flow Gas Baffle. -3 Bedroom Minimum Design110 GPD Uplift=62.4 LBS/FT(6'-2"X 11'-0")_ r N @ 11.Fill Shall meet specs in 310 CMR 15.255(3). •,,•4 16,U No Garbage Grinder 4,228 LBS/FT Total Daily Design Flow=330 GPD 4,228 LBS(7.2'-5.4')=7,610.4 LBSe� Use a 1500 Gal Septic Tank !�« Weight 21,230 LB>Buoyancy 7,610.4 LB: Tank Sinks fi�,�,/�li"'-•�..��C� LEACHING AREA Revision: Corrections to plan per Health Dept. 112812016 11, 1,000 Gallon H-20 Pump Chamber Revision: Change Septic location and layout 111912016 330 GPD/0.74(LTAR)=445.9 SF Required Dry Dead Weight= 14,500 LBS NOTES: Bottom Area Only= 16'x 28'=448.0 SF Uplift=62.4 LBS/FT(4'-10"X T-0")= PREPARED FOR: PREPARED BY. TI TLE: 1. Building Locations are Approximate and Should not be Site Plan Total Provided=448.0 SF(331.SGPD) 2,712.SLBS/FT ) g pp 2,712.5 LBS(7.2'-5.3)=5,154.8 LBS used for Construction Sam Y Jaxtimer • E11 lnpprl Q Proposed Ve to Upgrade LEACHING CHAMBER DESIGN 2.) The topographic information and building location was was 350 Main Street livan ee g (X p p 14-ft obtained from Town of Barnstable GIS maps and should only Osterville MA 02655 C011Sliltlllg, Inc. L All Pipes to be Schedule 40. Use Weight 14,500 LB>Buoyancy 5,154.8 LB:Tank Sinks P be used for Septic Permit. Spot shots are from an on theU At O 16'x 28'Field of Double Washed ground survey. Stone as Shown. � 3. The datum used is NGVD 29, a fixed mean sea level (508)428.3344 • P.O. Box 659 • 7 Parker Road,Osterville, MA 02655 1� seciCsullivanengin.com • wwwsuilivanengin.com 59 Fire Station Road datum. Barnstable ( ) Mass. 4) Contractors responsibility confirm with engineer before Draft: CTR Calc: CTR �Stel"Vl��e W construction is to begin, that drawing reflects the latest 20 0 10 20 40 80 = revisions. Review JOD DATE: SCALE: try Project # 98165 Project -Name: MarCh 26, 2015� 1 1�-20F J Fire Stoton Rd.