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HomeMy WebLinkAbout0067 FIRE STATION ROAD - Health 67 Fire Station Road Osterville P f . _ 117 007 ° o e e e o s e o TOWN OF BARNSTABLE p LOCATION 6 7 /F/rI r;"j�rloo 9 G� SEWAGE# D �a' 30 2 VILLAGE tyr/=r a/i/f% ASSESSOR'S MAP&PARCEL //1-0 0 7 INSTALLER'S NAME&PHONE NO.-5��-�/ZG -2XXFfV1W5� 9i40.0,7 SEPTIC TANK CAPACITY/,0d O f/,5V° ®✓t j e Ck"11e r LEACHING FACILITY: (type) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 6? AWE soq io.-f R D 6ullD;ntq -RSAC ... ar Rag ,t{9 • �, D=4 01% 'Rego, 20 (L OGr 2 S No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pphration for Mispo8al *pstrm Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( Complete System ❑Individual Components :Location Address or Lot No. } b Owner's Name,Address,and Tel.No. �S 1A S �61-4 Assessor's Map/Parcel 7 ' $ - 0(2 YA4 g }a rig t Z Z Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) N gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 4- Nature of Repairs or Alterations(Answer when applicable`) c �0V-4 eaZ .3�7 i S� i2L'Q- Stf STeM Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this B of Health. Signed Date 2/1 S/� Application Approved by / Date .2 Application Disapproved by Date for the following reasons Permit No. o'� 0( ! O G 1 Date Issued 2 — j t�. No. "I Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: j PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitation for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( Complete System ❑Individual Components Location Address or Lot Now.. ff ��i b Owner's Name,Address,and Tel.No. S^ Assessor's Map/Parcel . bV 7- �(j�1 n-( L . , / Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms i� Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) /V gpd Design flow provided /V gpd Plan Date Number of sheets Revision Date Title . Size of Septic Tank Type of S.A.S. Description of Soil Nature of}Repairs or Alterations(Answer when applicable) 11d�A�< Cbk, ui1� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. .._ (( "" Signed ti .W_ f '�,+__. -, i Date Application Approved by Date Application Disapproved by / Date for the following reasons Permit No. a O f� O G( Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance T S IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned )by xof n l :� i vim ';;• -ate" � has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.:1019—00 dated a, " 5- r Installer Designer #bedrooms n/ Approved design flow gpd The issuance of his pe it shall not be construed as a guarantee that the system will ct_i7.,,asldn esigneDate Inspector r V _1 --------- - -------- --------- ----------------- ----------------------- - ---------------------------------- ------- No. a O I _ (7 6 1 Fee 2. 5 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS ,s Disposal 6pstem Construction J)ermit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit.,____ (3 0 C""'eff 5 Date �J !�j— Approved by `�n i No. ; Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:�_ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftphLation for Disposal *pstem Construction Permit Application for a Permit to Construct( Repair( ) Upgrade( ) Abandon( ) omplete System ❑Individual Components Location dyes or Leo C� ��1`� :��1., Owner's Name,/Address/and Tel o. Assessor I ladel In taller's Name Address,and Tel.No eltp J 7�2 Designer's Namq,Address,and Tel.No. Type of Building: r� s Z —3� Dwelling No.of Bedrooms / Lot Size 21 12 sq.ft. Garbage Grinder( ) Other Type of Building e f° A> 'Q No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided So 7 C. gpd Plan Date fQ 131ZDl 13 Number of sheets � Revision Date Title I:4 -P'4-t &Voje,.1 Size of Septic Tank !YZ o k ^^elow AJAP Type of S.A.S. ff.t, Description of Soil of^l D^c fr d °-n r, 4 ^e/` t--1 Nature of Repairs or Alterations(Answer when applicable) RedJ lke Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by - Date �O Application Disapproved by Date for the following reasons Permit No. O�� Date Issued b`� i 'p, 1 - .y �' p l� k y l.. * •'wTM ( +yM K'• *dam% f'Y/fI'. •� •• 44-41 e. No. Fee y` .• t,: - THE COMMONWEALTH OF MASSACH,- SETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppfi.tation for MisposaY, pstetWonstruttionertntt Application for a Permit to Construct( Repair( ) Upgrade( ) Abandon( ) [�°C plete System ❑Individual Components Location Adddreess oor(�L11ot,No. C 7 F,F-e %¢o� R Owner's Name,Address and Tel No. . Assessors{�!Iap' rbel! /!°? Installer's Name,Address,and Tel.NoSdg (Ila_ 9 72 g Designers Name,Address,and Tel.No. Type of Building: Y ( Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )' Other Type of Building Re J Lo t/i /•g No.of Persons Showers( ) Cafeteria( ) Other Fixtures , Design Flow(min.required) 4/!5;10 gpd Design flow provided F SO 7,6 gpd x Plan Date /d 13hol Number of sheets Revision Date Title �. �¢I (4,:;dt Size of Septic Tank /S O 0 h boo t�Jt�f� Type of S.A.S. F4 4— 0,-jr4,,S R-/S ,q .)-4oy e r{ Description of Soil 0-6 A 4 71 69isiy SAh .92 2.(;j' C/o/ c 1,✓nr'S " 41. C/ 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 not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. .` 5 Signed cl u/ Date F Application Approved by t Date ./0-Cfr-Cx Application Disapproved by ! Date for,the following reasons Permit No. 019 '" 3 O/Z-" Date Issued /6- Y1 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Eertifitate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( Repaired( w) Upgraded<(` ) Abandoned( )by fA at- - - F,,P e- - ,i - o a - has been constructed it accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.C;2a$'3G;I-dated l©"L f"t2� Installer Designer #bedrooms $^ Approved design flow - C d gpd- The issuance of this permit sh 1 not be construed as a guarantee that the sys�will fbnctlon ss esign•d. Date Inspector_ No. 0�0 O ' UZ' Feet/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS - �is�osaC �pstem construction hermit Permission is hereby granted to Construct( w)*--/Repair( ) U grade(. ) Abandon(+ -F-, ) System located at "? �/ 540 6't e o,/ and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be�f ompleted within three years of the date of this permit....... o 1 t Date / d�" `Y' ! p Approved by V' j `r 6 Town of Barnstable oFTME r Regulatory Services: Richard V. Scali Interim Director * sAMSTnaM • MAC Public Health Division i639. Fn.,,,�►�°i Thomas McKean,Director , 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax:. 508-790-6304 Installer& Designer Certification Form 4/7/20.19 2018:-302 111/007 Date: Sewage Permit# Assessor's MaplParcel Designer: Sullivan Engineering&:Consulting, Inc. Installer: �/,4, - t Address' 711 Main Street/PO Box 659 Address' Osterville,MA 02655 10/4/201,8 On ` Oee aq&a S was issued a permit to install a 4Z-1- 1r (date) (installer) 67 Fire Station Road,Osterville septic system at - based on a.design drawn by (address) Sullivan Engineering&Consulting, Inc. dated 10/3/2019 (designer) X I 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. 1 I certify that the septic system referenced above was installed with major changes (Le; greater 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. I certify that the system referenced above was constructed in compliance with the terms of the I\A approval letters (if,applicable) 4 CHARLES T. ROWLAND (In taller's.Signature) CIVIL No. 52699 ' (Designer's Signature) (Affix D aamp Here PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. "` Q:\Septic\Designer Certification Form Rev&14-13doc. Town of Barnstable P# Department of Regulatory Services Public Health Division Date 200 Main Street,Hyannis MA 02601 MKS r`' Date Scheduled �2-,4�� Time, Fee Pd. V Soil Suitability Assessment for Sqva&e Dispi,sal �L Performed By: cPl Pf(Y1Ul.? (.V13U�TIYW� Witnessed By: LOCATION&GENERAL INFORMATION Location Address W1 Fire S}zJio+� f A. Owner's Name JC)V)n •} �c� 1 -C r- ►'l C� �� (t, 0?-USS Address G3 �Tc.,f'�/t( f}S1�l0.►�GL +, Assessor's Map/Parcel: t7 0 -1 Engineer's Name �u,llt�uh. i intr C�v NEW CONSTRUCTION REPAIR Telephone# C Land Use Res, Ph,g� S r` is ri/h. Slopes(%) S -(d Surface Stones M1 Distances from: Open Water Body .�SB ft Possible Wet Area j�6 ft Drinidng Water Well ft Drainage Way /V A ft Property Line C�'�.d ft Other ft � f. SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity holes) PAW 0747TON RV s *'�lV sr Parent material(geologic) ufeit/Q Depth to Bedrock S00 Depth to Groundwater: Standing Water in//Hole: R�—qq Weeping from Pit Face Z Estimated Seasonal High Groundwater DETERNIIN TI W FOR SEASONAL HIGH WATER TABLE Method Used: kjo*ed 54 0 ",-W-4'a> - Depth Observed standing hole: in. Depth to soil m ttles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment & Index Well# Reading Date: Index Well level Adj.factor Adj.Groundw Level PERCOLATION TEST Date SIV Time. Observation Hole# Time at 9" Depth of Pero 3 C Time at 6" Start Pre-soak Time @ d Time(9"-6') End Pre-soak S Rate Min./Inch 2A; oh Site Suitability Assessment Site Passed _ Site Failed. Additional Testing Needed(Y Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first not'ry the Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISEPTIC\PERCFORM.DOC I DEEP OBSERVATION HOLE LOG Hole.# I Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) 32` to DEEP OBSERVATION,HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) ( (USDA) (Munsen) Mottling (Structure,Stones,Boulders. Consistenex.° Gravel) 32- I DEEP OBSERVATION HOLE LOG Hole# Depth from I Soil Horizon Soil Texture Soil Color Soil Other Surface(in) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravell I � it DEEP OBSERVATION HOLE LOG Hole# Depth Horizon Soil Texture Soil Color Soil Other Surface(in.) ( (USDA) (Munsell) Mottling (Structure,Stones,Boulders. from Soil Consistency.%Graven Flood In I ante Rate Man: Above 500 year flood boundary No Y Yes 'thin 500 year boundary No_ Yes 'thin 100 year flood boundary No Yes De th of I iaturallyOccurrine Pervious Material Does at leg st four feet of naturally occurring pervious material exist in all areas observed throughout the area propo 3ed for the soil absorption system? �=— If not,whz t is the depth of naturally occurring pervious material? Certification I certify th t on (date)I have passed the soil evaluator examination approved by the Department`of Environmental Protection and that the above analysis was performed by me consistent with the required trainingefxpeipse and exp9rier.We /ndescribed in 310 CMR 15.00117. Signature C s Date lei Q:\SEPnC\P RCFORM.DOC M John O'Dea From: McKean, Thomas <Thomas.McKean@town.barnstable.ma.us> Sent: Thursday, September 15, 2016 5:24 PM To: John O'Dea Subject: Re: 67 Fire Station Road, Osterville Yes, it is sufficient in my opinion. Please provide a copy of all pertinent documents to the health inspector., From: John O'Dea Sent: Thursday, September 15, 2016 4:53 PM " To: 'McKean,Thomas' Subject: RE: 67 Fire Station Road, Osterville Thomas—was the information in the email below,and the building permit attached enough to document out records??? John O'Dea, P.E. Sullivan Engineering&Consulting, Inc P.O. Box 659 Osterville;MA 02655 508-428-3344 508-428-9617 (fax) From:John O'Dea [mailto:john@sullivanengin.com] Sent:Thursday,September 08, 201611:58 AM To: 'McKean,Thomas'<Thomas.McKean @town.barnstable.ma.us> Subject: RE: 67 Fire Station Road,Osterville Thomas, As a follow up to our discussion, with the help of Albert Schulz(who has nothing to do with this project—but we spoke to as a source since his in-laws have owned the house across the street)we spoke with Ralph Jones yesterday who was the 6th prior owner from 1961 to 1978. He stated that when he purchased the property it was a 3 bedroom, and he added the 2 bedroom wing referenced below as occurring sometime between 1968 and 1976 based on aerial photography(prior to any overlays)—for what he considered a total of 5. On the scan of our field book floor layout inspection from June 29th of this year the"Living" Room would have been the 3rd bedroom when he purchased,and the side by side bedrooms where the addition—for the total of 5—not 4 as�suggested below. While at Town Hall on other business yesterday Albert found the attached building permit,which also has the number of bedrooms listed as 5. Please let me know your thoughts. 1 John O'Dea, P.E. Sullivan Engineering& Consulting, Inc P.O. Box 659 Osterville, MA 02655 508-428-3344 508-428-9617(fax) From: McKean,Thomas [ma ilto:Thomas.McKean@town.barnstable.ma.us] Sent:Tuesday,August 30,2016 5:21 PM To:John O'Dea<iohn@sullivanengin.com> Subject: RE: 67 Fire Station Road,Osterville Can you obtain an affidavit from a previous owner- in regards to the number of bedrooms in existence prior to the adoption of the Ordinance? If yes,we need a signed affidavit and a floor plan showing the four bedrooms. From: John O'Dea [mailto:john@suilivanengin.com] Sent: Tuesday, August 30, 2016 4:24 PM To: McKean,Thomas Subject: 67 Fire Station Road, Osterville Thomas, In March we were contacted by a potential buyer for the above referenced project for an overall evaluation. The property is located within an Estuarine,WP,and Zone 2 overlay. Among other items,we noted quickly that there was a discrepancy on the bedroom count between the septic permit (#96-399-attached)and all other documents. Shortly thereafter we were contacted by the owner for a more thorough review on the septic system,who was very concerned considering to the best of their knowledge they had purchased what had always been a 4 bedroom dwelling years before. We have found no plan that accompanied the septic permit application for a repair by Roger Roberts. The application described the repairs as 4 infiltrators with 4'of stone. The as-built card that accompanied the compliance request show that there were 4 bedrooms and the design was modified to 2-4'x40'x2'trenches,which are suitably sized. The information corresponds with that contained on the Assessor's records, an inspection by Jim Ford in 2000,an inspection by Capewide in 2010,a real estate appraisal prepared for the current owner in 2010 when they purchased the property,and a personal inspection of the house by us this summer. Although the footprint and layout of the house suggest that it was modified perhaps 4 times since its original construction in 1939, based on a review of available aerial photography and our site inspection,we believe the most recent modification occurred sometime between 1968 and 1976, prior to any Town or State flow overlays. 2 It is my opinion that number of bedrooms specified on the 1996 permit application was an error that was corrected during or prior to installation, and that the existing 4 bedrooms dwelling can remain or be replaced without constituting new construction. Please let me know if you agree. John O'Dea, P.E. Sullivan Engineering& Consulting, Inc P.O. Box 659 Osterville, MA 0265S 508-428-3344 508-428-9617 (fax) 3 Il_ f"ngineering Dept.(3rd hoory Map q Parcel 6 '"ei mit# C , House# ` Dale Issued 1 3 '' S Board of Health'(3rd floor)(8:15-9:30/1:00 3 /3 JF Fe Conservation Office(4th floor)(8:30:9:30/1:00-2:00) 13 m C�'+�1• �� �� Planning Dept.(1st Odor/School Admen.Bldg.) 1ME ft Definitive Plan Approved by Planning Board 19 BARNMABLE, d VZ" MA8& MAC TOWN OF.BARNSTAB.L B ' ding Permit Application Project Street Address Village Owner f Address Telephone Permit Request74'/ Oa t , First Floor A0 square feet Second Floor square feet Construction Type Estimated Project Cost $ G 006� QD Zoning District AP Flood Plain Wa er Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes No On Old King's Highway ❑Yes J No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other 1 - Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing- - New Half: Exi sting New No.of Bedrooms: Existing New Total Room Count(not including baths):Existing New Fir t Floor Room Count Heat'Ilype and Fuel: Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes No Fireplaces:Existing New EA ting wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: E Pool(size) ❑Attached(size) Barn(size) m�- ❑None Shed(size) _ /p •X / Other(size) Zoning Board of Appeals Authorization ❑ Appeal# I tecorded❑ Commercial ❑Yes �No If yes,site plan review# Current Use Proposed Use Builder Information �.�7G Name �! - � Z, & 04,4 Telephone Number 9 7A�? x c� w s 9 c+ I .. I {{y i l �.... L x o L...... ► — —J r Commonwealth of Massachusetts Title 5 Official Inspection Fora, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 67 Fire Station Rd. Property Address Janet Smith Owner Owner's Name information is required for Ostervllle Ma. 02655 4/30/2010 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: A. General Information When filling out 34kaj forms on the I computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name 4:1 P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: f ® Passes ❑ Conditionally Passes ❑ Falls ' ❑ Needs Further Evaluation by the Local Approving Authority d = N i 4/30/2010 Inspector's S'jgriX64 Date o-s�i The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and 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•09/08 Title 5 Official Inspection Form:SubsurfV- Disposaystem- age 1 of 17 r7 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 67 Fire Station Rd. Property Address Janet Smith Owner Owner's Name information is required for Osterville Ma. 02655 4/30/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 t Commonwealth of Massachusetts W Title 5 Official Inspection Fora, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 67 Fire Station Rd. Property Address Janet Smith Owner Owner's Name information is required for Osterville Ma. 02655 4/30/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: El Cesspool is within 50 feet of a surface water Pool or privy Y ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wM 67 Fire Station Rd. Property Address Janet Smith Owner Owner's Name information is required for Osterville Ma. 02655 4/30/2010 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 coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow t5ins-09/08 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 67 Fire Station Rd. Property Address Janet Smith Owner Owner's Name information is required for Osterville Ma. 02655 4/30/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the!presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 200'Ogpd- 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. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone 11 of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 i 05/10/2010 09:10 FAX 5084283928 CAPEWIDE 2 002/002 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "< 67 Fire Station Rd. Property Address Janet Smith Owner Owner's Name information is required for Osterville Ma 62655 4/30/2010 ' every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was'provided by the owner,occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received"normal flows in the previous 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. ElDetermined 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 I Residential Flow Conditions: Number of bedrooms(design): 4"` a Number of'bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.20$ (for example: 110 gpd x#of bedrooms): 440 t5ins•09108 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17 l Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 67 Fire Station Rd. Property Address Janet Smith Owner Owner's Name information is required for Osterville Ma. 02655 4/30/2010 every page. City/Town State Zip Code Date of Inspection D. System Information Description: The system consists of a 1500 gallon tank,D-Box and two 4,x40'x2' leaching trenches Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2008:85,000 g ( y g (gp ))' 2009:219,000 Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 12/2009 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 67 Fire Station Rd. Property Address Janet Smith Owner Owner's Name information is Osterville Ma. 02655 4/30/2010 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 67 Fire Station Rd. Property Address Janet Smith Owner Owner's Name information is required for Osterville Ma. 02655 4/30/2010 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: 1996 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line. 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): 1' Depth below grade: 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 Sludge depth: 1" t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 67 Fire Station Rd. Property Address Janet Smith Owner Owner's Name information is required for Osterville Ma. 02655 4/30/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 8n Distance from bottom of scum to bottom of outlet tee or baffle 14 How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound.NOTE:Tank is not H2O loading and is in driveway. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: 0 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °w 67 Fire Station Rd. M Property Address Jainet Smith Owner Owner's Name information is Osterville Ma. 02655 4/30/2010 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: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 67 Fire Station Rd. Property Address Janet Smith Owner Owner's Name information is required for Osterville Ma. 02655 4/30/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No 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.): Box is Ievel.Box has two outlet Iaterals.No evidence of solids carryover.No evidence of leakage. Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No Alarms in working order: ® Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber appears structurally sound.Pump,floats and alarm are in proper working order. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page Q of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 67 Fire Station Rd. Property Address Janet Smith Owner Owner's Name information is required for Osterville Ma. 02655 4/30/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2-4'x40'x2' ❑ 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.): Sandy dry soil.No signs of hydraulic failure.No ponding or danp soil.Stone was dry at time of inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes' ❑ No t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 67 Fire Station Rd. Property Address Janet Smith Owner Owner's Name information is required for Osterville Ma. 02655 4/30/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map . Abutters Map Size ■ Zoom Out i l l I ''l J,In MN k 3 "Ni u s, rnn�.'• � r Pry l i x G- fl 2 � LI a� ail 0 Feet _ 5 Set Scale 1" = 20 I Aerial Photos I MAP DISCLAIMER rnn%/rinhf,)nnr�,)nlO Tnun of Romefohle AAA All rinhte roc—, 1 •• /'/// /1/1"I A[' r�1'%/__-..__._/_._._ _ ___._._/.___._ __.___/l._.__.__.i_TTl_...'11"/A/1^7n .___._-._..1__ _1_ } A/nA/AAtA +. Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 67 Fire Station Rd. Property Address Janet Smith Owner Owner's Name information is required for Osterville Ma. 02655 4/30/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of Leaching 5.4' 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: AS-Built ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M a' 67 Fire Station Rd. Property Address Janet Smith Owner Owner's Name information is required for Osterville Ma. 02655 4/30/2010 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 �9 -z- COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PaDYECTION R E'VED ia1AF I� ' T0520 oar_1 0� 7 04 �T I TUVvi,. :JY HEALTH P-,I L'E TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A k CERTIFICATION i 1 Property Address: 67 Fire Station Road Osterville, MA 02655 a fey. Owner's Name: David Colombo Owner's Address: C:s I Date of Inspection: September 10, 2004 Name of Inspector: (Please Print) James M. Ford l Company Name: James M. Ford - Mailing Address: P.O. Box 49 �g ' OsterviUe.MA 02655-0049 r� Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: , ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails ! Inspector"s Signature: Date: September 18, 2004 i The system inspector shall sul a copy of this inspection report to the Approving Authority(Board of Health for DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,600 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. L Notes and Comments 1 i k ****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. E Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) I Property Address: 67 Fire Station Road r Osterville, M4 1 Owner: David Colombo Date of Inspection: September 10, 2004 f 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. I Comments: i B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or: repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. i I Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health, *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: I The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed f ND explain: 2 y � Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 67 Fire Station Road Osterville, MA Owner: David Colombo Date of Inspection: September 10, 2004 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any),determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply.. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 f c i Page 4 of 11 l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) i Property Address: 67 Fire Station Road Osterville, MA Owner: David Colombo i Date of Inspection: September 10, 2004 I D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No • r ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_ ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as I 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. i E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) i Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 t Page 5 of i l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 67 Fire Station Road Osterville, MA Owner: David Colombo Date of Inspection: September 10, 2004 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS,located on site? M ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ Was the facility owner(and occupants.if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)]. 5 Page 6 of I 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 67 Fire Station Road Osterville, MA Owner: David Colombo Date of Inspection: September 10, 2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 1 Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): end Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be ` obtained from system owner) I Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed 9113196-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 67 Fire Station Road Osterville, MA Owner: David Colombo Date of Inspection: September 10, 2004 BUILDING SEWER(locate on site plan)- Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 10" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500 eal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: Measurina stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There did not appear to be an sy ikns of leakage GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: concrete metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 67 Fire Station Road Osterville, AM Owner: David Colombo - Date of Inspection: September 10, 2004 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: i Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box was level. No solids were present. PUMP CHAMBER: ✓ (locate on site plan) Pumps in working order(yes or no): Yes Alarms in working order(yes or no) Yes Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): cycled through the pump, and the pump was in working order. The liquid level was normal 8 Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) R Property Address: 67 Fire Station Road Osterville, MA Owner: David Colombo Date of Inspection: September 10, 2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: ✓ leaching trenches,number,length: 2-4'x 2'x 40'(per as built card) 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.): There did not appear to be any signs offailure or backup CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 Page 10 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 67 Fire Station Road Osterville, MA Owner: David Colombo Date of Inspection: September 10, 2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. G U- 3 g � y ao 2-10 a a - aa` cy ac� ay� ay 10 Page I 1 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 67 Fire Station Road Osterville, MA Owner: David Colombo Date of Inspection: September 10, 2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 12 +/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic maps and water contours maps the maps were showing approximately 12'+/-- to Around water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 I. 41 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS John Graci DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 - i TRUDY COXE Secretary ARGEO PAULCELLUCCI DAVID B.STRUHS Governor Commissioner i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 67 FIRE STATION RD. OSTERVILLE MAP 117-PAR 007 Name of Owner COLLEEN RYLEE Address of Owner: BOX 382 OSTERVILLE MA.02666 Date of Inspection: 1120/00 a Name of Inspector:(Please Print)JOHN GRACI _1 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) JA N 2 8 2000 .. Company Name: n/a , , A� TOWN TMgARNST,4g� Mailing Address: n/a, Telephone Number: nla �'i CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and y ` maintenance of on-site sewage disposal systems.The system: X Passes The inpection Is based on criteria defined in Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system Is _ _ Needs Furtjl�su�bmita tion By the Local Approving Authority performing at the time of the inspection.My inspection does _ Fails not Imply any warranty or guarantee of the longgevity of the septic system and any of Its components useful life. Inspector's Signature: Date:1/21/00 The System Inspector sh copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS,RECOMMEND NOT DRIVING OVER THE OVER THE SEPTIC TANK IT IS H10. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A • CERTIFICATION(continued) Property Address: 67 FIRE STATION RD.OSTERVILLE MAP 117-PAR 007 ' Owner: COLLEEN RYLEE Date of Inspection:1/20/00 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to.or less than 5 ppm,Method used to determine distance nla_(approximation not valid). 3) OTHER Iva r 4 - revised 9/2/98 Page 3 of 11 z uh SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A _ r CERTIFICATION(continued) Property Address: 67 FIRE STATION RD.OSTERVILLE MAP 117-PAR 007 Owner: COLLEEN RYLEE Date of Inspection:1/20/00 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh., y 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a . private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that thet well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance nL&(approximation not valid). . 3) OTHER nLd ' revised 9/2/98 Page 3 of 11 I - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM' - PART A CERTIFICATION(continued) Property Address: 67 FIRE STATION RD.OSTERVILLE MAP 117-PAR 007 Owner: COLLEEN RYLEE Date of Inspection:1/20/00 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: s. . . I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. , X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool: X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped n(a. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. s X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. - • - X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: , You must indicate either"Yes"or"No"to each of the following: y° The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of,10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No - X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply '. X. 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 912/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , PART B CHECKLIST Property Address: 67 FIRE STATION RD.OSTERVILLE MAP 117-PAR 007 yz Owner: COLLEEN RYLEE z� Date of Inspection:1/20/00 "a 5 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following ~ Yes No X Pumping information was provided by the owner,occupant,or Board of Health. #"' X None of the system components have y , - y p e been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection- X As built plans have been obtained and examined.Note if they are not available Lwith N/A„'W.. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. °Y N X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site T..- X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H; X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) ' [1 5.302(3)(b)1 � X The facility owner(and occupants,if different from ownerj'were provided with'in_formation on the proper maintenance of SubSurface Disposal Systems. t v "�; RFC � •,. � _... c yx F' W . i revised 9/2/98µ .�, Page 5 of 11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 67 FIRE STATION RD.OSTERVILLE MAP 117-PAR 007 Owner: COLLEEN RYLEE Date of Inspection:1/20/00 - FLOW CONDITIONS RESIDENTIAL: Design flow:-M g.p.d./bedroom Number of bedrooms(design): 4 Number of bedrooms(actual):4 Total DESIGN flow: 44Q Number of current residents:4 , Garbage grinder(yes or no):NQ Laundry(separate system)(yes or no): NO If yes,separate inspection required w Laundry system inspected(yes or no):JLQ Seasonal use(yes or no):M n Water meter readings,if available(last two year's usage(gpd): nLa Sump Pump(yes or no): NO ` Last date of occupancy: nLa COMMERCIALIINDUSTRIAL Type of establishment: nLd Design flow: nLa gpd(Based on 15.203) Basis of design flow: nLa Grease trap present:(yes or no):JLQ Industrial Waste Holding Tank present:(yes or no): NO ' Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ Water meter readings.if available:nLa Last date of occupancy: nLa OTHER: (Describe) nLa Last date of occupancy: n(a j GENERAL INFORMATION PUMPING RECORDS and source of information: nta 4 System pumped as part of inspection:(yes or no):YF.;z If yes,volume pumped nta• gallons Reason for pumping: nLa TYPE OF SYSTEM XSeptic tankidistribution box/soil absorption system r - Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other:,n[a APPROXIMATE AGE of all components,date installed(if known)and source of information: Sewage odors detected when arriving-at the site:(yes or no): NO revised 9/2/98 t Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C i SYSTEM INFORMATION(continued) r. Property Address: 67 FIRE STATION RD.OSTERVILLE MAP 117-PAR 007 '4 Owner: COLLEEN RYLEE k ' e. Date of Inspection:1120/00 BUILDING SEWER: (Locate on site plan) Depth below grade: 1,6" Material of construction:_ cast iron X 40 PVC _ other(explain) Distance from private water supply well or suction line: TOWN Diameter: n!a _ Comments: (condition of joints,venting,evidence of leakage,etc.) nLa SEPTIC TANK: X (locate on site plan) Depth below grade: i Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NQ nla Dimensions: L 10'6"H 5'7"W 6'8" Sludge depth: 1 Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness:Q Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: Q How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOM6"END PLUMPING EVERY TWO YEARS FOR MAINTENANCE GREASE TRAP: (locate on site plan) Depth below grade: e Material of construction: concrete metal Fiberglass _ Polyethylene_other(explain) _ nLa Dimensions: n1a Scum thickness: nLa 3 t Distance from top of scum to top of outlet tee or baffle:-nLa Distance from bottom of scum to bottom of outlet tee or baffle nLd Date of last pumping: n& Comments: • :' (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,, etc.) Wa x revised 912/98 a Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM, PART C SYSTEM INFORMATION(continued) Property Address: 67 FIRE STATION RD.OSTERVILLE.MAP 117-PAR 007 Owner: COLLEEN RYLEE Date of Inspection:1/20/00 F TIGHT OR HOLDING TANK: NQ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) k Depth below grade: nLa Material of construction: concrete metal_ Fiberglass _Polyethylene_ other(explain) - - t Dimensions: nLa Capacity: n& gallons " Design flow: Wa gallons/day Alarm present: NQ Alarm level:jiLa. Alarm in working order:Yes—No—: NQ Date of previous pumping: nLa f Comments: (condition of inlet tee,condition of alarm and float switches,etc.) t nta DISTRIBUTION BOX: X - (locate on site plan) Depth of liquid level above outlet invert:LEVEL WITH BOTTOM OF PIPE Comments: a _ (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) DISTRIBUTION BOX IS STRUCTURALLY SOUND T , PUMP CHAMBER: NQ (locate on site plan) r Pumps in working order:(Yes or No): YES Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) s PUMP CHAMBER IS FUNGTIONING PROPERLY r - S ' a r revised 9/2/98 - Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INS PECTION FOR PART C SYSTEM INFORMATION(continued) . Property Address: 67 FIRE STATION RD.OSTERVILLE MAP 117-PAR 007 Owner: COLLEEN RYLEE r Date of Inspection:1120/00 SOIL ABSORPTION SYSTEM(SAS): X - (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: - Wa Type: - leaching pits,number: n/a leaching chambers,number: _nLa leaching galleries,number: _n/a - I f' leaching trenches,number,length: 2-TRENCHES-4'X 2'X 40 a leaching fields,number,dimensions: nLa . overflow cesspool,number: n/a Alternative system: nla Name of Technology: jiG3 Comments: ' (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE SAS IS FUNCTIONING PROPERLY SOIL PROBED DRY CESSPOOLS: (locate on site plan) -• Number and configuration: nla Depth-top of liquid to inlet invert: nta Depth of solids layer: n& Depth of scum layer. n(a Dimensions of cesspool: n(a Materials of construction: nla Indication of groundwater: nl0 inflow(cesspool must be pumped as part of inspection)nLa Comments: a (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nLa PRIVY: (locate on site plan) Materials of construction:n& Dimensions:nLa Depth of solids: n/A r Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n[a revised 9/2198 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C - SYSTEM INFORMATION(continued) n _ Property Address: 67 FIRE STATION RD.OSTERVILLE MAP 117-PAR 007 Owner: COLLEEN RYLEE Date of Inspection:1/20/00 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes Into house) n/a 17 cc - A.. revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued), # Property Address: 67 FIRE STATION RD.OSTERVILLE MAP 117-PAR 007 Owner: COLLEEN RYLEE Date of Inspection:1/20/00 NRCS Report name: nLa Soil Type: aLa j Typical depth to groundwater: n!a h , USGS Date website visited: n& Observation Wells checked: NO Groundwater depth:Shallow _ Moderate _ Deep SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow ll wells Estimated Depth to Groundwater 10 Feet 1 Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions _ Checked with local Board of health Checked FEMA Maps Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS _ r ' . 1 j revised 9/2/98 Page 11 of 11 TOWN OF BARNS AB E LOCATION • SEWAGE # VILLGE C� - +ly���s� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER i PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by r I n M 7'Y uc, x t Ir TOWN OF BARNSTABLE LJCATION V Pitt Trio(!on fz . SEWAGE # '(` 3 )' VILLAGE 0 Ert ry 11 6— ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I 2W 1-411 k 'F /CIO 66 Ptl M P LEACHING FACILITY: (type) a 7/-'1&A Cl%�S (size) 'A X yX 4/0 NO..OF BEDROOMS / BUILDER OR OWNER IbAK C Q 10M p ,.... PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 ez str -within 300 feet of leaching$facility) / `' `' Feet Furnished by_r4_s'o I f i � � � � � � � � � o s � � p i � � c w �� � 4� \ � _ � �y .,, Fra�-r -- -- - s TOWN,OF BARNSTABLE LOCATION ��s� SEWAGE # VILLAGE Q� /UV/Ile- ASSESSOR'S MAP & LOTS[ ' INSTALLER'S NAME&PHONE NO. �i�0 � � � /C— SEPTIC TANK CAPACITY AwMle 7-PA.#— LEACHING.FACILITY: (type) Tepo,-C-ke4 (size), q)e d-X NO.,OF BEDROOMS ' G BUILDER OR OWNER o PERMITDATE: 2 COMPLIANCE DATE: I^ ;Separation Distance Between the: Maximum Adjusted Groundwater Table and 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) j Feet Furnished by i i s 'a• � I CAJ �,1 �b o ty o� � ; ASSESSORS MAP Na No. / / / PARCEL KC' li' Lr Feei . THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppfication for �Digpogal bpotem Conotruction Permit Application is hereby made for a Permit to Construct( )or Repair( �an On-site Sewage Disposal System at: Location Address or Lot No. &7 4'✓c 6T0mc- & 05—, Owner's Name,Address and Tel.No. Assessor's Map/Parcel ,r In is Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil S _ Nature of Repairs or Alterations(Answer when applicable) wS`�f�� 1. 1 v_a�, 1 Y I I V +r,-Nr l-b 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 q1f Environmental qde nd not to place the system in operation until a Certifi- cate of Compliance has been i s BoTr ` Signed Date I Application Approved by Z Date Application Disapproved for the following reasons Permit No., k� ' Date Issued ;0! Fee No: THE COMMONWEALTH OF MASSACHUSETTS-,, $ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ZIpprication for-N`Mtopoga[ brae =Sewage ructton Permit Application is hereby made fora Permit to Construct( )or Repair( Disposal System at: Location Address or Lot No. 7 /c Owner's Name,Address and Tel.No. a J 14W1ES Assessor's Map/Parcelj In er's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. bB�s ao &rrc, N Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ''S 75— gallons per day. Calculated daily flow 33<D gallons. Plan Date Number of sheets Revision Date Title h Description of Soil Nature of Repairs or Alterations(Answer when applicable) SVv51 AAA\ 'Scm JWliO�T A A y =—V_r.t 1_-CyGr'Mxl_S J,c 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 d d not to place the system in operation until a Certifi- cate of Compliance has been i 's B Signed -..a -Date Application Approved by .'Date Application Disapproved for the following reasons x Permit No., ,& ° `{ "9 Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE;\MASSACHUSETTS Certif trate of Compliance S I TO ,(fthat thF On-site Sewage Disposal System installed( ) ; epaired/replaced on P_Z%VA by ,P-- o-1v Installer m -e TevV�1 at r-G.S`t fo+`hJ r`.J �... CAS __ has been constructed in accoWance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated f R .� Date Inspector ----� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS- TEM WILL FUNCTION SATISFACTORY. s- __ _ No.--- ---------------------------Fee 61 THE COMMONWEALTH OF MASSACHUSETTS f PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS 30tg o ar �Vgte onf&uctton Vermtt Permission is hereby granted to to construct repair(�an On-site Sewa a System located at No.##! ✓�-:�Z-i4�G �'�,_ street and as described in the above Application for Disposal System Construction Permit. f7 No. Date The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must gb e completed within three years of the date below. r'�� Date: LJ "✓ O Approved b Board of Health CERTIFICATION OF SKETCH AND APPLICAA A%I J A WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) IR n' k 4 TV i �'`iSn I, hereby certify that the ap1clioilt ale arks construction permit signed by me dated property located at �-Z via-,��,✓ �S cv , following criteria: y �k;•.�,x3r}3�ri�{.-0� '��'+-^fry�i�i�_.iy���(':tr73 9� �� �'�k*�3_y y��,",,,�46r.a` �`�X a ` k'�ia • There are no wetlands within 300 feet of the pm{tosal t:system " • There`tire no private wells within 150 feet of the proposed sgttl system • The observed groundwater table is 14 111 or greater I low the 1 � • There Is no increase in flow and/or change in use proposed E • There are no variances requested or needed. ' ✓`, ;� ` err � t pt 731,•rll ayrs n'kh+j�,t x5 � g x . x 2 �.'�j ti�il4 ,wr �x.�•�•8-, .r.'fi '�,a fi`'L",].� • wrs rF�f.L r s'F k f�i,Alf; �, E l�3'9`�"k fi��'x ! ��,1JAlD �4;l�• �,.��� � a qr�,�E'� ht•r' �`r F SIGNED R •I,. NJ wa, LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNS OLR MUM .. _ .. ., .>Fxti"7`����} '�y y�k eft r • a3*'� .°u�i ��hX, � t �� -s V ' '"� fi �,?:iS>•,4�'$kit'ire �l '_. { r':•,.s � ����k�i (Attach a sketch plan of the proposed system. Also if the licensed installer s ' this plan should be submitted]. ,. "' �tr'��•�°.`T"` .�� ,��,�� ..y�,,�?. 1t ° lip cr i.: F s f5 c tyrl'�",;y yip ytU ? 'atFi.g.� •� , vL i st r� � epgyP �yZ�ii'ty'`'�, k R a x 3 i4 a„ •xi g SJ w 7r f°ray -i�i .� r �.i 1°/A °j� �*i� �.r T �'.•4�' r t r�p<<r� c k _ 'c'�'x� �13�"�� aya�s'-r><✓ h� A fix 00 o e r, ' `� �ii FLOOD ZONE: ASSESSORS REF. Zone AE Elev. 12, re tripout of unsuitable Material Map 117, Parcel 007 AE Elev. 10 & re1-5'PS laced with clean medium sand to _ meet 310 CMR 13.255 (3) X (Min. Flood Hazard) a Community Panel No. - - - - - #250001 0544 J Cover to 6" of grade OVERLAY DISTRICT. July 16, 2014 to Inspection Port GP - Groundwater Protection District k D-Box Finish Grade _ _ _ ad . ( 7{7� ( ,, #{'^^^� {- 'e ` .. k A .9 r F, ..;..'"'^"�tF:.•-5� ".,•�,"x tail...., itE €E ��7 ����1 � ----�li ":tA.' T' Filter • 'r' ;:.r Fabric RR ike Compacted Fill . 90.00 AND/OR I utility { ZONE 1/8" - 1/2" p c° ,� 8 8 B ® ® ® Pea Stone 12.0' ����`�o �� y S72°50'22"VI/ Pole RC 314 1 1 2 4 ,�• . „ 0 SF PO Area (min.) 87,12 ( ) Double Washed 4 of one p, 3 e �� �, �E ,z •* "F Front (min) 20' \ Stone o// ....... .. n R D I Stone 4' • Frontage Width (min) 100' 12' A �tfQ s y 6 1`a'ra 48.0 -- -- ----------9 _0'-Offset / a '',` ►� ;i -ram • Setbacks: ------LOT CALCULATIONS: FEME' 'o' _2 Frant 20 CROSS SECTION OF FLOW DIFFUSOR X Mir,• qOZ nE . i �dwn �>_,1 ., Side 10 Upland Lot Area = 27,179 SF 5-Flow Diffusers d 7 W� Rear 10' Q Lot Coverage: Dwelling 2,514 SF az'�rd --r .�~~ � /� I Location Plan. Deck 682 SF NOT To SCALE PROPOSED SAS DETAIL 59.0' S�a �� � • Total 3,196 SF (8.5%) SCALE 1" = 10' 10 �I o Ex. F.F. El. 11.8' No Front Door Access Cover (typ.) ( ) (See Note 6) 11 Pro. F.F. El 13.5' *Final Foundation Grading To Be Over Inspection Port N/F To be Confirmed Coordinated With Landscape Plan Gerald P. Belostock 1 i #59 F.G. EL. 13.7-14.3f DESIGN DATA I t 0 1 Sty w/f F.G. EL. 28.00* - F.G. EL. 12-13' F.G. EL. 13.0'f F.G. EL. 14.55' Min. o Dwell in Single Family -Pro Garage i co g Install -4 Bedroom @ 110 GPD i�E ll x ` I 0 Department Approved W El�v.' 11.1 Effluent Tee Filter oo Splash Plate No Garbage Grinder I` 11.8' As Required Total Dail Flow=440 GPD the Outlet & Gas Buffle y _ EL. 10.50 Use a 1500 Gal Septic Tank o ✓ I =' Installer To co I -Proposed j EL. 10.00 1500 Gallon \ Confirm Prior D-Box Top El. 12.93 t St w f Septic Tank EL. 9.75 1500 Gallon LEACHING AREA Proposed Foundation � y / I U To Any Work EL 9.60 EL. 1 7 - Drain Water I ` N/F H-20 Required Septic Tank EL. 12.81 a ® ® e a F] 440 GPD/0.74(LTAR)=594.6 SF Required Drain to Intercept I ;Dwelling ► I Bot. EL. 11.60 St i - iTank I Sam Y. Jaxtimer (See Note 5) H-20 Required !12. Sidewall=2(12.0 +48)(11 /12 )=110.0 SF I : I `EL. 51 \ 1 (See Note 5) Flow Diffusor Bottom Area=(12.0'x48')=576.0SF I Pro FFE 135 �- L :ssv.] Total Provided=686 SF(507.6 GPD) ro TCF 12 Deck t - To Be Installed On . .: \ I 59 . RRIPBp s, k; +P Stable Compacted Base edding,"T"s, & Baff Is`.. 1 I 11. I is Per tie card „ as Per Title 5 Remove & :Re Lace I \ i -SepticSystem EL. 6.6 Pro I To be Removed 2. .... . .. . .. p Groundwater•� . ALI...Unsuitbble. .SoiLs. w/thrn :5 of LEACHING 40. Use I ! .r�Pump I High G ndwat DESIGN '"' To Be Installed On The Duter Perrmeter of The :Systerri P Groundwater stud port 6-500Gal.LeachingChambersina I Deck I Chamber Stable Compacted Base by SullivanEngineering 12.0'x48'DoubleWashed re .. : . :.I Stone Field as Shown. 1 St W f I hl y I �I Dwelling I Lawn of 12 _. ;- � roposed 1500 Gallon Septic Tank ! X DEVELOPED PROFILE OF SYSTE�l1 r°p°Sed 1°°° Gallon Pump Chamber NOT TO SCALE � �, � D-B x I I I Lhed \ o I _ Z Existing SAS 12. I I I I D- _ _ T 12 - to be Removed 53.34 110.04 `. S7 � � cb dh hit i 13 8 42 06"W S66° 14' 55"W / I I 5t- ow pi Nser _. --- top elev. 14.05' Locate Junction Box - _ --------� I`I of Stone 10'_Offset ___-- I I 4 \ Outside of Tank r ----- I' I 5',S1rri I O �\-'------------- I I p Out H I \ �O, I I � Pump Power & Float Control -M6Z.Reserve Cables Installed In Accordance PERC TEST: 15,667 \ ° I I With Federal, State & Local Conduit Thru Chamber For \ \ POI CE'I A �-� \ 24"0 Steel Manhole 27,179f SF o Power & Float Cables PERFORMED BY:CHARLES ROWLAND PE- SULLIVAN ENGINEERING \ Bldg. & Elec. Codes Frame & Cover I W oy 9" Min. &CONSULTING,INC. Per Record Plan a, �I j Alarm To Be On Separate Finished TH-1 �R,r' 4"0 Sch. 40 PVC Service From Pumps Grade Cover SOIL EVALUATOR NO.13586I� tV \ From Guest WITNESSED BY:DONNALD DESMARAIS,R.S.-TOWN OF BARNSTABLE \`� L ` 120 \ House 1/2"0 Goly. Pipe I ;_yl , MAY21 2018 town I co ° B \ \ \ Bench Mark. I/(y For Float Support �``='m" ��" `� �-;�" � (iAi -9�°� ��\ 200.0' � ike Elev. 14.29' I � �• BUf SITE PASSED o� �,�. �;0 P 4'10" 4.2„ _ 4„� Sch. 40 PVC °�Bo A^ ���� 0\,se From Septic Tank ° � 9�0 `� edgeI f-9 \ Compartment Galy, ChainDrill 1 8"f� Hole TEST HOLE - I EL. 14.2 TEST HOLE- 2 EL.14.5 �. or "ti °f town 24"0 Opening Above For Drain A.LAYER A.LAYER A 796 Shed I For Steel Manhole Inv, 9.60 : ..... .. O �� \ • I To D-Box 8' Frame & Cover Emergency Storage .... ......... ....... ......... \ \ I \..._ Min. 2' Cover 6" 13.7 6" 13.7 ..SANDY LOAM.... SANDY LOAM.......... .. Volume 623 Gal. , I B..LAYER.IOYR 5/6 Bw LAYER LOYR Sf6 �\ \\ Sp Alarm On El. 7.1D g BROWNISH YELLOW : BROWNISH YELLOW co 32" LOAMY SAND 11.5 32" .:..: LO)kMY SAND.......:: .:.11.5 Pump On El. 6.85 C LAYER 2.5Y 6/6 PERC TEST \ j, -.______ p BROWNISH YELLOW 25 GALLONS GONE IN 10 MIN. \\ ""� 10'_Offset ' 108" MEDIUM SAND 5.2 PERC RATE<2 MIN/IN(LTAR=0.74) \� Pumps Off El. 5.85 g o PUMP CHAMBER PLAN VIEW D E TA 1 L GROUNDWATER ENCOUNTERED 3 " C LAYER 2.5Y 6/6 11.2 � 2"0 Sch. 40 PVC BROWNISH YELLOW � '\�- � $0.50 o- Threaded Pie 100.0' 1 p log MEDIUM SAND 5.2 0� , g °33 45"W •' � . Check Valve GROUNDWATER ENCOUNTERED 100.0' NOT TO SCALE ._. 13- Top of Con c. EL 5.35 I `~ 9 " Bottom El. 5.10 BVW 4 - - \ 12-. _ N F a .,., : . _- _. _ �` - \�1__,. Adam J. Hostetter & ,, Secure Pipe at Top \ risten Hoseotes Tr. & Bottom of Chamber Stable Compacted �10 , \ _ 4/10 H.P. Liberty Base \ LE40 Series Pump or *Prior to Ordering Pumps the Contractor �- Approved Equal* Must Confirm the Compatibility of the SEPTIC NOTES Existing Electrical Service 1.Location of Utilities Shown on This Plan Are Approx.At Least 72 Hours Pump Chamber Oimen tions should be BVW 3 :\\ 8 50.0' confirmed prior to setting Switch Elevations Prior to Any Excavation For This Project the Contractor Shall Make _ the Required Notification to Dig Safe(1-888-344-7233)and contact � Sullivan Engineering&Consulting Inc.(508-428-3344). \ 0 _ -� BVW 2 2.The Contractor is Required to Secure Appropriate Permits From TowngE \ \ Agencies For Construction Defined by This Plan. PUMP 1/�P CHAMBER V I BER SECTION DETAIL \ \ 3.Wherever Sewer Lines Must Cross Water Supply Lines Both Lines Shall \ Be Constructed of Class 150 Pressure Pipe and Shall be Water Tested to Assure Watertightness. In General,Water Lines Shall be Constructed in NOT TO SCALE \ Edge Of VW 1 Coordination With COMM Water,and Shall be in Accordance s ��l�OF 4 With 248 CMR 1.00-7.00&310 CMR 15.00. \ \ 4.A Minimum of 9"of Cover is Required for All Components. \ \ 0 R T. cU 5.All Structures Buried Three Feet or More or Subject � to Vehicular Traffic to be H-20 Loading.It is the Engineer's o. 5 99; N I Recommendation that H-20 Always be Used. \ 6.Install Watertight Risers and Covers to Within 6"of Finished Grade Over Septic Tank Inlet and Outlet,Pump Chamber Inlet,D-Box, ` ssiONAI NG LEGEND: and One Leaching Chamber.Cover to grade over Pump. All covers are to be maximum 18"for concrete or 24"Cast Iron. CDT Cedar Tree 7.Septic System to be Installed in Accordance With 310 CMR 15.00& 248 CMR 1.00-7.00 Latest Revision and the Town of Barnstable HT Holly Tree Board of Health Regulations. NOTES: PREPARED FOR: PREPARED BY.• TITLE.8.All Piping to be Sch.40 PVC.DT Deciduous Tree Sife Plan 9.D-Box Shall Have a Minimum Inside Dimension of 12",and a Minimum 1) Structures were located using conventional surveySump of �" CT Coniferous Tree 10.The Sepaz'ationDistance Between the Septic Tank Inlets and method located between 3/3/2017 and 3/17/2017. John M. Cx Kathleen A. Lynch Trs • Enginocring & Propos, Ipro,/Inmerlts y� Outlets Shall be No Less than the Liquid Depth.Inlet Tees Shall Extend Property lines were established using all available Lynch Realty Tru s t + � ) Utility Pole • 0 a Minimum of 10 Below the Flow Line.Outlet Tees Shall Extend 14 information. ivan,; �°L O -E- Electric 63 Ashland StreetC*'nsllulnl Inc. Below the Flow Line,and Shall be Equipped With a Gas Baffle and approved Filter. 2) Datum used IS NA VD '88. Datum WOS based On � -G- Gas Boston MA 02112 CapeSury plan of Farrington Residence at 50 Fire (508)428.3344 • P.O. Box 659 7 Parker Road,Osterville, MA 02655 Wetland Flag Station Road using 0.87' adjustment from NGVD 67 FireSite-ion � Light Post NA VD. g J seci(�sullivanengin.com wwwsullivanengin.com � Sar °� Osterville w 0 cB/DH 3 Ede of Stream is com lied from GIS hotos and is Draft: CTR Field: WHK JOD CTR W ) 9 P P 20 o io 20 4o so / / OHw- overhead wires approximate. Stream location should be field verified. Review: JOD .: CTR DATE: October 2018 SCALE: 1 „-,ZOO Cn - -25- - Elevation Contour = 1r-2 Comp Project: 30012 Project # C291