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Home My WebLink About0901 MAIN STREET (OST.) - Health 901 Main Stlkc'�T 117-041 Osterville y r a tKWE tgyy Town ®f Barnstable M Inspectional Services Department 639. Public Health Division 200 Main Street, Hyannis MA 02601 lhumas A McKean.l nU (Hlicc 508-862-4644 FAX 508-790-6304 Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §36(e 44 failure criteria.at�d associated( 00) repair deadline An "X" marked in the ❑ is th Tst��entADEADLINE CRITERIA to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or destructed pipe. e into the house due to an overloaded or clogged SAS or cesspool ❑ Backup of se��'ag ❑ Structurally unsound septic tank or SAS ONE'] YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box is above the outlet Invert due'to an overloaded or clogged SAS or cesspool ❑ A ortion of the SAS, cesspool, or privy is below the high groundwater elevation p u A portion of the cesspool is located within a Zone 1 to a public well well A portion of the cesspool is located within j,,feet 1ern passes ifate tlee water analysis with no acceptable water quality analysis. ( ) indicates the well is free from pollution). Two 2 YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Ali); "conditionally passed systems' (broken cover; relocation of a pipe; relocation o1•a driveway due to 11-10 components; etc) r� Leaching facility with standing liquid level at or above the invert pipe (per town Code §360-20 h) O HER ---�9-tJ"ln�j •- - - �� •IV�—l'-1 ` � � � -G �r,Cln_�_�1_o-1LP�11-✓�-�--- Repair deadline: ..__-__ _ -- -- -- Q\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS doc i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 901 Main Street. Map 117, Lot 041 V Property Address Mary Madeline.Crowley Trust '. Owner Owner's Name information is Osterville Ma _ 02655 5/17/2_021_ ' required for every _ page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information At on the computer, use only the tab Jeffrey M. Wall' key to move your Name of Inspector cursor-do not Wall Septic Service use the return key. Company Name P.O. Box 771 r� Company Address_ -- --- ---- H arwichp_ort,_ Ma 02646 Cityrrown — T State Zip Code aru 508 432 4908 _ _ 673 Telephone Number License Number B. Certification I certify that: I.am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 16.000);; 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ® Conditionally Passes (10e k-:' cr�f e�eFi�l ��Q�tr e`Y1�n�' 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails oot In p is Si nature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of.the DEP. The original form should be sent to the system owner and copies sent to the buyer; if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 x Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 901 Main Street _ Map 117, Lot 041 Property Address Mary Madeline Crowley Trust Owner Owner's Name information is required for every Osterville Ma 02655 5/17/2021 ------ — - page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. S-Y-0—M-9111 Passes. ❑ I h of found any information which indicates that any of the failure criteria described in 310 C .303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: �M 2) System Conditionally Passes: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N,ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance Indic ting that the tank is less than 20 years old is available. ❑ Y N ❑ ND (Explain below): t5iasp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form • Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 901 Main Street Map 117, Lot 041 Property Address a Madeline Crowley Trust_. owner Owner's Name Trust---.- - information.e Osterville Ma 02655 5/17/2021 required for.every .._ _ page. CltylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): -Irrp-C-hv ber-pu-nps/el9fms-rr�a19�PSM.15"ys of m wll pass i pprov .ebs�ervaborrof-sewage=b rp-erbreaic'MY tar Ig s a Ic wa er eve I strTtiati�"'du'e•- -•�°•-°•to•�of�ert°orabstrr�etEd-pipe�s)-or°-dae-to aWtxr�;set�led-®�-aeea�efa�ist�i�+tica�-tie�c:�rs4er�-w+lt- -.gass4pspeet4on-4(vwit-h-appRwe4-ef-Beard of HeaR4+)— ❑ - broken pipe(s)are replaced ❑ Y Z�N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y W, ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y N ❑ ND (Explain below): :�.��:_l�SST 0,6KTi o�►b_ GPI S u•a aloe 7-0 e o Sree L. 7 "70'77 C/21*4'4t, u ld 5"��T�' Z>.yu�6�/1r�- ❑ 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): -he BGaFd Of HGalthi ❑ Conditlor" -exoist h require further evaluation by the Board of Health in order to determine if the system is failing to pro eU alth, safety or the environment. a. System will pass unless Board of Health d t ree min's-ir,-�rdance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which wi ljprotest�blic health, safety and the environment: t5insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ,i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 901 Main Street Map 117, Lot 041 v Property Address Mary Madeline Crowley Trust __T� Owner Owner's Name -- information is required for every Osterville __ _ __� Ma 02655 5/17/2021 __ page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) Cesspool or privy is within 50 feet of a surface water El Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. 8yste ill fail unless the Board of Health (and Public Water Supplier, if any) determines t t the system is functioning in a manner that protects the public health, safety and envi nment: ❑ The system has eptic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface wa supply or tributary to a surface water supply. ❑ The system has a septl ank and SAS and the SAS is within a Zone 1 of a public,water supply. ❑ The.system has aseptic tank d SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and 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, performe t a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammo iq nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are tr ered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ , ,/ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 901 Main Street Ma_p 117, Lot 041 Property Address Mary Madeline Crowle Trust Owner Owner's Name information is Osterville Ma 02655 5/17/2021 required for every ._..—__ �. _ _._.. page. City(Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than % day flow ElRequired pumping more than 4 times in the last year NOT due to clogged or EM obstructed pipe(s). Number of times pumped: ❑ [t� Any portion of the SAS, cesspool or privy is below high groundwater elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or El tributary to a surface water supply. ❑ Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ An portion of a cess ool or privy is less than 100 feet but greater than 50 feet Any p p Y from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] The system is a cesspool serving a facility with a design flow of 2000 gpd- ❑ 10,000 gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to'determine what will be necessary to correct the failure: system must serve a feeility with a de ' flow of 10,000 gpd to 15,000 gpd. For large s s, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Sectl 4. Yes No ❑ ❑ the system is within 4 of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tribu o a surface drinking water supply ❑ the system is located in a nitrogen sensitive area inn Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supp II t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form TSubsurface Sewage Disposal System Form - Not for Voluntary Assessments . ..... 901 Main Street Map 117, Lot 041 Property Address Mary Madeline Crowley Trust Owner Owner's Name information is OSterVllle required for every _ ._ Ma 02655_ 5/17/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no" for each of the following for a//inspections: Yes No ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? ❑ Has the system received normal flows in the previous two week period? / p ❑ .[_[4-/ Have large volumes of water been introduced to the system recently or as part of / this inspection? m/ ❑ 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? r u k(ii?� ❑ Were all system components, exc Ing 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. El Determined in the.field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 15insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 901 Main Street Map 117, Lot 041 v Property Address Mary Madeline Crowley Trust Owner Owner's Name information is Ostervllle Ma 02655 5/17/2021 required for every — page. City/Town State Zip Code Date of Inspection D. System Information Flew N ber of bedrooms (design): ---- -- Number of bedrooms (actual): DESIG flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description. Number of current residents: — Does residence have a garbage grin ? ❑ Yes ❑ No Does residence have a water treatment un ❑ Yes ❑ No If yes, discharges to: ------------ Is laundry on a separate sewage system? (Include I ndry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use?. ❑ Yes ❑ No Water meter readings, if available (last 2 years usage(gpd)):. Detail: Sump pump? ❑ s ❑ No Last date of occupancy: Date t5lnsp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 commonwealth of Massachusetts Title 5 Official Inspection Form lv Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 901 Main Street Map 117 Lot 041 Property Address Mary Madeline Crowley Trust Owner .Owner's Name — information is OStervllle required for every Ma 02655 5/17/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons perday(gpa) Basis of design flow(seats/persons/sq.ft., etc.): - oa Grease trap present? ❑ Yes [?/No Water treatment unit present? ❑ Yes Q/No ��- If yes, discharges to: -- -- Industrial waste holding tank present? El Yes M/No Non-sanitary waste discharged to the Title 5 system? ❑ Yes E�'/No Water meter readings, if available: �oi��'=1b °may `" -7d 4",ew r��• v�?, Last date of occupancy/use: '�-� -0Gc- ;Ip led— Date Other(describe below):j e.e;�¢T e "��Si�s.JIta%/rz tLy'" Sn6. Gah 3/.7cz�9 f rn dic, S_: s'oo CfIG. s 'fin b-�o1f 3.27/8/ f'e/2.«,ir'A�PPLro� qS-T3�•crCr'lndiC�4tL Se l't Kr p-FS�X'i C e/�c, /�� <✓►� c�!/ep eS Gtlr/� A�1' �� /�Pl��tea L , Se�T`� �,.a/2� (,-pit-cl�-PoT'"Pu,•�p�.C...�/��tS 3: Pumping Records: Cu^.4 Source of information: - -- Was system pumped as part of the inspection? [0 Yes ❑ No If yes, volume pumped: —1— --�- gallons How was quantity pumped determined.? `� � Reason for pumping: .�' TD --- - - k5�=�- t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 901 Main Street_ Map 117, Lot 041 Property Address - Mary Madeline C_r_owley Trust _ Owner Owner's Name — information is Osterville Ma 02655 6/17/2021 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ( Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ' ❑ Yes 2/No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: Eg/cast iron ❑ 40 PVC ❑ other(explain): -- - Distance from private water supply well or suction line: If _---- - feet Comments (on condition of joints, venting, evidence of leakage, etc.): 15insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Vim'F 901 Main Street Map—117, Lot 041 Property Address Mary Madeline Crow Trust Owner Owner's Name --- _—� — information is OStervllle required for every ___..; __ Ma 02655 5/17/2021 page. City/Town 'State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: ST�eC,�o,�e (51ow,e feet Material of construction: ID concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) e: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ff Yes ❑ No Dimensions: P 5(c i Piar S AWK 1550 iff9C 1. Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle -- 0 — Scum thickness - ------- — Distance from tog, of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle A.;/D ?rn( rrie-/e, u-,0-6<'1 How were dimensions determined? 1"`�—L�7 -- Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels a related to outlet invert, evjdence of leakage, etc.): P it_ G ___.._. ........_�.:....._.!_dl7`�c.�'T�T_x'_�1._`u/2-�_� 'j`t<'�,�5' 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments P 901 Main Street Map 117, Lot 041 V -- Property Address Mary Madeline Crowley Trust__ Owner Owner's Name information is Osterville _ Ma_ 02655 5/17/2021 required for every _ page. Citylrown u State Zip Code Date of Inspection D. System Information (cont.) TFOP De p below grade: feet Material o nstruction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness -- -- Distance from top of scum to top of outlet tee baffle Distance from bottom of scum to bottom of outlet tee baffle — Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or ffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): a el 1 Depth w grade: -- — Material of construe l ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: -- gallons Design Flow: -- gallons per day t5insp.doc-rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 I Commonwealth of Massachusetts P Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 901 Main Street _ __Map 117, Lot 041 Property Address — Mary Madeline Crowmev Trust Owner Owner's Name — information is — required for every Clsterville Ma— 02655 _5/17/2021 wn page. GtyfTo - _. State Zip Code Date of Inspection D. System Information (Cont.) Alar 7esnt: ❑ Yes ❑ No Alarm level: — — - Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float �hes, ): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box l;if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): 41- 49 V-c F� c!"�. fv�o �/o Gd✓t i2�'rf�/�/T I Pei t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 901 Main Street Map 117, Lot 041 Property Address Mary Madeline Crowley Trust Owner Owner's Name information is required for every Cisterville _ _M_a__ _02655 5/17/2021 —__— _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Pu in working order: ❑ Yes ❑ No* Alarms in workiP grder. ❑ Yes ❑ No* Comments (note condition ump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS met 'ceated, explaip why! �oT2 __G►�_�'�Gil Gan 3�3 �E31 7r,r ,G/� � G�IS eiL /ec l ' S?"eacry_._ Type: leaching pits o 'U rtj number: �� 9� GiQu,�LeyeC ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: --- —— --- ❑ innovative/alternative system Type/name of technology: --- t5insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 901 Main Street Map 117, Lot 041 Property Address —— --- — — Mary Madeline Crowley Trust Owner Owner's Name —— — ---- information is Osterville required for every __. _ _ Ma 02655_ 5/17/2021 page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): r l�'tecr�uwt Sa�n 0000 S. G✓1 o. i' mod, Oct, c JEZ4-i Ga di Pi,G I S y4e �_cs' VeGcT �o:� - S'c fi,edGcGec/ 70 �" /S -e car»m��p� Gts'Ih a / To�t!nal iTS. iiG 1�—6e�spesls{ Nu r and configuration _ Depth—to f liquid to inlet invert — Depth of solids la Depth of scum layer Dimensions of cesspool �— Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic ilure, level of ponding, condition of vegetation,. etc. : t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 901 Main Street Map 117, Lot 041 Property Address Mary Madeline Crowley Trust Owner Owner's Name information is required for every Os_terville Ma 02655 5/17/2021 - .__. page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) MaterIa 0nstruction: Dimensions Depth of solids -- Comments (note condition of soil, signs of hydra ailure, level of ponding, condition of vegetation, etc.): i I t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 901 Main Street : Map 117, Lot 041 u -- Property Address Mary Madeline Crowley Trust _ Owner Owner's Name information is Osterville _ _ _ Ma 02655 5/17/2021 required for every _ page. City/Town _. State Zip Code^ Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters 7ha ilding. Check one of the boxes below: nd-sketch in the area below ❑ drawing attached separately 3 4- 'o r 3 S,6 3 S'7. 3 � t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 901 Main Street Map 117 Lot 041 Property Address - -- Mary Madeline_Crowley Trust Owner Owner's Name --� information is Osterville required for every _ _ Ma 02655 5/17/2021 _ page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: WCheck Slope "W'Surface water heck cellar Shallow wellsQ, Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: [� Obtained from system design plans on record If checked, date of design plan reviewed: —Date 3--��3�� ( ��U r bra 9 ) ❑ Observed site..(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑. Checked with local excavators, installers -(attach documentation) Accessed USGS database -explain: You must describe how you established the high ground water elevation: �iIt- Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of.Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments- 901 Main Street_ Map 117, Lot 041 Property Address Mary Madeline Crowley-Trust Owner Owner's Name information is Osterville _Ma 02655 5/17/2021 required for every ._ _ _ page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: M/A. Inspector Information: Complete all fields in this section. [I/B. Certification: Signed& Dated and 1, 2, 3, or 4 checked C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate [�4 (Failure.Criteria) and 6 (Checklist) completed D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 I• y - i �-7 Y O 4G V d r' ( Ass u eD i ht r t 1 �CER-TI -�Lr TH6 Svc. CUU r'-�eMS To L } GFF1G s �calL.p t IQ F 1 - 3 5 Y?E-Z-1 k et4xJ Rl4l_j VAk L �-L&vW = -15 61 P n 6.3 - c113 c p D. C) Tv W L) of c3Ae -)5 rA-61,L 5- c TAuK D�sFb�A�F'Iez- uF3C vz. 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THE COMMONWEALTH OF MASSACHUSE775 E30ARD HEA TH .....OF ........ .: ..../ :....U......, �'. ........................... , 1 1utt it n for 3igvofial ark-4 Tnu-5trurtinn perutil Application is hereby made for a Permit to Construct (/,/)�or Repair ( ) an Individual Sewage Disposal System at: �y !� ._.t,�. 7L..'e�' '4J,� .._ .---•---- .......................................... 0 (lii.... //�� /,\/��rL,t`�`-.a(n�o{rn- d ep/s�'s �• /� "ea:................. ... 4M.).... - ........... _.__......_____ OC Lot O. 1 CC411J. naa............................... ........ .............. 5 C ---- stailer Address .... --..Sq. feet 1 Type of Building Size Lot • U E?x ansion Attic Garbage Grinder ( ) Other—Typel oof Building,- .--. - �..... No. ers P s.. ..................( _)Shoyvers ) - Cafeteria ( ) a a G. . Other fixtures ... .. ._... .. ..` ... .......�a �. ............ �. Design Flow...........................................gallons per perso�er day. Total daily flow.................. ......................gallons. a W p 1 g g Ri Se tic rank L L' t.ud ca>actty . tit) ._ allons Len th................ Width................ Diameter............ Depth.........._.... Disposal Trench No- -------------------- Width..... )6........ Total Length......2.-`I---: Total leaching area._�.:�.�.'sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tagtk ( . ) dA /'Y '-' Percolation Test Results Performed b Date...... :-.r '.- .�....---•.•-. 7 y...-.. nit.... _. .................. as Test Pit No. l................minutes per inch Depth of 'hest Pit.............._..... Depth to ground water........................ Y Test Pit No. 2................riainutes per inch Depth of Test Pit_................. Depth to ground water......................... •. ................... ................. . . • Description of Soil---------0.�.... .-------•--� � :-....../ 7 � .� :a ..:... x ........................................ ..... -;L-.... �q;.L, .............................................................................. UNature of Repairs or Alterations Answer when applicable.................. ........................................_................................ ............................................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in .+ operation until a Certificate of Compliance has been ' su d b e Uo d �heal 2 ed.._ ..... I .... Da c Application Approved By........4ej- Date l Application Disapproved for the following reasons:........................ ------------•............_..------............... •-•--------------•--.....-•-----....--•----•.........---......---- Date Permit No........ Issued........................................................ Date M i t THE COMMONWEALTH OF MASSACHUSETTS BOARD iOF HEALTH OF........ ° t � j } T l IS-..1 C '19I.Y Tlr t 9,g.Individual Sewage Disposal System constructed (�) of Itetiaired b �'� ................. . _ 1 y all�,c,�r�v 1 ' h r f liar Ueen �nst111ed in. accor anct- m with the PeiSaons Of ; le XI of The'State Sanitary Code as described tr► the d ated_. s application for Disposal Works Construction Permit 1 0.... � s T IE ISSUANCE OF THIS CERTIFICATE SHALL ijOT EE CONSTRUED AS dG GUAR�►IdTEE;TIFIAT*-T�°IE t 4 II : SVST{£Wl WILL FUNCTION 5ATISFACTORY. :,' ....... Inspector.... ----•'_.. -/ r t0CATIONt 90 / S1'W A tMIT 111; ,. MILLAGE INSTA LLER'S NAME ADDE'ESS. D U I l D E P OD OWN Eft DATE 'PERMIT ISSUED I DATE C.OMPLIANlCE ISSUED II 70 I t { � i t { 1 !q t x 4 S b F C I 1 .Table 3-2 Do's and Don'ts of Private Septic System Management DO. DON'T. Do have the on-site system Inspected and pumped by Do not use the toilet or sink as a trash can by a licensed professional approximately every / 7'0 3 dumping non-biodegradable material (clgarerte butts. years. Failure to pump out the septic tank can cause diapers; feminine products, etc.) or grease down u)e system failure, If the tank fills up with an excess of sink or toilet. Non-biodegradable material can clog solids, the wastewater will not have enough Ume to the pipes,while grease can thicken and clog the I settle in the tank, These excess sollds will then pass on pipes. Store cooking oils, fats, and grease in a can to the leach Aeld,where they will clog the drain lines for disposal inane garbage. and soil. Do know the location of the on-site system and drain Do.not put.paint thinner, polyurethane, anti-freeze,' field,and keep a record of all Inspections, pumping, pesticides; some dyes, disinfectants, water repairs,contract or engineering work for future softeners, and other strong chemicals into the references. Keep a sketch of It handy for service visits. system. These can cause major upsets in the sep.t,c tank by killing the biological part of the on-site system and polluting the groundwater. Small amounts of standard household cleaners, drain deansers, detergents, etc. will be dlilitod In the tank and should cause no damage to the system. I . Do grow grass or small plants (not trees or shrubs) Do not use a garbage gender or disposal, which above the on-site system to hold the drain field in feeds Into the on-site tank. If there is one, severely l place.Water conservation through creative limit Its uso. Adding food wastos or other solids landscaping is a great way to control excess runoff, reduces Una system's capacity and Increases the need to pump the on-site tank. if a grinder is used, the system mu.st be pumped more often: I Do install water-conserving devices in faucets, Do not plant trees within 30 feet of the system or I showerheads and toilets to reduce the volume of water paWdrive over any part of the system, Tree roots w:!! ` running Into the on-site system. Repair dripping faucets dog pipes, and heavy vehicles may cause the drain and leaking toilets, run washing machines and field to collapse, dishwashers only when full, and avoid long showers. Do divert roof drains and surface water from driveways Do not allow anyone to repair pr pump thu system —' and hillsides away from the on-site system, Keep sump without first checking that they are licensed system pumps and house footing drains away from the on-site professionals. i system as well. Do lake leftover hazardous chemicals to an approved Do not porform excessivo laundry loads with a hazardous waste collection center for disposal. Use washing machine. Doing load after load does not bleach, disinfectants, and drain and toilet bowl cleaners allow the on-site tank Ume to adequately treat wastes sparingly and in accordance with product labels, and overwhelms the enUre.on-site system with excess wastewater. This could flood the drain fielc without allowing suffident recovery Ume. Consult ,nU, an on-site tank professional to determine the gallon capacity and number of loads per day lhat can sa(eiy o into the system. Do use only on-site system additives that have been Do not use chemical solvents to dean Ine plurnbinS allowed for usage In Massachusetts by MA DEP, or on-site system. "Mirade" chemicals will kill Additives that are allowed for use In Massachusetts microorganisms that consume Harmful wastes. I have been determined not to produce a harmful effect These products can also cause groundwater to the Individual system or Its components or to the contamination environment at large, rmpJnvw.mau.povl0ey+�aalrs+atw✓mpp�L4�.doc 3-17 r. ya THE COMMONWEALTH OF MASSACHUSETTS Application is hereby made for a Permit to Construct 4--for Repair an Individual Sewage Disposal System at: 634- 1 A ............M ---------------- ... ...... ............ ....lairo ---4ner staller Address Type of Building Size Lot.... ....Sq. feet Dwelling—No. of Bedrooms.... ................Expansion Attic Garbage Grinder ( Other—Type of Building .. Z Other Distribution box Dosing tafk The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been psupd b e b d I f 4h Wh; �j 7e . .................... ... Application Approved By------- V,—---------------------------- Date _____ ' Date Permit No. °"= ___________ _ _____ _____ _ __ ____________ __ __ _ __ _ __ ____ ____ ____ _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Application is' hereby made for a Permit to Construct or Repair an Individual Sewage, Disposal Location-Add7-ess or Lot.No. 71 .....0Q. i ----Aet: ------------................................................ .................................................................................................. Owner Address Other Distribution box Dosing tana( Percolation Test Results Performed by-----_-------14-ill ---------------------------------..... Date-------Tt_Cr-,A_/------------ . The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—,The unde rsigned further agrees not to place the system in operation until a Certificate of Compliance has been issued'i��jhe board of health. Daie Application Approved By.......ee, ...... ........................ Date Date Date THE COMMONWEALTH OF MASSACHUSETTS ZOARD OF HEALTH T I I S PEA C F Y That the Individual Sewage Disposal System constructed Repalred ......P------&.07,;V�------------------------4-----/--------J_n---�a_,1_1_er---%--------------------*--------------- ------------------------------------------------- ----- ------:.7 ..4 has been installed in accordanc with the provisions of Hcle XI of The State Sanitary Code as described in the 4�) .................. application for Disposal Works Construction Permit -----------_ dated--- THE ISS.UANCE .QF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION 5ATISFACTORY. DATE.......... ------- ......................... lnspector.__4�2_4�_. P................ THE COMMONWEALTH OF MASSACHUSETTS 130ARD .9F HEALTH NC)................ 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