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Home My WebLink About0933 MAIN STREET (OST.) UNIT #E - Health (2) A °117 = 067 � r o l TOWN OF BARNSTABLE LOCATION!q 33 N q3,3 F IYlorb J S . SEWAGE# ZQV VILLAGE Osre-jtV I (ALE- ASSESSOR'S MAP&PARCEL 10 .� INSTALLER'S NAME&PHONE NO.?466eT .Oct Q. CsoA).411 SEPTIC TANK CAPACITY tDOO a01. LEACHING FACILITY.(type) SOO kekl.. CAAA-r^b c(size) 10.193 x 3$ NO.OF BEDROOMS q I= �trcln Vr� ) OWNER t vs PERMIT DATE: tp I Z COMPLIANCE DATE: Z 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 (`O(;��T �, OU-e— CO, P t'-�V Pt1 C w Pr�-1 A-. fV Goo S Ile C S to A 59.1 (� l 3 q ►�., � «s 4os ��.. ►Z l 25 Zg;� vLV►4r Certified Mail#7014 1200 0001 0358 1014 ,�j Tati� Town of Barnstable Regulatory Services BARNSCABL& ' 9� 6 MASS. ,0$ Richard Scali,Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 11, 2015 Richard Callahan 1 770A Main Street Osterville, MA 02655 V44�1�1 � - lb ^l5 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STAT SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 933 Main Street Apt.B, Osterville, MA was inspected on May 8, 2015 by Timothy O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violation(s) of the State Sanitary Code were observed: 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Bricks on front step have become dislodged. = You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by repairing steps. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and.ask to speak with the inspector who performed the inspection. PER ORDER OF E BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Q:\Order letters\Housing violations\Rental ordinance\933 main unit B 5-8-15 t Commonwealth of Massachusetts Lt Title 5 Official Inspection For Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 933G Main Street Property Address W M Thibeault aS Owner's Name Osterville MA 02655 11/8/14 O—z"I Cityrrown State Zip Code Date of Inspectio asp I � Sp�� Inspection results must be submitted on this form. Inspection forms may not be altere ino aniy� way. A. General Information c 0 ��-7 1. Inspector: �a,,- -- - Frank Nunes III - Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code 508.272.6433 Telephone Number B. Certification 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 ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority A 11/8/14 Ins or's Sign Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the'DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system ' I perform in the future under the same or different conditions of use. f 7f1�Q� 933 G Main Street-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 l I Commonwealth of Massachusetts RR Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 933G Main Street M Property Address Thibeault Owners Name Osterville MA 02655 11/8/14 Cityfrown 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: Pumping suggested every 3 yrs to prolong the life of the system B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: n/a ❑ 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 933 G Main Street•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 933G Main Street Property Address Thibeault Owner's Name Osterville MA 02655 11/8/14 City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: n/a ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: n/a 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. 933 G Main Street-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts M r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 933G Main Street Property Address Thibeault Owner's Name Osterville MA 02655 11/8/14 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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: n/a 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 ❑ ® 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. 933 G Main Street-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments M 933G Main Street Property Address Thibeault Owner's Name Osterville MA 02655 11/8/14 Citylrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No ❑ ® 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 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. 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 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. 933 G Main Street•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments _ t wM , 933G Main Street Property Address Thibeault Owners Name Osterville MA 02655 11/8/14 Cityrrown 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. ® ❑ 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)] 933 G Main Street•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 933G Main Street Property Address Thibeault Owner's Name Osterville MA 02655 11/8/14 Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 2 Number of bedrooms(actual): 1 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 220 Number of current residents: 2 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 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Occupied Date Commerciallindustrial Flow Conditions: Type of Establishment: n/a 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: Last date of occupancy/use: Date Other(describe): n/a 933 G Main Street•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M '(a 933G Main Street Property Address Thibeault Owner's Name Osterville MA 02655 11/8/14 Cityf'rown State Zip Code Date of.Inspection D. System Information (cont.) General Information Pumping Records: Source of information: No pumping per owner 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): Approximate age of all components, date installed (if known)and source of information: 2008 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No 933 G Main Street-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 933G Main Street Property Address Thibeault Owner's Name Osterville MA 02655 11/8/14 City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 2' 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.): Septic Tank(locate on site plan): Depth below grade: 18"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) Outlet cover to 3"of grade If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1500g Sludge depth: 411 Distance from top of sludge to bottom of outlet tee or baffle >12" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle >2" Distance from bottom of scum to bottom of outlet tee or baffle >21, How were dimensions determined? Measured 933 G Main Street-03f08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 933G Main Street Property Address Thibeault Owner's Name Osterville MA 02655 11/8/14 Cityrrown 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.): Pumping suggested every 3 yrs to prolong the life of the system Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): n/a Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): n/a 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): n/a 933 G Main Street-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 i I ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 933G Main Street Property Address Thibeault Owner's Name Osterville MA 02655 11/8/14 Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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.): n/a *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Cover to 3"of grade, very good condition Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No f 933 G Main Street-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 933G Main Street Property Address Thibeault Owner's Name Osterville MA 02655 11/8/14 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 1 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Cover to 3"of grade, 1"of effluent in chamber at this time, no indication of past backup, system in very good condition 933 G Main Street•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 933G Main Street Property Address Thibeault Owners Name Osterville MA 02655 11/8/14 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): n/a I 933 G Main Street•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 933G Main Street Property Address Thibeault Owner's Name Osterville MA 02655 11/8/14 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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. Z-,- A P� 933 G Main Street•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 933G Main Street Property Address Thibeault Owner's Name Osterville MA 02655 11/8/14 Cityrrown 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: >126" 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: 2008 NGW 126" Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators,installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: see above 933 G Main Street•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Town of Barnstable Office: Sob-862-4644 °�►y. Fax: 508-790-6304 Regulatory Services Department Public Health Division MAW Thomas A.McKean,CHO 200 fi Main Street,Hyannis,MA 02601 n. , Payment Receipt w.., ._..._....... __ _ _ __. r ._.__._....__........... ___._...... Septic Inspection Payment received: $50.00 (Check) on 4/10/2015 Permit number 10757 Check number: 1198 Check amount: $50.00 Name on check: Frank Nunes ill Owner: GAYLE M TR KILEY Address: 933 MAIN STREET(OST.),Osterville Note: (credit $25) old ck dtd 11/17/14 on Ip desk.only one inspect. ............................................................... .............. _.... ................................................................ ............. ........ ..._........... .... ........................._.............._..._....................................................... ` - `� .z �_J4 r Hazardous Materials Inventory Sheet Checklist `1 D- Date Physical Street Address-Check database to ensure it exists Working Phone.Number dual Amounts ( ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials) -� Storage Information - location of storage, how long is storage for? If none, note that. ✓ Disposal Information -where and who? If none, note that. Applicant Signature-understand what is listed and noted —Staff Initial -any questions, know who to ask SI Vehicle Washing/Rinsing? -provide a vehicle washing policy and explain it- note that it was given Attach the Business Certificate with your sign off and comments **The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. YOU WISH TO OPEN A BUSINESS? - For Your Information: Business Certificates cost $30.00 for-4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the Town (WHICH YOU MUST DO BY M.G.L. - it does not give you permission to operate). You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1" F1., 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. DATE: f rq r Fill in please:, ' APPLICANT'S YOUR NAME: � sq a BUSINESS YOUR H E AD RESS: /`7 g%^ l �f /yi o Z 90/�- TELEPHONE # Home Telephone Number: NAME OF NEW BUSINESS IV q e 4f� Sc�1(yTYPE OF BUSINESS Z IS THIS A HOME OCCUPATION? YES NO Have you been given approval from the building division? YES NO ADDRESS OF BUSINESS 3 -41,A/ ST ®-sier�� /lp7 aZ6S AP/PARCEL NUMBER. - When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of. Barnstable. This form is intended to assist you in obtaining the information you, may need. You MUST GO TO 200 Main St. —(corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this ' town. �. 1. BUILDING COMMISSIONER'S OFFICE ' This individual has been informed of any permit requirements that pertain to this type•of business. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH ` This individual has .e infor e e e it req 'rements that pertain to this type of business. Authorized Si atu e* ,' "`'' MUSTCOMPLYWI4HALL COMMENTS: US MATERIALS REGULATIONS 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has Ma info ed o el nsing requirements that pertain to this type of business. A thorized Sign ure COMMENTS: TOWN OF BARNSTABLE . Date: � / 7/ 67 TOXIC AND HAZARDOUS MATRJIALS ON-SITE INVENTORY NAME OF BUSINESS: Ca/L7^ G^l BUSINESS LOCATION: ��3 `I/ "� _57—, e2f_l_fl-tlil f l�9 o2 INVENTORY MAILING ADDRESS: /�� '� TOTAL AMOUNT: TELEPHONE NUMBER:- CONTACT PERSON. EMERGENCY CONTACT TELEPHONE NUMBER: �s-68� V 2 a MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Ct'T Hydraulic fluid (including brake fluid) Refrigerants M Z C,�el,' gF�1Sc (f Motor Oils Gr - Pesticides �yc ✓ NEW USED - (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Z,12 q Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes 6! We ' Fertilizers Asphalt & roofing tar PCB's 1C9'� Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW_ USED _ _ .Any,other_products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes ay be toxic or hazas le a list): �. r ' o do Laundry soil & stain removers (including bleach) Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers 30 Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS 2 TOWN OF BARNSTABLE LOCATION 61 PLA ' SEWAGE# 4V9-2/ VILLAGE 0eS+0,'<-\I V ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. lk C?aV oL-� < b %T7 SEPTIC TANK CAPACITY f SOo LEACHING FACILITY: (type) (size) Z NO,OF BEDROOMS OWNER e ` PERMIT DATE: 1A107 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ,4 Feet Private Water Supply Well and Leaching Facility(If any.wells exist _�- on site or within 200 feet of leaching facility) �5 Feet Edge of Wetland and Leaching Facility(If any wetlands exist �-M> within 300 feet of leaching facility) � �4 Feet FURNISHED BY � — ZS3 3 z i9 No. . /' " � '� Fee 0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes II '' ►� Potation for Mioonf �&paem Cou0tructiou Vermit Application for a Permit to Construct( )zlpair( ) Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. [ `� Owner's Name,Address,and Tel.No. osn-1VI'//e Assessor's Map/Parcel h S-P/, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �J 6 /' k � eet/, Gfk�✓ S Type of Building: A op Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of BuildingPLO-5, No.of Persons Showers( ) Cafeteria( ) Other Fixtures 44 Design Flow(min.required) gpd Design flow provided mo 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) 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 ofe;z nd not to ce the system in operation until a Certificate of Compliance has been issued b this B ar Sign Date Application Approved by Date Application Disapproved by: op Date for the following reasons Permit No. Date Issued � I ..r�,,T... --,-.-..- .,..�� t N w --• «w,. -r - o. /' 1 V +��'. -R-tom (.li .. � Fee HE COMMONWEALTH OF MASSACHUSETTS Entered inrcomputer: -" 1 Yes ^� PUBLIC HEALTH DIVISION, - TOWN OF BARNSTABLE, MASSACHUSETTS 4 Application for i� og'I 4bp5tem Con5tructiou Permit Application for a Permit to Construct IP4 repair( ) Upgrade( ) Abandon( ) ElComplete System EJ Individual Compponents Location Address or Lot No. ��` �� Owner;s,Name,A ddress,and Tel.No.Assessor's Map/Parcel U/ 61 6 1)19"."l Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building f Dwelling No.of Bedrooms Lot Size �)U(� sq.ft. Garbage Grinder ( ) Other Type of Building Apes', No.of Persons Showers( ) Cafeteria( ) t Other Fixtures Design Flow(min.required) AA(/ gpd Design flow provided �y 0 J - gpd Plan Date Number of sheets Revision Date Title Size of.Septic Tank /� Type of;S.A.S. J p ��C 4� r r Description of Soil r: Nature of>Repairs or Alterations(Answer when applicable) r' r.�.� ^Al) - a 1V Date last inspected: U V F 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 Enviprimental Code and not tofpl'ace the system in operation until a Certificate of . r Compliance has been issued by this Boar of e�1"th. ` g ' + Si n•dA „/�. Date Application Approved by / / / ,r / /�/ / // / Date Application Disapproved by: --- V y I Date / for the following reasons Permit No. "' Date Issued v r- arn• ————————— ——— — —— ——— —— ————————————— -=------------- ---- --- - -, -. -. �..-,r -,ram., -------.-. -. ---.-. _.- . ,-'-----'-- -------_. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS • � A Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (/Upgraded ( ) Abandoned( )by _ r at.0336 has been construc ed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer G?, � lif^��/�Ti rJC Designer 4r CV Alt-1191 #bedrooms ,_� Approved design flow n gpd The issuance of this perm't shall not bye-construed as a guarantee that the system will function as designed Date / C/J Inspector No. ( //) r _ . Fee T THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 'Wi5pogoz �&pgtem Cow9tructiort permit 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 recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be con4pleted within three years of the date of thiMA p Date f1l Approved by 07 17/2008 06: 49 5084775313 ENGINEERING WORKS PAGE 01 Town of Barnstable Regulatory Senices 1 Thomas P. teller,Director old Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 (Xike: 508-862-4644 Fax. 508-790-63(4 _ r&Designer Ce ti® Foenn Date- Sewage Penmit# � .��Assessor's MaplParce1 DeA ero Address° / 2- !N, �S S �e�� Address: � x was issued a permit to install a (date) (installer) septic system,at Q�� M 4 � � � �S�• based on a design drawn by (address) dated /7 l Q LF (designer) 1 certify that the septic system referenced above was installed substantia y according to the design, which may include minor approved changes such as lateral rrIocati f the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major,changes (i.e. greater Haan 10 lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State dt Local Regulations. Plan revision or . certified as-built by designer to follow. z McENI EE v9 (Installer's Signature) g CM � 9-, c i s a� (Designer's Signature) (Aft Designer's Stamp Here) lb1LEASE 1�ETIJRi�I TO BAIdWSTABLE 1'UI$LIC IiEALTH I)IVISIOAI. CERTIFICATE OF KQ J. CE Mu.L NQT BE ISSUED UNTIL BOTH THIS FORM AND AHMI CARD ARE ➢.3ECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANYL1'OU, Q:HWtVS%YdoVc&igi=Ccrfi6cation Foam 3-26.04.doc ar - Bk 23025 P�30 36221 - t�7--t�3--2iGtaB a"0 12��3a DEED RESTRICTION WHEREAS, Tracey L. (Patterson)Thibeault of 933G Main Street located in Osterville, MA, is the owner of 933G Main Street, Osterville, MA and being shown as Lot 7 on a plan entitled"Plan of Land in Osterville-Barnstable, Mass. Property of Dana M. and Marion M. Marston," dated October 5, 1950,Bearse and Kellogg, C.E., duly recorded with the Barnstable County Registry of Deeds in Plan Book 95, Page 135. WHEREAS, Tracey L. (Patterson)Thibeault as owner of said lot has agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition of obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage. WHEREAS,the Town of Barnstable Board of Health, as a pre-condition to granting a Disposal Works Construction Permit for a septic system in compliance with 310 CMR . 15.000, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on said lot be put on record with the Barnstable County Registry of Deeds by recording this document. O NOW THEREFORE, Tracey L. (Patterson)Thibeault do hereby place the following restriction on her above referenced land in accordance with her agreement with the Town of Barnstable Board of Health which restriction shall run with the land and be binding upon all successors in title: Vj 1. 933G Main Street, Osterville, MA may have constructed upon it a house containing no more than two (2) bedrooms. Tracey L. (Patterson)Thibeault agrees that this shall be a permanent deed restriction Affectingthe dwelling located at 933G Main Street Osterville,g , O ernlle, MA and being shown as Lot 7, in Plan Book 95, Page 135. Page 1 •� Bk 23025 Pg 31 #36221 For title of Candace S. Lowe see the following Deed: Book 10738, Page 099. Executed as a sealed instrument this day of-Uv 1-Y , 2008. Owner's signa Owner's signature Owner's signature COMMONWEALTH OF MASSACHUSETTS ss Date 2008 Then personalty appeared the above named- 7)U G„ -1W-rAfAU L f known to me to be the persons who executed the following instrument and acknowledged the same to be their free act and deed, before me. otary Pu lic My com pj CREGORY C.11gd NOTARY PUBLIC OMMONWEAITH OF MASSACHUSETTS SON EX?IRES NX/2011 REGISTRY QF DEEDS UE ATTE Page 2 A TR COPY, K. 0%,.A c Hu a JOHN F.MEAD REdISTER . BARNSTABLE REGISTRY OF DEEDS i AsBuilt Page 1 of 1 p2 TOWN OF BARNSTABLE LOCATION 9J J N?a 1,' If{ 'th 61 ��c�r SEWAGE f VILLAGE 0 S f�,��l r�( ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO:. j?n,� k SEPTIC TANK CAPACITY __-ISD0 LEACHING FACILITY:(type) !}f j oo (size) Z _ NO.OF BEDROOMS OWNER—T PERMIT DATE: COMPLIANCE DATE:, It Separation Distance Between the: Maximum Adjusted Groundwater Table to,the Bottom of Leaching Facility 44 / 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 � � , y t ,p\ t) � Q •fir loJ� ZS3 i http://issgl2/intranet/propdata/prebuilt.aspx?mappar=l 17065&seq=1 11/6/2014 K t Zc Town o5f Barnstable P# 12 M . t ; Departinent:of Regulatory Services -774 • �. Q t �et� Public Health D><�><s><on Date s ZUO Main Street Hyannis MA 02601 # r S 3 ��70IT -IOa h Date Scheduled <;Tlme Fee Pd i Soil Suitability Assessment for Sew ge Di osal: ' 0 Performed Bed 1 Location Address O 's Na me 3 �1iq ',1- sr -� _ . Address Assessor's Map/Parcel: �' ®Cp� Engineer's.Name �e �7 NEW CONSTRUCTION :REPAIR Telephone# - ��'-5 7 i Land Use ' S'�y� tn ( Slopes(go) 2 Surface Stones NIA Distances from: Open Water Body?�-� ft Possible Wet Area -?2 c ft Drinking Water Well 2 l JV ft Drainage Way 5ej ft Property Line :ft Other ft SKETCH:_(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) - 0 Q- ! -_ qv �VJa t� � Parent material(geologic) C/Lhu1QJ j`l - 17epth to Bedrock �µ2. ✓ l + Depth to Groundwater: Standing Water in Hole: C Weeping from Pit Face Estimated Seasonal High Groundwater )DETMMNATION FOR SEAS.GNA .01GH WATER:�' Method Used: '} Depth Observed standing in obs.hole: in, Depth to soil mottles: in. Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor AdJ,Groundwater Level URCGI.AT40N TEST Observation Hole# u Time at 9" Depth of Pere Time at 6" Start Pre-soak Time @ Time(9"•6") End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed x Site Failed: Additional Testing Needed(Y/N) 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 notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP OIRSERVA,TION HOLE LOG -hole* 1 � Depth from Soil Horizon Soil texture Soil Color Soil Other Surface(in.), '� (USDA) . (Munsell) Mottling (Structure,Stones,.Boulders. = = C n isten . [0712 313, 3 --12to C M< Sc,,,,A s Yi2 -S/6 DEEP OBS LOG Ht�le Depth from Soil Horizon Soil Texture' Soil Color Soil Other Surface(in) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. iisfstenc %Gra el a-tZ j� S L 16 Y/Z 3/3 Z.3s S� Yt s�8 Ali TION HQLE LO I le# Depth from .Soil Horizon - -Soil Texture Soil Color Soil-- Other O Surface(in:) (USDA) (Munsell) Mottling '(Stnicture'Stones,Boulders. _ Consistency, Gravel) .. ) MWORSERVATION A& LOG kIale:#. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) - ) (Mansell) Mottling (Stricture,Stones,Doti iders. Consistency. Flood Insurance Rate May: Above 500.year;flood:boundary. No_ Yes 1!l Within 500 year boundary No Yes ✓Mthtn 100�year.flood boundary No Yes . Depth of Naturally Occurrini Peryio us-Materlal, ,:. : Does at 1 east four,feet:of naturally occurring pervious materiaT_exist in all areas observed throughout the . area proposedf or.the soil absorption system?. If not,what Is..tf a depth,of.natur-ally occurring pervious material?. Certification •- ,.., ..l a° - I certify that on, L l �'�`.(date):I have passed the soil evaluator examination approved'by the; Department of Environmental Protection and that the above analysis was.performed,by.rife consistent:with the required tr "ing,expertise and experience described m 31O C1VIR15 017. i f Signature`' - `Date Q:\SE1yr1QPERCFORM DOC .--T-0 � � -7� P..If�;, ..�..`MM•41 l)cpar ,_�nto . �� t Services .. k J Y � :Public ��1th l�i�Yi�1Dn Date <� �` � ° 200"Main SttFct,Hyannig MA 02ti01 IQa Date Schti�d / 2- of Ttlne Fee ixd i f - �x�ii Assessment g Performed B '! '��1 Wunessed BQFE y Location Address3 i S Owner's Name i"ta U '► �- -� . To't cQy .PC.t+--erSo TfA' hq O"f t Address d' �cTlc. Ce l�. C�Serv`I Sri 62 Assessor's Map/Parcel: C I " O CD� Engineer's.Name ,Q� C tJ , NEW CONSTRUCTION 1REPAIR Telephone# 3 ) Land Use Re S d(2v��-�.a� l Slopes -2 Surface Stones• N1A Distances from: Open Water Body Z" ft Possible Wet Area?Zcf ft Drinking Water Well 71 ft Drainage Way SU ft Property Line I(j +(`� ft Other ft SKETCH:_(Street game,dimensions of lot,exact locations of test holes&perc tests,locate wetlands s proximity to holes �. 33 q -33 �� .f --�-tit-- - 5 ter,Q CUB -- Pareot inaterial(geolo •a CJU t.A)k- �7 ( Z � ) l . Depth to Bedrock Depth to..Oroundwater Standing Water in Hole: G _ Weeping from Plt Face / Estimated Seasonal High Groundwater 9 l/1'��,�+��,� •ram /•�"(�� y''�y� TER." y1�1 Vl1is'!�!J�i�111�1 1' V+\ 1�R k7lStt]W1� A \:T .�1 •>'LL '�►9Fr+ :'•;'; Method Used: Depth Observed standing in obs.hole: �= ' !n, . Depth to soli mottles � l� �..�. Depth to weeping from side of obs.hole: In., Groundwatet Acju#anent; -- Index Well# Reading Dater Index Well level Act.factor. ., Acli Ground vyg` r Level..�LJt Observation Dqt®,r ,-+=� : ,-;�.—�- y 1 Hole# Time at 9" iV Depth of Pere Time at 6" �2t3 i Start.Pre-soak Time® End Pre-soak 12;.`t S Z`-1 g�llcr� S Rate Min./Inch Site Suitability Assessment: Site Passed x Site Failed: Additional Testing Needed(1IN) Original: Public Health Division Observation Hole Data To Be Complete MAI d on Back------.---- **'If percolation test is to be conducted within 100, of wetland,you must first notify the Barnstable Conservation Division at least one (1) week prior to beginning. QAr"I"I IC1PERCFORM.D.QC 'DEEPlot SERVAT10N fi }LE L 3G Depth from Soil Horizon Soil Texture Soil'Color Soil .. Other " Surface (USDA) . . (Ivtunseli). Mottling (Sttucture,Stones,.l3oulders• a 1'2 s (.a; rZ 3t3 'ytZ _/g � 'VAr ' flC? t 'LU►Cle Depth from; Soil Horizon Soil Texture SoII Color: Soil Othff Surface(ln,) ' (USDA) (Mpnseli) Mgtthag:. (ShtiCtute,Stones;boulders. . ns 1�o,00 RVATION 110Z,E- 0 Depth from Soil Horizon Soillexture Soil Color Soil., Other Surface(ln.)' (USDA) (Munsell) Mottling (Structuie,'St6nes,'B01ilders Mar SOLE LOG• Depth,from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stricture,Stones,Rouldar9• Mood InsuranceRate Mawr Above 500;year flood houndary No_, .Yes Within 500'year boundary Is v\. Yes Wttblu 100 year flood^Boundary No Yts Depial0eeurc>lrte Ptecaious Matexlal Doi$at least facet of nattally occurring pbi�vbus matl;ial exist Il9 all areas abs�rved.throughout the: are ;'proposed or the soil absorption system? If not,vuhatis>tho depth ofnaturtlll occurring pervious material? :.. Ce`"itc login ' r �aa� I rttfy taco (elate);I have pa.seed the soil evaluator examination approvedb+Lxttt; De- ent.ofEnvlronmental Protection and that the above analysls was perforiYled by me cottsiatettt v�ith thre9u>ardd'. >itg,expertise anti experience described'itl 310 CMR 15,017 { SI bate s Q'CSl?P`1'IG1� CiRM DOC 4� 7 Town of Barnstable P# fl Department of Regulatory Services � �sr�B� Pu Health D><�><s><on Date A{A &- r 9. 200 Mam Street,Hyannis MA 02601 : r H f Dates6fidau, T777777777 _ v Soil Suitability Assessment for Sewage Disposal _P f �°`�—e,e— 6-' S w►cnesgea By Performed ,- L0.CATTr�N &.LSE Iti��,I1�Q��t7��1 Location Address p J `�J ./yl�"'✓t. S 1^'C I CIO..i_= Owner's Name �"�x✓t /C Q C Address �rft if le vh �Ep.r..ti �( c-2 !'►') - . cif, Assessor's Map/Parcel: 1 )7 _6 (a Engineer's.Name NEW CONSTRUCTION_p :REPAIR X. ;Telephone# Land Use S 1 ` f/�I Slopes(%) l Surface Stones /v/ ' Distances from Open Water Body? ft Possible Wet Area�ft Drinking Water Wel12 �ft x , , Drainage Way�� ft Property Line� ft Other ft. SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes): { --------------- -a ..t. .- ... ..... .. ..- _ .. a. 1~i cr .. Parent material(geologic) O`� �` A Depth to Bedrock 1 ?� Depth to Groundwater: Standing Water in Hole: Jv 1 ) 2 4 Weeping from Pit Face Estimated Seasonal High Groundwater - } T) INATION OP.SEA9.ONA.L.MGH'WATER,,,,,TAB V Method Used: C r, Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment a ft.N co Index Well# Ln Reading Date: Index Well level Atij�factor, Adj,Groundwa 'vel= y'' I� -COLA 1 #Jt1. Jt': ►71 ht8„�,,.,�.� '�P1We Observation Hole# Time at 9" co �( rn Depth of Perc �� U Time at 6" .� 714 Start Pre-soak Time Q ` 5 � Time(9"-6") End Pre-soak f S'yl�+1+1u+e Rate Min.Mch ' Site Suitability Assessment Site Passed _ Site Failed: Additional Testing Needed(Y/N) 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 notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEPTIC\PERCFORM.DOC SEEP OBSERVATION HOLE LOG bole# } Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) . (Munsell) Mottling (Structure,Stones,.Boulders. C nsistenGravel) 3/ 12 136--�Z C� l::� S 5" �7 , O�J C Z (,USDA) (Munsell Mottlin (Structure, tones ' Depth from Soil Horizon Soil Texture Soil Color Surface(m.) ) S Boulders. onsistenc Gravel Z-2 5 L L10 ?� AJ D 0,006URVATTON HOL L00 fi le Depth from Soil Horizon Soil Texture Soil Color Soil Other. Surface (USDA) (Munsell Mottling (Structure;"Stones,Boulders. Consistency, o Gravel G 5— S hE 'OSERVAT .C11� TOLE.LOGIal�:#. Depth.from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stonoa,aoulders. Consistency. Flood Insurance Rate Map: Above 500 yearflood boundary. No_. Yes Within'500 year boundary No A Yes Wjthtn;100 year flood boundary.No� ... Yes Death of.:Naturallv:0ecurring Pervious Material Does at least four;feet of naturally occurring pervious material.exist to all`areas observed throughout the area proposed for.the soil absorption system? P-S If not,what ii.th,depth of:naturally occurring pervious material? Certification Icertify that on,_. ! date),I have passed the soil evaluator examination approved by thee, Department of Environmental Protection and that the above analysis.was performed by.me consistent';with the required tr 'nin expertise and experience described m 310 CMR 15 017.= f �> Signature Date l �/ .. i Q1SEPfIC1PERCFORM DOC f DATE;_1 /9/00 ---- PROPERTY ADDRESS: 93-, Main Street--------------------- -- 02655----------------- On the above date, I Inspeoted the septic system at the above address, This system consists of the following; 1 . This is title five septic syste. ( ��rCode ) _ 2 . 1 -1500 gallon septic tank. 3 . 1 -Distribution box. 4 . 3-330 Basedcon my`�n�poctlon, I certify the following conditions: 5.. This is a title five septic system. (..9C5' Code 6 . The septic system is in proper working order mat the present time. r _ - r 7 . The 330 cultec rechargeis were dry at time of inspection. SIGNATURE:,/ Na me :_ Yussmtn.t:. _____- Company:_LO7e2h_P _Hacomber_& Son , Inc . RECEIV:ED Address:_ Box_66___— _____ -- — JAN 1. 0 Centerville I_ Ha__02632-0066------------ TOWLE HEALTH DB Phone:----508_775,3338_-__ _ THIS CERTIFICATION GOES NOT CONSTITUTE A OVARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC• T+nki•C�sspoolr;•L�schll�idi ; Pumped L Installed Town Sewer Connsotlona P,O. Box 6� JJ39e�7y, MA 02632-0066 75• -\ COMMONWEALTH OF MASSACHUSETTS 01 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 933 Main Street s ervi e,Mass. ; Owner's Name: Joeanne Stubbins Owner's Address: 1 9 01 Box 462 marstons IF111s,Mass. 02648 Date of Inspection: 1 /9/01 , Name of Inspector: (please print) Joseph P.Macomber Jr. 4 Company Name: J.P.Macomber & Son Inc. Mailing Address: Box 66 CentervilleFMass. 02632 Telephone Number: 5os-775-vug 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: 4 Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature- Date: The system inspectors ubmit 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I Page" of 11 % OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 933 Main Street Osterville,Mass. Owner: _Joeanne Stubbins Date of Inspection: 1 /9/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section b ,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: dill E B. System Conditional) Passes: Y Y One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND)in the for the following statements. If"not determined" please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. 'A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: .C� 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&LL The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will . pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 A J Page 3 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART A CERTIFICATION(continued) Property Address: 933 Main Street s ervi e, ass. Owner: oeanne Stubbins Date of Inspection: 1 /9/01 C. Further Evaluation is Required by the Board of Health: __Aj 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: d Cesspool or privy is within 50 feet of a surface water �L Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. Svstem will fail unless the Board of Health ( PP and Public Water Supplier, Y)if an determines that the system is functioning in a manner that prot ects the public health safety and environment: 4212 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. Zo The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. Al 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 feet or more from a private water supply well"�Method used to determine distance �GQ{ "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of I 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 933 Main Street OstPrvillP,Mass_ Owner: 7oeann - S 3bbi nG Date of Inspection: 1 y 9/n 1 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 —�Ve 4,Z7a— wk--, r _ Liquid depth in.cesspoal is less than 6"below invert or available volume is less than 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.] Alb (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303.therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large 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• You must indicate either"yes"or"no"to each of the following: , (The following criteria apply to large systems in addition to the criteria above) Yes no _ ,the system is within 400 feet of a surface drinking water supply +� a system is within 200 feet of a tributary to a surface drinking water supply 1 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. 4 Page 5 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 933 Main Street Osterville,Mass, Owner: Joeanne Stubbins Date of Inspection: 1 /9/01 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,Z�uding the SAS, located on site ? Were the septic tank manholes uncovered,opened,and the interior of the,tank inspected for the condition of the baffles or tees, material of construction,dimensions, depth of liquid,depth of sludge and depth of scum ? _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no Existing information. For example, a plan at the Board of Health. r• ' 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)) f Page 6 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 933 Main Street Osterville,Mass. Owner: Joeanne Stubbing Date of Inspection: 1 /9/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): .� DESIGN flow based on 310 CMR 15,203 (for example: 110 gpd x # of bedrooms):54)jj Number of current residents: c,�kb� Does residence have a garbage grinder(yes or no): tO Is laundry on a separate sew a system (yes or®): _ [if yes separate inspection required] Laundry system inspected or no): Seasonal use: (yes or no): y O Id Water meter readings, if available (last 2 years usage(gpd)): J� ��s Sump pump(yes or no): /o�_�y idDpS' ��CJ� �, 4 +6;26' Last date of occupancy: , In 1999 a serious water line was found'. �f COMMERCIAL/INDUSTRIAL � Type of establishment: Design flow(based on 310 CMR 15.203): 4,1A gpd Basis of design flow(se ats/persons/sgft,etc.): 4j�f Grease trap present(yes or no): dL Industrial waste holding tank present(yes or no):Ab/ Non-sanitary waste discharged to the Title 5 system (yes or no):.� Water meter readings, if available: .0 Last date of occupancy/use: �;1 OTHER(describe): •�� GENERAL,INFORMATION Pumping Records Source of information: Has not been pumped since system was installed. "'as system pumped as part of the inspection(yes or no): Lo If yes, volume pumped: _0 gallons-- How was quantity pumped determined? 4/� Reason for pumping: ,(lid' TYPf OF SYSTEM Septic tank,distribution box,soil absorption system Single cesspool dD Overflow cesspool Privy A(& Shared system (yes or no)(if yes,attach previous inspection records, if any) 4 Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) 4&ight tank ,V Attach a copy of the DEP approval' /L Other(describe): Azl �Mroximate aee of all components date ir};talled (if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):Al� 6 Page 7 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:933 Main Street Osteryill_e,MasG_ Owner: Joeanne Stubbins , Date of Inspection: 1 [9/ 1 BUILDING SEWER(locate on site plan) Depth below grade:_ Materials of construction: ast iron 240 PVC mother(explain): AJ,* Distance from private water supply well or suction line: Comments(on condition ofjoints, venting, evidence of leakage,etc.)': Joints appear tight.No evidence of leakage_ System is vented through the house vent. .SEPTIC TANK: locate on site plan) Depth below grade: d y Material of construction: dconcreteNllmetaIA/d fiberglassXLpolyethylene ,120other(explain) X//� If tank is metal list age:,&I,�4, Is age confirmed by a Certificate of Compliance(yes or no)4A,) (attach a copy of, certificate) Dimensions: Sludge depth: �! Distance from top of slud a to bottom of outlet tee or baffle: 4114 Scum thickness: .IJ Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: tii9 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert_,evidence of.leakage, etc.): Inlet & outlet tees are *--in place The tank is G ructLral y snunrl and chnwc nn evidence of leakage.Liquid level at the outlet invert is fifty one inches. GREASE TRAP:4)0(locate on site plan) . Depth below grade:4A Material of construction:,VAconcrete.dA metalAIA fiberglass�/�olyethylene mother (explain): 1W ' — — Dimensions: NA Scum thickness: A44 , Distance from top of scum to top of outlet tee or baffle: N•9 Distance from bottom of scum to bottom of outlet tee or baffle: 214 Date of last pumping: r/�9 Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage; etc.): Grease trap is not present - 7' Page 8 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 933 Main Street s ervi e, ass. Owner: Joeanne Stubbins Date of Inspection: 1 /9/01 TIGHT or HOLDING TANK: 16 (tank must be pumped at time of inspection)(locate on.site'plan) Depth below grade: AA Material of construction:Am concrete metal Afiberglass L4 polyethylenex)l? other(explain): Dimensions: IVA Capacity: allons Desien Flow: i1J gallons/day Alarm present(yes or no): Alarm level: Allf Alarm in working order(yes or no): Date of last pumping: AM Comments(condition of alarm and float switches,etc.): Tight or holding ranks ara not prAcerit DISTRIBUTION BOX: �(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:_ l Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box has one lateral.No evidence of solids carry over.No evidence of leakage into or out of the box. PUMP CHAMBER: 4)() (locate on site plan) Pumps in working order(yes or no): N/9 Alarms in working order(yes or no) ( ? Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): Pump chamber is not present { 8 Paee 9 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 933 Main Street Osterville,Mass. ` Owner: Joeanne Stubbins Date of Inspection: 1 /9/01 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) Located If SAS not located explain why: Zleaching pits, number:aching chambers number: q�+�G n^ . yE� l41 eaching galleries,number:_0 1 leaching trenches number, length: • C A� � g � leaching fields,number,dimensions: tW 00 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.): Loamy sand to boney sand to ,fine sand.No signs of hydraulic failure or ponding. Soils are clry. vegetation SAS is dry at .this time. CESSPOOLS:A, 1_(cesspool must be pumped as part of inspect ion)(locate on site plan) Number and configuration: (d Depth—top of liquid to inlet.invert: A)4 Depth of solids layer: A)h Depth of scum laver: Dimensions of cesspool: Materials of construction: /(J Indication of groundwater inflow(yes or no): - Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Cesspools are not present. PRIVY:A�(locate on site plan) Materials of construction: Dimensions: /21 Depth of solids: ti19 ' Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): . Privy is not present-.' 9 Page 10 of 1 I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 933 Main Street ` Osterville,Mass. Owner: Joeanne Stubbins Date of Inspection: 1 —9/01 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. 10 f G 4 No. �.7 15F Fee 5 0 .0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS mig;pozal *pgtem Conotrucrion Permit Permission is hereby granted to Construct( )Repair( )Uppgrade4X)f Abandon ( ) Systemlocatedat 933 Main Street Osterville,Mass. and as described in the above Application for Disposal System Construction Permit, The applicant recognizes 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 th' rmit.' Date: /' 9 !�;7 Approved -115 THE'COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate ,of Compliance • THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) UpgradedXX ) Abandoned ( )by J•P•Macomber & Son Inc. at 933 Main Street Osterville,Mass. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No "$dated q, I Installer J•P.Macomber & Son Inc. Designer. J.P.-Macomber &. Son Inc. The issuance of this ermit sh 1 not be construed as a guarantee that the s t ill function as ign Date "' '� Inspect �f2-� Page 1 1 of 11 x OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 933 Main Street s ervi e,Mass Owner: Joeanne Stubbins Date of Inspection: 1 9 01 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 1 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtaine from system desi laps on record - If checked,date of design plan reviewed: —a—Q __�/(2bservecl site u ' roe / bservation hole within 150 feet of SAS) �hecked with local Board of Health-explain: hecked with local excavators, installers-(attach documentation) —Accessed USGS database-explain: You must describe how you established the high ground water elevation: Installed syst-Pm 1 n4g4g7 No water PnrnuntPre� at 92 ' PPrmi t {} 97-53$ lI i Y .. rr^-n.rr--rT-!rn-,rr.•n'rrra-nr.1,•r rrrr•-.•r+-.ervrr:++a�rr.. *rs-v*ra-rrsr.q-s+ .re.-ra-r-r-r..- .--..,' M " Barnstable TOWN OF BUARU OF HEALTH J SUIISURFACR SEWAGE DISPOSAL SYSTEM INSI'RCTION FORM - PART D - C.ERTIFICATION I •••�•••^T•••••e—�.f I�^.�TTt T!T"RI.1(1TI TT 1ITTf 1RT1'1'T^!'1"I.Tt't TT1Cr•T'In!►w.T1f fA'NIIRte'!A'ROTt 1 . , mRn r.—rl'r•r•-,. .^..AAA -TYPE OR PRINT CI,EARLY- ; PROPERTY INSPECTED STREET ADDRES$ 933 Main Street Osterville Mass. ASSESSORS MAP, BLOCK ANU• PARCEL - # L OWNER' s NAME Joeanne• Stubbins PART D - CERTIFICATION I NAME. OF INSPECTOR. Joseph P-.Macomber -Jr. ` COMPANY NAME J.P.Macomber & Son Inca COMPANY ADDRESS Box 66 Centerville 'Mass. 02632 Street Town or city State -LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 -1 578 CERTIFICATION STATEMENT I certify -that I have Y personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and omplete as of the time of .inspection , The inspection was performed and any recommendations regarding upgrade, maintenan*ce ,' and repair are consistent with my training and experience in the proper function and maintenance of on site sewage disposal systems . i . Check one ; a4Y_stem PASSED ,. • - • . The inspection°.which I have, conducted has' not found any 'information which indicates tl,lat the system fails to adequately protect` public, health or, the 'environmen.t s. as, defined - in 310 CMR 1.5 , 303 . Any failure - criteria not evaluated aie 'as, stated in. the FAILURE CRITERIA- r section of this form , . System FAILED* _. The inspection whichI `have^-con trcted has found that the- `system- fails to Protect the j)ublic he.•a1th and'-the environment in accordance with Title 5 , 310 CMR 15 , 303 , ' and-- as specifically noted on, PART 'C — FAILURE CRITERIA of this inspection form , Inspector Si nature jtt"�� SDate d ` � e copy of this cert.iTication must be provided to the OWNER, the BUYE()Fn Nhere app1looble ) and the BOARD OF .HEALTIr, * ' If the inspection FAILED, -the owner or"#'operator shall u pgrade ' tha system within one year of -tithe date 'of ' the inspection , unless allowed or required otherwise as provided in 31`0 .ChJR 15 . 305 . partd . doc 1 /01 DATE. _ --- .- PROPERTY AOORESS; 93 _Main Street -_Osterville,Mass_______ Last- �House all the wax Gallery Place On the above dale, I Inspected the septlo ayitefM at the above address. This system conalsls of the following, 1 . 4-6 'X8 ' block cesspools. 2 . Two in the back. In series. 3 . Two on the westside of house. In series. eased on my In3pec110111, I cortify the followlnV oondltlons;, 4 . This is not a title five septic system. 5 . This is a split sewage system. 6. The sewage system is in proper working order at the present time. 7. The oveflQws look as .good as new. , 8. The system is presently dry. SIGN AT U R E rt a m e : ,3.,..K.P s s m k tc. Company;�o' •3h_P-- Macomber-b Son , Inc , Address ;_ Box-66---_ __Conc #111111L Nraj_026J2-0066 Phone___ 508_775:3978------- THIS CERTIFICATION o0C8 NOT CONSTITUTE A CIVARANTY OR WARRANTY JOSEPN P, MACOMBER & SON, INC, Tankti-Qvi 9olt-Lo;ohf1o1d+ 00 pvmpld 4 In+tilled Town Sfw#r Conn#900 n1 P,0, 8ox 66 JJ38irY1775 bA 2632-0066 A i e P rrnrw r n Ire—.-rrTrnrmrv+rnrrrnnrenrr.arn-n-re�rrr�n*.nl*n ner+iir ns�r+s+lrel k TOWN OF Barnstable BOARD OF HEALTH SUDSURFACR SEWAGE DISPOSAL .SYSTEM INSPECTION FORM - PART D •- CERTIFICATION I...T.y_T..._..T—�.IIT.�.�TT111 rR11'tf.TRl T1R'.1RT fTfT.T:r—'•T r{ITTTt•R11R�TC.AR.At i1n1IR - .,T I-TT'T'T•�f! •�..^ -TYPE OR PRINT CI,EARLY- PROPERTY INSPECTED STREET ADDRESS 933 Main Street Building I Osterville,Mass'. ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME Joeanne Sttlbbins PART D - CERTIFICA TION I NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J-P.Macomber & Son Imo: COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Street Town or City State L(P COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 - 1 578 • R I S>elp CERTIFICATION STATEMENT I ' certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and omplete as of the time of +inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , Check one , ' • , y` System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or Lhe environment as defined in 310 CMR 15 : 303-, Any failure criteria not evaluated are as stated. in the FAILURE CRITERIA section of this form , System FAILED* The inspection which I ha con toted has .found that the system fails to Protect the public health and the environment in accordance with Title - ,5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , Inspector Signature bate ne copy of this ce t.ification must be provided to the OWNER, the BUYER ( where applicable ) and the I30ARD OF HEALZ'll, * If the inspection FAILED, the owner or oporator shall upgrade ' the system within one year of the date of. the inspection, unless allowed or required otherwise as provided) in 3.10 CMR 16 , 306 , partd .doc Commonwealth of Massachusetts Executive Office of Enviroiunental Affairs Dept. of Environmental Protection One winter Street,Boston,Ma. 02108 John Grad D.E.P. "Title V Septic inspector P.O. Box2119 Teaticket, MA 02536 WILLIAM F.WELD (508)564-6813 Governor CA� � ARGEO PAUL CELLUCCI Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM v v PART A CERTIFICATION Y - Property Address: 933 Main St.Osterville Gallery Place Unit#7 Address of Owner:^ �'� Date of Inspection: 5/22/98 (If different) ® ` Name of Inspector: John Graci Gilmore:349 Lincoln Rd.Walpole 0 081 I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name, Address and Telephone Number. 00 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 maintenance of on-site sewage disposal systems. The system: - X Passes - This Inspection Is based on criterla defined In Title V Conditionally Passes code 310 CMR 16.303.Myfindings are of how the system is performing at the time of the inspection.My inspection does Needs F rt r Evaluation By the Local Approving Authority not Imply any warranty or guarantee orthe longevity ofthe Falls septic system and any of Its components useful life. Inspector's Signature: Date: 811198 s b The System Inspector shall s ibmit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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. INSPECTION SUMMARY: ;- Check A, B, C,or D: . A] SYSTEM PASSES: , G x I have not found any information which indicates that the system violates any of the failure criteria` defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below, COMMENTS: B] SYSTEM CONDITIONALLY PASSES: ); _One or more system components need to be replaced or repaired. The system, upon completion ' of the replacement or repair,passes inspection. Indicate yes, no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection, or , the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank '. failure is imminent.The system will'pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04127197) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 933 Main 3L Osterville Gallery Place Unit#7 Owner: Gilmore:349 Lincoln Rd.Walpole 02081 Date of Inspection:5122199 _ Sew.aae backup or breakout or hioh static water level observed.in,the distribution b.ox is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced —The system required pumping more than four 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 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 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 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and 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 presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: _ I have determined that the system violates one or more of the following failure criteria as defined 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 Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of offliient to the surface of the ground or siirface.waters clue. to nrl overloaded or clogged cesspool. SAS is in hydraulic failure. (revised 0427/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 933 Main St Osterville Gallery Place Unit#7 Owner: Gilmore:349 Lincoln Rd.Walpole 02081 Date of Inspection:5122198 D]SYSTEM FAILS(continued) 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: 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 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 933 Main St Osterville Gallery Place Unit#7 Owner: Gilmore:349 Lincoln Rd.Walpole 02081 Date of Inspection:5122199 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: _x_ — Pumping information was requested of the owner,occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the 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 with N/A. 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. ' _X_ — The site was inspected for signs of breakout. x All system components, excluding the Soil Absorption System, have been located on the site. 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. x The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is unacceptable)115.302(3)(b)j. pevleed 04127/87) II SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 933 Main St Osterville Gallery Place Unit#7 Owner: Gilmore:349 Lincoln Rd.Walpole 02081 Date of Inspection:5122198 • M1 FLOW CONDITIONS RESIDENTIAL: Design flow: 220 9•P.d./bedroom for S.A.S. Number of bedrooms: s Number of current residents: t Garbage grinder(yes or no): No Laundry connected to system(yes or no): No Seasonal use(yes or no):'No Water meter readings, if available(last two(2)year usage(gpd): n!a Sump Pump(yes or no): No Last date of occupancy: nle COMMERCIAL/INDUSTRIAL: Type of establishment: nie Design flow:0 gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings, if available: nre Last date of occupancy: nra OTHER:(Describe) rde Last date of occupancy: o GENERAL INFORMATION ` PUMPING RECORDS and source of information:* Lest pumped In 1988 by:MecComber - - - System pumped as part of inspection: (yes or no)Nu If yes,volume pumped:0 gallons Reason for pumping: rda TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions,system , Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components,date Installed(if known)and source information: 1980' a , Sewage odors detected when arriving at the site:(yes or,no) No {revised 04127)97) s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 933 Main St ostervllle Gallery Place Unit#7 Owner: Gilmore:349 Lincoln Rd.Walpole 02081 Date of Inspection:5122J98 SEPTIC TANK: x (locate on site plan) Depth below grade: +' Polyethylene_other(explain Material of construction:x concreate_metal_FRP lens_ Y Y ) If tank is metal, list age nia . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: 1-e16"H57"w410" Sludge depth:+" Distance from top of sludge to bottom of outlet tee or baffle: 26" Scum thickness:+" Distance from top of scum to top of outlet tee or baffle:S" Distance form bottom of scum to bottom of outlet tee or baffle: 17" 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 and functloning properly.Recommend pumping every two years. GREASE TRAP:_ (locate on site plan) Depth below grade: rda Material of construction: _concrete_metal_FRP_Polyethylene_other(explain) Dimensions: nra Scum thickness:nra Distance from top of scum to top of outlet tee or baffle:nra Distance from bottom of scum to bottom of outlet tee or baffle:nla Date of last pumping;,l_ 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.) n!a BUILDING SEWER: (Locate on site plan) Depth below grade: is-- Material of construction:_cast iron x 40 PVC other(explain) Distance from private water supply well or suction line?o— Diameter: 4^_ Qeimments: (conditions of joints, venting,evidence of leakage, etc.) (revised 04127 87) 1. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued), Property Address: 933 Main SL Osterville Gallery Place Unit#7 Owner: Gilmore:349 Lincoln Rd.Walpole 02081 Date of Inspection:5122198 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_FRP_Polyethylene_other(explain) Dimensions: nie Capacity: nla gallons Design flow: nia gallons/day Alarm level:_nta Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches, etc.) rds DISTRIBUTION BOX: x (locate on site plan) Depth of liquid level above outlet invert: liquid level with bottom of pipe Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.) D-Box Is structurally sound. PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no)No Alarms in working order(yes or no)_Yes Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) nia (revised 04127197) I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 933 Main St Osterville Gallery Place Unit#7 Owner: Gilmore:349 Lincoln Rd.Walpole 02081 Date of Inspection:5122198 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: nia Type: leaching pits, number: one 1000 gallon leach pit leaching chambers,number:nia leaching galleries,number: rda leaching trenches, number,length: nia leaching fields, number, dimensions:rda overflow cesspool, number:ma Alternate system: n1a Name of Technology:_nia Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Leach pit and all components are structurally sound and functioning properly.Leach pit now has 2'of water In It CESSPOOLS:_ (locate on site plan) Number and configuration: rJa Depth-top of liquid to inlet invert: rda Depth of solids layer: rda Depth of scum layer: nia Dimensions of cesspool: n1a. Materials of construction: n1a Indication of groundwater: rda inflow(cesspool must be pumped as part of inspection) n1a Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) rda PRIVY:_ (locate on site plan) Materials of construction: n1a Dimensions: n1a Depth of solids: ma Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) n1a (revised 0427)97) ~ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 933 Main St osterville Gallery Place Unit#7 Gilmore:349 Lincoln Rd.Walpole 02081 5122f98 SKETCH OF SEWAGE DISPOSAL SYSTEM: r include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) i�il4� �A �a i3 Pap• 9 of 10 (revised 04r17197) r I • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 933 Main St.Osterville Gallery Place Unit#7 Gilmore:349 Lincoln Rd.Walpole 02081 5122/98 Depth of groundwater 12, Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions F Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS maps and charts - } (revised04/17197), page 10 of 10 ' F ,.vwa.r� �,• ,2yyr SYST C � l'M ov i 116— (zn!'L--nEs C f 0-ael 6 a iv rip • • .. z c t-4 2 • IS 6r F r r r- LEGEND N r SePuit Rd -- --- EXISTING CONTOUR x 100.98 EXISTING SPOT GRADE EXISTING WATER SERVICE Pond EXIST. CESSPOOL W Pond TO BE .PUMPED FILLED WITH SAND $ W PROPOSED WATER SERVICE s� DISCONNECT SEWER EXISTING GAS SERVICE REDIRECT PLUMBING o` 60.00 OH W OH W �`�� OVERHEAD WIRES °c. r 8q �.- LOCUS••,, r �'`-�01 TEST PIT \ S ORa �°� aC OHW i ` 4 GS BENCHMARK ti l O day SUee �a 00� 1p2p8 _ .- -- _ 10233CL 7p- C _ - _ Nsh S I LOCUS MAP NOT TO SCALE 102,- + GENERAL NOTES: EXI5TING DWELLING;' ' 1. ALL CHANGES TO.THIS PLAN MUST BE APPROVED BY THE LOCAL 4 N BOARD OF HEALTH AND THE DESIGN ENGINEER.2• ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: ,TOF 37' �/ j7 p 310 CMR 15.405(1)(b): NEW SEWER OUTLET / /- , ,' , t / �`r ?p efl 1) A 1' variance to the 3' maximum cover requirement, for 4' of INVERT EL.=99.25(MIN.) Ul / ' / ,- /' / gum • ? 7 max. cover, S.A.S. shall be vented and H-20 Rated.. f/ `fig z 2) A 13' variance, S.A.S. to crawl, space, for an 7' setback. 5' MIL' POLY LINER 01 �! f' k J �' " _._ _ 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 5' OUTSIDE S.A.S. ' ,4 k CHARCOAL ENT °2p 1 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE BETWEEN EL 99.0- 95.5 70 '� DESIGN ENGINEER. �N- ti; t ' �'00 s� 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING '4y ' ' 15.5��...� +/ TP-1 f FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. CUT & PATCH PAVEMENT 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF AS REQUIRED EXIST. RET. WALL a�� i TP-2 ,� THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF TOP EL.='100.4-101.6 I HEALTH FOR PROPER INSPECTIONS.,DURING CONSTRUCTION. (SEE NOTE 9) N OEL 10' BIT-CONC' BENCHMARK 5ET 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. '{ I DRVEWAY PK. NAIL, 'EL. 100.00 8, THERE ARE NO PRIVATE WELLS WITHIN 150' OF THE PROPOSED S.A.S. CUT & PATCH PAVEMENT ` ( (ASSUMED DATUM) 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS I PROPOS © S.A A.S. t AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE AS REQUIRED - ,l -.�. -{--. 10 �`''� .__ DIRECTED BY THE APPROVING AUTHORITIES. F T 'VERIFY TH PAVEMENT 10, IT SHALL BE THE RESPONSIBILITY 0 HE CONTRACTOR TO VE E THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING BIT-CONC DRIVEWAY 00 CONSTRUCTION, AP 1 17-065 BIT-CONC DRIVEWAY 1 1" WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND ON ALL SIDES OF THE' S.A.S_ AND REPLACE 3,580'±'SF WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE �� OF *Sj, W W W INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. (AS MARKED OUT) 59.86' PETER T. y�J� PROPOSED SEPTIC SYSTEM UPGRADE JT o McEJIL PROPOSED SEPTIC TANK " " CIVIL 933 MAIN ST., BLDG. G , OSTERVILLE, MA No. 351�09 RELOCATE WATER SERVICE Prepared for: Tracey Thibeault, 933G Main St., Osterville, MA 02655 REGI ZE <� (MAINTAIN 10' SETBACK FROM SEPTIC) 18 WIDE PRI ATE WAY Engineering by: Surveying by: SCALE DRAWN JOB. NO. ES G CONSULT WITH COMM WATER DISTRICT Engineering WOrAS HOOD 5URVEY GROUP 1"=10' P.T.M. 173-08 12 West Crossfield Rood 18 Route 6A Forestdcle, MA 02644 Sandwich, MA 02563 DATE CHECKED SHEET NO. t it ( 1 I, /1 (508) 477-5313 (508) 888-1090 6/7/08 P.T.M. 1 of 2 r. ` f w NOTE: ITO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:98.0 'FOR A DISTANCE OF 15' AROUND THE ,PERIMETER OF THE S.A.S. PROPOSED TANK INSTALL RISERS & COVERS OVER INLET & PROPOSED D—BOX PROPOSED SAS. OUTLET AND SET TO 6" OF FINISH GRADE INSTALL RISER & COVER INSTALL RISER & COVER OVER ONE CHAMBER AND 15.5" Ii 1fi" 2„ T.O.F.=103.37 SET TO 6" OF GRADE SET TO 3 OF F.G. fT0 SERVE AS INSPECTION PORT EXISTING F.G. EL: 102.6(MAX.) F.G. EL.=101.5t F.G. EL:, 101.5E CHARCOAL VENT " 12" 15.5" O L = 1 1' L = g' L _ ¢' 2" LA R OF 1/8" TO 1/2" 6' $" S=1 0 (MIN.) 0 S=1% (MIN.) Q S=1% (MIN.) t DOUBLE WASHED STONE 7-7 4"SCH40 PVC 4"SCH40 PVC 4"SC'H40 PVC' �(OR APPROVED FILTER,FABRIC) p to" w 6" W ®®E363 a 2" ta" ®®®®®66 ®®a®®®® H— 10 LOADING INV.=99.00 46" LIQULEVEL kINV.=98.75 y D_BO/�LEVEL3.5' S.2' ,I 3,5' /\ - ca BAFFLE INV.=98.57 INV.=98.40 ,',— PROPOSED D-BOX EFFECTIVE WIDTH - 12.2' N.T.S. PROPOSED 1500 GALLON SEPTIC TANK (kj-10) 1-500 GALLON LEACHING CHAMBER MODIFY INTERIOR PLUMBING INV.=97,50 SURROUNDED WITH STONE AS SHOWN •TO EXIT HOUSE AT, OR ABOVE, H-20 RATED INV.=99.25t TOP CONC. ELEV.=98.6 , BREAKOUT ELEV.=98.00 ®® ® ® ® ® ® INV. ELEV.=97.50 ®®® NOTES: 1) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND ®®la®® ®®®®® ®® ®E3®® ® ® U ® ® 37" TRUE TO GRADE ON A MECHANICALLY COMPACTED BOTTOM ELEV.=95.50 SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN w ®® ®® 310 CMR 15.221(2). 3.5' 8.5' 3.5' N Z ®��®®® ® ® ® ® ® 2) INSTALL INLET &. OUTLET TEES AS REQUIRED. 5' MIN. ABOVE BOTTOM OF EFFECTIVE LENGTH 15.5' - 3) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE T.P.;.EXCAVATION OR G.W. AS MANUFACTURED BY TUF—TITE, ZABEL OR EQUAL. LEACHING SYSTEM SECTION 4) MAXIMUM COVER OVER SEPTIC TANK, D—BOX & S.A.S: NO GROUNDWATER, EL.=90.5 = 102" SHALL BE 36". SEPTIC SYSTEM. PROFILE N.T.S. -4" KNOCKOUT' 20" DIA. COVER -SOIL LOG 4" KNOCKOUT 4" KNOCKOUT 62" DESIGN CRITERIA DATE: MAY -2, 2008 (REF#12,218) 4 SOIL EVALUATOR: PETER McENTEE PE 0 WITNESS: DONNA MIORANDI R.S. NUMBER OF BEDROOMS: 1 BEDROOM + HEALTH AGENT 4" KNOCKOUT SOIL TEXTURAL CLASS: CLASS 1 ELEV. TP- 1 DEPTH ELEV. TP-Z DEPTH _ 0" 0" DESIGN PERCOLATION RATE: 5 MIN/IN j' �'; 101.2 A 101.0 A N6; A SANDY LOAM SANDY LOAM T1N6 . DAILY FLOW: 110 G.P.U. 1OYR 3/3 10YR 3/3 mum o DESIGN FLOW: 220 G.P.D. 100.2 12" 100.0a 12, 500 GALLON CAPACITY, H-20 LOADING B 1 GARBAGE GRINDER: NO i /j�% f SANDY LOAM SANDY LOAM PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY // TOYR 5/8 10YR 5/8 98.2� $ LEACHING AREA REQUIRED: (220) = 297.3 S.F. �\ 18 )r22' p C PERC 36" 97.1 C 35" CHAMBERS - N.Ts& .74 S•-• a 48" 1 1 n/ USE 1-500 GALLON LEACHING CHAMBER WITH J N 1 1 PROPOSED SEPTIC SYSTEM UPGRADE DOUBLE WASHED STONE ON ALL SIDES ^' PROP. S.A.S MED. SAND MED. SAND �� 5YR 5/6 5YR 5/6; 933 MAIN ST. BLDG. G , QSTERVILLE, MA ------- SIDEWALL AREA: 2(12.2 + 15.5') X 2 = 110.8 S.F. �-15.5'--I BOTTOM AREA: 12.2' x 15.5' = 189.1 S.F. Prepared for: Tracey Thibeault, 933G Main St., Osterville,, MA 02655 TOTAL AREA:................ ................ ................... ........299.9 S.F. 90.7 126" 90.5 126" Engineering by: Surveying by: SCALE DRAWN JOB. NO. PERC RATE <2 MIN/IN. ("C" HORIZON) Engineering Works HOOD 5URVEYGROUP NTS P.T.M. 173-08 12 West Crossfield Road 18 Route 6A DESIGN FLOW PROVIDED: 0.74(299.9) = 221.9 G.P.D. /��/ NO GROUNDWATER ENCOUNTERED Forestdale, MA 02644 Sandwich, MA 02563 DATE CHECKED SHEET NO. S.A.S. LAYOUT (508) 477-5313 (508) 888-1090 6/7/08 P.T.M. 2 Of 2 1.