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HomeMy WebLinkAbout1390 MAIN STREET (OST.) - Health 1390 Main Street Osterville A= 119-004 / I TOWN OF BARNSTABLE LOCATION k3go /��.c� �/' SEWAGE 2p VILLAGE Q�yre."II >e ASSESSOR'S MAP&PARCEL 1 q 0 OQ4 INSTALLER,'S NAME&PHONE NO.Tcg5 A T� as —yr�y SEPTIC"TANK CAPACITY /SW /41 CGS LEACHING FACILITY:(type) J? J#11t&J& 161 (size) if,,y 3.Z, NO.OF BEDROOMS OWNER 5�1 PERMIT DATE: S °L COMPLIANCE DATE: Separation Distance Between the: No%e- exxoV..4le p Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Jl�f\�(C 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 �C A-in+ bu oo'--ay,S- co obi pb „ ' O- 66 5-ROWS Oc 3iv Isfcer I)ZOx Commonwealth of Massachusetts Title 5 Official Inspection Form a� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 1390 MAIN ST Property Address ; FISH Owner Owner's Name / information is required for OSTERVILLE `� MA 5-8-15 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: S only the tab keyI ly to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. D.A.BROWN INC "ITV Company Name ., P.O. BOX 145 Company Address CENTERVILLE MA 02632 City/Town State Zip Code 5084204534 S14297 Telephone Number License 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 _ . 5-8-15 InspfXs Sig ure Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under „ the same or different conditions of use. 't5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 1390 MAIN St Property Address FISH Owner Owner's Name information is 5-8-15 required for OSTERVILLE MA ' every page. Cityrrown 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM WAS PUMPED FOR MAINTENANCE AT TIME OF INSPECTION B) System Conditionally Passes: t ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair;as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements.-If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether.metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. ' A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): ti t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1390 MAIN ST Property Address FISH Owner Owner's Name ' information is required for OSTERVILLE MA t 5-8-15 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber•pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired: B) System Conditionally Passes (cont.); ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑. Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y d❑ N ,❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N. ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health):. ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): Y 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 1390 MAIN ST " Property Address FISH Owner Owner's Name information is required for OSTERVILLE MA 5-8-15 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.). 2. System will fail unless the Board of Health (and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health,,, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water _ supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of.ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: K 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 El ® 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 Y2 day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G1M , 1390 MAIN ST Property Address FISH Owner Owner's Name information is required for OSTERVILLE MA 5-8-15 + every page. Cityrrown State Zip Code Date of Inspection . B. Certification (cont.) Yes No ❑ ® ,Required pumping more than 4 times in the last year,NOT due to clogged-or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® ;Any portion of.a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion,of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at'a DEP.certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a'design flow of 2000gpd 10,000gpd. I ` ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 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. t 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. j Yes No - El ❑ 'the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within'200 feet of a tributary to a surface drinking water supply El ❑ J the system+is located in a nitrogen sensitive area (Interim Wellhead Protection Area 7 IWPA)or a mapped Zone 11 of a public water supply well - If.you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5,0fficial Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts , F . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments '< 1390 MAIN ST Property Address FISH r Owner Owner's Name information is required for OSTERVILLE MA5-8-15 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior'of the tank inspected for the condition of the baffles or tees; material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on:. ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): ' DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 550 t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System r Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM ,•' 1390 MAIN ST Property Address " FISH Owner Owner's Name information is OSTERVILLE MA 5-8-15 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: SYSTEM WAS INSTALLED IN SEPT OF 2012 AND CONSISTS OF A 1500 GALLON-TANK D-BOX AND A 5 BEDROOM S.A.S CONSISTING OF 25 BIODIFFUSERS Number of current residents: • } 3 Does residence have a garbage grinder? El Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection El'Yes ® No information in this report.) . Laundry system inspected? ❑ Yes ❑ No 1 Seasonal use? 0 Yes ®>, No Water meter readings, if available (last 2 years usage(gpd)): Detail: N.A WEEKEND NOT OPEN Sump pump? ❑ Yes-❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: ; Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? El Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system?' ❑ Yes ❑ No ' Water meter readings, if available:. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 1390 MAIN ST Property Address FISH _- Owner Owners Name information is required for OSTERVILLE MA 5-8-15 every page. Citylrown state Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/user z. MAY OF 2015 Date Other(describe below): r General Information Pumping Records: Source of information: DEBARROS SEPTIC Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? TANK SIZE Reason for 'MAINTENANCE pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool El Overflow cesspool ❑ Privy ` ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract, ❑ Tight tank.Attach a copy of the DEP approval. Other(describe): t5ins-3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Vol u ntary'Assessments M 1390 MAIN ST Property Address ' FISH Owner Owner's Name information is required for OSTERVILLE MA 5-8-15 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed'(if known) and source of information: 9/6/12 PER PERMIT Were sewage odors detected when arriving at the site? r ❑ Yes Z No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: "® cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: ' feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 2 • feet Material of construction: ® concrete ❑ metal.' ❑fiberglass ❑ polyethylene' ❑ other(explain) y If tank is metal, list age:. years Is age confirmed*by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 1500 Dimensions: . Sludge depth: LIGHT t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of.17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 1390 MAIN ST Property Address FISH Owner Owner's Name information is ILLE MA 5-8-15 required for OSTERV • every page. Cityrrown State, Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) 4 Distance from top of sludge to bottom of outlet tee or baffle Scum thickness LIGHT Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK WAS PUMPED AT TIME OF INSPECTION Grease Trap(locate on site plan): , Depth below grade: feet Material of construction: ❑ concrete ❑ metal. ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection -Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 1390 MAIN ST F Property Address FISH - Owner Owner's Name information is required for OSTERVILLE MA 5-8-15 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) t Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,, liquid levels as related to outlet invert, evidence of leakage, etc.): , Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: { Material of construction: ❑ concrete ❑ metal" ❑ fiberglass ❑ polyethylene ❑ other(explain): f Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No ' Alarm level: Alarm in working order: + ❑ Yes. ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc:): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for voluntary Assessments 1390 MAIN ST Property Address .> FISH Owner Owner's Name information is required for OSTERVILLE MA 5-8-15 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Oil Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): BOX LEVEL NO LEAKAGE OR CARRY OVER e Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): G - , If SAS not located, explain why: t5ins•3/13 Title S Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form t m p . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1390 MAIN ST Property Address FISH Owner Owner's Name information is required for OSTERVILLE MA_ 5-8-15 every page. Cityrrown State Zip Code., Date of Inspection D. System Information (cont.) Type: w ❑ leaching pits '' number: . 25 • ® leaching chambers -number: BIODIFFUSERS ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: f ❑ 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.): OPENED OBSERVATION PORT AND THE BIODIFFUSERS WERE DRY 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 Y Dimensions of cesspool Materials of construction Indication*of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1390 MAIN ST Property Address FISH Owner Owner's Name information is OSTERVILLE MA 5-8-15 required for ` every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): ` v Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): U t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 , Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1390 MAIN ST Property Address FISH ' Owner Owner's Name information is OSTERVILLE MA 5-8-15 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks'or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately 4 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1390 MAIN ST Property Address FISH Owner Owners Name information is required for OSTERVILLE MA 5-8-15 every page. 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: NONE AT TIME OF PERC 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: MAY 2015 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation), ❑ Accessed USGS database.-explain: You must describe how you established the high ground water elevation: DESIGN PLAN k Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not,for Voluntary Assessments _ M , ' 1390 MAIN ST Property Address FISH Owner Owner's Name information is required for OSTERVILLE MA 5-8-15 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate.file • t A. t5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17- Assessing As-Built Cards Page 1 of 2 TOWN OF BARNSTABLE LOCATION /310. ' SEWAGE#: ,a0)2,-,17 7. YMUGE OS tm,P II a ASSESSOR'S MAP&PARCEL 119-Ohs j INSTALLER'S NAME&PHONE NO.Z64,4 AI�2t l>�.ni» SEPTIC TANK CAPACrrY /Spp N eLj LEACHING FACMI°I'Y:(h'Pe) • ' f - -(size) /y.R.Y .3,X NO.OF BEDROOMS OWNER_F►5�1 PERMrr DATE: 'L COMPLIANCE DATE: ^ Separation Distance Between the: Nt7Ne eNcouNiereJ Maximum Adjusted Groundwater Table to the Haltom of Leaching FacilityFeet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Fe Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ` Fed FURNMBWBY_] ybgC, R-tnt"'!O T l� liinl—aZ F�71'-gS•2 � �FtC, y poi—a9,S" • DEox-N�.3 �c-39 . ( © Cut. w s aot�s oG 3ro ffXr ats t Icer at7ox ►92x32 Y http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=119004&seq=1 5/9/2015 Town of Barnstable P#_ Department of Regulatory Services s Public Health..D><vis><on Date KAM 200 Main Street,Hyannis MA 02601 ". Date Scheduled �/ C� , Time Fee Pd. _ _. .. . Soil Suitability Assessment for S e Disposal PerformedBy- Witnessed By: S LOCATION&GENERAL INFORMATION Location Address 13 9 a,Me,� I ` Owner's Name Address /3 (C� Mof'k Assessoes.Map/Pamel: Engineer's Ne/ NEW CONSTRUCTION REPAIR Telephone# 73 -7 y Land Use 12eS.O&,1 1) 9'0 Slopes l P Z P ( ) Surface Stones A 'Distances from: Open Water Body �3 ft Possible Wet Area�t ft Drinking Water Well ft Drainage Way�� ft Property Lane Q ft Other` ft SKETCH:'(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands A proximity to holes) f i �% r'= ± 9C Parent material(geologic) MAa. 011tVJ0,1'1 Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Flee Estimated Seasonal High Groundwater �Z_� DETERMINATION FOR SEASONAL HIGH WATER TABLE 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.&ctor Adj.Groundwater Level,— PERCOLATION TEST ,. . , Date Thne Observation Hole# Time at 9" Depth of Pet+c Z�_ 9 4I jov.� Time at 6" .Start Pre-soak Time® A Time(9"-6") End Pre-soak Rate MinJlnch 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:\SEPTICIPERCFORM.DOC t DEEP.OBSERVATION HOLE LOG' Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. vl ,vim' L lam' i o`((Lq/Z- 2 C �"c 2°�- IV DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders., Consistency, Gravel) 10 YIZI Y co - d� 3z- /�--c 5�,,� z�rY DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,.Stones,:Boulders. ConsistencX. Gravell d DEEP OBSERVATION HOLE LOG , ' Hole# Depth from Soil Horizon Soil Texture !Soil Color Soil Other er Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Flood Ingurance Rate Map: Above 500 year flood boundary No— Yes "Within 500year'boundary No Yes Within 100 year flood boundary No_0�' Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification hat on Ct: (date)I have passed.the soil evaluator examination approved by the I certify t Department of Environmental Protection and that the above analysis.was performed by me ctinststent with . the required training,expertise and experience described tn'�10 CMR 15.017: { Signature Date �(Z' Q:\S9PTl0PBRCFORM.DOC No. �Q� ^ / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN O BARNSTABLE, MASSACHUSETTS Yes application for bispoSal 6pstrin Construction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Lo tion Address,or Lot No./00 Owner's Name,Address,and Tel.No. meter U Ite Assessor's Map/Parcel q - 00 / I S Installer's Name,+� Address,and Tel.No. Designer's Name,Address,and Tel.No. 6�951� ,�60 �—NC 5- _ /rVLeliN WFJ�'CS —��17 S�) Type of Building: Dwelling No.of Bedrooms Lot Size ,'2D,02-q sq.ft. Garbage Grinder( ) Other Type of Building �nJS'P No.of Persons 3 Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) SSQ gpd Design flow provided �sy , gpd Plan Date �'°l`/ 12— Number of sheets 1X_ Revision Date Title Size of Septic Tank 1 j®® Type of S.A.S. �6 iby 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 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe L Date ` /Z Application Approved b Date Lf E�5 t Application Disapproved by Date for the following reasons Permit No. C '� �"" � Date Issued No. c/c r' a / _. Fee THE COMMONWEALTH.OF MASSACHUSETTS Entered in computer: �C, Yes PUBLIC HEALTH DIVISION -T -QFBARNSTABLE, MASSACHUSETTS application for Vspo8al 6pstem (Construction Permit Application for a Permit to Construct( ) Repair(4pgrade( ) Abandon( ) ❑Complete System ❑Individual Components LoMtion Address dres'storr Lot No.�°��(, d.[,9Q ��' Owner's Name,Address,and Tel.No. 3 Assessor's Map/Parcel o H Installer's Name,Address,and Tel.No. W>. Designer's Name,Address,and Tel.No. 1". 0051�5 h ►3cvw.) �evc ` , ., �N��' 1* (�o/I�5 508-q7t5313 Type of Building:. Dwelling No.of Bedrooms 49_ Lot Size ;?o Q 2+/ sq.ft. Garbage Grinder( ) Other Type of Building BLS,e No.of Persons Showers( ) Cafeteria( ) ! Other Fixtures Design Flow(min.required) S 5(. gpd Design flow provided j S gpd Plan. Date 6_1'2L1 � ) Number of sheets 1L" Revision Date Title Size of Septic Tank ►5760 Type of S.A.S. Ii��� , ��� •(� Description of Soil Nature of Repairs or Alterations(Answer when applicable) 'j( l { Date last inspected: ! f`t Agreement: �d� The uridersgnrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe Date L. Application Approved b i Date Ll Application Disapproved by Date fi a for the following reasons Permit No. L I. � " Date Issued ......__ .. _----.--- _ _- - ---- -- ---.-- - . .._ _ -:--- -----;_-. , THE COMMONWEALTH OF MASSACHUSETTS BARNSTABL'E,MASSACHUSETTS Certificate Of Compliance _ k THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed Repaired( Upgraded( i g P Y ( ) P ( �� Pg ( ) Abandoned at c.o�,j 'A No has been constructed in accordance / j with the provisions of Title 5 and the for Disposal System Construction Permit No:�(.D 0�7 dated 1!j/ k--- Installer� ��.� E k �Jlcwn3loC Designer ,rr/V �� #bedrooms S' Approved design ow gpd i The issuancq of Ihis permit shall not be construed as a guarantee that the system t l f nct'o i ned. Date Inspector No. - i� ' Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6pstrm Construction Permit Permission is hereby granted to Construct O� Repair(01-< Upgrade( ) Abandon( ) System located at � F ,� !� f-Y/rJr//k• d and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with 1411 h j Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date 1 Approved b ► J ,F 09/07/2012 06:11 5084775313 ENGINEERING WORKS PAGE 01 Town of Barnstable Regulatory Services Thomas F.Geller,Director e a KulPublic Health Division Thomas McKean,Director Zoo Main Street, Hyannis,MA 02601 office: 508-862-4644 Fax: 508-790 6304 Date: tP Sewage Permit# Assessor's Map/Parcel Installer&Designer Certification Form Designer: 1✓r, War 1A.Y. Inc , Installer: Address: 1 z W. i el Address: -- Tir .-d a 4 f On ,ljfQ RrdLij rt was issued a permit to install a (date) (installer) #4 septic system at Mel',A . 6.S'�-�CCVi 1k based on a design drawn by (address)' - / doe- /4r—&/ C ` dated f . (designer) 1 certify that the septic system: referenced above was installed substantially according to the design., which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. 1 certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if required)w ed and the soils. were found satisfactory. 1H OF PETER T. WENTEE staller's Signmm) CIVIL ,�N0.96109 O � /� J fBTE (Designer's Signature) —(Affix Design --- PLEASE REEM TO BARNSTABLE P LIC HE H DlVi15 N. CER ICATE OF OMpLIANCE WILL NOT BE MW D UNTIL OTki THIS ORM AND ,A - BUILT CARD ARE RECEIVED By THE B MTABLE Jr. H1jr IJEALTH D THANKYOU. gAoffice forms\desip =mertr5eation for-Aw Cff LEGEND a N - 98--EXISTING CONTOUR x 100.98 EXISTING SPOT GRADE hoc W EXISTING WATER SERVIC Valle Rd �� a G EXISTING GAS SERVICE O.H. V.-OVERHEAD WIRES 05�eN TEST PIT w BENCHMARK LOCUS \Ge Rd �Cape Cod Academy LOCUS MAP NOT TO SCALE 00. \` GENERAL NOTES; . 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. 20,024f S,f. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS A OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE M BLU 119-004 _- LOCAL.RULE$ AND.REGULATIONS. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH�AND THE DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO, .THE DESIGN x 98.05 ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.- x 98'72 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 1p�q HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. O 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. THERE ARE NO WELLS WITHIN 100' OF THE PROPOSED S.A.S. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. x 98,52 10: IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. x'98.37 __ 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS �' Ber��hma?k�-S� _ IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND g REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 6OTSIDE COR.IS7EP 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE LO- EL.=101.55 (Assumed) INSPECTED BY THE DESIGN ENGINEER PRIOR TO BACKFILL N 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. • ,` Q0 X 99..8 MgSX OF 100.41 TP-2 ,-` x TP-1 -----32 1_� 1�00 r- T-- ---r--� - o PETER T. ® -- �---�-- -�---a McENTEE 100.83 PRQPO ED_I I CIVIL _ PROPOSED x •_ [_ aN • No. 35109 =• � � ` SEPTIC TANK + SHRUBS SPIKE2 II _ I r 100.52 0. ...,. :... . - CESSP❑❑L 0 100.91 x 0 100.76 j 0 ( + CE RZ0L 100.30. 100.84w0 x 100.67 X 100,69 EXIS71NG CESSPOOLS B G 100.78 TO BE PUMPED, FILLED 100JIS 100,06 5 1 0,B9 W/SAND & ABANDONED x x EX. 4" PVC EX. 4" C.I. INV.=99.3t INV.=99.1t / x 100.60 EX. 2" STEEL INV.=100.1 t EXISTIN x 100. HOUSE&1390) 0 100.89 0 . \ T.O.F.=101.3t Z 100. 6 nl r 100 01� I x 100, 59 x x 100.96 I 99.84 0 00\ o 100.01 100.46 x CB CB 0 99,73 x 9).1:3, . 100. 100.50 -----r lob, 151.07f(DEED 100.33 100.12 100,55 100.55 100. 0 100.45 OWNER OF RECORD DEED &DEED BOOK 73 REFERENCES 3EALTY TRUST 4 MAIN S TREET F�sH, SHRISTOPHER C TR PLAN BOOK 123 - PAGE 83 VVV 1390 MAIN STREET PLAN BOOK 382 - PAGE 9 OSTERVILLE, MA 02655 Engineering by: SCALE DRAWN JOB. No. PROPOSED SEPTIC SYSTEM UPGRADE PLAN Engineering Works, Inc. 1"=20' P.T.M. 226-12 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. 1390 MAIN STREET OSTERVILLE MA (508) 477-5313 8/24/12 P.T.M. 1 of 2 Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 u NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < £L:97.8 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC -.TANK PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER,& COVER INSTALL INSPECTION PORT OVER END UNIT T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6 OF GRADE EXISTING F.G. EL=100.9t F.G. EL.=100.8t F.G. EL.=100,0 to 100.8(MAX.) ' � ' MAINTAIN 2% GRADE (MIN.) OVER S.A.S. L = 20' L = 10' L = g'(MAX) INSPECTION ® S=1% (MIN.) Q S=1% (MIN.) ® S=1% (MIN.) 4"SCH40 PVC - 4"SCH40 PVC 4"SCH40 PVC 6" °..I 6' 11.3" TO 14" INVERT LCONNECT .50 48" UOUID I LEVEL ADD INV.=97.77 PROPOSED INV.-97.60 (5 ROWS OF 5 UNITS AT 6.25'/UNIT) + 0.7' WEDGE = 32.0' • GAS BAFFLE INV.=98.25 D-BO� INV,=97.44 SOIL ABSORPTION SYSTEM (PROFILE) Jimry 5 OUTLETS (MIN.) PROPOSED•SEPTIC TANK EXISTING SEWERS AT HOUSE ESTABLISH VEGETATIVE COVER =93.1 t (SEE- NOTE 1 BELOW) BACKFILL WITHEAN NATIVE OR PERC SAND TO TOP OF CHAMBERS NOTES: BREAKOUT=TOP 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE.INVERTS ". TOP ELEV.=97.83 AND SEWAGE FLOW, PRIOR TO INSTALLATION. INV. ELEV.=97.44 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND TRUE - BOTTOM ELEV.=96.50 TO GRADE ON A MECHANICALLY COMPACTED 6" CRUSHED 2.83' STONE BASE, AS SPECIFIED.IN 310 CMR 15.221(2). 5' MIN. ABOVE BOTTOM OF 3) INSTALL INLET & OUTLET TEES AS REQUIRED." T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH=14.2' 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE EXISTING SUITABLE NO GW 6 AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. . ., EL=89. = t MATERIAL USE 5 ROWS OF 5-16"(H-20) ADS BIODUFUSER UNITS + WEDGE WITH NO`SEPARATION BETWEEN EACH ROW & NO STONE SEPTIC SYSTEM PROFILE TYPICAL SECTION N.T.S. ----------------- SOIL LOG 32.0 ,T � . PROPOSED i4N. DATE: AUGUST 24, 2012 (REF#P-1.3,725) SPIKE 64.3` S.A.S. SOIL EVALUATOR: PETER McENTEE (SE#1542) 100.52 �� ----- �� WITNESS: DONALD DESMARAIS R.S.-HEALTH AGENT ------- Elev. - - TP 1 Depth Elegy. TP-2 7 Depth "' F ' of 100.6 0" 100.5 ` A SANDY LOAM... _ __.- A .SANDY LOAM �� 99.1 1OYR 4/2 18' 99:5 1OYR 4/2 0.. B B N SANDY LOAM' SANDY LOAM 12" 1OYR 5/6 1OYR 5/6 97.4 C 38" 98.0 C PERC 42"/54, HOUSE(#1„ 0 M-C SAND M-C SAND 2.5Y 6/4 2.5Y 6/4 S.A.S. LAYOUT 89.6 132" 89.5 132"' 75 PERC RATE <2 MIN/IN. ("C" HORIZON) NO GROUNDWATER OBSERVED DESIGN CRITERIA �_y 76" - NUMBER OF BEDROOMS: 5 BEDROOMS PROFILE SOIL TEXTURAL CLASS: CLASS I 11.3 TO INVERT DESIGN PERCOLATION RATE: <2 MIN/IN DAILY FLOW: 550 GPD 16" DESIQN FLOW: 550 GPD T1.2" GARBAGE GRINDER: NO LEACHING AREA REQUIRED: (330 GPD) 743.2 SF �� 34" .74 GPD/SF SECTION END CAP PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY (H-10) PROPOSED D-BOX: 1 INLET, 5 OUTLET (MINIMUM), H-10 RATED 16" HIGH CAPACITY (H-20) BIODIFFUSER UNIT USE 5 ROWS OF 5-16" (H-20) ADS BIODIFUSER UNITS MODEL 16" HICAP W/NO STONE AND EXTENED 0.7' W/ CONTOURED WEDGE LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.70 SF/LF OF UNIT) DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. (BIODIFFUSERS) 25 UNITS x 6.25 LF x 4.73 SF/LF _ 739.1. SF SIDE WALL HEIGHT 1 6" (CONTOURED WEDGE) 5 ROWS x 0.7' x 4.73 SF/LF = 16.6 SF OVERALL HEIGHT 16" LVD TOTAL AREA =.. 755.7 SF OVERALL WIDTH 34" 4640 TD, OHIOEMAN 302 - 13.6 CF arcsoHILLIARD, OHIO 43026 DESIGN FLOW PROVIDED: 0.74 GPD/SF(755.7 SF) = 559.2 GPD CAPACITY (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC. Engineering by: I I I SCALE DRAWN JOB. NO. PROPOSED SEPTIC SYSTEM UPGRADE PLAN Engineering Works, Inc. N.T.S. P.T.M. 226-12 12 West Crossfield Road, Forestdale, MA 02644 DATE ' CHECKED SHEET NO. 1390 MAIN STREET OSTERVILLE MA (508) 477-5313 8/24/12 P.T.M. 2 of 2 Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632