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HomeMy WebLinkAbout0315 MAIN STREET (OST.) - Health 315 MAIN STREET, OSTERVILLE A=164-003 i tt t. o 1 s z� ii Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 315 Main Street Main Housei System 1 of 2 Property Address Frank Minard Owner Owner's Name information is is required for every OSterville MA 02655 2/14/2014 page. City/Town i; ( State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, I `� use only the tab 1. Inspector: '+ — key to move your cursor-do not ,lames Ford use the return Name of Inspector key. Q1.6 .Company Name a y t P.O. Box 49 Company Address Osterville MA 02655 City/Town State Zip Code 508-862-9400 x' i S12482 Telephone Number License Number B. Certification r -1 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. 1 am:,a'DEP approved system inspector pursuant to Section 15.340 of _ Title 5 (310 CMR 15.006). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑s Needs Further luat&!by the Local Approving Authority t 2/17/14 Ins p is gnature Date The y tem inspector shall submit a copy of this inspection report to the Approving Authority(Board of He h or DEP)within 30{:oays of completing this inspection. If the system is a shared system or has a design flow of 10,000c!pd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. , L ****This report only describes'.sunditions 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. LCC, J 1 Ov i t5ins•3/13 Title 5 Official Inspection Form: lbrree Sewage Disposal System•Page 1 of 17 I; Commonwealth of Mass•.achusetts W Title 5 Official Inspection Form, Subsurface Sewage Dis osal' stem Form-N 9 p Y of for Voluntary Assessments 315 Main Street Main House System 1 of 2 Property Address j Frank Minard t Owner Owner's Name information is required for every Oster ille MA 02655 2/14/2014 page. City/Town State Zip Code Date of Inspection B. Certification (cont ) - Inspection Summary: Check jA,B,C,D or E/always complete all of Section D . A) System Passes: I ® I have not found any info6ation 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: e . r - B) System Conditionally Passes: 0 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 substantia°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 p ass inspection if it is structurally sound, not leaking and if a Certificate of Gompliance indicating that4he tank is less than 20 years old is available. F1 Y ❑,N ' El ND(Explain below): i t5ins-3113 ' f Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 i . f � 2 Commonwealth of Massachusetts Title 5 Official °Inspection Form Subsurface Sewage DisposaU System Form -Not for Voluntary Assessments wM 315 Main Street Main House! System 1 of 2 Property Address i 1 Frank Minard Owner Owner's Name i information is required for every Osterville. " ' MA 02655 2/14/2014 page. Cityrrown 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�pi.pe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(withlaliRroval of Board of"Health): t: broken pipe(s)are replaced: .. ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box!' beveled or replaced ❑ Y ❑ N ❑ ND(Explain below): i. h ❑ 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 pipes)are replaced [IY ❑ N ❑ ND (Explain below): it:� ❑ obstruction is reemoved s ❑ Y ❑ N ❑ ND (Explain below): i C) Further Evaluation is,, equired by the Board of Health: ❑ Conditions exist which iequire 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 1°5.303(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 (Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r 1 I # I 'Commonwealth of Mass' husetts Title 5 OfficiaJ ]nspection Form Subsurface Sewage Disposalp$ystem Form-Not for Voluntary Assessments ' r, i 315 Main Street Main House!'. System 1 of 2 Property Address Frank Minard Owner Owner's Name information is Osterville MA 02655 2/14/2014 required for 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) i determines that the system is functioning in a manner that protects the public health, safety and environment: s. ❑ 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: nY • **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: i''s•i D) System Failure Criteria Applicable to AII,Systems: r . , You must indicate"Yes" br`9No"to each of the following for all inspections: Yes No ► ; ® Backup;of sewage into facility or system component due to overloaded or cloggk; AS or cesspool 0 ® Discharge or ponding of effluent to the surface of the ground or surface waters duet. an overloaded or clogged SAS or cesspool El ® Static;l,iquid level in the distribution box above outlet invert due to an overloaded lj or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/Z day flow t5ins•3/13 } Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i Commonwealth of Mass6c:l usetts Title 5 Official"Inspection Form Subsurface Sewage Disposal;System Form-Not for Voluntary Assessments ,M ,•'' 315 Main Street Main Hous61 ystem 1 of 2 Property Address Frank:Minard Owner Owner's Name !' information is required for every Osterviille MA 02655 2/14/2014 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ';} I 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 portibn of the SAS, cesspool or privy is below high ground water elevation: ❑ ® Any p®rtion of cesspool or privy is within 100 feet of a surface water supply or tributafy 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. El ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet !I, � 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 anembnia 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,Odbgpd. ❑ ® The system fails. I have determined that one or more of the above failure criter€a �jdst as described in 310 CMR 15.303, therefore the system fails. The systeO owner should contact the Board of Health to determine what will be neceg�ary 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 t•'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 Secti&6 D above the large system has failed. The owner or operator of any large system considered a signifi%ant threat under Section E or failed under Section D shall upgrade the system in accordance with 016 CMR 15.304. The system owner should contact the appropriate ro riate regional office of the Deparj,rrt'ent. t5ins.•3/13 ` Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I I t Commonwealth of Massachusetts u Title 5 Offici `J . nspection Form Subsurface Sewage Disposai"system Form -Not for Voluntary Assessments la- I c�M 315 Main Street Main Hous S stem 1 of 2 � Y Property Address } . Frank Minard Owner Owner's Name information is required for every Osteryille l) .i: MA 02655 2/14/2014 page. City/Town ' .i 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 I . . ® ❑ . Plum pi��g,information was provided by the owner, occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? i .; ® El Has thsystem 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 in��leetion? ❑ 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 al! 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? El ® Was t11 4.facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The si'," and location of the Soil Absorption System (SAS) on the site has been dr fermined based on: E ❑ Existing" information. For example, a plan at the Board of Health. ® ❑ Determi bd 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)] .ITe D. System Information: Residential Flow ConditioPis I ` 9 per as g Number of bedrooms (desigFi)°' Number of bedrooms(actual): built DESIGN flow based on 310 il,-& 15.203(for example: 110 gpd x#of bedrooms): 990 is V' 15ins•3/13 t" Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 - Commonwealth of Massusetts W Title 5 Officizi[ Inspection Form Subsurface Sewage Disposau System Form-Not for Voluntary Assessments °M r 315 Main Street .Main Housa System 1 of 2 Property Address i ! -- Frank Minard , Owner Owner's Name P information is required for every Osterville MA 02655, 2/14/2014 page. City/Town State Zip Code Date of Inspection D. System Informatici Description; F j Number of current resident 2 Does residence have a gar' age grinder? ElYes '® No Is laundry on a separate sewage system?(Include laundry system inspection Information in this report.) ❑ Yes ® No Laundry system inspectedry i i' El Yes,® No Seasonal use? ; {t� i ❑. Yes '® No Water meter readings, if avl ilable last 2 ears usage F g � ( Y 9 (gPd)): . Detail: • .. unavailable € Sump pump? ❑ Yes ® _No Last date of occupancy: = currently, ' Date ,Commercial/Industrial FIow;Conditions: Type of Establishment Design flow(based on 310 AMR 15.203): 1, , ;• Gallons per day(9Pd) ' Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? _. ❑ Yes El No Industrial waste holding tank.present? El 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, - it Commonwealth of Massachusetts Title 5 Official" Inspection Form Subsurface Sewage Disposai System Form -Not for VoluntaryAssessments nts 315 Main Street Main Hous t System 1 of 2 � . Property Address Frank Minard Owner Owner's Name information is required for every Osterville ; MA 02655 2/14/2014 page. City/Town State Zip Code Date of Inspection D. System Information; (cont.) h ' Last date of occupancy/use:.. Date Other(describe below): I' e • f;i General Information Pumping Records: Source of information: Was system pumped as pa;r of the inspection? El Yes ® No If yes, volume pumped: " l' gallons How was quantity pumped 82termined? Reason for pumping:_ i Type of System: k ® Septic tank;di'stribution'box, soil absorption system i. . ❑ Single cesspool ❑ Overflow casspool j ❑ Privy i. ❑ Shared sys r`ri (yes or no) (if yes, attach previous inspection records, if any) Ik �. ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenan6o 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): I !Sins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Mas ':��c} husetts Title 5 Official' inspection Form Subsurface Sewage Disposa),System Form -Not for Voluntary Assessments °M 315 Main Street Main House ;System .1 of 2 Property Address Frank Minard Owner Owner's Name t , information is required for every Osterville MA 02655 2/14/2014 page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all corr1, orients, date installed (if known)and source of information: installed - 10/5/1995 per ihf o �i Were sewage odors detected"when arriving at the site? ❑ Yes ® No Building Sewer(locate on Site plan): Depth below grade: feet Material of construction: :' ❑ cast iron ® 40;PVC. El other(explain): Distance from private water".supply well or suction line: feet Comments (on condition of'ioiots, venting, evidence of leakage, etc.): 1 Septic Tank (locate on sitelplan): ' Depth below grade: 10 11 feet Material of construction: ® concrete ❑ rrm%al ❑fiberglass ❑ polyethylene ❑ other(explain) L : 3 .: r t- If tank is metal, list age: years Is age confirmed by a Certifl ate of Compliance? (attach a copy of certificate) El Yes El No Dimensions: (i' J. 2500 gals. 2„ Sludge depth: t5ins•3/13 Title 5 Official cal Inspection Form:Subsurface Sewag e Disposal osa System•Pa ge e9 f17 9 P Y 9 0 E , � F ii li i� Commonwealth of Massachusetts Title 5 Officiai'I` Inspection Form Subsurface Sewage Disposa.6 System Form -Not for Voluntary Assessments 315 Main Street Main House System 1 of 2 Property Address Frank Kinard Owner Owner's Name j information is i required for every Osterville i, '`i MA 02655 2/14/2014 page. City/Town kState Zip Code Date of Inspection D. System Information. (cont.) Septic Tank (cont.) 6i Distance from top of sludge`to bottom of outlet tee or baffle 34 I•,• Scum thickness i; 10 Distance from top of scum-6 top of outlet tee or baffle II,�:k Distance from bottom of scto bottom of outlet tee or baffle 15 t` How were dimensions determined? measure Comments (on pumping rec'6mmendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to o6tM invert, evidence of leakage, etc.): The tees were present. There was no sign of leakage. recommend pumping the tank r .f ; t Grease Trap (locate on sit ! pan): Depth below grade: feet Material of construction: El concrete ❑ metl;; ❑fiberglass . ❑ polyethylene ❑ other(explain): Y'. f N/a y � t Dimensions: Scum thickness . s Distance from top of scum tip top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle f ` Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massyzchusetts Title 5 Officia , Inspection Form Subsurface Sewage Disposa6 aystem Form-Not for Voluntary Assessments °a �,•'' 315 Main Street Main House System 1 of 2 Property Address Frank Minard Owner Owners Name information is required for every Osterville ` MA 02655 2/14/2014 page. Cltyrrown f State Zip Code Date of Inspection D. System Informatl®n (cont.) - Comments(on pumping rehommendations, inlet and outlet tee.or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): }, i;• hf I Tight or Holding Tank.(tar"lzk,must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal '. ❑fiberglass ❑ polyethylene .. El other(explain): N;a Dimensions: Capacity: f gallons Design Flow: gallons per day AI'arm present: ❑ Yes ❑ No Alarm level: Alarm`in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm;and float switches, etc.): ppr-i 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 n _ L • Commonwealth of Massachusetts v Title 5 Offici9l Inspection Form Subsurface Sewage Disposal ,System Form -Not for Voluntary Assessments w a •'�r 315 Main Street- Main House, System 1 of 2 Property Address r Frank Minard Owner Owner's Name f ; information is required for every Osterville MA 02655 .2/14/2014 page. City/Town State Zip Code Date of inspection D. System Informations (cont.) Distribution Box(if present,,must be opened)(locate on site plan): Depth of liquid level above!outlet invert even Comments (note if box is I�vel and distribution to outlets equal, any evidence of solids carryover, any. evidence of leakage into on out of box, etc.): The ID-box was normal. Th)�cover was 16"below grade. Pump Chamber(locate on"site plan): , Pumps in working order: y ❑ Yes ❑ No' Alarms in working order: ❑ Yes ❑ No* F Comments (note condition Of pump chamber, condition of,pumps and appurtenances, etc.): N/a t. f l ;I 1 I.{J i 1 If pumps or alarms are not in working order, system is a conditional pass. i Soil Absorption System (§AS)(locate on site plan, excavation not required): If SAS not located, explain vyvhy: i. i t5ins•3/13 t Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 s; t . t, Commonwealth of Massachusetts Title 5 Official InspectionForm Subsurface Sewage DisposdI System Form -Not for Voluntary Assessments 315 Main Street Main House System 1 of 2 Property Address h {{ Frank Minard it Owner c information is Owner's Name ' required for every Osterville ' MA 02655 2/14/2014 page. Cityrrown Stat e ZipCode Date of Inspection D. System Information (cont.) Type: , ❑ leaching pits number: ❑ leaching ch mbers number: ❑ leaching galleries number: t® leaching tre�irles number, length: 2- 10'x67' ❑ leaching fiefs:! number, dimensions: ❑ overflow cesspool number: ❑ innovative/altea native system t Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 9 , There was no signs of failure.'A camera was used for the inspection i , - i Cesspools (cesspool must;be`pumped as part of inspection)(locate on site plan): Number and configuration , . N/a Depth—top of liquid to inlet�'nvert Depth of solids layer Depth of scum layer 4 t s , Dimensions of cesspool I. Materials of construction } r Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 i Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 r, f L 3. r ` Commonwealth of Massachusetts Title 5 Officil' Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M a 315 Main Street Main Housg: .$ 'stem 1 of 2 Property Address Frank Minard Owner Owner's Name t information is , required for every Osterville MA 02655 2/14/2014 page. CltylTown State Zip Code Date of Inspection D. System Informati6n (cost.) Comments(note condition bf'soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 4/ y. Privy(locate on site plan): ; �• Materials of construction: C Dimensions r- 4 Depth of solids Comments(note condition Of Loil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/a e, ,r t ri V5 is fa t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 �7 t. ;. I f SN• a Commonwealth of Massachusetts v Title 5 Official,, Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments • 315 Main Street Main House System 1 of 2 Property Address Frank Minard `? ' Owner Owner's Name information is required for every Osteryille I` MA 02655 2/14/2014 page. CityRown Ei State Zip Code Date of Inspection D. System Informatiol p (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 e1 Aers the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately ' I y a• I. A ' 07 r 10 l5ins•3/13 j Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 • b i ' Commonwealth of Massachusetts H W Title 5 Official` Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments CM , 315 Main Street _Main House System 1 of 2 Property Address Frank Minard Owner Owners Name M information is required for every Osterville ' MA 02655 2/14/2014 page. City/Town y State Zip Code Date of Inspection D..System Informati®n (cont.) Site Exam: ❑ Check Slope E ❑ Surface water ❑ Check cellar. ❑ Shallow wells . Estimated depth to high groynq water: 30' feet Please indicate all method l used to determine the high ground water-elevation: ❑ Obtained from{system design plans on record If checked, date;of design plan reviewed: Date ; 1 ❑ Observed site(,,abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health explain: Using topo andiwater contours maps i ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USES database -explain: You must describe how y6. Ostablished the high ground water elevation: see above. I:. • i Before filing this Inspecti®n Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 V Commonwealth of Massachusetts Title 5 Offici " Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '�M a •''t 315 Main Street Main House System 1 of 2 Property Address Frank Minard I' Owner Owner's Name I i information is required for every Osterville MA 02655 2/14/2014 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked f: I ® Inspection Summary L4,(.System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated,depth to high groundwater ® Sketch of Sewage Dis.'6,§ql System either drawn on page 15 or attached in separate file I. . ' 3 , 1 e _ !: •I r 6 ' � •Ft .• III II { I 4i I r ' u . I a- , rtltl ; , i a ' It li !� t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 f Commonwealth of Massachusetts r W Title 5 Official, Inspection Form Subsurface Sewage Dlsposal System Form -Not for Voluntary Assessments 315 Main Street Guest House:Gym, Boat& Pump House. System 2 of 2 Property Address it Frank Minard Owner Owner's Name information is required for every Osterville MA 02655 2/14/2014 page. City/Town State Zip Code Date of Inspection l � / Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness)checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: D key to move your cursor-do not ,James Ford l use the return key. Name of Inspector C16 Company Name , P.O. Box 49 Company Address Osterville MA 02655 City/Town +. + State Zip Code 508-862-9400 ri. ' S12482 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 � e ❑ Needs Further valuation by the Local Approving Authority F, t 2/17/14 Inspe t is Signature Date The sy em inspector shall submit a copy of this inspection report to the Approving Authority(Board of H h 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 inspeci,Igp 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: s ce Sewage Disposal System-Page 1 of 17 h Commonwealth of Massachusetts i' Title 5 Officiol Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments g. r. 315 Main Street Guest Home;,Gym, Boat& Pump House. System 2 of 2 Property Address Frank Minard Owner Owner's Name u �! information is required for every Osterville ;�' MA 02655 2/14/2014 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont. i Inspection Summary: Check;A,B,C,D or E/always complete all of Section D A) System Passes: 8 ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 on in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. s Comments: 1' i .'r•' it • � r � i ^ B) System Conditionally Passes: ❑ One or more system gloTponents 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 expla;in l,`° The septic tank is metal andover 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. �i A metal septic tank will puss 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): j1 r i t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 f , t , I Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal $yytem Form - Not for Voluntary Assessments 315 Main Street Guest House,'G m, Boat& Pump House. S ,M Y p stem 2 of 2 Y Property Address Frank Minard a Owner Owner's Name information is required for every Ostervillle k MA 02655 2/14/2014 page. City/Town s State Zip Code Date of Inspection B. Certification (cont.�, ❑ Pump Chamber pumpO/alarms not operational: System will pass with Board of Health approval if pumps/alarms are repaired. n B) System Conditionally Passes (cont.): El Observation of sewage 8,ackup 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)`,a: replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution bo� is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): 1, 0 ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspect On if(with approval of the Board of Health): a ❑ broken pipes)ate replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed• ❑ Y ❑ N ❑ ND(Explain below): ,I • 1? 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 'sy';stem is not functioning in a manner which will protect public health, safety and the environment: t, ❑ Cesspool or ptrkvy is within 50 feet of a surface water El Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 °. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 l , i f, Commonwealth of Mass husetts Title 5 Offici [ Inspection Form _ o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 315 Main Street Guest House% Gym, Boat& Pump House. System 2 of 2 Property Address Frank Minard Owner Owner's Name information is required for every Osterville t MA 02655 2/14/2014 page. City/Town i 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: . i` ❑ 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 peptic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has.a sept clank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to deterrnii�e-distance: **This system passes if th'e•well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicatesiabsent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, pro4ided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. ; 3. Other: li ♦ Il f 4: d j. D) System Failure Criteria Applicable to All Systems:' You must indicate"Yes"�or"No"to each of the following for all inspections: k Yes No 4 ® 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 tog 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'%I day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 8 ' s • !, Commonwealth of Mastic usetts W Title 5 Official' Ins ection Fo r orm Subsurface Sewage Disposa0 System Form - Not for Voluntary Assessments, °M e,.•'' 315 Main Street Guest Howe,'Gym, Boat& Pump House. System 2 of 2 Property Address !: Frank Minard Owner Owner's Name information is required for every Osterville {° MA 02655 2/14/2014 page. City/Town State Zip Code Date of Inspection B. Certification (cont) Yes No k, i ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: Y ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. Any pagtibn of cesspool or privy is within 100 feet of a surface water supply or El ® tributary to a surface water supply. 1, ❑ ® Any pfoftion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any Poi•tion 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 systeriti 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, proMided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] I ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,0810gpd. ❑ ® The!system fails. I have determined that one or more of the above failure crite,, 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 necAar<y to correct the failure. E) Large Systems: To be co sioered a large system the system must serve a facility with a design flow of 10,000 gptai#0:15,000 gpd. For large systems, you mu'st'.indicate either"yes'or"no"to each of the following, in addition to the questions in.Section D. Yes No El ❑ the dystem is within 400 feet of a surface drinking water supply ❑ ❑ the v,y5tem 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 ❑ Areal 11WPA)or a mapped Zone II of a public water supply well If you have answered°yes'i'tb any question in Section E the system is considered a significant threat, or answered "yes" in Secti6hi 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 witM13�1d CMR 15.304. The system owner should contact the appropriate regional office of the Depa�trnent. i t5ins•3/13 ti I' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 ii Commonwealth of Massachusetts Title 5 Offici „�i Inspection Form Subsurface Sewage Dispos yjstem Form Not for Voluntary Assessments °�M A,•'` 315 Main Street Guest HouGym, Boat& Pump House. System 2 of 2 Property Address I Frank Minard � Owner Owners Name information is li required for every Osteryille MA 02655 2/14/2014 page. City/Town !; State Zip Code Date of Inspection C. Checklist i1 ` 1 , Check if the following have[ been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumpipginformation was provided by the owner, occupant, or Board of Health ❑ ® Werein! of the system components pumped out in the previous two weeks? ® ElHas th �sMstem received normal flows in the previous two week period? ,g i Have large volumes of water been introduced to the system recent) or as r ❑ ® Y y part of this ins'action. ® I❑ Were as built plans of the system obtained and examined?(If they were not availat 4e]riote as N/A) ❑ z Was thli. 'e facility or dwelling inspected for signs of sewage back up? ® ETWas the site inspected for signs of break out? ® ❑ Were ali"system components, excluding the SAS, located on site? ® ❑ Were thb: septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimens#ons, depth of liquid, depth of sludge and depth of scum? t,t .,. ❑ ® Was th"I facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? ,,, , The size end location of the Soil Absorption System (SAS) on the site has been dote(mined based on: z ❑ Existing'=information. For example, a plan at the Board of Health. ® ❑ Determk d in the.field (if any of the failure criteria related to Part C is at issue approxh Lion of distance is unacceptable) [310 CMR 15.302(5)] ii; N .r D. System Information., Residential Flow Conditions: f:i .;'. per as 3 Number of bedrooms (design):- built Number of bedrooms (actual): i.. DESIGN flow based on 310C1VIR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I'S F Commonwealth of Mas ,46husetts v Title 5 Offici "i" inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � ,•'• 315 Main Street Guest Ho u 'e;,:Gym, Boat& Pump House. System 2 of 2 Property Address Frank Minard ;I i Owner Owner's Name information is required for every Ostervi le ± MA 02655 2/14/2014 page. Cityrrown ( 't State Zip Code Date of Inspection D. System. Information Description: 4 _ 4 4 ` i Number of current resident:;i ' n/a Does residence have a garpage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected?, ❑ Yes ® No Seasonal use? i' ❑ Yes ® No Water meter readings, if ava,ila`ble(last 2 years usage(gpd)): Detail: I u unavailable Sump pump? El Yes ® No i; Last date of occupancy: '.' currently Date Commercial/Industrial Flc�rq;conditions: Type of Establishment: i, Design flow(based on 310;;G��R 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 discharlpsd to the Title 5 system? ❑ Yes ❑ No Water meter readings, if av`3'ilable: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 ii . Commonwealth of Massachusetts Title 5 Officil Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M A,•y 315 Main Street Guest Hou,4,&"Gym, Boat& Pump House System 2 of 2 Property Address Frank Minard Owner Owner's Name I information is MA 02655 2/14/2014 required for every OStervllle page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) t; Last date of occupancy/use: a Date Other(describe below): f General Information �i Pumping Records: '`,.( �I Source of information: , Was system pumped as pa;,rt:of the inspection? El Yes ® No If yes, volume pumped: K gallons , How was quantity pumped Idetermined? i Reason for pumping: � { Type of System: t ® Septic tanA distribution box, soil absorption system ❑ Single ces'tpgol ❑ Overflow cesspool EJ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ InnovativefAlternative technology. Attach a copy of the current operation and maintenan§e'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): i t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 • i f !i Commonwealth of Massachusetts W Title 5 Official',, In*spection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 315 Main Street Guest House,.Gym, Boat& Pump House. System 2 of 2 Property Address Frank Minard b' ` Owner Owner's Name information is required for every Osterville MA 02655 2/14/2014 page. City/Town l; State Zip Code Date of Inspection D. System Information n' (cont.) Approximate age of all conk portents, date installed (if known)and source of information: installed -4/17/1998 per iRtlf Were sewage odors detecfed when arriving at the site? ❑ Yes ® No Building Sewer(locate on_ite plan): Depth below grade: i feet lU Material of construction: ' 9 � ❑ cast iron ® 40�o:'VC ❑ other(explain): Distance from private watO supply well or suction line: feet Comments (on condition of,joirjts, venting, evidence of leakage, etc.): l; Septic Tank (locate on sitean): . �. .Depth below grade: 40" feet Material of construction: , t ® concrete ❑ metal ❑fiberglass El polyethylene ❑ other(explain) y. Ki P 4i If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gals. H-20 y 2" Sludge depth: i t5ins•3/13 f Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 ' i a . Commonwealth of Massachusetts Title 5 Official; Inspection Form Subsurface _Sewage Disposal System Form Not for Voluntary Assessments 315 Main Street Guest House;'Gym, Boat& Pump House. 7M 10y`• S . stem 2 of 2. Property Address Frank Minard Owner Owner's Name h ' information is required for every Cisterville ! ' MA 02655 2/14/2014 page. City/Town z- r State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) , Distance from top of sludge to bottom of outlet tee or baffle 29 Scum thickness ` { 1 N. Distance from top of scum Ito:top of outlet tee or baffle 6 Distance from bottom of scus- to bottom of outlet tee or baffle 15 How were dimensions determined? measure Comments (on pumping repommendations, Inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage„etc.): The tees were present. There was no sign of leakage. Steel cover was to grade. a• P l ry Grease Trap (locate on sit'e,plan): Depth below grade: i feet Material of construction: ; ❑ concrete ❑ metp.l ' ❑fiberglass , ❑ polyethylene ❑other(explain): N/a Dimensions: Scum thickness Distance from top of scumtto;top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: ,,. Date e ,s t5ins•3/13 t. g Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 I 4 Commonwealth of Massachusetts Title 5 Offici U, Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 315 Main Street Guest House,,.Gym, Boat& Pump House. S stem 2 of 2. Property Address Frank Minard Y Owner Owner's Name isrequired for every Osterville ar . MA 02655 2/14/2014 ' page. City/Town 1' State Zip Code Date of Inspection D. System InformatiQp. (cont.) e. Sil Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): r; Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: 1 , Material of construction: t ; ❑ concrete ❑ metal ` ❑fiberglass ❑ polyethylene ❑ other(explain): N/a a '+ r� - Dimensions: bl Capacity: ' "' gallons ;j Design Flow: 1, r, { gallons per day ti sl Alarm present: f; ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: a' Date Comments (condition of alarm and float switches, etc.): is r r, t { i Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No r S f. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 f r Commonwealth of Masgachusetts m W Title 5 Official; Inspection Form Subsurface Sewage Disposa� System Form - Not for Voluntary Assessments 315 Main Street Guest Hous`e,`.G m, Boat& Pum House. S stem 2 of 2 Property Address Frank Minard Owner Owner's Name information is required for every Osterville " ` MA 02655 2/14/2014 page. Clty/Towr State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present.must be opened) (locate on site plan): i. Depth of liquid level above�;ou'tlet invert even Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or'out of box, etc.): The D-box was deep couldl'ri'ot locate and ground was frozen 1 :I 1 I I, a,I .. t Pump Chamber(locate onsite plan): Pumps in working order: <' ® Yes ❑ No" E Alarms in working order: i ® Yes ❑ No" Comments (note condition 8�pump chamber, condition of pumps and appurtenances, etc.): The pumps for the boat hod'se were just replaced 2 months ago E; e+. If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (,�AS)(locate on site plan, excavation not required): If SAS not located, explain w,hy: • i1 i,. • t, t5ins•3/13 t Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 l r H , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal $yistem Form -Not for Voluntary Assessments 315 Main Street Guest House, Gym, Boat& Pump House System 2 of 2 Properly Address e Frank Minard # Owner Owner's Name I information is required for every Oster,rille MA 02655 2/14/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pit { number: a , 5-infiltrators ® leaching chambers number: 40'x 8'x 2' 4 j ❑ leaching galleries number: ❑ leaching tr enrohOs number, length: ❑ leaching fieid$ number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system i. Type/name.bN!technology: Comments (note condition`, f,soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Dug down beside infiltrators :'There was no signs of failure. t � I t .A 7� •. t i Cesspools (cesspool must tie pumped as part of inspection)(locate on site plan): a Number and configuration N/a Depth—top of liquid to inlet invert Depth of solids layer q. l; Depth of scum layer a Dimensions of cesspool IF 41 Materials of construction Idication of groundwater inflow ElYes ElNo 5 t5ins•3/13 4 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 i . �i I , husetts Commonwealth of Massac u Title 5 OfficialInspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 315 Main Street Guest Hou66,:'Gym, Boat& Pump House. System 2 of 2 Property Address Frank Minard Owner Owner's Name information is Osterville MA 02655 2/14/2014 required for every s ' 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.): !; I iI 1; Privy(locate on site plan):i e� Materials of construction: Dimensions ' Depth of solids ` Comments (note condition bf;�soil, signs of hydraulic failure, level of ponding, condition of vegetation, 1 , etc.): . N/a i . I, 1,y Gf 4 . a t5ins 3/13 n Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 : £i Commonwealth of Massachusetts Title 5 Officil;: Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments �M 315 Main Street Guest Hou§e !Gym, Boat& Pump House System 2 of 2 Property Address Frank Minard Owner M Owners Name information is required for eve ryOsterville MA 02655 2/14/2014 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(jelow 0 drawing attached separately S ; ti P 6ArA9t A ' F From AST' 6yM 804( + f f i I (43y7 r. 7i f. j ; y i 3 /a33 y y(0 ca t5ins-3113 a Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 f. li Commonwealth of Massachusetts Title 5 Offici fInspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •''r 315 Main Street Guest House'G m, Boat& Pump House. System 2 of 2 Property Address Frank Minard Owner Owner's Name information is required for every Osterville , MA 02655 2/14/2014 page. Clty/Tcvvn State Zip Code Date of Inspection D. System Information �cont.) Site Exam: it ❑ Check Slope i ❑ Surface water ❑ Check cellar I I r ❑ Shallow wells r Estimated depth to high grQU'111 d water: ' 30' feet Please indicate all method'used to determine the high ground water elevation: ❑ Obtained from system design plans on record a, If checked, date,of{design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) t Y ® Checked with local Board of Health -explain: ii Using topo and water contours maps ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: see above. Before filing this Inspectiuh Report, please see Report Completeness Checklist on next page. t5ins•3/13 f' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 i R:. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal I ystem Form -Not for Voluntary Assessments i ,M a •''t 315 Main Street Guest House°G m, Boat& Pump House System 2 of 2 Property Address Frank Minard Owner Owner's Name w� information is required for every Osteryiille ' MA 02655 2/14/2014 page. City/Town ! State Zip Code Date of Inspection E. Report Completeness Checklist Y' ® Inspection Summary: A,,B'C, D, or E checked Yi t ® 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 1. k, l t1 1 .t I '• 11 . 1; it i i . 1 a r (Sins•3/13 ( Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 . i l �.. .S! r Town of Barnstable Departutent of Regulatory Services ,Date l BAI1H81ABrt Pudic Health Division , . MAWL t63q. �e� 200 Main Street,'Hyannis MA 02601 T Date Scheduled y/ �o� :Time %3a Fee Pd. AIto4 e 00 Sail Suitability Assessinent for Sewage Disposal �u%l,"y�Y► h "rr,2�r� Z�'1.0 l wiuu9sedBY: t Performed By: i .. LOCATION Si Gl';NERAL INFORMATION : Location Address _ Owner's Namc fdn)ttnl y Q ale :3/5/'Y'Icia� Sfre�1- �. 3/S Cue/%s/e�- Sf _' . .r,• � i - ' Address or r jt,T e1,0O3ae1� � t> Assessor's Map/Parcel: �� ugiucc /� C- N NEW CONSTRUCTION REPAIR Telephone N J D�'y c11 33 y . _ pp 1_ \\ W7 Land Use I\6YAtth'tiy� Slopes(%) ��Z®% Surface Stones a Distances from:' Open Water Body (000� - R Possible Wet Area Z� it Drinking Water Weil.500 1t Drailnaga Way 520 R Property Line' IO R.. Other R SI EWHO-(Street name,dimensions of lot,exact locations of test holes&pert tests;locale wetlands in proximity to holes) �-- L dca S . a Parent material(geologic) Depth to Bedrock S Q0 -4 Depth to Groundwater: Standing Water in Hole: /V d IJ� Weeping from Pit face Esthnated Seasonal High Groundwater Ct: Z.S— (TN-1 t-Z-Z7:� — MTh DETERMINATION FOR SEASONAL IIIGhI WATER TABLE Q Method Used: >� — Depth Observed standing,in obs.hole: in. Depth to soil mottles ft. Depth to weeping front side of obs.hole: in. Groundwater Adjushncnt R• Index Well p Reading Date: Index Well level Adj.factor Adj.Groundwater Lev cl_ PERCOLATION TEST Date 4 ` o. rime t�30 Observation. 2 Hole k Tung al 9' Depth of Pere (1O y$ ' Time at 6" - Start Pre-soak Time© Time(9"-G") i� .. End Pre-soak 9.5min Rate Min./Inch Site Suitability Assessiiircnt: Site Passed Site Palled: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back-----------. ***If percolation testis to be conducted Within 100' of Ivetland,you must first notify the BarnstableConservation Division at lcast.one(1)week prior to beginning. Q:I IEALTti/W P/PERCR)P1M l UcyUl Gum L''.S LP il rOBSER izoll sATION HOLextuie E it LOG soil hole It 1 r Surlltce(In.) (USDA) (Munsoll) Mottling (Sttucturo,Sloncs,lluuldc►s. ['.nnvlstanaV.°/ndYaVCI)__..� 3y° 36 >- 3 ej Set, zs DEEP OBSERVATION HOLI•;LOG Hole It 2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Mottling (Structure,Stones,Boulders. Surface(in.) (USDA) (Mansell) Consislency,%Gravcl) P t_u ^Y Sa.�IZo (_ Z DEEP OBSERVATION HOLE LOG. Hole#.3— Dcpth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistcncv %G►:wci) _ LoAm L0P*--f DEEP OBSERVATION MOLL LOG hole# r Depth from Soil Ilorizon Soil Texture Soil Color Soil lhc Surface(in.) (USDA) (Munseil) Mottling (Structure,Stones,Boulders. Consistency %Gravcl) — U D — 1� t_o►VY L y-3^IZo„ L ,IYled, S� Z S Tlood Instirance Rate Map: \' Above 500 year flood boundary No_ Yes ✓ /k Qor�k 6 1 � 5`VC- Within 500 year boundary No Yes— Within100 year flood boundary Not Yes Death of Naturally Occurring Pervious Material Does at least four feet of-naturally occurring pervious material exist uY all areas observed throughout the are proposed for the soil absorption system? \ arnot,what is We depth of naturally occurring pervious material? Certification ,I, v I certify that on -�'fQ-F- (date)I have passed the soil evaluator examination approval by the. Department of Envirotunental Protection and that the above analysis Was performed by me consistent Willi the required training,expo iso and experience described in 310 CMR 1.5.017. Date C NO Signature 0 7 Q:lI CALTI-uwrmGRCrORM �of,trErr�,," Town of Barnstable r# Department of Regulatory Services • Public Health Division. Date BAAp61A8U[ // b O t � _ . NAM !� 200 Main Street,Hyannis MA 02601 Date Scheduled / Time f Fee P . 'AQ�1 O D Soil Suitability Assessment for Sewage Disposal Performed By:. ale i 1/Cp Y) �'�I l^ � .' Witnessed BY: LOCATION& GENE,RAL INFORMATION Location Address : Owner's Namel-C/j))itnl y 6 a4oiu. l Kell .3/5h'�ai�q / /^e��' •, 3i5 Gc�ej�es/e y- sf (.J,0 < p Address. PS Qo2j`�93 � /77/4 frrel oo3aetngineer'sName.`[lh �J'e'ssessor s Ma /Parcel• ,Q A P V j/%YQ , 33 y 4. NEW CONSTRUCTION REPAIR Telephone N J D,"y-a f- Land Use Slopes(%) Surface Stones Distances from: Open Water Body It Possible Wet Area ft, Drinking Water Well ft Drairage Way ft . Property Line • R Other tt $,KETCH.(Street name,dimensions of lot,exact locatioris.of test holes&.pert tests,locate wetlands in proximity to holes) Locus 8 j �u.rt o� �h`crrCe l Parent material(geologic) — Depth to Bedrock-- Depth to Groundwater. Standing Water in Hole: Weeping from Pit race Estimated Seasonal High Groundwater I DETERMINATION FOR SEASONAL IIIGH WATER TABLE , Method Used: in. t rp Depth Observed standing in obs.hole in. Depth to soil mottles: f Depth to woephrg from side of obs hole: in. Groundwater Adjustment E �= n• � ? Index Well g Reading Date: Index Well level Adj.factor Adj.Groundwater Levch i_ Q PE TEST Date Time ' E Observation Time at 9" T v Hole N Depth of Pero Time at 6" Start Pre-soak Time© Time(9"-G') End Pre-soak Rate Min./Inch Site Suitability Assessent: Site Passed Site Failed: Additional Testing Needed(YM) m Original: Public Healttr Division Observation Hole Data To Be Completed on Back-----__�_ ***If percolation test is to be conducted witlliu loo, of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:I IEALTtI1W P/PERCFORM DEEP OBSERVATION HOLE LOG hale It Depth fi um Soil horizon Soil Texture Soil Color Soil Other 9urthco(in.) (USDA) (Munsoll) Mollling (Structure,Stuncs,Bouldcas. e y DE1 P OBSERVAT ON BOLL LOG hole 0 Depth from Soil Horizon •Soil Texture Soil Color Soil Other Surface(in.). (USDA) (Munsoll) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Dcpth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsoll) Mottling (Structure,Stones,Boulders. Consistency.%Gi:avcl) DEEP'OBSERVATION HOLE LOG hole It Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsoll) Mottling (Structure,Stones,Buuldcrs. Consistency %Gravel) IF, Insurance Rate Man: Above 500 year flood boundary No_ Yes Within 500 year boundary No— Ycs Within 100 year flood boundary No Yes Deuth of Naturally occurring Pervious Material. Does at least four feet or-naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Jf not,what is the depth of naturally occurring pervious material? Certification 1 certify that on (date)I have passed the soil evaluator examination approved by the Department of Envirotunental Protection and that the above analysis Avas performed by me consistent with the required training,expertise and experience described in 310 CMR 1.5.017. Signature Date ' Q:I ICA.LTI-IMPMERUORM .-MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) : INSTALLATION DATE: lcm '�_By .. . /,joill.441's INSTALLER ADDRESS: -'CERT .NO. (:A*TANK LOCATION: �BOVE BELOW GE EMICAL TESTING CERTIFICATION I PASS C 'I FAYL-,� DATE ' LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND ' ZONE OF CONTRIBUTION [ ] YES NO DATE TO B --'EMOVE FIRE DEPT. PERMIT ISSUED ' ] YES [ ] NO DATE CONSERVATION [ ~^ CHECK IF N/A DATE BOARD OF HE DATE � PLEAS1 ��P7-y �" r�L� Tj$�.i� �� � � �G r Gp� r r � •. r�us� �� r r TOWN OF BARNSTABI E G, —� L':OG:�t-71i?Rl .315, SEWAGE # �� ✓� VIULIAGEw, 06 to V Z/ -f ` �. ASSESSOR``S MAP& LOT s INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY �' • %� - ` LEACHING FACILITY: (type) l (size) NO.OF BEDROOMS • t ? -BUII.DER O O O�Gl✓ ` ,""PE ITDATE. %,j-�7 COMPLIANCE DATE: l _ Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If,any wells exist on site or within 200 feet of leaching facility) Feet` Edge of Wetland and Leaching Facility(If any wetlands exist = within 300 feet of leaching facility).;' r `, Feet Furnished by 1r 3c �.. A 3 - Icl gq- �a - 3 No. 7_7 Fee 4] t,. 3'3 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Mi$pogal *psAem Con.5truction Permit Application for a Permit to Construct(,/)Repair.( )Upgrade( )Abandon( ) ler omplete System ❑Individual Components Location Address or Lot No. �'�j�f��yST �O/�T Cayo wner's Name,Address and Tel.No. Assessor's Map/Parcel ®S ��/ � F �� ����� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 71 - Type of Building: Dwelling No.of Bedrooms ✓� Lot Size sq. ft. Garbage Grinder(e-6p Other Type of Building A o. of Persons Showers( ) Cafeteria( ) Other Fixtures Z eq°w,w 77z 6A41 Design Flow Y/1 gallons per day. Calculated daily flow �,3® gallons. Plan Date { Number of sheets / Revision Date —T Title Size of Septic Tank /,09® Type of S.A.S. 4V6,X 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 Certifi- cate of Compliance has been issued b this B o �� ��� Signed Date Application Approved by Date -7 Application Disapproved for ty follo g reasons Permit No. 2 7 • �' Date Issued y -eV 3 i� Fee Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC/HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIPPYtcatton fo/r 30t�poga1 *pgtem� �Congtructton Vermtt Application for a Permit to Construct(V)Repair( )Upgrade( )Abandon( ) TComplete System ❑Individual Components �r Location Address or Lot No. Owner's Name,Address and Tel No. Assessor's Map/Pa_cel Installer's Name, ddress,and Tel.No., Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder('�© Other Type of Building of Persons Showers( ) Cafeteria( ) Z 62 /LI N Other Fixtures Tf "'Design Flow ��� gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. MOZ y XZ Description of Soil (Nature of Repaiis or Alterations(Answer when applicable) tr' _I Date last inspecte3: 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 Certifi- cate of Compliance has been issued o Alth: ra Signed Date Application Approved by t�c�•M-cam Date 16 ,( — 2 -7 Application Disapproved forte following reasons y f. Permit No. 7 ' SJ�CS Date Issued THE COMMONWEALTH OF MASSACHUSETTS a BARNSTABLE, MASSACHUSETTS Certiftcate of Compliance TI4IS IS TO CERTIFY,that the On-site-Sewage Disposal System Constructed( k1f Repaired( )Upgraded( ) Abandoned( )by 4del-ta at �x has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. '!.� dated Installer Designer The issuance of this permit shall not be co rued as a guarantee that the system will unction as designed. Date L4 Inspector —-------------------------------------- No. ! 7 ~y Fee 100 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Ot5po5al 6/pgtem Congtrurtton Vermtt Permission is hereby ranted to Construct(y)Repair( )Upgrade( /)Abandon( ) { System located at granted to S� ©5'�C_111_ille 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 this permit. Date: Approved by TOWN OF BARNSTABLE LOCATION 31.5�P .5T SEWAGE # VILLAGE ©✓`' 7��/'(�i��C� '` ASSESSOR'S MAP & LOT V e1V-3 INSTALLER'S NAME&PHONE N0. ` ✓'�/��' � /25�`" 7 7/ � � SEPTIC TANK CAPACITY LEACHING FACILITY: (type) :� f (size) ��,� D X NO.OF BEDROOMS BUILDER OROO�gP k'PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: I Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i le q _fiv l v ,1 Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection Southeast Regional Office William F.Weld - Governor Trudy Coxe Secretary,EOEA .David B. Struhs Commissioner ® , ENT LEGAL MATTER: PROMPT ACTION NECESSARY CERTIFIED MAIL- RETURN RECEIPT REQUESTED May 13, 1996 Frank Minard RE : BARNSTABLE,7BWSC 519 Rockaway Valle Y Road Boontown Township, New Jersey 07005 �R'FN 4 12097 . NOTICE OF RESPONSIBILITY M.G.L. c. 21E, 310 CMR 40 . 0000 On April 19, 1996, at 10 : 00 a.m.... the Department of Environmental Protection (the "Department") received oral notification of a release and/or threat of release of oil and/or hazardous material at the above referenced property which requires one or more response actions . During installation of a swimming pool, an Underground Storage Tank (UST) containing gasoline was discovered. w, The Massachusetts Oil and Hazardous Material Release ro• Prevention and Response Act, M.G.L. c. 21E; and the .Massachusetts:. ` Contingency Plan (the "MCP") , 310 CMR 40 . 0000, require the. .. r, performance of response actions to prevent harm to health., safety, Public welfare and the environment which may result from this release and/or threat of release and govern the conduct of such actions . The purpose of this notice is to inform you of your legal responsibilities under State law for assessing and/or remediating the release at this property. For purposes of this Notice of Responsibility, the terms and phrases used herein shall have the meaning ascribed to such terms and phrases by the MCP unless the context clearly indicates otherwise The Department has reason to believe that the release. and/or` threat -of release which has been reported is or may be a disposal site as defined by the M.C:P. The Department also has reason to I believe that you (as used in this le tter, "you and your refers , to Frank Minard) are a Potentially Responsible Party (a "PRP") with liability under M.G.L. c .21E §5, for response action costs . This liability is "strict" , meaning that it is not based on fault, but 20 Riverside Drive • Lakeville,Massachusetts 02347 • FAX(508)947-6557 • Telephone (508) 946-2700 v -2- solely on your status as owner, operator, generator, transporter, disposer or other person specified in M.G.L. c. 21E §5 . This liability is also "joint and several" , meaning that you may be liable fo= all response action costs incurred at a disposal site regardless of the existence of any other liable parties . The Department encourages parties with liabilities under M.G.L. c . 21E to take prompt and appropriate actions in response to . releases and threats of release of oil and/or hazardous materials . By taking prompt action, you may significantly lower your assessment and cleanup costs and/or avoid liability for costs incurred by the Department in taking such actions . You may also avoid the imposition of, the amount 'of or reduce certain permit and/or annual compliance assurance fees payable under 310 CMR 4 . 00 . Please refer to M.G.L. c.21E for a complete description of potential liability. For your convenience, a summary of liability under M.G.L. c.21E is attached to this notice. You should be aware that you may have claims against third parties for damages, including claims for contribution or reimbursement for the costs of cleanup. Such claims do not exist indefinitely but are governed by laws which establish the time allowed for bringing litigation. The Department encourages you to take any action necessary to protect any such claims you may have against third parties . At the time of verbal notification to the Department, the following response actions were approved as an Immediate Response Action (IRA) • Removal .of 50 cubic yards of Contaminated Soils. ACTIONS REQUIRED Additional submittals are , necessary with regard to this notification including, but not limited to, the filing of a written IRA Plan, IRA Completion Statement and/or an RAO statement . The MCP requires that a fee of .$750 .00 be submitted to the Department when an RAO statement is filed greater than 120 days from the date of initial notification. Specific approval is required from the Department for the implementation of all IRAs and Release Abatement Measures (:RAMS) . Assessment activities, the construction of a fence and/or the posting of signs are" actions that are exempt from this approval requirement In addition to oral notification, 310 CMR 40 . 0333 requires that a completed Release Notification Form (BWSC-103 , attached) be submitted to the Department within sixty (60) calendar days of April 19, 1996 . -3- You must employ or engage a Licensed Site Professional (LSP) to manage, supervise or actually perform the necessary response actions at this site. You may obtain a list of the names and addresses of these licensed professionals from the Board of Registration of Hazardous Waste Site Cleanup Professionals at (617) 556-1145 . Unless otherwise provided by the Department, potentially responsible parties ("PRP' s" ) have one year from the initial date. of notification to the Department of a release or threat of a release, pursuant to 310 CMR 40 . 0300, or from the date the Department issues a Notice of. Responsibility, whichever occurs earlier, to file with the Department one of the following submittals : (1) . a completed Tier Classification Submittal; (2) a Response Action Outcome Statement or, if applicable, (3) a Downgradient Property Status . The deadline for either of the first two submittals for this disposal site is April 19, 1997 . If required by the MCP, a completed Tier I Permit Application must also accompany a Tier Classification Submittal . This site shall not be deemed to have had all the necessary and required response actions taken unless and until all substantial hazards presented by the release and/or threat of release have been eliminated and a level of No Significant Risk exists or has been achieved in compliance with M.G.L. c .21E and, the MCP. If you have any questions relative to this notice, please . contact Michael Moran at the letterhead address or at (508) 946 2855 . All future communications regarding this release must reference the following Release Tracking Number: 4-12097 . Very truly yours, Q �- Richard F. Packard, Chief Emergency Response / Release Notification Section P/MM/j t CERTIFIED MAIL #P606 845 341 RETURN RECEIPT REQUESTED Attachments : Release Notification Form; BWSC-103 and Instructions Summary of Liability under M.G.L. c. 21E CC : Town of Barnstable ' . Town Hall 367 Main Street M Hyannis, MA 02601 ATTN: Warren J. Rutherford, Town Manager -4- cc Board of Health Town Hall 367 Main Street Hyannis, MA 02601 ATTN: Brian R. Grady, R.S. , Chairman Fire Department 1875 Route 28 Osterville, MA 02655 ATTN: Chief John M. Farrington DEP - SERO ATTN: Andrea Papadopoulos, Deputy Regional Director rF �y TOWN OF BARNSTABLE LOt ATION /S- ,cam SEWAGE # �^ 1 b VILLAGE allerailk - ASSESSOR'S MAP&LOT I 603 3 HiSTALLEk"S NAME&PHONE NO. SEPTIC TANK CAPACITY .cam�0 e> LEACHING FACILITY: (type) JGfyt�iA4$ (size) �O X 67 X I NO.OF BEDROOMS— PT / 00R OWNER. PERMIT DATE:_ ,^-� �� -q��COMPLIANCE DATE: Separation Distance Between the: a Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 3 Feet Private Water Supply Well and Leaching Facility (If any wells exist fi//#on site or within 200 feet of leaching facility) Feet Ed gc cf Wetland and Leaching Facility(If any wetlands exist 1 within 300 feet of leaching facility) / Feet Furnished by f 1.A49 ➢ /C;L 4i4 ® _ I S ( 9 TOWN OF"BARNSTABLE LOCATION 3)5- /&110 Sd� SEWAGE# VILLAGE- ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE SEPTIC TANK CAPACITY v2r' C'O �cC LEACHIIVG FACILITY: �n`�13 !G' a (type) (sine) n C 7 x 1 NO.OF BEDROOMS D UII.D Ga �,Q �cn'L-!Lt_,S / dYt F.+�ir-lam PERMTTDATE: 7�i COMPLIANCE DATE: /0/d�)5,z-- Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility J Feet Private Water Supply Well and Leaching Facility (If any wells exist /J� on site or within 200 feet of leaching facility) � l Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching fa ili ) C Feet Furnished by t_x, J ��9 r io 7 S3 ' As-ACV 3 y A G'Y?'. rldll y� Trce i THE FOLLOWING IS/ARE THE BEST IMAGES.. FROMPOOR QUALITY ORIGINALS) I m DATA TOWN OFBARNSTABLE �i l L 3Js� 1&1 LOCATION c1 SEWAGE # VILLAGE C.�5f"g//Xe ASSESSOR'S MAP & LOT INSTALLER'S NAME &PHONE SEPTIC TANK CAPACITY o2 S'C0 64,( LEACHING FACILITY: (type) (size) 7 ' X 1 NO. OF BEDROOMS 0I PERMITDATE: 7�/`�Cg� COMPLIANCE DATE: �� 5-z— Separation Distance Between the: Maximum Adjusted Groundwater Table-and Bottom of Leaching Facility J 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 C Feet within 300 feet of leaching fa Furnished by wi -,d; JS ! Q�-s3 - - - - - - - - - - rrce ' rKE COMMCINWEALTH OF MASSACHUSEiTS BOARD OF HEALTH f(a19 TOWN OF BARNSTABLE ininl Works, nr 'tiun rrnti Permission is hereby granted_-_-_-__ - an Inciivi Sew Di Systern i to Con, )yQ� Rya' ( CC_-- .�Va� - •------ ------ _ as shownas the application for Disposal Works[gtiuctton Penirit o.. .__. r m 4_._..--•---..-..— tf5 Pon 36'JOSwm"SOMaRM"LWC- 5�EW5 i HE COMMONwEALTki OF MASSAC24USETTS BOARD OF HEALTH � TOWN OF'BARNSTABLE - f,Qrtif cute of (fumplinurr (n . 7'HJ.S $ 'TO CE TiFY,Th the f 'viduai Sew Ke pisa1 Syscern anstrucred 1 i or Repaired M l' m d s l7C T I..- -A '- m fl'7g (u by has;beErs installed in accordance u ifs the provisions u#Ti'I�l E of f he t xe Environdated Gee as d cri in - the application for Diss Construction Pe rrnir No.ix�sai Work � r. - ME ISSUANCE OF THIS CERTIFICATE SHAM NOT BE CONSTRUED AS A GUARA HAT THE � H SYSTIEM Will FuNCT[ON SATISFATC 4�� o { T 1 lnspecrur . - - .. -f u DATE . I .. O LL Lo Cll lD 9 ; �f U-+` i J I MM DD YYYY ❑Delete RS _ A 10192.0 ( U OB 20 2007 11 1 07-0002459 000 change Basic sic 1 FDID -* State* Incident Date * Station Incident Number * Exposure No Activity ❑Chec1: this box to Indicate that the address for this incident is provided on the Wildland Fire Census Tract I Module In Section B "Alternative Location Specification". Use only fox Wildland fires. B Location* ®Street address 307 .�J MAIN ST U U; Intersection Number/Milepost Prefix Street or Highway Street Type Suffix ❑ front Re . I J IOSTERVILLE u 100000 -u Rear Of - . - Apt./Suite/Room City state zip Code Adjacent to El Directions Cross street or directions, as ao licable Midnight is 0000 C Incident Type .* 4i E1 Date &-Times E2 Shift & Alarms 4,11 (Gasoline or other flammable I Check boxes.if Month Day Year Iir.Min•Sec Local option dates are the Incident Type same as Alarm * - ,' - ,always ALARM: I_1 Aid Given or Received* Date Alarm Shif OB 20 2007 �16 19:00.� t or., Alarms District Platoon -ARRIVAL required, unless canceled or did not arrive 1 ❑Mutual aid received °' UU � Arrival-.*. ��y '- •08 20 I 200�116:20 i 09 I .E3 2 ❑Automatic aid recv. Their FDID Their _ State - CONTROLLED Optional, Except for wildland fires Special Studies 3 ❑Mutual aid given I �. I 4 ❑Automatic aid given I I " Controlled " u I I Local option 5 ❑Other Hid given. , Their LAST UNIT CLEARED, required except for wildland fires I I Incident Number Last Unit �I � Special Special l N ONone El cleared L 0J i 20� 1 20071 16� 57•19 Study ID.11 Study Value f .Actions Taken ak Gl - Resources* G.2 Estimated :Dollar .Losses .& Values ❑ Check this box and skip this .LOSSES: Required for all fires if known. Optional section if an Apparatus or for non fires. 43 (Hazardous materials I Personnel form i5 used. None Apparatus Personnel Property 1 , 000 , 0001 ❑ Primary Action Taken (1) i J Suppression I Contents .$u , 000 , 000 El Additional I Action Taken (2) I EMS PRE-INCIDENT VALUE: optional � Other 0001 0001Property :$1 , 000 000 Additional Action Taken (3) ❑ Check box if resource counts include aid received resources. Contents '$1 , 000 , 000 Completed Modules -Hl*CasualtiesONone H3 Hazardous Materials Release I Mixed Use Property ❑Fire-.2 Deaths Injuries N ❑None NN Not Mixed Fire 10 Assembly use Structure=3 U U .1 []Natural Gas: slow leak, no evauation or aazMat action, 20 ' Education use Service Civil Fire Cas.-4 2 []Propane gas: <21 lb. tank (as in borne BBQ grill) 33 Medical use ❑Fire Serv. Cas.-5 3 [:)Gasoline: vehicle fuel tank or portable container 40 Residential use Civilian 51 Row of .stores EMS-6 4 me Kerosene: fuel burning equipnt or portable storage H2Detector .53 Enclosed.mall ❑HazMat-7 Required for Confined Fires. 5 ❑Diesel -fuel/fuel Oil:vehicle fuel tank or portable 58 Bus. & Residential ❑Wildland Fire-8 6 []Household solvents: home/office spill, cleanup only '59 Office use 1 'Detector alerted occupants - QApparatus-9 ❑ 7 Motor oil: from engine or portable container 60 Industrial use ary OPersonnel-.10 Z[:]Detector did not alert them 8 Paint: from paint oan, totaling< s5 gallons 6-5 arm63 tuse use Arson-11 jJOUnknown 0 ❑Other: special H-Mat action, required or spill>55ga1., 00 Other .mixed use Please cossslete the HazMat form J Property Use* Structures 341❑Clinic,clinic type infirmary 539 ❑Household goods;sales,repairs .342 Doctor/dentist office -579 ❑Motor vehicle/boat sales/repair 131 Church, place of worship 361❑Prison or jail, not juvenile '571 []Gas or service station 161 ❑Restaurant or cafeteria 419®1-or .2-family dwelling 599 ❑ Business office 162 ❑Bar/Tavern or nightclub 429❑Multi-family dwelling 615 ❑.Electric generating plant 213 Elementary school or kindergarten 439❑Rooming/boarding house 629 ❑Laboratory/science lab 215 ❑High school or junior high 449❑Commercial hotel or motel 700 ❑Manufacturing plant 24.1 ❑College, adult education 459❑Residential, .board and care 8.19 ❑Livestock/poultry storage(barn) 311 ❑Care facility for the aged 464 QDormitory/barracks 882 Non-residential parking garage 331 ❑Hospital 519❑Food and beverage sales B91 ❑Warehouse Outside 936 ❑Vacant .lot 981 ❑Construction site 124 ❑Playground or park 938 ❑Graded/care for plot of_land 984 [:] Industrial plant yard• 655 ❑crops or orchard 946 ❑Lake, river, stream Lookup and enter a Property Use code only if 669 ❑Forest (timberland) 951 ❑Railroad right Of way you have NOT checked a Property Use box: 807 ❑outdoor storage area 960 ❑Other street Property Use 1419 glg ❑Dump or sanitary landfill 961 ❑Highway/divided highway 931 ❑open land or field 962 ❑Residential street/driveway Ll or .2 family dwelling NFIRS-1 Revision 03 11 99 ' e '.t t (Y)MM Fi rdr)i str;ct 01920 08/20/2007 07-0002959 MM DD YYYY 1 01920 U 1 8 1 1 201 1 2007 1. 1 J 1 07-0002459 1 000 complete FDID * State.* Incident Date * Station Incident Number * Exposure Narrative Narrative: Caller Name INSPECTOR MACNEELY Caller Phone 329 Caller Address : 329 ON LOCATION' OIC : INSPECTROR MACNEELY jgifford 2007/08/20 16:20:09-- 329 AT EVENT MANNING hS 1' jgifford 2.007/.08/2.3 1.6:.,37.:00 329 OFF WITH AN _INSP. CTIONOF A .UNDERGROUND ;DANK REMOVAL AND.. REPORTS TANK. LEAKING . Received call from Enviro-Safe Corporation reporting that they: are enroute -to 307 Main Street Osterville to remove gasol_ne from an underground tank removed during excavation of a site for a new residential structure. 329 on location with Enviro-Safe vac truck and contractor Edward Crowell Inc. from South Dennis, MA. tank was already removed from .the. ground and remaining .product was being. pumped from the tank. Contractor states they "bumped" into tank during excavation of site for new single family home. Site was previously occupied by caretaker barn for the "Old Hall Estate" 315 Main Street Oste.rville. Contractor removed tank which was damaged during removal and leaked some product onto the ground ,unknown quantity. Envro-Safe completed product removal from tank, total quantity removed from tank was 177 gallons. Besides damage from removal of tank no other obvious leaks visible on tank. There is some evidence of overfilling on top of tank over time. No immediate hazard :from tank at 'this time, decision made to cover tank and surrounding area with plastic for the night. Completion of removal and evaluation of site by LSP from Bennentt & O'Reilly to be completed tomorrow. 8/21/07 328 FPO Pulsifer on location to continue investigation. LSP (David Bennett) on location, contractor reviewed location and operations to this point. Tank dry iced by Enviro Safe for transport. TjSP states ground contamination found at west end of tank and requests 72 hour DEP notification. In addition, Barnstable. Board. of Health Inspector 'David Stanton notified in person by FPO MacNeely on 8/21/07. at 0830hrs. .Inspector Stanton to visit sitte later in day. Additional phone call received from LSP David Bennett stating additional contamination found on site and another .15 yards of contaminated soil excavated from site. Tracking #RTN4-20719 and case officer Andy Jones 08/23/2007 15:50:34 mmacneely (70MM F;rP n;Gtrscr 0}920 08/20/2007 07-0002459 K3. Person/Entity Involved Lccal Option - Business name (if applicable) Area Code Phone Number IuI � u QCheck. This Boy.. if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. .Then kip the three U duplicsate address Number Prefix .Street or Highway Street Type Suffix lines. II II - Post Office Box II I I Apt./Suite/Room City - - , State Z-p'Code''. ". More people involved? Check this box and attach Supplemental Forms (NFIRS-IS)...as...necessary Same as person involved? R2 Owner Then check this .box and,skip The rest of this section. ... Local Option Business name (if Applicable) II Area Code Phone Number. ❑ Check this box if Mr.;Ms., Mrs. First Name MI Last.Name - Suffix same address as incident location. Then skip the three l� duplicate address Number Prefix Street or HighwayI . Street Type Suffix lines. I I u Post.-Office Box. Apt./Suite/Room City _ Statet Zip Code - I, Remarks Local Option Caller Name INSPEC^_OR MACNEELY Caller Phone 329 Caller Address : 329 ON LOCATION OIC : INSPECTROR MACNEELY jgifford 2007/08/20 16:20:09 - 329 AT EVENT MANNING IS 1 jgifford 2007/08/20 16: 37 :00 329 OFF WITH AN INSPECTION OF A UNDERGROUND TANK REMOVAL AND REPORTS TANK LEAKING Received call from Enviro-Safe Corporation reporting that they are enroute to 307 Main Street Osterville to remove gasoline from an underground tank removed during excavation of a site for a new residential structure. 329 on location with Envirc-Safe vac truck and "contractor Edward Crowell Inc. from South Dennis, MA. tank was already removed from the ground and remaining product was being pumped from the tank. Contractor states they "bumped" into tank during excavation of site for new single family home. Site was previously occupied by caretaker barn for the "Old Hall Estate" 315 Main Street Osterville. Contractor removed tank which was damaged during removal and leaked some product onto the ground ,unknown quantity. Envro-Safe completed product removal from tank, total quantity removed from tank was 177 gallons. Besides damage from removal of tank no other obvious leaks visible on tank. There is some evidence of overfilling on top of tank over time. No immediate hazard from tank at this time, decision made to cover. tank and surrounding area Z Authorization I8350 IMACNEELY, MARTIN 0. ISR. INSPEC I I 1 081 IL3jj 2007 Officer in charge ID Signature Position or, ran): Assignment Month Day Year Check. X❑ 18350 I IMACNEELY, MARTIN 0. I ISR. INSPEC I I L 08� I� I 2007 Box if same Position or rank Assignment Month Day Year as Officer Member making report ID Signature in charge. COMM Fire District 01920 08/20/2007 07-0002459 - CENTERVILLE-OSTERVILLE-MARSTONS MILLS.FIRE DISTRICT 1875 ROUTE.28 CENTERVILLE, MA .02632 (508) 790-2375/FAX#(508)790-2385 OIL/HAZARDOUS MATERIAL RELEASE FORM F.A:# 0.7-0002459 LOCATION: ADDRESS OF RELEASE: 307 Main Street Osterville, MA 02655 DATE OF RELEASE: Unknown PRODUCT RELEASED: Gasoline ESTIMATED QUANTITY: Unknown CORRECTIVE ACTION TAKEN BY RESPONSIBLE PARTY: Notifications NOTIFICATIONS: FIRE DEPARTMENT: YES( XK NO( ) DATE: 8/20/07 TIME: .1620 NATIONAL RESPONSE CENTER YES( ) 'NO(x� _DATE: 'TIME: DEPT. OF ENVIRONMENTAL PROTECTION YES(x) NO( ) .DATE: 8 21 -TIME: BOH OIL SPILL COORDINATOR: YES( ) NO(xy DATE: TIME: TOWN BOARD OF-HEALTH: YES(x� NO( ) DATE: 8/21L07 TIME: 083Ohrs TOWN HARBORMASTER: ' YES( ) NO( x) DATE: TIME: OTHER-AGENCIES: COMMENTS: See attached COMM Fire Department report #07-0002459 for detailed information REPORTED.BY: FPO Martin MacNeely 'DATE: 8/24/07 COPY-FIRE DEPARTMENT COPY-D.E.P. COPY-'BOARD OF HEALTH C-O-MM FORM#58 apt N _ � � � y ,•.•}k 6r. ,�k. .. .••eta .. _ ..big+.,, f s t �• i H - s;. ram.. - �-_ 'fi' �}`{• � �a r f 1 A � 3 N y �F r MTi h E•67113 32q { a � � i .. t i � -�,ah;^J �y fir'� � _r � �. .1,.s I 1R ` t 3'������`�Y.. ,. � a„ 1 ' Y�����F� 3�. Ifs I} W% j,, � �,r � d ,; ,� �� 3��, ����rj .�a ..� '�� `���: �'� � { `x { '{ t ��z �. ��* �`-s. r�;;� �,,. S� rt:; � ��4 7 } �G� � k ) y Ra � ��: i++- �% M � �;. . � ` ' ��` � �� r� d q � `� �'� �l t a� e 777 - 'ad*a nraa�r� eti*X4 9I� - ' n .ti,�.,�y ' i , —9 '�"h nY� .•, .yam .R i��� � �"�P ` ,fit, '�.+. `4► '�'`,� ,,�i ,'� � � � '� �.'' r - ...r_. tot f �. lip IN r ! 4 J or 1� f �•� f( �a .ti� ..fie � � yY � r. �11-42.N-I ,. n. a 44 J - per 4- k v� • �` � � Via.? �� '*ems. k S r No.s"----�{-'r� Fee-----4- ----�r- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rVell Con.5tructionj3ermit A ication is heresy made for a it to Construct ( 6-r, Alter ( ), or Repair ( )an individual Well at: -------------------------------------------- -------- Location — Address Assessors Map and Parcel r1�..�\ /N j GNurcr Mfi��ry ,Sj'. OSl U'v� ll� �tG —--- — — ---— — — ------— --—— — --—------ ——— — —------_—--- — Owner Addre ------ Installer — Driller Address Type of Building . Dwelling-- ---------------------------------------------- Other - Type of Building --- No. of Persons------------------------_-_--________ ,, Type of Well- 4 r�0 �-e - ------- - Capacity-------------------- - ---- ---— Purpose of Well--- ii`�� �d=-o_'ti, It--- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation u it a Certificate of Compliance has been issued by the Board of Health. s 4 r Signed date Application Approved By �-------- _---- `A-_ date Application Disapproved for the following reasons: --------------------------______________—__—_-__-______ ----------- — --- --------------------------------------- / � date Permit No. � �L-� ------ Issued-------------r- v r �� ------------------------------ date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO C®EATF, That the Individual Well Constructed ( 11, Altered ( ), or Repaired ( ) bY— -- J' - (L-- --- ---- - -- - • / Installer ,� n.�a�w casc� l`o at Ot ----- — has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit NcJB � Dated "- - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----- - -- Inspector----------- —__---_- { t No.----- ---- ----. 10 � �Fee- N ------------- BOARD OFH@AL'T41 T O W �O F--�B-A R-N,S� }A-B,L E i zpplit,tiori �ior0fll eon truition ermit A Iication ts.hereby made for a pe�n tt"to Construct Alter ( );•or Repair ( )an individual Well at: ` ST D - �- `'` �- Location —•Address As___`_'s Map and Parcel " N1tn+U,tcl MG�litilYE 'US' Owner Addre , �- --�u--- -- -- Installer - Driller Address Type of'Building iDwelling --------------- -------------------- Other - Type of Building --- ------- ------- No. of Persons - — — --- - -- Type of Well- �� �`� G. --- ----- --- ---- - CapacrtY -- - - — Purpose of Well -/ii �L� _ -- - - G � -Agreement: The undersignec'agrees`to install the aforedescribed'individual well in accordance with the,provisions.of The .Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned futher agrees not to. place the well in operation;un it a Certificate f Co pliance has been issued by.the Board`of Health. • --- date i Application Approved By ---- - -— ? — date ... Application Disapproved.for the following reasons -- -------- - ---_— -- d ------------ C Permit.No. -- --- to ---� :Pa4�!b0 eclree4+e!!e!q!iMsibso�aaslisaSoebb:Qba.Oeto'R�.cult3eiecaes:asawrgseeeaeae6.s'Goaeae6t+a�riwo�eMaiis4a�s6ib<vuealeoF.A isatR�nsila0alceeoal4o,�e.sa�aeaeaeafes�loe:'+eie:r:.?.N k BOARD OF.HEALTH TOWN ., OF "BARNSTABLE F C ertif irlate wf Comohanre THIS IS TO g TI�YThat' Individual Well Constructed ( fe) Altered{ ) or Repaired— -- -- — -- Installer --- ---— ---------- — --- --- ---- at --- _— ------ -- - - has been installed m-accordance with the rovis>ons of the.Town.of Barnstable Board of Health Private Well Protection P Regulation as described in.the application for Well Construction Permit Nth'--P-�f'"`�Dated_,O_" =- ..THE ISSUANCE O-,THIS>CERTIFICATE SHALL NOT BE CONSTRUED AS A'.GUARANTEE THAT THE WELL SYSTEM WILL'FUNCTION SATISFACTORY.' DATE'__--- Inspector -- -- -- '1 -- --— -77 ff�t+:rt:e��:rq.�y?:�arsae�ereaw:.e+e'snaearae�e va:eee:ese+eaeswatireaw4rna�raaa+rasp*69ae:"a:s►esesQss:.aeeama�cac�a�,a•,iw,i•.,,�+ae{.,.� +.i4ae�F:!^aS.r3..seaw+w.fa�ra�a^an:+:+a+..�: BOARD OF HEALTH L TOWN OF B'ARNSTA'BLE ell Coriotructton erttttt :f;, No '-~____L Fee ` Permission is hereby granted '0 ' S64to Construct (; Alter (,. ); or Repair'( ) an-.Individua Well at: -- Street -- .— — — - as shown on the application for a Well Construction Permit No. /may ~'� G� =---. Dated --_—_------------------ ,A Board of Health DATE "'� . . .. .-^/ S yYv �9 fin'` ,�o! r �t � 1 lua w C'I I i _ _ _ _ _ ___ _. .. _ . i evv � ♦ • '� •Cf Public - Landin' s • 40�p ! . + `° ! CMG East B y S. iws• i Beach •� • 1s IF 4 j • LOCAMON MAP DESIGN DATA HYANNIS QUADRANGLE n M SINGLE FAMILY 3 BEDROOM SCALE: 1: 25,000 1 BEDROOM GARAGE ASSESSORS 2 BEDROOMS TOWER MAP 164 PARCEL 3 NO GARBAGE GRINDER F" DAILY FLOW = 3 x 110 = 330 GPD ZONES: A. P. SEPTIC TANK = 330 x 200% = 660 GPD USE 1500 GALLON RF - 1 �\ LEACHING SYSTEM DESIGN: MINIMUMS 1 AREA = 43,560 S. F. o USE 6 CULTEC RECHARGER 330 CHAMBERS/2' STONE o ' FRONTAGE = 20' o_ APPLICATION AREA REQUIRED: WIDTH 125' 330 GPD _ 0.74 GPD/SF = 446 SF FRONT SETBACK = 30' SIDE SETBACK = 15' APPucATtoN AREA DESIGN: REAR SETBACK = 15' SIDEWALL AREA = 40' x 2' x 2 = 160 SF BUILDING HEIGHT = 30' BOTTOM AREA = 40' x 8' = 320 SF (OR 2.5 STORIES IF LESS) `O TOTAL AREA = 480 SF PERCOLATION RATES 5 MIN/INCH n SOIL CLASS OG z� rs o ` TSM 0 CB/DH a EL = 28.70' 28.7 NOTES: x 2 ELEVATIONS REFER TO NGVD 3 2 TOPOGRAPHIC INFORMATION: 07-21-95 do 12-19-95 f LX`34.:,► SEPTIC SYSTEM COMPONENT TOP OF BANK i 30.1 S 3•i.4 STONE WALL I ! O / / x '.,., CEMENT BOUND/DRILL HOLE EI / 34.6 \� 9 x \.\ \ 9.6 L1. OAK TREE (DIAMETER) x 37• - \ ORS x 24.0 / x 37.81 x\`36. 6 0 MAPLE TREE (DIAMETER) } 2` x 3�14 3b - 6" MLOCK`• \ �a x 35.5 `* x 5.5 Iri n V W I x,�2 8 29�� \ x Q PAVED DRIVE x13" , HOLLY TREE �\ 1 BDftM \\ u'�A x S,2 0.4 x--39. ' 3t1�' 6: FF=39' Y' ,39.7 x ' U` C�+ZaG TRELLINE x 0.6 x' .1;] sa &LLY 2 �9 \ u• 4o I x 4 \ J'�F� 2 3�?27,./9 p6 x40.3 1 - i x .0 x 40.3 \c ,�:.z V 3 ! Oj D,B 0 ITE $ OP S ;a � TO WER 26 7 17� x 40.6 PINES P C A x 7.5 x ORT 40�AVED DRIVE 38.P _ - 40.1 -�BDR / �3;�438 DK p ! 3 Q � x: 15.2 ! �i 33 D EXISTING SINGLE FAMILY DWELLING ; 5T" �x •1 / g d \\ 5 a I Z _ � A.�a✓ i s 33. SEPTIC TANK 1NV EL 32.8' .. toy $� x 4.9 CB/OH FND. i K g4.a-•, \ FIRST FLOOR EL = 41.8 • \ 3 } BASEMENT EL - 34.4' _ / 12" GR � / � \ �• 1 I 8.3 . a \ \\ a ( x 28 "v E w " ' S�/ 0" L x `'8.7� 33"7 / 1"'` 20. 2" 35 16' EEC \ /./ 3 29. x x .7 2ytn' 37 � i3R x s ,Z a \ 5;q 12 ` - - � x 8.8 TBM O CB/DH 17 }5,a X X EL = 10.14' 6 X- x(.6 a x 4.8 \ L 0 T 7 x 42 (AREAS PER LAND COURT PETITIC"IER'S PLAN) \X 46,513 S. F. t WETLANDS a �, 542,006 S. F. f UPLANDS x 4.1 1=i 588,519 S. F. f TOTAL 1x�5.1 ��o� 4 F I E L D 1 , �, INSTALL SUBMERSIBLE 1/2 - 1 HP 6 NON GRINDER PUMP ABLE TO PASS N' 2" SOLIDS WITH TOTAL DYNAMIC HEAD OF 20 GPM (MODEL & MAKE SITE PLAN 1 , ACCORDANCE TO BE WITHTITLE 5 BY GINESECT10N x 3•' , 15.229 (a) LESS THAN 25% OF DESIGN FLOW AT �4.6 x 2.8 x 3.2 315 SOUTH COUNTY ROAD Z OSTERMLLE, MASS, 4- FOR 5 6 CAST IRON 00 FRANK MINARD TOP CONC BLOCK FND EL = 5.4' .� SOIL PIPE / G CS DH FND. 5.0 / LAST IRON SOIL PIPE INVERT EL = 2.7' PECK / NO BE DROOMS ROOMS / SCALE: i�' a ,�, DECE�9SER 29, 1995 - � 1 TOILET DAXTED t ' 812 MAIN STREET. / G009 OSTERVILLE, MASS., 02655 (508)-428-9131 4 5 4 s7 CENT V s � - , ER IEEE RIVER 150•0 \AJAE � COMPUTP ON i GRAPHIC SCALE 40 0 20 40 60 160 IN FEET ) 1 inch = 40 fi~ TEST HOLE BAXTER do NYE, INC. (SULLIVAN) 07-14-95 40.0' 0 a'Pvc P�P>E LOAM t�A - 39.2' 10" I -- -- --- -- N � SAND © T45T. CF t 38.4' 20" ��F�_ 29 FG=3& Fe,36 OF QVG 4�%4A PETER r !1° 5�`�° R �►� �O' 8 saxrER SULLIYA,�1 ��+ COARSE SAND © "�� jug p tin[ IN1 3 S4,s pLAN VI�yV - LAC�}It�', c1�4AMBEe$ 40 2 xs NO.29733 Lsd«t CHAMP F.� d t5ob S a7.f 2L bv>< CIVIL �, 32.0' 96" 2 TAW- 3 MAX I, h I � •`' �� °0 0 a u n � �Z•29.95 ` a CUL�c e r I•�• ' 33o v a �I w*5Le moo yy 'CIELOF'Q� pitOFll. -k-- - �T°►,E 2.0' f WATER - ELEVATION hb TG�i 8• i 95111 (PPP03.DWG) .1