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HomeMy WebLinkAbout0095 MILNE ROAD - Health 95 Milne Road Osterville A = 119 011 e ° 14 _ T a ° ° ^ p s a p a ^ ° ° 4 ° ° ^ 4 r c ° e i ° ° TOWN OF BARNSTABLE LOCATION SEWAGE # 2002-28� VILLAGE D S re k V IZZ le ASSESSOR'S MAP & LOT1L. _ INSTALLER'S NAME&PHONE NO. TR M .A C SEPTIC TANK CAPACITY 1•SD LEACHING FACILITY: (type). W e`LS (size) 3 s��� 4 I2 NO. OF BEDROOMS 1pr BUILDER OR OWNER -mck �Ulbvmyl PERMITDATE: COMPLIANCE DATE: Z Separation Distance_Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility .Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within-200 feet of leaching facility) . Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) ° Feet Furnished by I ..n o i P -TOWN:OF STABLE', `. . L(}CATiON / ' "` o, e SE�IAGE# TILLAGE° �5' rJ L(e ASSES,S�R`S 1� &�aT 7hi5TAi.LER' £c `'HG1dB Tv4 Sepazation Dtancc Benin d►e: MaxirnumAd tel Grreunwat�rTable fi lte Bottom of Ichcng Facifity feet Prixate Vitater Supply well and Leaclua�gtty (Qf aaywel#s exist oa eats pr widiiia Z�f6t of ieisrhiug fae�etyj t Esige of lz0 d:and I.eaclu g#"sty(Fgany wetlands exist within 3t30 feeE n teacEung fi'm Furnished by GN, cp Y B TOWN OF BA.RNSTABLE -F C LOCATION �.5� ./I/I �' � SEWAGE # VU LAGE_ .S�� i//��Q ASSESSOR'S MAP & LOT ° D INSTALLER'S NAME&PHONE NO. f ®N SEPTIC TANK CAPACITY /, Sty p LEACHING FACILITY: (type) — /Q,,e y' z11 taZ'LS (size) NO. OF BEDROOMS BUILDER OR OWNER Twva5 �U I i,VA PERMIT DATE: U COMPLIANCE DATE: Z Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within-200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by PS , 9S i 0 I ! �O �,e�r No. Fee$50.00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE,, MASSACHUSETTS 01ppYication for Miopoml bpotem Cou5truction Permit Application for a Permit to Construct( . )Repair( )Upgrade(,Abandon Y ' /Complete System ❑Individual Components Location Address or Lot No. f LN _ Owner's Name,Address and Tel.No.T o m a s S u 11 i v a n Assessor's Map/Parcel 232 Crawford Street 11q % Northboro ,Mass .01532 Installer's Name,Address,and Tel.No. 5 0®—7 7 5—3 3 3 H Designer's Name,Address and Tel.No.5 0 8—7 7 5—9 7 0 0 �JeC.�d�% v PAS,2S -771-j7d0 J.P.Macomber & Son Inc. P,(9,864 2S6 Box 66 Centerville ,Mass . 02632V 2 73 -0ZSd Type of Building: C . Dwelling No.of Bedrooms_ Lot Sizesq.ft. Garbage Grinder(Ab Other Type of Building No.of Persons Showers( ) Cafeteria(_ ) Other Fixtures G Design Flow 440 gallons per day. Calculated daily flow /.S gallons. Plan Date Number of sheets Revision Date Title 11 i v ®1t Z S Mzk or d// ,q Size of Septic Tank /x)o / Type ofjjS.A.S. 3 Z)�- W=&Z to Description of Soil N adtu� gg Repaifs or Alterations(Answer when ap plicable) O m i t t i n g sewage system. Installing 1-180 gallon septic tank 1-)Iistribution ox - ga on leaching chambers packed in 4 ' of stone . 33 'X12 'X2 ' 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 issu by this o of alth. SignedWA Date 7���021 Application Approved by w IA . Date ZLSIGa Application Disapproved the following reasons Permit No. rh —a. Date Issued X Fes$50.00 No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓�l� 4 ?,1.' Yes PUBLIC HEALTH DIVISION -'TOWN OF BARNSTABLE, MASSACHUSETTS ` « 0(pprication for 0i.5po.5al 6potem Construction Permit a!l f Abandon V ,❑/Com lete System El Individual Components Application.for a Permit to Construct( ( )Upgrade'( ) p yi .a A LocationAddress or Lot No. [ 1n1 e_N ? Owner's Name,Address and Tel.No. h O nl 8 Sullivan Assessor's Map/Parcel D T t1 iGl - 232 Crawford Street Northboro,Mass.01532 Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No-5 0 8—7 7 5—g 7 0 0 ? J,C�ad0714� , S fbg-~ 71Vdo iJ.P.Macomti�r & Son Inc . i P4-S /2 P.01 8 O'A ?...S& j Box 66 Centerville,Mass.02632 Ilu, V .9Y AalA,, IPA 6Z67310 SIR Type of Building: ,. ( 97U 0-f Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder(4 Other Type of Building 'No.of Persons Showers( ) Cafeteria( `) Other Fixtures Design Flow 44a gallons per day. Calculated daily flow 7.S gallons Plan Date & 1A Number of sheets Revision Date Title �i 76 L/n. Size of Septic Tank �I C,�q ° Type ofS.A.S.' 3 Qn/ t.cJ-//S w/i �(A.t i Description / 4 t of Soil iv y�ti�-t 2' S t� 5 Tr•-5r?, f*X- -4 2 4 76 /U&J5 �yatu Rep ' or Alterations(Answer when a plicable) Omitting sewage system. Installing 1-1reSUo ga�lon septic tahk 1-IJistribut on box Ul ga: .on ieaching chambers packed in 4 of stone. 33 X12 'X2 ' - t Date-last inspected: - r 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 by this o offkalth. Signed j Date-7/S/0 2 Application Approved by / 14v. r Date, G Application Disapproved the following reasons - Permit No. t) -M l ''`_Date Issued :? a ti THE COMMONWEALTH OF MASSACHUSETTS x BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded(/ Abandoned,(,-')by J.P.Macomber & Son Inc. at QK7C&V/4..LC has been constructed i accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.290;t- a k/ dated--? .S 1 Installer J.P.Macomber & Son Inc. Designer Ronald J. Cadillac PLS, RS f The'issuance of this p unit shall not be construed as a guarantee that the Sys will f nction as a igne14 Date Inspector - { --- ---------------- ———— —.—.-------_---- - No. '�U©a- Fee$ 50.00 THE COMMONWEALTH OF MASSACHUSETTS - - PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 0iopogal *pgtem Conotruction Permit Permission is hereby granted to Construct( )Repair( )Upgrade.(114Abando�4 System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this p\ 't. \ ✓�� Date: / Approved by �.•. �^'- o// Commonwealth of Massachusetts Title 5 Official Inspection Fdrr i Subsurface Sewage Disposal System Form =Not for Vol u ntary"Assessments U °` 95 Milne Rd 1a Property Address Michael Ewald Owner '•s rr+ Owner's Name p"1 information is required for every Osterville .✓. ' , f MA 02655 2-19-16 page. City/Town - State Zip Code Date of Inspection CO3 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, M A. General Information 1. Inspector:., Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 4, ,� E f .; �.. .;c, - . . Company Address E. Falmouth MA 02536- City/Town State Zip Code 1-508-495-0905 S13971 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, g i , ❑ Conditionally Passes;r ❑ Fails- Needs Further Evaluation,by the Local Approving Authority:. • :. - 219 nspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-3/13 TrUe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17C t D Y Commonwealth of Massachusetts Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 95 Milne Rd 5• Property Address Michael Ewald Owner-,% Owner's Name information is Osterville MA 02655 2-19-16 requiredJor every page.;•' City/Town State Zip Code Date of Inspection fu B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: . k ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the Conditional Pass section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or not determined" (Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑,Y ❑ N ❑ ND (Explain below):_ t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Forms Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 95 Milne Rd -' Property Address = - Michael Ewald Owner Owner's Name ' information is t Oservill 1916 e '}` MA 02655 2- - t required for every r page. City/Town = 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/alamis are repaired. ,Irk B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or-high static Water level in the distribution box due to broken or obstructed,pipe(s) o'r due to a broken, settled or'uneven distribution box. System will ' pass inspection if(with approval of Board of Health): ❑ broken'pipe(s) are replaced ❑ l' ❑ N ❑FND (Explain below): El � obst'rtiction is'remo 14,ve' `',1r 'r`1 t ❑ Y ❑ N ❑ ND (Explain below): - ,'� .. . , ❑ distribution box is leveled or replaced ❑ Y�"❑ N" ❑ ,ND (Explain below): t.4 ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is`Required by theBoard of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. • 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, x safety-and the environment: ❑ Cesspool or privy is within 50 feet of a surface water f ' ❑ Cesspool or privy is within 50 feet'of a bordering vegetated wetland or a salt marsh t5ins-3/13 Trtle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection, Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 95 Milne Rd Property Address Michael Ewald Owner Owner's Name information is required for every Osterville MA 02655 2-19-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: r The system has a septic tank and soil absorption system SAS and the SAS is within ❑ Y p P Y (SAS) 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. f ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate."Yes"or"No"to each of the following for all inspections: Yes No t ❑ ® Backup of sewage into facility or system component due to overloaded or k clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•3113 Titie 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official -1 n'spection Form t Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments, { 95 Milne Rd Property Address Michael Ewald Owner Owner's Name information is required for every Osterville _ MA 02655 2-19-16 •'r' page. City/Town State Zip Code Date of Inspection B. Certification (cont.) • ` ` Yes No -n ., F•*w ,e +,ti t' . ti ❑ ® Required pumping more than 4 times in the last,year NOT due to dogged or obstructed pipe(s). Number of times pumped: T ❑ ®' Any portion of the SAS,"cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or ❑' ® tributary to a-surface water supply. y� ❑ ® • • ' Any portion'of a cesspool or privy is within a Zone 1 of a public well. ❑ ' ® Any portion of a cesspool,or,privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or,privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence ' . of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis •and chain of custody must be attached to this form.], The system is a cesspooly,serving a facility with a design flow of 2000gpd- ❑ ® T 10,000gpd.. , .,t. . ; 11 The system fails. I have,determined that one or more of the above failure { ❑ ® criteria exist as described in 310 CMR 15.303,therefore the system fails.The } system owner should contact the Board of Health to determine what will be " -- necessary to correct the failure.,1' 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. ; "'"° ' rI 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 �,,; ❑; a ,❑, ,,, the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have ariswemd"yes"to any'question in Section E the system is considered a significant threat, or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Trtle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ti 95 Milne Rd Property Address Michael Ewald Owner Owner's Name information is required for every Osterville MA 02655 2-19-16 page. City/Town State Zip Code Date of Inspection C. Checklist . . . - Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No i. . 0 ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® - Have large volumes of water been introduced to the system recently or as part of this inspection? ® El available as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ` ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,•depth of sludge and depth of scum? ® '❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a'plan at the Board of Health. El Determined in the field (if any of the failure criteria related to Part C is at issue ® approximation of distance is unacceptable) [310 CMR 15.302(5)] D..System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•3f13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts ° $ • rt,1: ++� f. - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary'Assessments - M 95 Milne Rd Property Address Michael Ewald Owner Owner's Name information is required for every Osterville MA 02655 2-19-16' page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a"garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection,, information in this report.) ❑ Yes ® No Laundry system inspected? A ❑ Yes ® No Seasonal use? �,1,. .�d .c . t. •� �,�., r•r. ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)):- Detail: Sump pump? ❑ Yes ® No Last date of occupancy: r • k ,. 2-2016 Date Commercial/Industrial Flow Conditions: Type of Establishment: 'Design flow(based on'310•CMR 15.203): ^ Gallons per day(gpd) .Basis of design flow(seats/persons/sq.ft etc.):•I T Grease'trap present? � " ' •'� s�° t• '' ❑ Yes ❑ No Industrial waste holding tank present? f �,.,F- ++ fry _ ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts _ Title 5 Official'Inspection Form Subsurface Sewage Disposal System.Form -Not for Voluntary Assessments M 95 Milne Rd Property Address Michael Ewald Owner Owner's Name information is required for every Osterville MA 02655 2-19-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) ° Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: ` Source of information: Owner---pumped 1-2016 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance Type of System: ® Septic tank, distribution box, soil absorption system. ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative.technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. _ ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts - '►"` • :r ' �,. Title 5 Official Inspection Form`' x�= Subsurface Sewage Disposal System Form -Not for Voluntary Assessments `: M 95 Milne Rd Property Address Michael Ewald Owner Owner's Name information is required for every Osterville MA_ 02655 2-19-16 7 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) .r V` Approximate age of all components, date installed (if known) acid source of information: 2002 Were sewage odors detected when arriving at the site? A ❑ Yes ® No Building Sewer(locate on site plan): �•' .;Y Depth below grade: 24" feet Material of construction: -,)k,{ It T ❑ cast iron ®40 PVc. ❑`other.(explain): Distance from private water Supply well or suction line: feet. Comments (on condition of joints, venting,evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: #:" +{: 18" feet` Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) -If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a;copy of certificate)I`T) ❑ Yes ❑ No Dimensions: • .1500 gal Sludge depth: t5iris•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 95 Milne Rd Property Address Michael Ewald Owner Owner's Name information is required for every Osterville MA 02655 2-19-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 1 0. Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance,from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts _ w Title 5 Official. Inflection form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments -tu a 95 Milne Rd y Property Address Michael Ewald Owner Owner's Name information is 4 required for every Osterville: r . + MA 02655 2-19-16� 7 page. City/Town -. State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or,baffle condition, structural integrity, liquid levels as related to outlet invert,3evidence of leakage, etc.): • - �,:'•� :�T_t..$�,3 ,�'�3) �«Y `�'Xt'„''rae,.'.f '• ,.Ott•,f�:''ip� Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: f Material of construction: X ❑ concrete ❑ metal- z = ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: tr f Capacity: { gallons Design Flowi:­u ., tf" .4;, ft Y� ;.._ gallons per day Alarm present: - ❑ Yes ❑ No - Alarm level: - Alarm in working order.' ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official-Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 95 Milne Rd Property Address Michael Ewald Owner Owner's Name information is required for every Osterville MA 02655 2-19-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) tr r Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from field. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order:, ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): r *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts . Title 5 Official .Inspection Form o Subsurface Sewage Disposal System Form =Not for Vol untary'Assessmentsz,11!.* 95 Milne Rd Property Address 14, Michael Ewald a { Owner Owner's Name information is required for every Osterville '' MA 02655 2-19-16 it -.•' page. City/Town * State Zip Code Date of Inspection D. System Information (cont.) i j Type: s ❑ leaching pits number. ® leaching chambers number: 3-500's ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number;dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system �•. s Type/name of technology: Comments (note condition of soil, signs of hydraulic failure,'level of ponding;--damp soil, condition of vegetation, etc.): Leach chambers in good working order and empty at inspection with stain line at 8"off bottom of chamber. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,•''� 95 Milne Rd Property Address Michael Ewald Owner Owner's Name information is required for every Osterville ' MA 02655 2-19-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): + t5ins•31113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection.,Form Subsurface Sewage Disposal System Form :Not for Voluntary Assessments>� °M 95 Milne Rd ' Property Address " Michael Ewald 'i •_� Owner Owner's Name r information is required for every Osterville MA 02655 2-19-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) , :M F • ' '$ 4:�''' Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately ` 14 i, 't 1 , n. i ` f Y f•., _ r Ire It 0 PU 7 -T7 r III A—e- b2 30 ter- r A -6 ' r t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts 4 W Title 5 Official Inspection form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 95 Milne Rd Property Address Michael Ewald Owner Owner's Name information is required for every Osterville MA 02655 2-19-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope i ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 124 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water'elevation: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 95 Milne Rd Property Address Michael Ewald Owner Owner's Name information is required for every Osterville MA 02655 2-19-16 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i t5inse 3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 .r r i 99g r� N �e u• w. M. �'K n P C'a6r Of TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMIJCAL STORAGE REGISTRATIION MAP NO. �! PARCEL NO. f ADDRESS OF TANK: /d1 ' it VILLAGE: v </e NumbWr Ytrwmt MAILING ADDRESS ( IF D I FFFfERENT FROM ABOVE) :' OWNER NAME: cr os-�- CT1`d+/ F1 C K kPHONE-: I c"z' - ® j INSTALLATION DATE:TCf� 11f7H INSTALLER ADDRESS: { CERT.NO. *TANK LOCATION: sl tM,1 ci51,. ( wi y of Nose ia, ee f -�o c1)1m11,ey' (OKWORZOM r^N_w ILOQAT=ON WI T_H ll",GOPQOT TO mU2LO2/NO) CAPACITY 3TYPE OF TANK ��� AGE YRS'''FU�EL%CHEM I CAL Q/l TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND _ ZONE OF CONTRIBUTION [ ] YES [ ] NO DATE TO BE REMOVED ! !` FIRE DEPT. PERMIT ISSUED C ] YES' C ] NO DATE CONSERVATION C ] CHECK IF N/A DATE / a HOARD OF HEALTH TAG NO. C ]. DATE /! - � ao / * P ,EASE .PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD r cE1\ 5�, r6 re C ._ � � /� JOB NO. 802-06 NOTES Sullivan4.dwg d 1. LOCUS IS A.M. 119, PARCELS 10 & 11. 2. ELEVATIONS SHOWN ARE TOWN GIS f0.8' 9. I`nn 3. LOCUS IS IN FLOOD ZONE C ON FIRM DATED JULY 2, 1992. o, rn 4. ALL PIPES TO BE 4" SCH 40, AND PITCHED AT 1/4" PER FOOT. (UNLESS NOTED) Z 5. MUNICIPAL WATER IS AVAILABLE. LOTS WITHIN 100' ARE ON TOWN WATER. �a < 6. COMPONENTS TO BE AASHTO H-10, UNLESS NOTED. A a 7. INLET TEE TO PROJECT DOWN 13", OUTLET TEE DOWN 14". 8. IF TWO OR MORE LINES, WATER TEST D-BOX FOR EQUAL FLOW NOT TO v D-BOX EXIT PIPES TO BE LEVEL FOR FIRST TWO FEET. SCALE J 9. DEPTH OF COMPONENTS NOT TO EXCEED 3', OR VENTING MUST BE PROVIDED. BUILD UP COVERS TO WITHIN 1' OF GRADE. MORTAR CHIMNEYS IN PLACE. ONE COVER OF TANK TO BE WITHIN 6" OF GRADE. LOCATION MAP DISCONNECT 1 1/2" WASHER LINE 10. .STONE TO BE DOUBLE WASHED 3/4 TO 1 1/2" WITH 2" MIN. 1/8 TO 1/2" PEA STONE ON TOP. CONNECT WASHER TO SEWER INSIDE 11. IF UNSUITABLE SOILS, OR SOILS DIFFERING FROM THE SOIL LOG ARE FOUND, N/F CONTACT THE BOARD OF HEALTH, OR R.J. CADILLAC. 12. IF AN OVERDIG IS CALLED FOR BELOW, FILL MATERIAL FOR 5' AROUND AND UNDER LEACHING TEST HOLE 1 MCMULLIN IS TO BE CLEAN GRANULAR SAND MEETING SPECIFICATIONS OF 310 CMR 15.255(3). 1.3. PUMP AND FILL ANY EXISTING CESSPOOLS. REMOVE ANY CLOGGED SOIL, BLOCK, AND STONE IN DEPTH (inches) ELEV.(feet) 33 LEACH AREA, AND DISPOSE OF AS DIRECTED BY HEALTH AGENT. 5.0 14. ALL CONSTRUCTION TO MEET TITLE 5 AND LOCAL REGULATIONS. O A layer 10yr- 3/2 3 TEST HOLE DATE: March 21, 2002 4" sandy loam E layer 10yr 4 2 35.4 UN SCH 40 BACK TO CAST IRON PERFORMED BY: Ron Cadillac, Soil Evaluator :;:.... S 7 BENCH MARK--TOP CONC. ® N.W. END OF CAST IRON ESTIMATED 8" loam sand 33.6 �� / x 34.5 878200 E CORNER BULKHEAD=35.53 GIS.f0.8' ADJUST AS NECESSARY WITNESSED BY: / 35.3 ' " B layer 10 5 8 2ao.s4, PERC RATE: <2 -00 /inch (C layer) Y Yr / SHED ' // / _ 34.6 NF SOIL SURVEY(1993): Carver coarse sand 34" loamy sand 32.2 / / r 3a.6 GEOLOGIC MAP(1986): Mashpee pitted plain deposits Comm 34.7 / 1 4g J. 34.4 ^ kllnvert rt 32.98t FIRE / U I X 33.6 (� 1 Invert 32.57 a / / 31 t. Pipe 50" 4.9 .0 3 .4 Use Gas Baffle 3 DRY WELLS DIST. 5�� 36.3 W , : :: : :: : ::....:.... 34.7 Invert 31.80 C layer 2.5y 5/4 U W / ' e / Proposed fine sand L _ X O 34.E a19 /ft 9 min. cover - Top Conc.=32.8 (trace silt) 4 2 h t e O S=1/4"/ft Top Peastone 32.5 T / / 35,3 35.6 :33,43 V \ l Proposed S=1/8"/ft min. F .8235 C 0, . 3 .3 f 1500 Gal. 2 f4.3 35.6 � 3 .0 S9j' Z� 32.9 I Proposed - -- - ,. L 0 T E 10 x I 24 132" no water 24.0 T H 1 x 4, e 0 35.15 a.:.... :; 13 6 1 29.7 �e -----:..... ..: I Invert 31.97 Invert 31.70 BENCH MARK--TOP OF WOOD 4'� 34. 4.d' I 5.7 Bottom STAKE=35.15 TOWN GISf0.8' 34.5 34.8 1 6 Stone or compact Proposed Proposed i _. 3 ' �3.a 31 14't 4' 3o.7s(28'-8" OFF HOUSE CORNER) -30 r334 r Bottom TH1=24.0 3_P3.3331 Pot 3.4 0ck 42 /0 ILOT 3 331 34.1 plRTPARK * • 30.97 DESIGN DATA .62 TOTAL AREA=31 ,940±S.F. � N� AREA $f� 30. �z; h BEDROOMS: 4 0 :.3_' _ _ GARBAGE GRINDER: No LEACH AREA 29.4 32.5 31.8 . 31.0 REQUIRED, CAPACITY: 440 GPD 3 USE 3 DRY WELLS WITH 4' OF STONE w 78Y820`jy2 SEPTIC TANK: 1500 GAL., 2 8 ' 2.1` 3os 30.66 - ALL AROUND FORA 33'-6" LONG BY BOTTOM LEACHING AREA: 429.8 SF 232.81• = 12'-10" WIDE BY 2' DEEP LEACH AREA. 28 32.5 [(33.5' X 12.83')] 3 30 9.8 30.56� SIDE LEACHING AREA: 185.3 SF 7.5 - 28.9 307 1.1 [2(12.83'+ 33.5') X 2' DEEP)] DESIGN CAPACITY: 455 GPD [(429.8 SF + 185.3 SF) X .74 GPD/SF] NO GRADE CHANGES ARE PROPOSED 26.9 = 27,9 29.4 30.8 30.40 N/F WILLIAMS, TR. SITE PLAN FOR THIS PLAN IS A VALID COPY ONLY IF IT BEARS AN ORIGINAL RED STAMP AND SIGNATURE. TH OM AS F. SULLIVAN , JR . -\H OF M488� ��p��H of n�'1ss9c LOTS El & 3, 95 MILNE ROAD, OSTERVILLE, MA LEGEND ��� RO AL s ; ON ' �G� MAY 69 2002 SCALE: 1 "=30' JA E o A cn TH 1 TEST HOLE LOCATION, NUMBER C n " 1060 �#35779 � W WATER LINE MARKINGS E OVERHEAD ELECTRIC WIRES (IF SHOWN) Fc�sTE�� �gtioEs� �0 S'1NITAR P� S�R�F RONALD J. CADILLAC PLS RS x 9.5 X 8,7 EXISTING & PROPOSED ELEVATIONS ('X' MARKS POINT),,-6---- EXISTING CONTOUR �,�� PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN �� 8-- PROPOSED CONTOUR P.O. BOX 258 UTILITY POLE (IF SHOWN) WEST YARMOUTH, MA 02673 x - FENCE (IF SHOWN, NOT ALL SHOWN) (508) 775-9700 HEALTH AGENT APPROVAL DATE ©2002 BY R.J. CADILLAC PAGE 1 OF 1