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0148 MILNE ROAD - Health
148 MI.LNE ROAD, OSTERE'ILLE A = 119 052 y D QEQ� N' YI 'r l f D TOWN OF BARNSTABLE LOCATION 00 Gee . SEWAGE# VILLAGE O`S'?�`1.������ ASSESSOR'S MAP.&PARCEL// — r� INSTALLER'S NAME&PHONE NO. �� � "�o�`l✓ ' �'G�D�T� SEPTIC TANK CAPACITY LEACHING FACILITY:(type)T��"'b'��fo ,�-d'Tic,✓(size)/3]z ems'-]ram NO.OF BEDROOMS OWNER - Ir,--,, ?i PERMIT DATE: 1/— > —,/3 COMPLIANCE DATE: �- Separation Distance Between the: � Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �a 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 Z e-IeO /� eb \n I �Q �1 Q h � o r� TOWN OF BARNSTABLE 6 LOCATION I�>h t P-d SEWAGE # S!Ff1" 191 to t VILLAGE OCTkrvlL ASSESSOR'S MAP&LOT ` INSTALLER'S NAME&PHONE NO. Oak" SEPTIC TANK CAPACITY 't(b G A l . LEACHING FACILITY: (type) (size) X t NO.OF BEDROOMS BUILDER OR OWNER ] PERMITDATE: I alUI1 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 10 + . 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) l Feet Furnished by �` �►` ins 0'Ion CIO b'S v r 1Pe a vi T H .a J 1,2 C A-6 C-,I S, LOC&TIOt,,! : - - SEW&C-4E PERMIT UO. _ .�Te� �..(�� �.r�rt �� —�►��.— ���� i�9-tea. IPISTALLER-5. U&ME 6- ADDRESS - - --- ST - -- DATE--P-ERWT t.SSUED. __��Z!�-L7-�. 172 . ---.-. z { -- -D ATE - COMPLI &MCE ISSUED - / t i 3 7b ►� Town o Barnstable I'kk �gTl{ri r �yy Department of Regulatory Services Public Health Division >�srwer� ]Date . . MA&4 20 Main Street,Hyannis MA 02601 • �Ec�t'nt.`t� E` . r ej AM Date Scheduled— Tune fee Pd. Soil Suitability Assessment for S e'Dis u Performed By: Witnessed By LOCATION& GE,N ERAL INFORMATION locationAddress����J�/���s- Owner's Name �—J T Address 9 �l0'/'7 l/C61ra v Assessor's Map/Parcel: ,��Jq Engineer's Name�� _115W AO �ji rt NEW CONSTRUCTION REPAIR d, Telepbbne# Land Use. Slopes(96) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SIMTCLI:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands fu proximity to holes) V Parent material(geologic) Depth 1:013edrock f� LV Depth to Groundwater. Standing Water in Hole:_ Weeping front Pit Fflec Cz. ' Estimated Seasonal High Groundwater DETERARNATION FOR SEASONAL LIIGII WATER TABLE Method Used: Depth Observed standing in obs.hole: In. Depdt to soil mottles: In, Depth to weeping from side of ohs.hole: In, Groundwater Adjuatment ft. Index Well# Reading Date: Index Well level Adj.fhetor 9a : A(U.droundwater Lave] v PERCOL,A'TION TEST matt: Time Observation Hole 4i _ _ Time at 9" Depth of Pere Time at 6" Start Pre-soak Time @ Timd(9"-6") " End Pre-soak Rate Min./Inch," - Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to begir>Ining. Q:\-9EPTIC\PEIZCFORM.DOC DEEP-OBSERVATION HOLE LOG Dole# Depth from Soil Horizon Soil Texture .Soil Color Soil . Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. onsiAtency.%Gravel) DEEP OBSERVATION HOLE LOG Mole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% ravel 110, DEEP OBSERVATION HOLE LOG hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(iu.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION BOLE LOG Vole# Depth from Soil Horizon Soil Texture Soil Color Soil Other k Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, ` Cons' tencv.96 QraY4(1 Flood Insurance R to Mau: Above 500 year flood boundary No— es ✓___ Within 500 year boundary No Within I00 year float boundary No �Ies es . Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring perviou a erial exist in all areas observed throughout the area proposed for the soil absorption system? g�. If not,what is the depth of natu ally occurring pervi us matarial? �J Certification I certify that on ® !ntal (date)I have passed the soil evaluator examination approved by the Department of Enviro Protection and that the above analysis was performed by me consistent with . the required training,expertise a ex ence described in 10 CMR 15.017. Sign Date a J Q:\SEPTIC\PERCPORM.DOC No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes —l� PUBLIC HEALTH DIVISION -TOWN OF 9ARNSTABLE, MASSACHUSETTS 2pplitation for Disposal 6pstrm Cunstrurtion VPrmit Application for a Permit to Construct(� Repair( ) Upgrade( ) Abandon( ) �omplete System ❑Individual Components Location Address or Lot No, ,4�,p Owner's Name,Address,and Tel.No. Assessor's Map/Parcel �� S Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. TI rpe of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building �'C�f' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �� gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title / 2 C Size of Septic Tank �d� I r" 6!4,e Type of S.A.S. -!2 �7 r (Z 3—5M Description of Soil I►'t Lj,�. 5 U,n Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Ith. Signed 'n Date Application Approved by 11 i) v I i P Date f' 3 Application Disapproved by Date for the following reasons Permit No. 2(Z t �_ Date Issued l� �� ra tr No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 4� PUBLIC HEALTH DIVISION TOWI`0:0'. 'A'RNSTABLE, MASSACHUSETTS Yes 01pplication,for Misp 8al .pstrm 6ustrUction Permit XI Application for a Permit to Construct(;*� Repair( ) Upgrade( ) Abandon( ) complete System ❑Individual Components Location Address or Lot No,�jp /Z,4o0a Cal b Owner's Name,Address,and Tel.No. Assessor's Map/Parcel � s`ot. Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. jr er;> Type of Building: Dwelling No.of Bedrooms Lot Size „ 2 sq.ft. Garbage Grinder( ) Other Type of Building &�Fde_r No.of Persons Showers( ) Cafeteria( ) J Other Fixtures Design Flow(min.required) y O'® gpd Design flow provided gpd Plan Date f/-— "/ — j Number of sheets Revision Date „J Title Size of Septic Tank,�el& /3` G'�l Type of S.A.S. �j 3 ,�j }C 1 ` Description of Soil yl i Nature of Repairs or Alterations(Answer when applicable) j' 14 A Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the�Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of He lth` - Signed Date Application Approved by ivN M I I/Jk^zc•.e_, k)_Z�—j Date 7—/ Application Disapproved by Date for the following reasons Permit No. _�r�p"t—H ;3 Date Issued �� 7 _. TH E COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) _.Abandoned( )by Sl,OV eBy E p C X Eee o/e e at J y ���'' /� O,I'T has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer J�� ���� d� Designer ®JI y/d 4? Jy�f f JIP•✓ /0't�` #bedrooms Approved design flow �y . gpd The issuance of this permit shall of ,e co strued as a guarantee that the system wifl f mcti�on as designed. Date I Inspector V f. No. a 0 �� — L j 3 Fee lb d THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS -Misposal 6pstem Construction Permit Permission is hereby granted to Construct(4-< Repair( ) Upgrade( ) Abandon( ) System located at /J�'00 ,/W E 0 —J ® ✓'r- and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 Q V r� Approved by NOV/12/2013/TUE 10:46 AM ,.w FAX No, P. 001 Town of Barnstable NT Regulatory Services Thomas F.Geiler,Director AANO MAM Wams Public Health Division 1639. A�� Thomas McKean,Director 200 Main Street, Hyannis,MA 62601 Office: 508-862-4644 Fax: 508-790-6304 Date: »—�� Sewage Assessor's Map/Parcel-/�/,9--'Ia Installer &Designer Certification Form Designer: � � Installer; ----��� Address: Address: 1J4ffttA414L;P On »— �' '� was issued a permit to install a (date) (installer) septic system at I .� l�� based on a design drawn by (address) dated (designer) certify that-the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. �^ I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but is accordance with State&Local F- ',bons. Plan revision or certified as-built by designer to follow. Stripout(if r? �cted and the soils were found satisfactory. OF 41, DAVID (Ins a er's Sign re) MASON � Nil.1066 Is T ' esi er s Signature) l ) �� •� � PLEASE RETURN TO BARNSTABLE PUBLx .�fE OF COMPLIANCE WILL NOT BE ISSUED VN i iL btj i t1 i Hl6 li URNi AND AS- BUILT CARD ARE RECEIVED )BY THE BARINSTABLE PUBLIC HEALTH DMSION. THANK'YOU, q.loffice Fonnsldesignerceitification£onn,doc Aug 13 .09 06: 17p Colleen Mason (508) 833-2177 p. 1 COMMONWEALTH OF MASSACHUSETTS kipEXECUTNE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION David D.Mason,RJ%Certified Title V inspector,508433-2177 TITLE 5 -- OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 148 Milne[toad,Osterville Owner's: Myron Williams 5&c) Owner's Address:P.O.Box 657,Osterville,MA 02655 Date of Inspection:. 15 l Zvo� Name of inspector:(please print)David 8:1Vlason � > Company Name: N.A. r Mailing Address:4 Glacier Path A _ East Sandwich,MA 02537 FIN Telephone Number:508=831,2177 CERTIFICATION STATEMENT . I certify that I have personally inspected the sewage disposal system at this address and that the information reportar blow is true,accurate and complete as of the time of the inspection.The inspection was performed based'on my -77 training and experience in the proper fimction and maintenance of en site sewage disposal systems.Uam'h.DEP approved system inspector pursuant to Section 15.360 of Tide 5(310 CMtt 15.000).. The system: X_ Passes Conditionally Passes _ Needs Further Evaluation by the Local'Approving Authority Fails q Inspector's Sigrlatu Date: 4a46l� 1 The system inspector shall submit a copy of this inspection report to the Approving Au t city(B'oard'of Health or DEP)within 30 days of completing this inspection.If the system is a shared'syste n or has a design How of 10,000 gpd or greater,the inspector and the system ownd shall'submit the rcp6irto the appropriate regional'office of the. DEP.The original should be sent to the system owner and copies scat to the buyer,if applicable;and the approving authority. Notes and Comments:System as inspected appears to leave operated based on occupancy level". Increase in occupancy may cause hydraulic failure.The information as identified represents only the condition ofthe system on August 5,2009 at t:00 PM. Note;high water use can be due to extensive lawa irrigation.system. ****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. Lo Aug 13 09 02: 33p p, 2 Page 2 of 1 I OFFICIAL INSPECTION FOIE NOT FOR VOLUSTARY ASSESSMEN 9'S SUBSURFACE S1EWAOE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address. 148 Milne Road,Osterville Owner's:Myrna Williams Date of inspection: August 5,2009 Inspection Summary: Cheek A,B,C,D or E/ALWAYS complete all of Scelion D A. System Passes: _X, 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 Ate indicated.below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional pass's section need to be replaced or repaired_The system,upon completion of the replacement or repair,as approved'by the Board'of Health,,will pass, Answer yes,no or not determined(Y,N,ND)in the for the following statements explain If"not determined"please 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 pasti i:nspcctiott if the existing tank is replaced with a complying septic tank,as approved by the Board of Health. *A metal septic tank wi11 pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less that 20 years old is available_ ND explain: __ Observation of sewage backup or break out or high static water level in the distribution.box.due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if'(with approval of Board of).lealth): _— broken pipe(s)are replaced obstruction is removed CC?MPC.I:'CEQ} distribution box is leveled or Mlaced (THIS 1S REQUIRED TO BE ND explain: 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 pipc(s)are replaced obstruction is removed NU explain, OF'F'ICIAL INSPECTION FORM - NOT- FOR.VOLUNTARY ASSESSMENTS Title 5 Inspection Form 6/15/2000 2 Rug 13 09 02: 33p p. 3 Page 3 of I l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPiE;;CTION FORM PART A CERTIFICATION(continued) Property Address: td$Milne(toad,Osterville Owner's_Myrna Williams Date of Inspection:August S,2009 C. Further Cvatluation is Rxquired by the Board of Health: Conditions exist which require further evaluation by the Board of stealth 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 31'0 CMIt IS ).that the system is aot functioning in a manner which will protect public healtly 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 Z. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 t"eet 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 I of a public water supply. _ The system has aseptic 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,perfermcd'at a C3EF certified laboratory,for conform bacteria and volatile organic compounds indicates that the well is five from pollution.from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal'to or,less than.5 pprn,provided'that no other failure criteria are triggered. A copy of the analysis must be attached'to this form_ 3. Other: The primary cesspool'knot a typical configuration for a Cesspool. rt appeam to be a pipe: cylinder with an inlet pipe and outlet pipe with tee conneetod to a pr"ast4'deepx6'diameter Ieaech pit with stone. Permit on file with the BOH for the pre-rapt leach pit. OFFICIAL INSPECTION FORM..—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPIIC'I't()N FORM PART A Title 5 Inspection Forni 6/15/2000 3 Aug 13 09 02: 33p p. 4 Page 4 of 11 CERTIFICATIION(continued) Property Address: 148 Milne Road,Osterville Owner's: Myrna Williams Date of Inspection:August 5,2009 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all.inspections: Yes No X Backup of sewage into facility or system component due to overloaded,or clogged SAS or ccs%pocaI _X_ Discharge or ponding of effluent to the surface:of the ground or surface water.;due to an overloaded or clogged SAS or cesspool _X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X Liquid depth in cesspool is Icss than 6"below invert.or availablevoltltne is less than'/s day flow _X_ Rewired pumping more than 4 times in the:last year!j0T due to clogged or obstructed pipc(s). Number of times pumped' _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. WX Any portion of cesspool or privy is within 100 feet of'a surface:water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a ZA)ne 1.of a public well, X Any portion of a cesspool or privy is within 50 feetof'a privatewater supply well- -X Any portion of a cesspool or privy is less than 100'feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.!This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile oe'ganic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.! _No_.... (Yes/No)The system fails,1 have d'etcnnined 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 I lealth to determine what will be necessary to correct the failure- E. Large.Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gp(L You muwa indicate either"yes"or"no"to each of the hallowing;. (The following;criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of'a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area IWPA)or a mapped Tone It of a public water supply well If you have answered"yes-to any question in.Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator ofaany large system considered a. significant threat under Section E or failed under Section D shall upgrade the system in accordance.with 310 f'MR 15.304.The system owner should contact the appropriate regional office of the Department. OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSM1+',1` 1,'S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 'Title 5 Inspection Fortin 6/15/2000 4 Rug 13 09 O2e33p p. 5 Page 5 of 1 I PART R CHECKLIST Property Address. 148 Milne Road,MtervUle Owner's: Myrna Williams Date of Inspection: August 5,2009 Check if the following have been done,You[Host indicate`des"or"Ito"as to each of the following: . Ycc No _X—_ — Pumping information was provided by the owner„occupant,or Board of Health _X_ _ Were any of the System components pumped'out in the previous two weeks ! — —X—._ Ilas the system received normal flows in the previous two week period':' — —X— Have large volume;of water been introduced to the system recently or as part of this inspection? —X— — Were as built plans of the system obtained and examined?(If they were not available note as N/A) —X— — Was die facility or dwelling,inspected for signs of sewage back up'? 3C— _ Was the site inspected for sign~of'break out? X— — Were all system components,excluding the:SAS.located on site. X_ _ Wcre the septic tank manholes uncovered,opened,.acid the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of slud$e and depth of scum t _X_ Was the facility owner(and occupants if different from owner)provided with information.on the proper maintenance of subsurface sewage disposal systems'?' The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no K_ _ Fxisting information, For example,a plan at[lie Board of Health. X — Dcternvned in the field(if'any of the failure criteria related to Part C is at.issue approximation of distance is unacceptable)[3 10 CM 15.302(3)(b)] OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM IINSPEC rIO1N FORM Title 5 Inspection Dorm 6/15/2000 5 Rug 13 09 02: 33p p. 6 Page 6 of I 1 PART C SYSTEM INFORMATION Property Address: 148 Milne Road,Ostervilte Owners: Myrna Williams Date of Inspection: August s,2009- FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design)_2(per a.2sse-ugors records)Number of bedrooms DESIGN flow based on 310 CMR t 5.203(for example__1_I0:gpd'-x#of badroa ):(550 mod.capacity) Number of current residents: Does residence have a garbage grinder(yes or no):NO(Not.Allowed) Is laundry on a separate sewage system(yes or no) NO fif yes separate inspection required.]'Per owner Laundry system inspected(yes or no):NA Seasonal use:(yes or no): NO Water meter readings,if available(last 2 yearn usage(gpd))t 2008;90.000 gal. 2009; 168,000 Sump pump(yes or no):No Last date of occupancy: Seasonal(current) COMMERCIALJIN DUSTRIA L Type of establishment: Design flow(based on.110 CM R 15.203): gpd Basis of design flow(seaLs/personsAgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or.no): Non-sanitary waste discharged to the'ritle.5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): AL INFORMATION t umping Records r Source of information:Yprnwuth'Hcalth-Dcpartmeni� Was s stem um ed as yt s or no No f yes,volume pumped: t allons --P(ow was-c)uantity pumped detertniitcd7 Reason for pumping: Pumped after inspection as a maintenance pumping. TYPE OF SYSTEM -- _X Septic tank,distribution box,soil absorption system(1000gal pit.w/2' stone) _Single cesspool _Overflow cesspool Privy Shared system(yes or no){if yes,attach,previous inspection.records,,if any) _Innovative/Altemative technology,Anach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank ...-Attach a copy of the D EP approval Other(describe): Approximate age of all components,date installed(if known)and source of information:Approx. 1210/76 Were sewage odors detected when arriving tit the site(ye:5 or no):NO OFFICIAL INSPECTION FORM---NOT FOR.VOLUNTARY ASSES.SMENTSSUBSUR ACE SEWAGE DISPOSAL SYSTEM 1`NSPhCTION FORM Title 5 Inspection Form 0/15/2000 6 Flug 13 09 02., 33p p. 7 Page 7 of 11 PART C SYSTEM INFORMATION(continued) Property Address; 148 Milne Road,Osterville. Owner's: Myrna Williams Wle of Inspection: August 5,2009 BUILDING SEWER(locate on site plan) Depth below grade: Approximate; 14 Inches Materials of construction; cast iron _X 40 PVC_other(explain):. Distance from private waiter supply well or suction line:_NA Corninents(on condition of joints,venting,evidence of leakage,etc.): Appear;in good condition. No evident leakage. SEPTIC TANK:N.A.(locate on sits:plan) Depth below grade: 12" Material of construction: 3+_concrete_metal fiberglass.�polyethylene_other(explain)_ If tank is metal list age:_ Is age confirmed by a C'erlificate of-Cbmpliance(yes or no):_(attach a copy of certificate) Dimensions: Typical 1000 gallon tank Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle: 14" Scum thickness:2.5 inches Oistance tiom top of%Curn to top of outlet tea:or baffle::1.5" Distance from bottom of scum to bottom of outlet.tee or baffle: 12.5" flow were dimensions determined: Actual measurements with tape and'scour stick.. Condition of tank(on pumping recommendations.inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage;etc.) inlet tee in good condition,.FtfTuent level with nutlet pipe.Recommend pumping for maintenance pumping. GREASE TRAP: N.A, Depth below grade: Material of construction concrete_metal_.fiberglass__polyethylene other (explain)"- Dimensions: Dimensions: - Y 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 baffi'c: _ Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baf£?e condition,structural integrity„liquid'levels as related to outlet invert,evidence of leakage,etc,): OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Title 5 Inspection Form 6/15/2000 7 I Aug 13 09 02: 34p p. 8 Page 8 of I t PART C SYSTEM INFORMATION(continued) Property Address: Id$Milne(toad,())sterville Owner's:Myrna Williams Date of inspection:August 5,2009 TIGHT or HOLDING TANK:—N.A.—(tank must be pumped at time of inspection)il'ocrate on site plan) Depth below grade: Material of construction: concrete„,metal—fiberglass polyethylene othcr(explain): Dimensions: Capacity: -----.__...... ..._.V-dlons Design Flow: gallons/day Alarm present(yes or no): Alarin level: Alarm in working order(yes or no): Date of last pumping: Comments(Condition of alarm and float switches„etc_)_ DISTRIBUTION BOX:—NA— (if present must:be opened)(locate on cite plan) Depth of liquid level even with outlet invert: liquid level even with outlet pipe 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.):No record or indication of a d,box. 4 PUMP C HAMBC,R:_(locate on site plaan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(tote condition of pump chamber,condition of pumps and'appurtenances,etc.): OFFICIAL INSPECTION FORM—g�tNOT FtCa�1/2`i�jOLy,UN'`['®Alum' ASS�iFSSB9I��6+ggI7��F�ggNTS �71�B,7llld�.VAC E SEWAGE DISPOSAL,SYSTEM INSPECTION FORM Title 5 Inspection Form 6/15/2000 R Rud 13 09 02.: 34p p.9 Page 9 of 1 I PART C SYSTEM INFORMATION(continued) Property Address: 148 Milne Road,Osterville Owner's: Myrna Williams Date of Inspection: August 5,2009 SOIL,ABSORPTION SYSTEM(SAS):_X_(locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching,pits,number(11) 1000 gallon pit with 2'stone _leaching chambers,number: leaching galleries,number: leaching trenches,number,length: _ leaching fields,somber,dimensions: _overtlow cesspool,number_ innovative/alternative system Type/name of technology:T� Comments(note condition of soil,signs of hydraulic failure level of ponding;,damp soil,condition of vegetation, etcThere is ponding,there are signs of hydraulic failure;probed and no moisture noted,no incrbased'.growth in. vegetation,Probed soil did not indicate satunttion. Pit is 16"below grade.. Approx..3 feet of effluent.in the leach pit with indications of staining- CESSPOOLS:_(cesspool mustbc pumped as part of inspection)()ocatc on site.plan) ]dumber 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 or no): Comments(note condition of soil,signs of Hydraulic failure,level ofponding,.condition of vegetation,etc.): PRIVY:Jq.A,_(locate on site plait) Materials of construction: - Dimensions: Depth of solids' Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): OFFICIAL INSPECTION )FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Title 5 Inspection forts 6/1512000 9 f Rug 13 09 02: 34p p, 10 Pugs 10 of 11 PAIN C SYSTEM INFORMATION(continual) Property Address: 148 Milne Road,®sterville Owner's: Myrna Williams Date of Inspection: August 5,2009 SKETCH OF SFWACF,[DISPOSAL.SYSTEM Provide a sketch of the sewage disposal system including ties to at least:two permanent refercacc landmarks or benchmarks_Locate all wells within 1.00 feet.Locate where public water supply enters the building. b. OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Title 5 Inspection Form 6/15/2000 10 Rug 1.3 09 02a34p P. 11 Page 1 l of 11 PART C SYSTEM INFORMATION(continued) Property Address: 148 Milne Road,Osterville Owner's: Myrna Williams Ante of Inspection:August 5,2009 SITE EXAM Slope Surface water Check cellar (crawl space) Shallow wells L,stimated depth to ground water 20 fiat Please indicate(check)all methods used to determine the high ground water elevation: _X Obtained from system design plans on record I'f'checked,date of design plan reviewed: X _Observed site(abutting propertylobscrvation hole within.150 feet of SAS) _X_Checked with local Board of Health-explain:Recent Test.Holes_ Existing engineer records with 13011 _X_Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain; You must describe how you established the high grouted water elevation: Utilized existing site septic design information on file with the.Board of Health- Additionally„existing site and abutting site topography does not indicate ground water to be within 4 feet of bottom oflcaching tacility_ Title 5 Inspection Form 6/15/2000 11 I� CNO • ten- � 61 .� n. bl �+ r^ 0 3 l N Cl 1- rn L ty ty tj 3n n f k �7, Zi b �% o W c, 'XI ZiD 3> a n m N� U C_ 3 � !f., u' m rn f TOWN OF BARNSTABE I9 SEP 18 AM & Zy DlVI -C)ft! w a _ W K� U . k r r-1 >7 kli r!JQQ . v a � r V ro - � QC q w CA t �` t w a v3 z 41A. � �� LD z� Oa J a cL p — lu K ,_ LU k k F �.g 1 _ tt lu � 11. �Q y ,14- (=Q P� to B M p V X u ky. x q LUG + u } �' ° a 41 Q3 A +�t Health Master Detail Page 1 of 1 Agta.1tha N age, X S r Lociged In As: TowN\heaith Health Master Detail Monday, Application Center. Parcel Lookup. Parcel. Septic - Perc Well Fuel Tank Parcel: 119-052 Location: 148 MILNE ROAD, OSTERVILLE Owner: WILLIAMS, MYRNA L j� Septic 1, 6/27/2001W New Septic... Permit number: 120014.40 Permit type: Select type Issue date : 6/27/2001 Complete date : � - Septic tank size: ]x1000 Type/Size of SAS: 3-500g cham w/4'stone 34x1 _ . - Installer: Select Installer I I/A service type: Select service yP Innovative/Alternative Technology type: Select IA type Variance date: Abandon complete date : �+ Abandc j Repair deadline date Repair notification date: ': Comme _ 4 BR's I Inspection 8/12/2009 r . Inspection 4/4/1997 New Inspection... i Number Date Inspector f 5609 8/12/2009 Mason, David B. �j I Comments: Delel Save Septic Changes 1 Return:to Lookup �.� 4�0 L4 6e&+0OM `— o-mas A . (Vk, ear http:Hissgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=119052 9/28/2009 Lake IA, Lp�vp,1 (Ale i `"veP % o 0 o a (� ut t- r a 0 7 } �O ci G 0 G p � I . 1AC/✓�f77/t?P L rnuff,r 5 ��3•�Y� X Icl79'� cl -vim l%C`1lJ k� tr- 1 //2 X X G X�• S— — 7�. fj )y y.sx 2 • s 3ar �h ly)XS Y : r 3 ��s9C-1 Single Family - Long Report 02/02/97 Page 1 Address 148 MILNE RD. List Price $189,900 Town Barnstable List# 6021951 ListType MLS Listing Status ACT Style Split Level Rooms 10 FBaths 2 DescStyle Contp Beds 4 HBaths 0 Wn Nntanr AArniIRhtr. YrBuilt 1980 Approx # Lvls 2 TBaths 2 Garage 2 Car-Attach, DirEnt, PavDry OccupBy Other Leasbl Y Fplce Y SepLivQtr 1 st Bsmt Y County Barnstable LotSize 0.50 YrRnd Yes Village Osterville LivSpc 3201 or More MlsBch 1/10 to 3/10 Mile ConvenTo Chrch, School, Shpng BchDsc Lake/Pond Area South of 28 Street Public, Paved, TMaint BchOw Public Subdiv Dock NoDock OthAcc Zip Code 02655 Pool No DscAcc Basement Full, Finish, IntAcc Floors WtoW, Lino, Tile EquipAppl Dish, Intcom, GRange,' Refrig Roof Pitchd, Asphlt InteriorFt Attic, CableH SpclFnc Unkwn ExteriorFt Deck, Fenced, GreenH, OutBlg, Screen, StDoor, StWind, USprnk Siding Shing WtrSwr PriSew, TwnWtr, Gas, Elect, CATV HotWtr NGas HtCool NGas, HotWat, 3ZnHt Foundatn Main 30 x 60 Assoc No MshpReq No YrlyFee $0 FeeYear EL X . Feelncl Irreg N Pitchd, AdditSvc Idth Depth Irregular LotDesc Corner, Fence, Level Ad Copy HUGE FOUR BEDROOM HIP-ROOF 1980 CUSTOM BUILT HOME WITH 2-CAR GARAGE, IN-LAW SET-UP;2-FIREPLACES, FENCED YARD, ENCLOSED GREENHOUSE/BREEZEWAY, ON 1/2 ACRE OF LAND AND IN A GREAT AREA. WALK TO JOSHUA'S POND. REDUCED AND READY !!! IF YOU WANT QUALITY, VALUE AND LOCATION, HERE IT IS !!!!!!! Direc I OM MAIN ST. IN OSTERVI JUST WEST OF DOWNTOWN OSTERVILLE) AND THEN FIRST LEFT ONTO MILNE RD. TO#148 Map# 119 TitlRef B 4045 P 321 LCO AssmtStat Assessed Parcel# 052 Plan LandAsmt $48,800 UFFI N AnnualBttr $0 PlnLot Improvmnt $135,600 Asbest N UnpaidBttr $0 Zoning RES. Tota!Asmt $184,400 UTank . N FloodPlain Not in Flood Plain Use 101 - Single Family Taxes $ $2,402 LPaint No Tax Year 1995 Room Dimen Level Features Living Room 13.6 X23.6 2 Fireplace,Wall to Wall Carpet, Sliding Door, Exterior Balcony Formal Dining 13.6 X 16 2 Closet,Wall to Wall Carpet Family Room 14 X 26 1 Fireplace,Wall to Wall Carpet Kitchen 13.6 X 16 2 Ceiling Fan,Closet, Built-Ins, Linoleum Floor Master Bedroom 14 X 14 2 Closet,Wall to Wall Carpet Bedroom 2 14 X 14 2 Closet,Wall to Wall Carpet Bedroom 3 13 X 14 1 Closet,Wall to Wall Carpet Bedroom 4 14 X 14 1 Closet,Wall to Wall Carpet Bathroom 1 8 X 11 2 Linoleum Floor, Full Bath Bathroom 2 8 X 11 .21 Linoleum Floor, Full Bath Foyer Tile Floor Den/Library 12 X 16 1 Wall to Wall Carpet Laundry 8 X 11 2 Linoleum Floor Information Deemed Accurate but not Guaranteed-printed by Joseph Ford,Jr,Peter McDowell Associates-#6021951 i.• t � I / 101 Commorriveatth of Massachusetts Executive Office of Environmental Affairs qp� IV, — Department Department of ro Environmental Protection ©Te�oPlTgeF99J ho Goramer ` VAMM F.wow Ts o I confablimw SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t - PART A 1 CERTIFICATION Property Address: 148 Milne Road, Ostertdlle, MA Address of Owner: c% Llvian Hansen Date of Inspection: March 2S, 1997 (If different) 213 Abi Ingham Drive Name of Inspector: James M. Ford Centerville, MA 02632 Company Name,Address and Telephone Number. James M. Ford, P.O. Bar 49, Ostemlle, MA 02655 (508) 775-7927 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: ✓ Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: .9 Iil 4, 1997 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: Al SYSTEM PASSES: ✓ I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: „ One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined(Y. N,or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised V15/951 1 One Winter Street a Boston, Massachusetts 02108 a FAX(617) 5545-1049 a Tet*p *(617)292-5500 C v ",ed« a�cycW Pape' r. , "a `! SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A r CERTIFICATION (continued) Property Address: 148'Milne Road. Ostenille, MA Owner:, Estate ¢DeMelo Da[e of lInsp ti O��Maich 25, 1997 Bl SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more-than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Dl SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 148 Milne Road, OstenVle, MA Owner: Estate ¢DeMelo Date of Inspection: March 25, 1997 D] SYSTEM FAILS (continued) Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped „ Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. t Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well,water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply t the system is within 200 feet of a tributary to a surface drinking PP1 water supply the system is located in a nitrogen sensitive area (Interim Welhead Protection Area(IWPA) or a mapped Zone II of a public water supply well) F u - The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 148 Milne Road, Ostenille, MA Owner: Estate if DeMelo Date of Inspection: March 25, 1997 w Check if the following have been done: ✓ Pumping information was requested of the owner, occupant, and Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ✓ As built plans have been obtained and examined: Note if they are not available with N/A. ✓ The facility or dwelling was inspected for signs of sewage back-up. ✓ The system does not receive non-sanitary or industrial waste flow. ✓ The site was inspected for signs of breakout. ✓ All system components, excluding the Soil Absorption System, have been located on the site.. ✓ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth.of scum. . I ✓ The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. ✓ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Subsurface Disposal System. (revised 8/15/95) 4 f� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 148 Milne Road, Osterville, MA Owner: Estate ¢DeMelo Date of Inspection: March 25, 1997 FLOW CONDITIONS RESIDENTIAL: Design flow: 440 gallons Number of bedrooms: 4 Number of current residents: 0 Garbage grinder(yes or no): A Laundry connected to system(yes or no): Yes Seasonal use (yes or no): _ b& Water meter readings, if available: Home has been vacant br more than one year. Last date of occupancy: Presently unoc=ied. COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gallons/day Grease trap present (yes or no): Industrial Waste Holding Tank present (yes or no): Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy: OTHER: (Describe) " Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: No record on �fle at D•eatment Plant System pumped as part of inspection(yes or no): No If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM ✓ Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: 1977-As built card. Sewage odors detected when arriving at the site (yes or no): Ab (revised 8/15/95) $ I— a > SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 148 Milne Road, Ostenille, MA Owner: Estate c,f DeMelo Date of Inspection: March 25, 1997 SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 24" Material of construction: ✓ concrete _metal _FRP _other (explain) Dimensions: 8'X 4'6"X 5' - 1000 Gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness: _ n Distance from top of scum to top of outlet tee or baffle: -- Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Baffles are in Rood condition. Tank is three quarter fill: There is no scum laver -scum has broken down GREASE TRAP: Mne (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP _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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 148 Milne Road, Ostert ille, MA Owner: Estate gf DeMelo Date of Inspection: March 25, 1997 TIGHT OR HOLDING TANK: Abne k (locate on site plan) Depth below grade: Material of construction: concrete _metal _FRP other (explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet.tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: Abne (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER: -Abne (locate on site plan) Pumps in working order(yes or no): Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) d 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 148 Milne Road, Osterville, MA Owner: Estate cf DeMelo Date of Inspection: March 25, 1997 SOIL ABSORPTION SYSTEM (SAS): ✓ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: I leaching chambers, number: leaching galleries, number: leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) Comer¢shed covers ssv tem. Grass and shrub covers remainder. Measurements were taken tom the as built card. CESSPOOLS: None (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 (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: None (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.) (revised 8/15/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 148 Milne Road, Osterville, MA Owner: Estate ¢DeMelo Date of Inspection: March 25, 1997 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent references, landmarks or benchmarks. Locate all wells within 100'. I BAC_k la ash" /° 1 �..� o -° 63 ' Shed DEPTH .TO GROUNDWATER: Depth to groundwater: 20 +/- feet Method of determination or approximation: CVe Cori Commission Water Contour and U.S. Geological ftii MW Cotuit °quadrangle, (revised 8/15/95) 9 i � J 1 . No........ . ..... F1m1&..�4'.................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF ri /� . - ........OF. , 6. ..............I........ �.................. Apptiratioo -for Ii,iVoott1 Wv&a Tomitrurtioo Vamit Application is hereby'made for a Permit to Construct (or Repair ( ) an Individual Swage Disposal System at: , / r .�`./��r'..� , 1 • = - ....----• ........................... �f or ion.Addr or Lot No. Ow Address W .........-fL.._ r...... •. ��Yf J- .....................• ..... Installer Address Q Type of Buildin Size Lot----------------------------Sq. f et Dwelling Type o. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder Other—T a ding ____________________________ No. of persons_..._...................... Showers ( ) — Cafeteria ( ) Q' Other fixtures ...................... .. . Q � -.... - ---------------------- W Design Flow..._...._: __________________ gallons per person per day. Total daily flow....._-.-c�` d'---_ -.--.--..gallons. WSeptic Tauk�Liquid capacity gallons Length................ Width..___........_.. iameter---------------- Depth.-.-----_-.----- x .Disposal Trench—No_____________________ Width----------- 1 e gth otal leaching area....................sq. ft. f ,�� .� . Total leaching tre Seepage Pit No... ................. Diameter._ __._____�r�_ e be o et____._.__..____._ g � ------------------ ft. Z Other Distribution box ( ) Dosifig tank ( ) /�� aPercolation Test Results Performed by........................................................... ... Date------------------------.--------------- Test Pit No. 1................minutes per inch Depth of Test Pit-.-_-__--_•-____-_ Depth to ground water...-..___-.-..._-...__.- V-4 Test Pit No. 2_______________minutes per inch Depth of 'Pest Pit.-._-_---..---_-___. Depth to ground water-_.-.----__---_--------- ------------------- ------------------ a' S tlDescrtption of ............. - T-� /l - �.: ------------2L- ----------=--...-------------------------- vU Nature of Repairs or Alterations—Answer when applicable.__-------------------------------------------------------------------------------------------.. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the boaryd�of health. Application Approved B ��_.l . Date D PP PP Y '' '��-A -! !� l I �� - _z__ -- ...... • Date Application Disapproved for the following reasons------------------------ --------------------------------------------------------------------------------------- ----------------------------•---------------------------------••-•---.....----------•-----------•---•---•-----------•-----------•-•------------------------------------------------------------------- Date PermitNo......................................................... Issued..................... .................................. Date No.._--1CF-7...... Fmic. . .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD P:F HEA OF.... ... . ........................................... Application -for Dhipaiial Worko Towstrurtion Prrutit Application is hereby'made for a Permit to Construct or Repair an..Individua Swage Disposal System at: .......... ...... .................. A .... .............. ............................................ .......................... ............... . .. ... .,7 Add or Lot No. . . ....................... ................................................................................................ ow Address ...... . . ...... .... ........ ... .... ................................ ...................... ........................................................................... Installer Address Type of BuildlnE_ Size Lot............. Sq.;fet U DwellingZ'No. of Bedrooms.-------_-----2—------------------Expansion Attic Garbage----Grinder r'in"d"er 0.) ........... Other-Type of Building ---------- ----------------- No. of persons_.-__--...............__._. Showers Cafeteria P4 Other fixtuLes ------------------------------------------------------Desi n Flow D gallons per person per day. Total daily flow--------------------------------------------gallons. Liquid capacity/ "/ Length________________ Width-------- -----. iameter----- .......... Depth---------------- 9 Septic T.ink/�..... ty/A___F':allons Len- Disposal Trench-No. .................... Width------------ -- otal leaching area--------------------Sq. f t. Seepage Pit NO.-I--------------- Diameter.......... t be et --- Total leaching tar ------------------sq. ft. Z Other Distribution box Dos Kng tank 4 'g Percolation Test Results Performed by--------- ---------------------------------------------------_-_------ Date-.-.---------....-.--------.---.-------. a Test Pit No. I----------------minutes per inch Depth of Test Pit..._-.----._ --___-. Depth to -round water..__--.-_.---.._____-- /(� Test Pit No. 2----------------numitesper inch Depth of Test Pit.--_---_________:--- Depth to ground water.-.-._---_---------_____ ZZ-1......i'___1----- ----------------------- --- 0 - --- rle-----Z--- 7,Description t - 0 o joil ...... U -------------- ..... --------------------------------------------I--------------------------------------------------- ------------------------------------------------------ --------------------------------------- U Nature of Repairs or Alterations-Answer when applicable----------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------- ---------------------------- --------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code- The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. ign ----------- -- -------------- e• - . ... ----- -------------------------------- . Date Application Approved By.---,. --- ------- - _ --7 Date ------------------------------------------------------------------- ................ Application Disapproved for the following reasons:---------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------- Date PermitNo........................................................ Issued.---------- .......... ........................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD 0 HEALTH . .... .............OF.......... .......................................... Tprtifiratr of Toutphaurr T,IFI I Sj I CERTIF mt n ividual Sewage Disposal System constructed 4�-�or Repaired by...... ...... , -- ;e?- r ....... ....... ------- . ......... .............. ......._................................................. st, ---------- AXI- ----- ---------(...................................................................... has been installed in accordance with the provisions of ticl X1 of The State Sanitary Code as-Aescribed the Aj 41 -7 application for Disposal Works Construction Permit 0....... ----- dated ---X -?-,.--------- ...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL F.UNCTION SATISFACTORY. DATE..................0.1j?.r -------2_7................... Inspector----- - -------- . ................. THE COMMONWEALTH OF MASSACHU BOARD O/� HEALTH I S IT IS------il C7 CHU ?.. . ........!� .....OF ---------*--------------------------------- 0.... FEE.../Z4' Cr,140tru ' I Prrmit ��reb S Permis ion re by ranted_-- -------------------------------------- ........... .... .. ............... ....... -V- 4 ------ ---------- to Cons r c or air a V'iV al Sewa al Sy t at No- is S I ._ S .... .. --------------------------------------------------------------- St et as shown on the application for Disposal Works Construction P t D - 7 (11 ------- ated----- .. .................... f�B. d of Health DATE--- ---------------------------------- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS . e `1 f o. IDzil ; ti � E . 3 Jfdn Reference: , ssr 's. map If9 P 6 156. ,,may l .., r m. . (cazcu 'ate 1. Bk. 1'..49 - 00 M Z 3 o. 51 A c. fA 444,ac� I "Il . e 4R6 , Qjp ram cc,•..rr, •may . ,,::9 i ictkk -/ ` r_ xa TRi 7��r i AV CertzJ Zid . 'lot Plan 0. Location. /r4,eyJtl S�1TG �c2� ,�, O,eY 48 ffiln e Ro a d Barnstable, AA 4 .prepared ,,for r Craig -fa ueline Al.Fantuzzi " Scale: t to Date: August 19, 0f I certify that t1ze dwell-ngF shown hereon is located as it exists on r(\�� Of �/ Ryder �`o Ina • • • . a S:� , +� +��WL r � ���oMf�� d n4✓x the f and and that as so ; located it complies w�ti/' the minimum _- VVV d� P. L. S. pmPerty line setback requirements of tie Town of Barnstable. � , � ` -� ��, So. Orleans, A4 436867 .DateV • .moo„ esszonal Land Surveyor � � � ,��� //49 0.,) it , ASSESSORS MAP: L 9 TEST HOLE LOGS PARCEL: `� _ 1) The installation shall con,}.;, with Title V ajid Town ofNonBoard FLOOD ZONE: 4 ol�. SO I L EVALUATOR: I [Ieaith Regulations. -fit. 3 _ . ._ .1 L WITNESS 2) The installer shall verify the location of utilities, sewer inverts and septic REFERENCE: "' components prior to installation and setting base elevations. °� I DATE: D P P g PERCOLA ION RATE: -G- ,,M1W`1 t ' 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot.The first , -- two feet out of the d-box to the leaching shall be level. Q 7 4 This plan is not to be utilized for property line determination nor any other TA-2 purpose other than the proposed system installation. C 5) All septic components must meet Title V specifications. 6) Parking shall not be constructed over 1-110 septic components. 63 7) The property is bounded by property corners and property lines." Iwo Cj '� CJ �/y� 8) The property owner shall review design considerations to approve of total LOCATION MAP design flow and number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed approval of the design flow by the owner. l (�I 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated sail and replaced with clean sand per \ � „, ,� ?�•, d � Title V specs. �pt 10)System components to be 10 feet from water line. Sewer lines crossing the 0XV, WTI A , !� water line shall be sleeved with 4 inch SCI 140 PVC with ends grouted if applicable. The proposed SAS is being installed below the water service \Z e}. line. The line is to be sleeved as aforementioned and maintained in place. 11) If a garbage grinder exists it is to be removed and is the responsibility of the SEPTIC S Y S T E M I D E S I G N owner to ensure such. 12)The installer is to take caution in excavation around the gas line if such FLOW ESTIMATE exists. w` - L 13)The installer shall verify.the location,quantity and elevation of the sewer BEDROOMS AT �� GAL/DAY/BEDROOM GAL/DAY lines exiting the dwelling'prior to the installation. ...,.....+..+.ti...r...,....... D►./ R/D`J f"i2,_,. 14)This plan is representative only that a system can fit on a property meeting 1 1✓Ll t.� � jj SEPTIC TANK Title V requirements. . I � 1 AL/DAY x 2 DA S - ffiNAL — USE l GALLON SEPTIC TANK -� OIL ABSORPTION Sal EM " 14 OF uz JAVin ` ' - 12 ' a< /37►SIDE AREA: 7 p BOTTOM AREA: .' ll� O SEPTIC SYSTEM SECTION 1 1ION AL W lob GAL /K � SEPTIC TANK t� �d o _s o ` S I TE AND SEWAGE PLAN o ° LOCATION : PREPARED FOR : JN 1 o SCALE i DAV I D B . MASON,R5 DATE: "M 19131 5 DBC ENVIRONMENTAL DESIGNS EAST SANDWICH . MA DATE I HEALTH AGENT ( 508 ) 833— 2 177 I