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HomeMy WebLinkAbout0037 OAKVILLE AVENUE - Health 37 Oakville Avenue T efi � �� Osterville A= 143 - 006 V Ir i I TOWN OF'BARNSTABLE LOCATION 57 CJ4k-J 11/ 7 l,-"" I U45 SEWAGE # VILLAGE O 5-u-:ry;Ille ASSESSOR'S/MAP & LOT / - 0.6 INSTALLER'S NAME&PHONE NO.SOS-5�'20-9Z'.18 SEPTIC TANK CAPACITY I DO LEACHING FACILITY: (type) 2-SOO GaI, NO. OF BEDROOMS ' o� BUILDER OR OWNER lt�W !/! h C F'19r PERMITDATE: 7- ZS-/J COMPLIANCE DATE: 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 leachin f 1 ) Feet Furnished by 0kkVi16E 14 VE fcrF �( � �� 7L No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpplication for TMpOal *pgtem Construction Permit Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) F4 Complete System ❑Individual Components Location Address or Lot No..37 00W1111f 109YL'w(v6 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address, nd Tel.No.fi9B'Z96—77`�� Designer's Name,Address and Tel.No. Sob" 3G2' 2�12 ,,/osepk 0-c . s4e.--o s Type of Building: Dwelling No. of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 2 Design Flow(min.required) J� gpd Design flow provided 3 y gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) j5Z.MW11 p 1, ,� �!G d?C soo 6141 Leo el�4 ef 4*111W161� w�lr4 e -Srewlo- Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date 5 Application Disapproved by: Date for the following reasons i ,,,.Permit No. Date Issued -ii- No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Tipprication for Digoml 6p!9tPm cow5truction permit Application for a Permit to Construct(Repair( ) Upgrade( ) Abandon( ) L�Complete System ❑Individual Components Location Address or Lot No..? U!<I F�/�I(� �G���/= Owner's Name Address and Tel.N 7 e. o. Assessor's Map/ParcelD0G osrv/�/�� Installer's Name,Address,and Tel.No.S ���- 77�� Designer's Name,Address and Tel.No. ✓os e/'6 D-c [ya r-;-o S z2wl '/.� 'W1=yi=r� Type of Building: Dwelling No.of Bedrooms � Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 1 Design Flow(min.required) 3o gpd Design flow provided gpd Plan Date Number of sheets Revision Date I Title :. Size of Septic Tank tType of S.A.S., r Description of Soil Nature of Repairs or Alterations(Answer when applicable) /¢/ / d U 6,,71 — ,-x Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Date Signed g � i Application Approved by - , Date — ? 5 — ► Application Disapproved by: Date ' for the following reasons Plermit No. d Date Issued THE COMMONWEALTH OF MASSACHUSETTS _ BARNSTABLE, MASSACHUSETTS i Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( 1 ) Upgraded Abandoned,( )by at '3rJ /,1�q� 1//��/_= �� j j Sj/I/V�/lj_ has been constructed in accordance '' with the provisions of Title 5 and the for Disposal System Construction Permit No. a� — 2 L dated --7" 2 5-::V 1, Installer ,/U 5 /�� �e /Jf�/'`U S" Designer /��j^f'/:!% liG�/y #bedrooms Approved deem flow 3 5b gpd The issuance of this permit shall not be co strued as a`guarantee that the syste�ill fu cti' s designed. Date /� r Inspector No., �/O` ' Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS 05po5al *y5tem Construction Permit Permission is hereby granted to Construct Repair ( f�)� Upgrade ( ) Abandon ( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this g Date - 2 - Approved b j pp . Y i Town of Barnstable 'ME Regulatory Services - Thomas F. Geiler, Director • HARNSTABLe. Public Health Division pT� A. Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 503-362-4644 Fax: 1403-790-6304 Installer & Designer Certification Form Date: L It Sewage Permit# O/ — �S' Assessors vaplParl ? Designer: ��_ Installer: Address: �b I�� Address: ( Or. Z— ��'^- J was issued a permit to install a' (date) f installer) septic system at �� O -��L.lA,�, kyENV based on a design drawn by (address) 4 dated �d 1 (designer) ,. 1 certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation ofythe distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or anv vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. � �/� '3► D E M., y� (I aller's Signature) . No 1140 f ' RfGlSiE�� �,� SANITAO* Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNST LE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification Form 3-264doc i P " ri'own.of Bamstable. , " •� P# t►+E Department of Regulatory Services Date � Public'Health Division ,Iresa - ibs¢ tee$ 200 Main Street,Hyannis MA 02601 1•' - Time Fee Pd: Date SGi]edule d I oil'-Suitability.Assesskrh ht fob ,Sewage Disposar a Performed By. �`i •�9` ���� b Witnessed By: _� LOCATION &:GENERAL"INFORMATION V1 NC jI Location Address J� DQ ` / p/ I� Owner's Name M Q�j ,,� V I� ! UI Address 0AV v)t Assessor's Map/P4tcel:, jq� ,2/QDr Y I Engineer's Name �sf✓y�h NEW CONSTRtl I ION. " REPAIR h j Telephone#--5 6& 3 G 2-6 2-Z ���// Land Use f�i � '�Y � Slopes(%)_R9�:7.i Surface,Stones :. ; 0U Distances from: Open Water Body -0 ft Possr6le Wee Area ft Drinking Water Well.- ft 1 Drainage Way �V -ft. Property Line ! r ft Other fit SKETCH:($treet name,dimcnsioris;of lot,exact locations of test holes&perc tests,Ion a wetlands m proximity to holes) OAKVILLE AVENUE ' PROP.I SOOG I -` - �' SEPTIC TANK - - - vOS ezlsnNc EXISn NG 110\ note 10) _ �1EA L � of Parent material(geologic) A. 0 �� J� Depth to Bedrock Depth to Groundwater.'Sta ding Water in Hole:' ' 1' r' Weeping from Plt Face 4 .::- , Estimated Seasonal High Groundwater — D TERMINATION]E'OR-SEAS Oj L-HI Method Used: j I r Depth td Sgll Mottles In. Depth Cibserved standing' obs.hole: Depth toiweeping from side of obs.hole I it1. '©foutldti•'lr[ef djUtltment AdJ,tito ndwaterLevel..,,,o. Index Well# Reading Date: Index Well level x PRCOLATIOlr1"TEST : D$tp.._. ,'._ xlvs�:.:�.. W . Observation I Ttme at9"` Hole# j r' �to TtmeatG" Depth of Pere ; Tana(9f"6") _.. Start Pre-soak Time.C� End Pre-soak ' Rate MinJInch . Site Failed: Additional Testing Needed(Y/N)• ' - Site Suitability As sesmenG Site Passed - ' Observation Hole Data To Be Completed on Back-- Original:.Public 1141th Division k ***If percolajibn test is to be conducted within 100' of wetland,.you must first notify the ¢ Barnstable,C44servahon Di`ision at least one(1) wedk prior to beginning-. DEEP OBSERVMd6N HOLE'I OG, Hole# Depth from Soil Horizon " Soil,-Texture Soil Color.. Soil Other .Surface(in.) (USDA)_ (Munsell) Mottling (Structure,'Stones,Boulders. h , Consistency.%Gravel n Alt-1�.�°'' �� �,' � �" , - , 2 �•� DEEP OBSERVATION HOLEIOG '"• `Hole# Depth from Soil Horizon 'Soil Texture Soil Color_ Soil Other Surface(in.) (USDA), (Mansell) Mottling (Structure,Stones,Boulders. Consistency,%Gra el (�t'--tom' •::`U►� Cc�� i o .�•-31� • DEEP OBSERVATION HOLE LOG Hole# Depth from' Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel t DEEP OBSERVATION HOLE LOG Hole# P Depth from Soil Horizon Soil Texture Soil Color Soil ther Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones.Boulders. C nsisten ravel) .r Flood Insurance Rafe Map: Above 500 year flood boundary No4 Yes Within 500 year boundary No''`✓ Yes Within•:100 year flood boundary No_ . Yes • Depth of Naturally,Occurrinl;.Pervious Material Does at least four feet of naturally occurring pervious material exist.in all areas observed throughout the Area proposed for the.soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification ]:,certify that on (date)I have passed the soil evaluator examination approved by the Department of-Enviroin rhental Protection and.that the above analysis was performed by me consistent with the requir i expert se and experience described in 3:10 CMR 15.017. , . Signature Date Q:N.SEPTICIPERCFORM.DOC Town of Barnstable = arnstable MA Regulatory Services Department � "'m"aCh" � IIAFtNSTABLE, 1 06 I 3S. Public Health Division 9. �� ArED MAC a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 dU Thomas F.Geiler,Director FAX: 508-790-6304 � Thomas A.McKean,CHO CERTIFIED MAIL# 7006 0810 0000 3525 5590 July 12, 2011 Marie Gomes 37 Oakville Avenue Osterville, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at,37 Oakville Ave, Osterville, MA. was last inspected on 6/09/2011 by Mark Polselli, certified septic inspector for the State of Massachusetts. According to the private septic system inspector, the system "Fails" due to the following: • System must be replaced. - Cesspool structurally unsound. You are ordered to repair or replace the septic system within one (1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period may result in future enforcement action PER ORDER OF THE BOARD OF HEALTH c�n, .O-.... Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures\1-1 SAMPLE 60 Day Deadline.doc f Commonwealth of Massachusetts Title 5 Official In, Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2 2-_ .—llv, llP 9 Property Address --__lam / Q`✓1�'✓ . ��� .— Owner Owner's Name information 5 OS- /✓l!/e � required for every page City Town State Zip Code Date_o ns on Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form Important:When filling out forms A. General Information on the computer, I ( /►./� / use only the tab 1. Inspector. key to move your cursor-do not G✓ S� i — usethe return key. Name of Inspector_ key. 0 Company Name /"1O I I /♦ I I Company Addr�� 4� �� CitylTown State Zip Code YO oao� — Telephone umber 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 co sewage disposal systems. I am a DiP approved system inspector pursuant to Section 15.340 of - Title 5(310 CMR 15.000). The system: El Passes ❑ :_Conditionally Passes Fails cCk k ❑ Needs Further Evaluation by the Local Approving Authority. t tw - AA/ c' w !» Inspecto 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 regionall 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 undler the same or different conditions of use. A t5ins•11116 Tina 5 arm in spection Forth:Subsurface Sol Disposal hem•Fags 1 of 17 . t i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forr> Not for Voluntary Assessments �e Property Address Owner Owners Name //� f opt tv - information is required for every State Zip Code Date of pe ion page City/Towrl B. Certification (cont.) Inspection Summary: Check A,B,C,D orj'E /always complete all of Section D A) System Passes: I - ❑ 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: B) System Conditionally Passes: i ❑ 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 past;. 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 yearn old' or the septic tank (whether metal or not) is structurally unsound, exhibits substantial inflltrationi or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is feplaced with a complying septic tank as approved by the Board of Health. I * 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): I; Title 5 official Inspection Form:subsurface Sev1e9e oisposei System-Page 2 d'17 t5ins•11/10 - i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner Owner's Name information is `— �� _ required for every J State Zip Code Date of I pest n page City/Town B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced! ❑ Y ❑ N ❑ ND (Explain below): obstruction is removed ! ❑ Y ❑ N ❑ ND (Explain below): distribution box is leveled orlreplaced ❑ Y ❑ N ❑ ND (Explain below): — t _ ❑ The system required pumping morelthan 4 times a year due to broken or obstructed pipe(s). Thr� system will pass inspection if(with approval of the Board of Health): ❑ broken pipes) are replaced; ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): i — I , C) Further Evaluation is Reg6ired by the Board of Health: ❑ Conditions exist which requite further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is1within 50 feet of a surface-water El I Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh Page 3 or 1I t5ins•11/10 Title 5 official Inspedion Forth:Subsurface Sewage Disposal System' 1 ( i Commonwealth of Massachusetts Title 5 official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments lef �Y i Property Address C-o Owner 5wner's Name � hL11 information is ©s4-e✓v, required for every j State Zip Code Date Ins ion - p�e Cit _r olm B. Certification (cont.) j 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply orl tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used toidetermine distance:] — ** This system passes if the welllwater analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and tH,e presence of ammonia nitrogen and nitrate nitrogen is equCaI to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. . 3. Other: I — 4 i i i + D) System Failure Criteria Applicable to!All Systems: t You must indicate "Yes" or"No"to �ach of the following for all inspections: Yes. No ❑ r-,L� _ ,Backup of!sewag, into facility or system component due,to overloaded or %clogged SAS or cesspool 1 Discharge!or ponding of effluent to the surface of the ground or surface watem El ED/( -'due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloadbd El �1 �r clogged SAS or cesspool El �„/ Liquid depth in cesspool is less than 6" below invert or available volume is less t� than Y2 day flow t5ins•11f10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of MassachLisetts Title 5 Official Insaection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address 4� i 0 ✓1'I�S — r Owner Owners Name J/ ,l �r 6 information is 0 4✓v1 ! e f �//� V�6J-� required for every City/Town State Zip Code Date o nspe on B. Certification (cont`) ,: S�7�tGv �t 0So�h oL Yes No iss Qo �' " Required ing more than 4 times in tF�elast year NOT due to clogged or q pumping I Q E_ obstructed ipipe(s). Number of times pumped: Any portion of the SAS, cesspool or privy.is below high ground water elevation. -;iAny portion of cesspool or privy is within 100 feet of a surface water supply or 6 tributary to a surface water supply�- " +. r cesspool orprivyis withina Zone 1 of a public well. ss Any portion of a ce, p ❑ L� t` 4ny portion of a cesspool or privy is within 50 feet of a private water supply well. Q [� 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. [Thus system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence oj ammonia nitrogen and nitrate nitrogen is equal to w the analysis that no s than 5 ppm, other failure criteria are triggered. A copy o and chain of custiody must be attached to this form.) Q Q The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. The system fails.jl have determined that one or more of the above failure criteria exist as described in310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No Q ❑ the system is within 400 feet of a surface drinking water supply Q ❑ the system is within 200 feet of a tributary to a'surface drinking water supply Q El Area systeM is located in a nitrogen sensitive area (Interim Wellhead Protectior, Area -IWPA) or a mapped Zone Il�of a public water supply,well If you have answered-yes- to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Departmerit. TRIe 5 official Inspection Forth:Subsurface sewage Disposal system•Page 5 of 17 t5ins 11/10 i r Commonwealth of Massachusetts Title 5 officiail inspection Form Subsurface Sewage Disposal System Form)- Not for Voluntary Assessments �� Property Address Owner Owners Name `/✓6 `l'e- informations QS-� required for every I State Zip Code 4Datef lion page City/Town C. Checklist { Check if the following have been done. Ylu must,indicate"yes" or"no" as to each of the following: Yes No f I ❑ 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? i []/❑ Has the system received normal flows in the previous two week period? Have large volumes Hof water been introduced to the system recently or as part of ❑ ,this Inspection? I �/ ❑ Were as built plans of the system obtained and examined? (If they were not available note as NIA) �. Was the facility or dwelling inspected for signs of sewage back up? � Was the site.inspected for signs of break out? n ❑ Were ail system components, excluding the SAS, located on site? p 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: ❑ a_- xisting info mation,I. For example, a plan at the Board of Health. ❑ Determined yin 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)] I i D. System Information h Residential Flow Conditions: / I Number of bedrooms (design): Number,of bedrooms (actual): /n f( L DESIGN flow based on 310 CM 15.203 (for example: 110 gpd x#of bedrooms): i d 15irts•11110 - rdle 5 Ofridal Inspedion Forth:Subsurface sewage Diapo System•Page 6 o-17 Commonwealth of Massachusetts Title 5 Official Imsp6ction Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address �T Q✓4l42s Owner Owners Name q. information is re red for every City�Town State Zip Code Date of I pe on pag D. System Inform n Description: , Number of current residents` Does residence have a garbage grinder? ❑ Yes lo/ Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ®,No Laundry system inspected? Yes No/ Er No I Seasonal use? El Yes Water meter readings, if available (last 2iyears usage(gpd)): Detail: I _ — � ❑ Sump pump? Yes No 1. Last date of occupancy: ate CommercialAndustrial Flow Conditions: Type of Establishment: Design flow (based ion 310 CM R 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): - — Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? { ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•1 i/10 Title 5 official Inspedion Form:Subsurface Sewage D4=1 Sydern•Page 7 of 17 i Commonwealth of Massachusetts Title 5 Official lnspdctio;n Form Subsurface Sewage Disposal System Form . Not for Voluntary Assessments QG!✓vll� �y� - Property Address 6—c Wl�s Owner Owners Name QJ / L information is - required for every { State Zip Code Date of nspe ion page. Cityrr D. System Information (cont.) Last date of occupancy/use: r Date Other(describe below): i - General Information I .. Pumping Records: i Source of information: Was system pumped as part of the inspection.? ❑ Yes ❑ No If yes; volume pumped: galions How was quantity pumped determined?' Reason for pumping: Type of System: I ❑ Septic tank. distribution lbox, soil absorption system Single cesspool Overflow cesspool ❑ Privy Shared system (yes or no) (rf yes; attach previous inspection records, if any) ❑ Innovative/Alterhative 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) Tdis 5 OfficW Inspedion Forth:Subsurface Sewage Disposal System•Page 8 of 17 i I 1 commonwealth of Massachusetts Title 5 Official Inspection Form, nts ` Not for Voluntary Ass4 essme Subsurface Sewage Disposal Syste/m Forth� f r Property Address _--- Owner owners Name i tD information is OSI�v, l �- pate of ns on required for every State Zip Code page FaTTTown D. System Information (cons.) tea a of all components, date installed (rf known) and source of information: Approximate g — I Were sewage odors detected when arriving at the site? ❑ Yes o Building Sewer (locate on site plan): Depth below grade: I- feet I Material of struction: t ast iron El40 PVC other(explain): (� Distance from private water supply well or suction line: feet l Comments (on condition of joints, venting, evidence of leakage, etc.): l i Septic Tank (locate on site plan): I Depth below grade: feet j Material of construction: ❑ other(explain) ❑ concrete ❑ metal fiberglass ❑ polyethylene — t If tank is metal, list age: yearn Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions' Sludge depth: j e System•page 9 of 17 title 5 Official Inspedion Form:Subsurface Sewag bins•11110 _ - commonwealth of Massachusetts Title 5 official inspection Form Subsurface Sewage Disposal System Form -INot for Voluntary Assessments V � Property Address C-0 ►leg ` Owners Name / ^� r / r own 6 5 Owner � oa information is �S ✓v� ! /�� -- State Zip Code Date o nspe on required for every City/Town page. D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee e or baffle Distance from bottom of scum to!bottom of outlet tee or baffle How were dimensions determined? , outlet tee or baffle condition, structural integrity, Comments (on pumping recommendation's inlet and liquid levels as related to outlet invert, evilence of leakage, etc.): { i j i Grease Trap (locate on site plan): feet Depth below grade: I Material of construction: i metal fiberglass ❑ polyethylene ❑ other(explain): ❑ concrete ❑ +; i 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 irrtle 5 Metal inspection Form:subsurface sewage Djsposal hem-Page 10 of 17 rsim•i v10 i Commonwealth of Massachcrsetts � • official �r�s e�cti®n Form Title 5 offic�a l p Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address j Gm �s / t0 �� Owner Owners Name /) 1 �//J� 0d-6 information is �S �/(/� { Ze, Date of I pedion 'required for every I State Zip Code Me. City/Town D. System Information (cunt:) I Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): -- I j Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): I Depth below grade: Material of construction: 4 ❑fiberglass ❑ polyethylene ❑ other(explain): ❑ concrete � metal j — I Dimensions: f i . Capacity: gallons Design Flow: gallons per day ❑ Yes ❑ No Alarm present. j Alarm in working order. ❑ Yes ❑ NO Alarm level: Date of last pumping: Date Comments (condition of alarm and float switches, etc.): — I f -- f I {. No * h co of current pumping contract(required). Is copy attached? ❑ Yes ❑ Attach copy T*&5 official Inspection Forth:subsurface Sewage Disposal systemPage 11 at 17 t5ins•11110 I. L I Commonwealth of Massachusetts manT itle 5 Official Inspection Form Assaments I Subsurface Sewage Disposal System Form -i Not for Voluntary QA�/vr `/e e— — Property Address Owner owner's Name ^�1 / — � IL �a b information is (,f/J 7�w6 i State Zip Code Date of ped on required for every City i page. D. System informat6on (cons ) } Distribution Box (if present must be op ened) (locate on site plan): Depth of liquid level above outlet'invert Comments (note if box is level and distrib any evidence of solids carryover, any ution to outlets equal, evidence of leakage into or out of box, etc!): I I I — i Pump Chamber (locate on site plan): ❑ yes . ❑ No pumps in working order. I ❑ Yes ❑ No Alarms in working order. Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): _ I I _ i — 4 cat ion site plan, excavation not required): Soil Absorption System (SAS)i(lo If SAS not located, explain why i — Page 12 or 17 rule 5 official Irapadion Form:subsurface Sewage Disposal System• _ P Commonwealth of Massachusetts t Title 5 Official Inispe6, tion Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments o 9 Property Address f112f ./ -- Owner Owners Name Q� / yr / Qa65� 6 information is f e✓ ` i Date f Ins edion required for every i State Zip Code page City(rovm D. System Information (cunt.) Type: 1 — EJ leaching pits number: — (� leaching chambers number: number: leaching galleries leaching trenches number, length: aching fields number, dimensions: � . if overflow cesspool j number. (� innovative/alternative system Type/name of technology: If hydraulic failure, level of ponding, damp soil, condition of Comments (note condition of soil, signs vegetation, etc.): 1 IaG4-s , J GNra l CA,V jVNHG Cesspools (cesspool must be pumped alas part of inspection) (locate on site plan): Number and configuration i Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer , Dimensions of cesspool Materials of construction f. Yes ❑ No. Indication of groundwater inflow Me 5 Ofrroal inspection Form:Subsudam Severe oisposal hem-Page 13 d 17 t5ins•11110 j I t Commonwealth of Massachusetts � official Ir�spe�Ction Form , Title 5 Subsurface Sewage Disposal System Form i Not for Voluntary Assessments r _ Property Address tL_=—l'`�J�s Owner Owner's Name information Q S7�✓�� Me State Zip Code Date o Inspection required for every CitylTown page D. System Information (cont.) Comments (note condition of SORT, signs of(,hydraulic failure. level of ponding, condition of vegetation, etc.): {; i i Privy (locate on site plan): Materials of construction: i Dimensions Depth of solids i Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): — i - fi i 1 i - Form:Subsurface Sewage Disposal SYdOM'Pale 14.of 17 Title 5 Official Inspection. t5ies•11/10 I I I Commonwealth of Massachusetts IBM isff Title 5 official Inspe0ion Form ments Subsurface Sewage Disposal System Form Not for voluntary Assess ,r Ll Property Address � Owner Owner's Name �,//4 j/� ( b�jt� 6information is O I — Date of 1 pedion required for every I State Zip Code page Cr/(Town D. System Information (cunt.) rovide a view of the sewage disposal Sketch Of Sewage Disposal System: P system, including ties to at least two permanent reference landmar the build'%ng Check one of the boxess or benchmarks. Locate )wells within 100 feet. Locate below where p c water supply ente hand-sketch in the area below I ❑ drawing attached separately I ' � e s j� 1 I i ;41 - � a �{ Title 5 official Inspection Forth:Subsurface Sewage Disposal System.page 15 of 17 . t5ins•11110 . Commonwealth of Massachusetts Title 5 Official Inspedion Form sments Subsurface Sewage Disposal System Form i Not for Voluntary Ass Property Address C-0 �--r ers Name ( ,�/� Owner Own OS_(„ /e I �e 0.1 6", informations 1 G Date of Ins on required for every State Zip Code page City/Town D. System Information (cont.) i Site Exam: i I ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells. /� Estimated depth to high ground waterfeet CCC///��� Please indicate all methods used to dete ine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design pl In reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of �ealth -explain: ❑ Checked with local excavators;installers - (attach documentation) ❑ Accessed USGS database - explain: __----- — You must describe how you established the high ground water elevation: W �at✓► I G� / 4/0 --- f /p N✓1 i Before filing this inspection Report, Tease see Report Completeness Checklist on next page. TRIe 5 OffidW Inspection Fonn:Subsurface Sevs9e Dispose,hem'f 9e 16 of 17 t5ins•11110 . a Commonwealth of Massachusetts Title 5 official. Inspe� tion Formsments Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address Owner Owners Name /e, I �,� information is VS-4e✓(//Ile, I �� required for every State Zip Code Date o Inspection page. City/Town E. Report Completeness ChecOist Inspection Summary: A. B, C, D, or E checked Inspection Summary D (System Failure Criteria Applicable to All Systems) completed em Information- Estimated deptf to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I i 1 1 i l Tine 5 official Inspection Form:Subsurface Sewage I Leo.Page 17 of'17 15ins•11/10 t i OSTERVILLE 11f 0 /� f� - BUMPS RIVER R 56 A r\ V I L E o.�,� 5� OF�A .Ep A \/E N U E WAY F \\ 246.75 ft 58 LOCUS 9 \ \ I z \ v `I !II PROP. 1 500G O 1` SEPTIC TANK I LOCUS MAP TH-2& EXISTINGr LOCUS INFORMATION DWELLING / y PLAN REF: 382/19 TOP OF FNDN G % r; TITLE REF: 24692/086 7A. E - 60.30 PARCEL ID: MAP 143 PAR. 006 a IN ESTUARIES PROTECTION OVERLAY DISTRICT 1p 0 1 I a I a s, SEPTIC SYSTEM . REPAIR PLAN I I Ej �Ie i I o ' ° LOCATED AT: S 37 OAKVILLE AVENUE It I o I OSTERVILLE, MA I , PREPARED FOR -�/ ---- f MARIE VINCENTE Ex15t. Ce55p001 \\ (see note I O) JULY 20, 2011 PARCEL 6 AREA = 31542 sf +- 58 ��\ �� OF �Assq �\ I ; 4RR -. No. 1140 PLAN 5� S NITARO�� .I SCALE: 1 in = 30 ft 309 30 60 BENCH MAR TOP OF FOUNDATION ELEVATION — 60.30 9 0 10 -20 30 _ BARNSTABLE OIS DATUM MEYER & SONS, INC. 51.12 ft 4 f 01 P.O. BOX 981 G EAST SANDWICH, MA. 02537 (508)362-2922 q an SHEET 1 OF 2 J 1296 ELEV. TOP FOUNDATION NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS (Existing) FINISHED GRADE (57.80) :z = 60.30 F.G.EL: 58.50 F.G,EL• 59.0 F.G. EL: 57.80 " MAINTAIN 2% MIN SLOPE OVER LEACHING AREA •v 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2" •' STONE OR FILTER FABRIC 4 DOUBLE WASHED STONE 4" SCH 40 PVC tot ®®®®.. p ®®®® @ S= 1% MI MMMUUMMEMOM TEE'S ARE TO BE 14, INV.56.0 e N ®MM®MMMMMOM Y 4 SCH 40 PVC 2 E F. DEPTH MMMMMMM15MMM INV.56.60 INV.55.8 4' 2 X 8.5' 4' j -PROPOSED DB-3 ExlsnNc ouTLET BAF�E EFFECTIVE, LENGTH = 25'- EL.57.21 „ . .:. ... .. . ..... . H-10 DISTRIBUTION BOX INV. ELEV.= 55.00 INV. 56.85 PROPOSED 1,500 GALLON SEPTIC TANK OF MA GAS BAFFLE TO BE . INSTALLED ON ��P� ss9�y BREAKOUT OUTLET TEE AS MANUFACTURED BY D ELEV.= 106.5 TUF-TITE, ZABEL, OR EQUAL TOP CONC. ELEV. 55.50 No. 1140 INV. ELEV.= 55L ®®« p M® ' NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING MMEMMEM . PIPE INVERTS PRIOR TO CONSTRUCTION '�fC�S91T MMMMMMM 2) TANK AND D-BOX SHALL BE SET LEVEL AND TRUE '�4NITAR�a� BOTTOM EL.- 53.00 M M M M M M M TO GRADE ON A MECHANICALL COMPACTED SIX �.� 3.75' 5 FT. 3.75' INCH CRUSHED STONE BASE, AS SPECIFIED IN INS CMR I LET &(z) SEPARATION` 8.10 FT. EFFECTIVE WIDTH 12.5' 3) INSTALL INLET & OUTLET TEES AS REQUIRED SEPTIC SYSTEM PROFILE BOTTOM OF TESTHOLE EL: 44.9 r SOIL ABSORPTION SYSTEM . (SECTION) (500 GALLON LEACH CHAMBER) DESIGN CRITERIA GENERAL NOTES: S O I L LO Ci S P#:13346 NUMBER OF BEDROOMS: 2 BEDROOM EXISTING/3 BEDROOM DESIGN 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL TEXTURAL CLASS: CLASS I (0.74 GPD/SF) BOARD OF HEALTH AND THE DESIGN ENGINEER. DATE: JULY 15, 2011 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DESIGN PERCOLATION RATE: <2 MIN/IN OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE SOIL EVALUATOR: DARREN MEYER, R.S., CSE #1614 LOCAL RULES AND REGULATIONS. WITNESS: DONALD 'DESMARAIS, BARNSTABLE B.O.H. DAILY FLOW: 110 G.P.D. X 3 BR DESIGN FLOW:'. 330• G.P.D. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR GARBAGE GRINDER: NO not designed for garbage grinder) TO DE I GN ENGINEER.NSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE SEPTIC TANK: 330 gpd x 200% = 660 gpd USE PROP. 1,500 GALLON SEPTIC TANK DESI - 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING Elev. TP 1 Depth Elev. TP-2 Depth FROM THOSE SHOWN HEREON SHALL REPORTED TO THE DESIGN 58.00 0" 5690 0" LEACHING AREA REQUIRED: (330) 445.94 S.F. ENGINEER BEFORE CONSTRUCTION CONTINUES. '4 LOAMY SAND � A LOAMY SAND - 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 2 LOAMY AN .74 10YR 3 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 57.00 / 12" 59.32 7" THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF B B USE TWO (2) 500 GALLON PRECAST LEACH CHAMBERS, W/ 4' STONE HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. LOAMY SAND LOAMY SAND ON SIDES & 3.75' STONE ON SIDES: 25' L x 12.5' W x 2'D 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 10YR 5/8 IOYR 5/8 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED BOTTOM AREA: 25 x 12.5= 312.5 SF To A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE 55.17 C 34" 54i.07 C 34" THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D CONSTRUCTION. i' 10. EXISTING CESSPOOL TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. PERC O EL 53.50 MEDIUM SAND MEDIUM.SAND DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 2.5Y 6/4 � . zsY 6/4 PROPOSED SEPTIC SYSTEM UPGRADE PLAN 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. 46.00 120" 44}90 120" 37 OAKVI LLE AVENUE, OSTERVI LLE, MA 14. NO WETLANDS WITHIN 150' OF PROPOSED LEACHING. PERC RATE <2 MIN/IN. ("Cl" HORIZON) Prepared for: Vincente 15. ALL PIPING To BE 4" SCH 40 0 1/8-/FT (UNLESS SPECIFIED) NO GROUNDWATER OBSERVED Engineering b : Surveying b •' 9� 9 Y Y 9 Y: SCALE DRAWN I, Darren M. Meyer, R.S., CSE, "hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 Meyer&Sons,Inc. 1E^co Tech Environmental N.T.S. DMM to conduct soil evaluations and that the above analysis has been performed by me consistent with the PO BOX981 requirements of 310 CMR 15.017." I.further certify that I have passed the Soil Eval. Exam In October, 1999. EAST SANDWICH,MA 02537 (508) 364-0894 DATE CHECKED SHEET NO. 508-362-2922 07/20/11 DMM 2 Of 2