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HomeMy WebLinkAbout0060 OLD EAST OSTERVILLE ROAD - Health E= 145 ast-Osterville �UfRIJ F/R .41 41, a o •',fl. 50 ° " ° •• - , • a . a a o . w e '� g.. a -, •. _ n y , =y ° n p ° s' 0 ,a 0 ° , , II, n .. op `, , � q " . , ° „ 5 � . a e � . , k 0<5 Commonwealth of Massachusetts Nor- 0 �n Title 5 .Official Inspection Form ` a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Old East Rd. T h Property Address ,. h:r Estate of Peter F. Mahoney Owner Owner's Name information is Osteryille �/ Ma. 02655 March 6 2020 required for every page. Cityrrown State Zip Code Date of Inspection !g `x 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. Inspector Information on the computer, Thomas Roux use only the tab key to move your Name of Inspector cursor-do not use the return Company Name key. 89 Mayflower Lane Company Address East Wareham Ma. 02538 Cityrrown State Zip Code 774-678-9066 S14531 Telephone Number License Number B. Certification I certify that)am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000);I have personally inspected the sewage disposal system at theproperty address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Mop— 7, Z© 20 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Old East Rd. Property Address Estate of Peter F. Mahoney Owner Owner's Name information is required for every Osterville Ma. 02655 March 6, 2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 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: 2) System Conditionally Passes: ❑ One or more system components as described in the"ConditionalPass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial'Infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 60 Old East Rd. Property Address Estate of Peter F. Mahoney Owner Owner's Name information is required for every Osterville Ma. 02655 March 6, 2020 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 or replaced ❑Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑Y ❑N ❑ ND (Explain below): ❑ obstruction is removed ❑Y ❑N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if ` the system is failing to protect public health, safety or the environment. I a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Old East Rd. Property Address Estate of Peter F. Mahoney Owner owner's Name information is required for every Osterville Ma. 02655 March 6, 2020 page. Cityrrown State Zip Code, Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water Y P supply well. ❑The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: i 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or ❑ ® clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 I Commonwealth of Massachusetts �n Title 5 Official Inspection Form 1' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 60 Old East Rd. Property Address Estate of Peter F. Mahoney Owner Owner's Name information is required for every Osterville Ma. 02655 March 6, 2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 '/z 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 SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Z Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) 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 CA. 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 Zone II of a public water supply well t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts F .Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 60 Old East Rd. Property Address Estate of Peter F. Mahoney Owner Owners Name " information is required for every Osterville Ma. 02655 March 6, 2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? Z ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Wasthe facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ 0 Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Y 60 Old East Rd. Property Address Estate of Peter F. Mahoney Owner Owner's Name information is required for every Osterville Ma. 02655 March 6, 2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 331.5 gpd Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: approx. 3 months Date l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 I ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 60 Old East Rd. Property Address Estate of Peter F. Mahoney Owner Owner's Name information is required for every Osterville Ma. 02655 March 6, 2020 page. Citylrown State. Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: No information Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 60 Old East Rd. Property Address Estate of Peter F. Mahoney Owner . Owner's Name information is required for every Osterville Ma. 02655 March 6 2020 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 18 years, Design plan dated 7/16/2002. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 3.1' feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: +10' feet Comments (on condition of joints, venting, evidence of Leakage, etc.): t5insp.doc-rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Old East Rd. Property Address Estate of Peter F. Mahoney Owner Owner's Name information is required for every Osterville Ma. 02655 March 6, 2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 2.1 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 81 x 5.67'W x 5.67'H Sludge depth: <1" 'Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 14" Distance from bottom of scum to bottom of outlet tee or baffle 8° How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The water level in the septic tank was about 8"to low. The tank has possibly not filled up from after the last pumping. The outlet of the septic tank has 2 outlets. One goes to an old pit, and the outlet tee goes to a D-Box. (See as-built). The septic tank has risers to within 6 to 8 in. of finished grade. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts 1901 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Old East Rd. Property Address Estate of Peter F. Mahoney Owner Owner's Name information is required for every Osterville Ma. 02655 March 6, 2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: , gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 60 Old East Rd. Property Address Estate of Peter F. Mahoney Owner Owner's Name information is required for every Osterville Ma.. 02655 March 6, 2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes. ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0° Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-Box is in good condition. The D-Box now has a riser, with the cover about 8 in. below grade. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface,Sewage Disposal System•Page 12 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Old East Rd. Property Address Estate of Peter F. Mahoney Owner Owner's Name information is required for every Osterville Ma. 02655 March 6, 2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. PumpChamber locate on site plan): ( P ) Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Since the septic tank and D-Box are both functioning correctly, the SAS is draining. The old pit was dug up. The pit was the original SAS, that failed and was replaced by the 2 chambers in 2002. Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 r Commonwealth of Massachusetts r� Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 60 Old East Rd. Property Address Estate of Peter F. Mahoney Owner Owner's Name information is required for every Osterville Ma. 02655 March 6, 2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): There was no evidence of hydraulic failure for the chambers. The pit structure was the original SAS. The pit is still connected to the septic tank, it was never abandoned. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 6120 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 f Commonwealth of Massachusetts �9 ,�p Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Old East Rd. Property Address Estate of Peter F. Mahoney Owner Owner's Name information is required for every" Osterville Ma. 02655 March 6, 2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 60 Old East Rd. Property Address Estate of Peter F. Mahoney Owner Owner's Name information is required for every Osterville Ma. 02655 March 6 2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately -e �' � ( l �. YU t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 f TOWN OF BARNSTABLE LOCATION i0 �1� 1¢sT vs/: �Y' SEWAGE #��aa2-3GD VILLAGE_ �T� t/�ll= XSSESSOR'S MAP & LOTI r 47J--J INSTALLER'S NAME&PHONE NO Ste$-v20- SEPTIC TANK CAPACITY :0W. ff LEACHING FACILITY: (type)°t-,s A;P 61WI (size) f NO. OF BEDROOMS BUILDER OR OWNER f� li� (�09��o.G•'8�T`/' PERMITDATE: R-/9-o°z COMPLIANCE DATE:— P 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 leadhin facility Feet Furnished by .� i _ n ( i t a fo s , s.r= A +e - fox 3 L'7 . )A +0 L4. j Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 60 Old East Rd. Property Address Estate of Peter F. Mahoney Owner Owner's Name information is required for every Osterville Ma. 02655 March 6 2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: below 10' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 7/16/2002 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: From the design plan on file. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Old East Rd. Property Address Estate of Peter F. Mahoney Owner Owner's Name information is required for every Osterville Ma. 02655 March 6, 2020 I' page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed 8r Dated and 1, 2, 3, or checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6 (Checklist)completed ® D. System Information For 8: Tight(Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 TOWN OF BARNSTABLE l� LOCATION 60 AV 4-114-7T d Si AV SEWAGE # 2 Oat-3G 0 VILLAGE 0 9rg,-y1?X ASSESSOR'S MAP & LOT/VS- INSTALLER'S NAME& PHONE NO.,5'08-1i20-275Y Jo51p4 SEPTIC TANK CAPACITY 10W LEACHING FACILITY: (type) d,-4/ W-514 (size) -1J-X / r NO. OF BEDROOMS BUILDER OR OWNER x—,VIW geoawdo 227i" PERMITDATE: COMPLIANCE DATE: R" 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 facility)�j Feet Furnished byi�a r . 4 s s f l D Fc No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V 00, Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0[pplitation for 35igogaf 6potem Conotruction Permit Application for a Permit to Construct(�epair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.6 17 (910 i�5f 0S X&Y° Owner's Nam Address and Tel.No. Assessor'sMap/Parcel O,TNrif1,�j/% V!¢Ve eAp-pf114 n5 ' D Installer's Name,Address,�nd Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 2 as No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank - e, - Type of S.A.S. _ Description of Soil cz5 R St Cis Nature of Repairs or Alterations(Answer w en applicable)�,i��y"/�f� — Sr04(®!3/, Lj'd '�i__! �'t-�s 94 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signed Date R Application Approved by Q- Date Application Disapproved for the following reasons Permit No. Date Issued -p , �, .. No. a�S.�U .5•,,�.. � a �,fit-•:��e �,,,�:.: �3 Fee r , ' ry a Entered in computer: V y THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ' Z(ppfication for �Di000al *p$tem Congtruction Permit Application for a Permit to Construct e,�Kepair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.G 0 C)I %14Sr OS T Owner's Nam ,Address and Tel.No. Assessor.'sMap/Pazcel 03jr�^V/%//s' Dq�// �14rp/1bJ r/,e r o Installer's Name,Address,and Tel.No. ' r $ Designer's Name,Address and Tel.No. Type of Building: =' Dwelling No.of Bedrooms `_ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building ' No.of Persons Showers( ) Cafeteria( ) Other Fixtures /f Design Flow gallons(er day. Calculated daily flow gallons. a Plan Date Number of sheets Revision Date Title _ Size of Septic Tank 1l,.� Type of S.A.S. r s - Description of Soil Nature of Repairs or Alterations(Answer w / Y1�,G, h f Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signed _ s Date Application Approved by Q. j Z! Date Application Disapproved for the following reasons IF i '* Permit No. Date IssuedI A I �_ ----------- ---------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS a 'Certificate of Compliance THIS IS TO CEVIFY,that the On-si a-Sewage Disposal System Constructed(C- 'Repaired( )Upgraded( ) Abandoned( )by ✓ c a-,—,o / ,rah`.e�S I at 0 t S / i has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer t,Ia1�_4 yi�.�rra�3 Designer *7`/s� ,7y/1i i/,*A The issuance of this permit shall not be construed as a guarantee that the systeon ed. Date 2� - ) 2 Inspector i . f __ _ _ -- _ No. l� � � ------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS I y 5' 0 PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Disspossar 6potem Construction Permit Permission is hereby granted to ConstructS / Repair( )Upgrade Abandon( ) System located at G /o! 503,r 0,9 12. and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction ust be completed within three years of the date of this p/4114it. Date: k — Approved by / TOWN OF BARNST/A'BLE LOCATION GO t�l�,�'Gl4�T f/S%: ' t,��l SEWAGE # _2002--T41,' VILLAGE 1 Yl,6X-16& ASSESSOR'S MAP & LOT/rl� INSTALLER'S NAME&PHONE NO.,ng- IY24-975,7 SEPTIC TANK CAPACITY r' LEACHING FACILITY: (type)!�-5� K 6Av My61.r�� (size),2..5-X NO. OF BEDROOMS BUILDER OR OWNER ,,a—w;, ad 7z-, PERMITDATE:_ -�90®�, COMPLIANCE DATE: .��g 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 facility Feet Furnished by s A, s r FAILED INSPECTION COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS W DEPARTMENT OF ENVIRONMENTAL PROTECTION W o- O,,M s�0v 1 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORry RECEIVED ' PART A CERTIFICATION JUN 2 7 2002 Property Address: 60 OLD EAST OS�T ERVILLE RD OSTERVILLE,MA 02655 P Y a TOWN OF BARNSTABLE Owner's Name: CARPENTER HEALTH DEPT. Owner's Address: PO BOX 601 N. DIGHTON MA 02764 Date of Inspection: 6/10/02 Name of Inspector: (please print) � JOHN GRACI MI14P 145 Company Name: SEPTIC INSPECTIONS 41C PARCEL Mailing Address: P.O. BOX 2119 TEATICKET, MA.02536 LOT Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT 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 tin e of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340,of Title 5(310 CMR 15.000). The system: Passes lk' _ CondlFurt" sses: Needvaluation by the Local Approving Authority X Fails Inspector's Signature:. Date: 6/10/02 l3 The system inspector shall submit 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:he report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent toile buyer, if applicable, and the approving authority. . s Notes and Comments SYSTEM FAILED TITLE V INSPECTION. STAIN LINES INDICATE LEACI I PIT HAS BEEN FULL OVER PIPES. LEACH PIT HAS SOLIDS ON::PIPE AND STONES ARE BLACK. ****This report only describes condifions at the time of inspection and under the conditions of use at that time.This inspection does not address how-4the system will perform in the future under the same or different conditions of use. ViA.. Title 5 1ncr�rrtinn Pnrm (,!I S/?(1(l/l's''`'_ 1 t a• ti Page 2 of OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 60 OLD EAST OS.TERVILLE RD OSTERVILLE, MA 02655 Owner: CARPENTER Date of Inspection: 6/10/02 Inspection Summary: Check A;B,C,D or E/ALWAYS complete all of Section D A. System Passes: _ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM FAILED TITLE V INSPECTION. STAIN LINES INDICATE LEACH PIT HAS BEEN FULL OVER PIPES. LEACH PIT HAS SOLIDS ON PIPE AND STONES ARE BLACK. B. System Conditionally Passes:`t:1 _ One or more system component§as'described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or_repair, as approved by the Board of Health,will pass. i Answer yes, no or not determined(Y,N,ND) in for the following statements. If"not determined"please explain. years`old* or the septic tank(whether metal or not) is structurally unsound,exhibits n/a The septic tank is metal and over 20 substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years�old is available. ND explain: n/a n/a 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): ' brokeni.pipe(s)are replaced _ olis.truction i1"removed distribution box is leveled or replaced ND explain: n/a n/a The system requiredpumping°rnorethan 4 times a year due to broken or obstructed i e s . The system will ass Y Q .'�. , s' Y ppO Y P inspection if(with approval of the Board of Health): _broken.pipe(s)are replaced _obstruction is removed k ND explain: n/a Page 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r r. PART A _. CERTIFICATION(continued) Property Address: 60 OLD EAST OSTERVILLE RD OSTERVILLE,MA 02655 Owner: CARPENTER Date of Inspection: 6/10/02 C. Further Evaluation is Required by the,Board of Health: Conditions exist which require further-evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board'of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner+which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet clew, bordering vegetated wetland or a salt marsh r t� i 2. System will fail unless the Board of Health (and Public Water Supplier,'if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water'.supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank ana 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 n/a "This system passes if the weljl'water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds`indicates'ttat 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. 3. Other: n/a ' �s .,t ',13 Page 4 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 60 OLD EAST OSTERVILLE RD OSTERVILLE,MA 02655 Owner: CARPENTER Date of Inspection: 6/10/02 �.�:�; t,, },V D. System Failure Criteria applicable to all systems: You mast indicate"yes"or"no"to each of the following for alLinspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluer.i to the surface of the ground or surface waters 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 less than 6"below invert or available volume is less than %2 day flow X Required pumping more thanA times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped NO PUMPING INFORMATION. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X 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 Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water 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,co,liform bacteria and volatile organic compounds indicates that the well is free from pollution from tliat?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:) ' X _ (Yes/No)The system fails.,rhave' determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. .y; E. Large Systems:. ;. ,S To be considered a large system ttie'system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200,feet of a tributary to a surface drinking water supply I,0a X the system is located in a nitroger.sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply,well If you have answered"yes"`to y.q'anuestion in Section E the system is considered a significant threat,or answered "ycs" in Scctiun D above the lorgc syslcni,lias failed. The owner or operalor orally large y;'(em cowlidered a!dgoilicnnl Ihrenl under Section E or failed undei`Scction Dshall upgrade the system in accordance with 310 CW 15.304. The system owner should contact the appropriate regional office of the Department. ' n Page 5 of 1 1 a OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE',SEWAGE DISPOSAL SYSTEM INSPECTION FORM f, ,t PART B CHECKLIST Property Address: 60 OLD EAST_;OSTERVILLE RD OSTERVILLE, MA 02655 Owner: CARPENTER Date of Inspection: 6/10/02 Check if the following have beengdone..You must indicate "yes" or"no" as to each of the following: Yes 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 Has the system received normal flows in the previous two week period? t X Have large volumes of water,been.introduced to the system recently or as part of this inspection? X Were as built plans of the`syste'm obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out'? X _ Were all system components,excluding the SAS, located on site? X _ 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? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems''`' t . ' 1 The size and location of_the Soil Absorption System(SAS)on the site has been determined based on: Yes no X _ Existing information.For example,`a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.30;, )(b)] - tit i t ite `c Page 6 of I 1 s? OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 60 OLD EAST OSTERVILLE RD OSTERVILLE, MA 02655 Owner: CARPENTER Date of Inspection: 6/10/02 + FLOW CONDITIONS RESIDENTIAL ; Number of bedrooms(design):1i;,Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR' 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage systei ,ftes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years`usage(gpd))� U U 31 t C)C)Sump pump(yes or no): NO Last date of occupancy: 12/31/01 COMMERCIAL/INDUSTRIAL Type of establishment: n/a 1. 1 I Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no):!NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5'system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a' OTHER(describe): n/a <,,GENERAL INFORMATION Pumping Records "'`�' Source of information: NO PUM'PING INFORMATION Was system pumped as part of the'in�spection(yes or no): NO If yes, volume pumped: n/agallons--'How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil tabsorption system _Single cesspool _Overflow cesspool _Privy a _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a < Approximate age of all components,dateinstalled(if known)and source of information: 1982 BY OWNER Were sewage odors detected when arriving at the site(yes or no): NO ;;din•s. �• ;!1 A Page 7 of 1 I s OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 60 OLD EAST OSTERVILLE RD OSTERVILLE, MA 02655 Owner: CARPENTER Date of Inspection: 6/10/02 BUILDING SEWER(locate on site plan) Depth below grade: 30" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER i SEPTIC TANK: X(locate on site plan) Depth below grade: 24" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is,-age confirmed,by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8' 6" H 5'7111W 4' 10',"' Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 8" Distance from top of scum to top of outlet tee or baffle: 4" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage. etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:_(locate on site plan), Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations,,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,-etc.):. n/a k h ri. , r 7 fk Page 8 of I I ti OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 60 OLD EAST OSTERVILLE RD OSTERVILLE, MA 02655 Owner: CARPENTER !, , Date of Inspection: 6/10/02 ' of TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day r Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:_(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a 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.): n/a I, PUMP CHAMBER: _(locate on.site plan) Pumps in working order(yes or no). NO t Alarms in working order(yes or no):NO Comments(note condition of pump charmer, condition of pumps and appurtenant es, etc.): n� n/a .bt t , t Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION continued Property Address: 60 OLD EAST OSTERVILLE RD OSTERVILLE, MA 02655 Owner: CARPENTER Date of Inspection: 6/10/02 { t SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): LEACH PIT FAILED. STAIN LINES INDICATE PIT HAS BEEN FULL OVER PIPES. PIT HAD 2' OF LIQUID IN IT AT TIME OF INSPECTION.THERE ARE SOLIDS ON PIPE AND STONES ARE BLACK. BOTTOM OF PIT IS AT 10'. CESSPOOLS: (cesspool must b'e pumped'as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a F Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan)'` 'tA Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a s , ids S: Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 60 OLD EAST OSTERVILLE RD OSTERVILLE, MA 02655 Owner: CARPENTER Date of Inspection: 6/10/02+ SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 1 N ct t 1 ✓ AC �Y 4z �riS e ,, Page I I of l I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C . ; SYSTEM INFORMATION(continued) Property Address: 60 OLD EAST OSTERVILLE RD OSTERVILLE, MA 02655 Owner: CARPENTER Date of Inspection: 6/10/02 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet. Please indicate(check)all methods used to determine the high ground water elevation:. NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established,the high ground water elevation: HAND AUGER- 12+FT. y l .F i41 l � Nd�-4.. Finc............................. THE COMMONWEALTH OF MASSACHUSETTS BOARWDF .......... -L.T.-H.............................. Appliration for Dispaual Work owitrurtion Prrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal em .............. ... t........ .......................V. .... .....................*7. --- . ............ .... ..... ...... I�t------------ .............. Loc i - ddre, Z .. . . ..... ...... .... ........... .......... .......... OW Addr s, ....... . ... ... .......... ................................... ......... . .............. ------- ....... Installer �kddress Type of Building Size Lot . ........2�... feet U Dwelling—No. of Bedrooms:__.___ ................---------Expansio Attic Garbage Grinder (4/17 P4 Other—Type of Building ............................- No. of persons__.............._._._ Showers Cafeteria 04 Other fixturt5- - -----------_--_----------------------------------------------------- . ............... .................................... daily flow......5.�75,6 ................ ....gallons. Design Flow...................2-5 --------------gallons per person per day. Total 1:4 Septic Tank—Liquid capacity&I"._gallons Length................. Width._-.._.._._..... Diameter._._............ Depth...._........... Disposal Trench—No..................... Width..._.........._.._._ Total Length___.........._...._. Total leaching area.....................sq. f t. Seepage Pit No.--_________________ Diameter.._.__.......:...... Depth,below inlet.................... Total leaching area..................sq. f t. Performed by--_------ D z Other Distribution box Dosing to Percolation Test Result t ............ 1,72Y------------------- ... ..... ate... S2_ Test Pit No. 1................minutes per inch Depth of Test Pit._1.2_- . Depth to ground water_. Test Pit No. 2................minutes per inch Depth of Test Pit..............7.......Depth to ground water...................____. P4Soil-- ............................................................... Description of S --- .................................................................................... 0 - ............... ................................................................................................... U .................. ............................................. --------------------- --------------------------------------------------------------"----------------------------------------------------------I-- ---------------------------------------- -------------------- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... .............................................................................I..............................................................I............................................................ 'Agreement: The.undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with I T d.f rther agrees not to place the system in the provisions of= !E 5 ofthe State Sanitary Code The under u under er u ' r "r"' t operation until a Certificate of Compliance has been ed by the r f health. ---7 ig d.... .... ................. ...................... ............................ ........... .. .............. ApplicationApproved By.... ....... ....... .......................................................................... ..... .... ... .... ......... ...... Date Application Disapproved or e followilowinn g reasons:.............................................................................................................. ........................................................................................................................................................................................................ Date PermitNo..................................---------------------- Issued....................................................... Date IdL No.cipp i!f `.... ` Fss........................... THE COMMONWEALTH OF MASSACHUSETTS BOAeR[ F Appliratinn for Disposal Work nntrnrtinn ramit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System-at: .._ Li ...._... ----- ---- ... ddres Lo............. � a' LoActi _ ... .. a.._, �R ? ..---•..- C�_ "fix... `�� . . --- ow Address -- ---------_---------------- ....... ....-••• . ��` . -------�---------- Installer Address // d Type of Building Size Lot._I__77 .....Sq./feet U Dwelling—No. of Bedrooms---____ (4_____Expansio Attic Garbage Grinder V Other—T e of Building No. of persons________ ________________ Showers Z Cafeteria Q' Other fixtur __._. ------------ ----- - w Design Flow.................. , ------------gallons per person per day. Total daily flow....... :__ �Jgallons. WSeptic Tank—Liquid capacity/0*._gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length...................."Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing to ( / aPercolation Test Results Performed by.____.___._ ._ '. ! _ _____,____ Date.__1.7.1 Test Pit No. L__________ _minutes per inch Depth of Test Pit-----/_2....... Depth to ground water...A1044,,,_- (i Test Pit No. 2________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of Soil..-Alt- --- id .... --------------------------------------------------•--------------------- x �., ----- w UNature 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 TITLE 5 of the State SanitXed Cd The unders• d further agrees not to place the system in operation until a Certificate of Compliance has by the b rd f health. ign •Applica.tion Approved By..-- --•• • !`-'......................................................................... -_---��••. ............... Application Disapproved r e following reasons______________________________________________________________________•__________._._.__.._...___________________ --•------•-•--•-••-----------------•-•-•••••-••••-•_••---•-••-----•-•---•--•--••-._......._..-•••----••--•---•-•----•-•.._..----••-•------...--••••-------•••-••••••-•••-•-•_-••---•----•---•••--------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOA F H E TH P-�................:..OF..... �j/` ..... . . _._............................_... T 05rrfifiratr of ( ompliFanrt THIS IS TO TIFY,VThe Indivi Sewage Disposal System constructed, or Repaired ( ) by-•...................••••-__ G .[.Si.. --•'� -- s Iler �'y � .. at--••-•----••--•---••-•-•-•••-•-••-- ----• ................. -- -----' r has been installed in accordance with the provisions of T TIE 5 f he State Sanitary Code d ribed in the application for Disposal Works Construction Permit No. _'^ ______________ dated_--. .._ ".:_. ....____.____ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSYRU AS GUARANTEE THAT THE SYSTEFA WNI F�CTION SATISFACTORY. DATE.... ..°�_ 1_._d.' _._........ Inspector... _.. ��`'� THE COMMONWEALTH OF MASSACHUSETTS D F T "��..:....8 OFRY!"004LTk ........................... .-�a 1 No. ---•�=-r-----..... _ FEE. Maps nrkV vui r n an it Permission is hereby granted_______ : . �1 __ to Construct ) or epair ( ) Indivi al SeVe Disp ystem at No. � .: Street as shown on the/applicaion for Disposal Works Construction Permit No_____________________ Da f DATE--••- -•----•-•-----••--•-•--•--•••••••-•----•---• B r'd of ealth FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M A�C(, C DATA r �( - g �.tzQ oM GwNpEcz: Ito x 3 = 33 o G.P P TASK = 33ox15oi% =a4 y6•P. o u5E- loon GA%-. t '12.1a oSAL PIT uSE ►vo0 GAt_. -g�- _ ►�q S►DG.vdAt.L A2CA �O $.F 9 Z•j� r 37 (�,PQ BOTTOM AREA° . jro �F, r /Yo/' 6 t8 S.R x I• c0 -ToTA 1- D E51GN = 14.2 rj -roTAL- PAIL-Y F%I = 330G?o e. 20 a ,' j PE2CoL.ATtow RATE] I"w ZMIN or,-LE55 A � -m N 44. / I) '• To prE 28 � 41ALAN 44 II I' MCHARDA. �. N i b BA TER H 1 E ST�rL.\/{L-1.� No.2a048 N 4 Q/STE�ypQ' h� sua�� At � 4f ToP FWD=So 1•lot_rc FG d8 'A'�9 •Y� LoA.H �, loov- jwq. iDIST• INS. GA1.. 4&S�tSai.. 50-A SfiVTIG Z' Joao J tJ� L1L�G TAW K Gat.. 4 L,o LEAcu 4• PIT INV. INY,l `,� w I T tJ �' Z 46.4 cp •Sp,�. WA546D 6TvN6 GEQTIFtGD PLoT PL�►►J PRoPILr--- L0 A-TIoN 3G /Z� NO 5GALE 5C-ALE 'IL GO .. VATE \v- Z"I-$2 o K/4 TE2 I�2pt�`j�D P 1•-A 1�.1 R E P E 26 W,C er G E QT►F Y 'T H AT or 1+E FO V J.I���T101J 61"O WN �r q NERI. ►•1 G oOM?LN?5 WITH- AS S I oEL1N E 1 AWD 9.6QU%9-EMENT!51 ZoWN IS NoT� 1...A1.1ij LOCiNMED WITNI T .E F cp LAIN t>A-r .L�_7L�- M BAx Ecze NYE INC. -T EQ�� v�N I,S u ilv EYb`es i REGIS I� u L&KI Ili KI T g�S�D o0d AN ®sTG2.VILI-Er • M{as5. T IS P �I Iu5R- TutAew1 5vevGY -rN D E PF'SETS 6u0u0 APPLI�AN r �ALISIDL, �JILDI�Jie _. NOTE: Topography is From T.O.B. G.I.S. OTESS. � � a 1. Water Supply For This Lot is Municipal Water 2. Location of utilities Shown on This Plan Are Approx. _ At Least 72 Hours Prior.to Any 1!-avation For This Finish Grode 1'TL Project The Contractor Shall Make The RequiredNotification to Dig Safe(1-888-344-7233) � ' iFllter3. The Contractor is Required to Secure Appropriate Fabric Cornpocled F111Permits From Town Agencies For Construction Defined by This Plan eu I/2a 4. Install Risers to Within 121,of, + Peo St" Finished Grade M /� T� 5. All Structures Buried Four Feet or Nlore or Subject/ 11` !�J OSO To Vehicular Traffic to be H-20 Loading. Leaehinp 6. SepticSystem to be Installed in Accordance With aChamber 3/4�—1 1/20'L� ( SIZ310 CNIR 15.00 Latest Revision:nd:The Town of Double Barnstable Board of Health Regulations 4—t0'�j� �� 7. All Piping W be ScIU40 PVC r2• If Encountered Remove&Replace �r All unsuitable Soils Within 5'of the Y Outer Perimeter of the System. n� CROSS SECTION OF CHAMBER \, NOT TO SCALE. p PRoPosED D-1�x • + R7=mom_-n Vie; a3Ai`�oN6� i — t . O ! N F.G. c c i F.G. - - TI x+STiN6 IG'COt�+� : L TAN ->-z e. .� K EA.t_'.NS uCc to00 Gallon. — p 4c r £ a.� Septic Tank To E!. I De C'>4 - st'ii I Bedding as ` +� A ! Per Title 5 I �j DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM F;^M Ty-5 -Xp DW-LUNG { �', / L4 Not toScole Design Data TEST HOLE -1 EL. 48 OF Single Family-3 Bedroom 1" LEAVES 8 TWIGS 47.9 With NO Garbage Grinder A LAYER 1.OYR 3/3 DARK BROWN Daily Flow=110 x 3= 330 GPD SWIVA111 y, Septic Tank:330 GPD x 200%=660 GPD 3 LOAM 47.75 No.29733 3 / Use Existing 1000 Gallon Septic Tank CNIL B LAYER 1'OYR 4/2 d ' - DARK GRAYISH BROWN Leaching Area 13" FINE SAND 46.9 a- 330 GPD 1074=446 SF Required C1 LAYER 10YR 4/6 N L --�" Sidewall=2(12'+.25')2= 148 SF DARK YELLOWISH BROWN / 4 Bottom Area= 12"x 25'=300 SF 31" FINE SAND 45.4 i 448 SF Total;Provided SITE PLAN C2 LAYER 10YR 5/8 YELLOWISH BROWN PROPOSED SEPTIC UPGRADE i Leaching Chamber Design 40" MED. SAND/SOME GRAVEL- 44.67 All Pipes to be Scti�edule 40. Use C3 LAYER 2.5 Y 6/6 AT 2-500 Gal. Leaching Chambers in a OLIVE YELLOW / 12'x 25'Washed'Stone Field as Shown. 96, MED. TO COARSE SAND 40.0 60 OLD EAST ®S'I'ERVILLE ROAD C4 LAYER 2.5 Y 6/6 OLIVE YELLOW OS'I,ERVILLE A� �: - / _ �T t FINE TO MED. SAND BY ' n,�T E . —� +— I SCALE: t, — ®t 120" NO GROUNDWATER ENCOUNTERED 38.0 APPROX.GROUNDWATER EL.t, SULLIVAN ENGINEERING OSTERVILLE, MA- . DATE: JULY 16, 2002 �.REv+sr�+v I USC EX�s:i�:: �% ':.. -'Ar�'•c _ -'Z� ..,_ '