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HomeMy WebLinkAbout0379 PARKER ROAD - Health 379 (aka 329) Parker Road Osterville A= 115 - 022 I Wioki4xm nn — GoI�6u- MIE, O BARNSTABLE 'eCgr �Y01_VCU SEWGE#o6 LOCATio « \ O 4 VILLAGE 0 5etCJt e ASSESSOR'S MAP&PARCEL //,5 o�Z c� INSTALLER'S NAME&PHONE NO.Z JQ r_CJ ,s r,_r- sog•ya8-Sti(q SEPTIC TANK CAPACITY (SOO G�, ffact oa- 4 `& LEACHING FACILITY:(type) Ob 6 C Y Ca (size) %a /O v X o2S NO.OF BEDROOMS /11A OWNER W4VIJO C k \ PERMIT DATE: '3 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 leaching facility) Feet FURNISHED BY 19 j i379 per Rd bvI ih N��^�-P�nnu ✓��CJ��1�Y�S 9 or = CATJON `� SEWAGE PERMIT NO. VILLAGE INSTA�LLE`R'S NAME !i ADDRESS OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED r ,Y TOWN OF BARNSTABLE - LOCATION W t M 0 GOI_/— - COU2 S O- SEWAGE # �-- VILLAG ASSESSOR'S MAP & LOT a INSTALLER'S NAME & PHONE NO. % SEPTIC TANK CAPACITY LEACHING FACILITY:(type) G e ,� �,`� (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER 1)AV etj enA.7' /,3 U C; 0 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: ZC9 VARIANCE GRANTED: Yes No � - C16 ? kc 3 7 ' � .� 72 ' - .D -a- L �. [ r q� t II� - TOWN OF BARNSTABLE LOCIE �QVIUVA, 3p�—I PA(kt.,/ �� SEWAGE# VILLA ASSESSOR'S MAP&PARCEL402�3- INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY V50. Imo, AL — /(a 6(ox LEACHING FACILITY:(type) (size) �//��snAL NO. OF BEDROOMS OWNER PERMIT DATE: 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 leaching facility) Feet FURNISHED BY �n3�e,J�itY� FCi v � 1 y p a. 3- y 60 sy , yy -7 TOWN OF BARNSTABLE Loi ATIO?'; 3�°t P�rk�/ Ave SEWAGE # 41 VILLAGE O S7 G lVA, - ASSESSOR'S MAP & LOT - Oa;- INSTALLER'S NAME&PHONE NO. 1_ SEPTIC TANK CAPACITY low 6i�tc- 41rA -5cA , LEACHING FACILITY: (type) S' �X�� e,!.r (size) 6d 9"STOOL NO.OF BEDROOMS BUILDEROROWNER WIAAAD 60 tr CIQ� PERMIT DATE: 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 leaching facility) Feet Furnished by /1SUri PA 7. Di E �, 53 0 No.._...... _t`G�5 : �.' Fims...41 esC7........ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH � .`' ........OF..... �/ ----------------------------------------- A#Vftrafiou for Elhipoii al Worka Toutitrurtion famit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ® ..................-......-=/,.......- SLica.P... 1.- /�or....... ....... -... .. ...._....... .. .._.. Loca��ioyy-,,,� rees t No. I / pt,¢ Idd�� �+-.� S�Q y��Por Co�Y ......................_.. ...-• ��'- ,1- __............ T.T.. .... ............................................./ ner / m dry,- a 19r , ,R l[,� ........................... .........................................................DSO Gli���i y'1 �T, --- ................... 14 Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms........ ................._.............Expansion Attic ( ) Garbage Grinder ( ) Pk Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures --------=--------------------•-•. ... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity/ .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 ( ) a Dosing tank ( ) aPercolation Test Results Performed b ...................... . . . ...._____.__.___.___.. _._ Date................._ Test Pit No. L_______________minutes per inch Depth of Test Pit.................... Depth to ground water"`?..------------------ 44 Test Pit No. 2________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q+' `._.. •-•------......................................................... O / Description of Soil--•---------`--::„.::...�!h��f�--•--41.:...��"A��--------------------------------------------------------------------------------------------- U -----=•---•----•---------•-•-•••..........::..........•-•-•---.._.._.._•-•-----------.......... W ---•----••----------------------------•-•--•--------------••---•- ••---•----•------•------••-• --•------------•-•. j U Nature of Repairs or Alterations Answer when applicable_..___ttift/. . ______d � __ �� da- � p --------- ........... Agreement: - The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of L I'i!Z- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b issue by the board of lth. Signed...... -- ----•--•--•--•-•=! ! ._...I...... Date Application Approved BY - � /!.-/�r- "--•-------- Date Application Disapproved for the following reasons-------------------------------------•-------•-----------------------------------------------•--•-----........._ -------------------------•----------•-----•-------...--•-------...._.....--------•-•----•--•---•--..._...._...•.--..•.--..-------•----------------------------------------------•-•---•-•--•-•------_..._ Date PermitNo......................................................... Issued-....................................................... Date No..........$- �--e7/5 f y ,.F�s.. ,......` .�......... THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH vx............OF".. —¢. ,/f ApplirFation for Uhgppii al Works Tong rnrtiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ----------.. Location-Address or Lot No. .............•--------. ._. W�✓d ---•-----._ 4.0.eo�...., -... .� 7' '�f+q;i'..................•-------•-- ��+f9'....�*�•��-7F'ytlddress 1 a ...........•........._.. .__._. ,5`P.._r & :t .3]t.... 1,�, r���,�a ...... / q - !� O1n�taKef�- y,----.....--••---•---•-------•- Address Q Type of Building Size Lot............................Sq. feet Dwelling No. of Bedrooms......... _Ex anion Attic Garbage Grinder p� Other—Type of Building ............................ No. of,persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ----.....--•••-••--••--••••..... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity./w 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 tank ( ) Percolation Test Results Performed by-- --------------------- .............. -.----------------- Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................ G4 -- ----------------------- -- / ----------........................................................ Descriptionof Soil -a`#! f'--------------•---•--------------....-------------------------•---------•........--•---. U ............................. ......•-•••-•-----........_-------•--.... .......------....-------------•-----•-•--------------------....-------------•--••---•-------...........----•---••••-•-•••--- W Nature of Repairs or Alterations—Answer when a licable._..---. �t d! P - d U P PP y/-- �............a�/ o -----------------------------•---•----•----•----•-------------•--------•--•--------...-------------------------•_ ?-` Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE, 5.of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b issue by the board of h lth. If Signed...... ... • . _.. .... !Q-- f...._L Date Application Approved. By-••-•-•••-••-•----•---------•••-- .� 1�......„i"•'�. - --•-- Date Application Disapproved for the following reasons---------------•--------------------------•-------------------••-----------------•---••-••--••----••••---•••••... .......................................................•--------••---•-•------------------------------•-- -------------------------•------••----•---•---------------------------------------------•-•--- Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... . .............OF..... .. ... ............................................................ Qurrtif iratr of Tomph atta THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired (w) by-----------------------ja_4-4. .....A.-44#...------------......----------------•------------------....----............•.......------------........._.......... ------- Installer has been installed in accordance i the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-------- dated..........:..................................... THE ISSUANCE F THIS CERTIFICATE SFIALL NOT BE CONSTRUED�ASA ARANTEE THAT THE SYSTEM VIIILL UN ION SATISFACTORY. , DATE.....1`'../� `"--- ----------•-••-- --.---.--•----------------------------------•- Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........74.g4ep.............OF........ r. B.fis t.3/erg Z.0..................................... r� No.._..--''..--.-elf • FEE..... ......... Disposal Works IL-5nn�#rnr�ilaat �ernti� rt Permission is hereby granted...........J,o4 ._____ ____. - t .._:._...__ . to Construct ( ) or Repair ( 4,),.,an Individual e age Disposal Syst atNo................... Street as shown on the application for Disposal Works Construction Permit No..................... Dated................... v DATE......................................... • Board of Health r' FORM 1255 HOSES & WARREN. INC., PUBLISHERS -�--- i cam,, Commonwealth of Massachusetts 1/5r 6 a Title 5 Official Inspection Form ( Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r_ v � 59 Washington Ave Property Address - r,a Wianno club "dormitories" ' Owner Owner's Name information is required for Osterville Ma 02655 11-4-19 every page. City/Town State Zip Code Date of Inspection C1 r` 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. Impo a"t When A. Inspector Information When filling out P s14f j Lfa(a,.. forms on the computer, use Douglas A Brown only the tab key Name of Inspector to move your D.A.Brown Inc cursor-do not Company Name use the return key. P.o Box 145 Company Address Centerville Ma 02632 City/Town State Zip Code 508-420-4534 S14297 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property 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 -��� & 11-4-19 InsKctors 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 �n l Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 59 Washington Ave Property Address Owner Wianno club "dormitories" information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. City/Town 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: system met or exceeded all passing requirements at time of inspection. 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): l5insp.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 I' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments l; 59 Washington Ave Property Address Wianno club "dormitories" inform Owneration is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Cityrrown 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. 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 I� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments L 59 Washington Ave Property Address Owner Wianno club "dormitories" information is Owners Name required for Osterville Ma 02655 11-4-19 every 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 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: 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 Commonwealth of Massachusetts lip Title 5 Official Inspection Form /I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v � 59 Washington Ave Property Address Owner Wianno club "dormitories" information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Cityrrown 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 'h 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. ❑ ® 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 11 of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts �e lip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 Washington Ave Property Address owner Wianno club "dormitories" information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Cityrrown 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 aH 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? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. El ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 Washington Ave Property Address Owner Wianno club "dormitories" information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3260 gpd Number of bedrooms(actual): see attached plan DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: see attached design plan Number of current residents: 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: separate documentation for water usage supplied by Wianno Club Sump pump? ❑ Yes ❑ No Last date of occupancy: seasonal mostlyDate t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -,Not for Voluntary Assessments L 59 Washington Ave Property Address Wianno club "dormitories" inform Owneration is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: dorminatory Design flow(based on 310 CMR 15.203): 3260 Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): dormitory 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: Facilities manager states yearly pumping Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: maintenance 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 L 59 Washington Ave Property Address Wianno club "dormitories" inform Owneration is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Cityrrown 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): pressure dosed system Approximate age of all components, date installed (if known) and source of information: plan date jan 14 2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts �n l Title 5 Official Inspection Form (/ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4' 59 Washington Ave Property Address owner Wianno club "dormitories" information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 3 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: 10,000 2 compartment Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was functioning properly at time of inspection All tees were in place. Tank is on regular maintenance schedule. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments L; 59 Washington Ave Property Address owner Wianno club "dormitories" information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Cityrrown 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 Commonwealth of Massachusetts �d - IF Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 Washington Ave Property Address Owner Wianno club "dormitories" information is Owner's Name required for Osterville Ma 02655 114-19 every page. City/Town 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 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.): I t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts �e Title 5 Official Inspection Form f I° Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 59 Washington Ave Property Address owner Wianno club "dormitories" information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No* Alarms in working order: ® Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * 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: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 4428 sq ftpressure dose Eloverflow 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 Commonwealth of Massachusetts �n Title 5 Official Inspection Form (/ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4' 59 Washington Ave Property Address Wianno club "dormitories" inform Owneration is Owner's Name - required for Osterville Ma 02655 11-4-19 every page. Cityrrown 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.): 4428 pressure dose field. s.a.s appeared to be functioning properly at time of inspection with no signs of failure. 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 Washington Ave Property Address Wianno club "dormitories" Owner information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Cityrrown 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 I Commonwealth of Massachusetts �m I9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 59 Washington Ave Property Address Wianno club "dormitories" Owner information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. City/Town 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form ° Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 59 Washington Ave Property Address Wianno club "dormitories" inform Owneration is Owner's Name - required for Osterville Ma 02655 11-4-19 every 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: see attached design plan 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: attached 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: attached design plan 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 Washington Ave Property Address Wianno club "dormitories" Owner information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. City/Town 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 & Dated and 1, 2, 3;or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 Failure Criteria) n h( C e a) and 6 (Checklist) completed ( ) p ® 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 FO iW 3q W O Jg -moo r-�e Ir I Ills A q $I = - c9ww F 8 1 a gg g 5 e ai E R 1108 a psi €Fhi a Y gdpgi@ a §§j opF i g`�3 �&. ����� WHN51HU 1 1 9! DUMP 3 � s�'e�r��93«�_k�ub>�� 1 g 'ak#F p ii d w \ ,'a :. t Ads aie I Ei6� F: gs XX �ypgg.` pj 71m �? •+_ A'E � i�-2f �� �i� � �m � - � E F �� I^ate -� �}�a^+ :,��� saaaas b _. — I I w _77- I ' I - -------- 'I pm I (.L 3 ,796 i i f 1 Commonwealth of Massachusetts l Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 91 Bay St Property Address n Wianno Club (golf course rest station) ; Owner Owner's Name t information is +. required for Osterville Ma 02655 11-4-19 1.1 every page. Cityrrown State Zip Code Date of Inspection i- Inspection results must be submitted on this form. Inspection forms may not be altered iritany way. Please see completeness checklist at the end of the form. Important: A. Inspector Information cS 3l7 When filling out p / forms on the computer, use Douglas A Brown only the tab key Name of Inspector to move your D.A.Brown Inc cursor-do not Company Name use the return key. P.o Box 145 Company Address Centerville Ma 02632 City/Town State Zip Code 508-420-4534 S14297 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property 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. ❑ Fail f 11-4-19 ���oes&gr�ature 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 DER 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 r r cam, Commonwealth of Massachusetts �d l.? Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^ � 91 Bay St v Property Address Owner Wianno Club (golf course rest station) information is Owner's Name required for Osterville Ma 02655 114-19 every 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: system is not yet 2 yrs old and sees very little usage. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/2 12018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts r� l Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s � 91 Bay St v Property Address Wianno Club (golf course rest station) inform Owneration is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Cityrrown 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 FIND (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 FIND (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. 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 v 91 Bay St Property Address Owner Wianno Club (golf course rest station)information is Owner's Name required for Osterville Ma 02655 11-4-19 every 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 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: 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 J Commonwealth of Massachusetts �u �F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 91 Bay St V Property Address Wianno Club(golf course rest station) inform Owneration is Owner's Name required for Osterville Ma 02655 11-4-19 every 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 'h 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. ❑ ® 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 91 Bay St Property Address Owner Wianno Club (golf course rest station) information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Cityrrown 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? ❑ ® Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® 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 �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 91 Bay St Property Address owner Wianno Club(golf course rest station) information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: Number of current residents: 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 information in this report.) ❑ Yes ❑ No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts IF Title 5 Official Inspection Form /// Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4' 91 Bay St Property Address Owner Wianno Club(golf course rest station) information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: golf course rest station Design flow(based on 310 CMR 15.203): 330Gallons 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: Wianno Club is providing all water usage documents Last date of occupancy/use: mostly seasonal Date Other(describe below): 3. Pumping Records: Source of 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 91 Bay St Property Address Wianno Club (golf course rest station) Owner' information is Owner's Name ' required for Osterville Ma 02655 11-4-19 every page. City/Town 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: 12-14-17 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 ,4N�, Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 91 Bay St Property Address Owner Wianno Club (golf course rest station) information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 2 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: 1500 2 comp Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): tank is clean and functioning properly at time of inspection t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Ig Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 91 Bay St Property Address Owner Wianno Club (golf course rest station) information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. City/Town 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 Bolding 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 Commonwealth of Massachusetts �m Title 5 Official Inspection Form III Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 91 Bay St Property Address Owner Wianno Club (golf course rest station) information is Owner's Name required for Osterville Ma 02655 11-4-19 every 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts �tl I Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 � 91 Bay St u- y Property Address Owner Wianno Club (golf course rest station) information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): " 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: 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 Commonwealth of Massachusetts �e i.? Title 5 Official Inspection Form f S Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 91 Bay St Property Address Owner Wianno Club (golf course rest station) information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Cityrrown 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.): chambers were dry 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments J 91 BBB St Property Address Wianno Club (golf course rest station) inform ' Owneration is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Cityfrown 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 91 Bay St Property Address Owner Wianno Club (golf course rest station)information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. City/Town 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 t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts ,ig Title 5 Official Inspection Form 1 I' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I u 91 Bay St Property Address Owner Wianno Club (golf course rest station) information is Owner's Name required for Osterville Ma 02655 11-4-19 every 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: greater than 5 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: 10-2019 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: design plan 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 Commonwealth of Massachusetts �. �P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 91 Bay St Property Address Owner Wianno Club (golf course rest station) information is Owner's Name required for Osterville Ma 02655 11-4-19 every 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 & Dated and 1, 2, 3, or 4 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 Page 1 of 2 \ - V0W G(wc ('CPS(S tG.L • �rw � a f r;,:, 0WN OF BARNS TABLF J,, .w .� d d' i LOCATION au S o '(�o r('cr�c SEWAGE;# odd/ VILLAGE —, — i OSIery ASSESSOR'SMAP&PARCEL _ INSTALLER'S N O a NAM&PHONE.90: _ Z— ' ace. r_- ��-3.16-3rs,• SEPTIC TANK CAPACITY 6260 LEACHING FACILITY:(type) S- r i NO:OF BEDROOMS rYz�o OWNER PERMIT DATE: /I 020-/7 COMPLIANCE DATE:. UGC �y Separation Distance Between the: ��I !W-Va iiuni Adjusted Groundwater Table to the Bottom of Leaching Facility Private Wafer Supply Welt and'Leaching Facility atom o Leacells hing a ----Feet site or wtthm300 feet of leaching facility) Edge Of.Wetland and Leaching Facility(If any wetlands exist within. 300.teetof leaching facility) FURNISHED BY J" J .fi� • t• t•i�•ryrw. WviceJ t C5 • f y https://tOwnOfbaMStable.US/Departments/Asceccina/Prn„A,.+�, 17-1 -ITTli x _ Commonwealth of Massachusetts r I Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 329 Parker Rd _a Property Address tQ Owner Wianno Club ( Golf club house) 17 information is Owner's Name required for Osteryille Ma 02655 11-4-19 b every page. Cityrrown State Zip Code Date of Inspection `:'w" 61 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: A. Inspector Information When filling out p �J�J Lf 3 0 9 forms on the computer,use Douglas A Brown only the tab key Name of Inspector to move your D.A.Brown Inc cursor-do not Company Name use the return key. P.o Box 145 Company Address VQ Centerville Ma 02632 AA City/Town State Zip Code 508-420-4534 S14297 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property 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 11-4-19 Ins a is 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 r Commonwealth of Massachusetts �d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 329 Parker Rd Property Address Owner Wianno Club ( Golf club house )information is Owner's Name required for Osterville Ma 02655 11-4-19 every 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: At time of inspection this system was functioning properly. There was little to no information at Board of health on the design flow for this system so I am inspecting for functionality only. 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structural) unsound exhibits substantial infiltration or exfiltration or tank failure is imminent. System Y Y 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.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts IF Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V� 329 Parker Rd Property Address Owner Wianno Club ( Golf club house ) information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Cityrrown 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. 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.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts �d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 329 Parker Rd Property Address Owner Wianno Club ( Golf club house )information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. City/Town 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 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: 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 Commonwealth of Massachusetts Title 5 Official Inspection Form I' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 329 Parker Rd Property Address Owner Wianno Club( Golf club house) information is Owner's Name required for Osterville Ma 02655 11-4-19 every 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 'h 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. ❑ ® 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 11 of a public water supply well t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts rm Title 5 Official Inspection Form I° Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 329 Parker Rd Property Address Wianno Club( Golf club house ) Owner information is Owner's Name required for Osterville Ma 02655 11-4-19 every 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? ❑ ® Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® 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 i Commonwealth of Massachusetts �,-P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 329 Parker Rd Property Address owner Wianno Club ( Golf club house ) information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. CitylTown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: Number of current residents: , 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 Seasonal use? ❑ Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts j; lip Title 5 Official Inspection Form 11. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 329 Parker Rd Property Address Wianno Club ( Golf club house ) Owner information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Golf club house/restaurant Design flow(based on 310 CMR 15.203): unknownGallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): unknown 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: Facilities manager stated yearly pumping of tank and scheduled pumping of grease trap for maintenance. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: it5insp.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 ^ � 329 Parker Rd v Property Address owner Wianno Club ( Golf club house) information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Cityrrown 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): grease trap also Approximate age of all components, date installed (if known) and source of information: unknown Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ® cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 p Y rY 329 Parker Rd Property Address Wianno Club ( Golf club house ) Owner information is Owner's Name required for Osterville Ma 02655 114-19 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: close to grade 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: 4500 gallon per as-built Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank looked strucyurally sound. Inlet tee need to be repaired ( partially missing ). Tank is pumped yearly for maintenance. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts iip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 329 Parker Rd Property Address Owner Wianno Club( Golf club house ) information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: close to grade feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: , 1000 per as-built 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.): Grease trap is in working condition ( very close to building ) Grease trap is on regular pumping schedule. 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 Commonwealth of Massachusetts r: I Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4' 329 Parker Rd v Property Address Wianno Club( Golf club house ) Owner information is Owner's Name required for Clsterville Ma 02655 11-4-19 every 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts ►F Title 5 Official Inspection Form 11. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments s � 329 Parker Rd u Property Address Owner Wianno Club( Golf club house) information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * 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: Type: ® leaching pits number: 5 4x6 pits with 4ftstone ❑ leaching chambers number: ❑ 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 Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments L 329 Parker Rd Property Address Owner Wianno Club ( Golf club house) information is Owner's Name required for Osterville Ma 02655 11-4-19 every 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.): One pit was opened and was in FAIR condition. This system is showing some signs of its age with light staining near the pipe invert but not above or triggering failure criteria. 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts �m l� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 329 Parker Rd Property Address owner Wianno Club ( Golf club house ) information is Owner's Name required for Osterville Ma 02655 11-4-19 every 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 329 Parker Rd u Property Address Owner _Wianno Club ( Golf club house ) information is Owner's Name required for Osterville Ma 02655 11-4-19 every 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts ,tP Title 5 Official Inspection Form j S Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 329 Parker Rd Property Address Owner Wianno Club ( Golf club house ) information is Owner's Name required for Osterville Ma 02655 11-4-19 every 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: greater tan 5 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Previous passing inspection report. 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 Commonwealth of Massachusetts �. �9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u— 329 Parker Rd Property Address Wianno Club ( Golf club house ) Owner information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Citylrown 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 & 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 ' Assessing As-Built Cards Page 1 of 2 (ooir tr,t— w�rrzvnv�.v��-/�// 3 ].TOWN OF ARNSTABLE LOCAT>o0 PArkw' R1 SEWAGE# vrLLAGE dS 1 ry ASSESSOR'S MAP&PARCEL IS— Oc9 L INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY Y50D T,AA LEACHING FACILITY:(type)S" SrXf, bQu Sal. (size) 6v STO^L NO.OF BEDROOMS OWNER W)AAlb GI"L PERMIT DATE: 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 welts exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) 11 Feet FURNISHED BY ZIIV,cTtp�, S_ FprC t ' 101 A a cAA ov a Q irp 13 t y p a a ty a3 o t 3 l9 37 9, sy yy aq f y https:Htownofbamstable.us/Departments/Assessing/Property_V alues/HMdisplay.asp?mapp... 8/31/2019 Sullivancomulting, Engineering & Inc. Chuck Rowland chuck@sullivanengin.com (508)428.3344 • www.sullivanengin.com P.O. Box 659, 7 Parker Road, Osterville, MA 02655 STAFF MEETING SPR AGENDA Meeting will be held Tuesday,November 3,2015 Regulatory Services 2:00 P.M.4:30 P.M. -200 Main Street, Hyannis Building Division fi NEW APPLICATIONS: SPR 027-15 Wianno Club 379 Parker Road (off West Street), Osterville Map 115, Parcel 022 Zoning: RF-1 : Proposal: Construction of two new buildings within the existing golf course P g maintenance area which will house a storage area for the golf equipment; and, upgraded fuel station, equipment washing station, and chemical storage facility. SPR 028-15 West Main Gas 577 West Main Street,Hyannis Map 269,Parcel 003 Zoning: HB, WP/GP Overlay District Proposal: Applicant proposes to eliminate the existing carwash bay and convert this area to retail space; also, add s.f. to existing building expanding the existing convenience store use. Zoning Board of Appeals relief will be required. FORMAL SITE PLAN REVIEW NOVEMBER 19, 2015 e AP 'LICE ON FOR SITE PLAN REVIEW * GP or WP areas restrict wastewater discharge to 330 gallons per acre per day into on-site system. LOCATION: Subdivision Plan Business Name:Wianno Club ANR Plan Assessor's Map# 115 Parcel# 022 Site Plan Property Address: 379 Parker Road(Off West Street) Osterville,MA 02655 S'R ` APPLICANT OWNER OF PROPERTY Name: Wianno Club Inc. Name:Wianno Club Address:107 Sea View Ave Address: 107 Sea View Ave. Osterville,MA 02655 Osterville,MA 02655 Telephone: 508-428-6981 Telephone: 508-428-6981 Fax: Fax: AGENT/ATTORNEY ARCHITECT/DEVELOPER/CONTRACTOR/ENGINEER Name: John Kenney Name: Sullivan Engineering&Consulting,Inc. Address: 1550 Falmouth Rd Suit 12 Address:7 Parker Road/PO Box 659 Centerville MA 02632 Osterville MA 02655 Telephone: 508-771-9300 Telephone: (508)428-3344 Fax: 508-775-6024 Fax: (508)428-6917 ZONING DISTRICT CLASSIFICATIONS STORAGE TANKS(HASMAT/FUEL OR WASTE OIL) District RF-1 Overlay(s) AP Existing Gas&Diesel Proposed Gas&Diesel Lot Area - Sq.Ft. 147 Ac.Per Town Assessing Number 2 Number 2 Fire District COMM Size 2000/275 Size - 1500& 1500 Setbacks (ft.) Above Ground No/Yes Above Ground Yes Front 30' Side 15' Rear 15' Underground Yes/No Underground No Contents Contents Number of Buildings Maintenance Area Only-Existing 2000 Gal.below Existing 1 Proposed 2 ground Gasoline&275 Gal.Diesel above ground storage Demolition 0 tanks to be removed.Proposed 1500Ga1.Diesel& 1500 Gasoline above ground storage tanks. TOTAL FLOOR AREA BY USE: Maintenance Only UTILITIES Existing(sq ft)Proposed(Sq.Ft). Sewer- ❑ Public X Private Size 1000 gal Basement 0 6,000 Residential 0 0 Water-X Public ❑ Private #of Bedrooms —0--0— Restaurant 0 0 Electric- ❑ Aerial X Underground Retail 0 0 Gas-X Natural ❑ Propane Office 0 0 Medical Office 0 0 Grease Trap- ❑ Size gal Commercial(specify 0 0 Sewage Daily Flow * 450 gal Wholesale(specify) 0 0 Institutional(specify) 0 0 Industrial(specify) 4 859 6 000+2 184 PARKING SPACES CURB CUTS All Other Uses On Site Required 27 Existing 1 Gross Floor Area 4 859 14 184 Provided 27 Proposed 0 On-Site 27 To Close 0 Off-Site 0 Totals 1 Handicapped 0 Old King's Highway Regional Historic District File# N/A Approved? ❑ Yes ❑ No Hyannis Main Street Waterfront Historic District File# N/A Approved? ❑ Yes ❑ No Listed in National and/or State Register of Historic Places? ❑ Yes X No Previous Site Plan Review File# Approved? ❑Yes ❑ No Previous Zoning Board of Appeals File# Approved? ❑ Yes ❑ No Is the site located in a Flood Area(Section 3-5.1) ❑ Yes X No In Area of Critical Environmental Concern? ❑ Yes X No Is the Project within 100'of Wetland Resource Area? ❑ Yes X No Site sketch—informal presentation X Yes ❑ No Site Plan prepared,wet stamped and signed by a Registered PE and/or PLS. X Yes ❑ No Parking and Traffic Circulation Plan X Yes ❑ No Landscape Plan and Lighting Plan X Yes ❑ No Drainage Plan with calculations and Utility Plan X Yes ❑ No Building Plans,(all floor plans,elevations and cross sections) X Yes ❑ No Note that all signage must be approved by Code Enforcement Office at the Building Department Lot area in sq. ft. 6,403,320 sq.ft. Total Building(s)footprint Existing 14,259+/- sq.ft. (includes Pro Shop&Accessory Structures) Proposed(6,780+2,184,)8,964+/-sq.ft. Maximum Lot Coverage as%of Lot N/A % GROUND WATER PROTECTION OVERLAY DISCTICT REOUREMENTS: DISTRICT: AP Lot Coverage(%) Required N/A Proposed 3%+/- Site Clearing(%)Required N/A Proposed Presently Cleared PRINCIPAL BUILDING ACCESSORY BUILDING(S) X Yes ❑ No Number of floors 2 Height: 12 ft. Number of floors 1 Height: 12 ft. (To Plate) (To Plate) FLOOR AREA: FLOOR AREA: Basement 6,000_sq. ft. Second N/A sq. ft. Basement 0_sq.ft. Second 0 sq.ft. First 6,000 sq. ft. Attic N/A sq. ft. First 2,184 sq.ft. Attic 0 sq.ft. Other(Specify) 780 sf(covered ramp) sq. ft. Please provide a brief narrative of your proposed project: The Wianno Club is proposing two new buildings within the existing golf course maintenance area which will house a storage area for the golf equipment,and upgraded fuel station,equipment washing station,and chemical storage facility. I assert that I have completed(or caused to be completed)this page and the Site Plan Review Application and that, to the best of my knowledge,the information submitted here is true. Signature of Applicant Date Printed Name of Applicant WIANNO GOLF CLUB NEW TURF MAINTENANCE FACILITY BUILDING " B " 155 WEST STREET OSTERVILLE, MA 02655 NEW BUILDING B __...._.._,:....,.._._.._.... ._. NEW BUILDING C 2,184 S.F. t12,760 S.F. PESTICIDE & FERTILIZER - - VEHICLE EQUIPMENT STORAGE BUILDING ,' t, j, / / STORAGE BUILDING- h I f d 8 4 / � a f _ NEW ABOVE, EXISTING BUILDING ' q GROUND FUEL y MAINTENANCE/ STAFF _ _.. ......... - .---"" 1 -` STORAGE SYSTEM" BUILDING TO REMAIN BUILDING B - SHEET LIST Number Sheet Name A130.00 COVER SHEET A80.01 SITE PLAN ARCHITECTS AB1.01 BUILDING"B"-FLOOR PLAN BROWN LINDQUIST FENUCCIO&RABER ARCHITECTS, INC. AB2.01 BUILDING"B"-BUILDING ELEVATIONS 203 WILLOW STREET SUITE A AB3.01 BUILDING"B"-CROSS SECTIONS YARMOUTHPORT,MA.02675 TEL, (508)362-8382 FAX. (508)362-2828 WWW.CAPEARCHITECTS.COM it CONCEPT PLANS N 09 . 18 . 2015 s� 1 BUILDING "C" STAMP: r - - - - - - - - - - - - - - - - - -- G ,P .O��.SED V� l1CLE / E4UIP-MEN�STORAC�E BUILD �.. r;',% \ .6,000 S.F. MAIN LEVEL.` 6,000 S.F. FULL BASEMENT Y I 1 12,760 S.F. TOTAL \ i !1 , i I II ,: is I' I �= j r i. C I i !, ll Il,.: :li I I. : I i „ I€ i' Ili dS I ,l I !. II ji it ..........._..._........._.._.. . .. 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FAX 508-36242828 p m �, ��) 155 WEST STREET N OSTERVILLE, MA 02655 WIANNO GOLF CLUB NEW TURF MAINTENANCE FACILITY BUILDING " C " 155 WEST STREET OSTERVILLE, MA 02655 NEW BUILDING " B " NEW BUILDING " C " 2,184 S.F. t12,760 S.F. PESTICIDE & FERTILIZER VEHICLE / EQUIPMENT STORAGE BUILDING s r.,, STORAGE BUILDING , _ `_`�` I� NEW ABOVE EXISTING BUILDING "A a GROUND FUEL _.. -MAINTENANCE /STAFF — _ :STORAGE SYSTEM 10 BUILDING TO REMAIN BUILDING C — SHEET LIST ARCHITECTS Number Sheet Name BROWN LINDQUIST FENUCCIO&RABER ARCHITECTS, INC. AC0.00 COVER SHEET 203 WILLOW STREET SUITE A AC0.01 BUILDING"C" SITE PLAN a YARMOUTHPORT,MA.02675 TEL. (508)362-8382 FAX. (508)362-2828 ACl.00 BUILDING"C"-BASEMENT PLAN WWW.CAPEARCHrTECTS.COM AC1.01 BUILDING"C"-FLOOR PLAN AC2.01 BUILDING"C"-BUILDING ELEVATIONS AC2.02 BUILDING"C"-BUILDING ELEVATIONS AC3.01 BUILDING"C"- CROSS SECTIONS 8 a CONCEPT PLANS 2015 i a 9 c� , BUILDING "C" STAMP: ..".,,,,PROPOSED VEHICLE EQUIPMENT STORAGE BUILDING \ 1­6 000 S.F. MAIN LEVEL,,;`,/ 6,000 S.F. FULL BASEMENT." ­1............... 12,760 S.F. TOTAL -------------------- ...........__..................... Ill l ... ....................... ................. -----------_.._............... ............... .......... ................. --------------- 7771 ............................................ A� ......... ............... ..................... ................. ......................................... ..... ............... .............. 0 ............................... .............. 0 ................... ............. M P .................................. .................... ..... .............................................. ........... .................... ................ 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LU ............ ...... ............................... < FUELING U)� x PAVED MAINTENANCE STATION 28'-n,, YARD LU k TITLE: 'A BUILDING "C" SITE PLAN 7777�� 7777777777777 777777. 11111!hWil 1,11111 Jill! DATE ISSUED: !ill 09.18.2015 1 H Ni: RNSIONS: M JIM H IM HIM M Wl I— I! % 1: HIM Him l: I Mimi Ill! DRAWN BY: Author DRAWING NO.: X� BUILDING "A" .................................... EXISTING GOLF MAINTENANCE SHOP & STAFF BUILDING BUILDING"C"-ARCHITECTURAL SITE PLAN 4,800 S.F. ACO.01 ( NO WORK THIS BUILDING ) I I I W b § b I * II 4 I 1 7 r A II Z 'u D ' m Z < c 4 b b r b In , c e a 8 4d2b 4 2 -01 } �D 0 � 1 r 1 V o'Z m m ao a I I 8 I n � v m Do N NEW TURF MAINTENANCE FACILITY BROWN LINDQUISTFENUCCIO&RABER ^ j z m ARCHITECTS,INC ` ) ° m �Z WIAN N O GOLF CLUB 203 WILLOW STREET,SURE A PH 508-362-83382 Z YARMOUMPORT,MA 02675 :...cw.wwhrn FAX 508.362-2828 m � _ 155 WEST STREET p z OSTERVILLE, MA 02655 10'-0' 9'-7' 5° C � A b= zv § �20 �nx Z. �3° RAMP DOWN TO BASEMENT C) t cu II Z O n T O m Z 6 b x b 4 b u n s 300 . bo0'i b O b b - oNEW TURF MAINTENANCE FACILITY - BROWN LINDQUISTFENUCCIO&RAKER z { Z o O ARCHITECTS,INC OZ WIANNO GOLF CLUB - 203 WILLOW STREET'SURE A PH 505-362-9392 YARMOUIHPORT,MA 02675 ucwo,emco., FAX 508-362-2820 155 WEST STREET ° N z OSTERVILLE, MA 02655 — _ t .............. s. 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I E E i € I E - I T I E LEVAIONS E � UPPER METAL SIDING !(COLOR#1)! :I 3 EE t I jj}j I k f I E I k t I ' { i I f - _ . DATE ISSUED: LOWER METAL SIDING t 09.18.2015 ! €[[ 'I COLOR#2 i I { f 1) 1 s REVIS IONS: LLL 22 I I f I I !E t F 1 BUILDING"C"-NORTH ELEVATION DRAWN BY: Author p DRAWING NO.: a ! I AC2.02 ri I ' N A O I I O II II L Q O N _.. O ti N y _ I ' a { '... . li I I \ II .. ... > .I I d ............ I € .. � ,`gym _ , ... =' a ..... ......... ....... -� ......... I .... ... r .. _ i r t ... i ` ...r .__ _. .... 11 w � k r ... ... .,,, .. .... # ... F w I I wt 4 .... I I '1 .. - / r .. _. .. L ...... ...... Lo ' I I I . f o I to u°•i� cQ ao 10 .... 12'-0' io 1019" 12-0 ... 0 o I _Im O p p Np A� A Q A� Do �, NEW TURF MAINTENANCE FACILITY BROWNLIND9UISTFENUCCIO&RARER ^ z r= ARCHITECTS,INC ` J � o WIANNO GOLF CLUB 203N1LLOW5REE,SU EA PH508.362-8382 WO O YARMWHPORT,MA 02675 ww m rn w FAX 508-362-2828 N n 155 WEST STREET p$ m - OSTERVILLE, MA 02655 J N - N i/ ' ,; -� lli i Fairway ` ,�t / ......,....;..... 11 ­1'l,'""l­1I',­l-­I,,,­­I1­1­-,'1"­­,,-1_"1I'61"­-.1_I II j I AddiParkin0 inrflow F r�' ,� ': N • / / ....... 'orie G Lewis � . �, � / Gravel Parkin Lot Mar) i g �� / w / - Spaces IiI ­_1­,_. 1 1 0 0 / .... ,, `� �` . ; �r` % i� ,-. : Q / t`x" / 1 v /.: \ bg f / i /: a CD / ` .. i / \_ / r `: ....... CO CJ9 , �`.. / Rough : / / 'I t { / e ' / / i I ; a / r 1 � i MIS .,St ���b i�ea�* t : � � I 7 �r ,mot. +.� ' �y $ t ♦ �r Fairway Extent of l l 1, r ; L *a ' } ..; '' •' ., • ,r �s, :' / / 500 Gallon Leaching / t 2 7' r,- • , ;J i f `o Pa�emend I I Chamber H-20 with 4' f 63 � _, -' / l of Stone for Ramp CS , i I f / n, I , .......................................... ......... / Trench Drain .... i -j y 3 s k N J . 1 j t ... / i o f : .. ! : , ; ; ..... / 1 ' � I R h ...... > ......................... .................................................................. ou 9...' w / I of Green _. / / .............. ,- / ri / Ed9e......�.. ( /' "^�. •V % / / / : - Ei ro�:��1 � ^new�t Rns!�t`i^'��,'r x+` 1 ter j I / /` r , l ...... ....... / _._. ___ Ou......... .... Landscape Berm ) ' ; \ ! I /` i*� t _ \ ' ` . r 9 ,,, j)f i Rough I , ( .........,.. Proposed Fence I I{ / 1 Rough Q ' a j Drip Edge P BLD d ... �, ,- / 4,. � � ,ry ` ropose `� (\ e:�.<; I � rr , , w ( i ( t / l � i li \ `� '" „ � I .: ;\ , '�, �\ -- Perforated Pi T I , i\ k ; i ,r Proposed Fire \ I l ,; ,,---, / / �i/ �~ ��. I� i � '� r t t Sty 1 p__- __-. Hydrant --- / j'; !, - __ \ i /�I —.. , t I `. 1 I F III " at a ., tl .................. 1 - 0 '. ion U 9 r / ; // - :5-``'- r D ` f l C //%r,/ _.... o I 2 P d 6 �, /'' d J 9 t I E / \ ,, `` i f t \ .` l tit ;. l j __ ,� � � i ) , ,� � �,• ropose oute 1 I I w /� Ifs '�,'J �-4""`•�� "�'��\\,�� !i f I,I { /l: r ! .�l 1 \ \ \ � es BLD � , _ ASSESSORS REF.. I I 1 W ' / ` Wig, rj 1 l r`/ �/� z � , \ 1 , �'\ i , t; i `' i `` (q Map 115, Parcels 022 � . � , I { I 1 1 ` �v,; \ti+ I l ! \�\ , \ 1 Existing _t •, ' . � c� �, 1 r \ \ �' BLD ,- _ //b , , , ,��\�� �� ; 1`I', a , , ", I `,`\ OVERLAY DISTRICT I ,,/ \ �� 1 / 1 - _. ': ' - "� - _�' _,..`\\\\ \\, ,. \ ;t ; i r rl /( ; `� 1 1,' . — r r0 eC Ion IS rIC/ " " / , A fe P t t D t t »_, 1 I AP _r_r _ _. _._ -- _ r,. ._ ----.. q I � G - . __ _.. t tj Et f _.. ..._ _..- \ \\� I I : t _..._ __,. __,_ .___ , t f , r ' t• i -_ Wooded Area l r i r. . .. " _ _ - ._ -_`_ 1/ \ ,�; { ... ; �; 5— _ -- _=.. --= -� >` /% t.' �`` --- ZONE. i ' ' - - . i 1 ` ` ' ,l` __. a ,, 1 .__ ,� �, �\� � -. _ � verview e c _ _ r�1 + I 1 w cr r Proposed` _. N \� '� _.._ ��� / \ 1 1"=100' - 1 , � ' 1 RF �._ 1 - - _ - �, i Metal !From ° y 11 _.... ,_. __. i . a ` _._ -. ` Area (min.) 87,120 SF R- 5 St ra e Facilit " oo° 1 ,, ----- LL \ \.i Sand Trap , 1 g x m e' s I K== �, _._ . . Fron to e min 206 2 �, o I t., 3 Wianno Maintanca Area g ( ) , f 11� o O�pO sf Sty act = i i Width (min) 125 0 _. ...,. 3 j 1 13 I m° rtrt ,, ` i Il f Setbacks: r 11'0 0 Q \ i i ar Event Front 30' { I 1- , , \ 1I Desi n Storm 25 Ye w_ i I w Run-0ff 5 1000 gallon leaching basin with 4 feet stone , u I I I i I : i w Side 15 �, i i i o _., , Area Total 1 055 Leaching Capacity 139 5=cfm . 2;s r ' _ _� _.__.. ear 1 sty w/f I ; %f I 1 V I o ,t % Rough Runoff C 0 965 Storage Capacity. 2410 cf -. .. ......_.... ' = Time Rainfall CxA Time Volume 1 Volume 2 Storage NET`:. R 15 Rest Station r-.r"-LI Pr I o d _ .._...._ _ a m 1 M Mat Frame 1 ! ' _ ' 2L5 � I I , Minutes = Intensity Seconds Inflow cfy IRecnarge cf Re�g-cf L- J - I rn i { Proposed W tora e Facility Wastewater Holding �' E• 5 7.2 1.62 300 2200 698 1502 908 24xs Concrete Pad :. .... ....... _.... I i ..... ; 10 5 7 1.02 600 3483 1395 2088 322 2184 isf 1 Sty. _.. rn tank 1500 GOoris ;,,., _.�_ ._v_.. w Bclow I y t O 1 15 47 102 900 4307 2093 2215 195 Zone: X (Minimum Flood Hazard) / : / V 1 i 1 i Final locptibn to be / / E t I. { , , Ground Fuel i J a 1 i ❑ coordinated with final -' / C o. .. , 20 41 1 02 I 1200 5010 2790 �220 190 ° ommunity Ponel N Storage Tank I 22.0 ; r ? 1 i 16 1 location Jof flo r"'catch �� / 30 3 3 1 02 1800 6049 4185 1864 546 #250001 0757 J &1 Pump I O A .i fr i` Leachin i basins in 'buildin 45 2 55 1.02 _2700 7011 6278 734 _.. 1,676 to b2 Removed i g I i I I r 9 _ __ , ...._.. July 16, 2014 ! I i Catch Basin --'� i /' l 60 2 1 1 02 3600 7698 8370 -672 3 082 Typ. --L i f / 2„ 54 8798 12555 3757 6 167 I µN 90 16 1.0 00 / _.. € ;' O R-S�•5 /''� 2ox3"` ® 1 �. j -' Fairway 120 ..._i. 1 3 1.02 7200 9531 16740 7209 9,619 1 ® o Ptopo ed 10x� 80 1__ 1. 2 Co rete Dump�ter Pad . S, I iz=�o.a' _0 Q I � [ l �.._ _. 1 / 1 Existing Storm I o > I wit 6 Fence ,, I.... 2 - .. 40 0.82 1.02 14400 12024 33480 21456 23,866 1 ! Water System Q o '\ 1 �( "\ :: 1801 13197 41850 28653 31 063 Building Coverage With Overhangs: 300 0 72 1 02 1 i / 3 �, v, E ; � , 1 Proposed 22x25 360 0 64 1.02 21600 1 14077 50220 30143 38 553 1 to be Removed o a� I i_.._.._. .__ ... ._._...._ ....1... Existin Buildin 4,858 sf : cre 9 Dr/p Edge -J I / Stone Over I L. `1` i / / / •.rt to pad ... _.. Pro Fertilizer & Wash Bl d 2,184 sf , c .' a - # 1 1 . 1 ;' Area 1 13761 f(Buildin C1= 1 iw/ 4" Paved Area : o ,� I / i : Area 2= 32 2061sf a = .:._ Pro Storage Bld 6, 720 sf P pforated Pipe I v o \�i -lIi;,' P � ..t i (Some Pavement Exposed) I C2 95 _._.. 4..._ .-- I t.s To be Re aved > i . 1 1 1 0 Total 13,762 sf I ® p \ " I Runoff C 44 358 45 968 6.665 / 'ZPx .......:.. :, � . I I ' 1 I Pro osed 300d Gallon _-__ _... I'::-I _...__. .__.. .. . , I , j t { �,**6 ,~; Ir;ti ervious Surface 4reo rr~vet-r,(j?: j 1` , i FuelStora e .Structure f f o /. :I 1� ` g Drainage Ca1CUlationrA Pavement, Dumpster Pad, R-21.5 Storm Water ❑ ! { \ I 0 / i & Fuel Pad 32 206 sf / ; Leach Pit 1 i � 1 1'-6" fr '------ - 3 c� 1 1000 Gallons r; ' r \` Water Supply 1 , '{ f ` `t `(i Cape Cod �/II 1 1,�1,,,.-I""\,I-,�I\I 0,A,_.),�",I,,­�-,,_,".,.­.�,­"�"I 1,/,,I,",:,'1,�1.,­,.. --\-..:::/-:f:,I,�_:.I..::\.a::;,:1�::::::: ..I.:..l..:.:'.i.�..::a: ....I.'_...,.,;�,',.­�,.-.',��I:F�.":I­.1 ,-(,.�' I .�_'.I�'.''._'_..'..7,'._':..�._'..;-__,�.�...­-,,.-i3O- 1 ' •' ! ___ ._ _..._ .__ -._ ..__. _ ,1 " w/ 4 of Stona �To Be'R lvoate 1 i 1 Berm T t w_, � \ j r 1B4 EI=21.8' NGVD �L :::, y ;l "�.. 1 To of MAG NAIL -� l \ 3 r ~ * ..... ®....... ` , © 261 r i � II � PAR 1 Bituminous Surface Course . _ ..... ..," __, Aron Exls Concrete P _... . - �_ rI ting _ ❑ \ `� : _ _._ _._ ___.. _ __. __ ___ -_ -_ _.._ ._._. • \ -- . ` --- Bituminous Binder C e _.. v N - _.._ -> .._ ..._ ..__ .._ ..._.. \, - r f paces Y _.. �. i 1 .., ❑ .,__. __ /�> -- , _ter �r �� `� ....-. - �.�� 1 ours \ 1 / i P e rp ose arkin -., r , T,- ti '� '` "" ._._- { - _ 12 Gravel Base Course 27 ....... �..� ..l.-)Z.�.I. .. . o g .....I.... c I '<s,.... _ � - - - -_ Spaces � >/ i >'/ ( �'�� '�� >~� '�-� ' �� � / #153 1 � -,. - _ - '' Existing 10 across fairway 1 Sty Metal \ 1 / ~ 0" \ \ \ \ \\\ \ Compacted Su,7 Grade :: Maintenance Building Watery 1 O s/ ~ ~ ' / \ ' Proposed Buildings Fertilizer Storage 2184 SF /% scab on Grade EI=22.4' IunctilonI � CUrbin D II Equipment Storage 12,000 SF 1 g eta I ! / 4 j ..X t € �ti' ;i Y1 4— `� Not to Scale Existing Building / q Pmen t Stor g 4860 SF❑ A u a e ,..._.... r7 ,M r �.--- AIL �/ ` �,-_--_---- , Required Parking Requirements f' Existing Diesel Storage ~' ------ �' (Town Zoning S240-56)Stone Drive Tank to be Removed ` 2<: j ' rn _ 1 to be Paved �o 1" 2 184+12000+4860=19,044 { See Pavin Detail Le Baron Model LF248-2 ' . ,/ 1 \ 9 Frame & Grade Typ. 19,044 SF/700 SF=27.2 Parking Spaces ---- I R -------------- \ ough _ _. _.- ... o lft 20 E pl yes 11 Max employees per Sh' m o e Paved Drive ;11 Proposed arkin / / j,_ p g 20/1.3=15 Parking Spaces t 11 ,/ �� ' � ® ® ;J,-' ��Mortar Shim as Required 27>15 Q 10 ® 1 ® �\ -Precast Conc. Riser 45 ® I — \ . _._ r pprox � � `' 2' Typ or Brick & Mortar Shim 27 Spaces Required __ .__. .•, '. ® 1 _ -- \ - P \ \\ \ Mortar Joints As Required Typ. - \ \\ ....... ,t, Edge of Proposed ---------- \ DPE pe \ 1 1% TYP t Pavement \\� \I�\ 12"0 H Pi Typ . ` \\ `N 4' TYP 2' c _- 0® ® Q ® ®C 3 ' " Filter Fabric Rough i ... Typ. „ ''' n . : \ .. 2 1 1/2"0 ' H s "� �, ..............................: yP• ® ® ® ® 0® ® ® ® = 0 �\ ale T 0 = 0 �. }: ow\ \%�\ �` ,: ` \�\ , ," Y 1`� 6" of Crushed :X O® ® ® ® =O n +s. -1 `� i Stone T Catch Basin �' ''' , __. _ .;. _._ YP ` / Trap ` � 0® M3 ® ® =� .— _.. ._ � / - er g° _ .-_ .._. ._ ._... ._.. _ a on e` / 1000 G ll Dryw ll U"S 3i6 ' All Components Double Washed Crushed Stone a �'� ��. Fairway Rough Green f20 Drainage System To Be H-20 TYP• t 4 / , _ - Developed Schematic Load Capacity _ E�� p Permitting Set _. Not to Scale - 1___� ` _ : •-_ _ Notes/Revision: PREPARED FOR: PREPARED BY. Title: _ Proposed Improvements Plan 1.) The property line information shown was Wianno Cub CapeSury • compiled from available record information. a Englneering& V"" At Wianno Club Maintenance Area 2. The topographic information was obtained ivaConsulting,Inc. 7 Parker Rood o Osterville MA 02655 Off West Street ''' from an on the ground survey performed on (5oa)asa3a�a • eaeo,�ll �s • 7�erkerrroed,o8tervme,NtnoWs or between 02/DEC/13 and 03/DEC/13. seclQwIlivanengin.com • www.suilWanongln.com (508) 420-3994 / 420-3995fox I S u Barnstable (Ostervill e) Mass. a 3.) The datum used is NGVD '29, a fixed mean 20 0 10 20 40 80 Field: WHK/RRL/MJD Review: RLH a) sea level datum. t Comp.: RLH/CTR Job Name: Wianno Maintonce Date: Scale: rr r f Draft: CTR/RLH Drawing #: C515_13g1 ex1 September 18, 2015 1 =20