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Home My WebLink About0015 PICASSO PLACE - Health r PICASSO PLACE, OSTERVILLE 145.0?9 r F { 0 TOWN bP BARNSTABLE LOCATION SEWAGE# 7 VILLAGE: L LAGE;: Q V N'`� � .- ASSESSOR'S MAP&PARCEL qJ INSTALLER'S NAME&PHONE NO. Ci -Toy 9 v e SEPTIC TANK CAPACITY, I SN 1 O y 6 (,G(� e2 6 X LEACHING FACILITY:(type) (size) JU X a S )4 a NO.OF BEDROOMS \Ch OWNER PERMIT DATE: 9��.SS� 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 d 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 Lq ° � ♦_ •. • 0 Ln coCertified Mail Fee 0r $ �5 MA. f Extra Services&Fees(check bar,add tee as appropriate) i �� 4 ❑Return Receipt(hardcopY) ❑Return Receipt(electronic) $ Postmarlfl�� O ❑Certified Mail Restricted Delivery $ '�L,`y�. O ❑Adult Signature Required $ ❑Adult Signature ResMcted Delivery$ 0 Postage r %- Tate $ _ _ `. ®p O r )Postage and Fee r •�^Q' $ REED, ANDREW . a O Sent To _ 15 PICASS PLACE o st,eetaniiApGNo.,Ui'OSTERVILLE, MA-02655 """""... Cry State,ZIR+4® i :r. r r r rrr•r• Certified Mail service provides the following benefits: •A receipt(this portion of the Certified Mail labeli. for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate •Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service- Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent. Important Reminders. Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). - or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is-notavailable for requires the signee to be at least 21 years of age, International mail. and provides delivery to the addressee specified ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retaili. . of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is Insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. USPS postmark.If you would like a postmark on(.+ •For an additional fee,and with a proper this Certified Mail receipt,please present your .r endorsement on the mailpiece;you may request Certified Mail Item at a Post Office'for the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion__ of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, - complete PS Form 3811,Domestic Return - Receipt,-attach PS Form 3811 to your mailpiece; IMPOKANIh Save this receipt for your records. Ps Form 38O0,April 2o%(Reverse)PSN 7530-02-000-9047 ,. Er _- t� ,- -. _ Certifierd Mail Fee ,2' Extra Services&Fees(checkbox,add feeas appropriate) N-n V:: n � El Return Receipt(hardcoPY) $ {S; V OO ❑Return Receipt(electronic) $ Post r f Certified Mail Restricted Delivery $ s^ Her 0 ❑Adult Signature Required $ a []Adult Signature Restricted Delivery$ t-3 Postagea m $ j Total Postage and Fees j $ REED, A_N_DREW C.,_r a sent To 15 PICASSO PLACE 0 RieelandApt.No.,o:Poit OSTERVILLE, MA 02655 airy State,Z%P+4® �,. f - Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this r delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(including the recipients retail associate. m signature)that is retained by the Postal Service— Restricted delivery service,which provides r for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent. Important Reminders: Adult signature service,which requires the L. •You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Wife,First-Class Package Service®, available at retail). or Priority Mail"service. Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age international mail. and provides delivery to the addressee specified •Instimnce coverage Is notavailable for purchase by name,or to the addressee's authorized agent] with'Cerdfied Mail service.However,the purchase (not available at retail). of Citified Mail service does not change the •To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. USPS postmark.If you would like a postmark on.}-, •For an additional fee,and with.a proper this Certified Mail receipt,please present your 1, endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion, of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply F,i You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version:For a hardcopy return receipt, �= complete PS Form 3811,Domestic Retum Receipt;attach PS Form 3811 to your mailpiece; IMPORTANT.Save this receipt for your records. Ps Form 3800,April 2015(Reverse)PSN 7530-02-000-9047 No: Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pphLatlon for Mfia-posal 6pstem Construction Permit oi Application for a Permit to Construct( ) Repair(V�Upgrade( )"Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. `S o LCA S s 6 ,G Ow/ner's Name,Address,and/Tel.No. Assessor's Map/Parcel -)5 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size 1S�O sq.ft. Garbage Grinder(.NO Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 0 gpd Design flow provided _ gpd -Plan Date ` ba i ( S-� Number of sheets Revision Date Title Size of Septic Tank !E!S(C $ 16 bU Type of S.A.S. \ c,L C.Se Description of Soil ��,,� S C, r} Nature of Repairs or Alterations(Answer when applicable) AC� H a Cj \J 2 6'60 64 L CSn,%.e.A S tO I S tt-a re, X t9 Dee m Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. G S gne Date Application Approved by Date l Application Disapproved by Date for the following reasons Permit No. ao I per-' :7 Date Issued L No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION;- TOWN OF BARNSTABLE, MASSACHUSETTS Yes �.;.. t Zippfication for Misjoir�,*pstem Construction Permit Application for a Permit to Construct( ) Repair(V�Upgrade ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. CA 5 S 6 kc,C(',, Owner's Name,Address,and Tel.No. Assessor's Map/Parcel J Installe Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. a Type of Building: Dwelling No.of Bedrooms Lot Size �,So sq.ft. Garbage Grinder A)D Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) y gpd Design flow provided ' { gpd Plan Date 1 a® Number of sheets Revision Date Title Size of Septic Tank ey t �k (4 40 Type of S.A.S. A N.e Ll_ eY t5A Description of Soil C) Nature of Repairs or Alterations(Answer when applicable) ��- ('�a Q �(�, j a S-6 D 6e L C VV kt-A S�--r S. SO I Z n nZ I �.� t a X �,�. f x Q i?to Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of FJalth. Si\gn d� Ie Date C Z f Application Approved by 11, Date Application Disapproved by Date E for the following reasons Permit No. t 1 CC' C94 Date Issued C _ - - - -------------------------- --------------- _ = __ - = -_ _--------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE MASSACHUSETTS (Certificate of Compliance y THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by �('e��C r\AC'�.r'- . at ( �_ T:>( C c,5 5 6 PF rn L-f,. G'Sh -JjIV has been constructed in accordance l with the provisions of Title 5 and the for Disposal System Construction Permit No->V X J dated ! Installer. ,.� �r-6,f VL_ Designer «G Ci #bedrooms Approved design flow gpd The issuance of this perm it�all�n/ot be construed as a guarantee that the systemill functi:n esn ed. �r. Date. I 7 �d `� Inspector _ No.. Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction permit Permission is hereby granted to Construct( ) Repair(V( Upgrade( ) Abandon( ) System located at ( CC. SS O d*,kts'LJ1��'{. and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her du tyto comply with I, Title 5 and the following local provisions or special conditions. Provided:Construction m st be co pleetted within three years of the date of this permit. Date ` O Approved by ,-- _ Town of Barnstable - ,�' ,� Regulatory Services Richard V. Scali,Interim Director Public Health Division Thomas Mcgean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: dLt I l Sewage Permit# )Assessor's Map\Parcel1 �c/ Designer:, SXE1P Rah A,.•hA i.S,'PC Installer: 54;;nr Address- C7• V�O�C �� Address: 1l3 D ``1 AY-J40V' A. 021-co S PAX o Z&&o On permit to install a ,� oZ�� • t'i�-�K was issued a (date) (installer) septic system at R, S,S 1� VIC4 U Wt-V't Q based on a design drawn by (address) 1}6�13 4AA&,dated (designer) Z_ I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system,referenced above was installed with major changes (i.e. ri greater than 10' lateral relocation of the SAS or any vertical relocation of any component ' of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils` were found satisfactory. - I certify that the system referenced above was constructed.' N nce with the terms of the I\A approval letters (if applicable) 5�1 (Installer's Signature) IO. (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION.' CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND 'AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-1.3.doc Town d Barnstable P# i 5 l Cog Department of RegWatory Services B a Public Health Division Date g a0 ta.v 200 Main Street,Hyannis MA 02601 k�:+ rFil t,,xi°' tm� Fee Pd Date Scheduled U Tfine' JL • • . � • h�5 Soil Suitability Assessment for Se e Disposal Performed-By: ��«�"'� 1�14`�P' e '�� Witnessed By. LOCATION&.GENERAL INFORMATION Location AddressJar. r.l ( S o � o�� Owner'a Name NJ r C Address c Assessor's Map/Parcel: Lis(d 7GI Engineer's Name S�-w e- 14` rS NEW CONSTRUCTION REPAIR Telephone# c.2 Land Use- Slopcs(96) S_�± Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft i Drulhage Way --t— ft Property Line 10'F ft Other — ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands-in proximity to holes) � IC P�SSc) P� �� ' I 1 _ \ q? Parent material(geologic) 0zT"'-'q H Depth to Bedrock Z ' Depth to Groundwater. Standing Water in Hole: Weeping from Pit Fnoa N A Estimated Seasonal High Oroundwater /A DETERMINATION FOR SEA ASONALIE(IGH WATER TABLE Method Used: e Depth Observed standing in obs.hole. _ In, Depth to soli mottles: In. De�th to weeping from aide of obs.hole: in, Groundwater Adjustment fY. LxWell-#_ Reading Date: _ tndrx Well level ,._, Adj,-Actor,,,,,._, Adj.GroundwateY•Levgl,.,_, PERCOLATION TEST Dale Observation Hole# ' Time at 9" - eI Depth of Pero Time at 6" tart Pro-soak Time @ . U'�u Time(911•61) nd1?ro-soak Rate Miu./Inch �Z Site Suitability Assessment: Sito Passed Sitp Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on B ack---- -- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:ISEPTlMERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Sail Horizon Soil Texture Shcl Color Soil• Other Surfaca(in.) (USDA) (Munsell) Mottling (Stnucture,Stoned;Boulders. o u1stency.96'drival) -!A— /l 14?40•'` dvf S DEEP OBSERVATION HOLE LOG Hole# Depth from. Soil Horizon Soil Texture _ P Soil Color , Soil "; 'Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. DEEP OBSERVATION HOLE LOG Hale# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. onsistancv. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Solt Color 8011 Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Scones;Boulders. Co t Flood Insurance Rate Map: Above 500 year flood boundary No— Yes ._ Withln 500 year boundary No✓ Yea ' Within too year flood boundary No._,,__ Yes �. Depth of Naturally Occurring Pervious Material Does at least four feat of naturally occurring pervious mtiterlal exist in all areas observed thrpughout the area proposed for the soil absorption system? `f If not,what is the depth of naturally occurring pervious material? Certification t <<F 4 approved b the l `f r e amination a rov I certify that on � ` • (date)I havepassed the soil evaluate x pp y Department of Environmental Protection and that the above analysis was performed by me consistent with . the required train i ,c perNse and experience described in 10 CNM 15.0177. _ Dat, Signature Q:1.SEpT1C\PERCPORM.DOC t z z0VI oF'"E Taw 'town of Barnstable - U.S.POSTAGE PITNEY BOWES » � Public Health�Division�` • BARNSfABI.E. v MASS. m 200 Main Street "TEn u+p 0 Hyannis,MI :62601+ ` ri a ... '' ZIP 0260-_0��++ �++ r 02 4VV oOV.V 7015 1730 0001 4987 5400 0000336455auc. 21 2018. ! i. REED, ANDREW PC'6 LD'!'ti�ly' TO NOT DELIVERABLE AS ADDR-ESS'ED 3 f t Y ka w H irx w z v S y _ 9:40002M'6159.2191-S0 Cgs 1 ''UT'F SC' 1{0Qe 603.4pg0€3Z0tg0 5 �2-5g2 y)2--8160 g9-21-y�36 n l.:r. \\\ N Complete item `'�"' and 3. A. Signature I I P I ■ Print your name a'ljd address on the reverse Agent 1 so that we can return the card to'you. X O Addressee Is Attach this card to the back of the mailpiece, B• Received by(Printed Name) C. Date of Delivery � or on the front if space permits. l 1. Artie D. is delivery address different from item 1? 1:1 Yes If YES,enter delivery address below: p No REED, ANDRE W 15PICS0PAS LAC E TVILLM0' OSERE, A265 5 i 3 II I IIIIII IIII II I III I III I II I I I II II I I II IIIII III 3. Service Type ❑ - I Priority Man H ss® ❑Adult Signature ❑Rgitered MaU4 l I El Adult Signature Restricted Delivery ❑Registered Mail Restricted Certified Mail® _�Pelivery 9590 9402 3630 7305 4607 93 Certified Mail Restricted Delivery 'Return Receipt for ❑Collect on.Delivery `Merchandise 2. Article Number(fransfer from service_/abe0 estricted Delivery ❑Signature ConfirmattonTM Mail 3 Signature Confirmation { 015 17 3❑ I]0 - 7 01 4 9 8 7 54011 �oa1 allRestricted Delivery Restricted Delivery ;I , , _ _ PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt ; - 1 1KE ram, Town of Barnstable Barnstable Regulatory Services Department 1"mmicaC" nntuvsenHM MASS. i639. m Public Health Division �� A�FD µABA 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO SECOND NOTICE CERTIFIED MAIL#7015 1730 0001 4987 5400 t - _August 20, 201-8 -- REED, ANDREW C 15 PICASSO PLACE OSTERVILLE, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 15 Picasso Place,'Osterville, MA was inspected on' 07/25/2018 by Sean M 'Jones, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS.or cesspool. You are ordered to repair or replace the-septic system within.one (1) year from the date you receive this notification: Failure to repair/replace the septic system within the deadline period will result in future enforcement action. t PER ORDER OF THE BOARD OF HEALTH n, R.S.; CHO Agent of the Board of Health . Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\15 Picasso Place Osterville-Second Notice.doc I Town of Barnstable Barnstable Regulatory Services Department ■ RNSTABLK , r qq, 16 q. , Public Health Division ""Ash 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO SECOND NOTICE CERTIFIED MAIL#7015 1730 0001 4987 5400 August 20, 2018 REED, ANDREW C 15 PICASSO PLACE OSTERVILLE, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 15 Picasso Place, Osterville, MA was inspected on 07/25/2018 by Sean M. Jones, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH ' Eaan*, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\I5 Picasso Place Osterville-Second Notice.doc f tKIE Tom, Town of Barnstable Barnstable Regulatory Services Department 1AF`°edcaUt1y BARNSTABLE. MASS. 1639• Public Health Division �0 m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 5349 August 3, 2018 REED, ANDREW C 15 PICASSO PLACE OSTERVILLE, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 15 Picasso Place, Osterville, MA was inspected on 07/25/2018 by Scan M. Jones, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH T mas McKean, .S., CHO � r Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\15 Picasso Place Osterville.doc Town of Barnstable &ARN619. Regulatory Services Department j°jf�MAC A Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x" marked in the o is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE 1 YEAR DEADLINE CRITERIA Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). a TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Cl Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form r l Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . , 15 Picasso Place l*qa Property Address Andrew ReedXL Owner Owners Name -c information is / ; required for every Osterville / Ma. 02655 7/25/2018 page, Cityrrown � � State Zip Code Date of Inspection " Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information Q(� s/ 13 J p on the computer, use only the tab 1. Inspector: key to move your cursor-do not Sean M. .Jones use the return key. Name of Inspector S.M.Jones Title V Septic Inspection Company Name 74 Beldan Lane Company Address - Centerville Ma 02632 Cityrrown State Zip Code 774-248-4850 smjonestitle5@gmail,,com SI4522 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am.a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000).The system: Passes ❑ Conditionally Passes Fails ❑ Needs Further Evaluation by the Local Approving Authority 7l25/201 8 Inspector's Signature- Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a.design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP,The original should be sent to the system owner and copies sent to the buyer, if applicable; and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection.does not address how.the system will perform in the future under the same Or different conditions of use. t8ins dot•rev,6116 Title S Offtaol liupevion form:.Subsurface Sewage Disposal //Sy3ttam-Page 1 of,7 /--�/ t C 1� Commonwealth of Massachusetts Title 5 Official Inspection Form _ 1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �. 15 Picasso Place Property Address Andrew Reed Owner Owner's Name _ �...�...,:,.....,......,. �.,.: information is Osterville Ma. . 02655 7/25/2018 required for every M. __ page. Cityfrown State zip Code Date of-Inspection B. Certification (cont.) Inspection Summary: Check A,B,CD or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health; will pass. Check the box for"yes'`, "no or"not determined" (Y, N, ND)for the following statements. if"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank,(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. `A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6t18 Tale 5 Official inspection Form,Subsurface Sewage Disposal System•Page 2 of I T I Commonwealth of Massachusetts _ , � Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form Not for Voluntary Assessments 15 Picasso Place Property Address . Andrew Reed Owner Owner's Name information is Osterville Ma. 02655 7/25/2018 required for every �.,�.:.�.....___...w...��,.�..., page. Cityrrown State Zip Code at of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cost.): 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 C1 ND (Explain below): r C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment: 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.3030)(b)that the system is, not functioning in a manner which will protect.public health; safety and the environment: 0 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 i5ins.doc•rev,6116 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts =q- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �.f. 15 Picasso Place „ Property Address Andrew Reed Owner Owner's Name information is required for every Osterville Ma. 02655 7125/2018 ...�.,_.,..,�,...�.,..�.. __ page. Cityrrown State Zip Coe Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ 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. El The system has a septic tank and SAS and the SAS is less than 100 feet but,50 feet or more from a private water supply well", Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must. be attached to this form, 3. Other: D) System Failure Criteria Applicable to.All Systems:. You must indicate"Yes" or"No"to each of the following for all inspections Yes No Z E 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 Static liquitl level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than y2 day flow 16ms.doc•rev,6116 Tide 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 4 o117 Commonwealth of Massachusetts �a6 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments y 15 Picasso Place Property Address Andrew Reed Owner Owner's Name information is Osteryille Ma. 02655 /25/2018 required for every page. Cltyrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No Required pumping more than 4.times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: F 0 Any portion ofthe 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 well. Any portion of a cesspool or privy is,within 50 feet of a.private water supply well. El Z Any portion of,a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.[This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered..A copy of the analysis and chain of custody must be attached to this form.] ® The:system is a cesspool serving a facility with a design flow of 2000gpd 10,000gpd. 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. Ej 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 Ono"t to each of the following, in addition to the questions in Section D, Yes No the system is within 400 feet of'a surface drinking water supply El 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 if you have answered"yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ina,doc•rov,6r18 Title 5 OfGtfai Inspection Form'Subsurface Sewage Disposal System-Page 5'0l i7 Commonwealth of Massachusetts == Title 5 Official Inspection Form Wj Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Picasso Place Property address ---- Andrew Reed Owner Owner's Name information is Cisterville Ma: 02655 7/25I2018 required for every _ a page. City/town state Zip Code bate of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following; Yes No ❑ ® 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 NIA) [y:] ❑ Was the facility or dwelling inspected for signs of sewage back.up? M ❑ 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 isunacceptable) [310 CMR 15.302(5)1 D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example:.110 gpd x#of bedrooms): 22-20 gpd Lfiins doc•rev 6115 Title 5 Official Inspeciion Furm.Subsurface Sewage Disposal System•page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form = 't�i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments V!,, - 15 Picasso Place Property Address Andrew Reed Owner Owner's Name ,-,�..,..•,..,_,:-.....�,:.:..�,_..,, ._..,�., information is Osterville Ma. 02655 7/25/2018 required for every — - �..,......�.. _ --.W..; ..�,.-_.-..,..._.,..m.-.-,-.— page, CltyrTown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? 0 Yes ®. No Is laundry on a separate sewage system?(Include laundry system inspection El Yes 0 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: current Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15,203): Gallons pecday(gpd} Basis of design flow(seats/persons/soft, etc.): -� Grease trap presenf? Yes' No Industrial waste holding.tank,present? [❑ Yes No Nan=sanitary waste discharged to the Title 5 system? El Yes n No Water meter readings, if available: -- �- -�--- - - -- t5ins doc-ray.SMS Tide 5 Official inspection Form,.Suirsurfaee savage Disposal system•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Picasso Place Property Address Andrew Reed Owner Owners Name ~---_— information is required for every Osterville Ma. 02655 7/25/2018 �.-----.�- page. City/Town State, Zip Code Date of Inspection D. System Information (cont.) . Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? [] 'Yes ( No If yes, volume pumped: gallons How was quantity pumped determined? —�- -- --� � Reason for pumping: Type of System: © Septic tank., distribution box, soil absorption system 0 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 l/A system by system operator under contract Tight tank Attach a copy of the DEP approval. [� Other(describe): t5ins.doe,rev,6113 Title 5 offrdal Inspodon Form.Subsurface Sewage Disposal System-Page 8.0r 17 Commonwealth of Massachusetts - 1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 15 Picasso Place Property Address Andrew Reed Owner Owner's Name information is required for every Osterville Ma. 02655 7/25/2018 page. City/rown State Zp ode Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if,known)and source of information: original system 1984 Were sewage odors detected when arriving at the site? 0 Yes 0 No Building Sewer(locate on site plan): Depth below grade: f • feet Material of construction. ❑ cast iron 40 PVC Mother(explain): Distance from private water supply well or suction line; fee Comments(on condition of joints, venting, evidence of leakage, etc.): Joints ok, no leaks, vented through roof.. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: XL7 concrete ❑ metal Q fiberglass ❑ polyethylene ❑ other(explain)- If tank:is metal,list age; years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) d Yes ❑ No Dimensions: 1000 g llons Sludge depth: i5ins,doc•rev,6116 Tifle 5 Official inspection form.Subsurtace Sewage Disposal Sysiem•page 9 of 17' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Picasso Place Property Address Andrew Reed Owner Owner's Name information is Osterville Ma 02655 7/26/2018 required for every - -- --- - - page. CityfTown _^ State Zip Code Date of inspection D. System Information (cont.) Septic Tank(cons) 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? measurements not taken 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 structurally sound, covers are to grade on risers. I 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 -------w� Date of last pumping: Date t5ins.doc•rev.6tiS Tide 5 Official inspection farm:Subsurface Sewage Disposal System•Page io.of i l Commonwealth of Massachusetts -= Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .! ' 15 Picasso Place Property Address Andrew Reed Owner Owner's Name information is required for every Cisterville Ma: 02655 7/25/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee-or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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, Alarm present: ❑ Yes El No Alarm level: Alarm in working order: n 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? 0 Yes Q No t5ins:doc•rev.5/16 Ufa 5 Otririat Inspection Form:Subsurface Sewage Disposal System-Page 110 17 Y Commonwealth of Massachusetts Tithe 5 Official Inspection Form ! a Subsurface Sewage Disposal System Form-Not.for Voluntary Assessments 15 Picasso Place Property Address Andrew Reed Owner Owner's Name _ information is Osterville Ma; 02655 7/25/2018 required for every ,.�.,�..�...,�.,�.,...,_ �..•-.�,......»�•...�<.. page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert o! Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc,): D-box was video inspected from tank, water level was 1"above outet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes No* Alarms in working order; ❑ Yes 0 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. Soil Absorption System(SAS) (locate on site plan, excavation not required). If SAS not located,explain why: . 15ine.dac rev.6116 Title 5 Official Inspea k)i Form.Subsurface Sewage Disposal System Page 12 0117 I Commonwealth of Massachusetts T Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r<� 15 Picasso Place Property Address . Andrew Reed Owner owner's Name information is Osterville Ma; 02655 7/25/2018 required for every ,...,.......�...w.»;.�...,,..�. ,,........�... T page, CltyrTown State" Zip Code Date of Inspection D. System Information (cont.) Type: . 1 leaching pits number: leaching chambers number: leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: overflow cesspool number; innovative/alternative system Type/name of technology: --- Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc): Leach pit was located and opened, Pit was found full above top into riser resulting in a failing inspection. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan)`. Number and configuration --------- Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction - --- -- -- Indication of groundwater inflow ❑ Yes ❑ No t5ins-doc-rev.6118 Title 5 Official Inspection Forrn subsurface sewage oisposai system-page 13 ot'17 - Commonwealth of Massachusetts Title 5 Official Inspection Form r. Subsurface Sewage Disposal System Form Not for Voluntary Assessments r 15 Picasso Place `r Property Address Andrew Reed Owner Owner's Name .�..:,.._.....�.-�...�,.;,,� _.�._...._ information is Osterville Ma. 02655 7/25/2018 require d for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil,;signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Privy (locate on site plan): Materials.of construction: ------�--�- -- Dimensions Depth of solids Comments(note condition of soil; signs of hydraulic failurejevel of ponding,, condition of vegetation, etc.): i5 ns.doc, rev,6t16 Tine 5 Official Inspection Form;Subsurface Sewage Disbasal System Pege 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form t. W w Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . �..'` 15 Picasso Place Property Address Andrew Reed Owner Owner's Name information is Osterville Ma. 02655 7/25/2018 required for every page. City/Town State Zip Code Date of inspection ' D. System Information (cont.) 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 f O, At 4 , r �! t5ins.doc•rev:6i]B Tide 5 Official Inspection Form'Subsurface Sewage 01soesat System•Page 15 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form WSubsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Picasso Place Property Address Andrew Reed Crooner Owner's Name information is Osterville Ma. 02655 7/25/2018 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high,ground water-, feet- Please indicate all methods used to determine the high groundwater elevation: Obtained from system design plans on record If checked, date of design plan,reviewed: pets Observed site(abutting property/observation hole within 150 feet of SAS) El Checked with local'Board of Health -explain ❑ Checked with local excavators, installers=(attach documentation) ❑ Accessed USGS database-explain: You must describe-how you established th o hi h groundwater elevation:evation: 9 Groundwater elevation was not determined, 806 a till"g thig IfiaPedti6fi ROPMF P105§0 906 Rdpc)Pt G6ffipl loiw�ss Ch@ckllst ofl iioxt Pago, 15ins tloa rev.5t IS Title 5 Offioai Inspeciton Form,Subsurface Sewaga Disoosat System-Pago 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form•Not for Voluntary Assessments 15 Picasso Place Property Address _ Andrew Reed Owner owner's Name Information required for every Osterville Ma. 02655± 1/25/2018 page. Citylrown State Zip Code Date of inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed © System Information—Estimated depth to high groundwater X Sketch of Sewage Disposal System either drawn on.page 15.or attached in separate file 15±ns.doc•rev,6116 Title 5 official Inspection Form;Subsurface Sewage M sai System-Pa a}7 of 4 � Y 4 - 77 -7iff�ji THE ro - _ U.S.POSTAGE>>RTNEY e0WES of wtio Town of Barnstable P Public Health Division / G O ' a" ASS.LE. MASS. ` 200 Main Street 67q. 0� MPN Hyannis,MA 02601 t { 0ZIP 2 02601 $ 006.670 0000.3.36455 AUG. 0.3. 2018. 7015 1730 0001 4987- 5349 Vu ' ---=REED, ANDREW C _ � , RETURN RECEI -- = 5_pICAR.q _n-Pi:ACF Uj - R�EQUEST r9�.�TE �� 7, 7 „ a RETURN 'TO 'S E'N'"E`32' NOT DELIVERABLE AS ADDRESSED UNABLE T13 FORWARD 930368953D'35937.3 U.T:F BC. 14002e * 0369- 0,03`07-03-•.37 _�, ®-Z;_ t .. .. .rM ... .SIENDIER COMPLETE THIS SECTION C OMPLETE THIS SECTION. DELIVERY A. Signature ■ Complete Items 1,2,and 3. I ❑Agent I ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. I y B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. { 1. Artf D. Is delivery address different from item 17 ❑Yes if YES,enter delivery address below: ❑No REED, ANDREW C 15 PICASSO PLACE O_STERVILLE, MA 02655 -- -— -- — 3. Service Type ❑Priority Mail Express@ 1 ❑AdultSignature ❑Registered MailR , ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted i 9590 9402 4116 8092 9363 40 Certified Mail® fSM.1"griatureConfirmation"m elivery { \' Certified Mail Restricted Delivery eturn Receipt for O Collect on Delivery erchandise o_r.Wj—.-r.. ,Delivery Restricted Delivery . Ail ❑Signature Confirmation I. 7 015 1730 0001 4987 5 3 4 9 ~,il Restricted Delivery Restricted Delivery g PS Form 8811,July 2015 PSN.7530-02-00 Domestic Return Receipt. y0-9053 _ _ L_ P• , Town of Barnstable Barnstable . Regulatory Services Department AN-fteftaC'j aARNSTABU- MPM. Public Health Division i639• QED µa+°i 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 5349 August 3, 2018 REED, ANDREW C 15 PICASSO PLACE OSTERVILLE, MA 02655 } ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 15 Picasso Place, Osterville, MA was inspected on 07/25/2018 by Sean M. Jones, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action: L ORDER OF THE B . OF HEALTHas McKean, R.S., CHO r ` Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\I5 Picasso Place Osterville.doc COMMONWEALTH OF MASSACHUSETTS � 6 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ''# DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617)292-5500 SFA j r � y T1 'COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor - J Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 15 Picasso Place, Osterville, MA Name of Owner: Steve Romagna Address of Owner:44 Brookside Avenue Date of Inspection: September 25, 2000 Belmont, MA 02478 Name of Inspector: (Please Print) James M. Ford I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: James M. Ford Mailing Address: P.O. Box 49, Osterville, MA 02655-0049 Map: 145 Telephone Number: (508)862-9400 Parcel: 079 CERTIFICATION STATEMENT I certify that I have personally.inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: ✓ Passes Conditionally Passes Needs Further Eval 2 n By the Local Approving Authority Fails Inspector's Signature: Date: September 25, 2000 The System Inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. NOTES AND COMMENTS • } f,.:. t x:,x:f �1+,<�,� .S•�r. t '.�..-+a+stR I+,a 1« ,. revised 9/2/98 , Page Iof11 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: IS Picasso Place, Osterville, MA Owner: Steve Romagna Date of Inspection: September 25, 2000 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: ✓ I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not.metal, is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup bitreakout or-lrigh static water level observed in the distribution box is due to broken or obstructed pipe(s) or due,to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health) broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed revised 9/2/98 Tage2of11 I _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 15 Picasso Place, Osterville, AM .._'. Owner: Steve Romagna Date of Inspection: September 25, 2000 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b) THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: =The system has a•septic.tank and soil absorption system(SAS)and,the SAS is within 100,feet to a surface water supply or L 'tributary to a surface water.supply .a..u, _ The system has a septic tank and soil absorption system andthe SAS is within a Zone 1 of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 9 2 98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Pr Address: 15 Picasso Place, Osterville, MA Property Owner: Steve Romagna Date of Inspection: September 25, 2000 D. SYSTEM FAILS: You must indicate either"Yes" or "No" as to each of the following: _ I have determined that one or more-of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due-to.an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or'privy is within a Zone 1 of a public well: Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool,or privy is less than 100 feet but greater than 50 feet from a private water supply well with'no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST i Property Address: 15 Picasso Place, Osterville, MA T Owner: Steve Romagna Date of Inspection: September 25, 2000 ^3`t : a a.• p A Check if the following have been done:-You must indicate either':Yes'or1;'No" as,to each of the,following..,,, Yes No ✓ _ Pumping information was provided by the owner,occupant,or Board of Health.. *✓ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. (*The house was unoccupied.) ✓ As built plans have been obtained.and examined. Note if they are,not,available,with N/A. 1, ✓ The facility or dwelling was inspected for signs of sewage back-up. ✓ _ The system does not receive non-sanitary or industrial waste flow. ✓ _ The site was inspected for signs of breakout. ✓ _ All system components,excluding the Soil Absorption System,have been located on the site. ✓ _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for conditions of baffles or tees, material of construction,-dimensions,depth;of liquid,depth of sludge, depth of scum. sa The size and location of the Soil Absorption.System on the site has been determined based on: t fit..sa. )it 1.. ✓ _ Existing information. For example,Plan at B.O.H. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [15.302(3)(b)l• ✓ _ The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. I.r r n Z ' } • �. revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 15 Picasso Place, Osterville, MA Owner: Steve Romagna Date of Inspection: September 25, 2000 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom. Number of bedrooms(design): n/a Number of bedrooms(actual): 3 Total DESIGN flow n/a Number of current residents: 0 Garbage grinder(yes or no): No Laundry(separate system)(yes or no):No laundry; If yes,separate inspection required Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last two year's usage(gpd): 1999-13 000 pals.:1998-12.000 teals. Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: evd(Based on 15.203) Basis of design flow Grease trap present: (yes or no) Industrial Waste Holding Tank present: (yes or no) _ Non-sanitary waste discharged to the Title 5 system: (yes or no) Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Purmed in 1993-per owner. System pumped as part of inspection(yes or no): No If yes,volume pumped: gallons Reason for pumping: TYPE OF SYSTEM ✓ Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE,of all components,date installed(if known)and source.of information: Sep 6186-per as built card Sewage odors detected when arriving at the site: (yes or no) No revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Picasso Place, Osterville, MA Owner: Steve Romagna Date of Inspection: September 25, 2000 , . �tat:Ei;; rt ;„ •fir..., `la .. . BUILDING SEWER (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 16" Material of construction: ✓concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance—(Yes/No) Dimensions: 1000 gal. Sludge depth: I,, Distance from top of sludge to bottom of outlet tee or baffle: 30" ,, E_ . : , _;,,. `,,•; r, Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 9" Distance from bottom of scum to bottom of outlet tee or baffle: 14" How dimensions were determined: Measuring stick Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) Both tees were present The liquid level was even with the outlet invert. There were no signs of leakage. Scum and sludge were minimal Recommend installing risers to bring cover with 6"of grade. I GREASE TRAP: None (locate on site plan) Depth below grade: 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: _ Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, -- _evidence evidence of leakage,etc.) revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Picasso Place, Osterville, MA Owner: Steve Romagna Date of Inspection: September 25, 2000 TIGHT OR HOLDING TANK: None .(Tank must be pumped prior to,or at time,of inspection) (locate on site plan) Depth below grade: Material of constriction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacity: gallons _ Design flow: gallons/day Alarm present: Alarm level: Alarm in working order: Yes_ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX: ✓ (locate on site plan) Depth of liquid level above outlet invert: — Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) The D-box was located, but not due up. There were no signs of failure in the leach nit PUMP CHAMBER: None (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order: (Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 Page 8of11 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Picasso Place, Osterville, MA e. _ .. �E A a^t '-, , �v . r Owner: Steve Romagna z.,;;c •; .^. +c Date of Inspection: ( September 25, 2000 ;., .'.'� ; ..r ' ;a •,' «, ;+ :r.+;ti SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan, if possible; excavation not required;location may be approximated by.non-intrusive methods) a _� If not located,explain: Type: leaching pits, number: I-6'x 6' leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields, number,dimensions: overflow cesspool,number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.) . The nit was dry. The scum line was 4'up from the bottom. There were no signs of failure. The bottom to grade was approx. 10'. The cover was 3' below grade. Recommend installing risers to bring cover within 6"of grade. CESSPOOLS: None (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: ,• u" Depth of solids layer: Depth of scum layer: Dimensions of cesspool: K Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection). Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.) PRIVY: None (locate on site plan) Materials of construction: Dimensions:' Depth of solids: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) revised 9/2/98 page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Picasso Place, Osterville, MA Owner: Steve Romagna Date of Inspection: September 25, 2000 Map:'145 Parcel. 079 SKETCH OF SEWAGE DISPOSAL SYSTEM: ' include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) 3A�k A � � 0 Al- aq lea- 33 (0 3 AS- 3(P y a3- ag Ay- yO . .,., s ;♦. a .._ . ., a t' mot' III revised 9/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Picasso Place, Osterville, MA f1 Owner: Steve Romagna Date of Inspection: September 25, 2000 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater 30 Feet Please indicate all the methods used to determine High Groundwater Elevation: — Obtained from Design Plans on record — Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions - '�a z 5 ✓ Checked with local Board of Health } } Checked FEMA Maps Checked pumping records Check local excavators,installers ✓ Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) The bottom of the pit to grade was approximately 10'. Using the Barnstable topographic map and Cape Cod Commission water contours map, the maps were showing approximately 30' +/-to groundwater at this site. Using the Cape Cod Commission Technical Bulletin, the high groundwater adjustment for this site(SDW 253, Zone C, 8100)was 6.7'. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, `written or implied, relating to the system, the inspection and/or this report. revised 9/2/98 Page 11of11 _ J y . Jul . a .mod �`� 1 ` �r TOWN OF BARNSTABLE LOCATION 15" P,CASS0 621AClz SEWAGE # �t',LLAGE O S T-VV, uL ASSESSOR'S MAP & LOT/ys 07 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY- P LEACHING FACILITY: (type) tT '(size) GX to NO.OF BEDROOMS 3 BUILDER OR OWNER ST' Ve- RWAGYlA e PERMITDATE: COMPLIANCE DATE: a Separation Distance Between the: S<� � t^S� 9 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 J 'Foe,8 CO l� • fif — to ra J Q ION 9 9 0 col C6 C► 0 M cl 3 M ` f � G '♦ m l ' O tw C r,,z. Z H N C \1 wt N C! Ic a `� II s FEs... � ..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....---........ ..........................OF................................_........----------------------........................... AppliratiOn for Diupu.sal Works Tonutrnrtiun ramit ` Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at:.... O / �' T �(,c j SS'(� �41.............. -----------•• ------- 1... .... _ Location-Ad s f Lot No. ... .e .% -�........._.. a ...... ..(...�} -••-•----••----•--..... ..--• ---••---•--- Owner Address Installer Address UType of Building Size Lot.._._/J�.C�_�Sq. feet �. Dwelling—No. of Bedrooms................ .......................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers a YP g ------------------------•-•• P ( ) — Cafeteria ( ) a' Other fixtures ... w Design Flow.................... ..1 gallons per person per day. Total daily flow............. .. . ...........0.....•.•....gallons. WSeptic Tank—Liquid capacit)(0__V-ellons 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 ( ) r' 0-4 Percolation Test Resul s Performed by............................!: _..... -... . ......�'"�e Date.............7/ /53 a Test Pit No. 1.__ Sminutes per inch Depth of Test Pit........ Depth to ground water... ...._ Gz, Test Pit No. 2.......... ...�inutes per inch Depth of Test Pit........... . Depth to ground water._ ..._._. x ...._..... f�o �_ Description of Soil............................................ ................................................. ........ --•-•• ---------------- U .....----••----•-•----------•--••••••-•-•-•-•-•-•••--•-••••.........................••.-Ai", -0.----f------ r w UNature of Repairs or Alterations—Answer when applicable...................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i1TLL 5 of the State Sanitary Code— The undersigned further agrees of to place the system in operation until a Certificate of Compliance has been issued by the board of li lth. Signed............... - ----- ......... ..................... .... •...? Application Approved By-------------------------- = -•--- ......._.......__................... � � ...:......... Date Application Disapproved for the following reasons:-------•--------------------------•-------------------------.........---------------------------.........----•- ....••••••-•.................••-•-••-••-•-•---•••--•---••-•..............--••--•-••-•-----...•-----•...-----•-•-•----•-••-•-••••-••••-•-••••-•••-••---•--••-•-•-•-•-•••--•-••••-•-----.......•-•----•--- Date PermitNo.......................................................... Issued........................................................ Date No......P.�.3'..�f� FEE...��I.... ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................. ... ....................OF.......................... Appliration for Uiupuuttl Work.5 Tonutrur#inn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: - y� f .....................................................�..._........-----................---r ................�. .. Location Add s ; © S"` r t No. "lir?::.:. r ' �... .................... Owner / Address a ---.._......•-•••-•--....•••....-•.............•••-............= Y-<._•__...;��a � ............. Installer Address Type of Building Size Lot.....� AF_l _(PSq. feet Dwelling—No. of Bedrooms.................fir...................._.....Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ... No. of persons........................... Showers a g ------------------------- P - ( ) — Cafeteria ( ) dOther fixtures • --------•......................------------------......-------•-••---••••-- Desi n Flow----------------••. ..... W g . ._..__.___..gallons per person per day. Total daily flow..........................�.__._..__..gallons. WSeptic Tank—Liquid capacity(J0-.V_Rllons 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 ( ) T Percolation Test Resul s Performed by...........................................• ! ._....`__ ...... Date....__.......7A4'1..0> Test Pit No. 1... inutes per inch Depth of Test Pit Depth to ground water...�, � Gz, Test Pit No. 2.........._ _%. inutes per inch Depth of Test Pit...._................ Depth to ground water........................ Description of Soil.................. r - U----�--•- x __.. .._�.... -----e --- W /V - UNature of Repairs or Alterations—Answer when applicable....................................._.-..._................_...................._....=_.__.___. ------------------------•-----•-_••--•-••---•-••••••----......_.....-----------••-••--•.._._.......-----•----...------------------------------------------•--•--.....--•--------------•----••...-•_..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL% 5 of the State Sanitary Code—The undersigned further.agre snot to place the system in operation until a Certificate of Compliance has been issued by the board of lth. Signed.---- •--• ,✓' ................................... ....... --... . Pat Application Approved By.................. = r ............................................. �...........................•:......_. �_.? 1 � Date Application Disapproved for the following reasons:-----••------------------------•----•--...--•--••------------••-------------•---........._. ......_...---..... -•••--•-_•----•--•••-••••-•------....-•--....•---•------•-•••••....•-••--••••--=----------•••-•••-•.... ......_---------------------------- ---------•------------- •---•------------••---•-------- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF................................................ 01rdifiratr of TVIntpliattrr THIS IS TO CERTIFY, ThpLt the Indiv' al S age Dispo System cohstru ,( or I�epa r ) by............................ •-• • ...----- -- •_... a J... SS 6_......_.......-_______-... �ostaller at. == -_-_--------•----•-•-----•------•-----------------•--__.----•--------------------•----•-------------•-••-•--•------------ has been installed in accordance with the provisions of TIME 5 o The State Sanitary Code as described in the application for Disposal Works Construction Permit No----6.-3:'..ell_______.___. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , 3_�9 ..........................................OF........................ ..... .._......... No.................•-•-- - FEE......................... UinVoual Workii Tonntralt' n am: , Permission is hereby granted..................... �lr.'al.�_S................� -........................................................................ to Construct ( is/hereby Repair ( ) an I i iviW- alSewwage Disp�os at No ••--•-••--- s -5.0.......... ....................6.5.�".'.".-.� 1 / Stree as shown on the pli ion for D' osal Works Construction/Permit No..............j..... Dated.......................................... r � Board of HealthDATE�--lv- •'-'--�-.. .. -----•............................... FORM 1255 A. M. SUL IN, INC., BOSTON �-n�`W Tz A S8•o� 4zAs4 :f 3Z' bd ' /k t� !✓t�7� O � JOvv GAL ` 11 ` w 1 vG 1pa Vx"o'` O dJ6F'AA/fSlplat/^\�`ST L 4TH'. O T �A IO 'VA OF T v' o r MORSE '78 No.10951 O ti OVAL-/ D L) T � 5'T�+TC HWy LEGEND is EXISTING SPOT ELEVATION Ox0 qy�-OF M,�ss CERTIFIED PLOT PLAN EXISTING CONTOUR --- 0 -- ,1, 4 icy 4+.. FINISHED SPOT ELEVATION o �� d '� ROBERT FINISHED CONTOUR 0 a E�oR o y IN APPROVED B ARD OF HEALTH �! o sua DATE AGENT — � SCALES DATE , S'r � %�$3 DREDGE ENGINEER/MG Cot IN CLIENT• `1 CERTIFY THAT THE PROPOSED EGISTERE REGISTERED J08 N0.� _ BUILDING SHOWN ON THIS PLAN CIVIL LAND , ..CONFORMS TO THE ZONING LAWS ENGINEER R MBY,i.,� ,......_.. OF BARNSTABLE MASS. 712 MAIN STREET 3/ 03 �!` NYANNI S, MASS. SHEET ! OF. .�'.. A E REO. LAND SURVEYOR jj15Nr ? W y • y h ; '� ' i t Y t , ok If �N > o 'o '�, � � ►: �, � tiw � :-'. •• . + • • , . �•`y' .� � � w" wow . -, � � � 4 WtjZ f zp� ao � �1 r w o t C1 rc d1Ki/V4pfl� � • ae �• o • • • F*: QOQ d yeti V O � � ltt� � � ��\ � • • o �4aee . !•.er h!v��a are• • v &'' a ♦ M ` ♦ ♦• • s ♦ r e V I Ala Q • � � • � d � / N �r'r ter � i 5 w4 1 r ( V{. ff 1 .. }5 F' 1"ikrtl ' � `�'•S :� � \.1 1 1 r' ' ' +' \ �' #r:;lti t Fl"'+1 1;j i •1. .. /•� - yea- `1 s ,� _- ts•a+11t t lY� t,1 del,}dt� �4Se�t�rE..�'" •{ ( y 40• 1.. .�. �. .. •J • VO ivA 4 4 �� a SMS x•-.�M O U) 2 t t� �i ... -.,'k. � t�3� � � t Mf.1�u r '�;' n - _ [MI� � •s Q p � � . OhNuu qb iA 7 a� $ ( �, l .�':S. '',". : i,��• `t .,t, � • . ' `first �, �' ,;� w ' ®0 44 � r LOCATION �...OT 49aN0. VILLAGE QS-MLJjLLg DATE . 07 M ss APPLICANT L 1`i�Q1E P'A9 1`T CCQ.� FEE ADDRESS.- C��, wILL� ,�, TELEPHONE .NO,.:1"IL361 Non-refundable ENGINEER MLCQ.fiD&r. E Q10jIs TELEPHON N0 spL! DATE SCHEDULED' JVLe �L� a (�8'S APPlicant'ls signature SOIL ^ - SUB-DIVISION NAME "6tMMj%Q1E4- 0- 0STC&IILLF." -DATE , 0 7 9 _ TIME 9 3e EXPANSION AREA: YES ✓ t.L NO J O N w R. E I 2 ENGINEER ') TOWN WATER✓ PRIVATE WELL jak ha J A GO P-6 I BOARD OF HEALTH - Jim D iz t SCQ 1..L EXCAVATOR SKETCH: (Street ,name,etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands .in proximity to test holes ) NOTES: C-AS--An kAv r 58,E 4-7: &�L 60 Mr LOT j LoT v o �8,00 PERCOLATION RATE: nee._, TEST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: 1 0'- o " Lo nn 'i 5 1 2 2 3 3 4 4 5 �� 5 ..6 6 8 5 8 9 ) 9 10 10 11 11 12 12 13 � w� 14 13 15 15 16 16 SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS ,�- LEACHING TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: . g NOTE: ENGINEERING PLANS MUST SHOW .NUMBER._ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETXRETUNED 0 BOARD .OF HEALTH `_COPY, RETAINED BY APPLICANT- ,-- '.".,"... m U Q L — w � v` v l , —41 yb Ix FFF Q 0�91 T `1 -- V Q l ' C:9 77.1 ��. C) r+ V F7 o I s S t r Iry Zl- I arc arc �r customizable system customizable system f ACCESS COVERS MUST BE WI THIN 9" MINIMUM. INVERT ELEVATIONS ' DESIGN CR I TER I A : GENERAL NO TES : 6" OF FINISH GRADE 3' MAXIMUM COVER FIRST 2' t0 INVERT OUT SEPTIC TANK: 96.3 DESIGN FLOW: BE LEVEL MIN 2" OF PEASTONE INVERT /N DIST. BOX: 96.67 3 BEDROOMS AT //0 G.P.D. PER I. THIS PLAN /S FOR THE DESIGN AND CONSTRUCTION OR F I L TER FABR/C INVERT OUT DIST. BOX: 96.5 BEDROOM EQUALS 330 G.P.D. OF THE SEWAGE D/SPOSAL SYSTEM ONLY, 4" D/AM PIPE at 3 3/4" - l 1/2" D/A. INVERT IN LEACH CHAMBER: 96.3 98.3 96.5 $� 2 o DOUBLE WASHED STONE BOTTOM OF LEACH CHAMBER: 94.3 NO GARBAGE GRINDER 2. VERTICAL DATUM IS ASSUMED. FOR BENCH MARKS OAS 6.67 s' 6.3 �� 94 SET, SEE $I TE PLAN. ADJUSTED GROUND WATER: N/A SEPTIC TANK REQUIRED: BAFFLE 3 OUTLET 2-500 GAL LEACHING CHAMBERS OBSERVED GROUND WATER: N/A 330 G.P.D. X 200% - 660 GAL. J. ALL CONSTRUCTION METHODS AND MATERIALS AND EXISTING D-BOX W14' STONE AROUND. 12.8'w x 25'1 x 2'd BOTTOM OF TEST HOLE #I: 88.3 SEPTIC TANK PROVIDED: /000 GAL. EXISTING MAINTENANCE OF THE SEPTIC SYSTEM $HALL 1000 GAL H-20 CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL SEPTIC TANK 6" CRUSHED STONE OR COMPACTED BASE SOIL ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS. DESIGN PERC RATE ( 5 MIN/INCH PROFILE : NOT TO SCALE SO/4 TEXTURAL CLASS - I 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER EFFLUENT LOADING RATE - 0.74 GPDISF AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER 330 GPD / 0.74 GPD/SF - 446 S.F. REQUIRED THAN 3' IN DEPTH SHALL BE CAPABLE OF W/TH- STAND/NG H-20 WHEEL LOADS. PROVIDED: 2-500 GAL LEACHING CHAMBERS W/4' STONE AROUND. A-471 S.F. 5 Q ALL SEWER PIPE L SHALL BE SCHEDULE 40 PVC OR P r 471 S.F. x 0.74 - 348 G.P.D. SOIL TEST P l T DA TA 6� 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED -6-- PRECAST CONCRETE OR APPROVED POLYETHYLENE. 84• E �/ `"�"-�-..,. TN0ICATES y IIJDIC�iTEs/ \ PERCOLAriON - OOSERVED BOTH SHALL BE WATERTIGHT. D-BOX SHALL BE WATER \ rEsr - GROUNDWATER TESTED FOR LEVEL WHEN THERE IS MORE THAN ONE TP of P*1$765 TP f2 OUTLET. N L 0 T 48\\� `� �\\ 0. HORIZON TEXTURE COLOR 9e.3 0" HORIZON TEXTURE COLOR 98.6 _ a l 5. l 06+ S.F. �` l �� l A LOAMY IOYR A LOAMY IOYR 7. BEFORE CONSTRUCTION CALL "DIG SAFE SAW 5✓2 SAA19 S✓2 /-88$-DIG-SAFE AND THE LOCAL )VTER DEPT. s- - - - • - - - - - - - - - - - 97.8 s• - - - - - - - - - - - - - - - ae.t FOR LOCATION OF UNDERGROUND UTILITIES. LOAMY IOYR B LOAMY IOYR I I / SAND 4/6 SAND 4/6 �TWtN SPRUCE l - - - - - - - - - - - - - - - 96.6 s. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE 20- - - - - - - - - - - - - - - - 96.6 2q. ME01W IOYR MEDILW IOYR C SAND" 6/s C SAND s/s DES 1 GN ENGINEER TWO DAYS PR/OR TO CONSTRUCTION OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE CONS TRUCT I ON /NSPECT I ONS. + r 40- EXISTING / / 9. EXISTING LEACH P/T TO BE PUMPED DRY AND � l � // / l I DWELL/NG / / 1 BACKFILLED. rNv warER ea.3 r2D- ' ' 'ad R '98.6 /0. ALL UNSUITABLE MATERIAL IA A 8 HORIZONS/ ENCOUNTERED BELOW THE INVERT OF THE LEACHING / SHw / / DATE: AUGUST 29. 2018 DECK / ) 1 TEST SY: VEPHEN MA$ FACILITY TO BE REMOVED FOR A D I STANCE OF 5* / / WITNESSED SY: 06MALD DESMARAI S AROUND AND REPLACED WITH SAND IN ACCORDANCE PERC.RATF_=C,2 MIWINCH- _ h . �l_... _._t' wr TH TITLE 5. I SEPTIC TANK SHED "ON $ONOTUSE 99.5 o // i�EL-!0/.is / i lOI. + /EXISTING / I I PIT / tRELLISTER 12*PINE 1 a 36'P/N� j -BOX 98.3 of ! 247INEAtC )• .':. 98.3 / 27900 GALLON :/ 97.3 o / iLEACHI NG CHAMBERS/ :•.'7• •... / �w« / W/4' STONE ARO f2S. / 1,6 G ?00.2 ` \ +97.4 S E P T / C SYSTEM D E S I ON N / 7a.0o• f 5 P I CASS0 PLACE` MAP 1 4S . PAR'C'EL 79 N 85.33'/0'W CB,DH FNV B A R N S T A B L. E . ( O S T E R v I L_ L, E ) n/ .4 . PREPARED FOR $ �t 9 LEGEND L OCUS S.T.A 7-,E H�' C1 A N D R E W R E" E Iiy �i 1'� ,� -- Dn r T � � C8 CONCRETE BOUND .. . w WATER TINE SCALE : l •- 20 SEPTEMBER 20 . 2018 c Rix/TE 28 _G' GAS LINE /� OHW--- OVER HEAD WIRES S T E P H E N A . . H A A S O LIGHrPOST ENGINEERING N m -£--- UNDERGROUND ELECTRIC L i NE / P 0 . Box 16 _T_ UNDERGROUND TELEPHONE LINE / .. ,:��' SouDennis ,th MA 02660 --CTV- UNDERGROUND C48LEVISION LINE �t\�f -I-40.4 SPOT ELEVATION t 508 ) 362--8 1 32 .. ...••40....... EXISTING CONTOUR LOCUS MAP P 0 /O 20 40 1 1 PROPOSED CONTOUR JOB NO., 18-0/8 __ _