HomeMy WebLinkAbout0180 PINE LANE - Health 180 PINE LANE
Osterville
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer.
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ftPlitation for BisposaY,*pst;em (Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade('+Abandon( ) [91�omplete System ❑Individual Components
Location Address or Lot No. 111a Lane—, Owner's Name,Address,and Tel.No.
D5luM I I c/
Assessor'sMap/Parcel 11-1-()-13 TaIcrmavi
6 (N Installerqq
s N e dre and Tel.N . Designers Name,Address,and Tel.No. 6 u 33
1�pe of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(�o
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided a_1) gpd
Plan Date -1 201 q I Number of sheets Revision Date
Title Sl� ��(,�— t
Size of Septic Tank- Type of S.A.S. -6w rml M I ZX`25
Description of Soil Q# 16, 9,ed " 3 S
LA Y- , ry oa C S
MPA Sam
12 I Z /� LIJt VI/ 0
Nature of Repairs or Alterations(Answer when applicable)
&A na 5II r& I WL rtAAA r, +D bY_ at? C yA P rd rn l�n 1-}
IA,Y\L� ,��r_ S�perA-k_ PLrmI-� �� 2ND Uhlt.
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 BoVdpf Health.
Date
Application Approved by Date q l Q(
Application Disapproved by Date
for the following reasons
Permit No. 5�, �� Date Issued 30 I �1
No. — Fee
4- �_�
� . THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
- PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ZIPPULAtion for -MisposaY,, . B onstrULtIon 3pErmit
Application for a Permit to Construct( ) Repair( ) ,Upgrade(Abandon( ) [ complete System ❑Individual Components
Location Address or Lot No. I
N OlAt I n�� �j Owner's Name,Address,and Tel.No
Assessor's Map/Parcel D*ry I i( TA l e r Ma vl
Installer's Name,Address and Tel No. Designer's Name,Address,and Tel.No. Nvi 6b
r Jos-c /' �� �'v f
Type of Building: ; J
Dwelling No.of Bedrooms ?Lot,Size sq.ft. Garbage Grinder
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided 3 0 gpd
Plan Date 11 Number of sheets Revision Date
Title SI
Size of Septic Tank Type of S.A.S. 1-6()D I 1/y,M 6 r5,-12.xI 5
Description of Soil ) # 16, 9,61 - "
n"41� �� �1/�I(���r 5_ 16 M$� Y1Gt� `�Z "1 7 rtr t// — !€l umd
Nature of Repairs or Alterations(Answer when applicable)
iD b4 cp l?1��M W I o,J (A o' 1
,
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 Bo rd f Health.
Signed �", Date
Application Approved by Date J/T
Application Disapproved by Date
for the following reasons
Permit No. "N Date Issued c ) 3 U '
----------------------------------------------------------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
CPrtificatr of CompYiancr
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed(� Repaired( ) Upgraded( )
Abandoned( )by /,�.� j �'ti' ,_j
at 0S /I i (a has been constructed in accordance ] )
with the provisions of Title 5 and the for Disposal System Construction Permit No ,I,l —U/ dated
Installer Designer
#bedrooms Approved design flow gpd
The issuance of this permit shall not b construed as a guarantee that the system will fµncti e
Date Inspector
--------------------------------------------------------------------------------------------------------------------------------------- f
No. QQ I` _ e / — Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Mispos Y 6pstem Const union 3permit
Permissionfis hereby granted to Construct(�) Repair( ) Upgrade( ) Abandon( )
System located at lb VW-f UJ U-C)5kr\1i1
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit.
Date � ! Approved%
M
Town of Barnstable
Inspectional Services
Public Health Division
HAarrsrML&
M^� Thomas McKean,Director
dot ° 200 Main Street,Hyannis,MA 02601
Office: 508-8624644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: U, Sewage Permit#�U 0 Assessor's Map\Parcel
Designer: ? (k3U �Tn�taller: Jn
Address: Address: R/ 77OE
oA.sW//.�
On "V U c%s 4 was issued a permit to install a
installer
(date) (installer)
septic system at A I PA I based on a design drawn by
' r (address)
63A, �,i dated
_tdesigne
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.
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 in compliance with the to rms of
the IAA approval letters (if applicable)
�P�tH OF
q
CHARLES T.
G ,
onler's Signature) g ROWLAND
r,1
O CIVIL
" No. 52699
,o C
(Designer's Signature) (Affi"� A '� p Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DI SION. 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.
1\toaWepts\HEALTMSEWER connecASEPTIMesigner Certification Form Rev 9.14-13.DOC
t §
October. 18, 2018
Re: 180 Pine Lane, t Osterville MA 4
. �Y
To Whom It May Concern.
,
My husband and.I purchased 180 Pine'Lane,^Osterville in January 2018 The tlowner had recently
passed away so we did not have any,input from him;and there were no kn_own relatives,as to.how the
house had been used and number of bedrooms etc. We were told by the executor that three of the
bedrooms upstairs had been rented out or were used by"friends"of.the owner and the owner was
living in a room on the first floor.. - '
z Y.
We were told the cesspool would fail and.would need to be replaced,the inspector who wrote"
up the Title V report did come inside the house and looked at the rooms. Per the only field,card he
could find, he wrote that the house was.a three bedroom but 1a fourth room fit the:criteria for being
considered a bedroom and the-system was designed for.ifour bedroom.;There is-another room on the
second floor which also fits the.bedroom criteria: closet, 2 standard windows and over'70 s.f;;at,the;
time we saw it,there was a cradle in the room(I do not believe'any child had lived therefor along time,.
` but the house was built in the 1850's'so it would seem very plausible that this room would have been
used as a bedroom). The septic inspector did not think that'room (labeled bed room;'#2 on the floorplan)
.had"expected privacy', but I don't know�if people in the 1850s had much expectation.of,privacy=that
is the room in which the cradle rested. Y
Thank you.for reviewing this and please let us know,if there is anything we can do to help.you
with your decision '
Sincerely
Elizabeth Talerman ti
... . -,
t t4 R
z
s
r = THE COMMONWEALTH OF.MASSACHUSETTSam`°mp°r�"
PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE,MASSACHUSETTS
fipfitation for.-Disposal*PZt m C=0trurtvorr pxntu z
Application for aPerinit to construct( ) ) Upgrade(L-rAbandon( ) Complete System individual components.
Components
LocationAddiess cr l of No.I�a Owner's Name Addmss and Tel No
pslrrvalZ 1 ,
Asses Map/Parcel'- p
Installer's Name,Address and Tat.No Desigwr's Name,Address,and Tel No `
.�� ��.apt @� -�Z�- � • .,;
Type of Building:
I Dwelling No.of Bedrooms' G Lot Size I ���1 sq.ft Qarbage Grinder��1t�
Other Typo ofBuilding No.of Persons SLowers ) C ofetena G )(
Other Fb=es
Design Flow(min.required) '27, gpd .:,Design$ow provided gPd r
Plan . Dada + 0.10�p TN,.um/bberoyf�sheets
�� Revision Data M.
_ - 11LLe� (Jf hY'\Y/!�v•V.i 1 V\ •L� : y.. b� 01 -
Cll� T of SAS 2OQ (0S\ [ r►1irS1�i in' �Z7ZS
Size ofSeptic'Tank_ r YPe _ s
Description of soft
_K 10('Afte
ri
Ca
r
a Il) t C � ' "y
Nature of Repairs orAlterations(Answer when applicable)
���.�... �;,1PJ� y c�et���or� Sc�:c_. .� ham: `r•�,olac�-t�l � •• ,:,.� A -
�,edcear�n yrv,1S 5e?�.At6 �r�tt leaf. 7 � ��� (�'3�t�rzlne
Date last inspected:
Agreement: r
1 The undersigned ogees to ensure the construction and maintenance'of the afore described on-site sewage disposal'system in.,
accordance with the provisions of Title 5 of tSic Environmental Code and not to place the.system inoperation until a Certificate of
Compliance has been issued by this Board of Health.
ApplicationApprovedby ' Data '
D r
ApplicationDisapproved by' ate r
for the following reasons
PeritNo. ��/� ^�� *' Date Issued
---
_ .THE COMMONWEALTH OF MASSACH a'ffs
•BARNSTABLE,MASSACHUSETTS 4 ,
'irfifitaftof CC
mplianice
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaned
Abandoned( )by
I L�t� � ,j1� a ' has been constructed naccordance
with-the provisions of,Title 5 and the for Disposal System Constractirmftinit NeAV�7 O�dated
L't Designer
Installer `
#bedrooms '
Approved design flowC� ; gpd
The issuance of this permit shall not be construed as a guarantee that the system will function as resigned a
Date Inspector
-- 4'NO 1 ------------
THE COmmoNWEA.LTH of MASSACHUSETTs
PI7BLIC HEALTH DIVISION-BARNSTABLE,MAS S
SACHUSETT
t pu�ai�pstem �Gotrstruttiun Erma
r O
{ Parmissron is hereby granted to Construct(, ) �+ (') Upgade( ) Abandon
System locatedat 6 �U 2
' t
t aPp recognized to comply with
and as descrbed in the above Ap
plication fm Disposal System Construction Peimrt The Leant reco ed h>s/her duty Ply
h
Title 5 and the following local provisions or special condthons ` r
'i
1 , Provided:Constructiorrmastbe within three ofthe date of this p
K'
t Approved by
Date '
t I_ k 1J •b k -h r�_a J n
�'' t S, w
o N �/._ '3G Fee J V.
LL!!
THE COMMONWEALTH OF MASSACHUSETTS `�'n60ID �
PUBLIC HEALTH DIVISION'-TOWN OF BARNSTABLE,MASSACHUSETTS
applica ton for Disposal oppotlem cimstm,ttiun Vertu t
Application for a Permit to Construct( ) Repair,(,) '( 'Abandon( ) [-�Cromplete System ❑Individual Components,
Location Address or LotNo.. (1�t\C—�. O-wtn�er�'ss Name.Address and Tel No
Assessor'slvlapTarce1
Inst.
Name,Address,and Tal.No Designer's Nana Address,and'Te1,No
I.u, G r.J 90
- V
Type of Building:
Dwelling . No.of Bedrooms "" 1 Lot Size O sq.ft Oa<bage Gamder
Other Type ofBur7ding No.ofPersons i Showers( ) Cafeteria{:)
Other Fudiires'
Design Plow(min.reposed)'. ZZ C3 '. gpd'>'.Design flow provided.: U Mt✓� gpd
Plan Date tl.c t7' Ahmmber of sheets Revision Date
Tide�Jk W
Size of Septic Tank 1SL� Type of S.A.S 7 !
Description ofSoII e , (,� IbI Z S(yltl�i(De1W�-'
t_�fox f9-'g''G C.&:& `I��(l� co�rsz�cA 7. .
Nature off Repass or\Alta ti as(Answer
when applicable) s '-
�L -t W
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage deposal system m '`
accc¢dance with the provisions of Title 5 of the Environmemd'Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Pate'"
Application Approved Data' '
Application Disapproved by
, ,. Date'.'
for the following reasons
,
Permit No.�ni:y SL } Date Issued
THE COMMONWEALTHAFMASSACHUSETT5
BARNSTABLE,MASSACHUSETTS
>= c�lertffita�te of C WPhand.
THIS IS.TO CERTIFY;that the On-site Sawage Disposal system Constructed( )• Repaned(, ) Upgraded( ) r
Abandoned( )by
at O�1r\e o has been constructed M accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer - Designer.
#bedrooms 7' Approved design flowQ gpd
The tssuance'of this permit shall not be construed as a guarantee that the system will function as designed. ,y
Date i Inspector
} _� Fce J
THE COMMONWEALTH OF MASSACHUSETTs _
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETT5
�LSt1DSAI�pStEM GnStMttIDIC'J)E3na:
Penmesion is hereby granted to Construct('f: R`epair( ) Upgrade( } Abaiudon( )
System located at 71 V-,Q G, i l y'l�_'
e
and as dasm'bed in the above Application for Disposal System Construction Permit. The applicant recognized hislher duty to comply with
Title 5 and the following local provisions or special conditions.
Provided Construction m bee pleted within three years of the date oftbis permit f
Date Approved by.
oz
a � ,
I�
m
OFFICIAL uls-E
ca Certified Mail Fee •—
Extra Services&Fees(check box,add fee as appropriate)
❑Return Receipt(hardcopy) $
❑Retum Receipt(electronic) $ Poslmdik
❑Certified Mall Restricted Delivery $ , re �
O ❑Adult Signature Required $
[]Adult Signature Restricted Delivery$ __ �n "+.�✓'L
O Post.
m $
r,- Total
rq
$ QUINN.MICH_AEL F&KAVANAUGH.KEVIN F TR
rq 180 PINE LANE
o fiee OSTERVILLE.MA 02655
City;
:rr r rr rrr•r.
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electronic version:For a hardcopy return receipt,
complete PS Form 3811,Domesfic Return
Receipt attach PS Form 3811 to your mailpiece; iMPORTANr Save this receipt for your records.
Ps Form 3800,April 2015(Reverse)PSN 7530-02-000-9047
lea Pine (��e
ps.�-vilt�
1
1
Complete items 1,2,and 3. A. Signatur
M�X
_
o Print your name and address on the reverse X gent
I! so that we can return the card to you. l�—A ❑Addressee
m Attach this card to the back of the mailpiece, B: Fleceived by(Printed N me) C. Date of Delivery
or on the front if space permits. C 1�
-.- --- - y -'irery address different from.item 1? ❑Yes
enter delivery address below: El No
a*
QUINN.MICHAEL F&KAVANAUGH,KEVIN F TR
180 PINE LANE
OSTERVILLLE.MA 02655
II I II I I I :3."Servlce Type 0 Priority Mail Express®
III III I II II II I I I IIIII I IIIII I III I I I I ❑Adult Signature ❑Registered MailTM
Adult Signature Restricted Delivery 0 Registered Mail Restricted
9590 9402 1933 6123 1789 58 `�ertified Mail® /�e6very
6 Certified Mail Restricted Delivery I�Ytetum Receipt for
❑Couarf�n Delivery erchandise
2__ArtirlwNl l.+he (r Delivery Restricted Delivery 0 Signature Confirmation TM
7 015'' ;4 9 8 7 6.3 8 4 E !ail ❑Signature Confirmation
17 3.0 �'� 1 'Y: sa�dlCAail Restricted Delivery Restricted Delivery
(over$500)
PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt
USPS TRACKING
First=Class Mail
Postage&Fees Paid
USPS
Permit No.G-10
9590 9402 1933 6123 1789 58
I United States •Sender:Please print your name,address,and ZIP+4®in this box•
I Postal Service
I
I
I I
a�' 4ws Town of Barnstable
Health Division
200 Main Street
Hyannis,MA 02601
I � I
I � I
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'Town of Barnstable P#15, ds 1
Department of Regulatory Services
- : BAPBWABLM ? Public Health Division Date
t' 163 a�� 200 Main Street,Hyannis MA 02601
Date Scheduled Tit/l$ Time Q Fee Pd. 11,3d X
h
Soil Suitability Assessment,f ors Sewage Disposal
Performed By:�Ci6V.-% k4iftC/i1��'. Witnessed By
LOCATION&GENERAL INFORMATION
Location Address �U o Fi m ®BLav)�? Owner's Name gR®�® ccr s �`12f 0� .�-K'�'O �r � .
(VL 1� 1� 0-ZU-5S Address 34 W LLCL GOUT V�CJ°M g ee -lCwttke
Assessor'sMap/Parcel: b� Engineer's Name SV`k`v to urn, V 11
NEW CONSTRUCTION b REPAIR Telephone# �,�® �� 3
0
Land Use �� 1 Slopes(%) "(J 0 Surface Stones /V
Distances from: Open Water Body Possible Wet Area 75§�—_ft Drinking Water Well 1�I�ft
NMI ft
Drainage Way N� ft Property Line �S _ ft Other M�
SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes)
0
P
T
Parent material(geologic)0AWec,1i Depth to Bedrock '.0 •/�
Depth to Groundwater: Standing Water in Hole:�en & Weeping from Pit Face /V Ar
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used: &W.tlMd(?f
Depth Observed standing in obs.hole: in. Depth to soil mottles: M.
Depth to weeping from side of obs.hole:. in. Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level
PERCOLATION TEST Date 1711ti Time P®
Observation
Hole# Time at 9" 1.
Depth of Perc b7 GO"
Time at 6"
Start Pre-soak Time @ 11:� W �tv� Time(9"-6") 14 S
End Pre-soak WO 5 M,v\
Rate Min./Inch
Site Suitability Assessment: Site Passed !✓ Site Failed: Additional Testing Needed(YIN)
Original: Public Health Division Observation Hole Data To Be Completed on Back---=-------
***If percolation test is to be conducted within 100'of wetland,you must first notify the
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:\SEPTIC\PERCFORM.DOC
DEEP OBSERVATION HOLE LOG Hole# _
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consiam-c %Gravel
0 or I ay
gilt 41
i9-36% C• to'44
3G-TL C-t- 40 1 Ib`(l� Sf
7Z-137.".
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture. Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
/ Consistency.%Gravel)
040.1
Tz-3S a
?`t-13Z•• C
DEEP OBSERVATION HOLE LOG Hole# _
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)— _
t� rr
a•
Sit-13Zto` Q2
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture i Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
0—loan p/Its
37
Flood Insurance Rate Mat):
Above 500 year flood boundary No_ Yes
Within 500 year boundary No .100� Yes
Within 100 year flood boundary No_ Yes
Devth of Naturally Occurrine Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on 1� ,_ (date)I have passed the soil evaluator examination approved by the
Department of Environmental Prot ction and that the above analysis was performed by me consistent with
the required tr ' g,expe d experience described in 310 CMR 15.017.
Signature Date
a .
QASEPTICTERUORM.DOC
i
� ram,
Town of Barnstable Barnstable
Y�
ti
Regulatory Services Department ;m` C j
BARNSPABM
9� MASS
Public Health Division
iOrFO My�e 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 6384
December 12, 2017
QUINN, MICHAEL F & KAVANAUGH,KEVIN F TR
180 PINE LANE
OSTERVILLE, MA 02655
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 180 Pine Lane, Osterville, MA was inspected on
12/07/2017 by Thomas Roux, 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:
• Single Cesspool.
You are ordered to repair or replace the septic system within two (2)years 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 TOE OARD OF HEALTH p
omas cKean, R.S., CTro
Agent of the Board of Health
Q:\SEPTIC\Title V Inspection Report Letters Mai Iing\Failed or Needs Further Evaluation Letters\180 Pine Lane Osterville.doe '
of TKE Toy, '
i
Town of Barnstable
� Aa7NCTlAi i' f
'M' Regu
t63¢ latory. Services Department
1b�
Public Health Division
200 Main Street,Hyannis MA'02601
Ofca: 508-8624644 Richard Scab,Director
FAX 508-790-6304, Thomas A McKean,CHO
Feb 6, 2007
Rev. 5111116
DEADLINES WREPAIR 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 pouding of effluent to the surface of the ground .
❑Pumping more than 4 times during the last year not due to clogged or obstructed
pipe. =•
o 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 wafer quality analysis.'(This system'passes if the wafer analysis
indicates the well is free from pollution).
TWO (2)YEAR
DL�-
Single"Cesspool-
❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation
of a driveway due to H-10 components, etc)
o Leaching pit or cesspool with high liquid level,<12"below inlet(per Town Code
§360-9.1)
❑Leaching facility with standing liquid level at or above the invert pipe (per Town
Code §360-20 h)
OTHER
Repair deadline:
Q;ISEPTICIDEADLINES To REPAIR FAILED SYSTEMS.doc
//7
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
til
180 Pine Lane
Property Address
Michael F. Quinn Revokeable Trust
Owner Owner's Name m.,g
information is Ma. 02655 December 7, 2017 x
required for every OSterVllle
page. City/Town 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 A. General Information ^
filling out forms ���¢ / o` -7-L30
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Thomas Roux
use the return Name of Inspector
key.
—v Company Name
89 Mayflower Lane
Company Address
East Wareham Ma. 02538
City/Town State Zip Code
774-678-9066 S14531
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 16.340 of
Title 5(310 CMR 16.000).The system:
❑ Passes ❑ Conditionally Passes ® Fails
❑ Needs Further Evaluation by the Local Approving Authority
& j— 2
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 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 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.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
�o y�� �s
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
180 Pine Lane
Property Address
Michael F. Quinn Revokeable Trust
Owner Owner's Name
information is required for every Osterville Ma. 02655 December 7, 2017
page. Cityrrown -State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 180 Pine Lane
Property Address
Michael F. Quinn Revokeable Trust
Owner. Owner's Name
information is required for every Osterville Ma. 02655 December 7 2017
.
page. Cityfrown State Zip Code Date 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 (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO(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):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
at 180 Pine Lane
Property Address
Michael F. Quinn Revokeable Trust
Owner Owner's Name
information is required for every Osterville Ma. 02655 December 7, 2017
page. Cityrrown State Zip Code 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.
❑ 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
® ❑ 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 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 Y2 day flow
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
180 Pine Lane
Property Address
Michael F. Quinn Revokeable Trust
Owner Owner's Name
information.is required for every Osterville Ma. 02655 December 7, 2017
page. Cityrrown 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:
❑ ® 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 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 2000gpd-
10,000gpd.
® ❑ The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CM 15.303, therefore the system fails.The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ 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
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.
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal.System Form-Not for Voluntary Assessments
180 Pine Lane
Property Address
Michael F. Quinn Revokeable Trust
Owner Owner's Name
information is i
required for every Osterville Ma. 02655 December 7, 2017
page. Cityrrown State Zip Code Date 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 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)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): No Design Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for exam le: 110 gpd x#of bedrooms): No design
3 "Wcoo/M.S
�OS ICI Ie JD ef/ "D -
i
t5ins-3/13 Tide 5 Official Inspection Form:Subsurface SewageLLUisposaMystem•Page If of 17 // 1�
ROOM I,s > -7OS.,1 , ,3w"-dowSt @21 ���4 h�, � � �� ��Gclricw� SerOrP, Cl01do
Commonwealth of Massachusetts
A"N' Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
.' 180 Pine Lane
Property Address
Michael F. Quinn Revokeable Trust
Owner Owner's Name
information is Osterville Ma. 02655 December 7, 2017
required for every
page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 1
Does residence have a garbage grinder? ❑ Yes ® No
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: current
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments
a 180 Pine Lane
M
Property Address
Michael F. Quinn Revokeable Trust
Owner Owner's Name
information is required for every Osterville Ma. 02655 December 7 2017
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: No records
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
® 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):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
a 180 Pine Lane
4M
Property Address
Michael F. Quinn Revokeable Trust
Owner Owner's Name
information is required for every Osterville Ma. 02655 December 7, 2017
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
50 years+/- , House was uilt in 1850.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 2.5
feet
Material of construction:
® cast iron ❑40 PVC ❑ other(explain):
Distance from private water supply well or suction line: +10'feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Septic Tank(locate on site plan):
Depth below 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:
Sludge depth:
t5ins•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
l
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
180 Pine Lane
Property Address
Michael F. Quinn Revokeable Trust
Owner Owner's Name
information is required for every Osterville Ma. 02655 December 7 2017
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness
Distance from top of scum to top of outlet tee 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.):
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
t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 10 of 17
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
M 180 Pine Lane
Property Address
Michael F. Quinn Revokeable Trust
Owner Owner's Name
information is required for every Osterville Ma. 02655 December 7, 2017
page. Cityrrown 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 ❑ 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
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
180 Pine Lane
Property Address
Michael F. Quinn Revokeable Trust
Owner Owner's Name
information is Osterville Ma. 02655 December 7, 2017
required for every
page. City/Town. 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
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.):
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.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
180 Pine Lane
Property Address
Michael F. Quinn Revokeable Trust
Owner Owner's Name
information is required for every Osterville Ma. 02655 December 7, 2017
page. CityrFown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ 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.):
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration 1
Depth—top of liquid to inlet invert
16"
Depth of solids layer 21,
Depth of scum layer
<1"
Dimensions of cesspool 5.5' Deep X 6' in Diameter
Materials of construction stone and concrete
Indication of groundwater inflow ❑ Yes ® No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
180 Pine Lane -
Property Address
Michael F. Quinn Revokeable Trust
Owner Owner's Name
information is required for every Osterville Ma. 02655 December 7 2017
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.):
Waste was visible along the inside of the structure all the way up the sides. The inlet pipe also had
solids on top of it. This is an indication of hydraulic failure.
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.):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 180 Pine Lane
Property Address
Michael F. Quinn Revokeable Trust
Owner Owner's Name
information is required for every Osterville Ma. 02655 December 7, 2017
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 bT-C-W`IA 1 f /v TS
t�e ovsev
A fc ce-u Poo 1 = 2 2, y d
O
n e-S r 0
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Fora
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
180 Pine Lane
Property Address
Michael F. Quinn Revokeable Trust
Owner Owner's Name
information is required for every Osterville Ma. 02655 December 7 2017
page. CitylTown 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: below 10'
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: 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:
There at least a 10'drop in the back to the abutting property.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
w„ y 180 Pine Lane
Property Address
Michael F. Quinn Revokeable Trust
Owner Owner's Name
information is
required for every Osterville Ma. 02655 December 7, 2017
page. Citylfown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
I
® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 17 of 17
TO OF BARNSTABLE
LOCATION / 9'0 P t r>f- t a-4 e SEWAGE#
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NO.OF BEDROOMS /
OWNER J��Gr' •��
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 facili_ty)/ Feet
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SECOND FLOOR PLAN FIRST FLOOR PLAN
FIRST FLOOR LIVING SPACE = 928 SF
II SECOND FLOOR LIVING SPACE = 462 SF
WINDOW SCHEDULE DESIGN BASED ON AND—ON 4M SEMES DOOR SCH E TOTAL LIVING SPACE = 1390SF
LTR. 0".. ROUGH OPENING REMARKS GLAZING # OTY DOOR SIZE REMARKS ING
A' 68 Y-0-X5'-0' 6.9.20.4s.66S.F. 1 1 34•x B3' 3'-0'ENTRY w/SIDELIGHT R-SHIN. 7.O S.F.
B 3 2'-0'%Ya' TW2<JB DX 3x5.73•17.195.F.
5.F
O Y-0i'X 33{' TWZUBOH 2 •,.JB . 2 8 2'-0'%fi'3' BPANEL INTERIOR DOOR
3 1 Y3-x6'8 6-PANEL STEEL FIRE—R
E 4 2 T-0•xe'-0' 6 PANEL INTERIOR DOOR
5 1 Y-0'xs3' OLGH STEEL IRE°° FLOOR PLANS
6 1 Y Xv% 6 PANEL INTERIOR DOOR i DATE: 29 AUG 201e FPROIECT. 180 PINE LANE,OSTERVILLE,MATOTAL 82.17 S.F. 5'a-xD-0- 5 FT INTERIOR BIFOLD PAIRGREYWING DESIGNB-0-xr-0' GARAGE DOOR 3BEDROOM CAPE
0'dx6-0• SLIDING GLASS DOOR 300 S.F. SCALE: 1l4'•1'-0'TOTAL 37.0 S.F. - 131 QUAKER MEETINGHOUSE ROAD,EAST SANDWICH,MA 02537www.greywing.com (508)888-0886 ® 2D1s GMYWIDg Desig�so®eeaaeesO:G181003B SHEET:A3 OF 4
I
I�
TBM E1=42.2 MS
- i-42 Top of MagNail
1 avement Edge
\ ZONES:
(30' Wide - PU'Wic Way) Street RC
i �0uth { FLOOD ZONE: Front 20'
IV
/ \ Zone X Side 10'
Pavement Ede \ FEMA Map No. Rear 10' R
- -- - 43 - -a- SEPTIC NOTES 25001 CO544J
-- -- -` ( 1.Location of Utilities Shown on This Plan Are Approx.At Least 72 Hours
"",. � \ July 16 2014 V8
� � Prior to Any Excavation For This Project the Contractor Shall Make '
" 69.40 NS 4:30 E l the RoquiredNotifications to Dig Safe(1-88&344-7233)and contact Fron t 20'
'( I
OVERLAY :DISTRICT K
- Sullivan Engineering&Consulting Inc.(sos-42&3344). Side 0'
2.The Contractor is Required to Secure Appropriate Permits From Town Rear 0'
/0
+ I Stone
I Agencies For ConahuctionDefinedby This Plan • WP - Wellhead Protection District
{ l i 3.Wherever Sewer Lines Must Cross Water Supply Lines Bolh Lines Shall l BA
t I Be Constructed of Class 150 Preserve Pipe and Shall be Waa'W Tested to
+
• (l 1 I Asomi;Watertightness.In General,Water Lines Shall be(constructed in Fron t 20
c
Coordination With COMM Water,and shall be m Accordance Side -
/ _ --J With248CMR1.00-7.00&310CMR15.00.L Rear
0 26. J V _ ..-42 - 4.A Minimum of 9"of Cover is Required for A8 Components. B
1 \ / ' 5.ALL Structures Buried Three Feet or More or Subject
451` j t -" "" I to Vehicular Traffic to be H-20 Loading.It is the Engineer's x
J t 13.7' ` N Recommendation that H-20 Always be used
{ 6.hista7 Watertight Risers and Covets to Within 6"of Finished Grade
Over Septic Tank Inlet,Outlet,D-Box,and One Leaching Chamber
Per System All covers are to be maximum 18" 24"Cast Iron. Location In
Plan:
-46, 1
1 { ' i 801 1 �` { 7.Septic System to be Installed n Accordance With 310 CMR 15.00& Scale: 1"=2,000±'
{ ' �} { 248 CMR 1.00-7.00 Latest Revision and the Town of Bamstable Finish Grade
Board of Health Regulations. 3'Max.
�•
I 8.All Piping to be Sch.40 PVC. 9"Min
IDS \ Compacted Fill
_■ f' \ II A 3 k S \ 9S� Shall Have a Minimum Inside Dimension of 12",and a Minimum Filter
c ASSESSORS REF.:
�N{ { 10.The Separation Distance Between the septic rank fi"and Ike;- 112" Map 117, Parcel 073
dlOr
2 ' H j / ' c Outlets Shall be No Less than the Liquid Depth.hilet Teca Shall Extend Pea Stone
7-- / a Minimum of 10"Below the Flow Line.Outlet Tees Shall Extend 14"
1 ' e I { 1 1 3/4•' - 1 1/2"
{ ' { { Below the Flow Line,and Shall be Equipped With a Gas Baffle. LEACHING Double Washed
M 1 � T -2 { ' `� 1 { CHAMBER stone
! t 1 6 1 1 11 4' - 10"
12*
Q. CROSS SECTION OF CHAMBER
--p ED I�o�oL D \ 1°� + {' NOT TO SCALE
ZE
J
-P Pa
ro Driveis
cD 180-A
'r - 6 See Note 6 (typ.)
15
� fig/ ~ "r. � %',`hl`" \� � \ \ \ `\ � \y✓ DESIGN DATA F.G. EL. 44.00t - *Final Foundation Gradin To Be F.G. E 4 Min.
Par I Q\ Sin&FamilyCoordinated r Landscape Plan
Q o 1 I \ ;l \ 0 3 Bedroom Q 110 GPD 3.7 Complies
ro - 17, \ \ No Garbage Grinder Flow Equilizers -- 1• With
Breakout
Total Daily Flow=330GPD EL. 43.2 f As Required
Installer To
1 3il! t Use a 1500 Gal Septic Tank Confirm Prior EL. 1500 Gallon
To Any Work Septic Tank EL. 42.25 Ton EL. 42.50
LEACHING AREA H-20 Required
/&/ ff _ --( 4 (See Note 5) D-Box L. 41A.13
dmkk �, \ 1 22.3 �. _,1 1 t0 Sla _ / - - \o 330 GPD/0.74(LTAR)=446 SF Required
1\') Sideway=2(12'+25)2'=148 SF Leaching
Ar `� 180 2- qiy F' �` s � { � Bottom Area (IT 300SF R To Be Installed On
l � •-_ __t / � y ( 9= \ /� Chamber
l RC t ` ` Total Provided=448 SF arable Compacted
/ OPOapelii /�.,. -y 32 i _ 3 0
�� FILING i- -�
IN Z LEACHING CHAMBER DESIGN Inspection Port, ................ua...............r .......................rIepiace
BE. \ o� & Baffels #t }riswtviDle Soils SVi3hrn 5 of
1 / Pipesto be Schedule 40.Use as Per Title 5 n
X 0 \S 2-5 .Leaching Chambers in ..........
Qtiti k'Drlrpletsr Qf 1t+ 5� tern: M
® f-r! 0' Q N T THt 4 Q 12'x 25 Double Washed Stone Field as Shown
l 1L�.CIL1 vi
o� L. 34.5
�- ......,. . Yr. :�o DEVELOPED PROFILE OF SYSTEM - A Na Groundwater
. j Per Test Hole 3 & 4
. . . . . :'' t 3 ` EL. 4
..........
Groundwater
/ `t' } NOT TO SCALE T 0 . Standard
/
P PO�E•D � � MI/Y
F.F. Ell 50.4
��
10.0' f o i i k DG &
-46- ' "W i'f /+ / f 180-B See Note 6 (tin•) --
f / DESIGN DATA tit o.
- � ,,,• �,•,,. F.G. EL. 48.0 F
TEST,; 1�,851"
! PEM9 D'H'Y:70HN ODEA,PE Single Family InsEL. 46.0
T i \ _ .SULLMAN ENGINEERING&CONSULTING,INC. Petra Schaefer & Carl A Nosenzo =1 Bedroom Q I10 GPD Installer r
3.75' Complies
Confirm Priorri With
SOIL EVALUATOR NO.2911 No Garbage Grinder To Any Work Flow Equilizers Breakout
WITNESSED BY:DONNALD DESMARAIS,R.S.-TOWN OF BARNSTABLE Total Daily Flow=110 GPD r As Required
DECEMBER 14,2018 Minimum Design Flow=330 GPD
SITE PASSED Use a 1500 Gal Septic Tank Slab D. 42. EL. 1500 Gallon rr
Septic Tank EL. 4.50 H-20 Too EL. 43.00
(See Note 5) .5
TEST HOLE-I EL.46.5 TEST HOLE-2 EL.46.5 TEST HOLE-3 EL.45s TEST HOLE-4 EL.45.5 LEACHI 4 8NG AREA D-Box L
O/A IAYER.l0YR.3f2::...:.r O/ALA7CER'IOYR.34 .: O/A 1 ASZER 10StR W%-.:.::.. ......;t1/�k iAYBR' 330 GPD/0.74(LTAR)=446 SF Required. I i1 9 Leach in g
VBRY:3fz48ICf3RrlY..... D3tR7:: VBRYP?Y ORztYLSHBROWN VBRYi3A1tKr#RPcYiSH'BROA2I: YBRYifAHICQRAYt§H'BRA�VOf 1dewall=2(12'+25V=148SF R � k Chamber
" ::rr::::c:..r ...........: . ....... . S = \�Q o Be Installed On /� 42.00 i
46.0 12" :.:.':::.:SANDY.'LOAM::...:::. W4 SANDY LOAM.:::.:. ..: 44.7 Bottom Area-(12'x 25�-300 SF .'l
e ompac a assBot. EL 40.00
:.:.H LAYER:IOYR4l6::..:::.: :;:::.B LAYERa0YR416.':::::: 13 LriYER 10YR4t6 . ... Total Provided=448 SF
_............ ..... ...... ... ... ...... .:....... . ..... .............................. . . "T"
Bedding. s "...::.:.::.:::.•:::•::::::.
DARKYELLOWISHBROWN'.:'.r. . .... ..HHRQ...... . ......DARKYELLOWISHHRf...... . ::::::DABKYBLLOA/ISHBROWN..... •^T*�. :.:
_ ................... Inspection Port I.EriCfaU;ifered:Rbue:':..:`.#::::::.:.;:
P
44.9 22" ":': :.:::LOAMYSANI7.::::::: 44.7 2 ':. " " ''LOAMY'SAND 4 ".:. .iOAMYSANIk . 432 CH�EL G CHAMBER DESIGN & Baffels al. nu,olzle::. ovs."Whiiin:5 0 h
CI LAYER10YRs/6 CI LAYER i0YR5/6 CI LAYER I 5/6 Cl LAYER OYRS/6 gyp\ as Per Title 5 {pe ................../4lttrf16k6!:?�:: 1ifl11
ysfiifil..
YEILOWISHBROWN YELLOWISHHROWN YELLOWISH BROWN YBLLOWISHHROWN All �Atedule40.Use
C .:: io
3" COARSE SAND 4.5 3" COARSE SAND 4.6 z COARSE SAND 23 COARSE SAND 42.4 aIO kW(&G g Chambers in a M
C2 LAYER IOYR 5/6 C2 LAYER IOYR 5/6 C2 LAYER IOYR 516 C2 LAYER IOYR 5/6 'U t�l�t abed Stone Field a8 Shown. EL. 34.5
YELLOWISH BROWN YELLOWISH BROWN YELLOWISHHROWN YBLLOWISHBROWN p r No Groundwater
CI4iL
MED.SAPID MED.SAND 4" �•SAPID 41.0 WED.S� 40.8 � Per Test Hole 3 & 4
PERC TEST' Wa.9 C3LAYER23YN4 C3 2.5Y614 ,4d168 DEVELOPED PROFILE OF SYSTEM - 8
9"-6"-14.5 MIN LIGHT YELLOWISH BROWN LICW YELLOWISH BROWN o
2» PERC RATE<s M1N/II9(LTAR=0.74) 5 9.8 N ED.SAND MED•SAND �O $T E��O 4<c� EL. 4
Groundwater
LAYER 25Y6/4 C3 LAYER 2.5Y6✓ FERCTEST 40.5 �y\� NOT TO SCALE Per T.O.B. Maps
LIGHT YELLOWISHBROWN LIGHT YELLOWISH BROWN 9"-6"=14.5 MIN S/0NAL
1 " NED.SAND 3 .5 1 » MED.SAND 135.5 I " PERC RATE<5 MKIN(LTAR-0.74) 34.5 1 „ S
NO GROUNDWATEROCOUNTEnED NO GROUNDWATER. NOG UNDWA ArIEEED
REVISION: New Dwelling Footprint ® 180-8 109125119
TI TLE: PREPARED BY. .PREPARED FOR: NOTES:
Site P'an 1.) The information shown hereon was obtained (n
Proposed Improvements CapeSury by an on the ground survey performed on or Z
} Engineering 23 West Bay Rd, spite G �-a�er.m a�,1 between 18/APRI18 and 07/MAY/18. �
A( Suffiva C0118wftj.. Osterville MA 02655
./ (000)4aaaaM•rA11=6aa•7Ararae•a,0dWWftMA02Na (508)420-3994 (508)420-3995 fax
l80 Pine Lane "�0"'""""w`°"°"'""�""''°°"' aapesarvftape`od.net 2.) Datum used is approx mean sea level.
BamstableIt osterville Mass. _q
o
Draft: JOD Field: 20 0 10 20 40 80
DATE January 7, 2019 1 20'
SCALE: Review: JOD Comp.:
°' =
Project: 38016 Project: C 739