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Home My WebLink About0080 POND STREET - Health 80 POND STREET OSTERVILLE , 'A= 118 103 / C I I No.__..Q.. '....j FEs..., .....M THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 4:c.") u.............OF..........P � ....---.....................-- Appliratiun for Biipuual Works Tonutrurtiun rrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ....5.:..........��. ------------------------------------------------ Location.Address or Lot No. W ................•................................................................... ---•-----•-"...... ............. / Address •--•---•-- ............... .............•--stall.-..c.`.J.---------------------------•---.....- ---. ..........---._..__...---•----••---.....ddre•---•----.._.....-•------......._......._..--- Installer Address dType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms--- f .............................Ex} sie� Attic Other—TYPe of Building --------•- - ........... No. of ersons..... -. -•---•-•-•-•--._._ Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------------------- ---------------------------------------------------------•--.-------------•-.- W Design Flow.......... .....//0..........gallons per person per day. Total dailyflgw____.... v........................gallons. WSeptic Tank—Liquid capacityl5OD-aallons Length_5r._: _.�. Width./0'41._ Diameter__._==_. Depth................ x Disposal Trench—No. .................... Width.................... Total Length___.....r__. _...i`otal leaching area....................sq. ft. 3 Seepage Pit No._......!:;�n_____-. Diw"eter...34XL4...... Depth below inlet.. .. . ?,. Total leaching area.._.__ D..sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.........{t.(�1�.l.d..�.15.....Q.c__hk Date....V5.Aij-------_.. Test Pit No. 1......._4----minutes per inch Depth of Test Pit..__..,lC ...... Depth to ground water..... ......... (i Test Pit No. 2............:...minutes per inch Depth of Test Pit.................... Depth to ground water........................ ..........................................:.................................................................................... O Description of Soil.............�.. �.... "� 7.f L....:.F ,c71! �:L. W 1-4 ---------------------------------•----•---•-•••-•-----------.....•--•-----------------------•----------------------------------------•-------••--•--------------••-•-•-•---•-------------------•-•-•-- U Nature 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 iI'l LE 5 of the State Sanitary Code—.The undersi r er agrees not to place the system in operation until a Certificate of Compliance has been i y the b of h h. Signed., . -----• -- ------ Date Application Approved BY•••••------ fi- ------ Date Application Disapproved for the following reasons:.............................................................................................................. --------------•---------•--------.....--•-............------•------------••-----•-•--••--....-----•.......-•-----••..........-•----•---------•-•-••----...-•••--•---........-••---••-----•---•--••------- QQ�' � s Date PermitNo......U... ..........J....:l.S.................... Issued........................................................ Date �..a■ter.. _��-- - y�s�.....� . .a..��aa..��...� ��.�.. ....�..«..��.�..��..��.�...��------ i ' t J. No....(7s.4�� Ficil THE COMMONWEALTH OF MASSACHUSETTS / BOARD OF HEALTH ...........................................OF.......................................................................................... Appliration for Disposal Works Tonshmdion Fermi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ....:..........._........_...................................................................... ........_.....................................................___-_____......_.._.._._.....•- Location-Address or Lot No. ................_....__........ .............Owner.......................................... ..............................................Address .............................».......... w Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.......................:....................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No............:........ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by--•-----------------------•-•-•--•--•......... ••__........................ Date........................................ ,.a Test Pit No. 1................minutes per inch Depth of Test Pit..................... Depth to ground water.................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q+' •-•------•••••••••••-••-•--•....•--•...•••--...••-••••••••••........••••••-•••••..............•-••-_..................................... •--- •--------- ••••-- 0 Description of Soil......................................................................................................................................................................... V ...._..... •- W UNature of Repairs or Alterations—Answer when applicable............................................................:.................................. ............................-........................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage sal System,in accordance with the provisions of J. 5 of the State Sanitary Cod The undersigne rther rees not to place the system in operation until a Certificate of Compliance has been i 19 the boardf h Signed •-•••• -. ......... ...... -••••f.. . . .......... -.. ...�$....."-•-FJ ate Application Approved By.............. . ... .................. .......................... _ ... ��.. ...tat Application Disapproved for the following reasons_____________________________________________________________________________•__----..-..............._...._.._ .......................................•----•---•--.......---•-----------•------..._...__................_.....---............---•-•----...-•--------•---------•------•-------..._----•-••-•.....__..._ Date PermitNo.......K-g�_:.... _g..5...---------------• Issued....................................................._ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /J � �..et,�t,.LO F..................6P .,. .,v,..a �L�1-r......_.............. (6rdif rate of Tomplinnrr THIS IS TO CERTIFY, That th ndividual Sewage Dis stem'constructed (sor Repaired by'** ... at. ............ - �� - - =°sta nit:: :'1............_.....'..''./•`--..... -•---•-•- .. v Inller .............. ---•- ....... : _----------•---_-•-•••_------------•-•••••- has been i stalledVnaccordance wi h fhe prckisions 6fiAt 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......... �.._____ .& dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NRBE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................................•--------...-•---•-•......................_.. - Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH c .............. ..OF........_...._-. : ... , .. ........................ No...'0 f 7 �'L� t" ,,. �� Fss..... J. ....... Disposal Works Tono#rudion rrrmft Permission is hereby granted._ ..p�. :. � ;91 �.:.:��---______ to Construct ( ) or Repair ( an I vi ual Sewage Disposal Stem atNo.................. . -T------------... .. r --•-•-•-•...••••--•--••-•.......•••••--••--••..._...-•••-••--•-•--•--.............._-- ereet as shown on the application for Disposal Works Construction Permit No. %,.�[f�t .. Dated.......................................... ............................... y / ............................................................ DATE................... t7 — el.. ..__`E Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON t THE TOWN OF BARNSTABLE �pF T0� • �+� OFFICE OF DAHaST,HL BOARD M OF HEALTH M�. �O i619• 367 MAIN STREET �O MAY k� HYANNIS, MASS. 02601 August 19, 1988 Ms. Marlene Weir ' 80 Pond Street Osterville, Ma 02655 Dear Ms. Weir: You are granted variances from Title 5, of the State Environmental Code, to install an onsite sewage disposal system at 80 pond Street, Osterville, listed as Parcel 103 on Assessor's Map 118. The variances granted are as follows: ,!Regulation 15 03 (7): The distance from the leaching facility to the property line will be 5 feet in lieu of the required 10 feet. Regulation 15.03 (7): The distance from the septic tank to the foundation wall will be 5 feet in lieu of the required 10 feet. Regulation 15.03 (7): The distance from the leaching facility to the foundation wall will be 13 feet in lieu of the required 20 feet. The above variances are granted with the following conditions: (1) The dwelling is restricted to four (4) bedrooms: Sewing rooms, study rooms, dens, enclosed porches, and similar type rooms are considered bedrooms according to the Department of Environmental Quality Engineering. (2) The dwelling must be connected to public water. (3) Garbage grinders are not authorized. (4) The designing engineer must be onsite to supervise construction of the system and certify in writing to the Board of Health that his design has been strictly adhered to prior to the issuance of a Certificate of Compliance. (5) The onsite sewage disposal system shall be pumped every two (2) to(4) four years. (6) The existing cesspool must be removed or collapsed and filled in. This variance is granted because the existing cesspool is located within fourty (40) feet of wetlands. The installation of a new onsite sewage disposal system located 101 feet from the cedar swamp is preferred to ensure protection of I I `o3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Pond St Property Address Owner Weir information is Owner's Name / required for Osterville ✓ Ma 10-22-2020 f` every 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: A. Inspector Information v t Lf When filling out p forms on the computer, use Douglas A Brown only the tab key Name of Inspector to move your D.A.Brown Inc cursor-do not Company Name use the return key. P.o Box 145 Company Address Centerville Ma 02632 City/Town State Zip Code 508-420-4534 S14297 '8"00 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 10-22-2020 In e s Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. t • Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v� 80 Pond St Property Address Owner Weir information is Owner's Name required for Osterville Ma 10-22-2020 every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: At time of inspection this system met all minimum passing requirements. This report can not predict the future performance under the same or increased usage. This system was installed in 1998 as per as-built. Tank was pumped in june of 2020 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 r Commonwealth of Massachusetts �I r: IF Title 5 Official Inspection Form II Subsurface Sewage Disposal System Form Not for Voluntary Assessments 9 p Y rY v 80 Pond St Property Address Owner Weir information is Owner's Name required for Ostervllle Ma 10-22-2020 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. , ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or' obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ i removed obstructions ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^ � 80 Pond St Property Address Owner Weir information is Owner's Name required for Osterville Ma 10-22-2020 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 80 Pond St Property Address Owner Weir information is Owner's Name required.for Osterville Ma 10-22-2020 every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No El ® 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 ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A co of the analysis p 99 copy Y and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1 80 Pond St Property Address Owner Weir information is Owner's Name required for Osterville Ma 10-22-2020 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? M ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts �e lR Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Pond St Property Address Owner Weir information is Owner's Name required for Osterville Ma 10-22-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: according to design plan this system consists of a 1500 gallon septic tank H-20 distribution box and 6 H-20 galley chambers with 2 ft of stone. As-Built card says that there is 2 to 3 ft of stone. Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ❑ No Does residence have a water treatment unit? ❑ Yes ❑ No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): Detail: This system is NOT designed for usage with a garbage disposal. The 2 yr average water usage was aroung 450 gpd for 2018 and 2019, There is a irrigation system on the property. Sump pump? ❑ Yes ❑ No Last date of occupancy: currentlyoccupied t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Pond St Property Address Owner Weir information is Owner's Name required for Osterville Ma 10-22-2020 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: pumping reciept from Bortolotti const 6-18-2020 - Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason.for pumping: Maintenance 1500 gallons t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts �e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ~ � 80 Pond St Property Address Owner Weir information is Owner's Name required for Osterville Ma 10-22-2020 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 1988 per as-built card Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts ! �9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 80 Pond St - Property Address Owner Weir information is Owners Name required for Osterville Ma 10-22-2020 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 2.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1f tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallon Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle .Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? design plan 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 pumped in Mid June of this year so there was not much solid or scum build up. t5insp.doc•rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form 41n Subsurface Sewage Disposal System Form Not for Voluntary Assessments u 80 Pond St Property Address Owner Weir information is Owner's Name required for Osterville Ma 10-22-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction:. ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass • ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts �m IF Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 80 Pond St L- Property Address Owner Weir information is Owner's Name required for Osteryllle Ma 10-22-2020 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: '❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): 0„ 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.): box was level with no signs of carry over t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts �e l Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments / 80 Pond St Property Address Owner Weir information is Owner's Name required for Osterville Ma 10-22-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No`` Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 6 ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: l t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 80 Pond St Property Address Owner Weir information is Owner's Name required for Osterville Ma 10-22-2020 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): There were no clear signs of failure or overload in the chambers or surrounding stone. We hand dug into the stone surrounding the Galley's and it was clean and dry. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts j; Title 5 Oifficial Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4' V 80 Pond St Property Address Owner Weir information is Owner's Name required for Osterville Ma 10-22-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Iig Title 5 Official Inspection Form 11. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 80 Pond St Property Address Weir Owner Owner's Name information is required for Osterville Ma 10-22-2020 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts 1; ii� Title 5 Official Inspection Form III Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Pond St Property Address Owner Weir information is Owner's Name required for Osterville Ma 10-22-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: There was no GW encountered according to perc data. Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ 'Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 • , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Pond St u _ Property Address Owner Weir information is Owner's Name required for Osterville Ma 10-22-2020 every page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Assessing As-Built Cards Page 1 of 2 TOWN OF BARNSTABLE LOCATION c E i,r SEWAGE# `o VILLAGE ASSESSOR'S MAP& L^OT INSTALLER'S-NAME& PHONE NO. SEPTIC TANK CAPACITY p a / / LEACHING FACILITY:(type)a17 1 (size)2•" �6 5�� NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER L/�t(�. DATE PERMIT ISSUED:_1,�Z�� DATE COLIPLIANCE ISSUED VARIANCE GRANTED: Yes v"" No r /o r Porlti https://town.bamstable.ma.us/Departments/Assessing/Property_Values/HMdisplay.asp?m... 10/22/2020 Assessing As-Built Cards Page 2 of 2 https://town.bamstable.ma.us/Departments/Assessing/Property_Values/HMdisplay.asp?m... 10/22/2020 TOWN OF BARNSTABLE /� LOCATION 78'� S/ SEWAGE VILLAGE; veASSESSOR'S MAP & LOT� / INSTALLER'S NAME & PHONE NO. 3 SEPTIC TANK CAPACITY ® LEACHING FACILITY:(type) d _(size) ate"� /�. NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER 4b. BUILDER OR OWNER O ll k a E DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED; VARIANCE GRANTED: Yes c�,-- f No i+„a ::1�. - ��1 �1 ��,.t 1 �� 4 •', 1 3� � � �� i � � � I� ro s� C\ --�---�_._.. . �� J� 'S GV/ E I � I 1 i 1 i i :'o, MIN. L.1. r� 10' MIN. + 1 1 TOP OF FOUNDA TION . o �iv ELEV.= IN VER T -- ~ •o ELEV= _ 3. INVERT ' o E-L E v= _252 a- o L1 • --.--- O C R TION MAP -'^L___7 I N VER T I N Vf R T ELE v= 24.9 ELI V- 24.8 INVERT M ►�� ,� _ /Z' _ T - - 2 LEVEL ELE 4.4 V 25,.1 4 c . n000000 ooCDoconCD 00000no DESIGN CALC.ULfti TIDIVS EDC3r�o C3o o ono CD oo 0000000 (jC3ciUc�oo CaCjc�ooc�o MMMMono CJC7C:AClC]C�Ej C3C7C7MC7MCD mmmCOomm .o 4 INVERT C3ooC3000 CDC000cooco 00000oo ►o 4 - • ELEV= 24.6 000cJoon CooCJ0000 00000coo (_-3 o Coo noo o nn 000 n n 000 oo0 21.1 DISTRIBUTION �� NUMBER OF BEDROOMS q 1500 GA1 L_ON >f f ,: TANK BOX 3.3 EFFECTIVE GARBAGE DISPOSAL. DEPTH 3 - 4X4 I-CACHING GALLEYS - W1 TH 314 "— 1 V2 STONC TOTAL ESTIMA TED FLOW <� *'� NO TES: ( 110 GAL./BR./DA Y X `I BR.) -- _12` REQUIRED SFP TT C TANK CA PA Cl T Y "'�UU 1 AL L WORKMANSHIP AND MA TFRIAL S SHAL L CONFORM TO THE D.E 0 E ACTUAL SIZE OF SEPTIC TANK TIRE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULAT- IONS FOR THE SUBSURfACE DISPOSAL Of SEWAGE. SEPTIC S YS TF'v1 PROFILE z LEACHING AREA REQUIREMF-N TS Stone - SIDEWALL AREA 0 �iAI_ /i F 2 NO CHANGE To THIS SYSTEM SHALL BF MADF UNLESS APPROVED IN NO SCALE BOTTOM AREA 'o5.3 GAL L./S.F. - WR17ING BY BENCHMARK ENGINEERING ASSOCIA lE S. End Center- End 1 " c,IL I_FAC.HIN6 ('APAI:I rY (_SIOFWa! I f f�OT�tI!M) !F r •J A COPY Of THESE PLANS SHALE Bf- XJ-PT ON SITF DURING 01 �.�r` f/r X 3 , - x v_I 11 4 /' 1;x /Ka' 'r �� 'ZS �� L CONSTRUCTION. -2 , RESERVE LEACHING CAPA CI rY 4 A COPY OF THESE PLANS SHALL BE FURNISHED TO THE INSTALLER * Town of Barnstable requires dou!`►• leaChrr7 capacity for 4or more bedrooms 5 ALI COMPONENTS OF THE SANITARY SYSTEM S7(ALL BE CAPAB(f Ol S tone WITHSTANDING H-10 LOADING UNLESS PLACED UNDFR OR Wl THIN 10 FF E T OF DRIVES OR PARKING AREAS, WHERF H-20 LOADING SHAi HI USE U Ar 6 All COVFRS TO SANITARY" UNITS SHAH BE BROfIGHT TO WITH/N 7:" PLAN VIE W OF F INI SHE U GHAL,I - ...r. r NO SCALE ANY MASONRY UNITS USED TO BRING C'OVEKS TO GRAD( 1101ALI Hr MORTARED IN PLACE B BFFORt HAChF1LIIN(: TILE SYSTEM, Tll( INSTALiFR �NALI N0771-t BENCHMARK ENGINLERING ASSOCIATL_`, L)H THE BOAR0 OF HEAL TH t l oil_ !7 ' TO INSPECT THE SY57EM A5 CONC.TWU(-JE.i.' 0111\/, /- 7 J — 9. EXISTING AND FINAL GRADES SHALL REMAIN £SSEN77ALL Y THE SAME / DA TE OF SOIL TEST _5 MAY BB UNLESS OT}-IERKISE NOTLL l WITNESSED BY PE M 1 Jeri _Uunning PERCOL A TION RATE 4 min /inch 10 HI AVY CONSTRUCTION FOIIIPMFNT SHALL NOT TRAVE-1 OVFP THS i R=3 0 0 . 00 .. SYS Tf M DURING OR AFTER CONSTRUCTION L=72 1,3 1 1. ANY EXISTING CESSPOOLS SHALL BE PUMPED OUT AND FILLED 78. = _ / �� OBSER VA TION HOLE I OBSER VA T107 HOLE 2 WITH SUITABLE MATERIAL. ELEVATION- 26.3 ELEVATION= 2 THE LOCATION OF THE PROPOSED SYSTEM WAS REQUESTED BY THE BOARD OF HEALTH AND WILL REQUIRE A VARIANCE r, „ FROM THE TOWN OF BARNSTABLE SET-BACK REQUIREMENTS r O — 6 Sad FOR THE SIDELINE AND STREET. 6" -36" sandy fill BREAKOUT CALCS. 2 e*X1a' L£ACHavc cAtLErS x p 3/4'-f 1/2 w� SME' ° 18' O ~ / 7 /� _ --- - -� '` : ,� ►� , Q � , / _ __ _ J ( 2. 6 ' X 15 0' ) / 60' 6.5' 36 -l20 Sand w/ some fines aN SIDES AND J ON I Z p 00 / , _ - _ 'S i 1 t ENDS EFFECAVE DEPTH ►�' / // / - - .. J.-V. H-20 LOAD01aon EX7S7?NC ' 6 O ' � 6.5' silty t 8s�1'r C mink co , cEssPpav 5AL AL AL AIL 0 AL i 1 s ASPHALT 01 _ ' �� DRIVE I g �- ' Test hole% 7 f �+► _ ' �_� � � I , NO WA TER A T 10 ELEV.= 16. 3 WA TER A T 91� _ , / I �l CEDAR WAMP IL A DATE DESCRIPTION DRAWN B Y CHECKED SITE AND SEPTIC PLAN ;\ i �0 I rcl i I 1 r 1 I LOT 103, T/ 80 POND S TREE T \ cq,� tic a' ' ' I GRAPHIC SCALE Acf Io ,o m w OSTERVILLE BARNS TABLE MASS. FOR MOWMARLENE WEALL IN FEET 150.00' I j7 ��/ // 1 o rt JOB NO. 88017 SCALE: 1" = 20' DATE: 5120188 N89'1'17'03"w1 / // DWG. NO. WE/RSEPT DRAWN BY: PEM CHECKED BY: / A b CABENCHMARK ALL / // , SU HOWARD W. SEARS RVEYING & ENGINEERING ASSOCIATES AL — -- I �j/ // , _ AT HERITAGE GREEN \ P.O. BOX 1409 MASHPEE, MA 02649 617-477-9870 �'