Loading...
HomeMy WebLinkAbout0130 SEA VIEW AVENUE - Health (2) 102 (aka�,13,0.) SEA-V E Ostervill`e -Wianno ub- esid. A = 162 - 019: I i � L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments } 100/102 Seaview Ave Property Address 0.4 Owner Wianno Club ( Cottages ) information is Owner's Name / ; required for Clsteryille V Ma 02655 11-4-19 every 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: A. Inspector Information When filling out P s��,l�3 I a• forms on the computer, use Douglas A Brown only the tab key Name of Inspector to move your D.A.Brown Inc cursor-do not Company Name use the return key. P.o Box 145 Company Address r� Centerville Ma 02632 City/Town State Zip Code 508-420-4534 S14297 �mn Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails / 11-4-19 :: pector Sig Kure Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 t f Commonwealth of Massachusetts Title, 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100/102 Seaview Ave Property Address Owner Wianno Club ( Cottages) information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Citylrown 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: ® 1 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 or exceeded all passing requirements. 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 i Commonwealth of Massachusetts i' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100/102 Seaview Ave Property Address owner Wianno Club ( Cottages ) information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): { ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 r c � Commonwealth of Massachusetts it? Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100/102 Seaview Ave vl Property Address Owner Wianno Club ( Cottages ) information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water. supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well"*. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts 1� lF Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100/102 Seaview Ave Property Address Owner Wianno Club ( Cottages ) information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone 11 of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100/102 Seaview Ave Property Address Wianno Club ( Cottages ) Owner information is Owner's Name required for Osterville Ma 02655 114-19 every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (co nt.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310.CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 X, Commonwealth of Massachusetts Ii� Title 5 Official Inspection Form 11.� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100/102 Seaview Ave Property Address Owner Wianno Club ( Cottages ) information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 6 Number of bedrooms (actual): 6 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 Description: Acording to as-built card this system consists of a 2500 gallon 2 comp tank and a 1500 gallon tank, d-box, and 7 500 gallon leach chambers with stone in a 62x10 ft area. Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Does residence have a water treatment unit? ❑ Yes ❑ No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: Wianno Club is supplying all water usage documentation. Sump pump? ❑ Yes ❑ No Last date of occupancy: seasonal Date 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 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V� 100/102 Seaview Ave Property Address Wianno Club ( Cottages ) Owner information is Owner's Name , required for Osterville Ma 02655 11-4-19 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: 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: Facilities manager states yearly pumping for maintenance. Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 r Commonwealth of Massachusetts it? Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100/102 Seaview Ave Property Address Wianno Club( Cottages inform ) Owneration is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ® Other(describe): 2 tanks Approximate age of all components, date installed (if known) and source of information: 12-29-12 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.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments L 100/102 Seaview Ave Property Address Owner Wianno Club ( Cottages )information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 2.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 2 tanks 1-2500 gallon 2 comp and 1 1500gallon. 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: 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.): Tanks are functioning properly with all tees in place. Tanks are on regular maintenance pumping schedule. t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I I° Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100/102 Seaview Ave Property Address Wianno Club ( Cottages ) Owner information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. CityTTown 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100/102 Seaview Ave Property Address Wianno Club ( Cottages) Owner information is Owner's Name required for Osterville Ma 02655 114-19 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover,,any evidence of leakage into or out of box, etc.): d-box was functioning properly at time of inspection with no signs of solid carry over or back up. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts �F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 100/102 Seaview Ave Property Address Owner Wianno Club ( Cottages) information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 7 500 gallon chambers ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 cam, Commonwealth of Massachusetts �= Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 100/102 Seaview Ave Property Address Owner Wianno Club ( Cottages) information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): There were no signs of failure or break out in area of existing s.a.s. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form f Subsurface Sewage Disposal.System Form Not for Voluntary Assessments 100/102 Seaview Ave Property Address Owner Wianno Club ( Cottages ) information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts re Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V 100/102 Seaview Ave Property Address Wianno Club( Cottages ) Owner information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts �u li Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100/102 Seaview Ave Property Address Wianno Club ( Cottages) inform Owneration is Owner's Name required for Osterville Ma 02655 11-4-19 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 9.75 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 10-2019 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: design plan and attached as-built card i 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 100/102 Seaview Ave Property Address Owner Wianno Club( Cottages ) information is Owner's Name required for Osterville Ma 02655 114-19 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 - assessing Hs-tsuiit uarcis Page 1 of 2 - � TOWN OF BARNSTABLE LOCATION 'ma 4icl fww,�r .� SEWAGE# VILLAGE_ C'l�,<<-r��i Lf _ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPA(frY i LEACHING FACM.-(type) sire) NO.OF BEDROOMS BUI DER OR OWNER o- Lc. PERMIT DATE:_/'e e COMPLIANCE DATE: Separation Distance Between the: Q ' Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Private Water Supply well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet Edge within 300 feet of leaching faclity) Feet Furnished by u���e p ,��y,iJs"�i"i ate. o 2sCIO 6.i /S,40 cv/p C.w Ole r.a 6 �2-Coerd4Ef e,v>' i 0 T 6/ http://www.townofbamstable.us/Assessing/HMdisplay.asp?maDDat=162019&seo=3 Ri1)ni,)nl Q PvTn S Grcg.\ /1 or-ok TOWN OF BARNSTABLE LOCATION /Oc;L S14 V/Gbv AVL SEWAGE# VILLAGE OsiCIVJ _ ASSESSOR'S MAP&PARCEL /CQ' 0(Cj INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY aSS aZ LEACHING FACILITY: (type) pep NO.OF BEDROOMS .j V OWNER Ln/14AII D C lul PERMIT DATE: � �9 COMPLIANCE DATE: Separation Distance Between the: �r` Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 3 . FD/ id 2- +'h SGA VIGW AVC. (Co rn 4; IV041-1trA Vii,il �f.�u✓�'� .��J�erl� C�}�✓ No. -` Fee do — J THE COMMONWEALTH OF•MASSACHUSETTS w 'Entered'in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS �! ftpl ration for Disposal *pstem Construrtion 3permit plication for a Permit to Construct(°'Repair(,—,-,upgrade(Abandon( ) Complete System El Individual Components Location Address or Lot No. / SeAv' w -AVe Q Owner's Name,Address,and Tel.No. W Anno G 1�� Assessor's Map/Parcel j �l,Z - 17� ��� ��� l 3� o�Hv,tiW Ins is Name,Address,and Tel.Now o1,-7.7 2��o Designer's Name,Address,and Tel.No. qaJ-,339Y Type of Building: Dwelling No.of Bedrooms I Lot Size 14 00 sq.ft. Garbage Grinder(ILly Other Type of Building u' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) U gpd Design flow provided 7.1,f gpd Plan Date dLo( )L Number of sheets Revision Date n Z Title V(v 01P Q d� >> Size of Septic Tank )v C, Q n Cc mg Type of S.A.S. U ' Z C 4n, /) Description of Soil - i '' ��c �I `tKed, stn4d MPG>'jH4 :� ein�� �_i k'rvHl.d,,ti�OrelA Nature of Repairs or Alterations(Answer when applicable) 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 BoMVWe_j S' Date /.?�<�/�^ Application Approved by Date u -2 b / 7112 Application Disapproved by Date for the following reasons Permit No. 2 b Date Issued 2 ot r� frI1; UA� l G� �Ud��^ EGj�P✓(N (u1*(n�2/) �7 n No. .. Fee cr Entere i,com uter THE COMMONWEALTH ORMASSACHUSETTS p PUBLIC HEALTH DIVISION -TOWN OF B-ARNSTABLE, MASSACHUSETTS Yes Sew .� aptation for -Disposal *pstrm- iOft permit r � A andon Com lete System Individual Components lication for a Permit to Construct Re air U adet` b � y ❑ Location Address or Lot No. I Q SQ y,�; w �}Ve Q 01 \ ' Owner's Name,Ad'drdss,and Tel.No. V,1 Assessor's Map/Parcel - (1� 1 3 0 P'.e t✓ 4M ? Ins y 's� Af.rddr sis,and Tel.No�'�"�.,ZB�� Designer's Name,Address,and Tel.No. I%�f-.3 3W X7- ls� o..�•q. . Sv I f 1/U 7 �a r/Lov d O IfP✓����e Type of Building: Dwelling No.of Bedrooms 10 Lot Size f{ 14, V V sq.ft. Garbage Grinder(/L/Y Other Type of Building 06iq,Q(J) No.of Persons Showers(�).Cafeteria( ) Other Fixtures rV — t Design Flow(min.required) G gpd Design flow provided` a t gpd Plan Date Number of sheets Revision Date 111241,2 Title Rrvoos-ed ivl L< up f 4k k�r / Size of Septic Tank 1000&a on Type of S.A.S. o 2 Description of Soil - N III 3 411- ,��' 9 t o g -Mod. krd 1, - 7) d r i f Nature of Repairs or Alterations(Answer when applicable) �-- i I i 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 ofe Compliance has been issued by this Board of He lr � S i��� �-•"+"--� a� Date/.��1�/�.-. , l Application Approved by e Date /a 2 b l 2 Application Disapproved by ` Date r for the following reasons 4 Permit No. )61) - 3 qt/ Date Issued 2 I. /-2 i ---------------------- ---- -- = _ __- _ ______-_______>_--___•-== _'-- =---_-- ---------- (��Ir AT N E 4 ` ,dr rr ��,'} THE COMMONWEALTH OF MASSACHUSETTS �c�c roA, J'oc,o 41 5'c( ( BARNSTABLE,MASSACHUSETTS - r Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X Upgraded( ) 13 Abandoned( )by o,/ e' —fo-5e, u at �}�� 2 t,u i c,N A-✓& 6)5�e ruJ10 has been constructed in accordance I with the provisio a Title 5 and the for Disposal System Construction Permit No. )0I2-3 7 Y dated 1012,4 J i z Installer cro/�ri/c�.��c� Designer #bedrooms �� Approved design flow �/� gp d The issuance-of this permit shalln�t�b+e construed as a guarantee that the system will r. 'o a(�s.designed. Date ,Jc- . / T/ f/ ' Inspector No. � o o- 3 yy FeeTHE COMMONWEALTH OF MASSACHUSETTS I PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal �&pstem Construction Permit Permission is hereby granted to Construct V.' ) Repair K-5 Upgrade(✓� Abandon( ) System located at Ay'p , Akkzll3o I 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. i Provided:Cons ction must be completed within three years of the date of this pe tl � v 1`Lx-Date G Approved by Y� Ile i_Ian.IOB.G®1 " . A; P.gel orl Na C!1-J y (1vOrtln rvSd�r cTtTgp�• .Fa OL_ , - 0 THE COMMONWEALTH (�ss�caas�TTsEaarea m —PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE,MASSACHUSETTS yG4 ftkation for Misposal Spst@tn Constrtettion 13@rni t Application for a Permit to Construct(n Repair W Upgade( Abandon( ) ❑Complete System ❑individual Component. Location Address or Lot No.802 S CA .t 3,VIl X V e Owner's Name,Address,and Tel.No. - Assessor'siviap/Parcel 162 4019 - Gi rl , 1305EZ Vi E%k; 5;E, _ ILL t. - t. Installer's Narne,Address,and Tel.No. Designer's Name,Address,and Tel.No. 92fr-3�14 _ 5t>ii.vetnt tub 1NC f,�az�c¢�J ' O52GILYnr.c.G. ' type of Buiidmg: - Dwelling No.of Bedrooms Lot Size It fo,300 sq.fL Garbage Grinder(J�D ' Other Tyoe of Building G6TI-P c 6 No.of Persons Shower( )Cafeteria Other Fcrtures DeAp Flow(min.required) 446 gpd Design Bow provided 444 gpd 0o Plan Date eti 1 Z4 1 w rr— Ntnnber of sheet 1 6F( Revision Dace N Title Taoft6 W, SePZL S've of Septic Tank 'type of SAS. C �. 2 ie Z" 1 Descriptiunof Soil 0-34.. ,:,�+_ 34'-59' •. VISI�(n - rb(c, 5A.U0 4to-Zz' -. ,. 0-ieo 5kp-�fl 72- 128" C2 wteo S-PAjo tau 6t2o�iv °v�r�:Gi uuct 2c�i Natum of Repairs orAltaratloma(Answer when applicable) t 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 Tide 5 of the Environmental Code and not to place the system in opemiimunfil a Certificate of Compliance has;been issued by this Board of Health. Date Sim V .Application Approved by � pare 1 Application Disapproved by y Data h - for the following reasons Permit No. 2 o +1-3 Y L1 - Date Issued t" 16 L , THE COMMONWEALTH OF MASSACHUSETTS- 3 C �12 Ri_E• BARNSTABLE,MASSACHUSETTS ' �@TtlfltaltP Of�018IIDI18I[tP - . THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repa'oetl( ) Upgraded(k) - Abandoned( )by `, atl02 S cda Y f c µ} 10"t�2Y t I u' has been constructed in accordance ' with the provisions of Tide Sand the for Disposal System Construction Permit No. e. r-3y Ydated u z _ kistaller Desi@oer SULLI V A rU Er•Y ,l,o— (l16 1 to(. H bedrooms 4 C;)(2b 0,A.C, -+. Approved design flow gpd - y The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Daze Inspector - : •t --------------• -------------------------------- - - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS + �isgusai�pstem�oadstraatiDat�emtit � 1 _ Permission is hereby granted to Construct /( ) Repgav( ) Upgade((�) .. Abandon System located at 1O 2 S ff 1C 1 Lti`a P{y 1� l and as described in the above Application for Disposal System Consttuctioe Permit The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions: Provided:Constru in a completed within three years of the date of this permit fiP /Zi Date 0 z- Approved `- T r - • t i EWu'l ®1 +13,9,6icM13®6famA=O,l�p�+ordafo-llmdffiisA�PnPYJIXaLWR4LCB�de=133121166M&4uEr=Fy(ttTA416FAr8i31p_SfoQB � w t INM'M12 • ' 1 TRANS. NO.: CITY/TOWN: APPLICANT: \AA 10^44 o ADDRESS: 102 SCA Vi"bz�[ At E C i'u-rt'I0br. G2es .l LAC-�i6b DESIGN FLOW: 4 .C� Q�, gpd- REVIEWED BY: ETEL DATE: bc t, 25,•ZD�Z N/A. ` OK. NO y !?3 sue.•,t*�'ra�rc �a ,*, s h,�i sJ' `�1 ^ �= �, t "�_- � E,;��� 'was ,��'"� ,�p,+r-. y� � aL�"• .. ' Legal boundaries denoted.[310 CNM 15.220(4)(a)] Street, Lot,tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] : Locus Provided [310 CMR 15.2204(i)] , Jf Plan proper scale? (F' 40' for plot plans, 1"=20' or fewer for components) [310 CNM 15.220(4)] Easements shown [310 CMRY15.220(4)(b)] X System located totally on lot served.[310 CMR 15.405(1)(a) for. upgrades]- if not, a variance is re uired' [310 CMR 15.412(4)]; Location of impervious surfaces (driveways,parking areas etc.) . x [310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR rs 15.220(4)(c) Location and dimensions of system components and reserve areas. [3l o CMR 15.220(4)(e) System Calculations [310 CMR 15.220(4)(f)) daily flow _ : X se tic,tank ca"ac ty re u ri`0'aiid rovided)'' X 0 soil'absorption systemA(re(fired andprovided) X m whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g)] Existing and" ro osed contours.[310 CMR 15.220(4)(g)]. X Location and log of deep observation holes (existing grade el on each test) [310 CMR 15.220(4)(h)) Names of soil evalua or and BOH representative [310 CMR x 15.220(4)(h) and (i)] Location and date of percolation tests (performed at proper ►k elevation?) [310 CMR 15.220(4)O] Percolation test results match loading rate? [310.CMR 15.2421: Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] + Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CM 15.103(3) and 310 CMR R 15:220(4)(n)] Address' l02 SEA �(;�Evt) G 1-t :'' �� Sheet 1 of 7 N/A OK NO Location of every water supply,public and private, [310 CMR 15.220(4)(k)] within 400 feet of the proposed system location in4he.case 3 ;. of surface water su lies and graveL acked. �ublic water.su l ",r X within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case .'. of rivate'water'su 'lywells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in.310.CMR 15.211 and any catch basins q� located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other'subsurface utilities located [310 CMR 15.220(4)(m)] (if waterline cross see 310 CMR-1 5.211(1)[1 Profile of system showing invert elevations of all system K com onents and the°bottom of the SAS [310 CMR15.220(4)(0)] Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)1 x Stamp of Registered"Land Surveyor(required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate 4(two in each of the primary and reserve unless trenches as permirtted in 310 CMR 15.102(2) or as X approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate.to demonstrate four feet of suitable material? [310 CMR 15.103(4)] x f� Test Holes adequate'to confirm adequate groundwater separation? x [310 CMR 15.103(3)] Benchmark within 50=75' of system [310 CMR 15.220(4)( )] k Materials specifications noted? [various sections of 310 CMR X 15.000] - System componentsmot> 36" deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405(l(b)] t- ,. Sheet 2 of 7 l02 c � �� Sh J E e�. t E v►.l � k .� r Address � �ll ',.. � l, � d r N/A . OK. . NO Size OK? [310 CMR 15.223(1)] X' Inlet tee located ten inches below flow line [310 CMR 15.227(6)] S C e kieT S 10 Outlet tee 14" or 14",+ 5" per foot for increase ft depth[310 CMR 15.227(6)] Outlet tee with gas baffle or a roved filter [310 CMR 15.227(4)] x Note regarding installation on stable.compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees (no less than liquid depth) [310 CMR 15.227(2)] S G"E o i'E Inlet/Outlet elevations at least"12" above high groundwater a (except as described 310 CMR I5.227(5)) or permitted for upgrades under LUA [310 CMkr,15.405 1 (k Minimum cover 9".(Tanks buried more than 9" must have risers , on all openings and on the d=box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(DJ Three access covers (inlet and outlet must be 20" or greater) - middle access at leastRB" (by 7/07) [310 CMR.15.228(2)] Access to within 6" of grade'; one.port for.systems<1000gpd, two for systems d [3'10 CMR 15.228(2 All at-grade covers secured to unauthorized.access? [310 CMR. t 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] ✓ `' . - Buoyancy calculation Required/Done [310 CMR 15.221(8)] X a H-20 Where appropriate? [310 CMR 15.226(3)] g.EE Setbacks from resources 310 CMR 15.211J . :g g� -�,R .- Required when other`than single-family dwelling or flow>1000 d [310 CMR 15.223(l)(b)J First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and (3)] "U" pipe through or over baffle,outlet of each compartment with .. gas baffle or approved filter, [310 CMR 15.224(4)] ' i Address l0 Z .J A Vt *%AJ A%) Sheet 3 of 7 * 7r N/A OK NO Located at least ten feet from any water line? [310 CMR 15.222(2)] oa '. s K Disposal piping at least 18"below water line (when water and sew er cross see 310 CMR 15.211 1 1. K Cleanouts required/provided ? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] K Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] Proper pitch'on all`runs?(.005"within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphonproblem/(leachfield below pump chamber) 0{ Endca s or vent manifoldspecified? X Size and orientation of discharge holes specified? (not smaller than 3/8" not larger,than 5/,8") [310 CMR 15.251(8) and 310 a CMR 15.252(2)(h)J Materials specified (310 CMR 15.251(5) specifies.various pipe types allowed) , K Stable compacted base [310 CMR 15.221(2) and 310 CMR ' 15.232(2)(a) K Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 V CMR 15.323(3)(a)]: Riser if deeper than 9' [310 CMR 15.232(3)(f)J K Inside minimum dimension.12" [310 CMR 15.232(2)(b)] e( Minimum sum 6" [310 CMR15.232(3)(e) K Watertight cover,,if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(0)] :A Oft VIEW X11vr.9wts«s �ke eta 5�ff .:I:zj� 9qIM .�Y��a�k�' •�._ � � 9i�. � �'�� V�• !:Yl{i�teR'� ?.V Capacity(emergency storage above working--design,flow)? [310 CMR 231(2)] N/a Proper setbacks [310 CMR 15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, disconnects accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. 310 CMR 15.231(6) and(8 Stable Compacted Base[310 CMR 15.221(2 Buoyancy calculations needed ?Provided? [310 CMRI 15.221(8)] p Address Z V Q-A Y - G*j kir, i�'.Ja o ; '.M "F :. , Sheet 4 of 7 N/A OK NO s N Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR R. 15.24.0(1) . Required separation to groundwater? [310 CMR 15.212)] '. Aggregatespecified as double washed [310 CMR 15..247(2)] E a C5 �c ar 44 System Venting required/provided? (system under driveway.or >36" deep) [310 CMR 15.241], Inspection ports specified:and.within 3,"final grade? [310.CMR 15.240(13)] ( , Breakout requirements met?,(No'violation of breakout elevation F within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] Chambers and Gal. in trench configuration supplied with inlet every 20 ft.-[310 CMR 15.253(6)] .` Each structure with one inspection manhole(if>2000 gpd must be to grade) [310 CMR 15.253(2)] Aggregate 1'minimum- 4'maximum: [310 CMR 15.253(1)(b)] Oc 2' sidewall credit maximum[31.0 CMR 15.253 1 (a)]. K In bed configuration,inlet every 40 s ft'[310 CMR 15.253(6 ] k t. , Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] ouA; . 100 feet- maximum length [Sl0 CMR 15.251(1)(a)] Minimum separation,2x effective depth or width,whichever eater(3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2)] ' Breakout'.OK?j3.10�yCMR 15.211(1)[4] and Guidance Document] minimum 2 distribution lines [3 i 0 CMR 15.252(2)(a)] ru Maximum separation between lines 6' [310 CM R1.5.252(2)(d)] ` Maximum separation between lines and outside of bed 4' [310. CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum,.12 maximum. [310 CMR:15.252(2)(g)] -- , Separation between beds 10'minimum. CMR--15:252(2)(f)] Bottom area used in calculations only[310 CMR 15.252(2)(i)] tA Address l�Z S EAT 1_E '44 Of #` .�. r: `1 Sheet 5 of 7 g N/A OK NO S v, �t.�:. t Pressure Dosed System ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] N'A.. Pressure dosing required on all systems.>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and UA Remedial Use A royals] •. ,. If used in gravelless system-make sure jet is directed as.not to scour soil interface [Guidance Document] Inspections once per year(systems<2000 gpd) or quarterly (>2000 d) good to note on plan [310 CMR 15.254(2)(d)] Construction in fill - Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by designer [310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer[310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2 Breakout requirements met? [310 CMR 15.252(2) and Guidance.Document]:` At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) 310 CMR 15:255 (2)(e)] G' 4 w e ate,,. teO. a Check DEP Approval letters for credits and design conditions N x If used with pressure dosing do not allow pressure discharge I to scour soil interface Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? N A T_ al__ �__t____1_..__L__�._��_�__7=. .. �1:_.1 ..�,1 ..1.__.. ]a�..,.t ..11 . 1S Mr LcUtuiutury uoilir,V1UPUiiy apYlicu auu uUab A uiccL all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance Are the variances listed on the plan'? [310 CMR 15.220 (4)O] X RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] X New construction or increased flow.proposed- [Refer to 310 CMR 15.414] 14o Address 10 Z S OA Y 16:It.! AV IS *.t t t*: �, .' C ;.: .' Sheet 6 of 7 Da l'�2�1i LL N/A OK NO Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 310 CMR,15.215'and 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well { . [310 CMR 15.214(2)] K Are the nitrogen loads proposed in compliance? [310 CMR _ K ; 15.216(1)] Pumping to septic tank ? [ 310 CMR 15.229] Shared System[310 CMR 15.290] x i t0 L A .11 l E � Address Z �. � Sheet 7'of 7 1 BEDROOM BEDROOM LIVING < ROOM • HALL HALL BEDROOM 4 -BEDROOM y PORCH 1 Wionno Club - Putting Green Cottage -Floor Plan 10=25-2012 ' k N.. a 12-3 y (�ti " 's}" (7 �r) Fee o� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE,.MASSACHUSETTS Yes Application for Misposal bpstem Construction Vemit - Application for a Permit to Construct(/) Repair X) Upgrade O Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 8O2 S C-rl" 5"1 A")C I!Owner's Name,Address,and Tel.No. S 24144t..LO vi �l ltrikvvo -`j Assessor'sMap/Parcel i(-- 019 r Eo; rI t� 11JC>sEi16i6v) Aj = SN-EIZ-VI LLC Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. �42>=:-3�14 S L-L.L-%V 13.t'Pt i,i C 11J L I,S A cv,e;a`�� Cis Z crL e t t..L E Type of Building: Dwelling No.of Bedrooms Lot Size 1 0(o e 300 sq.ft. Garbage Grinder(�6 Other Type of Building GAT-Ti:1-lo 6 No.of Persons Showers( Cafeteria Other Fixtures Design Flow(min.required) 440 gpd Design flow provided 444 gpd Plan Date raj Z q t 2-0 cZ Number of sheets l 61F Revision Date N A Title 1 MO&S r Size of Septic Tank l S^ O Type of S.A.S. 1 l7 k 4 OX 2` v r Description of Soil O 'l " C.,i. 3�'3 59 p'(c'J 5 hiU 7 Q to.--1 L vet cD 5 Asa�- Z2- \28" C z Nlt EC> 5 97 -i�1 b 6-�i.Ot�iy-(� \j Aw"G-r1. L.Iucoc)A.) t-'Z:(5L) Nature of Repairs or Alterations(Answer when applicable) k Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the.system in operation until-a Certificate of Compliance has been issued by this Board of Health. Si Date Application Approved by Date by Application Disapproved Date for the following reasons (.t' Permit No. 2 o J 1 -3 Y Y Date Issued ° 14 Z u�44Yl a"� �i THE COMMONWEALTH OF MASSACHUSETTS 0 1` BARNSTABLE,MASSACHUSETTS QCertifirate of Compliance THIS IS TO CERTIFY,that the On-site Sewage,DisposaI system Constructed( ) Repaired( } Upgraded(K) . Abandoned( )by at t O2 S EA V I c-vj 0 2Y I LLr has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Now. 07�-7Y Ydated u z- Installer Designer SULLY y A VU F I E f tljL t 6.1t(- #bedrooms q 13cp(L Go u1l�G Approved design flow gpd r The issuance of this permit shall not be construed.as a guarantee that the system willfunetion as designed, Date Inspector -' No. Fee Ikf_ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal Aipstem Construction 3permit Permission is hereby granted to Construct Repair) Repair( ) Upgrade(�) Abandon( } System located at 10 Z SF.., A V o 05 y V t Li { '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:Constmctio 'must a completed within three years of the date of this permit. P�-Date Approved by ' T Town of Barnstable _ - Reg ulatory Services- 65 ��� Thomas F. Geiler,Director 'Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508 790-6304. . . n _Installer_ & Designer Certification Form - _ Dater r 2�31 2- Sewage Permit# 3 4A Assessor's Map\.Parcel .......... — -..._ 1 Installer* c cDesigner. Address: ? �fz��v2�7 VS�yi u-Address: �a �• S:` � Y► ew�o On 0 '� Z ��,c,�Q �2 ac was issued a permit `to(install a (date (installer) 1 b `�'_�hrcNrN 0 w -' septic system at i 0'�. v base on a.design drawn by #^ (address) U rca v Aril E=A �d�C AG.' — dated Ads (designer) I cerkify that the ptic system referenced above was installed substantially according to the besign,which may include.minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced,abovewas installed with major changes (i.e.greater than W lateral relocation of the SAS or any vertical relooation_of any component of the septic system)but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow: (Installer's Signature) AMU -a - VOL. c(O�p�Q� J Affix Designer:s Stain- (Designer's Signature)- ( .gn p Here). .. ----- PLEAt E-:RO Br�R��FSTALE g1LIC ?T$DIV1SION:CERTII�'ICATE OF COWLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.THANK YOU. - Q:Healtb/SepfidDesigaer Certification Form 3-26-04.doc -.. 1. M. a - .y= t E �-, Sal - , . v W.. k w- " Town of,..arnstable K � ,yam • ,.& : ;n Itegulatory;Seiwlces- P,4 1659, s�°� rr Thomas F. Geiler,Di rectbr ->~9Q < �y . ` .''.Public Health Division.,i " _ „ , h # x � fk _ -- � :- g s r Thomas.McKean,'Director= _i ,r < ` . ;. 200 Maio Street;Hyannis,=MA 02601 A r.r .. 1 Z �' 3 } Office: 508-862-4644 _1"h t .'' Y ;, Fax 508 790-6304` - a`, h ykI Mr , a r « r a ,�:,,_,",�,--,.I1-�,-,,.4� r. _ _ - ,.. . 6taller Designer'Certif cation Form -�y f . t T ` ey< c r f 4 - 7 r Date•'` 1 1 Selvage Permit#- --Assess I-I T Map�Pat cel FF. « ©��� . as ;& s, '�' -� r hsr s. „s`k ads y t t 3 _ c xx�^ � 'l U-tIJ .��-1LC' y -bista�e " `;a f x` , Designer :.x s _ ` i. a:,.. .. ,. ^c , a nand S - at i-, to rvl ;.r t �s 4i 'ru o } '�- h Address. , . 'may, - a-:r * ,�:. a S R t, Fki t x ,..'i *" z) ,s, .a $r 's e a ,r I--s - On 11 Lam` was.issuedra perrrut tti install a r , -, `(date) (' staller) N ' ` I based on a design drawn b � �" 3 iO�'� � iC�" d y septic system at s - . r(address) r 5'.,�'��:,r�.�, .,G°-i c-= i"-` clated'L �Si' � V F1`Z�2 � t2 * §' ', u> ' (designer) /�. v i t:�-) i " +TI C� } 0, _* ° ,V ) p rt I certify that the septic'system referenced above was installed substantially, , ,s } , according to the design;which may include minor a roved than es such as PP g 3. lateral relocation of the distnbution box and/or septic tank k - .. . a r'- 1" _^:> 9 Sr. 'air., y d l` ;i�rh d.i.7` e . .:k, � t a z s , y, - I certify that the septic system referenced above was mstalled vvit, major changes '_ (i:e.greater than:10',lateral relocation of the SAS{or.any vertical relocation of any a , a , t, a coin onent`of the.septic` ystem)but m accordance with State, Local " x Regulations Plan revision or certified as-built by designer to'follow I l �: , g° r ,5* s' '_(Installer's Signature) /. k Qp 1" ti x � ,1 - - M t 'G ; .fi i 5 .° f . p, #� - .d .,) -.:,� g t .*,r 'Y C ti .,c'fiA,.f.' z+ v aM - }11 .; (Designer's Signature)Y (Affix Designer's Stamp Here) F} �, y�' .-? .:._ m,k .5 `,- ,ate a.: .«.:, _.�7 .r<,,,,...._ a PLEASE RETURN TO BARNSTABLE PiTBLIC HEAI:TH DIVISION CERTIFICATE OI+' s _J =COil2PLIANCE WII.I:NOT'BE ISSUED UNTIL BOTH THIS'FORM AND AS BITIILT CARD ARE ' RECEIVEID BY THE BARNSTABLE PUBLIC HEALTH DIVISION-THANK-YOU " ' , `,. � ' . Q Health/Sept c/Desiguez Certification Form 3-26-04.doa ,k __ ` `` ' , ,, $� - k ' r .�, F c., `'2 ., d r t -. hu l N :q i q, , - - x 3 -C sy - f t '',+x, ,#' .y ,F 4. s ° y K > Lu x,L. ; P u s., i.., ° ' ' n ; x ~ COMMONWEALTH OF MASSACHUSETTS , EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION / Putting Green Cottage North Property Address: 102 Sea View Avenue Osterville. MA 02655 Owner's Name: Wianno Club Owner's Address: Date of Inspection:. April 25, 2006 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford a --- Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 :- Telephone Number: (508)862-9400 CERTIFICATION STATEMENT ' I certify that I have personally inspected the sewage disposal system at this address and that the.infornation 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 DEP1 approved system inspector pursuant to Section 15.340 of Title 5(310 CAM 15.000). The system: , Passes Conditionally Passes Nee s Further Evaluation by the Local Approving Authority Fai Inspector's Signature: Date: May 7. 2006 The system inspector shall subs t 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. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page 1 r . Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 102 Sea View Avenue Osterville, MA Owner: Wianno Club Date of Inspection: April 25, 2006 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. Answer yes,no or not detennined(Y,N,ND)in the 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. ND explain: 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 obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 102 Sea View Avenue . Osterville. MA Owner: Wianno Club Date of Inspection: April 25, 2006 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 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 I . "This system passes if the well water analysis,performed at a DEP certified.laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 102 Sea View Avenue _ Osterville. MA Owner: Wianno Club Date of Inspection: April 25, 2006 D. System Failure Criteria applicable to all systems: You must indicate either"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 t ✓ Liquid depth in cesspool is less than 6°below invert or available volume is less than day flow ✓ Required pumping more than 4 tunes 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Yes (Yes/No)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. NOTE:A single cess ool automaticallX fails in the Town of Barnstable. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 102 Sea View Avenue Osterville, MA Owner: Wianno Club Date of Inspection: April 25, 2006 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: Yes No ✓ _ 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(3)(b)]. + 5 Page 6 of 11 } ,. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 102 Sea View Avenue Osterville, MA Owner: Wianno Club Date of Inspection: April 25, 2006 , FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n1a Number of bedrooms(actual): 3 ; DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): '330 Number of current residents: n1a Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n1a [if yes separate inspection required] ' Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Unavailable n Sump Pump(yes or no): No t Last date of occupancy: _ Currently occupied COMMERCIAVINDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): apd Basis of design flow(seats/persons/sgft,etc.); Grease trap present(yes or-no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION*` _. Pumping Records . Source of information: Pumped yearly for maintenance-per management Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: w TYPE OF SYSTEM Septic tank;distribution box;soil,absorptiori system ✓ Single cesspool , ✓ Overflow cesspool Privy Shared system(yes or.no) (if yes,attach previous inspection records, if any) t Innovative/Alternative_technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval j Other(describe): r t Approximate age of all components,date installed(if known)and source of information: Date of installation unknown .Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-, TOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SENVAGE DISPOSAL SYSTEM INSPECTION-FORM PART C P SYSTEM INFORMATION(continued) Property Address: 102 Sea View.4venue Osterville, MA Owner: Wianno Club Date of Inspection: April 25. 2006 BUILDING SEWER(locate on site plan) ' Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Connnents(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Cesspools acting as a septic tank Depth below grade: System A - 10" - Svstem B-10" Material of construction: concrete _metal _fiberglass _polyethylene ✓ other(explain) Cesspool block If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: Svstem A -5 W x 6'T x 10.5'bottarn to Qrade / Svstem B-5'W x 6'T x 10 5'bottom to grade 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: Measurine stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): System A-Single cesspool had 4'ofliauid on the bottom The scum line was up to the inlet pipe The cover was 10"below grade. System,B-Cesspool had 6'ofliauid on the bottom The liquid level was up to the outlet pipe The outlet pipe was 5'below Qrade The cover was 10"below_ Qrade. r GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity; liquid levels as related to outlet invert, evidence of leakage,etc.): 7 Page 8 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 102 Sea View Avenue Osterville, MA Owner: Wianno Club Date of Inspection: April 25, 2006" TIGHT or HOLDING TANK: None (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): r. DISTRIBUTION BOX: None (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: None (locate on site plan) Pumps in working order(yes or no): ` Alarms in working order(yes or no). Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 f " Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 102 Sea View Avenue Osterville, MA Owner.: Wianno Club Date of Inspection: April 25, 2006 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type t leaching pits,number: leaching chambers,number: µ leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: ✓ overflow cesspool,number: 10-from Svs[em B) 4 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.): Unable to locate SAS from System B. The outlet pipe was 5'below grade No information available at Board of Health or property management, CESSPOOLS: None (cesspool must be pumped as part of inspection)"(locate on'-site plan) Number and configuration: Depth-top of liquid to inlet invert: 4 Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: { Indication of groundwater,inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):- PRIVY: None (locate on site,plan) x Materials of construction: .0 Dimensions: Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 102 Sea View Avenue Osterville, MA Owner: Wianno Club Date of Inspection: April 25, 2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. fo rb SGA vl aw AVC 10 Page 11 of 11 s , OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 102 Sea View Avenue Osterville, MA Owner: Wianno Club Date of Inspection: April 25, 2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 15 +/- feet Please indicate(check)all methods used to detennine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation:.' Using Barnstable topographic and water contours snaps, the maps were showing approximately 15'+%to ground water at this site.. This report has been prepared only for the septic system and components described herein. This septic system has been inspected.and failed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees,either expressed,written or implied, relating to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. I1 y COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION - TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION r' Putting:Green Cottage North Property Address: 102 Sea'View Avenue Osterville, MA 02655 Owner's Name: `' Wianno Club Owner's Address: Date of Inspection: April 25, 2006 , Name of Inspector:(Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O.Box 49 Osterville.MA 02655-0049 k Telephone Number: (508)862-9400 CERTIFICATION STATEMENT ` I certify that I have personally inspected the sewage disposal system at this address and that the inforiiation reported below is true,accurate and complete as of the time of the inspection. The inspection was performed bhsed on my r:, training and experience in the proper function and maintenance of on site sewage disposal systems. "I`am a DEP . approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes . �. Nee s Further Evaluation by the Local Approving Authority„' ✓ Fai Inspector's Signature:` Date: Mav 7, 2006 ` The system inspector shall subs t 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 4 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. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page I r Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY,ASSESSMENTS ` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 102 Sea View Avenue Osterville, MA Owner: Wianno Club Date of Inspection: April 25, 2006 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. Answer yes,no or not determined(Y,N,ND)in the 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. ND explain: 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 P obstruction is removed distribution box is leveled or replaced T ND explain: The system required pumping more than 4 times a year ddto broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced w obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued): Property Address: 102 Sea Vi6v Avenue a Osterville. MA . Owner: Wianno Club r Date of Inspection: April 25, 2006 _ f 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 thesystem is failing to protect public health,safety or the environment. f - 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 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 apublic 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other, failure criteria are triggered.A copy of the analysis must be attached to this form. 5 3. Other: -x 3 Page 4 of 11 § OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY•ASSE_SSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A .z CERTIFICATION(cokinued) � Property Address: 102'Sea`View w A enue Osterville,MA x ` Owner: Wianno Club Date f o Inspection: ApH125 2006 D. System Failure Criteria applicableto all systems You must indicate either"yes"or"no"'to,each of the following for all inspections Yes No ✓" Backup of sewage into facility.or system componentt 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 overloadedor clogged SAS or cesspool a N v44 r ✓ ` Static liquid leve ml the distribution box ab love'outlet`invert due to an`ovedoaded or clogged SAS or .�,.; cesspool. { F *, k } Liquid depth irrcesspool is less than 6';below invert or available volume is less than,'%day'-flow ✓ Required pumping more than.4 times in the last year`NOT due to clogged or obstructed pipe(§) Number of times pumped_ ' ✓ Any portion of the SAS,'cesspool or privy is below high ground water devation. ✓ Any portion of cesspool or privy is within 10'0 feet of a{surface water supply or-tributary,to a surface i water supply: ✓ Any portion of a cesspool oruprivy is within'a Z6ne'1 of a public well. y-`x,. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. t ✓ 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 acce'table water quality anal si.s. This system asses if the"well water analysis',""_'* PP Y P q ,ty. Y � Y - P. performed at.a DEP certified laboratory,for coliform bacteria And ,volatile organic compounds indicates that the well'is free from pollution from that facility and.thepresence of ammonia i , 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 m"ust be attached to this form.] k ' _r Yes (Yes/No)The system fails. I have"determ`ined that one or more of the above failure'cr`iteria exist as n , described in 310 CMR 15.303,*therefore the systeils "The.systewner should contact the Boardbf Health to determine what mfa m o will be necessary to correct the failure. NOTE.A single cesspool automatically fails in the Town of Barnstable ' w' `' t :+ . E. Large System:, To be considered a large system the system must serve`a'facility with a.design flow of I0,000 gpd to 15,000 gpd. f You must indicate either"yes"or"no"to eacfi of the following:;:,`. ( g, apply .g y ins in addition to the criteria above) t , The following.criteria a 1 to lar"'e s ste Yes No _ . the s stem"is within 400 feet ofasurface"drmking watersupply ° the system is within 200 feet of a tributary to a surface drinking water supply the system is located in.,a nitrogen sensitive area a{Interim.Welihead Prot tection'Area-IWPA)or a mapped t „Zone II of a public water supply well t v' t - ' • .. Y�: ;.fig - Jlx If you have answered"yes"to any question in SectionYE 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, �Y ` 15.304. The system owner should contact the appropriate regional office of the Department. *' Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - r PART B CHECKLIST Property Address: 102 Sea View Avenue Osterville, MA ` Owner: Wianno Club Date of Inspection: Anri125. 2006 Check if the following have been done: You must indicate"yes"or"no"as to each of the following:, 'Yes No i ✓ Pumping information was provided bythe owner,occupant,or Board of Health -✓ Were any of the systemcomponents 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 sighs 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 a 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 4 maintenance of subsurface sewage disposal systeins? The size and location of the.Soil Absorption System (SAS)on the site has been determined based on: Yes No fi ✓ — 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(3)(b)]: • � 5 „ Page 6 of 11 ; OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C - SYSTEM INFORMATION Property Address: 102 Sea•View Avemu` .. . Osterville, MA Owner: Wianno Club Date of Inspection: April 25, 2006 FLOW CONDITIONS 1F,: .. RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 3 Y DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms)': 330" ' Number of current residents: n/a Does residence have a garbage grinder.(yes or no): No. Is laundry on a separate sewage system(yes or-no): n/a r [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)):. Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied' COIV MERCIALANDUSTRIAL k Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): `. Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/user R OTHER(describe): GENERAL INFORMATION Pumping Records r` - Source of information: Pumped yedrly for maintenance-per management ° a Was system pumped as part of the inspection(yes or no):, No If yes,volume pumped: gallons--How.was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distributiori 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) + Tight Tank Attach'a copy of the DEP approval } Other(describe): + . Approximate age of all components,date installed(if known)and source of information: Date of installation unknown Were sewage odors detected when arriving at the site(yes or no): No -> 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY-ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , PART C SYSTEM INFORMATION(continued) Property Address: 102 Sea View Avenue Osterville. MA Owner: Wianno Club - Date of Inspection: April 25, 2006 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron 40 jPVC _other(explain): Distance from private water supply well or suction line: Convnents(on condition of joints,venting,evidence of leakage,etc.): x. SEPTIC TANK: ✓ (locate on site plan) Cesspools acting as a septic tank Depth below grade: Svstem A - 10" - System B-10:' .. , Material of construction: concrete metal _fiberglass polyethylene ✓ other(explain) Cesspool block = t If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: Svstem A-5'W x 6'T x 10.5'bottom to grade / 'System B-5'W x 6'T x 10.5'bottom to vrade 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 baffler -- ,- _ w Distance from bottom of scum to bottom of'outlet tee or baffler How were dimensions determined: Measuring stick a Conunents(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Svstem A-Single cesspool had 4'ofliauid on the bottom.'The scum line was up to the inlet pipe The cover was 10"below garade, System B-Cesspool had 6'ofliauid on the bottom The liquid level was W to the outlet pipe The outlet pipe was S'below grade The cover was 10"below grade. GREASE TRAP,: None (locate on-site plan) Depth below grader - Material of construction: 'concrete...s_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: ., A Comments(on pumping rec(immendations,inlet'and outlet tee or baffle condition,structural integrity,liquid levels as related to u o tlet invert,evidence of leakage,etc.): 4 7 Page 8 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ._ SYSTEM INFORMATION(continued] Property Address: 102 Sea View Avenue <.• Osterville. MA m s Owner: Wianno Club Date of Inspection: April 25, 2006, TIGHT or HOLDING TANK: None (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: k. Capacity: gallons a Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no):: Date of last pumping: Commments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: None (if present must be opened)(locate on site plan) v `' Depth of liquid level above outlet invert: Comments (note if box is level and distribution to outlets equal,any evide'nceIof solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: None (locate on site plan) ' Y Pumps in working order(yes or no): �• ' Alanns in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): a . r 8 i Page 9 of 1 I ' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 102 Sea View Avenue Osterville MA Owner: Wianno Club Date of Inspection: April 25, 2006 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan;excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: ' leaching'fields,number,dimensions: ✓ overflow cesspool,number: 1 (?- roin System B) 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.): Unable to locate SAS from Svstem B. The outlet pipe was Y below grade No information available at Board of Health or property management. k CESSPOOLS: None (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: Y Dimensions of cesspool: Materials of construction: w Indication of groundwater inflow(yes or no): Conunents (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)`. PRIVY None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Conunents(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM` PART C SYSTEM INFORMATION(continued) y 1 Property Address: 102 Sea View Avenue , Osterville, MA Owner: Wianno Club Date of Inspection: April 25, 2006 { SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmark_ s or ' benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. . - 1 . -f.. .. mn rb A lox !, Se.A view- AVC 10 a Page l l of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) ' Property Address: 102 Sea View Avenue Osterville, MA Owner: Wianno Club Date of Inspection: April 25. 2006 �• SITE EXAM •. Slope Surface water r Check cellar Shallow wells Estimated depth to ground water 15 +/: feet Please indicate(check)all methods used to determine the-high groundwater elevation: Obtained from system design plans on record-If checked,date of design plan reviewed:' Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: . r Using Barnstable topographic and water contours maps, the maps were showing approximately 15'+1-to groundwater at this site. s This report has been prepared only for the septic system:and components described herein. This septic system has been inspected and failed as of the date of inspection. This report is not a warranty or guarantee that the system will l function properly in the fixture. There have been no warranties or guarantees,either expressed,written or implied, ' relatingto the septic stem, the in ection,this report and/or an components o the septic s stem which have not p Y P P Y . p f p Y r been located and inspected.' LEGEND PERC TEST: 11,383 PERFORMED BY:JOHN O'DEA,PE- SULLIVAN ENGINEERING SOIL D EVALUDESMAATORN0.2 Deciduous Tree O Mlsc Manhole WITNESSED BY:DONALESMARAIS,R.S.-TOWN OF BARNSTABLE ® Catch Basin SEPTEMBER 8,2006 ® Catch Basin (round) SITE PASSED Coniferous Tree Hydrant ® Iron Pipe TEST HOLE- 1 EL.19.0 TEST HOLE-2 EL.19.0 Light Post Dill Hole FIlL:.. ............. .. : .. ..:..: .FILL.. .. . Water Gate (round) CB/DH .:: ::: . .GRAVEL/HARDBACK .....GRAVEL/1fARDBACI{... g„ .. ... 18.25 5" . . .. ,.. .. 18.6 Bw LAYER l0YR.3/4 Bw LAYER 10YR 3/4...... © Gas Gate (round) 0 SB/DH . .... : DARiYIL4uWISH` :... ... DARICYELLfJVVISH . .':.. .. OHW Overhead Wires O Mag Nail Crystal Lake 13'::: I:oA1v1YsAm . 17.9 s° LoAMXSRND.: : :.: .. 18.3 25 Elevation Contour Guy B LAYER 1.O.YR 4/6. ...B LAYER QYR 4/6 G. Underground Gas Line O- Utility Pole DARK XEI,LOWISH EROvI'k I'':'::' DARK XELIAWISIi EREIWN ............. 24" SANP IOAM. . 17.0 19" SATJUYLOAM' 17.4 Finish Grade C LAYER 2.5Y 6/6 C LAYER 2.5Y 6/6 OLIVE YELLOW OLIVE YELLOW MED.SAND MED.SAND 3' Max. W„ �,, -,,,� „ Compacted" . .. __ ,•-_-mxx-�� Y PERC TEST 15.5 31" PERC TEST 16.4 9 Min Compacted,,Fill,, Filter v 25 GALLONS GONE IN 10 MIN. 25 GALLONS GONE IN 10 MIN. Fabric And Or � � „ PERC RATE<2 MIN/IN(LTAR=0.74) PERC RATE<2 MIN/IN(LTAR=0.74) � 120 9.0 120 9.9 v O 2., 118» _ 112.. N Pea Stone i 3' 314" - 1 112" SHING7 U C� LEACHING Double Washed WA CHAMBER Stone aNLo C A VOW NOT WITNESSED S STRIP OUT v !- 4' - 10' -� GRADE TO ELEV. v LEACHING 62'X10' - 10' - _ N o TEST HOLE - 3 EL.19.o AUGER HOLE-4 EL.17.0 14.2' o PROPOSED & INSTALLED 7-500 .... GAL. GRAVEL/HARDBACK GRAVEL/HARDBACK ... r LEACHING CHAMBERS CROSS SECTION OF CHAMBER 6" .. 18.5 34"..._ 14.2 - ................ w NOT TO SCALE SEPTIC PERMIT 251, _ DARK YELLOWISH DARK GRAYISH BROWN 91, :. .. .. ...... 18.3 39" LOAMY SAND 13.8 TH 1 # 2006-401 -- - -15__ _ -- �� _ - �p4' LOAMY.sAND .... W --_ -. ..'.: DARK YELLOWISH.BROWi3 DARK YELLOWISH BROWN TH 2 ......... .... .. I..... TH 3 - IMPERVIOUS _ r -_J t --' '. __ •_. n sAlkmY.LOAM. .. ... „ . .. :SAND 17.2 46 , .. 22 13.2 1 _ - DESIGN DATA � .- LINER 1 t 6_,% INSTALLED i OLIVE YELLOW YELLOWISH BROWN Three 2 Bedrooms:No Increase In Flow SEPTIC TANK BENCH MARK MED.SAND 721, MED.SAND 11.0 SEPTIC PERMIT 1500 GA�GON'�-'- -_ 18.38' - __ O 37" PER TEST 15.9 C2 LAYER IOYR 6/6 6 Bedroom @ 110 GPD _ � No Garbage Grinder -- _ 1 l 25 GALLONS GONE IN 10 MIN. BROWNISH YELLOW # 2006-617 ro�--__ - PA VED Total Daily Flow=660 GPD ~17- -- J / PARKING 120 PERC RATE<2 MIN/IN(LTAR=0.74) 9.0 128' MED.SAND 6.3 o i i N LEACHING AREA 1V 0 O 1 660 GPD/0.74(LTAR)=891.90 SF Required Q _.._.... -- ...._._ Ql p i Sidewall=2(10'+62)2'=288 SF LAWN O _ __ Bottom Area=(10'x 62')= 620SF /8 ._._ __ - _ _1102 ' I PROPOSED 2000 GA � Total Provided=908 SF INSTALLED 2500 GA €XI�TING C017gGESTY y /o I SEPTIC TANK SEPTIC TANK DESIGN 2-Compartment SEPTIC`P1�__..__..._.,9_.._____. � 1st compartment N TO BE PORCH o - -- REMQ.VEQ - _ __ __ As AS c EXISTING 2 Day Capacity=1320 i 2nd Compartment SEPTIC PIT TO BE SEPTIC NOTES I Day Capacity=660 Use a Two Compartment 2000 Gal Septic Tank REMOVED 1.Location of Utilities Shown on This Plan Are Approx.At Least 72 Hours EXISTING 3' ' Prior to Any Excavation For This Project the Contractor Shall Make LEACHING CHAMBER CONC. WALK the Required Notification to Dig Safe(1-888-344-7233). 2.The Contractor is Required to Secure Appropriate Permits From Town DESIGN WAY n Agencies For Construction Defined by Thus Plan. All Pipes to be Schedule 40. Use I REDIRECT 3.Wherever Sewer Lines Must Cross Water Supply Lines Both Lines Shall 7-500 Gal.Leaching Chambers in a PIPING TO Be Constructed of Class 150 Pressure Pipe and Shall be Water Tested to 10'x 62'Washed Stone Field as Shown. Assure Watertightness. In General,Water Lines Shall be Constructed in NEW TANK & Coordination With COMM Water,and Shall be in Accordance CLEANOUT IF With 248 CMR 1.00-7.00&310 CMR 15.00. - ' REQUIRED 4.A Minimum of 9"of Cover is Required for All Components. 5.All Structures Buried Three Feet or More or Subject to Vehicular Traffic to be H-20 Loading.It is the Engineer's ' Recommendation that H-20 Always be Used 6.Install Watertight Risers and Covers to Within 6"of Finished Grade Over Septic Tank Inlet and Outlet,D-Box,and One Leaching Chamber. ' 7.Septic System to be Installed in Accordance With 310 CMR 15.00& 182' 248 CMR 1.00-7.00 Latest Revision and the Town of Barnstable Board of Health Regulations. �/i6 h 8.All Piping to be Sch.40 PVC. W h 9.D-Box Shall Have a Minimum Inside Dimension of 12",and a Minimum Sump of 6". \ 10.The Separation Distance Between the Septic Tank Inlets and SEA SEPTIC PERM/T Outlets Shall be No Less than the Liquid Depth.Inlet Tees Shall Extend 284' # 2006-626 a Minimum of 10"Below the Flow Line.Outlet Tees Shall Extend 14" O o Below the Flow Line,and Shall be Equiped With a Gas Baffle. 150. h ___ I I.Septic Tank Shall be a 2,000 Gallon,with 2 Compartments. !� 110' The First Compartment Shall Have a Volume of Not Less Than 1,320 Gallons and the Second of Not Less than 660 Gallons. VIEW The Compartments Shall be Interconnected by a Minimum 4"0 Vented Inverted U-Shaped Pipe with a Gas Baffle on the Outlet. N 837335"E See Note 6 (typ.) F.G. EL.,17.9t F.G. EL. 17.25t � 361.53 A VE � rl L. 17.06 Existing EL _- - EL. 16.46 .Flow Equilizers __ C? (NORTH COTTAGE) EL. 2000 Gallon As Required EL. 17.19 (See Note 5) .64 Too EL. 15.75 'C! (EAST COTTAGE 2 Compartment D-Box L. 1 .00 - _ Installer To Septic Tank 1 9 Confirm Prior SEE NOTE 11 EL, i .° To Any Work �;„ Leaching 206.2' t �ttP Chamber 10' To Be Installed On Bedding,"T"s, :.. :.::.:::::::.. Provided Stable Compacted ase Inspection Port, >> !?gtSUAF.LC.etfi k�elYrdNe'&>'1epiacE - &Baffels :...AH 1/nstiiYable SoA51lAtM74'>8':Gf:. v .. ... .. - - 1 as Per Title 5 Ttie S7ut�r.Parimater sri.:7h�..Sysierri e Provided �- � �� - n PLAN VIEW allo VAR'/ \NVE. Per Test Holee4 1 "=30' DEVELOPED PROFILE OF SYSTEM Over the Counter Variance for Septic SAS Setback. NOT TO SCALE Groundwater FLOODZONE; Variance for SAS Setback 320 CMR 15.211 Per Test Town GIs Mop Required 20 Zones V11(el.17) & C Provided 10' with Impervious Liner Installed. Community Panel No. DEED 250001 0016 D (� Revision MAR 14, 2006 BOOK: 347 PAGE:321 vp LOVATION MAP; Per LOMR Case # Scale: 1" = 2000'f 05-01-0764P DIRECTIONS; # As Built Condition Permit 2012-344 From the West End Rottery head West on West Main Street. REVISION: Add Second Septic Tank and take out Date: 12120112 Take a left onto Pine Street and take a slight left onto "Plumbin to be Reversed" Note PLAN. East Bay Road. Turn left onto Wianno Ave and Continue to 4; OVERLAY DISTRICT BOOK: 32 PAGE: 143 & 42 Seoview Ave. The Building is on the Right # 102 REVISION: Add Note to Reverse Septic Plumbing Date: 11126112 ASSESSORS REF.; p g Ma 162, Parcel 019 AP - Aquifer Protection District CottageAdd Eastern P Moe Flow, LargerTankCandcSAS REVISION: Date: 11121112 GENERAL NOTES: PREPARED FOR: PREPARED BY. Title: ZONE; 1.) The property line information shown was 1 pp�^ Proposed Sulinccom iled from available record information. W onno CIub Sullivan En inee in , Inc. RF-1 p a' .•* Area (min.) 87,120 SF (RPOD) P. O BOX 249 PO BOX 659 for The Wianno Club • 2.) The topographic information was obtained from o Frontage (min) 20' an on-the-ground survey performed by CopeSury OStervilIe, MA 02655 Width (min) 125 on or between 17/MAR106 and 25/APR/06. OS tel^VIII e� Ma. 02�55 r� Setbacks: (508)428-3344 (508)428-9617 fax Barnstable c Mass. Front 30' OsterVi��@ , 4 3.) The datum used is NGVD 29, a fixed mean Side 15 , sea level datum. Draft: CTR Field: WHK CTR s ' Rear 15 30 0 15 30 60 120 / ������s=;; s , . Comp.: CTR/JOD Comp.: WHK/RRL Date: Scale: Review: 97039 Drawing # C515_4G1 October 24, 2012 Varies ----------------- -- ---- LEGEND PERC TEST: 11,383 PERFORMED BY:JOHN ODEA,PE- SULLIVAN ENGINEERING A� SOIL EVALUATOR NO.2911 Deciduous Tree 0 Misc Manhole WITNESSED BY:DONALD DESMARAIS,R.S.-TOWN OF BARNSTABLE Catch Basin SEPTEMBER 8,2006 @ Catch Basin (round) SITE PASSED Coniferous Tree Hydrant 0 Iron Pipe TEST HOLE- I EL 19.0 TEST HOLE-2 EL.19.0 ................. ........... ... ................. Light Post Dill Hole ........-.........FIIX............... .................. ........................ ......... UO • ............ ........... ......*... .......... Water Cote (round) El CBIDH 9" .......... ........... . .................... .. 1825 ...... ........ 18.6 Gas Gate (round) a SBIDH ............. iq........... ........ .......... ........ ......a)s ............ - OHW- Overhead Wires @ Mog Nail Crystal Lake 13'."""'I"'*'."'.'.".'.'.'.'tb 9AW.......*.... 17.9 8" V-V............ 18.3 ....ja� Jon. ............ -�A -25- Devotion Contour Guy .... .....Ja�YBR IO.YR./6. ..... ...... ..... ...... ...... .... ... 17.0 ............ G. Underground Gas Line Utility Pole 17.4 Finish Grade 24" mow, 19" C LAYER 2.5Y 016 C LAYER 2.5Y 616 OLIVE YELLOW OLIVE YELLOW 11111 IIIB 111111 :111 ::::1 II SAND MED.SAND 3 Max. 9. . %il .. MR UP: Min Compacted fill II 42" PERC TEST 15.5 31" PERC TEST 16.4 Filter 25 GALLONS GONE IN 10 MIN. 25 GALLONS GONE IN 10 MIN. Fabric J to PERC RATE<2 M[INAN(LTAR 0.74) 9.0 PERC RATE<2 MKIN(LTAR-0.74) 9.0 And/Or ILO. m 12011 1/8' - 112" 14VUKVV14VWA1J1KJ0UTJUX41zU%zW NUMIJURUWALMENCIIJUNIEKW Pea tone P 10 3 t;f3/4' -wash D, LEACHING Double Washed WA ' CHAMBER Stone U-) SN//�G 7-ON 5' STRIP OUT NOT WITISMSSED 4' - 10" C A VE 10' GRADE TO ELEV. LEACHING 62'X10' TEST HOLE-3 AUGER HOLE-4 EL.19.0 IEL 17.0 14.2' !a PROPOSED & INSTALLED 7-500 F11.111 L - Lk- ..........I.......................... ........ ..........]a ...... GAL. ................................... .................................................. ............................... .... CROSS SECTION OF CHAMBER LEACHING CHAMBERS 18.5 14.2 6 .......... ........ NOT TO SCALE ...UP If mova SH,... SH-BROVIN SEPTIC PERMIT 251, ............ ...... 18.3 39" .... 13. 'rH I # 2006-401 NJ ... .... ... .....................!�/R....... .. ......... TH2 ...... ----------16-- ................................................ • -W IMPERVIOUS .........I....... 17.2 446-1 .............. 13.2 _�J TH 3 C LAI EK 23 7 W5 '�yx DESIGN DATA INSTALLED LINER OLIVE YELLOW YELI.OWISHBROWF Three 2 Bedrooms:No Increase In Flow SEPTIC TANK BENCH MARK MD.SAND 72ft MED.SAND 11.0 6 Bedroom @ 110 GPD 0 _"4� (0 SEP TIC PERMIT 1500 �A 18.38 1 37" PIM TEST 15.9 C2]LAYER IOYR 616 No Garbage Grinder LL9N6--____ ___ -W lift, 25 GALLONS GONE IN 10 MEN. BROWNISHYELLOW Total Daily Flow-660 GPD # 2006-617 PA PARE PERC RATE<2 MINAN(LTAR=0.74) 9.0 MED.PARKING 1201 12WJ 6.3 J ri t LEACHING AREA ------- 0 1r 660 GPD If 0.74(LTAR)-891.90 SF Required 0I 1 Sidewall=2(10'+62)T-288 SF ho LAWN 0 - Bottom Area-(IV x 621- 620SF I PROPOSED 2000 G Total Provided-908 SF E&STING INSTALLED 2500 CA COTTAGE SEPTIC TANK SEPTIC TANK DESIGN SEPTIC-PlIF-----19---- 2-Compaftient TO BE PORCH Istoompartment RE.UaVED EXISTING 2 Day Capiacity-1320 .20- "1- 2ndCompartment SEPTIC PIT I Day Capacity=660 TO BE SEPTIC NOTES Use a Two Compartment 2000 Gal Septic Tank REMOVED 1.Location of Utilities Shown on This Plan Am Approx.At Least 72 Hours EXISTING 3' Prior to Any Excavation For This Project the Contractor-Shall-Shall Make the Required Notification to Dig Safe(1-888-344-7233). LEACHING CHAMBER CONC. WALK 2.The Contractor is Required to Seem Appropriate Permits From Town DESIGN WA Y Agencies For Construction Defined by This Plan. Ali Pipes to be Schedule 40. Use REDIRECT 3.Wherever Sewer Lines Must Cross Water Supply Lines Both Lines Shall 7-500 Cal.Leaching Chambers in a PIPING TO Be Constructed of Class 150 Pressure Pipe and Shall be Water Tested to 10'x 62'Washed Stone Field as Shown. NEW TANK & Assure Watertightness In General,Water Lines Shall be Constructed in Coordination With COMM Watts,and Shall be w Accordance CLEANOUT IF With 248 CMR I.00-7.00&310 CMR 15,00. REQUIRED 4.A Minimum of V of Cover is Required for All Components. 5.All Structures Buried Three Feet or More or Subject to Vehicular Traffic to be H-20 Loading.It is the Engineer's Recommendation that H-20 Always be Used. 6.Install Watertight Risers and Covers to Within&'of Finished Crude Over Septic Tank Inlet and Outlet,D-Box,and Ore Leaching Chamber. 7.Septic System to be Installed in Accordance WitbI CMR 15.00 182' 248 CMR 1.00-7.00 Latest Revision and the Tom of Barnstable Board of Health Regulations. 8.Ali Piping to be Sch.40 PVC. 9.D-Box Shalt Have a Minimum Inside Dimension of 12",and a Minimum h Sump of 6". 10.The Separation Distance Between the Septic Tank Inlets and SEPTIC PERMIT Outlets Shall be No Less than the Liquid Depth.Idet Tea Shall Extend SEA 284' # 2006-626 a Minimum of 10"Below the Flow Line.Outlet Tees Shall Extend 14" Below the Flow Line,and Shall be Equiped With a Gas Baffle. I I.Septic Tank Shall be a 2,000"on,with 2 Compartments. hW The First Compartment Shall Have a Volume of Not Less Than 110 1,320 Gallons and the Second of Less than 660 Gallons. VIE The Compartments Shall be Interconnected by a Minimum 4"0 W Vented Inverted U-Shaped Pipe with a Gas Baffle on the Outlet. AV/ -See No to 6 (typ.) F.G. EL. IZ251 F.G. EL 17-00+ A VE F.G. a. 179z ri IL IZ06 Existing EL Flow Equdizers EL 16.46 Galion k As Required EL. 17.19 4 TOO EL 15, (hi6fiTH COTTAGE) 2000 (Se e 5) (EAST COTTAGE 2 Par ent -Box Installer To Septic Tank 9 Confirm Prl if EL. Leaching TO Any Work Chamber 3ot- El 12, 206. Bedding.*T's, .................. 2' To Be Installed On .................................. to' ........ .... ............. ..... ............... ............. I.M.11I ...... .. .............. Stable Compact as* inspection Port. Provided &Belief$ as Per Title 5 ..................................... . .. ................... PLAN VIEW Provided 0; No Grou ndwater Per Test Hole 4 1 )1=30'# VARIANCE: DEVELOPED PROFILE OF SYSTEM EL 3.0 Over the Counter Variance for Septic SAS Setback. NOT TO SCALE Groundwater Na FLOOD ZONE: Variance for SAS Setback 320 CMR 15.211 Per Test Town GIS Mop CML Required 20' Zones V11(e1.17) & C Provided 10' with Impervious Liner Installed. Community. Panel No, 250001 0016 D PEED: Revision MAR 14, 2006 BOOK. 347 PAGE. 321 LOCATION MAP: Per LOMR Case # Scale: 1 2000'± 05-01-0764P DIRECTIONS: As Built Condition Permit # 2012-344 From the West End Rottery head West on West Main Street. REVISION: Add Second Septic Tank and take out Date: 12120112 Take a left onto Pine Street and take a slight left onto "Plumbing to be Reversed" Note PLAN: East Bay Rood. Turn left onto Wianno Ave and Continue to Seaview Ave. The Building is on the Right # 102 REVISION: Add Note to Reverse Septic Plumbing Dote: 11126112 ASSESSORS REF.: OVERLAY DISTRICT: BOOK: 32 PAGE. 143 & 42 K; Mop 162, Parcel 019 AP Aquifer Protection District Add Eastern Cottage Conection, REVISION: Date: 11121112 More now, Larger Tank and SAS GENERAL NOTES. PREPARED FOR: PREPARED BY.• Title: ZONE: 1.) The property line information shown was Proposed Sepoltic Upgradecompiled from available record information. Wonno Club Sullivan Engineering, Inc. P RF-1 Wianno &PO Box 659Area (min.) 87,120 SF (RPOD) 2.) The topographic information was obtained from P. 0. Box 249 for The Club Fronts (min) 20 an on-the-ground survey performed by CopeSury Osterville, MA 02655 Width (min) 125 on or between 171MAR106 and 251APRIO6. Osterville, Mo. 02655 Setbacks: (508)428-3344 (508)428-9617 fax Front 30' 3.) The datum used is NGVD 29, a fixed mean Sarnstable, 0sterville) as.Cj, Side 15'Rear 150 sea level datum. 30 0 15 30 60 120 Draft: C TR Field. WHKICTR ai Scale: 6" ow, rA Comp.: CTRIJOD Comp.: WHKIRRL Date: fl. I Review: 97039 .."dober 24,. 2012 Varies Drawing # C515_4G1