The URL can be used to link to this page

Home My WebLink About0058 SOUTH BAY ROAD - Health 58 SOUTH BAY ROAD Osterville A = 093 - 042 - 004 i Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments { ITO 58 South Bay Rd Property Address Terrance& Marjorie Huggard Owner Owner's Name ` information is required for every Osterville Ma 02655 9/17/18 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information sJ - 133as— on the computer, Michael DiBuono use only the tab key to move your Name of Inspector cursor-do not DiBuono Sewer And Drain use the return Company Name key. 35 Content Lane VQ Company Address Cotuit Ma 02635 City/Town State Zip Code 508-364-9587 S113522 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 9/18/18 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ie Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 58 South Bay Rd Property Address Terrance& Marjorie Huggard Owner Owner's Name information is required for every Osterville Ma 02655 9/17/18 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System contains a 1500 Gallon septic tank as well as an H2O concrete distribution box and 6 flo diffusers. Field is 8' x 52' 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 C� Commonwealth of Massachusetts , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 58 South Bay Rd Property Address Terrance& Marjorie Huggard Owner Owner's Name information is required for every Osterville Ma 02655 9/17/18 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form µ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 South Bay Rd Property Address Terrance & Marjorie Huggard Owner Owner's Name information is required for every Osterville Ma 02655 9/17/18 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public Y P p c water supply. I . ❑ 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 l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 58 South Bay Rd Property Address Terrance& Marjorie Huggard Owner Owner's Name information is required for every Osterville Ma 02655 9/17/18 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 '/Z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp:doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 58 South Bay Rd Property Address Terrance & Marjorie Huggard Owner Owners Name information is required for every Osterville Ma 02655 9/17/18 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 South Bay Rd Property Address Terrance& Marjorie Huggard Owner Owner's Name information is required for every Osterville Ma 02655 9/17/18 page. Cityrrown State Zip.Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Description: Number of current residents: 2 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? 0 Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available last 2 years usage d 238 Gpd Detail Sump pump? ❑ Yes ❑ No Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 58 South Bay Rd Property Address Terrance & Marjorie Huggard Owner Owner's Name information is required for every Osterville Ma 02655 9/17/18 page. Cityrrown 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: 2015 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 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 58 South Bay Rd Property Address Terrance& Marjorie Huggard Owner Owner's Name information is required for every Osterville Ma 02655 9/17/18 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): Approximate age of all components, date installed (if known) and source of information: installed 10/29/90 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2.5 feet Material of construction: ® cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): System is vented at the distribution box t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 58 South Bay Rd Property Address Terrance& Marjorie Huggard Owner Owner's Name information is required for every Osteryille Ma 02655 9/17/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 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: 3 Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 30" How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is sound and functioning as designed t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form I a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 South Bay Rd Property Address Terrance& Marjorie Huggard Owner Owner's Name information is required for every Osterville Ma 02655 9/17/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from.top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V6, 58 South Bay Rd Property Address Terrance & Marjorie Huggard Owner Owner's Name information is required for every Osterville Ma 02655 9/17/18 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 Level and at normal level H2O Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection Form I a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 South Bay Rd Property Address Terrance& Marjorie Huggard Owner Owner's Name information is required for every Osterville Ma 02655 9/17/18 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: ® leaching galleries number: 6 Flo's ❑ 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 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments L � 58 South Bay Rd v- Property Address Terrance& Marjorie Huggard Owner Owner's Name information is required for every Osterville Ma 02655 9/17/18 page. Cityfrown 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.): I 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 II Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 58 South Bay Rd Property Address Terrance& Marjorie Huggard Owner Owner's Name information is required for every Osterville Ma 02655 9/17/18 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 58 South Bay Rd Property Address Terrance& Marjorie Huggard Owner Owner's Name information is Osterville Ma 02655 9/17/18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 f 9/18/2018 Assessing As-Built Cards TOWN OF BARNSTABLE ~v ✓ LOCATION4pT lovT N -'?A Y Pg�O SEWAGE # V1LL�IGE�STE2 y///e ASSESSOR'S MAP& LOTI)93 OY2.05 INSTALLER'S NAME & PHONE NO.ARLN C vAVS-7 7;7 7S/3 OSEPTIC TANK CAPACITY LEACHING FACILITY:(type)1�'-Io4,,''ift!/SEoL S(size) A x S'1/ ,S�O.OF BEDROOMS �5_ PRIVATE WELL OR PUBLIC WATER Vo6/ BUILDER OR-04M R y T w,,E 2 DATE PERMIT 1SSUED:1,_rjrj DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No I �a 3 6' v✓ a . \ I http://www.townofbamstable.us/Assessing/H Mdisplay.asp?mappar=093042004&seq=1 1/2 I r Commonwealth of Massachusetts Title 5 Official Inspection Form ' la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 58 South Bay Rd v Property Address Terrance& Marjorie Huggard Owner Owner's Name information is required for every Osterville Ma 02655 9/17/18 page. CityrFown 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: 12+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: Test hole date 4/6/1990 6' Seperation 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: Test hole data on plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 58 South Bay Rd Property Address Terrance& Marjorie Huggard Owner Owner's Name information is Osterville Ma 02655 9/17/18 required for every page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ❑ A. Inspector Information: Complete all fields in this section. ❑ B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ❑ C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ❑ D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 f ` Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments O 58 South Bay Rd. Property Address Terrence&Marjorie Huggard Owner Owner's Name information is Osterville MA 02655 Aril 10, 2013 required for every p page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your ` cursor-do not Kevin J. Sullivan use the return Name of Inspector key. Ready Rooter, Inc. � Company Name P.O. Box 371 Company Address Sandwich MA 02563 Cityfrown State Zip Code 508-888-6055 SI-13517 Telephone Number License Number B. Certification 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority April 30; 2013 Inspectots Sign re Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or. has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform-in the future under the same or different conditions of use. f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 58 South Bay Rd. Property Address Terrence&Marjorie Huggard Owner Owner's Name information is Osterville MA 02655 Aril 10 2013 required for every P , page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"secti need to be replaced or repaired. The system, upon completion of the replacement or r air, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the follo ' g statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic to (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tan ailure is imminent. System will pass inspection if the existing tank is replaced with a complyin eptic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is ucturally sound, not leaking and if a Certificate of Compliance indicating that the tank is less th 20 years old is available. ❑ Y ❑ N ❑ ND(E ain below): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 58 South Bay Rd. Property Address Terrence& Marjorie Huggard Owner Owner's Name information is Osterville MA 02655 Aril 10 2013 required for every P , page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health appr al if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribu n box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution b x. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Ex ain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND xplain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ D(Explain below): ❑ The system required pumping more than 4 times a ear due to broken or obstructed pipe(s). The system will pass inspection if(with approval of 7rE] Board of Health): El broken pipe(s)are replaced Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Re ired by the Board of Health: ❑ Conditions exist which r uire further evaluation by the Board of Health in order to determine if the system is failing to rotect public health, safety or the environment. 1. System will pas unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that a system is not functioning in a manner which will protect public health, safety and the vironment: ❑ Cess 001, ol or privy is within 50 feet of a surface water ❑ C sspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 58 South Bay Rd. Property Address Terrence&Marjorie Huggard Owner Owner's Name information is Osterville MA 02655 Aril 10 2013 required for every A page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Wat/byh)e r, if any) determines that the system is functioning in a manner that pro public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SASAS is with' 100 feet of a surface water supply or tributary to a surface water su ❑ The system has a septic tank and SAS and the SAS is within af a pu c water supply. ❑ The system has a septic tank and SAS and the SAS is within 5 rivate watersupply well. The system has a septictank and SAS and the SAS is less than 1 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 EP certified laboratory, for fecal coliform bacteria indicates absent and the presence of amm is nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteri are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 58 South Bay Rd. Property Address Terrence& Marjorie Huggard Owner Owner's Name information is Osterville MA 02655 A nl 10, 2013 required for every P page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 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. E) Large Systems: To be considered a large system the system must serve a facili 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 follow' , in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surfac drinking water supply ❑ ❑ the system is within 200 feet of ibutary to a surface drinking water supply ❑ ❑ the system is located in a n' ogen sensitive area (Interim Wellhead Protection Area—IWPA)or a map d Zone II of a public water supply well If you have answered"yes"to any ques' n in Section E the system is considered a significant threat, or answered"yes" in Section D abo he large system has failed.The owner or operator of any large system considered a significant eat under Section E or failed under Section D shall upgrade the system in accordance with 31 CMR 15.304.The system owner should contact the appropriate regional office of the Dep ent. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 58 South Bay Rd. Property Address Terrence&Marjorie Huggard Owner Owner's Name information is Osterville MA 02655 Aril 10, 2013 required for every P page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR.15.203(for example: 110 gpd x#of bedrooms): 550 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 58 South Bay Rd. Property Address Terrence&Marjorie Huggard Owner Owner's Name information is Osterville MA 02655 Aril 10 2013 required for every _ P page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑' Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Yes 9 ( Y 9 (gP ))� Detail 2011-90,000 gallons 247 Gallons per day 2012-98,000 Gallons 269 Gallons per day Sump pump? ❑ Yes ® No Last date of occupancy: April 10, 2013 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per y(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Ti 5 system? ❑ Yes ❑ No Water meter readings, if availabl . i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 58 South Bay Rd. Property Address Terrence&Marjorie Huggard Owner Owner's Name information is Osterville MA 02655 Aril 10, 2013 required for every P page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped in June 2009 per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 58 South Bay Rd. Property Address Terrence&Marjorie Huggard Owner Owner's Name information is Osterville MA 02655 April 10, 2013 required for every _P page. Citylrown State Zip Code Data of Inspection D. System Information (cont.) Approximate age of all components, date installed if known and source f information: it PP 9 p ( ) o ormation: October 1990 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 21811 Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 2'feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) Tank is 2'deep with a riser on the inlet and outlet to within 6"of grade If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 11.5'X V X 5.5' 2„ Sludge depth: Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 58 South Bay Rd. Property Address Terrence&Marjorie Huggard Owner Owner's Name information is Osterville MA 02655 Aril 10, 2013 required for every P page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 34" Scum thickness 3-1 Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 11'` How were dimensions determined? Tape measure and dip tube Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): PVC Inlet and Outlet Baffles Tank should be pumped every 2-3 years for proper maintenance. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete El metal ❑ fiberglass polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scXtteeDistance from bottom oaffle Date of last pumping: Date Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 58 South Bay Rd. Property Address Terrence&Marjorie Huggard Owner Owner's Name information is Osteryille MA 02655 April 10 2013 required for every P , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integr' y, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (l;qen site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alar/nd t switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 58 South Bay Rd. Property Address Terrence&Marjorie Huggard Owner Owners Name information is Osterville MA 02655 April 10 2013 required for every P , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): One inlet and one outlet. No signs of high staining. D-Box is H-20 rated with steel ring and cover to within 6"of grade. Pump Chamber(locate on site plan): Pumps in working order: ❑ Ye ❑ No* Alarms in working order: es El No* Comments(note condition of pump chamber, condition of pumps and purtenances, etc.): *If pumps or alarms are not in working orde , system is a conditional pass. Soil Absorption System(SAS)(locate n site plan, excavation not required): If SAS not located, explain why: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments, 58 South Bay Rd. Property Address Terrence&Marjorie Huggard Owner Owner's Name information is Osterville MA 02655 April 10 2013 required for every P page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2-500 gallons each w/4 stone ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Cesspools (cesspool must be pumped as part of inspection)(locate on site p ): 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 inflo ❑ Yes ❑ No Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 58 South Bay Rd. Property Address Terrence&Marjorie Huggard Owner Owner's Name information is required for every Ostery p ille MA 02655 April 10 2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condit/bil, of hydraulic failure, level of ponding, condition of vegetation, etc.): f Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 58 South Bay Rd. Property Address Terrence&Marjorie Huggard Owner Owner's Name information is Osterville MA 02655 Aril 10,2013 required for every P page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately A,=95" A3=3o' 104 I A P�a , i r , � r r t • t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 58 South Bay Rd. Property Address Terrence&Marjorie Huggard Owner Owner's Name information is required for every Osterville MA 02655 April 10 2013 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: < 138" 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: July 5, 2012Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Test hole log from neighboring property#92 South Bay Dated 07-05-2012 ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how 9 you established the high round water elevation: Y 9 92 South Bay test hole log from July 5, 2012 Before filing this Inspection Report, please see Report Completeness Checklist on next page. Commonwealth of Massachusetts uvTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i 58 South Bay Rd. Property Address Terrence&Marjorie Huggard Owner Owner's Name information is Osterville MA 02655 Aril 10, 2013 required for every P page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file ' 7 90 602 4� 5 TOWN OF BARNSTABLE '� LOCATION,Kbi JOvT N �JA Y �� SEWAGE # �0-5e 7� VILLAGEOsTE/1 !i ASSESSOR'S MAP & LOTU 93- 6V-2•IVY' INSTALLER'S NAME & PHONE NO.X ee,,y 6SEPTIC TANK CAPACITY EACHING FACILITYAtype) ��triG�i Ff-USEaZ S (size) �O. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER,ob/G. BUILDER 3 tTA y 7- DATE PERMIT ISSUED: %O �02 J DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �f 06` 0� �o M No.... '.7.. � �- Flcs... THE COMMONWEALTH OF MASSACHUSETTS �"A OFM� BOAR® OF HEALTH ao'� RO T 7 ApplirFation for %jimFal Works Tonstrnrtinn Frr Application is hereby made for a Permit to Construct (vf or Repair ( ) an Individual S ystem at• '- .........._ �T .. .................... ..... -�... C [. �I'Z-�!. �--° - - Locatio -Address orNo. .. .... EJSE Owner Addre s W Installer Address Type of Building Size Lot_- Dwelling—No. of Bedrooms...............5.......................Expansion Attic ( ) Garbage Grinder ( ) a� Other—T e of Building No. of persons............................ Showers YP g ---------------------------• P ( )•-- Cafeteria ( ) Otherfixtures -------------------------------•-•--------------------.-•-•-------------•--•-•-•-•----------••---•-•----•----•-----• .......---- W Design Flow.................... .5................gallons per person per day. Total daily flow..............5!�..................gallons. 9 S _ tic Tank Liquid capacity_`. .gallons � Length_10_�__. Width.5.��.. Diameter---------------- Depth-�'--7 4 n A�No......�a........... Width.... Total Length..__-.�-�._Z-P.._ Total leaching area---- Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (X) Dosint tank aPercolation Test Results Performed ....... Date.An :.6,}_1_ . Test Pit No. 1.....Z ......minutes per inch Depth of Test Pit----41__�0.—. Depth to ground water.._`1C_.�_�'._... (s, Test Pit No. 2______ _.___.m'nut s per in Depth of Test Pit..... -4�_.._ Depth,to ground water.....1.�..--...... -. x Descripti of oil-------:.'cJ.� ....................................................... ---•---••-•----------••-••-•-.•-_.. Vw --------------------------------------------------------- Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss d by e bo d of Eal . l�... 61..../._.v Sign -------------------- •... _ Date Application Approved Bs _ ................................. Date Application Disapproved for the following reasons--------------------------------•--------------•-----•---------•----------------------•----.........--•••...... ..................................•••----........••----------•--••-----------•--••------•......-----...----------------------•----••---....-•------------•-•---••--------------•. ......----•----------- -Date PermitNo........ .._ .._....- .. Issued-•-...----•-••-------------••-••-••.--... .--•--- Date `.tee, No.../.d-:. Fins..........................._ THE COMMONWEALTH OF MASSACHUSETTS a�ZN OF BOARD OF HEALTH _ �� R BE ..._-...... ....................OF....... -'.t a .' ! -----..........................._... �A , ApplirFation for Disposal Works Tontrudion ram Application lication is herebymade for a Permit to Construct or Repair an Individual Sf;` System'at F, r ocatioKr.Address �7 .. ................................. �Ci4c� E� cJ�9C`.l .l .. 3 / Owner Address W Installer Address d Type of Building ' -' Size Lot...... ..:. �- _. ._Stir• r Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures --------------- --------------- . . . W Design Flow.......................................gallons per person per day. Total daily flow...............��U..................gallons. � S tic Tank—Liquid capacity ¢ .gallons 6 Length.l�-�'_.G". Width.5�s:> . Diameter................ Depth t2 _I.'.`. 1 x Dasposai� relic-1�—No. ......r........... Width---�� O .... Total Length....aa �"-1 i Total leaching area.... 1 ---s�y( Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area... ._........_sq. ft. Z Other Distribution box (A) Dosing tank ( � '-' Percolation Test Results Performed byfiRc CGW.�I J.. ....... _,. Test Pit No. 1.... .......minutes per inch Depth of Test Pit....11_t'.10..... Depth to ground water_._ fs, Test Pit No. 2.......& rl nuts per inch Depth of Test Pit 1 ? Depth to ground water........ r-- Pd "(�5 / ------+-- Wit= � r" �. < ,,= —ill O ` Descnpti of Soll �---- .... _ ----- ----- ci W ..................................... J U Nature of Repairs or Alterations—Answer when applicable................................................................................................ --------------------------------------------•-•-•--------•-•---•--.........---------•-•----•----•-------••---------------------------....--------------•-•-------............•-•---...--•---._......---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation.until a Certificate of Compliance has been issued by the board of health. Signed...................................................................................... ................................ Date Application Approved By- ................... .-�---- ----��:�::.� to - �Tate—9G Application Disapproved for the following reasons:-----•--------•--•--•-----------------------•-----------------••-------------. •-----------.._.._..---•••-- ..........................•---•---•••----•••----.....--•-----.....---••--•-•----------••--•--•------•-••.--------...•---•---•••-••-••--•••--•---------------•••--•--•--------•-----••------------•--••-- Date Permit No.....911.:...V--2 -------------------------- Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH \\ (Inr#ifirtttr of Toanpli anrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( Xor Repaired ( ) bY.................................................................................................................................................................................................... / .{ Installer at. 1..�!'1---c'��- - - -- -----•----•-•-- --•--------------- has been installed in accordance with the provisions of T ThE 5 f he tate Sanitaryeo a a�ed in the application for Disposal Works Construction Permit No.......p�.___ �j ...... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C%q ........... ?..:::................OF.._..... ��+�.f�.. : L��.r. ...................... FEEf No.. y.T l 6,0-•_.. .. Displill al Workii Tons#rurtion famit Permissionis hereby granted.............................................................................................................................................. to Construct)e- ) or Repair ( ) an Individual Sewage Disposal System at No.........Ce es-7--�-•-•----- S-- . --- -- ------ -- istree as shown on the application for Disposal Works Construction Permit No ated.............. - .. ............................. r ............................................... fDATE.................. ............................. Board of Health -•a- ------�----- -� FORM 1255 HOBBS & WARREN, INC., PUBLISHERS R A , • TEST PIT M TEST PIT #2 ... '�" n- ; �_ ELEV.=/2x6 0 ELEV.= 13x5 /0=6"-- --� --- CLEAN OUT AND .�� TOP30/L $ 70PS0/L $ �---- - � �'I `�'�'�., - � INSPECTION Cr`',TR . ALL ftE ATIONS S HOWN ,a R_. 9 fit Fa` UtPr N USC$GS DATUM 2_0., SUesok 2_0„ SU8501L r � o III I 1 I! -- -' 2. PITCH ALL LINES A MINIMUM OF 118" E-l". UNLE�c- ., h - —I_I �4,. 1 I I I OTHERWISE SPECI III D � 1 i T LIE 3. ALL PIPES TO AND YIN THE. SYSTEM SI-I�!�-L. HE CAS -- (� N IRON OR SCHEDULE 4C� PVC Fib' FINE L_ .. MIEDK/M o 1 '. -- - - --70 TO 4. ALL SEPTIC TANKS, DIS`rR!IE3'.` ' \ BOXES, AND, SAND i o ___.. - _- ---- I ,_ ,_� FOR f _ 2'0 'ht K sa/Wv GRAl1WLAR —r- LEACHING PITS SI~iA.-L DESIt� -t-- �'` I-- — ~-� LOADINGS WHEN UNDER PA14ING7 rt, _--- 2 I/2rr 3r. 14" DIAM 5. REMOVE ALL UNSUITABLE MATERIAL �3F=1�IEATH THE' -- --�-- -L- '; - � -_ —� INVERT ELEVATIONS OF T�H E` LEACHING f�'I T %t,`�f�? ., � TYPICAL DISTRIBUTION PDX ---_-_--- ---- �N� BACI .f- ��..�.v WITH c ® 1� � ® �t �I — A DISTANT:E' OF 10 FT. r- ''' CLAY- LIQUID NOT TO SCALE ---�- � — ® � � Ip I I'Y FLOW LINE � r ► O .. N RATE' LIQUID LEVEL _ FREE SAND �� GRAVEL Hu�' IN,t� �� , L.RC..t�LAI• ?O 23/4" OF 2 MINUTE,' < '�:R INCH OR L SS _p� - DISTRIBUTION BOX AND I wATE//��I/0=g" GAL. REINFORCED SEPTIC TANK BY 6. THE:. TOWN OF BARNSTABLE 60ARD OF HEAi.i`I'I Mt_�` r I OBSERVATION PIT + �1�PICAL 500GAL° SEPTIC TANK ACME PRECAST OR EQUAL TYPICAL FLOW DIFFUSOR BE r��' r. vuHE ` s "S_FEM IS NEAR � �I�PL TION ' ' ' ' NOT TO SCALE AND PRIOR TO BACKFII-LING i NOT TO SCALE PERCOLATION RATE= 2m/n/Inch ' ' ' >y : \ 7. UNLESS OTHERWISE NOTED„ ALL SYS'(EMI rOMPON57 �'�- I ' '\>TAINKS REINFORCED THROUGHOUT WITH OBSERVATIONS BY: EDBARRY ' >s ' ' ' ' ' SHALL. BE INSTALLED IN ACCORDANC �}$ �'I ' ITS E � ' ' '\ELECTRIC WELDED WIRE WITH 24-1 /2" TOWNOF'BARNSTABLE BOARD OF HEALTH a ; J' ' + >Y > OF THE STATE SANITARY C C)F?I" AND ANY Iw,O!�':i=fir > ��v1BEQDED STEEL RODS IN TOP 8 BOT- RULf�:' WHICH �+1iAY APPLY ENGINEER: ARROW ENGINEERING INC. + iJ ' ' ' + >TOM: +QONCRETE IS 4000 PSI TEST DATE: APR6 8. CONTRAC FOR IS TO NOTIFY ENGINEER, PRiC?R -I0 -I-HE' P-7586 Q' J ' ' ' ' + > INSTAL '-A ICifV OF SEPTIC SYS i Ei 1, (7f ItJY 7ISt�f fsP - ��Xa ANCIES BEJ WEr�N TEST PIT RESULTS .AND F-IF:I_ 1 CON,�ITIONS - � fr � �/Y� /� pp�� (ry� c/� t� 4 �A•,RRR i,, ,` �.A6 � e j I A t„r C E`J S .rt A i�H 0 L `_J �0 5 E P T I\+i k 1"'•.N K S A N L: I �_,A( �'J 1�•,;y PITS TO BE BUILT UP 10 12 INCHES BELOW I^ INISH , ■ GRADE t I✓I ' i > J a�' > a� TOP OF J FOUINDATION i a i' ' + EL 14.0 FINISH GRADE: a � t: , \+ �-- FIPJ! F{ GRAD FEPJISii G�'Af_ ! �-' wE� � r� i. � • ,,. :, J O JER {ANK 1 OVE_ R 9ox All__ r. ' ,� > �—FINISH GRADE _ '' ` 12.5 ' i Ja.: a' + t > , ' J + Ja ,> ' ' > > ,a ' Lj �.A/7i/�P Or /AAC _ . — f _ G — I . ALE ELEV- 135 133 EI E A 30 '\j_" , J + = .0�� T-1 ---— yr y( 1 _ ++ I s I 22 � • hl �07_ t---- _ i r�I\�'J'=10.00 AL. . _ 1� -�'-� _____---- REINFORCED __.._.- _ 7_;Z.__-- D r . 24 1500 Q �' G is ,�x iG BE LEVE',.. _,,..;..' - ,' - # CONCRETE 8 S,TAB _E INV=8. ELE -7 _" _ 88 BOTTOM V. ,g2, �;•: ,: (TO B E V E L 8 A ----DIFFUSOR UNITS ND WATER ' SEPTIC TANK24 4 H W. . , > - ,, _ - C. B�_E TYPICAL D I cRou I ,. _'••=., ,.-', \•,,,,.� s. , ,- . �` T I EL 8 STABLE) � TYPICAL SEWAGE S 1'� ► ��r I , 5,7 °4.4 # 'S y2' Z9• 8 MAP SECTION PARCEL Lai - ADDRESS � 93 42-4 ___ 6 pWE '4 a OS .I •� I PROF FI,. E 8� ZONING DISTRICT FLOOD HAZARD ZONE T� �N \500 G Z PNK I \ \°° LEGEND % r, I o EXIST. CONTOUR PROPOSED CONTOUR / EXIST. SPOT ELEVATION 8h0 E,IN�G �I U) I I � I e�F�S`� � s9p.60 E PROPOSED SPOT ELEVATION 8+0 2 SEPT. 10, 1990 _ ADD EXISTING MARSH RER ! 2� PERCOLATION TEST �+ ADDED 13 FOOT CONTOUR, HIGHLIGHTED 12 FOOT CONTOUR ( 100 YEAR FLOOD GLT _ I JULY 19. 1990 6DUNDARY );RELOCATED SEWERAGE. ADDED STRAW BALE DIKE.AM Pf{RAGMIT OBSERVATION PIT H 1 DATE REVISION BY J N0._... PROPOSED LOCATION OF DWE' I-A ING y = * x S SEWAGE DISPOE` AL SYSTEM ,1 41, DESIGN CRITERIA $ NUMBER OFBEDROOMS 5 - 54^r , .r � a�' PARCEL 42-4 SOUTH BAY ROAD ' z�� s�•' o PERSONS PER �DROOM _ `= ! OSTERVILILE BARNSTABLE I MA. {' g2 GALLONS PER PERSON PER DAY __55_ TEACHING REQUIRED 550gpd I LEACHING PROVIDED - 9P A1' PL("'ANC; L N I�,E.L_ lam\ �°"Z� 7/B,4 d ' 1 _,___. �►�� ' .� TERRANCE HUGGARD A R I OW E, � DISPOSAL NO � � � 51 EISENHOWER ENGINEERING INC HOWER ROAD CAPE DRIVE - SUIT / FtfJ:;ERT i 4 E P SEWER E DESIGN '''w� ` ra�t �'� _---_.-___,.,....._ ' ��6 ...:, I M AS H P" ICI A 02649 . . -SHAD DOTE ._....._.�_..._. 1 _. .-., ..-.9 ON, MA 02 7 I rp SBDEWALL... 120x 0,96 x 2.50 - 302.4 d ,1� .,.1Y, � � d I SCALE: t. ' r. I - � R3Av is O .3AD aw sv _,. _ 9P - •`' `%' ,/ i JUNE 9. 1990 I • of I t3 ; TOM, 52'x 8,O x /.O - 4/6.0 gpd :... , .i��, 1 AS SHOWN .-. 7/8.4 gpd I "�" i.`` 1l�1I�1 f3Y I-iE.CKED � Y, I s ti 7'`'-A.,. : s L A N ' . ,L._E= SCALE IN FEET °. SJR/HP GLT RER 6-289 I i