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HomeMy WebLinkAbout0082 WARREN STREET - Health (2) f 82 Warren Street Osterville f A= 162 061 �vr v,i _ 1 r c Commonwealth of Massachusetts ! 6 601 �. lig Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 84 Warren St F; Property Address Wianno Club(Tennis Area#2) Owner Owner's Name information is 7 required for Cisterville Ma 02655 -11-4-19 every page. City/Town State Zip Code Date of Inspection .' (s t 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 forms on the computer,use Douglas A Brown only the tab key Name of Inspector to move your D.A.Brown Inc cursor-do not Company Name use the return key. P.o Box 145 Company Address Centerville Ma 02632 City/Town State Zip Code 508-420-4534 S14297 `BOO 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 Ins or'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.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts I�-4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u— 84 Warren St Property Address Wianno Club (Tennis Area#2) inform Owneration is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: At time of inspection this system met all minimum passing requirements. 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 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 84 Warren St Property Address Wianno Club (Tennis Area#2) inform Owneration 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.) 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 ig, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 84 Warren St Property Address Owner Wianno Club (Tennis Area#2) 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 IF Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4' L 84 Warren St Property Address Wianno Club (Tennis Area#2) inform Owneration is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Citylrown 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 'h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Z Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® 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 Va Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 84 Warren St Property Address Wianno Club (Tennis Area#2) inform Owneration 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.) 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ~ � 84 Warren St Property Address owner Wianno Club(Tennis Area#2) information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. CityrFown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: 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: 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 Commonwealth of Massachusetts �d 1p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments L� ^ V 84 Warren St L Property Address Wianno Club (Tennis Area#2) 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.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: tennis courts Design flow(based on 310 CMR 15.203): unknown 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: 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 Commonwealth of Massachusetts �9 Title 5 Official Inspection Form i' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 84 Warren St Property Address Wianno Club (Tennis Area#2) inform Owneration is Owners 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): Approximate age of all components, date installed (if known) and source of information: unknown t Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 84 Warren St Property Address Wianno Club (Tennis Area#2) 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.) 6. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ .Yes ❑ No Dimensions: 1000 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.): Tank was functioning properly at time of inspection with no signs of failure or surcharge. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 84 Warren St Property Address Wianno Club (Tennis Area#2) 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.) 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 119 Title 5 Official Inspection Form (/ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4' u 84 Warren St Property Address Wianno Club (Tennis Area#2) 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.) 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 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4� 84 Warren St Property Address Owner Wianno Club(Tennis Area#2) information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. Cityfrown 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: 3 ❑ 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 84 Warren St Property Address Wianno Club (Tennis Area#2) 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.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Area of s.a.s was dry with no signs of failure or surcharge or break out to surface. 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 19 Title 5 Official Inspection Form I., Subsurface Sewage Disposal System Form Not for Voluntary Assessments 9 p Y rY 84 Warren St Property Address Wianno Club(Tennis Area#2) 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.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts �. lP Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 84 Warren St Property Address Wianno Club (Tennis Area#2) 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.) 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.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts ii� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 84 Warren St Property Address Wianno Club(Tennis Area#2) 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.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: greater tha 5 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: 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: Previous insp report from J Ford Septic. 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 L 84 Warren St Property Address Owner Wianno Club (Tennis Area#2) information is Owner's Name required for Osterville Ma 02655 11-4-19 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 I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Assessing As-Built Cards Page 1 of 2 V rfv--• —TON OF BARNSTABLE LOCATION SEWAGE N VILLAGE 'dlla 4 ASSESSOR'S MAP&LOT SEPTIC TANK CAPACITY LEACHING:FACILnT:(type) (size) NO.OF BEDROOMS / BUILDER OR OWNER 0-"0 6-/C�[1-' PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: I 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 Welland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 1�4 8 • t a oa 0 r 6 r2� 3 sy vo o https://town.bamstable.ma.us/Departments/Assessing/Property_Values/HMdisplay.asp?m... 11/10/2019 Assessing As-Built Cards Page 2 of 2 -„ . https://town.bamstable.ma.us/Departments/Assessing/Property_Values/HMdisplay.asp?m... 11/10/2019 r Commonwealth of Massachusetts /&a,,,,Qp/ Title 5 Official Inspection Form I' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ri u 82 Warren St 'J Property Address Wianno Club Tennis Building Owne informration is Owner's Name required for Osterville 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:When filling out p A. Inspector Information c f30� When 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 qkA Centerville Ma 02632 City/Town State Zip Code 508-420-4534 S14297 'efO° 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 4n6pps 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.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage'Disposal System•Page 1 of 18 Commonwealth of Massachusetts 11 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � j 82 Warren St Property Address Wianno Club Tennis Building Owner 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 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 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 4� V 82 Warren St Property Address Wianno Club Tennis Building Owner information is Owners 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 Commonwealth of Massachusetts �. lip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments n u 82 Warren St Property Address Owner Wianno Club Tennis Building 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 �n l Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments / 82 Warren St Property Address Wianno Club Tennis Building inform Owneration 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 Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A 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 �. �9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments L 82 Warren St _ Property Address Wianno Club Tennis Building Owner 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.) 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? El ® 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? ® El information 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 Commonwealth of Massachusetts Title 5 Official Inspection Form (/t Subsurface Sewage Disposal System Form Not for Voluntary Assessments 4' 82 Warren St Property Address Owner Wianno Club Tennis Building r 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 1. Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: 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: 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 cam, Commonwealth of Massachusetts �e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -'Not for Voluntary Assessments L 82 Warren St Property Address Wianno Club Tennis Building 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: recreation ( tennis courts) Design flow(based on 310 CMR 15.203): 768Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): sgft/persons 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: mostly seasonal Date Other(describe below): 3. Pumping Records: Source of information: Facilities manager states regular 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 82 Warren St Property Address Wianno Club Tennis Building 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): pump chamber also Approximate age of all components, date installed (if known)and source of information: actual install date unknown plan dated 2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts ii� Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form Not for Voluntary Assessments 4' v 82 Warren St Property Address Wianno Club Tennis Building Owner information is Owner's Name required for Osterville Ma 02655 11-4-19 every page. CitylTown 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) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 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.): Tank was functioning properly at time of inspection. Tees in place and no signs of failure or overflow. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 82 Warren St L Property Address Owner Wianno Club Tennis Building 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.) 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 Ma Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 82 Warren St Property Address Wianno Club Tennis Building 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.) 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.): box was functioning properly at time of inspection t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments L 82 Warren St Property Address Wianno Club Tennis Building Owner information is Owner s Name required for Osterville Ma 02655 11-4-19 every page. CityTrown 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: 6 per plan ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 I Commonwealth of Massachusetts it? Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 82 Warren St Property Address Wianno Club Tennis Building 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.) 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 in area of s.a.s at time of inspection. 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 �. P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 82 Warren St Property Address Owner Wianno Club Tennis Building information is Owner's Name required for Osterville Ma 02655 114-19 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.): t t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts �. 113 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 82 Warren St Property Address Wianno Club Tennis Building 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 �. It? Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 82 Warren St Property Address Owner Wianno Club Tennis Building 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.) 15. Site.Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 6.3 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record T If checked, date of design plan reviewed: attached 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: attached design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts �m i(-? Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 82 Warren St Property Address Wianno Club Tennis Building Owner information is Owner's Name required for Osterville Ma 02655 11-4-19 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 r A t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 w„ 4,2 LOCUS PLAN + sma,i•z000z000 15r9 XTE NI %"'2 -� ;;mom xx.,.xmx.. �`•,, � L�r. .._....... .. PLAN VMW PUMP CHA NEq OETPIL • d IbMwbMm<bxxwr wr.Mnuo— �iLw°m:aaal'1'Ym+�.. �z, a m,axn..,. L'L.� ma. .aYRre 'xm..b.°°b:M�a",."oo. �`xm•mx.,x,cm Zk OEVWMPROFILE OF PROPOSED.SEPTIC SYSTEM �e4eitliv wm x'° _ .„v •moo+y r..r. ...m,mmbaumm.,c PARTIAL PLAN xmasmx try - b r"'•°i.le.. tpa _ Mmm.mm SEPTIC SYSTEM REPAIR „ JUNIOR ACTIVITY AREA-TENNIS BLOC. 82 WARREN STREET r/•+/.• +r w^ OSTERVILLE•MASS. ,xxm,e•.• Fm THE WIANNO CLUB ./.r.p..�.r. 3fs,E:msxOxx omE:mall te,tow ' .noe..�.. wurvuvulMxErnnwlxc 09iERVILLE YR64 97039 • Assessing As-Built Cards Page 1 of 2 cnm� nous� TOWN OF BARNSTABLE �Ot LOCATION rr—'1 SEWAGE a - GOP' O� VQ LAGS Orrct4,111. ASSESSOR'S.MAP&PAP CEI4 IG Oaf — INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY rOu tip P Gnq�b�i LEACHING FACILITY:(type) (size)' {o NO.Of BEDROOMS OWNER WjAAA n OV� PERMIT DATE:, COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist „ on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within.300 feet of leaching facility) Feet FURNISHEDBY ;riis ailm 7- For _ h rd S i mzx w 4`, M O i https://town.bamstable.ma.us/Departments/Assessing/Property_Values/HMdisplay.asp?m... 11/10/2019 Assessing As-Built Cards Page 2 of 2 . G https://town.bamstable.ma.us/Departments/Assessing/Property_Values/HMdisplay.asp?m... 11/10/2019 J !� ' iOlin nnnIr i no" lit 41 .w?�'."�'• •R yR e�A• •.J - : •/'• '••I••••�• •' .4'.'.�• 4•.•.•.. • . . . .•.•. .•. .•.•.- • • •: � _..•-..•''4-` ?•/• • • •••[•♦ /`/••+Is �•• ••• '/•�• ••, '.'r•,,'•' / • 'f•'I�••�•'i���•�.••'•�•f�•�•�••N.•••r •••'••.•,•• r.�i"SY s•:♦'.'.'.• •. s /`� l • L w 4 I • [ ` I • • • / . •'. 1••� •,• • s I'I I / s• • I •s! • I .• I • .� i t • • . •F• ••• f ♦*~��. ♦ • '♦�+•• • /•sI -''F'�•.•r•♦ •/ r•I•••// • r ♦� w •••t w•• ••...L••,�''i�/�i i I.'• . s�/` a•.�• •. .•i. . . • . . . . . 1�.► .• r •.. • "�. .• � 4 • '•'u • .: •• - ,• r • j . I •••I •'I•• • �:w,• 1••s'w.• • I Is!/ • I • ./ /• • •�i•I•• �r ♦ � •+ 1'.. `••. r+• • 'r +•+ '/.•J•`.'.•�,+/••'♦; ` w/r. w/*s+1• �/•+//•/ +i/�/ t�/a 'r.1N �i+ �- '�Y . a_w1 m.r,n*sr'" ..�. :•.•+sc[d. .�•/�••. ///�• •s�•fa•yw••I' w•s �.�.•�•/. •/ �•.p6.��r+� �'��::��vaY°': � � e •w s i n I• Miorandi, Donna From: Michael Pillarella <chefmichael@wiannoclub.com> Sent: Thursday, September 26,2019 121 PM To: Miorandi, Donna Cc: James Galvano Subject: RE: New Project Assistance Follow Up Flag: FollowUp Flag Status: Flagged The project is slated to be placed in the tennis building that is down by the kids Camp. Presently it is an empty box. I do not have the exact address but it will not be attached to the main club. Let me know. Best Michael Michael J. Pillarella, CEC DIRECT: 508.681.4905 KITCHEN: 508.681.4904 Wian.no Club 1 107 Sea View Avenue I Osterville, MA 02655 President Cape Cod and The Islands Chefs Association From: Miorandi, Donna <Donna,Miorandi@town.barnstable.ma.us> Sent:Thursday, September 26, 2019 11:48 AM To: Michael Pillarella <chefmichael@wiannoclub.com> Subject: RE: New Project Assistance Hi Michael: For starters where is this location planning to be built? Donna From: Michael Pillarella [mailto:chefmichael@wiannoclub.com] Sent: Thursday, September 26, 2019 10:02 AM To: Miorandi, Donna Subject: RE: New Project Assistance Thankyou If you could contact me directly when you have a chance. Take care 1 10/9/2019 ShowAsbuilt(1700x2800) cnnu '. n owe TOWN OF BARNSTABLE r �Ot ` LOCATION SEWAGE#JODY- (o0P' v� VILLAGE _OSTtl4�I� ASSESSOR'S,MAP&PARCEI, /6 Z • d D 1 — INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY .��i GUp P GA4111L le LEACHING FACILITY:(type) (size)' �o NO.OF BEDROOMS ' „ OWNER WIAAA n PERMIT DATE:, COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If'ny 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 ZrM.l ea-,u, T Fwd ri d� �0 Q :;:• M _ 0 j QM v,tr T r https://itsgldb.town.barnstable.ma.us:8407/Home/ShowAsbuilt?mp=162001&sq=1 1/1 Michael I Pillarella, CEC rxeculive Chef DIRECT: 508.681.4905 KITCHEN: 508.68.1.4904 Wianno Club 1 107 Sea View Avenue I Osterville, MA 02655 President Cape Cod and The Islands C:het's Association From: Miorandi, Donna <Donna.Miorandi@town.barnstable.ma.us> Sent:Wednesday, September 25, 2019 3:50 PM To: Michael Pillarella <chefmichael@wiannoclub.com> Subject: RE: New Project Assistance Hi Michael: I have returned call twice from a Jim Galvano and never called me back. I am leaving on an emergency now and don't know when I will be back. Shall catch up with you soon I hope. Donna From: Michael Pillarella [ma i Ito:chefmichael@wiannoclub.com] Sent: Wednesday, September 25, 2019 2:04 PM To: Miorandi, Donna Subject: New Project Assistance Donna, I hope you are doing well and the summer treated you kindly. I am in the process of designing a new concept and would like to work with you to ensure all sanitations needs are addressed. I am not well versed in the requirements of this type of operation The concepts is a Cafe/Ice Cream Parlor Coffee Drinks Baked goods (baked off premise) Smoothies Premade sandwiches (not made on property) Equipment will be mostly refrigeration and sinks, no cooking equipment per se. I will have a soup warmer maybe a hotdog machine Basic questions: Do I need a three bay sink and or mop sink? DO the floors need to be a certain material? Do the walls need to be a certain material? Once I have a general layout I hopefully can send it to you for review. Thank you for your time and please let me know if,you have any concerns - Michael P 2 Miorandi, Donna From: Michael Pillarella <chefmichael@wiannoclub.com> Sent: Thursday, September 26, 2019 10:02.AM To: Miorandi, Donna Subject: RE: New Project Assistance Thank you If you could contact me directly when yo.u.have a chance. Take care Michael J. Pillarella, CEC Eyecutzve Che/ DIRECT: 508.681.4905 KITCHEN: 508.681.4904 Wianno Club 1.07 Sea View Avenue I Osterville,MA 02655 +r President Cape Cod and The Islands Chefs Association From: Miorandi, Donna <Donna.Miorandi@town.barnstable.ma.us> Sent:Wednesday, September 25, 2019 3:50 PM To: Michael Pillarella <chefmichael@wiannoclub.com> Subject: RE: New Project Assistance Hi Michael: I have returned call twice from a Jim Galvano and never called me back. I am leaving on an emergency now and don't know when I will be back. Shall catch up with you soon I hope. Donna From: Michael Pillarella [mailto:chefmichaelCa@wiannoclub.com] Sent: Wednesday, September 25, 2019 2:04 PM To: Miorandi, Donna - Subject: New Project Assistance Donna, I hope you are doing well,and the summer treated you kindly. I am in the process of designing a new concept and would-like to work with you to ensure all sanitations needs are addressed. I am not well versed in the requirements of this type of operation The concepts is a Cafe/Ice Cream Parlor Coffee Drinks ' Baked goods (baked off premise) Smoothies Premade sandwiches(not made on property) Equipment will be mostly refrigeration and sinks, no cooking equipment per se. I will have a soup warmer maybe a hotdog machine . 1 Basic questions: Do I need a three bay sink and or mop sink? DO the floors need to be a certain material?' Do the walls need to be a certain material? Once I have a general layout I hopefully can send it to you for review. Thank you for your time and please let me know if you have any concerns Michael Michael J. Pillarella, CEC Executive Chef DIRECT: 508.681.4905 KITCHEN: 508.681.4904 Wianno Club 107 Sea View Avenue I Osterville,MA 02655 President Cape Cod and The Islands Chefs Association CAUTION:This email originated from outside of.the of.Barnstable! Do not click links, open ' attachments or reply, unless you recognize the sender's email address and know the content is safe! CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! 2 • • L ,R Legend • Road Names #177 =5;11_ #55'7 r 533 aij c �• `tY � r ,� #1©2 J ti} F #f�170 "�•. per . ti Map printed on: 9/26/2019 This map is for illustration purposes only.It is not Parcel lines shown on this map are only graphic Town of Barnstable GIS Unit adequate for legal boundary determination or representations of Assessor's tax parcels.They are Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA o26o1 0 167 333 an on-the-ground survey.It may be generalized,may not accurate relationships to physical objects on the map 5o8_862_4624 reflect current conditions,and may contain such as building locations. Approx.Scale: 1 inch = 167 feet cartographic errors or omissions. gis@town.barnstable.ma.us O� M A 0 J c5 OCT ti ...-a BOWE s i; `ltlt�tl�l11 0004348364 (7C;'I'15 2004 MAILED FROM ZIP CODE 02655 107 Sea View Avenue Post Office Box 249 Osterville,MA 02655-0249 ;.Mr. Thomas McKean Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 i j!t(((({ [ t i i 4 f i it 14{{ it {{[fi jgg U(lf i it#( t � 4ttltt ( t� t t ��1 t S {t itl tt ittt� i4I it[[ t Itll WIANNO CLUB 25 October 2004 Mr. Thomas McKean Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 Dear Mr. McKean: I am writing you today with the purpose of enlightening your department on the condition and uses of the Wianno Club tennis facilityand its attendant septic stem p system, which Js .currently undergoing;scrutiny as to its condition.and possible;h.ealth risk: At present, Wianno Club has seven tennis courts. The courts are patronized only by Wianno Club.members and their,guests for approximately the period Memorial Day until Labor Day, though their most intense.'use is from about:J.une 20 untiL.August;15,,a two- month period.of.time:, The courts.are used_.quite heavily-in .the-mornings -..when,, cliildren's and.ladies' clinics"are�taking place. Men's..clinic is small and takes place only on Saturday morning, when other traffic is limited. Afternoon play consists of private lessons involving students and pros and casual play among the members. Afternoon Play is not usually heavy, except during tournament time, the last few weekends of the season. Almost never are the courts used after 6:OOPM. Virtually all of our Club members own or rent homes in the area. Many come via bicycle. They come to the tennis courts (golf course, too) dressed and ready to play-the game. Most leave within about two hours, perhaps three, of arrival and the only condition that has changed is that they are well exercised when they leave. They shower and change at home. There are no food or beverage service facilities in the tennis area. Now, Wianno.Club.is contemplating adding two tennis:courts;.;These will.provide , additional playing space for:the Club members,who are:already here,,.cutting,waiting time.but,adding`,little, if any,;to the:total use of the facilities In;other words;-we are spread�pg the load, not addipg-toit, 's _ , . . . We are also in the process of planning the upgrade'of existing septic facilities in order to ` comply with,current health regulations..-Though our c.urrent.septic system is,in;statutory P.O. Box 249. Osterville, Massachusetts 02655-0249 Tel:508-428-6981 • Fax:508-428-9036 wiannocl@cape.com violation, our engineering consultant, Peter Sullivan, PE, informs us that it is not currently being used at any rate approaching its capacity and that, if not in legal violation, might be good for another 20 years. Because our tennis program is probably as big as it is ever going to be, (Wianno Club itself is not growing by any appreciable amount) and because the period of intensive use of the facility is exceedingly short and the current system is of more-than-adequate capacity, we respectfully request the Health Department waive the requirement that Wianno Club enlarge its septic facility to correspond with the addition of two courts. We understand clearly that the current system'is in statutory violation of health regulations and are working expeditiously to rectify this problem at the soonest possible time. Thank you for your time and attention, Mr. McKean. If 1 or any representative of Wianno Club, including Peter Sullivan, can answer any questions you may have concerning the above, please feel free to call or visit at any time. Very truly yours, Ja k L. Thomson, CCM General Manager 3 Cc: Peter Sullivan, PE James Kjorlien, Tennis Chair r II ' 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION 15.203: continued \ /j ALLOWABLE GFD FOR" M GALLONS SYSTE TYPE OF ESTABLISHMENT UNIT PER DAY DESIGN (3) COMMERCIAL (continued) Retaii'Store per 1000 sq:ft. ' 50 t •200 Restaurant per seat 35 1000 Restaurant, thruway per seat 150 1000 service area Restaurant, Fast Food per'seat 20 1000 A, '^ tr Restaurant; kitchen flow per seat 15 [for sizing of grease „ trap only] f 3 Service Station _ per bay 150 450 0 [no gas] Skating Rink per seat 5 3000 k�° Swimming Pool per person 10 Tennis Club per court )50 ✓` Theater,Auditorium per seat —. Trailer, dump station per trailer —7 (4) INSTITUTIONAL c: Church or Temple per seat ;E ., �, Correctional Facility per bed 0 Function Hall per seat 15 _ Gymnasium per participant 25f (� Gymnasium per spectator Hospital per bed 200 "' 'j L.0. " " Nursing Home/Rest Home__ - _per bed_ ._ 150 Public Park, toilet per person 5 waste only Public Park, bathhouse, per person 10 showers and flush toilets . > ' VV% , (5) SCHOOLS Elementary School, without cafeteria, gymnasium or showers per person Elementary School, with cafeteria but 040 L. no gymnasium with showers per person 8 f Elementary School, with cafeteria, gymnasium and showers per person 10 Secondary/Middle School, without cafeteria, gymnasium or showers per person 10 6 Secondary/Middle School, with cafeteria but no gymnasium or showers per person 15 Secondary/Middle School, with cafeteria, gymnasium and..show:ers `-" � - per person 20 Boarding Schools, Colleges per person 65 3/24/95 (Effective 3,13 V95) 310 CMR - 511 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 Junior Activities Bldg. Property Address: 82-84 Warren Street C� Osterville, MA 02655 Owner's Name: Wianno Club Owner's Address: `s Date of Inspection: Al2H1 25, 2006 t rt Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford 5 Mailing Address: P.O.Box 49 cr,1 Osterville,MA 02655-0049 Cj.' --j =_ Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT r— �n I certify that I have personally inspected the sewage disposal system at this address and that the info ation reported below is true,accurate and complete as of the time of the inspection. The inspection was performed1based 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 N ds Further Evaluation by the Local Approving Authority F it Inspector's Signature: Date: May 7,2006 The system inspector shall S4 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 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 82-84 Warren Street Osterville, MA Owner: Wianno Club Date of Inspection: April 25, 2006 i 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 irruninent. 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: i 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: 82-84 Warren Street Osterville, MA Owner: Wianno Club Date of Inspect►on: 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 **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 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 82-84 Warren Street Osterville, MA Owner: Wianno Club Date of Inspection: April 25, 2006 d 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 „ ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ✓ Any portion of the 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.] No (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. 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: 82-84 Warren Street 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 no 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: 82-84 Warren Street Osterville, MA Owner: Wianno Club Date of Inspection: April 25, 2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no): [if yes separate inspection required] Laundry system inspected(yes or no):. Seasonal use(yes or no): Water meter readings,if available(last 2 years usage(gpd)): Sump Pump(yes or no): Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Junior Activity Building_ Design flow(based on 310 CMR 15103): -- gpd Basis of design flow(seats/persons/sgft,etc.): -- Grease trap present(yes or no): No Industrial waste holding tank present(yes or no) No Non-sanitary waste discharged to the Title 5 system(yes or no): No Water meter readings,if available: Unavailable Last date of occupancy/use: Summer use OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped yearly for maintenance-Der 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: 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) 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 on 5112193-per as built card 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: 82-84 Warren Street 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: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 12" Material of construction: ✓ concrete ._metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. 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: Measuring 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.): Tees were present. The tank was pumped months prior and has not been receiving any flow. 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 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 82-84 Warren Street 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.): 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) Conunents(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 82-84 Warren Street 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: -3 infiltrators Ex 22.75'(per as built card) 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.): The infltrators were dry. There did not appear to be anv simns o£failure The bottoms to.grade were 3' A video camera was used for the inspection. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) i 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 or no): Continents (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 r - Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) . Property Address: 82-84 Warren Street .'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. Q A g 1 O 3 d r 3 3y yo 10 • Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 82-84 Warren Street 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 feet Please indicate(check)all methods used to determine 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: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: The bottom o the leach field to grade was X. 1 hand augered down to 5.5'below grade and no water was observed. Using ape Cod Commission technical data, the high Around water adiustment for this site(Ml W 29, Zone A)was 1.T below grade. This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. . 11 COMM�N"WEELDTH OSPECTION SETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED JAN 2004 TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART.A �Y CERTIFICATION -� Property Address: 80 Washington Ave. (Tennis Bldg.) MAP O , Osterville, MA 02655 PARCEL - Owner's Name: Wianno Club LOT ta�94 1 5 Owner's Address: Date of Inspection: December 21, 2003 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Osterville,MA 02655-0049 Telephone Number: (S08) 862-9400 CERTIFICATION STATEMENT I certify that 1 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 Need Further Evaluation by the Local Approving Authority ✓ Fails Inspector's Signature: Date: Janua�3,20042004 The system inspector shall sub a copy of this inspection report to the Approving Authority(Board of Health or j 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 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 80 Washington Ave. (Tennis Bldg.) Osterville, MA Owner: Wianno Club Date of Inspection: December 21, 2003 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 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: 80 Washington Ave. ("Tennis Bldg.) Osterville, AM Owner: Wianno Club Date of Inspection: December 21, 2003 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 "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: ° Page 4 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 80 Washington Ave. (Tennis Bldg.) Osterville, AM Owner: Wianno Club Date of Inspection: December 21, 2003 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 ✓ 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 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. 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 1 I OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 80 Washington Ave. (Tennis Bldg.) Osterville, AM Owner: Wianno Club Date of Inspection: December 21, 2003 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 I, 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)]. Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 80 Washington Ave. (Tennis Bldg.) Osterville, AM Owner: Wianno Club " Date of Inspection: December 21, 2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system (yes or no): [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use(yes or no): Water meter readings, if available(last 2 years usage(gpd)): Sump Pump(yes or no): Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Tennis club Design flow(based on 310 CMR 15.203): -- gpd Basis of design flow(seats/persons/sgft,etc.): -- Grease trap present(yes or no): No - Industrial waste holding tank present(yes or no) No f Non-sanitary waste discharged to the Title 5 system (yes or no): No Water meter readings, if available: Unavailable Last date of occupancy/use: Summer use s OTHER(describe): GENERAL INFORMATION Pumping Records I Source of information: Pumped 101812003 per treatment plant Was system pumped as part of the inspection (yes or no): No If yes, volume pumped: . eallons--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) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Unknown-no information available Were sewage odors detected when arriving at the site(yes or no): No 6 f Page 7 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 80 Washington Ave. (Tennis Bldg.) Osterville, AM Owner: Wianno Club Date of Inspection: . December 21, 2003 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: Comments(on condition of joints,venting,evidence of leakage, etc.): C SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 12" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 0" Distance from top of scum to top of outlet tee.or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring 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.): Tees were present. The tank was approximately one-half full. There did not appear to be any signs of leakage 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 r 4 Page 8 of I l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 80 Washington Ave. (Tennis Bldg.) Osterville, MA Owner: Wianno Club Date of Inspection: December 21, 2003 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: gallonsiday 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.): i DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was level and clean. No solids were present. The cover was 27"below grade 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 Page 9 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 80 Washington Ave. (Tennis Bldg.) Osterville, AM Owner: Wianno Club Date of Inspection: December 21, 2003 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type j ✓ leaching pits,number: 2-4'x 6'(600 gaL) leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): Both pits were dry. The scum lines were approximately 6"up from the bottom. The,bottoms to grade were 6' The covers were 18"below grade. 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: 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), Materials of construction: 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: 80 Washington Ave. (Tennis Bldg.) Osterville, AM Owner: Wianno Club Date of Inspection: December 21, 2003 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. T �rs 7 s B . y a �o S o a Y6 a3 3 3 y yo 336 yS" y7 10 Page 11 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 80 Washington Ave. (Tennis Bldg.) Osterville, AM Owner: Wianno Club Date of Inspection: December 21, 2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate (check) all methods used to determine 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: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: The bottom of the pits to grade were 6. I hand angered down on the bottom of the leach pit to ground water, which was 7.0'below grade. The pit was 1'above ground water. Using the Cape Cod Commission Technical Bulletin the high ground water adjustment for this site(Ml W 29, Zone A, 12103)was 1.4, making the leach pits in the adjusted high ground water level by.4' This report has been prepared and the system 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 system, the inspection and/or this report. I 11 COMMONWEALTH OF.MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION F!REIVED 2004 TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A A le,A %?- w h 2 elc-qq Sr 'CERTIFICATION Property Address: 80 Washington Ave. (Junior Activity Bldg.) Osterville, MA 02655 Owner's Name: Wianno Club MAPS." Owner's Address: PARCEL Date of Inspection: December 21, 2003 LOT Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Osterville,'VA 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 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 Conditi nally Passes Needs rther Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: January 3, 2004 The system inspector shall submi 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 1 Page 2 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 80 Washington Ave. (Junior Activity B1dgJ Osterville, M4 Owner: Wianno Club Date of Inspection: December 2.1, 2003 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: e 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 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): i broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 1 l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 80 Washington Ave. (Junior Activity Bldg) Osterville, AM Owner: Wianno Club Date of Inspection: December 21, 2003 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 "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 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 80 Washington Ave. (Junior Activity Bldg.) Osterville, AM Owner: Wianno Club Date of Inspection: December 21, 2003 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 ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high groundwater 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 l 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.] No (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. 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 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 80 Washington Ave. (Junior Activity Bldg.) Osterville, MA Owner: Wianno Club Date of Inspection: December 21, 2003 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)]. N 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 80 Washington Ave. (Junior Activity Bldg.) Osterville, MA Owner: Wianno Club Date of Inspection: December 2i, 2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system (yes or no): [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use(yes or no): Water meter readings, if available(last 2 years usage(gpd)): Sump Pump(yes or no): Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Junior Activity Building Design flow(based on 310 CMR 15.203); -- gpd Basis of design flow(seats/persons/sgft,etc.): -- Grease trap present(yes or no): No Industrial waste holding tank present(yes or no) No Non-sanitary waste discharged to the Title 5 system (yes or no): No Water meter readings, if available: Unavailable Last date of occupancy/use: Summer use OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped 101812003 per treatment plant 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,distribution box,soul 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: Installed May 12193-per as built card 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: 80 Washington Ave. (Junior Activity Bldg.) Osterville, MA Owner: Wianno Club Date of Inspection: December 21, 2003 A BUELDING 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: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 12" Material of construction: ✓ concrete metal fiberglass - polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no) (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring 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.): Tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage. 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 I 1 . OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 80 WashinQion Ave. (Junior Activity Bldg.) Osterville, M4 Owner: Wianno Club Date of Inspection: December 21, 2003 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: Qallons. Design Flow: > allonslday 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.): 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 • Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 80 Washington Ave. (Junior Activity Bldg.) Osterville, AM Owner: Wianno Club Date of Inspection: December 21, 2003 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: ✓ leaching chambers,number: 3-infiltrators(7'x 22.759-per as built card 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.): The leach field was dry. There did not appear to be any signs of failure. The bottom to grade was 3'. A camera was used to conduct the inspection. 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: 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) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): 9 Page 10 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 80 Washington Ave. (Junior Activity B1dQ.) Osterville,M4 Owner: Wianno Club Date of Inspection: December 21, 2003 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. Q A 6 f - a O 3 . a a a8 ►9 3 3y y0 10 Page I I of I 1 t OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION(continued) Property Address: 80 Washington Ave. (Junior Activity Bldg.) Osterville, MA Owner: Wianno Club Date of Inspection: December 21, 2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate (check) all methods used to determine the high ground water elevation:, Obtained from system design plans on record- If checked, date of design plan reviewed: ✓ Observed site(abutting propertylobservation 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: The bottom of the leach field to grade was 3 1 hand augered down to S'below grade, and no water was observed. Using the Cape Cod Commission Technical Bulletin, the high ground water adjustment for this site (MI W 29, Zone A, 12103) was 1.4, This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 TnntS H ous%- &3 WG TOWN OF BARNSTABLE LOCATION AVC., SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL A� • U D 1 INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY 5U� G(Jd P Gn`6i LEACHING FACILITY: (type)_ -0rYwLl LS (size) �o NO.OF BEDROOMS OWNER W)AAA e (JuV PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet ` FURNISHED BY 2r/1Spe�Tlun l A 3 3 y 30 L 3 ay /s y q96 a( a 3 C 0 vc�i y � WA-R�t W %T i TOWN O BARNSTABLE U-3CATION Z C`� 1 SEWAGE # 26CY-669 VILLAGEc�v"�`� ASSESSOR'S MAP & LOT I�� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY C-4L EACH NG FACILITY: (type) � � (size) ,N ._OF-BEDROO S BUILDER O OWNE UNcti.,+-c7 1 PERMTTDATE: COMPLIANCE DATE: -3riy"�- Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching,facility) VVV Feet . Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of le ' facility) Feet Furnished by r 1 b c u � if 4 . G C � �e c�oz OF BARNSTABLE LOCATION ' W SEWAGE # VILLAGE CL�� ASSESSOR'S MAP & LOT 'DO/ r-•••••••. r c nr...r a nv/»rr ern C C SEPTIC TANK CAPACITY 'r LEACHING FACILITY: (type) (size) ,,'�NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: a�6� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet I Furnished by I- TOWN OF BARNSTABLE L(5!QATION F,�P- W 4a40-" SEWAGE # 93 `X3r6 V!3LLAGE � 4l) L.-L ASSESSOR'S MAP & LOT/6=�- -GU) INSTALLER'S NAME & PHONE NO.%0016--TV"COr77 StcPTIC TANK CAPACITY Z1060 t LEACHING FACILITY:(type) /N L��r�/Z- 3 (size), NO. OF BEDROOMS --- PRIVATE WELL OR P IC WATER BUILDER OR OWNS S' J1s! r'�3�.sU�2fc= //1-�y� GLfJQ DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes N� -_ _ � _ - ^_...� 1 j�©/G y/ � t ��y ........ N a� � � a � .. T x Fee No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Z(ppfication for Miopogar *pMem Construction Permit Application for a Permit to Construct( . )Repair()()Upgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot No.9? IN A RR Ls N ST M 66FT Owner's Name,Address and Tel.No. OSj,&rLVIL.Lffj 1~0 C.LUf3 Assessor's Map/Parcel ►a 9�'p✓�b�k+ A✓ M- I l.2 (P 1 O /Ll//GL6 j?ss Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No,S00-q 28-3 3 N y �� �.�tkS SLIL.L�vAN ENGINcfBCLING- I wL 7 PAR 1G wR ftG IL 0S�1.�21/fLLtr' /YI�SS Type of Building: Dwelling No.of Bedrooms Lot Size %.'2.6Aa -9.ft. Garbage Grinder Other Type of Building 13wI Me t J No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow "7&S gallons per day. Calculated daily flow 7 8 1 gallons. Plan Date 4.P R I L. 'Z 9, 2 0 0' Number of sheets 1 Revision Date 9 /5 O Title S E PT/G SYSTEM R E PA I fR Size of Septic Tank MA ST. 1000 GAL_ Type of S.A.S. M!X G30 L irAC611y-9 ckonitRis Description of Soil 0-d) Lo.4 A4 loterAmes s-p—) 9 I 2,91tOK Yet-is4 Z r'Iu toArsAF SAND-E-7 10yR blq Zq"= 4L yEG'15V QRw C&ARS S. AID-0- 10y2 Sh, , L4 (. - 1'2.I�t LT. YEG'IsM FiRw CoArse- SQ&D—G-- IU`lR L/y 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 Certifi- cate of Compliance has been iss b this Board . r Signe Date 6� Application Approved by -- Date Application Disapproved for the following reas Permit No. Date Issued .r No. r �' .Y 1 --w Fee y •THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes _ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ''Application for Migpool *pgtem Con5. tructioit Permit Application for a Permit to Construct( )Repair(X)Upgrade`('- )Abandon( ) ❑Complete System" ❑Individual Components Location Address or Lot No. w IZ t'N' 82 wner's Name,Ad ress Te�.No. OStC RVII Lt, Ml�S3 i. ?11E tlJtYaN�C) 1619 Assessor's Map/Pazce 10 7 5 ZF4IW& w F,I dL lN► - 1 lr�. �- f 0.5121//LL6 MA9SS .Sog y2 -S. Installer's Name—Address,and Tel.No. Desi ner's Name,address and Tel.No. SUIEL#V l , tNG-iNt I YVG 7'I���� '7 �'A 2 K E 2 2 i7 0S-r rZVIL(, IkIdSS �- Type of Building: Dwelling No.of Bedrooms Lot Size $' � 5 A sq ff. Garbage Grinder(NQ ..Other Type of Building 13 V 1 L 01 Ncy No. of Persons Showers( ) Cafeteria( ) r OtherFixtures ' Design Flow �l 8 gallons per day. Calculated daily flow 8 gallons. - Plan Date:'NP R I t- Z a/ 2 a r'T Number of sheets Revision Date S O Title SLl�77c SysT�M fZG1?A1R- Size of Septic Tank aX 1 51 . coo GAS 11 Typeof S.A.S. 1"-"' t,3 chw.9 C gml3r:(Z_ Description of Soil O-g L 0 4 W 10/G,Q/11C s--0- - 2y 1)1t ve4.'isN (3 r1V CoArsE SNND-E- - lo`/R 31q j ZC - Ll i, `/tL'15P GrZN CUA'l2SE 541VO-13 - I0` X 5 G L4 to 121 LT. `/E0514 13RNJ Co,ArsE 541vD - - IU`l2 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agre s,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 operatio until a Certifi- cate-of Compliance has beep' sue this Board e S- A / ;0 Signe El t Date Application Approved--by' /� ® ,� lid � A� Date / � . Application Disapproved for the following`reasous� Permit No. Date Issued s 11 -THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, th t the On site Se` a C e Disposal Syste nstructe ( ) Repaired (X) Upgraded( ) Abandoned( )by l /C - lvArr L am, 057LrVILl-E `n145s at h,as/b�e� constructed in accordance with the provisions of it 1 5 d the f r-Disposal Syste oust ction Permit No. _"M dated Installer f-ka Fl?ai esignerS L I 41 C G I IY/E 6 P_IIVy I N The issuance of this p t mall not be construed as a guarantee that the shy tern wil u n s designed. Date t•� `U3 Inspector ----- -------------�£----- ..— y. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 'Wi5po5al *p5tem Construction Permit 1 4_aVjL_LG Permission is hereb granted to Construct( ))RepairUpgrade( .)Abandon( ) System located at Z W/4rrEjt. ST CV 5 11"4_55 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. ! ' Provided: Constructioq must be completed within three years of the da of this er Date:_. Approved b _y �_ WIANNO CLUB 25 October 2004 Mr. Thomas.McKean Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 Dear Mr. McKean: I am writing you today with the purpose of enlightening your department on the condition and uses of the Wianno Club tennis facility and its attendant septic system, which is:currently undergoing scrutiny as to its condition and possible health risk. At present, Wianno Club has seven tennis courts. The courts are patronized only by Wianno Club.members and their,guests for approximately the period Memorial Day until WborDay,.though.their.most intense use is from about June 20 until August 15, a two- month.period of time. The courts are used quite heavily in the mornings, when. children's and,ladies'clinics are taking place. Men's.clinic is small and takes place only on Saturday morning, when other traffic is limited. Afternoon play consists of private lessons involving students and pros and casual play among the members. Afternoon play is not usually heavy, except during tournament time, the last few weekends of the season. Almost never are the courts used after 6:OOPM. Virtually all of our Club members own or rent homes in the area. Many come via bicycle. They come to the tennis courts (golf course, too) dressed and ready to play the game. Most leave within about two hours, perhaps three, of arrival and the only condition that has changed is that they are well exercised when they leave. They shower and change at home. There are no food or beverage service facilities in the tennis area. Now, Wianno Club is contemplating,adding two tennis courts. These will provide. additional playing space for the Club members who.are already here, cutting waiting -time but.adding little, if any, to the total use of the facilities.. pother words,.we are spreading the load, not adding to Jt. We are also in the process of planning the upgrade of existing septic facilities in order to j comply with current health regulations. Though our current septic system is in statutory P.O. Box 249. Osterville, Massachusetts 02655-0249 Tel:508-428-6981 - Fax:508-428-9036 wiannocl@cape.com Av . c c� Town of Barnstable i IHE'Ow Regulatory Services HAP 0� Thomas F. Geiler,Director MAM Public Health Division 16yq. Ea�;�•�'` Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 3 1301a5_ Designer: 54LLiVi¢/l/ E6►/��iyF�R�/*c Installer: aw"F Address: '°7 PAYkGa QP Address: on - was issued a permit to install a (dat installer) septic system at &L based on a design drawn by (address) dated V/2_,q/0 v Q ey. /h q lm6, (desi er) r certify that the septic system referenced above was installed substantially according to- the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. 't h o s'Ca a-t o Fy r Cram► i-'4"d W1, ` 1T« V v®vLy 'Mix Docms lue'l-G°a! -I FY CaMP4Jb re.,F W/7H pi4jimaov CPA Cte--etrzic.4 L Cac+DOS Vr f�iti� O'T�ii�Y �-.t3(�.u Lf4`firors+s` I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation.of any component of the septic system)but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow.. Su 'aastaller's Signature) ISO 33 C1 (Designer's'Signature} (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC H�A.LTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECErVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form k¢ ' ' •s No.... ..3 > CJ 0 FIza./ d THE COMMONWEALTH OF MASSACHUSETTS AMOVED BOAR® OF HEALTH b TOWN OF BARNSTABLE 14 ppliratiou for Di�ipaiitl Wnrk.6 Coit rurti rmt -mil--F-3 Application is hereby made for a Permit to Construct ( ) or Repair P< an Individual Sewage Disposal System at: c!-.....11l..t! ............................................................... ..... ---•---•-.....••- Location-Address or Lot No. ��JN �i�CJCS....... hJ! �h/� g�I "IY\.4.............. ---...!..�JJL `....... Opener _ Address -------------------- Y �. .............................. --- - � Iustaller Address Type of Building Size Lot............................Sq. feet .� Dwelling—No. of Bedrooms....................--- ------------------Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Buildil a. g ............................ No. of persons-----------.--------.--.---- Showers ( ) — Cafeteria ( ) 0 Other fixtures ----------------------------------------------------- ----------------•--------•...... WDesign Flow............................................gallons per person per day. Total daily flow..--..........._:��.®............gallons. WSeptic Tank—Liquid capacity.///M.gallons Length--. Width................ Diameter--.............. Depth................ x Disposal Trench--No. ..........l.._.-.._ Width........7------- Total Length..--- Total leaching area....................sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by....... ------------------------------- .................................. Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit...-----............ Depth to ground water.......----.........--.. fT4 Test Pit No. 2................minutes per inch Depth of Test Pit--...--............. Depth to ground water........................ P+ •---••••--•--••••--•--•------------•••--••-•--••-•-••--•----•••--•----••...............•-•---................•-•-••............-----••-•--•------•--••-....-' 0 Description of Soil----------------•-•..•-- A"J-D-----------------------•----••--•------------'--------------•--------------------•--•--------•---............---...---•------ x U .....•••••-•-•••--•••-••-••-••-•••••-••-----•-•-••-...•-•-•••••-•--•------••-•••••••-••---•-----•-••••-•-•---•--••-•-•-•-•---•-------•-•••-•-••-•--•-••••---•---••-•-••--•-.........•...-•............... W x ••--••••-• ••--"'---•---• ------------•••-•••••-•••-••------'••-'-•.............•----••••••-••••-•--.........------•--------•------•-•••...•-••---•-•-••••-•--- U Nature of Repairs or Alterations—Answer when appli ble......./. -.-.-%GIJo � . /?� r..4. r... :. s lF -•c ...................................................................................................' Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance be issu d t oard f health. Signed ......... Date ApplicationApproved By ..... .... . �..... . ........ ......... . ......... ........ :.................................... ................ .........'----'-- Due Application Disapproved for the following reasons: ................................._...................................... .. ............................................................................... ............... '-' - ' ' ........................................ ............ ........... -.. Dare Permit No. ..' ... .....�....... '--------------- Issued .............. .. . re ��'��.. - -+.�-r rtyr:+3.�.--.•ate-�S-y°^.:..�-,w-...-..---...y �•,•Lr••-rr+.----�..:d..-.�,,...,.,Ja...,...._,r��'..,y..�:.t..`-,.r`.,,•„rw.....,r.w.:o..�a.�...w.•..at,:::A---.v�w.��.wit��wt.:T'.,t„o.r..�.�.��r-��=N'�Y� No..__,... ...-....... - Uo Fica../.......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ap.liliratiou fur Di ipwiai lVork,s Tomitrurtio rumit Application is hereby made for a Permit to Construct ( ) or Repair (-<) an Individual Sewage Disposal System at: .... ,._............ _- • -•-••••-•-•••••�-_......•••••••-•--••• --•-••-•••-- ...•. --•---•--.._..----••••-•••.....-....-•-•-- Location-Address or Lot No. . Cj.. G..=U-�s-- L!i/. _J�7��1 .. J4 fs C S_! f1L 1!O[C ....... / Owner Address ---•-••-••-• ............................................ 9 ��1 ZI'I zf�l fL Installer Address UType of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms................... ---------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---__•.---------_----------- Showers ( ) — Cafeteria ( ) dOther fixtures --------------------------------------------•-•---------------•----------•------------- -------------•------------------------------•---•------------ w Design .Flow............................................gallons per person per day. Total daily flow----..-..-__.-_._�- ®............gallons. WSeptic Tank—Liquid capacity.//A)_galions Length--- :•"5' Width---------------- Diameter---------------- Depth................ x Disposal Trench—No_ __________ _____ Width.......�7------- Total Length---_s-�=_7- Total leaching area.-..................sq. ft. Seepage Pit No--------------------- Diameter........---------... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by--------- •---•-------••-•---......••-••---- ----••--•--•••-----••-•-•--- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------------------------------------------------- ---....... •--•-••-••-••--------------------:...-•••--••...__.....--••-........:..........••--•-••--- D Description of Soil....................... ------------------•---•-----•------ x w U Nature of Repairs or Alterations—Answer when applicable..-. % : - - 1'Jr_ ..................................... ................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has/b�e fi d f health.d Signed y ............. ! - - Dare Application Approved By ....� .. / ....... ...-- /�r--"?---- Dae ....... ................... Application Disapproved for the following reasons- -------------------------......_---------------------------------- .......-.......---- .................................. ------------------------------------------------------------- -- --------- -- i ----------------------------.-.......--------.-....-.-.----------- --- -- ----------........... q, - Dare Permit No. .... ... ...... Issued ---------------- THE COMMONWEALTH OF MASSACHUSETTS , BOARD OF HEALTH TOWN OF BARNSTABLE CLlerti tctt#e of Q-10mytiance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ; ) or Repaired ( ) b /�.:../T. .............................................. „ Installer at --------------------------------------------------------:._..__........------........... ------- t J -(2.jL �.i -, a ----------__---!>�s%�,.��.�. ..�..................... has been installed in accordance with the provisions of TITLE 5 okj 3State vironmental Code as described in the application for Disposal Works Construction Permit No. ------.._... " '.. .... iS � dated ......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE_.......... _�.oZ - __. ._------- ---- ------------- --- Inspector - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ow ( ,- / TOWN OF BARNSTABLE `dU— NO...... , --- FEE.--•.................. P �i�����t1 >ark� C�n�t�tr�rtuan �rrntit Permission is hereby granted------------------- Z ............ to Construct ( ) or Repair (-,-.)_an Individual Sewage Disposal System atNo....------------------------------------ = ------ V Street `�,�e► 11 t as shown on the application for Disposal Works Construction P runi't INNo_.-,--t--y J�.y..�IDIJa��ted---_.������_._�-°�'................... � J f 1. 1 rt •_ --..� ��� � Board of H`cal-th- � •---- - DATE.............. v FORM 36508 HOODS&WARREN,INC..PUBLISHERS • Will ' '. �'i Beach 8 ?kxnx ♦ -- LOC s •� teivll US nor 0.0 SA. r �O 42 / \ e e Y •,• 04Y� LOCUS PLAN rA+- �.--co Scale I 20001 Assessors Map 162 Parcel 5.A• 151-11 LOI NG- Groundwater OverlayDist. AP SEhTIG SYS•("GM S, as°ir PASSEp I4SpC.GT10N ,; .. •$; 24'0 Opening Above For M.H. I/a Goly Pipe For Frame 8 Cover. Float Support Pump Power a Float Control To D-Box Now No Cables Installed in Accordance _ >ELF.LTRI -sEP-r1c-rANV_ With.Local Bldg.8Elec.Codes. Re:PIPK extsT, %Lbc., ¢' O PUMA N 3 \` PLLIM1�1NC.76 Neal o Cs►4MBiR AO ` � � A T �, 4 0 From.Septic Precast Pump sePT}cSYE.TEiN� q v P, �Q'P,�s� Tank.Sch.40 PVC /�REA FbR -�Vvo(21 PRpPO5eD 'TENNIS COURTS o oA `�' - Chamber Vl PLAN -go 4"0 Sch.40 PVC Finished � � TE •, N I y X V�wT From Septic TankGrade �# !1 •►JC irA w. d. Conduit Thru Chamber '►�. .. _. _ ... _�•. _.. Conduit , .. .__ Gaty. ,n \�Cables."' -r.owr&Ftoot .. To D-Box - savu�ti I Emergency Storage "tChain a: t PUN4P EX%s-r.L.,1=Act-t 1 Vol.774Gal. ,e Min.2Cover PITS a- -aox . F%L_L. o n 5.1 7.1 W%rv4 CL_WAN MATeC21 AL. 0 (',\aF�\ Lao Pump on 4.6 b 2"0 Sch.40 PVC . Z ' I Ex\ST, 1000 GAL. FAR A Load Pullon 4.f Mercury Float Threaded Pipe ser7Tlc TANK'ToOt \ Switchs-4Req'd I P.UMPSM J•Ir%k-L%i 0 W� �1� �j Pumps off 3.6 Check Valve L_oT A[iEA CLEAtV MA-C>✓R�AL Q ti�g� Secure Pipeat Top& Gate Valve- 'S• .y Bottom of Chamber Bottom El. 3. I � I .obi one Men. T�NNI's COURTS r• a ♦ • s•. Topographic Information Was Obtained �• From Town of Barnstable G I S. SECTION (1000 GALLON SEPTIC TANK) J PUMP CHAMBER DETAIL PLAN VIEW Scale i Not to. , . Scale 111= 301 1 Z' NQTES VG f 14.0.16.0 1.Water.;u L ForThia Lot is Mun6;tpal Water 0 T.N. 6L.0 V. t 6.6- DP y. FG.9.6- F 2 Location of Utilities Shown on This Plan Are Approx. L.OAn.s/ At Least 72 Hours?rior to Any Excavation For This Top El.13.0 Project The ContractorShall Make The Required P-COX DARK YLLISH RRN CAARSC 9.1 } ,� »r Bot.E1.10.0 LLL NotificationtoDigSafe(1-88b-344-7233) ctlRaot.n$R P Zq� s SANQ Sot. E Coc3r3LISS %OY �y 76_ 1500 Gal. IOOOGal 12.4 •'12.2 33 The Contractor is i equiredto Secure Appropriate %O&CisH 13Rri COAR5F- Gal.Septic Pump , 1 0 .. Tee or Permits From Town Agencies For Construction �o � s�.N a I Y a s/G Tank Chamber 6.3 B Baffle Ad'.Groundwater El. Defined by This PlarI. y� . � L.T.YCzL:16H pi'�oWN COARsE Bedding as 3.7, Dec.2003. From 4. Install Risers as Rejuiredto Within 12°of C s./.ND-son.�e FiNes ►oYR[,/y " » f' Per Title 5 Report"Dated Jon.3 2004 All iSt Structures Bu�i 121 g Septic System Inspection 5. s _ 1�10 CrciouNO wA-�13R sd Four Feet or More or Subject �y?s u S�v�7. 14/0 Nr.-_nrz l N� w c. DEVELOPED PROFILE OF PROPOSED'.SEPTIC SYSTEM to Vehicular Trott c tableH-20 Loading. Not to Scale fa Septic System to be Installed in Accordance With _._._ y 5• ' 310 CMR 15.00 Latest Revision And The Town of Barnstable Board of Health Regulations T. All Piping lobe Sch.40 PVC. 0f" ._ PARTIAL PLAN n� ° .� aF.oa: . Not to Scale PET_._ DESIGN DATA $UWVA s a Filar Tennis BuildingD.297+ a A Fabric '_-cbnw«+ed Fill First Floor:1292 s.f. CIVIL Cell or(Storage):12925.f. ve=vz» Daily Flow . : $ °ia S'°°' 8 Courts x 4 Players/Court x '*(8 Courts Existing -2 Courts Proposed) ;, 3 gal./Player x 8 Hrs 768 gpd No Increase in Tennis Membership i Leaching Use Existing 1000gal.Septic Tank No Increase in Flow. c� ,., N chamber 3„•_ii,Z•o..bi. SEPTIC SYSTEM REPAIR p` washed LEACHING AREA F4-io' I I 768 gpd/0.74=1038s.f.Required iz'-o" Sidewalk 2 x 150�=300s.f. AT Bottom Area: 12 x 63 = 756s.f. cRoss SECTION of CHAMBER - TENNIS BLD'G. 1056 s.f. Provided JUNIOR ACTIVITY AREA --NOT TO SCALE LEACHING CHAMEER DESIGN Acoeo 1rr1L%TICS,MovGo SEPTIC 82 WARREN STREET t TK PuMPcHI R.MBC }c nl oorPRlr OSTERVILLE MASS. All Piping to be Schedule 40 PVC,Use 7- �l~�0$ ANot: L_e...GNING AREA, S 500 Go lion Leaching Chambers ina FOR Washed Stone Field as Shown. MoVill BBPrTICT/►NK r vuMP THE W IAN NO CLUB 1Z. 2e o4 CHAMSIll TO N1eW LAT N OCIO MA SCALE: AS SHOWN DATE: APRI L 28 2004 KE EX IST.1000 GAL. SGpT1G � q/IV/aN -rANK -rr+ENawPu► PCHAmsravk SULLIVAN ENGINEERING INC. ` - (3EV%si0W q/1s/04 *.oemo TseT a+oL.c.lNeoRnno.TloN OSTERVILLE • MASS. 97039 1 , ..a •• •1 �j Basch ° •rv° • L' i o. • iervitt LOCUS 01% 41 ? a r• • r - LOCUS PLAN Scale: I 2000' Assessors Male 162 1 Parcel I �.�:eLilcl�INCr _I Groundwater Overlay Disv. AP SEf�'TIG SYSTEM _ PASSao 1NSPt_tTlaN •ram ; 24"m Opening Above For M.H. Galy Pipe Fbr Frame S Cover. Float Support • X. �' Pump PowerS Float Control / To D-Box Cables Installed in Accordance ( 0 - WIth.LoCal Bldg.8 Elec.Codes. - N 4"0 From.Septic Precast Pump °, Tank.Sch.40 PVC Chamber a PLAN 15 , 9 T N I o_�bx . , PROP. Z'fd VENT• Finished dE d m Sch.40 PVC / From Septic Tank i� _ -. f'RbPOSEO PunnP �-n�s r [3�0o-• .. Conduit Thru Chamber Galy. Pum rzxIST.1_t�A.cN CNAMV3ER o stvl.ecR For PowerSFloat Emerrggency Storage t_;ain �To O-Sox 0 1 Vol.774 Gal. Cables. opI +M in.2'Cover P%T-sd-D-BOX . F% -L O 1 wlrH CLaAVIMArr—Vt a _ n 5.1 In 7.1 Lao Pumpon 4.6 e ( a 2"m Sch.40 PVC 2 E.x1ST, 1000 GAL. �R A Lead Puma on 4.1 Mercury Float ' svtPTic -•ANICTO RZMA/N �e44��R ' Switchs-4Req'd Threaded Pipe 1--'0T A FZr A 1,,'Q�, Pumps off 3.6 Checx Valve 26 Ac < y A Secure Pipe To S P P Gate Valve* Bottom of Chamber , Bottom El.3. I Wushcd T'tM"le. COuR-rS Q ►:f i ,. . r•:r . Stone Min. Topographic Information Was Obtained �, __ . SECTION T From Town of Barnstable 0I S. - - - _ _ s (1500 GALLON SEPTIC TANK) PUMP CHAMBER DETAIL PLAN I _._ _ - ' Not Scale Scale:1 301 ` .. NQTES x, y Vent I.Water Supply ForThiti Lot is Municipal Water F'G.9.6- • 0''... T N. ELEv. tSS FG. 14.0.16.0 12 LocationofUtilitiea �hownonThiaPlanAreApprox. r E t_oawa/ O _ At Least 72 Hours Prior to Any Excavation For ie :r Q o 0 RoAHtcS ri Top El.1&0 Protect The Contractor Shall Make The Required Fr2oM PUMP { DARK Yr-L15N (3Rr-4 coA r.se 9.1 + Notification to Dig Safe(I-888-344-7233) CiV.wtSUR ' , gANp -Some-coetBLr-S %OYRVq 11,;7.6- Exist.1000 1500 Gal. 12.4 (2.2 Bot.EI.10.0 i Gal.Septic Pump The Contractor is Required to Secure Appro�rioh -taox " 2q vr-0614 MRN COAP5e Tank Chamber Ad'.Groundwater E1.6�, Defined by This Plan. , 40' N 4 IaYR S/b Baffle Permits From Town Agencies For Construction e • T{Yc:la s H.araowN coARse ; 3.7, Dec.2003. From �� c Beddin os InstallRlsenasRaciuiredtoWithln 12 of SokNO-some FINCS IOYRG,/L/ q Septic System Inspection i Per Title 5 Finished Grade Report,Dated Jan.3,2004 . o t 1 NO Gnouwo wAzg,R 5.All Structures Buried Foor Feet or More or Subject' r , ; pA-t r.•. si&P-r. I4/0 4 DEVELOPED PROFILE OF PROPOSED:SEPTIC SYSTEM to Vehicular Traffic tobe H-20 Loading. j ell t stJLLIVAM OLKW Na"M Rom- ltvc- Not to Scale Septic System tobe'tnstolledin Accordance WEth ° 310 CMR 15.00 Latest Revision And The Town of Barnstable Board of Health Regulations 140 All Piping lobe Sch.40 PVC. rl.w o..e. ' MARTIAL PLAN DESIGN DATA - ..., . � � NOT TO SCALE iie+ie Caepoel.a nil ----*---- Tennis Building First Floor,1292£.f. iie-Ile 1 Cellor(Storage),1292s.f. Poosbne Daily Flow: U — .8 Courts x 4 Playe,s/Court x L°C� .' l.eehha etde 3 gal./Player x 8 Pars= 768 d cheme« ai+"-i lie"u. ! Use Existing 1000'ial.Septic Tank �r.'' weahed j LEACHING AR•A 1 T 4r°e ' j 768 gpd/a.74=1038 s-1 Required S 1 T E M R E PA I R i Sidewalk 2 x 150 _ 300s.f. AT Bottom Area: 12'x63'= 75ss.f. JUNIORACTIVITYAR EA— TEN NIS BLDG. CROSS SECTION OF CHAMBER 1056 a.t. Provided m sc��c 82 WARREN STREET itor i LEACHING CFAMBER DESIGN, OSTERVILLE°MASS. All Pipirig to be Schedule 40 PVC.Use 6•• FOR Soo Gallon Leaching Chambers ins THE WIANNO CLUB Washed Stone Field as Shown, �' SCALE:AS SHOWN DATE: APRI L 28, 2004 SULLIVAN ENGINEERING INC. OSTERVILLE MASS. 97039