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HomeMy WebLinkAbout0232 WIANNO AVENUE - Health 232 WIANNO AVE. , OSTERVILLE A=140-148 1 0 i /� l l /, ( -! Llg r D�/ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments RE °M 232 Wianno Ave Barn System .;,,,� Property Address W j MURPHY, MARCIA M �; Owner Owner's Name — information is •. required for every Osterville Ma 02655 6/1/18 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in`any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information / �l� � 3 on the computer, J D use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono use the return Name of Inspector key. DiBuono Sewer and Drain Company Name 35 Content Ln Compfew Cotu my Address MA 02635 City/Town State Zip Code 508-364-9587 SI 13522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6/4/18 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,.if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 `t Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 232 Wianno Ave Barn System Property Address MURPHY, MARCIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/1/18 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System contains a 1500 gallon H2O septic tank. As well as a H2O concrete distribution box and one 500 gallon H2O leaching chamber. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � M 232 Wianno Ave Barn System Property Address MURPHY, MARCIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/1/18 page. CityrFown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): j ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •'' 232 Wianno Ave Barn System Property Address MURPHY, MARCIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/1/18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 232 Wianno Ave Barn System Property Address MURPHY, MARCIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/1/18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number'of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool sE!rving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ti ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-W13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 232 Wianno Ave Barn System Property Address - MURPHY, MARCIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/1/18 page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 232 Wianno Ave Barn System Property Address MURPHY, MARCIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/1/18 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: Vacant Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ® Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑' Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM 232 Wianno Ave Barn System Property Address MURPHY, MARCIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/1/18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Not provided Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 232 Wianno Ave Barn System Property Address MURPHY, MARCIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/1/18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Installed 2007 Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® cast iron E 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): System is vented at the roof line Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 H2O If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 j e e Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 232 Wianno Ave Barn System Property Address MURPHY, MARCIA M Owner Owner's Name information is Osterville Ma 02655 6/1/18 required for every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 42" Distance from bottom of scum to bottom of outlet tee or baffle Sludge stick How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts - Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form Not for Voluntary Assessments ^M 232 Wianno Ave Barn System Property Address MURPHY, MARCIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/1/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 232 Wianno Ave Barn System Property Address MURPHY, MARCIA M Owner Owner's Name information is Osterville Ma 02655 6/1/18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Level and at normal level Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 232 Wianno Ave Barn System Property Address MURPHY, MARCIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/1/18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 1 ❑ 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.): No ponding no break out 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 t Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 232 Wianno Ave Barn System Property Address MURPHY, MARCIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/1/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments - 9 p Y rY 232 Wianno Ave Barn System M Property Address MURPHY, MARCIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/1/18 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 232 Wianno Ave Barn System Property Address MURPHY, MARCIA M Owner Owner's Name information is Osterville Ma 02655 6/1/18 required for every page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 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: 4/13/07 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Test hole data on plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 6/4/2018 Assessing As-Built Cards TOWN OF BARNSTABLE LOCATION Q3Q Gt//AAwo r- SEWAGE#C2Gb -/ $ VILLAGE ASSESSOR'S MAP&PARCEL/S/0 "/y©-oa/ INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY /SOO&51 fN d0 LEACHING FACILITY:(type)S00G111 Cff'*'*eC1J (size) 18.S'.X 42.83' NO.OF BEDROOMS -1 o OWNER t?AVk rh,r-{,/ PERMIT DATE: 4-I3'O1 COMPLIANCE DATE: OCC'. aco� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility of any wells exist . on site or within 200 feet of leaching facility) Feet Edge of Wettand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY $3 - aa i http://www.townofbarnstable.us/Assessing/HMdisplay.asp?mappar=l40148001&seq=1 1/2 f Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 232 Wianno Ave Barn System Property Address MURPHY, MARCIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/1/18 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ❑ System Information—Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Commonwealth of Massachusetts �W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments G"M 232 Wianno Main house _ Property Address �z MURPHY, MARCIA M Owner Owner's Name _ information is required for every Osterville Ma 02655 6/1/18s page. ` City/Town State Zip Code Date of Inspection t.Y_, z IT Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono use the return Name of Inspector key. DiBuono Sewer and Drain Company Name 35 Content Ln Company Address Cotuit MA 02635 Cityrrown State Zip Code 508-364-9587 S113522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6/4/18 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector,and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 4 Commonwealth of Massachusetts - Title 5 Official Inspection Form - o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 232 Wianno Main house Property Address MURPHY, MARCIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/1/18 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System contains a 1500 gallon septic tank. As well as a concrete distribution box and 6 Flo diffusers B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass - inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 232 Wianno Main house Property Address MURPHY, MARCIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/1/18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ 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): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is.within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 q, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 232 Wianno Main house Property Address MURPHY, MARCIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/1/18 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage.into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded El ® or clogged SAS or cesspool 99 P ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 232 Wianno Main house Property Address MURPHY, MARCIA M Owner Owner's Name information is Osterville Ma 02655 6/1/18 required for every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No j ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] The system is a cesspool serving a facility with a design flow of 2000gpd- ❑ ® 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth. of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 232 Wianno Main house Property Address MURPHY, MARCIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/1/18 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recent) or as art of El ® this inspection? y y p ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 6 Number of bedrooms (actual): 6 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 232 Wianno Main house Property Address MURPHY, MARCIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/1/18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1998 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M ,•'y 232 Wianno Main house Property Address MURPHY, MARCIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/1/18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 42° Distance from bottom of scum to bottom of outlet tee or baffle Sludge stick How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 232 Wianno Main house Property Address MURPHY, MARCIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/1/18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): f *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 232 Wianno Main house Property Address MURPHY, MARCIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/1/18 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Level and at normal level Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 232 Wianno Main house Property Address MURPHY, MARCIA M Owner Owner's Name information is Osterville Ma 02655 6/1/18 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Vacant Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate'sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d 109 Gpd 9 ( Y 9 (gp ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑. Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑. No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form - o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 232 Wianno Main house Property Address MURPHY, MARCIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/1/18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Not provided Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 232 Wianno Main house Property Address MURPHY, MARCIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/1/18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No ponding no break out 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 232 Wianno Main house Property Address MURPHY, MARCIA M Owner Owner's Name information is required for every Osteryille Ma 02655 6/1/18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts L •� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 232 Wianno Main house Property Address MURPHY, MARCIA M Owner Owner's Name information is Osterville Ma 02655 6/1/18 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 232 Wianno Main house Property Address MURPHY, MARCIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/1/18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10+ ft 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: 8/27/98 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Test hole data on plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 l OF BARN STABLE . TOWN L?CATION��2 ,. �n ►�U e. SEWAGE# g I ASSESSOR'S MAP & LOT ��O VILLAGE O -- INSTALLER'S NAME&PHONE NO. s SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 'n"` rc2 (size) NO.OF BEDROOMS 6 BUILDER OR OWNER PERMTT DATE: ® COMPLIANCE DATE: Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by C� A 0 a Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 232 Wianno Main house Property Address MURPHY, MARCIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/1/18 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist. ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ❑ System Information— Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BARNSTABLE S� CATION o? Gt//A.Xwo c. SEWAGE#cIG -/5/S i:j VILLAGE ASSESSOR'S MAP&PARCEL -00/ INSTALLERS NAME&PHONE NO. .J`/Qc4��s%- - SoB-yae ssaq SEPTIC TANK CAPACITY ASOO GI/ //-o7O LEACHING FACILITY:(type) S o O C%9trA*6J (size) /6-S"x /a-8 3 }f-ao NO.OF BEDROOMS OWNER t?()Uk My PERMIT DATE:. - 3`O7 COMPLIANCE DATE: eC oZOO' 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 130t i Zs� a� L Q00-7 A R4-Q� No. Fee T."HE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIpplication for Bi!gponY 6pacm Construction VCrmtt Application for a Permit to Construct(Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel N . Assessor's ;app/Par:erle� i ,��.. Installer's Name,Address a d el No. �. / Designer's Name,Address and Tel.No. -�� Type of Building: Dwelling No.of Bedrooms Lot Size 171010 tO sq.ft. Garbage Grinder (/t1Q7 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow min.requ'red) _gpd Design flow provided gpd Plan Date ,Number of sheets �visi�on Date d 7 Title�" G//✓�� Size of Septic Tank /.�;L'�"s J' Type of S.A.S. r 1.r f E Descripti of Soil a . K d 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 Environm Mal Cod nd no Altye/ystem in operation until a Certificate of Compliance has been issued b ealth. �a0p 1 ig Date Application Approved b Date Application Disapproved by: Date for the following reasons Permit No. (;LC 0 —7 s Date Issued 3 No. . aoo� y s �P �� {�� ',. Fee r CO MONWEALTH OF MASSACHUSETTS Entered in computer: ♦E PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ,ZIppYication for Tigponl *p5tem Cow6truction Permit Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel:1`o. Assessor's Map/Parcel T Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Y, � � hi 2�1� Type'of Building! Dwelling N& of Bedrooms Lot Size ��o�o sq. ft. Garbage Grinder 610 Other' Type of Building-34 CN No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flo (min.required) gpd Design flow provided �' e / gpd- Plan `Date r y/ �o ? ?�7 Number of sheets Revision Date �/� - Title-- ' / �✓- 2�z. V),n_�,,�.fc> At. /�rJ�4'r� Size of Septic Tank Type of S.A.S. /- 5066n (C_4 v'MJ Descriptilp of Soil �f7 �� t Z — ter ?`��`•�n7i Y/,c m' l 7''— Z , �( � �3 G2- - �Z,c�" ��s" �� /3 O- 1,2, Rd !7 Ly�p-.( S'nOr-,' -32 7/-/eo42SF \IQQ.��> Nature of Repairs or Alterations(Answer when applicable) '' ✓ Date last inspected: w Agreement: The undersigned agrees to ensure the consuruction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Cod- and nol o plac *e eystem in operation until a Certif cate of rhCompliance has been issued b tris-Boa,d_o✓Health. �/ rig e, f Date Application Approved , Date -Application Disapproved by: Date for the following reasons PermitNo. 4,0 7— S Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS r' Certificate of Compliance THIS IS TO CERTIFY,t at the On-site Sewage Disposal tSystqf in Constructed (x) Repaired ( ) Upgraded ( ) Abandoned( )by at a 3 a Q t a n 410 Y_ 'A QSt- has been constructed in accordance / / with the provisions of Title 5 and the for Disposal System Construction Permit Nofi _�Q-7 �� S dated �/ /� 34�` 1 Installer Designer iA 111 1, 0 #'bedroorns Approved design flow � a( gpd The issuance of th�i'js�.a it shall not be construed as a guarantee that the system w 117�functii as"delli aed'Gr � JJ d Date ! g Inspector YJ 19. Y- / �fJl i'i4-s_ .. No. 'r Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH D SION-BARNSTABLE, MASSACHUSETTS Mig Oga1 *p gtem Cow5truction Vermt � Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon' ( ) System located at Q 3 and as described in the above Application for Disposal Sysstem�Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Constructio7u) t be co pl ted within three years of the datCe of t i . 1 .+ 4`� Date G 1 ApprovedNby. TOWN OF BARNSTABLE L-XATION-912 W 14a D 19 y 2. SEWAGE # 9 v-Z' VILLAGE S ,,Ery ���_ y�ASSESSOR'S MAP & LOT L t® • NV obl � S �INSTALLER'S NAME&PHONE NO, kt i SEPTIC TANK'CAPACITY LEACHING FACILITY: (type),F:,'fd cLj Ds se? (size) NO.OF BEDROOMS 6 BUILDER OR OWNER ils-1 v PERMITDATE: 6261e. d 7,f COMPLIANCE DATE: A' 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 sA, 0 c f, No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE., MASSACHUSETTS 01pplitation for 0igpo!5a1 *pgte 1COngtrurtton Permit Application is hereby made for a Permit to Construct( )or R�air )an n-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Z3 Z 41/,3 A/A/o MA,6 Q/q nra1_-A1YV � �✓u� m.4s� /f✓O SOT ��� -/ S0 1,) /1/Z 8 --Peel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ,�/✓ABC� � Ge�/�r� �� Type of Building: Dwelling No.of Bedrooms 61 Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow !o D gallons per day. Calculated daily flow &9 F gallons. Plan Date 9b'' Number of sheets / Revision Date y Title ?,W)oS'_ t?K,4,( ®r ya /t/ /[Lr��i iee![ST,c9 l i►�li�SS 2310 0/40 41 4/O .4 U4:1t_ Description of Soil rywm st>s - COL-1-CJ�ia C.0-A;e-S 6 h Nature of Repairs or Alterations(Answer when applicable) CE �.f!-ClaYt=a'.Pl.(�G GE�tSR�G ,S�) 4JtTll GyaiKK.'�d�C'rss/�C- T/TLE s' s�sr�=/�9 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 issued by this Board o Health.o Signed zvl, G Date Application Approved b Application Disapproved for the following reasons Permit No. ��� Date Issued IN "f,f,r� "';;,,,;� ...i`,'...ts' �.�:,ty„F:'a•-�. :��=:=i..':`ri." v �.s _ � ...-�. `.; �F� ,,,%' � .«�i, - i ti+";�.*"..^ E / _ d n ' No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS Application for Migpogal-*pate icon5truction Permit Application is hereby made for a Permit to Construct( )or R air fan n-site Sewage Disposal System'at: Location Address or Lot No. Owner's Name,Address and Tel.,No. 7-3Z 4"J14 ✓i 10 /9G/e G2Sr?E,-Va1CGE 19�fAZ014 ✓yiu2 F 7­3 Z. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �niR Z� Type of Building: — - Dwelling No.of Bedrooms Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 9 fl gallons. Plan Date_ 4� Number of sheets f Revision Date Title J%t'OrUS (� 1N Uf 4-44, Description of Soil rwm 7s -' 02121zic— cor4 s 4.s!i?� ` 1 !JE>C�M�S �ECJ�t/ C. G.�9TE C�71/�Gi7-4;;e '!Je(/ �f�� =PTN Ti�J Gl�tZp/ 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 i 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 issued by this Board o Health. Signed �. Date Application Approved b Application Disapproved for the following reasons Permit No. 'yp Date Issued THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/ gjaced(,Y)on by for Z3 F,�Gr�r la Medg�-f, sft LCG- I as has-been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9S-�/rZ 'dated 7- Z4F 1 r Use of this system is conditioned on compliance with the provisions set forth below: —---- No. CTS� �G J W Fee"XRn�� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwigogaf *pgtem Congtruction Permit Permission is hereby granted to to construct( )repair( )an On-site Sewage System located—al 4/J Aftr D A6,,14. r 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. All construction must a completed within two years of the date below. Date: Z Approved by F % G r I TOWN OF BARNSTABLE LOCATION Q39 W J,4a f0 19 U e SEWAGE # 9 VILLAGE i e=1.. l�_ ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO C P 4\t IsCC/ LEc�S—�Sc 0 SEPTIC TANK CAPACITY LEACHING FACILITY: (type)�/Oc.j A-Mic-t (size) /01 �XS9 , NO.OF BEDROOMS BUILDER OR OWNER v Q PERMTTDATE: Oa!, �j�'� COMPLIANCE DATE: 4 -1 / 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 a Fl �0 0 0 3y 6 %0 04--0$---20 i r7 a 1 1l • 29 cx NOW, THEREFORE, A ct ?V• oes hereby place the (owner's name) following restriction on his above-referenced land in accordance with his agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: 1. d8 d u-7i/*-Nluo 4a&'. oar d!Li-E may have constructed ;F, > 9,9 address) r� upon the lot a containing no more than On,�_ ( i) bedrooms.VVi%ff^Vd �r�c��✓. c:S y l+ agrees that this shall be permanent dy'gd (owners na ) ✓�/k restriction affecting ocated on �✓ F � , and being shown on the plan recorded in Plan Book s , Pa ed� 7 F 441 Or on Land Court Plan For title of Ow^&, see the following deed: Book 76 3 G: , Page .__ Or Land Court Certificate of Title Number Executed as a sealed instrument 3�� da of w 7 y - -.-�- Oik ner's signature s 84e'�es signature A O ner's signature M COMMONWEALTH OF MASSACHUSETTS ,,�-+ 0\ ,ss 3 20o'7 Then personally appeared the above-named known to me to be the person who executed the foregoing instrument and acknowled ed the same to be u free act and deed, before me, 01/ Notary Public O.MURPHY My commissio ON pines: Notary Public I Commonwealth of Massaftestts (date) My Commisslon Expires December 21,2012 oaf BARNSTABLE REGISTRY OF DEEDS i Town of Barnstable : # 1 5 3 Department of Regulatory Services Public Health Division Date l I I ISM s 200 Main Street,Hyannis MA omo1 , Date Scheduled Time_� Fee Pd. 't Suitability Assessment for.Se age Dispo Performed Br• E� witnessed By LOCATION&GENERAL INFORMA ON Location Address w /VO Owner's Name J� "/YJv� j! Address am Assessor's Map/Parcel: Engineer s Name i7.0?/ 0 WIM ` /40—rt� ��� R./-14« r?� NEW CONSTRUCT& REPAIR Telephone# /_ S Land Use ��i <n�%r�( Slopes(%) < Surface Stones Nb'✓' Distances from: Open Water Body 1_S-Q ft Passible Wet Area,>6 ft . Drinking Water Well z—js—i�e-> ft Drainage Way�>/nQ ft Property Llne, Other "- ft SKETCH.-(S name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) G 5,- - CID / - Parent material(geologic) Depth to Bedrock ,,/ r yvQ Depth to Groundwater Standing Water in Hole: DNG Weeping from Pit Face o 64k V Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE ' Method Used Depth Observed standing in obs.hole, in. Depth to soli mottles: ln. Depth to weeping from side of obs.hole: in. Groundwater Adjuatment f[. Index Well# Reading Date: Index Well level Ad).thetor Adj.Groundwater Level PERCOLATION TEST »ate/ xltne �o�, Observation Hole# _...Z_., 't5me at 9" ,.�...�.� c / - Depth of Pere �07 Time at 6" Start Pre-soak Time C o—sue �.� Time(9"-6") End Pre-soap Rate MinJlnch 114 Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISEPTIC%PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sdil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones;Boulders. Consistency.%gravel) —ZZ.< F'LC — DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon„ Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. �c n C � i7_�i�J13 p• — DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. O— Grate DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Mottling (Structure.Stones,Boulders. Surface(in.) (USDA) (Mansell) — 1 f Flood Insurance Rate Maw Above 500 year flood boundary No_ Yes Within 500 year boundary No= Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring perno material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pAous materiai7 Certificatio n I certify that on (date)I have passed the soil evaluator examination approved by the th Department of Envi nmental Protection and that the above analysis was performed by me consistent wi the requir ,e pe ' d ce described in 10 CMR 15.017. Sig lure Q..\SEpTIMERCFORM•DOC I - SKETCH ADDENDUM Borrower/Client Marcia M.and'Paul M.Murphy Property Address 232 Wianno Avenue city Ostervilie County Barnstable state MA Zip Code n9655 Lender Cape Cod Bank&Trust Company N.A. —South Yarmouth � _T= a. a cc r I es 4anl � srn,� f van} q aiL i8 �� 2�_ �S•f•- �rJsrrt; I i4 zyx2G �2`f m Y L I ate. �fr Y3Y c �.J , e i _ a i - --- _ , pow? f r DATE: Town of • uartsrwstr, Board of Health sue- DATE: 200 Main Street,Hyannis MA 02601 Susan G.Rask,R.S. Office: 508 86211644 FAX: 50 - 62A 04 Sumner Kaufman.M.S.P.R. Wayne A.Miller,M.D. A lication to Construct or Expand to Six 6 or More Bedrooms LOCATION Property Address: 4.3, Assessor's Map and Parcel Number: Size of Lot: Wetlands Within 300 Ft. Yes / Business Name: No ✓ Subdivision Name: APPLICANT'S NAME:��t�L-�r��� �, Phone o Did the owner of the property authorize you to repre ent him or her. Yes N PROPERTY OWNER'S NAME CONTACT RSON Name: �t,� Nam : :: ) /f Address: ,� f dress: e F ! F OLloS� Irk- 41��� � sPhone:_ _ — Phone:���" �3 6 7 i 03 � car At c- IC) Checklist Please submit copies in 4 separate completed sets. ✓Four(4)copies of this application form .. _,--'Four(4)copies of engineered plan submitted(e.g.septic system plans) ✓Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans) Q:\Application Forms\SixBedroomForm.doc T "-guiatarry Services Thomas P.Geffer,Director Public Health Divis' g69' `$ ° Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 installer&Designer Cerficataon Foams Date: ! '' S Installer: .LJr�C� Designer: Address: Address: C9 Ponq/ S/. -/3-O ,-vc u,e� /:s was issued a permit to install a y (date) c (installer) septic system at 1��r►�n�eJ �' �. based on a design drawn by (address dated designer) 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. 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. OF er's Signature) � BMTSON R. HALL !, No.527 'gner S ) (Affix ' ) ` pLEASE RETURN TO BARN STAIRLE PUBLIC ALTH rD SION. CERTMCATE �]E` C®NIP'LIANCE �, N�DT' RE $SS�ID UNIEL BOTHTMS P(DR14� AND AS- BUILT-CARD ARE RECE ID By THE RAMSTA'BLE PUB. LIC ALT'li I3IV1SI�l�. THAiiIK YQ . Q:Health/Septicn3edpff Certification Foinn �titE 3 DATE: REc.BY Town ®f Barnstable KASS ` :59. & Board of Health. Ste- DATE: 200 Main Street, Hyannis MA 02601 Office: 508-8624644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman.M.S.P.n Wayne A.Miller,M.D. Application to Construct or Expand to. Six (6) or More Bedrobms LOCATION Property Address: Assessor's Map and Parcel Number: / / —in^t Size of Lot: Wetlands Within 300 Ft. Yes Business Name: No Subdivision Name: APPLICANT'S NAME: A901-- -I& Phone Did the owner of the property authorize you to repre ent him or her?"' Yes No .. PROPERTY OWNER'S NAME CONTACT MRSON Name: Address: 23Z WtAn�-)b ,- U4 /dress: ZrRQMg36M ^10- /rk4 ls�losS� Phone: � �f-�� _�_�2 � Phone: 'ems r— 414 2 , Checklist Please submit copies in 4 separate completed sets. ✓Four(4)copies of this application form Four(4)copies of engineered plan submitted(e.g. septic system plans) ---Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans) ~ 4:\Application Forms\SixBedroomForm.doc — SKETCH ADDENDUM Borrower/Client Marcia M.and Paul M.Murphy Property Address 232 Wianno Avenue City Osteryille County Bamstable state MA Zip Code 09655 Lender Cape Cod Bank&Trust Company. N.A.—South Yarmouth D � '{ -33 f C.CL fiz'n� C [� 00-0 1'31L S. i8 �4. 24x Z4 [wi'F iY Y L! Z" ., al Y3 Z's �. I ' t • 1 : S i : 1 j , p t I f , . i I JY iv , f ' G r I , e I , I �4pF.VE tp�� Town of Barnstable Y « SARNSMABLE, MASS. Board of Health ap i63q. �� ArfoMA�s P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Susan Rask,R.S April 27, 2007 Mr. Stetson Hall 28 Rambler Road Osterville, MA 02655 RE: 232 Wianno Avenue, Osterville A.=.140— 148 - 001 Dear Mr. Hall, a You are granted permission, on behalf of your client, Paul Murphy, to construct a new onsite sewage disposal system designed to be connected to a one bedroom "barn" at 232 Wianno Avenue, Hyannis, Massachusetts. This site also includes an existing six bedroom house with an existing septic system designed for six bedrooms. This approval is granted with the following conditions:. (1) The applicant shall record a deed restriction indicting that the "barn" shall not be rented out as a separate dwelling. The"barn" shall not be equipped with a kitchen. (2) The septic system shall be constructed in accordance with the revised plans dated January 7, 2007. Sincerely ours, /kj Wa frhmnan ill r, M.D Chat BOARD OF HEALTH TOWN OF BARNSTABLE Q:\WPFILES\6BedroomsHallMurphy2007.doc -(,1 NOW, THEREFORE,' Y/j, es hereby place the (owner's name) , following restriction on his above-referenced land in accordance with his a agreement with the Town of Barnstable Board of Health, which restriction shall run with.the land and be binding upon all successors in title: • a3a u� 101AM0 i4 yE.3 65rTLFT_may have constructed upon the lofrau dining no more than oNE ( �) bedrooms,rii • ;uo 4,E m _/X)- agrees that this shall be permanent deed (owners nar e)�'� �,,/ os rE V I L- r� restriction affecting r �ca- ted on AAA 1100AJA)c AI/E. �_-MA, and being shown on the plan recorded in Plan Book j1o _ , Paged ?sl Or on Land Court Plan For title of Q,,jA e..­ see the following deed: Book -6.3 G. Page ° 16 7 Or Land Court Certificate of Title Number Executed as a sealed instrument day of Owner's signature b k 5 O ner's signature' . Owner's signature COMMONWEALTH OF MASSACHUSETTS ss F�•`I 3 , 20o Then personally'appeared the above-named r known to me to be the person-who 6ecuted the foregoing instrument and acknowledged the same to be . G►e✓ ` free act and deed,before me, k•a�S S Notary Public My commission expires: CHARLES S. MURPHY t ZI /�Z Notary Public (date) 77, Commonwealth of Massachusetts y �+ My Commission Expires d December 21.,2012 & . . V �,�.� ---^� '';� �4 ��- ..�C'� — L�E/r\/ls V.f'/al✓�•�S'��y,V /N�ay.J� / ���/� `� ;J� -197 /8�;Q oF,F" rf 21', �' 8� �\, Fib' ,b a7f{F��/¢oaR�:�.t•: 32 Y,r' �✓o Rc% 1; ✓..�i�Q ��S�Ga v.✓ /assv� D /v!✓I, T ✓���9 � �/ X �� An 017�.14 O 77 I�✓�C /A o ZZx?.-2h.� 7,6' 6 6r �l?�I� iSckN�S C•EX✓S�'�� �I3��r ^'J �Cat�CE �--�i?pP /.c'�13r?M �S'/•��? \'✓9S 7 / `• �n/L ,✓w . � ��-r1-4�✓ 74* x. .7•�) ` 6-96 ` 1 �jr•�on1 . �iLL s, / 3.3 oar 1 p�— �� `LAG° I - X — -- - - . tiV �� ....� .a� _Y.__•. •_ _.,_ X — }� ?c — X x �(� t EL .7•: Q... '�N4 !tf� o� 1P��N' �ran�E / _ — — — a �� •r' ..w _ ...�.— _ .�_ TOP OF FOUNDAT10Nj�� � ! , 2gj✓—_� r,''_�i13��✓gL.! - _i�/i+(p��u o.J— �``_� �?" t.--��:•� ''; CONCRETE COVERS r r - fr 4"CAST IRONrnr r / 3, oC < ©� ��L3.�39, P9✓Er►'!�' �'T /- 7ca2�'x. r- ^�G- -�9J I t . OR SCHEDULE 40 + '�' P.V.C.PIPE MIN. 4"SCHEDULE 40 P.V.C. (ONLY) g'hunt� to LEACHING TRENCH (/)REQ. " ��Z� f�f �T"H �/' ► PIPE-MIN. 1/8 - 1/2 WASHED STON 3 MAX. /�/Y/) - ,�• :,� PITCH I/4 PER,FT. PITCH I/4 PER.FT. ../•A �•4 •r• ...� � � i •Z" ! Q'•�I. Q/Q A E & 1 i e INVES�T 1NVEP,T INVERT 'Q ii�: �b 4" t ELUZk4?.. SEPTIC TANK � . ;rll ,�;o�Ct .C7 'Ci•rCi'Cl ,�I' 24 Pr .`: Eh /..�Q BIOX E1 �9. ;I� ;C1,CI;Cf.;L7;'�b% �]-',C ,A n/n/n 1 / INVERT / pW/ I V/ V V V ,; ..��S-QQ.. GAL.. INVERT _ . __ ': EL• /r.� .� ELY �c//: INVERT 500GaI.Leach 3/4 II/2"-�; ; 6"CRUSHED STONE EL �:.vl ,( ) REO. �+ (WASHED STONE i Chamber If �3 t _ •-•t a PROFI LE OF —�4•►� ��— = ►. .; o GROUND WATER TABLE 4vt. / ! SEWAGE DISPOSAL SYSTEM. TYPICAL •CROSS SECTION SOIL LOG DATE�44//e��Q� Titdc .l.4iG?D/9!�'1 NO SCALE H NO SCALE- 7 TRENCH . 7 f!� TEST HOLE TEST HOLE - �r—!E✓��.50` G3, r L Y•"3" :31�. .. LEV.�-,3 .3 DATA :. 9 IIMIN. AX E DESIGN ;�8"_i�� FY�S .� 9���D� M. �✓ d �} QY ,. ,...�.�,.., � M NUMBER of BEDROOMS�� - .��F�2 Cr WASH ,"M 5'0 E "IF TOTAL ESTIMATED FLOW GALLONS/DAY •' •"`L - 8° �" " /7" m/suers? 17 ,W �ssyila - �t ^; _ 411 , , ♦ y BOTTOM L_4CHING AR.A .�: .. SO.rT:/TRENCH '-©:Q;CI:• 24° s � 6 l �o,e� - r ��8-1 3L' EZ fo-a, -3z� � =3u.1� I�SX �.83=�11,�j" ;;Lt sITE , PLAN 2 ,32 WIA NNO A VEl\lU� c .. - .SI E CACHING AREA ��7 33 SQ.FT./7REttCH '•(�;b=b�'; OS TER VILE E f,ray c " C .. /'. ..(5o / C. AREA INCREASE)GARBAG DISPO � • pc?c F 6Zn TOTAL LEACHING AREA �9.�e.. SO.F T. �� ��r • GL /ciXR71-f A?I f PERCOLATION RATE .. •G �-� 1 G- f��q�sa G �6 . :��•!.'�: 'PER.INCH G13.�� " 7/y LEACHING AREA PER PFr�COLATION RATE��,3:SISO.FT6;;%1 �_r- ;� sLZ�Is' • r Zforra.� riff L ai.�ts FOR / " �LZ/ef* 43e ZU1,8=5- APPROVED .. . . . . . . . .. GROUND WATER T.;?L L E Griv .... BOARD OF HEALTH ...-: WATER ENCOUNTERED — — — — DATE ....... .. ... p�jH OF I1Ab PAUL 10UPPHY WITNESSED BY : AGENT OR INSPE%TDR ������ST . ,�,.. . BOARD OF HEALTH cn ENGINEER . . . . . . . . . . . . . : . . . . . . . PQ PETITIONER : %-:7v !Y ' EVA0 h ` P�/,l/-!T �c� ; - �' /�� �✓.�J,ems�4r;�/ a►.r.,/ / P�.O/J C r!y�7 j' G�T8 f{ .�DE� .qT-Tr� �•J, ryn� '' . �a U, ,� : tea;- ✓i.��-des �aCCJ•S /%47 44 �X�?' t, t �oM /��AC/•� .�,1'Fq �lt>L,i� �-�C' •� .971' '9 .13� /✓�fiE�, O �/� /A� ���n% q Gl7 ,r/�13aM ,r�'/T 7�i/E `�✓9�s� M - � , I l l e- I ' Y �YYY ;tic' t��, o• 1°�. � � ev 0 , o��- �'�;. 8✓ i�'�r3� �C ��� I 'yCS9 �l +tECVr` �o odc o /< o , T C����LS2� TOP OF FOUNDATi0N1' �iV'P �?an�E� L _ f 5 >�r �; r�'=_l,c DE�r✓yL—:._� �t ._`/�+(tPG�R�T E T E COVERS ,�✓L��1.2� F���a`-o- -���G,,� -'`_..:_ .:..� _ — __.. � —' — �",g� '►." ! � •�c,.5^c�rr-Lx� — -� �,• �.�D! �;� 4°CAST IRON r9� ,�•,;,.,-,,,-z,,,;,. .. .,, ,r, . . . r. � �.,�isf/ � ,�"9•D'•� �.. .c-L,.�3,s-�•- QFTi OR SCHEDULE 40 4" SCHEDULE 40 P,V.C. (ONLY) -' LEACHING TRENCH ( )REQ.r < �G 3 •39' Gy9/'�cTt/ 'f_i �J HY✓/•� i P.V.C.PIPE MIN. 9, h11N. / � icv'' O���r a✓9G�Si� S• i i� PITCH I/4"PER.FT PIPE-MIN. � I/g°-1/2°.WASHED STON 3 , 3 MAX. 2 � PITCH I/4°PErR.FT. ; . ." �" C1 �,r Cl Cj 1 d,Y g o INVE�T L�e,L'a5� �, i• 'j�`Jy'�1tI r ,- 3 ,0 YJ, �- 4 n :•� INVF ... INVERT �_ INVERT ct"�% �. ; SEPTIC TANK E1�.91. v� DlST. ;Qa �?Got ty�C7, CI; Cfi Ci �, A, 4S. BOX E19 ;Oa�CI�G1;Cf,;p'i,L`1 CC`_77;CI�j�% ! 24 V Y / /-1 N! V 0 A V f� %� INVERT ...hsQC+?.. GAL. -- ;;= EL�G.�- f �LT�J/: INo. 'Precast 500Gal.leach 6 CRUSHED STONE ( ) REQ• Chamber =WASHED STONE ELAii �- 8 s - a� PROFI LE OF --Q,Y, -r = o GROUND WATER TABLE--WC- SEWAGE DISPOSAL SYSTEM, TYPICAL .CROSS SECTION i --- SOIL LOG NO SCALE LEACHING NG TRENCH . ENC H DATE��,��✓/r��QG TItdE ./.4:R4I�!''1 NO SOLE l i ���� ��''��� - ,ftp��x• �� TEST HOLE TEST HOLE;''`'9 , /�i�+/..Sl� �� =. .�'G33.5 ?' t _ - ELEV."'�' .. .. ELEV •3 DATA : - C/ _ 9 IN .., ..r,rr.. / M , .{�(+� WASHED MAX. N / `1�� i , vY .r...r . .r. �/- _M NUI.�3E Oi '.�C'J�OOIII.S /���.��.y��.L:':`T,�.,1. �j� S'IDNG [L TOTAL ESTIMATED FLOW .. . rA ..15� ... GALLONS/DAY ; :: •::�� �� _ g" mg ?�� , j„j T�aIB , r /1" /o>T G/8 /oY 616 BOTTOI�4 LEACHING AREA SO.FT./TR=NCH i..0.. ' ,p,� i T P � 2 ,32 WIAN S/ E L NNO AVENUE ��o.e3 .. . .8� � .�9. -�. . = 24 !�Sx{z,83 �'/ . 3a -,�,✓n �7 .[qye SIB E EACHING AREA ��7. .. SQ.FT./TRENCH . •�j.Yj'(� ' Y4.S>'/lo..5 k7ep°3Z33 GARBAGE DISPOM ..x.L./V4...(50% AREA INCREASE) . . , . OS TEP VILL E �,o" 2 . •?c • /•/O.Ce- TOTAL LEACHING AREA V-AD I � /Dyr2.7/9 .� �99z G . /D T�9 PERCOLATION RATE ... . ... . :��'!'�::� -PEER.INCH /�8S j4y4Z7/Y , EGy3r�� 7/�/ LEACHING AREA PER PERCOLATION RAT'c �.3:S�S0.FT6;;�i3 �- =, s FOR\ r � GROUND TER A �L�i 5� • , Z93�Z WA TABLE - _ ,,,/ APPROVED .. . . . . . . . .. .... BOARD OF HEALTH ..•!: WATER ENCOUNTERED r DATE......• .. .. P OF AGENT•OR• INSPECTOR � yGJ, Pq UL MUPPHY WITNESSED BY * -, ^.�. BOARD OFHEALTH . . . . . . . . . . . . . . . . . . . . . L 2 c-4i ENGINEER . . . . . . . . . . . . : . . . . . . . 527 Q 5�ro e s'rTF ED S . . ... . . . .. . . .. . . . . // EVAL' P�� PETITIONER : , ' . . "0/ /7c�1?�h;Y Lr f y ».i r .__..........-..r..—.._-...�m....-e...____-_..e.;._.. ._..-_ .._.-..... ._.«�..+w._-.__ ...w__+.._.,_ .�.• .........�.r+..__._._.._,�._-.+..n___. ..__ -rya ._ „ k ._ __.-.� € ....�e..� e TOP OF F OtMATION ELEV. CONC t.: RETE --- AVERS 4-" SCHEDULE 40 PVC PIPE 9 CLE AN BACKFLL MIN PITCH V8" PER I=T. „ �,�� ;. ✓tx M��-�..._ �4. mod'�✓�Y - '' � 'f it 11011. 4e CA;;.11. IRON PIPE r _�_ ! - \ - � �� S'Lv��° 7�7r��= L/ ( 4 4110 � t I ,3R EOUA_) WsIML L,�_ _ _.-'v Z� Ta ;sue .°_ I r r knr4,rin,M -.. ' I_ t � 'k s""�/` 3%4- T O t-v:r' CLEAN WASHED PITCH 1i4" PER FT. ,._ El FV,- iL iy lr e A� �v. �! c �� ► ('°—ELEV. t;l=III=-!,l=1ulII__!,�— L JCATIC?�� ���AR C.i ELEV. . ' � C C7 C7 �'�] u� •1 I~� ! e z GAS BAFFLE I EI EV. - !�G 9� , . . . " , . • , - { ,�, ��,�� ELEV. { DISTRIBUTION I ,�i� S 0 ILTEST ! \ WELL BCC X I y y y r ZONE DATE OF . TEST I f �oiITY•ESSED BY SOL EVALUATOR TO BE WATER TESTED --- in AD X-;ST------ PERCOLAT; N RATE I 1500 GALLON 6" STONE ON NATIVE GROUND OIL OBSERVATION HOLE I MECHANICALLY COMPACTED BASE _. ELEV DEPTH NZ TEXT COLOR MOTT_ SEP!I:,' [ ANK BOTTOM OF TEST I-+!)LE OR L&IS PROBABLE WATER TABLE ELEV. _ _.______ ------I -- T --� SEWAGE DISPOSAL SYSTEM PROFILE NO f TO SC k E ., DESIGN ;Ali CULL IO ,' �'' �� y', 0 � NCR Or BEDROOMS _ ` I GAREIA.GE DISPOSAL_ UNII TOTP1. ESTP',A,TED FLOW t•'/ _GAL. .fDAY X ._ .1 � 5-? GAL../DAY F '� ;�' WATER AT_�-_ E►_.=__�._ n Av,��ACE t �r�o taafa t REOI 12ED JIrPTr TANK CAPAC+`Y / �_ GAL. ^7IA/ (� / 'AAF t3a (UH)WAlf-H t101 i ACTUAL, SIZE OF :SEPTIC TANK ��U GAL. �� II �x I LFACH� AREA REOUIREMENTS SG'klZ'XZ' Tz�=tic_H/.6:rf,4 see vIrv—+ o �» n;� � OBSERV�...�IOi'�y HOLE 2 SOEWPLL ?.f AQj.: Y GAL_rSF.-JOAX � A ) / �/ t 1) ELEV.- __ DEPTH ! SDRIZ TEXT COLOR MOT Ti_m 90 TOM AREA t Z'i GAL/S.F-.-t,Ay [k/ � �' �.� � �+��' � 49 4 �, /►A \ r_. ��.-__ I _ � _ _� C l,EAL'r`#NQ CAPACITY iBOTT � WALLS ��� GALLJDAY -' r / „ - r : RESERVE LEACHING CAPACITY �- vA•�.iUA� AS T� O ~ ! n I APPROVED: BOARD OF HEALTH � ,�� f% ,'Ex 1 ':�T I N6- -_ i � { GATE AC;ED"sIT 0.2 I WATER AT-• ---�S � {^ C _--- \ , ST/t c', SS�i, iT."t+B- f ��G ?Uf�cS r (o 1 1 NOTES. �0. / 1 ), t 1� 1- ALL WORKMANSHIP Alm VuL�?ERIALS SHALL CONFORMTO DE.P. I\/e�N�Y ` \� , .3 j S-' ca f f v '��c +�C �t S°/" N f TITLE 5 AND TH TOWN Of: 8" RI'�TA�_.__ RULES AND ! ���Z REGULATM FOR T"-E SUBSURFACE DISPOSAL OF SEWAGE. I 2. EXISTqr AI�iD, FINAL GRADES SHALL REMANti ESSENTIALLY THE SAME. 1 3. ALL. 1 LhIEN~ S OF TIC SA*JTARY SYSTEM SHALL BE CAPABLE OF { �0 u �50:� `x 1 r'i { N6 \�. WITHlSf AtNi H-10 LOADING Il'.ESS THEY ARE LNDER OR WITI-NN [)VXJFL-L- ! N6 D 10 FT. OF DRIVES OR PARK AWAS. 'H--20 L0AD!',I SHALL EIL 1 49 9 USED UNDER OR WtT4q o FT. GF- +.DRIVE; OR F a,s ING AREAS DO 4 ANY MASONA,RY UNITS USED TO BPNG COVER" J T O GRADE SHALL `0 p `} / FEE WRTAIDED w PLACE. # f< .,•t� f 5. NO DETEr lATU N HAS BEEN MADE AS T Q CONPUANCE WITH \ 50. J �' L ; // DEED RES?RKTIONS OP ZONffi� 4 ,�G P ;tu / �j ` 6. EX+'i.VA.�rE AND RFt�LACE �U.TAE3LE MATERIAL- FOR S' A.RGItiI[? �J / / �,' Q P I EAG�-iNvG SYSTEM AiNC BAC.KFIL' WIT!-1 CLEAN `SAND. { t- {�� iV �'� �`� Q •� 7, EXISTING SYSTEN*S) TO BE ABANDONED - PUMP & FILL WITH CLEAN SAND { ` f { 8. SUBSURFACE COND+TONS TO BE VERIFED BY INSTALLER Ik v ">� U NECESSARY MIODIFICATK)NS TO DESIGN TO BE APPROVED BY BOARD HEALTH { G� I S O OF t+ :,� .,,� fAD lip PROPOSED S TP- PLAN OF LAND iN C STER'u II 1 (BARNSTABLE). MASSACHUSET T.� LEGEND: EXISTING SPOT ELFVAiTION Noo ,yL -esa ��� $ , ��/ �� fJ mac,, —PR As PR�ARI=r} FOr? ALE DATE .u.x.Y >q. EXISTII CON vOI p� _ FINAL SPOT FLEVATf+ON cai� r,�. f L , �{� f ° PA ��!l.►RPE ?�` V --- i_ FINAL CONTOUR ' ` Q� ti 4 �� PAUL E. SWEETSER.PROFLSSIONAL LAND SURVEYOR SOL TEST i_OCATICIN �1 f, Orr, :j s � ri � ( 260 CHAfiHAM ROAD - SOUTH± �IARWfCHIMA 02861 t5{38?432- `39 UTL ITY POLE -Q ►+ � AM ROAD TOWN WATER =— W=�..--=-`,� - �'' - \ U F - CATCH BASIN '°� � , �� fLE N0 _ , . � SHE.E t / `SO. 1'5160-00 1 - i I ' I__ _-- --- _� —., ��.=�=='�c�= - .���,�� �/o��,<;��moo; � '�s;��,►.�.�/�/�-��� c� / � \ \ _ � o \ �3 ,:;�".(T%�J� ��i'�:.' �F�'�Tir�NS o r L �•� C QCi/� G��� l ! /,�04-7-1.;�',r4-s Vo?,,11-16 .�I✓e ---r-- � ; � ��� �l \ l=�v��J%i©%r�' �6JSf� G�/✓ �/�`w CJ�E� � /(,)/y7 /C: F O /c /.S T/.,J rr ly �Gsn''tn pc 10'7�(As r- / 1 r � zl 7 kj �jr Ye, I - — EL -SO..�. . �it�o r� - us-� fJ oc.�r ,% yc%lr//�"�v7�.✓� TOP OF FOUNDAI ION ' j11 _�.cic�G�✓q�.! ��� __ _ /i(caEc ,XJ _ � '> '� -- - _ CONCRETE COVERS /-,��✓L jtL'�� 4"CAST IROPI�9 n err'► Qi cry .39" /- /oZ'xsh Ll�> �' OR SCHEDULE 40 f 4'SCHEDULE '10 P.V.C. (ONLY) 9 MIN " LEACHING TRENCH (/)REO. r uYF�r P �'f�'L�=`•?rri' w/�� ; ' P.V.C. PIPE MIN. 1�- c 36" MAX. ,•r' PITCH I/4"PER.FC } PIPE- 1,11N. 1/8 - I/2" WASHED SIONEr ✓� — ! PITCH 1/4"PER.FT. L-1 V �y — -- � i 1NVERr_ C2r n L—>>� :ci�b '�Y.�, d 4 �0 .�,0, �- ELF{/<,��1.. SEPTIC It�(VK INVERT DISf. INVERT Chi Cz]' E74Cl':C7r"C1 C1;C1 't5r 24 I •'% EL,��1.�J ©OX [�;Cl�j�% - 1 / INVER �.5��1... GAL.. INVERT W/ A NNO A V EL: � ELY ,`� INVERT Rewsf 500 Gal.Leach 3/4"-1 r/2" -- A ., CRUSHED STONE / Elz-: ..c.�C ( ) REQ. Chcimbef �-'uWASHED STONE [ • ' e' >T /i PROF I LL —.-- ►,;•',] / J /✓o 'GROUND WATER TAKE ��✓C 11 SIWAGE DISPOSAL SYSTEIM TYPICAL CROSS SECTION SOIL L_0 G NO SCALE LEACH ING TRENCH DATE + TIME . !4,GD!`!!''? 0 S-^L- - 7 - - -- - - - — TEST HOLc �3 �'`� ,f/.,%,.S//N(S-�J� r L�.; I TEST HOLE ✓•�. SG G� �3, S"/ ' ELEV. � -'��. . . ELEV. :3.s' DESIGN DAI;a . � �9 r 1 .8.-.I } - -T-,� .9, �•✓ay/sy�•-' r// `� �` �f/. /. ��a /4YJ tlut,l9EZ C= 8=0RCOh',s �w�,cp 317 'MAx TOTAL ESTIMATED FLO14 GALLONS/DAY = 8 ���yi ��m� [<>�/•rn,la _ p O - -� f6 � Ul r '� ;�/ p 7 3 %oYT? G/6 /�ry?ro/N BOTTOM LE-CACHING AREA .�//.1�... SO.r"T./Tr'tENC}i p Q.p r 4 T� N �y �� .� W lA NNO A V EN l 3a" ,jo,�j . .8� �> E o.�s �� �� _ ` , ', Li 4 SIDE LEACHING AREA � Z 1 30.F T./TRENCH r c 'E� yip SAi✓ r�� ��Y .5f// ` >/L f S /�, r Xl - //�1-Z - - GARBAGE . . . .. . % AREA INCREASE) / — / G TOTAL LEACHING AREA SO.FT.OZ — r— -I - PERCOLATION RATE PcR. NCH G /QX, /p - ,C ' ti ioyf7/10" /o I rACHING AREA PER PERCOLAi ION RATE fW,7:y�SO.FT L�-3 -/ 7/� � 9•or5 x ,7-` _ y3,�� f bz=!�Y' c �LZ/eS APPROVED GROUND Y/ATER T--BLE f"/✓<' . . . . . . . . . . . . . .. BOARD OF HEALTH f WATErR ENCOUNTERED OT �Pti1N U� � .. .! 'd DATE .. . . . . . . . . . . . . . . . . .. .: . . . . . . . . . . � IN OF Aq S ED WARD PA LI L M U R PH Y WITNESSED BY . AGENT OR INSPECTOR o� N � KELLEIC l .n r?.�r�as . . F3OARD OF HEALTH N1, o. 26100 c _Y `/ H a i � r Q �3'S 9fCI$T E�� At Lib s S rFgEDSPN�r PETITIONER i