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HomeMy WebLinkAbout0233 WIANNO AVENUE - Health 233 Manno Ave_ nue Osterville F/R 140 139 I �W 3—D-75 r No. Fee 5 0. 00 s THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �l Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplitation for Migogar *pgtent Construction Permit � Application for a Permit to Construct( . )Repair(Upgrade Abandon( )XKIYComplete System ❑Individual Components Location Address or Lot No. 233 V i a n n o Ave Owner's Name,Address and Tel.No.K 2-i/.t e u e i o 0.6.te2v.ii e Na3,s. 233 A/ianno {eve Assessor's Map/Parcef q0 /.3 0�3,t,e 2 2).i.e i e, t 7 a b b. 0 2 6 5 5 Installer's Name,Address,and Tel.No. 5 0 8-7 7 5-3 3 3 8 Designer's Name,Address and Tel.No.5 0 8-2 7 3-0 3 7 7 a. P. t?acomgen & Son Inc. aC, Cng.inee2-ing Inc. 5 Roundh.iii BL D Box 66 Centezv.ii e, Na.a,3. 02632 Caet Na2eham, t7a,3.s. 02538 Type of Building: DwellingX,Y No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 4 4 Q gallons per day. Calculated daily flow 5 5 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 0 m i.t.t.i n g c e.6,312 o o e.6. I n h.t a_U n g 1-K20 1500 gaiion zep.t.ie .tank. I-Leaching .t2ench. 91 'X4' r 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 Cod and not to place the system in operation until a Certifi- cate of Compliance has bee 'ss d by s o o flYalth. Sigried Date6/2 3/0 3 Application Approved by Date Application Disapproved for the following reasons Caved -in C.e%iSaoo.e Permit No. Date Issued 3 ®3 No. �� 3 a-7 s Fee$5 0. 0 0 ,z. . . ." Entered in computer: -"TIi.E COMMONWEALTH OF MASSACHUSETTS p Yes <�, PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE' MASSACHUSETTS ZippYication foiMigooar *p Army Construction Permit s i F Application for a Permit to Construct( )Repair(V Upgrade( )Abandon( )XMomplete System ❑Individual Components } Location Address or Lot No. 233 V.i a n n o Ave Owner's Name,Address and Tel.No-Ka.i 4 t e ld e—Po 0.6t vi are, Na.a.s. 233 O.ianno Av.e AssesyD l3 0.3.t eay.i.Pte, Na.6.6. 02655 Installer's Name,Address,and Tel.No. 5 0 8—7 7 5-3 3 3 8 Designer's Name,Address and Tel.No.5 0 8—2 7 3—0 3 7 7 ;. P. Nacomgez 9 Soi Inc. ;C, Eng.inee t.ing Inc. 5 Roundh.i2.E BL D t [3ox 66 Centeltv.i-tee, ft j-6. 02.632 Eabt Nalteham, Mas.a. 02538, Type of Building: DwellingXX No.of Bedrooms Z. Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 440 gallons per day. Calculated daily flow 5 5 0 gallons. ; Plan Date Number of sheets Revision Date Title Size of Septic Tank x Type,of S)A.S. (d' Description of Soil ' Nature of Repairs or Alterations(Answer when applicable) Omitting ce s.6po o l.6. I nh.t a e i.ing 1-K20 1500 ga2ion hept-ic tame. 1-Leaching t;tench._ 97 'X4' 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 bee `ss 'd by t `s 0 alth. Sig ed 7f// Date61231,03 Application Approved by Date G �?-3 y3 Application Disapproved for the following reasons . Caved .in eeh.61?oo-e Permit No. P`75 Date Issued (D 3 3 F. ..t----------.---.--.—.— .. - --- —.-- — r THE COMMONWEALTH OF MASSACHUSETTS ?LRNSTARLE, MASSACHUSETTS Certificate of Compliance - ,.�. -- THIS IS TO CERTIFY_,that the On-site Sewage Disposal System Constructed ( ) Repaired)(XX)Upgraded( ) Abandoned( )by R S o n In _ at 233 Id.ianno Ave 0.6teityiQ2e. Na s.a. has been constructed i ac r ance with the provisions of Title 5 and the for-Disposal System Construction Permit No. Z6V3 I dated. A- t� Installer. 10. Macomte_a k .Son Inc. Designer C E .i n nee2.ina i The issuance of this p r�u/�_sh not be construed as a guarantee that the system Date �`�` Inspector No. a�;)--a03 ' 9-7,,�' ------------------------.—Fee $50. DO THE COMMONWEALTH OF MASSACHUSETTS �, PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS , a . Mitpoar *vttem Couttruction 30ermit Permission is he granted to Construct( )Repair(YX)Upgrade( )Abandon( ) System located at 233 11d.ianno Ave 0.stenv.ie e, /'la.6h. 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:Construction must be completed within three years of the date of this pe it. �--- Date:__�n /� o 7. Approved by TOWN OF BARNSTABLE LOCATION Ll1l A0�m A. !/'P SEWAGE#1063 ,l et VILLAGE -7?et i/i 1 ! e ASSESSOR'S MAP & LOT LLV r 13, INSTALLER'S NAME&PHONE NO. °'` A C O .M e R S /V SEPTIC TANK CAPACITY A LEACHING FACILITY: (type) A C ON , ' (size) NO.OF BEDROOMS BUILDER OR OWNE PERMTTDATE: �3. O` 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. ion site or within 200 feet of leaching facility) Feet i Edge of Wetland and Leaching Facility (if any wetlands exist Feet within 300 feet'of leaching facility) Furnished by o 9) �Af TOWN OF BARNSTABLE I;OCATION% ' 0�n Ue Sal#�✓�S VILLAGE WT'er V =A SESSOR'S MAP&PARCEL IDS NAME&PHONE NO. ''t(�ar-LJ h SEPTIC TANK CAPACITY LEACHING FACILITY.(type) (size) NO.OF BEDROOMS q OWNER PERMIT DATE: CMO+,h�DATE' e 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 \ h 4 4 4 4 4 4 \ y h 4 'a 4 •• y 4 4 4 \ \ 4 \ 4 y h \ 4 4 ! ! Jv ! y \ 4 4 y y 1 4 \ 4 \ \ 4 4 4 4 h 4 4 4 4 h h \ \ y \ y 4 h 1 4 4 \ 4 y \ . y+y/'af y! •af ! ! f f ? f f I y h 4 y 4 v \ +\ \ !\ • h'y'4'\ 4 4 4 v y+♦ ! ? 1 .1 y f ! ? f r \ \ N f r f \ y y . fh!4!• 1 VJ TOWN OF BARNSTABLE LOCATION 3 �%tatnan o r2clC. SEWAGE # V1-:AGE (05TAI) a1 .c _ ASSESSOR'S MAP & LOT �'1 INSTALLER'S NAME&PHONE NO. tRo �, C�= ry , L.. �^e SEPTIC TANK CAPACITY S' O LEACHING FACILITY: (type) /1 a;IA c.t- (size) X NO. OF BEDROOMS BUILDER OR OWNER PERMTTDATE: 1-11OLI COMPLIANCE DATE: 16 OLI Separation Distance Between the: rjaz V u.v., 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 s j 1 .rL 1 b s .i r � o • r r r: i, to U9 �` va c- 0 cr, .us e �, TOWN OF BARNSTABLE LOk:ATION = -3 3 w-1,4.,l/,V o . A, ye SEWAGE #1063 :-7 VILLAGE 4 57 et V l l < <° ASSESSOR'S MAP &LOT �` O l3� L INSTALLER'S NAME&PHONE NO.1 04 A C 0 A =AV. ti SEPTIC TANK CAPACITY LEACHING FACILITY: (type) f1 t 1,A1 G . / (size) l �• NO.OF BE BUILDER OR OWNER ✓f }PERMIT DATE: ' , 23 0'7 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 Wedand and Leaching Facility(If any wetlands exist within 300 feet'of leaching facility) Feet Furnished by r i Z � I �f, Y j il0 r I No. d.. ` ,� Fee b� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ys f PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprtcation-for Digaal *p5tem Con!5truction Permit Application for a Permit to ConstrucRepair( )Upgrade Abandon( ) O Complete System ❑Individual Components Location Address or Lot NoA3 3 �✓ +�'d`^" �' /-- Owner's Name,Address and Tel.No. 9 d'F- 3 a-oo Assessor's Map/Parcel i q b 13 Ct p Installer's Name,Address,and Tel.No. 5-0 T 143)L 0530 Designer's Name,Address and Tel.No. Rv b.e.rT a. OA--,. C-, PO 3vx 15"311 ��. i<n�<� N 14,D_,rw, e k taco-l5 50?> 0273- 0 37 2 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil aja_ Nature of Repairs or Alterations(Answer when applicable) 17AAj- - / J 0 O ow f 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' sued by this Board of Health. gne Vrwc 1, . X-4� Date Application Approv Date 4 14 110 Application Disapproved for the following reasons Permit No. oZ�'-f —17 I Date Issued 4 o No. �vG s `, � 4° Fee �. i Entered in com uteri t/ .. i w THE COMMONWEALTH OF MASSACHUSETTS >:� p ,at POLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ' Y 3006 °tcoo for Xh5pbol *pztem Construction Permit Application for a Permit to ConstrucRepair( )Upgrade( )Abandon( ) O Complete System El Individual Components Location Address or Lot N.& 3 3 L Maw u �- - pwneer's Name,Address and Tel.No. E- •�,�_ _ , �.ao Assessor's Map/Parcel 1116 13 y` ►``¢ tj+c,t. � �s~ `��C Installer's Name,Address,and Tel.No. 50 r6 9 3)� U 5 3 v Designer's Name,Address and Tel.No. r:obg•rT (3• (�...�..- Cam. PO A/ it-I ar w L7 d to t r 1 Type of Building: r Dwelling No.of Bedrooms} Lot Size sq.ft. Garbage Grinder Other Type of Building 1 No.of Persons -Showers( ) Cafeteria( ) Other Fixtures ► Design Flow gallons per day, Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil i Nature of Repairs or Alterations(Answer when applicable) 'I ,1 a*, v • k Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance,with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. //I ' Date Application Approve d`b Date 1 1 0/U -L/ Application Disapproved for the following reasons t Permit No. S221 — /'7 I Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, hat the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by , {�v at r��? h.u ,r 11 ,� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. lid t/�dated // a J 1 Installer ' Designer The issuance o u permit shall not be construed as a guarantee that the system w'11 f n tion as des gned. Date 4 111 I M Inspector 4 a No. C)O -7 ---------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLE, MASSACHUSETTS '=igpogaf bpgtem Construction Permit Permission is hereby gr, ted to Construct( )Repair( )Upgrade(K)Abandon( ) System located at L j fa 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:Cons ction ust be completed within three years of the to odd f pe Date: L� � �U_14 Approverby-..—\ TOWN OF BARN$TABLE LOCATION 33 W i1AAV1 a 4ZcQ SEWAGE # VILLAGE s .th U sit. ASSESSOR'S MAP & LOT 0'l 39 INSTALLER'S NAME&PHONE NO. �o Q 6. Lt�• �^e SEPTIC TANK CAPACITY I S'C7 0. i LEACHING FACILITY:.(type), \ l- C_ (size) �i l X °•l X a NO. OF BEDROOMS y BUILDER OR OWNER PERMITDATE: 1 OL COMPLIANCE DATE: b 0 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 L Go' t !- 14SLO 13oo i- N ao 0 r3ok I ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for.Voluntary Assessments* 233 Wianno Ave Property Address Small Owner Owner's Name / information is required for Osterville __ _! MA _ 02655 _ November 20, 2012 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 A General Information ._...... .._... .. . . ...._. _. .. ._ . forms on the Fr computer,use 1. Inspector: only the tab key = to mo c your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name... , 189 Cammett Road Company Address Marstons Mills MA 02648 CitylTown --- ----- State Zip Code 508-428-1779 SI 12855 'L ^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 sand 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 Appr ving.Authority November 20, 2012 Job# 12-270 F Vnctr's ignature 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.be conditions of cme at that time. This inspection does not address how the system will perforrt' i,,n the futbee under the same or different conditions of use. M.) 'wry t5ins-11/10 Title 5 Official I s ec n Form:(Subsurfaa D�spO al System g7 . i r e-� �J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 Wianno Ave Property Address Smail t Owner Owner's Name information is required for Osterville MA 02655 November 20, 2012 every page. City/Town 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15..3Q3 or in 31.0 CMR 15.304 exist. Any-failure ci iteria not evaluated are indicated below. Comments: Tank was not in need of pumping at time of inspection, leaching trench was video inspected with no signs of surcharge found. 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. Systern 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): l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 Wianno Ave Property Address Smail Owner Owner's Name information is required for Osterville MA 02655 November 20, 2012 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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 l5ins•11/10 Title 5 Official Inspection form Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 Wianno Ave Property Address Smail Owner Owner's Name information is required for Osterville MA 02655 November 20, 2012 every 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 fl ❑ ® 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 15ins-11110 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 233 Wianno Ave Property Address --- Smail _ Owner Owner's Name information is required for Osterville MA 02655 November 20, 2012 every page. Cityrrown State Zip Code Date of Inspection B. Certification (Cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ [K Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ z 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•11/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 5 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 Wianno Ave Property Address Smail Owner Owner's Name information is Osterville re wired for MA _ 02655 November 20, 2012 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" asjo each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health LI 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): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,. 233 Wianno Ave Property Address -- -"--- Smail Owner Owner's Name information is OSterville required for MA 02655 November 20, 2012 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied. 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: 15ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7:)f 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 Wianno Ave Property Address Smail Owner Owner's Name information is required for Osterville MA 02655 _ November 20, 2012 every 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: Unknown 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 g Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ., 233 Wianno Ave Property Address — Smail Owner Owner's Name — information is required for Osterville MA 02655 November 20, 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1,_ —_ 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: 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: 10.5' long x 5.8'wide- 1500 gal. Sludge depth: _ t5ins•11110 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 9 of 17 L I Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 233 Wianno Ave Property Address Smail Owner Owner's Name -- information is required for Osterville MA 02655 November 20, 2012 every page. C1tylTown 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 30" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 12 How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level was at bottom of outlet invert and tees were intact Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El 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 15ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 f Commonwealth of Massachusetts i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4H 233 Wianno Av e e _ Property Address -- Smail Owner Owner's Name information is required for Osterville MA 02655 November 20, 2012 every page. Cltyfrown 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(expPain): 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form R Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 Wianno Ave Property Address Smail Owner Owner's Name -- information is required for Osterville MA 02655 November 20, 2012 I eve a every page. C ty/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 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.): No solids or high stains present. 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.). Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 Wianno Ave Property Address - Smail Owner Owner's Name information is required for Osterville _ MA 02655 November 20, 2012 every 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: One 91'trench. ❑ 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.): Leaching trench is under driveway, lateral pipe was video inspected with no evidence of surcharge found. Cesspools,(cesspoal 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 Wianno Ave Property Address Smail Owner Owner's Name information is required for Osterville MA 02655 November 20, 2012 every 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.): I t5ins•11110 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 233 Wianno Ave Property Address Smail Owner Owner's Name information is required for Osterville MA 02655 November 20, 2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including tiers 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 13 2 16 2 . J % /\ y J J f t •f J 42 Wianno Ave Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 233 Wianno Ave Property Address Smail Owner Owner's Name information is required for Osterville MA 02655 November 20, 2012 every page. Cityrrown 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: 20+ 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: USGS topo map. Ybu must desici'ibe how you established the high ground water elevation: Topo map shows property at el 20 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 Wianno Ave Property Address Smail Owner Owner's Name — information is required for Osterville _ _ MA_ 02655 November 20, 2012 every page. Cltylrown 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 cf 17 FAILED INSPECTION r D AT E,: 5/20/02 C' PROPERTY ADDRESS:233 Wianno, Ave . , Osterville ,Mass .-------------------- :. 02655 On the above date, i Inspected the septic system at the -abo' This system consists of the following; MED 1 . 3-6 ' X8 ' Block cesspools . x 2 . Cesspools are in series . JUN 0 4 :2002 TOWN OF BARNSTABLE Based on my Inspection, I certify the following conditions: HEALTH DEPT. 3 . This is not a title five septic 'system. �. � 4 . The sewage system is in failure . #2 cesspool is caving in . five or six blocks are missing . They are on the bottom of the cesspool . MAP 5 . This is the reason why this system fails . .._ ' PARCEL : 6 . A new title five septic system needs to be installed . 'r LOT 111'SIGNATURFE;1 _ Name :_�_�•_ Macomber Company : Joseph_P _—Ma.c^omber_& Son; . Inc ; Address : Box 66 __Centerville, `Ma •- 02632-0066 Phone:---508_7_75_3338 0. : THIS CERTIFICATION DOES NOT CONSTITUTE 4 GUARANTY OR WARRANTY JOSEPH- P. MACOMBER & SON, INC. Tank: ceapools l,eachflelds r. Pumped & Installed Town Sewer Connectlons P:O. Box 66 `Centerville, MA 02632 0066 775.3338 775.6412 i 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 Property Address: .233 Wianno -Ave Osterville .Mass . Owner's Name: Joy Hambly Owner's Address; _dame Date of Inspection: 5 20 02 s Name of Inspector: (please print)Joseph P .Macomber • Jr . Company Name: J. P.Macomber & Son inc . Mailing Address: Box 66 en 02632 Telephone Number: 8-775-3 38 CERTIFICATION STATEMENT 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true. accurate and complete as of the time of the inspection. The inspection was performed based on my rraining 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(3,10 CMR 15.000). The system: Passes . Conditionally Passes , eeds Further Evaluation by the Local Approving Authority . Fa* s Inspector's Signatur?ubmit Date: The system inspector shal 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 Coinments ****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 paged i Page 2 of OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM, PART A CERTIFICATION (continued) Property Address: 233 Wia'nno Ave Osterville ,Mass . Owner: - Joy Hambly Date orlospection: 5/20/02 ' Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes:'� 1 have not found any information which indicates tharany of the failure criteria described in 310 CMR 15.303 own 310 CMR 15.304 exist. q y failure criteria not evaluated are indicated below. Comments: The present sewage system is in failure . #2 cesspool"'is' �' cavinQ in A new septic system needs to Ue IIISLallea . B. System Conditionally Passes: 40 One or more system components as described in the "Conditional Pass" section need to be replaced or 3, 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. d,b The septic tank is metal and over 20 years old* or the septic tank.(whether metal or'not) is structwaily r 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: � a �fld Observation of sewage backup or break out or high static water*level in the disrributton boz.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.thes a year due to broken or obstructed pipe(s).The,system will pass inspection if(with approval of the Board of Health): broken pipes)are replaced obstruction is removed Page 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 233 Wianno Ave stervi e ,Mass . " Owner: Joy Ham y Date of Inspection:5 20 02 ° C. Further Evaluation is Required by the Board of Health: Ald 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: /10 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 andthe SAS is within a Zone I of a public water supple. 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 b t 50 feet or more from a private water supple well". Method used to determine distance "This system passes if the well water analysis, performed at a DEP'certified laboratory, for colifornt bacteria and volatile organic compounds indicates that the well is free from pollution from that,faciliry 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. r 3. Other: • 3 Page 4 of I 1 f OFFICIA-L INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM TART A CERTIFICATION (continued) Property Address: 233 Wianno Ave Osterville ,Mass . Owner: Joy Harnbly Date of Inspection: 5/20/02 ' D. System Failure Criteria applicable to all systems: You must indicate "yes" or"no" to each of the following for all inspections: Yes No/ _ _k ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ti ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due town overloaded or r. clogged SAS or cesspool Static liquid level in the istribution box bove 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 . i/ Any portion of the SAS, cesspool or privy is below high ground water elevation. r ; 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 I of a public well. r _ Any portion of a cesspool or privy is within 50 feet of a private water'supply well. VAny 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.1 J-6. (Yes?vo)The system fails. I have detennined'that'one or more of the above failure`criteria exist as dzscribed 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. Y E. 'Lange Systems: To be considered a large system the system must serve a facility with a design now of io,0o0 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) des no� t . _ !i 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-.1"A)_or a mapped. ' Zone 11 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 answere.d- "�es" in Section D above..the large system has failed. The owner oroperator of any large system considered a s,e.n1ficant threat under Section.E or failed under Section`D shall upgrade the system in accordance with 310 CMR 304• The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 1 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:233 Wianno Ave Osterville ,Mass . Owner:Joy Hambly Date of Inspection: 5/2 0/0 2 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No umping 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? ave 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'�~ /A) J ` JZ_ 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,4tluding the SAS located on site? 41dA Were th e tic tank anholes 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)] f 5 Page 6 of 1 1 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM, PART C SYSTEM INFORMATION Property Address: 233 Wianno Ave s ervi e , ass . Owner: Joy Ham y Date of Inspection: 5/20/02 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): 41A Is laundry on a separate sewage system-Cyes or no):.1�0 [if yes separate in°spection required] Laundry system inspected(yes or no): rr Seasonal use: (yes or no): Water meter readings, if available(last 2 years usage(gpd)):2000=58 , 000, gallons=158. 91' GPD Sump pump(yes orno):wU 2001=52 , 000 gallons=1.42 47 .GPD Last date of occupancy: COMMERCIAL/WDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system (yes or no):.4GP' Water meter readings, if available: Last date of occupancy/user OTHER(describe): _ a , GENERAL INFORMATION , Pumping Records _ Source of information: Was system pumped as part of the inspection(yes or no): If yes, volume pumped: Q gallons-- How was quantity pumped determined? N/� Reason for pumping: TYPE OF SYSTEM y0 Septic tank,distribution box, soil absorption system 1 Single cesspool ` Overflow cesspools 7 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) Night tank Attach a copy of the DEP approval`. ovP Other:(describe): Approximate aoe of all components,date in tailed(if known)and source of information:. •, ' Were sewage odors detected when arriving at the site(yes or no): 6 l Page 7 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION'FORM PART C SYSTEM INFORMATION (continued) Property Address:233 Wianno Ave Osterville .Mass . Owner:Joy Hambly Date of Inspection: S/2 0/0 2 BUILDING SEWER (locate on site plan) Depth below grade: Materials of construction: iron AM PVC other(explain):`L /1ty l Distance from private water supply well or suction liner V5'- Comments(on condition of joints, venting, evidence of leakage,etc.): Joints appear tight . No evidence of leakaQe . The system i_s vented through the house vents . SEPTIC TANK4*4,G(locate on site plan) Depth below grade: AIA Material of construction:concrete 4�gmetal4/Afiberglass,ll±polyethylene 4ther(explain) AIA If tank: is metal list age: .,i4 Is age confirmed by a Certificate of Compliance (yes or no):440(attach-a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: x14 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.): Septic tank is not prPSPnt _ GREASE TRAP,/.11ocate on site plan) Depth below grade: Material of construction;4/g concrete 4 meta14*fiberglass 41!fpolyethylene44/ other (explain): /U/9 — Dimensions: Scum thickness: 4114 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: _ t.4 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 Grease trap is not present 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: 233 Wianno Ave r 0 s t P r yi11P , Mag.S , ' Owner: Joy Ham hI y Date of inspection: 5/9 n/n g TIGHT or HOLDING TANKd4-(Ae(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: NA concrete,��4 metal.4.1A fiberglass4/4polyethylene Al other(explain); �tlA ' Dimensions: All?. Capacity: A4 gallons Design Flow: AIA gallons/day F Alarm present(yes or no): A24 " Alarm level: AM Alarm in working order(yes or no): Date of last pumping: .4)A Comments(condition of alarm and float switches,etc.): , Tight or holding tanks ara nnt _ presPnt DISTRIBUTION BO if present must be o 'ened locate on siteplan) Depth of liquid level above outlet invert: A119 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.): Distribution box is not present PUMP CHAMBER/l l4 (locate on site plan} Pumps in working order(yes or no): / Alarms in working order(yes or no): ,Ui9 Comments(note condition of pump chamber;condition of pumps and appurtenances, etc.): Pump chamhPr is not prPCPnt, , 8 i Page 9 of I OFFICIAL INSPECTION FORM —,NOT FOR VOLUNTARY ASSESSMENTS a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 233 Wianno Ave Osterville ,Mass . Owner: Joy Hambly Date of Inspection: 5/2 0/0 2 SOIL ABSORPTION SYSTEM (SAS): /(locate on site plan,excavation not required)L 3—Block cesspools in series . ( 6 X8. ) If SAS not located explain why: Located : See page 10 Type A)6 leaching pits. number: A)Q leaching chambers, number: d leaching galleries, nwnber: a leaching trenches, number, length; leaching fields, number,dimensions: (' $overflow cesspool, number: 04 //JJ t innovative/altemative system Type/name of technology: Apl m'p JMdj Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Loamy sand to fine sand .No signs of hydrailic failure . or ponding . soils are dry . VeQetation is normal #2 cesspool is caving in blocks laying on the bottom. CESSPOOLS: Zcesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet ftinvert: Depth of solids layer: Depth of scum laver: 09 Dimensions of cesspoolg('rr Materials of construction: /t/,Wr57; Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Same ,as above . 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.): Priv3Z iG- nnt t)resPnt 9 Pagc 10 of I I OFFICLA_L INSPECTION'FORNI— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM. INSPECTION�'FORM PART C SYSTEM INFORMATION (concinucd) Properry Address: 233 Wianno Ave Usterville ,lqa Owocr: Joy Ham y Ditc of Inspmioo:5 20 02 I � - SKFTCH OF SEWACE DISPOSAL SYSTEM ix P70ri0< ► sk<tch o(chc saw,ec drsposcl systcm inrly�ln� Icy l� a� Icasl two permnncnt re(crcncc`landmarks or ocncNnukf. Lo<<ic III wcllt within 100 (<ct.�Loc��tc �y rc ¢�lik w-tcr supplycncrs the building: 1 t r10 I Page I I of 1 1 p_ OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL+'SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 233 Wianno Ave s ervi e , ass . Owner: Joy Ham Fly Date of Inspection: 0 02 SITE EXAM Slope Surface water .. Check cellar Shallow wells Estimated depth to ground water 00 feet Please indicate (check)all methods used to determine the high ground water elevation: ,VO Obtained from system design plans on record - if checked, date of design plan reviewed: bse ved site�(abua�g grope bservation hole within 150 feet of SAS) /Ut7 Checked with oar o Health explain: Checked with local excavators, installers- (a ach documentation) Accessed USGS database•expIain: Tl�, You must describe how you established the high ground water elevation: Used ; Gahrety & Miller Model . 12/16/94 Water elevation above' sea . level Used ; USGS ; Observation well data June 1992 Usde ; USGS : Technical bulletin 92-000-1 Plata #2 jnn„ary IQ99 Annual ran un Leaching Pit I t Groundwater.. Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the bottom of the leaching pit and the adjusted groundwater table is',/ feet: 1'1 `:•'R1'lT�flf'!"ST.TT�1P'Ir�lrr'PiP'I!'i"TT:.lS7•I.TT:•.1TTTRT:T"I'1Y.'ff1 AT•'t-Q.f Tf7Q�iTCT.RZ .T1T'1Tr•TT—..�., �... 1 TOWN OF Barnstable BOARD OF I.1EALT11` SUIISHFACF SEWAGE DISPOSAL SYSTEM INSPECTION FORM_'- PART D.- CERTIFICATION -f't-r••.-•.•.r—r.11R^.�r+1.r.Tf•n.'rrlr-lTnmrTT•+-r-59�'Sfmr•7nrnvr TnTne4n'e RiS.IT.i►+►•M1rf ismrt ..:rrr•r-.�. �..� -TYPL OR P9114T CI.EARLY7- PROPERTY INSPECTED STREET ADDRESS 233 Wianno Ave Osterville,Mass . ASSESSORS MAP , BLOCK AND. PARCEL j'140/139 OWNER' s NAME Joy Hambly• PART D CERTIFICATION I NAME OF INSPECTOR Joseph P.Macomber Jr . COMPANY NAME J.P.Macomber & Son Inow COMPANY ADDRESS Box 66 Centerville ,Mass,. 02632 Street Town or city State LIP COMPANY TELEPHONE ( 508 ) 775 = 3338'` FAX (508 790 _ 1,578 it CERTIFICATION STATEMENT I certify that I have personally inspected,. the sewage disposal ' system at this address and that the information reported. is' true , accurate , and omplete as of the time of .inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in' the proper function and maintenance ' on- site sewage disposal systems . - Check one : Systeui PASSED The inspection which I have conducted has not- found any. Yinformation which indicates that the system fails to adequately protect public health or Lhe environment as defined .in 310 CMR' 16 , 303 . Any failure criteria not evaluated are as stated in..t.he, FAILURE CRITERIA. sectfon of this form . System FAILEll* The inspection which I hAv:co -d-acted has found that t'he system fails to protect the public health and the environment in accordance ' with Title 5 ,- . 310 CMR 15f303 , � and as specifically, noted on PART C FAILURE CRITERIA .of ,this inspection form ; r Inspector Signature Date '' copy of this c t.ification must be provided to the OWNER, t,he: BUYER and Where aPplicable ) .and the. I30ARD OF HEALTH. * If the inspection FA.ILED., the owner orf"operator shall upgrade ' the aystem within one year -of the date of the inspection , unless allowed. or required otherwise as provided i'n, 3.10 CMR 15 . 305 . partd .doc TOWN OF BARNSTABLE LOCATION 33 w- m Alw o A, v Q SEWAGE#z 003 VILLAGE D _71 et y/1 i e ASSESSOR'S MAP & LOT Lq0 p 131 INSTALLER'S NAME&PHONE NO. r/F A4 A A oS e N SEPTIC TANK CAPACITY O Q LEACHING FACmrm (type) A C H/A/ 6 . / • (size) Fl- �• NO:OF BEDROOMS BUILDER OR OWNE PERMITDATE: 23 0' COMPLIANCE DATE: 2-4 4 3 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 dN;n y I � a ! I 9 04/30/04 FRI 10:46 FAX 5084327057 I 2002 Town of Barnstable" Regulatory Services t : Thomas Jr.Geller,Director Public Health DIVWan Thomas McKean,Director 20o Mala 6tree%Et asub,MA 02601 o�.: son-B62-+64A gtt{�: $05-790-6304 TnstZaller A DesIgUr Q dW Date: L16 Dat�ne�: JG �nglr/eeri✓1g, tic, Installer: �rJ�c.� 8 Der, Tic. Address: F5 Y Ce,0,6 vz Addressi P d. 6y 15 3' E. Waie�a,m, Pnq 02S38 - llaruJ(cA, //Ifs OROS pa {�oher� B. 00r -f6c was issued a permit to install a Ln e: septic system at o?33 CJianno A✓c Os4e.,vr Il bued on a destp drawn by (addms) dated c�uL9, a6o3 /Qc✓'j44 Nc.. 311 d X 3 I ecitiy that the septic system retbmced above was Installed substantially according to the deser�tt,, wh! h may include minor approved changes such as lateral relocation of the diatribe c—m box and/or septic tank. _ L G AzH V/ 6,VC)l q ' rP—or , 7" JPJ^&t LOcac 4j0fgC kL pad} 9A;0 i 7 OK W-1/ )y I certify that the septic ssyysstterm referenced above was Uuwled with armor changes (i.e. gre>ator than 10' lateral relocation of the SAS or any vertical relocation of any compoaeut of the eepd.e arteai) but in awordanee with State &Local Regulations, Platt revision or certified as-bvslt by desipar to follow. JOHN L. CHURCHILL Ora �litutt C - No. s7607 A iiii a i o ®ear a Q:M.i jW9spWMwsip w Catttlt&cn Porn r c c � r - 7 a L — ti „9 "d � _ _0 __z C05 `JN I ZI�3N I�N3,lf Lid <., i _ �z ve7o� Z. •�•� 4 -4 30 cp1 m r b. E tp O� N 0n 8 (P �Z oZ ' w 70 y_. I III-I . . . . jj-. 3 A \ D X DOAO k Db GN -ke 144441--g r4l C. Z b mz • pi i i i i i i i ------ i -- `� 9 %Iz 3 m x 5 i A '.e. i ---------- i i ---------- 6 b A Din i 3 , m n D b � m z U, GN n8 o� mD A O � 3 O O , A - U l s� DAtE REVISIONS m D SECOND FLOOR PLAN o =° ' N. =o ZO Ih y E ion3ioa FlHai PUJ+s-PERMIT z N �BUIIDIN GO 10/S/04 5URD- r AWVE GARAGE 8 ° o o SMAIL RESIDENCE O � O � ;_ � 333 SERVICE ROAD SANDWICH•MA•02563 N o b o 233 WIANNO AVENUE PHONE, 508428-3200 P OSTERVILLE, MASSACHUSETTS FAX: 508-420-1321 E-MAIL: INFOeOLDECAPEBUILDERS.COM 1 . EXISTING I. NEW - ---------------------------------- 777777777-, ------------- '• 10'SONO-TUBES W/ BIGFOOT FOOTINGS DROP FOUNDATION TO I 8"POURED CONCRETE WALLS MATCH EXISTING FIRST ON U!"X10"KEYED FOOTING 4 _— FLOOR HEIGHT .EXISTING NEW :. - I CONCRETE PADS I I ' I I I I I .- I- • I p BEAM POCKET RYPJ Q I —_--__---__— _ EXISTING GAPE GOD r __ —I GELLAR NEIli-CRAWL SPACE I I I I I I A I I � •. I. DRILL 5 REBAR IY O.G. VERTICALLY INTO OLD WALL I - -- _._-I _____ _ ______ __,_-_____-_____ p. \ �_ - __--_ _ _ - _________ ___ _ _____.____-__________ e.-0 EXI5TING I NEW m - 4-0 DROP FOUNDATION WALL 24' m S"POURED GONGRETE WALLS: " ON 18"XIO"KEYED FOOTING - PITCH 1/8"PER FOOT MIN. - `4 m m - DROP 12" DOORS - 0 4 GARAGE SLAB u • z 4"POURED CONCRETE OVER 3 COMPACTED FILL W/6X6 W.W.H. EXISTING FOUNDATION - PROGRESS PRINTS-NOT FOR CONSTRUCTION OLDS GAPE BUILDERS, INC. 333 SERVICE ROAD • SANDWICH MA I I /All.11APPROVED NBU FOUNDATION -__ '-__ 10/13/03 PELLEGRINO RESIDENCE 1 233 WIANNO AVENUE • OSTERVILLE • MA s s4-0" OLDE GAPE BUILDERS,INC- FOUNDATION LAN D A-1 COPYRIGHT 2003 i 4 40'O° EXISTING NEW 17-0" •.. - - ,.�• 13.O,• 11-4�. z•_en y-g^ 1'.10' - 11=3 •. _ I Q 1S 839D --- DB30 BI36 1 _ GAB r+rsrrucE - w/sureH NE.eRTH - .. _ m ID I • O I , 44Z9 a9£9 04L9 - . - EXISTING I NEW EXISTING 'D DINING ROOM RENOVATED ® - I NEW OB AHOGANY DECK m - - _ GREAT ROOM - - - L090£D 090£D'090£D 09D£ L l - , Ll rOAK Y RENOVATED s BATH - - -' . RENOVATED , PLAV4 SEDROOMEXISTING n Q LIVING ROOM I 4 1 NEW :BA H EXISTING I NETU m MUD ROOM - - . 3O nIN:RFE DOOR ..1. ;:I ___ — I,I AGAMSB/B'RREDODE GUlB _ T 4 .- - A OVERHEAD DOORS W/ELECTRIC OPENERB� I '1 O (5)-SMOKE DETECTOR HEAT DETECTOR(R.O.R.) - I°1 NEU WINDOWS AND DOORS SCHEDULE INTERIOR NOTES: _ _ _ " CAR GARAGE m -ALL WINDOWS TO BE'ANDERSEN*TILTWASH 400 SERIES I: WITH PRE-FINISHED WHITE INTERIORS,WHITE SCREENS AND VINYL GRILLES -ALL INTERIOR CASINGS TO BE 3-1/Y STRATFORD SYMBOL PRODUCT CODE NOTES I 1 I - ALL INTERIOR BASEBOARD TO BE 5-1/4'SPEED BASE I 7)lOpg6 PREf1NISHED INTERIOR W/WHITE INSECT SCREENS -ALL FLOOR FINISHES TO BE AS SPEC'd I I I _O AND VINYL GRILLES -ALL INTERIOR DOORS TO BE'NUTTIG°OR EQUAL SOLID FACTORY MULLED UNIT CORE MASONITE 6 PANEL DOORS W/BRASS HINGES 9 9'x T'eTEEL INSULAT� 1 7W7446-2 OVERHEAD DOORB'W/BJiCTRIC OPENERS I -ALL DOOR HARDWARE TO BE SCHLAGE BRIGHT BRASS PLYMOUTH SETS I I 'I PRE-FINISHED INTERIOR W/WHITE INSECT SCREENS -PROVIDE 3/8'A.G.UNDERLAYMENT UNDER TILE I PROGRESS PRINTS-NOT FOR CONSTRUCTION 3 TW24310 AND VINYL GRILLES -PROVIDE 1/2'PARTICLEBOARD UNDERLAYMENT UNDER CARPET PRE-FINI5HED INTERIOR W/W EE WHITE INSECT SCRNS -ALL EXTERIOR WALLS TO BE YXd Ib'O.G. q TW7443 -ALL INTERIOR WALLS TO BE 7X4•Ib°O.C. AND VINYL GRILLES FRENCH WOOD HINGED DOORS WITH PRE-FINISHED -SET ALL HEADER HEIGHTS TO MATCH EXISTING .D — �. I I OLDE GAPE BUILDERS/ INC. S RUH60611 INTERIORS AND BRIGHT BRASS ESTATE HARDWARE — — — —- I I. 333 SERVICE ROAD • SANDWICH • MA FRENCH WOOD STATIONARY DOORS WITH PRE-FINISHED I. I 6 RUH316II - INTERIORS AND GRILLES /411=I 11 G APPROVLD T CN23S CASEMENT WITH PRE-FINISHED INTERIORS,WHITE SCREENS _ - 10/13/03 AND VINYL GRILLES PELLECsRINO RESIDENCE 7HERMA-TRU SMOOTHSTAR FIBERGLASS 6-PANEL " ' A 20 MIN,FIRE DOOR,4-9/16'JAMB,ADJ,SILL,SINGLE � _ - - 233 WIANNO AVENUE - OSTERV"E - MA THERMA•TRU SMOOTHSTAR FIBERGLASS 9-LITE DOOR _r OCl{ 24-0- o B TT 4-9/16°JAMB,ADJ.SILL,DOUBLE BORE w —` - A_ OLDE CAPE BUILDERS,INC. FIRST FLOOR PLAN A-2 COPYRIGHT 2003 i -41 RENOVATED (01 RENOVATED - MASTER SUITE MASTER BATH rcaReeo WALK-IN mtu CLOSET ® - a - • .m • - _ .. RENOVATED BATH ` RENOVATED - EXISTING e•-0 LIVING ROOM BEDROOM - - t EXISTING NEW ... UNFINISHEDSPACE 21 Q - UNFINISHED SPACE m � PROGRESS PRINTS-NOT FOR CONSTRUCTION OLDE CAPE BUILDERS, INC. 24.0 333 SERVICE ROAD • SANDWICH • MA /4r aIr-0r C UAll 10/13/03 PELLECaRINO RESIDENCE 233 WIANNO AVENUE • OSTERVILLE • MA OLDE CAPE BUILDERS,INC. • - -_ _COPYRIGHT 2003 SECOND FLOOR PLAN A-3 x /4" _...__. . --------------- -.-_ ._.__----. -- TOF ELEV. = 103.2' T PROVIDE PRECAST CONCRETE EXTENSION 5" DIA. OUTLET(S) VENT WITH 99 5'_99 96' GENERAL NOTE RISER WITH CONCRETE COVER TO WITHIN CHARCOAL FILTER FINISH GRADE OVER LEACHING TRENCH = REMOVABLE COVER ° 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE OVER D-BOX= 99.5 4" SCHEDULE 40 PVC MIN SLOPE 1 /° 6" OF FINISH GRADE OVER OUTLET COVER FINISH GRADE ° SLOPE @ 2/° MIN. OVER SYSTEM METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE OVER TANK , , 2" OF 1/8" TO 1/2" DOUBLE WASHED STONE - ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES. FINISH GRADE @ FND. EL.= 1 00.5 EL.= 99.5 BREAKOUT EL = 96.5 -96.96 __ 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD 20" MIN. ACCESS COVER 9" MIN � 4" PERFORATED PVC PIPE OF HEALTH AND THE DESIGN ENGINEER. (TYPICAL FOR 3) 36" MAX. 36"MAX. 12" MIN. 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL PROPOSED 4" 36" MAX. BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. PVC DRAIN PIPE 2 �_ PROVIDE WATERTIGHT - - -- -�� - - - - ---- -- , _ 4. TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE LESS THAN 6"� 3" 2" DROP MIN. 3„ 9„ JOINTS (TYP.) o v 96.0 ` ELEVATION = 96.96' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS j I A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF 10" 3" DROP MAX. I 4" PVC IN FROM SLOPE PERFORATED AT 0.5% PLUMBING IN 14" 97 25' SEPTIC TANK 4" PVC OUT TO O O O F O O O O O O THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. EXISTING DWELLING 98.0 O LEACHING FACILITY0 To BE REPLUMBED f '' S. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 97.50' 12" Ig OOoo O o0 r O O O 1 O O O 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 48„ OUTLET TEE 97.0 IN. 96.83 O O O O 3/4" TO 1-1/2" g O OSJ 96.50' DOUBLE WASHED STONE O N 3/4" TO 1-1/2" 7 LOCAL BOARD OF HEALTH TO BE NOTIFIED _ 0 6" CRUSHED STONE O O 32.8 22" ZABEL FILTER TO CROWN OF PIPE O DOUBLE WASHED STONE PRIOR TO BACK FILLING WHEN SYSTEM IS NEARLY COMPLETE AND OVER MECHANICALLY O O READY FOR INSPECTION. SYSTEM IS NOT TO BE BACK FILLED MODEL#A1801 HIP (GAS COMPACTED BASE O �O O O TO CROWN OF PIPE BAFFLE ON BOTTOM) WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH. 5 OUTLET DISTRIBUTION BOX 91 I 4' 8. ELEVATIONS BASED ON ASSUMED DATUM OF 100.0' MSL OBTAINED 6" CRUSHED STONE TO BE INSTALLED ON A LEVEL STABLE G p o o OVER MECHANICALLY BASE. FIRST TWO FEET OF OUTLET BOTTOM OF TRENCH ELEV. - 94.0' FROM TOP OF CONCRETE BOUND AS SHOWN ON PLAN. COMPACTED BASE PIPES TO BE LAID LEVEL. GROUND WATER ELEV= C 88.63' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PROPOSED 1500 GALLON CONCRETE SEPTIC TANK THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE LENGTH 11 .0' WIDTH 6.17' DEPTH 6.0' CROSS SECTION VIEW 5 MIN. AT1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY TYPICAL TRENCH PROFILE TYPICAL TRENCH SECTION DISCREPANCIES TO THE DESIGN ENGINEER. DISTRIBUTION BOX DETAIL (H-20) ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE SEPTIC TANK PROI*ILE(H-20) TRENCH DET,�11- STRUCTURES SHALL BE MADE WATERTIGHT. NOT TO SCALE NOT TO SCALE I�OT TO SCALE _ _ 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. _ TEST PIT DATA 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS 4 � r � � � �� � „� - a '� F f�� LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH �� . � ,� INSPECTOR: CASE THEY SHALL WITHSTAND H-20 LOADING. r I -,�k SOIL EVALUATOR: Samuel Philos Jensen 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT. DUST AND DATE: April 22, 2003 FINES. TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND I ELEV TOP = 99.63' UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES 't�� ' r � OF LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN 5, � N ELEV WATER = > 11' BGS COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN r ACCORDANCE WITH 310 CMR 15.255(3). PERC RATE _ < 2 !� � - • -, ,„ , �-: � , • MIN/IN .. err+ t r j 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES DEPTH OF PERC =_ 47"-65' FOUND IN SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. TEXTURAL CLASS. _ - 16. PROPOSED PROJECT IS LOCATED WITHIN: � 1 ASSESSORS MAP 140 PARCEL 139 0 99.63' FEMA FLOOD ZONE C Fill AS SHOWN ON COMMUNITY PANEL# 250001 0016 D E, p 17. OWNER OF RECORD: JOY K. HAMBLY VENT PIPE �, �'� w ' `' rt� � � MAP 140 CB/DH(FNC`' ,� ( A A �, �} & HELD)/ \ G "� * ` g" 98.88' PARCEL 140 ` � Sand Loam L I* 10 YR 4/4 ADDRESS: 233 WIANNO AVENUE �� ° � •," �� w". rt .;'°F� ���� r,re . a_ # ., 14" 98.46' 101.1�_ � � ,r• 4 ti ,r OSTERVILLE, MA 02655 a I� wp • air iq�i ifi �. w: Loamy Sand l 4'x 91' LEACHING TRENCH 18. ALL DISTURBED AREAS SHALL BE RESTORED TO ORi INA -CONDITION. 36" 96.63' 01 u1 s � " * 1 19. DEED REFERENCE: DEED BK. 14290, PG. 315 J ;W V �40 f P - F M-C Sand I� Perc rc 94.21 19. PLAN REFERENCE. PL. BK. 6 G. 3 - " I 2.5 Y 6/6 O gad._ a;oY` T �N H-20 DISTRIBUTION BOX O I . , w M-C Sand 2.5 Y 6/3 . 11U. a S E LOCUS PLAN 1500 GALLON H-20 - VP No Groundwater ___._ __ ..__ ______ ______ -..__ SEPTIC TANK =,!'`�'` �' MAP 140 \ rt f�' �.� 132" 88.63' LEGEND f SCALE 1" - 1000' PARCEL 139 _-- oo� 1 G 0.46 AC. ± '' I „� w EXISTING SPOT GRADES 5 �`� �' L I O N DATA r' 50 EXISTING CONTOUR O ` ��--1 3' .y` �yF �� )G � '101.t1 J ; -o 50 PROPOSED SPOT GRADES #233 O� It 11 \ IP(FND) w rF 9,56 ` EXISTING O� �4 1.12' INTO 50 PROPOSED CONTOUR TP 1' 4-BEDROOM _/'..� ------j0 v _ i R.O.W. NUMBER OF BEDROOMS (ACTUAL) 4 EXISTING OVERHEAD UTILITIES EXISTING 9�x63 DWELLING 07 NUMBER OF BEDROOMS (DESIGN) 5 ' TOF. = 103.2' l GARAGE 100.63 { DESIGN FLOW 110 GAL/DAY/BEDROOM GAS GAS- EXISTING GAS LINE TOTAL DESIGN FLOW 550 GAL/DAY W w - EXISTING WATERLINE �/ ' T'• DESIGN FLOW X 200 % = 1100 GAUDAY •� TEST PIT LOCATION USE 1500 GALLON SEPTIC TANK 3 (MINIMUM PER TITLE V) r(� PROPOSED 1500 GALLON SEPTIC TANK (H-20) Off` C�l 3 ,, c N INSTALL 4' X 91 ' LEACHING TRENCH �� -� �� ' � MAP 140 �... 4" SOLID SCHEDULE 40 PVC PIPE c � r CB/DH(FND ; ; SIDEWALL CAPACITY ❑ DISTRIBUTION BOX (H-20) & HELD) �, PARCEL 138 I � � 91' + 4' (LENGTH + WIDTH) X 2.0' (DEPTH) X 2 (SIDES) = 380 SQ.FT. 4" PERFORATED SCHEDULE 40 PVC PIPE XITING PLUMBING 380 SQ. FT. X .74 GAUSQ. FT. = 281.2 GAL. LEACHING/DAY N85°40'40"W 7 .67 TO BE MOVED r MAP 140 69.79' BOTTOM CAPACITY PARCEL 136 `' CB/DH(FND & HELD) 91' (LENGTH) X 4' (WIDTH) = 364 SQ. FT. REV. DATE BY APP'D. DESCRIPTION EXISTING CESSPOOLS TO BE PUMPED 364 SQ. FT. X .74 GAL/SQ. FT. = 269.4 GAL. LEACHING/DAY PROPOSED SEPTIC SYSTEM UPGRADE AND FILLED WITH CLEAN SAND(TYP.) B.M. TOTALS. PREPARED FOR: MAP 140 Top of C.B. Elev. = 100.00' JOY HAM B LY PARCEL 137 Assumed TOTAL NUMBER OF DISTRIBUTION LINES: 1 TOTAL LEACHING AREA 744 SQ. FT. LOCATED AT TOTAL LEACHING CAPACITY 550.6 GALJDAY 233 WIANNO AVE OSTERVILLE, MA 02655 SCALE: 1 INCH = 20 FT. DATE: MAY 19, 2003 RESERVED FOR BOARD OF HEALTH USE o �o zo ao ao FEET JOHN L. PREPARED BY: o CIIURCHiLL =+ M w JC ENGINEERING, INC. CML No 418' 5 ROUNDHILL BLVD. q EAST WAREHAM, MA 02538 SITE PLAN ,1 508.273.0377 SCALE: 1" = 20' MB Drawn By: B Designed By:-BMB -Checked By: JLC JOB No.432 � REMOVABLE COVER ON RISER TO WITHIN 6"OF FINISHED GRADE VENT WITH � ' GENERAL NOTES TOF ELEV. = 103.2 PROVIDE PRECAST CONCRETE EXTENSION RISER WITH CONCRETE IF DRIVEWAY IS TO BE PAVED A CAST IRON FRAME AND 100.0 -100.4 COVER TO WITHIN 6"OF FINISH GRADE OVER OUTLET COVER, IF DRIVE CHARCOAL FILTER -� FINISH GRADE OVER LEACHING TRENCH = 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION COVER MUST BE PROVIDED SLOPE @ 2% MIN. OVER SYSTEM WAY IS TO BE PAVED A CAST IRON FRAME AND COVER TO GRADE MUST 4" SCHEDULE 40 PVC MIN SLOPE 1% METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES. BE PROVIDED FINISH GRADE , 2" OF 1/8"TO 1/2" DOUBLE WASHED STONE 100.5' OVER TANK EL.= 100.5' 5" DIA. OUTLET(S) FINISH GRADE OVER D-BOX- 100.0' BREAKOUT EL = 96.42 -96.8 FINISH GRADE @ FND. EL.- - - 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD --- } \20" MIN.ACCESS COVER 9" MIN. + I 4" PERFORATED PVC PIPE OF HEALTH AND THE DESIGN ENGINEER. (TYPICAL FOR 3) 36" MAX ! 36"MAX 12" MIN. 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL . PROPOSED 4" 2 36"MAX. BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. ' PVC DRAIN PIPE I _ 4. TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE LESS THAN - PROVIDE WATERTIGHT - 95.92 ELEVATION = 96.96' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS 6" 3" 2 DROP MIN. 3„ 9" JOINTS (TYP.) j o f I A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 3" DROP MAX. 4" PVC IN FROM SLOPE PERFORATED AT 0.5% i THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. PLUMBING INSEPTIC TANK 4" PVC OUT TO O O O O O O O O O O EXISTING DWELLING 98.0 14 \_ 97.25' • LEACHING FACILITY 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. TO BE REPLUMBED 12, O ppW O 00 00 O 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 97.50' c 3/4"TO 1-1/2" ) j OUTLET TEE 97.0' MIN. 96.83' 00Ac? p 8 O' 48" 96.38' � DOUBLE WASHED STONE N O 3/4"TO 1-1/2" 7. LOCAL BOARD OF HEALTH TO BE NOTIFIED ��6" CRUSHED STONE TO CROWN OF PIPE O O p PRIOR TO BACK FILLING WHEN SYSTEM IS NEARLY COMPLETE AND -- 36.59' 22"ZABEL FILTER �� � 'T"J OVER MECHANICALLY DOUBLE WASHED STONE O j O TO CROWN OF PIPE O READY FOR INSPECTION. SYSTEM IS NOT TO BE BACK FILLED PIPE LENGTH MODEL#A1801 HIP(GAS COMPACTED BASE O O WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH. BAFFLE ON BOTTOM) 5 91' 4' OUTLET DISTRIBUTION BOX 8. ELEVATIONS BASED ON ASSUMED DATUM OF 100.0' MSL OBTAINED 6" CRUSHED STONE TO BE INSTALLED ON A LEVEL STABLE FROM TOP OF CONCRETE BOUND AS SHOWN ON PLAN. OVER MECHANICALLY BASE. FIRST TWO FEET OF OUTLET BOTTOM OF TRENCH ELEV. = 93.92 COMPACTED BASE PIPES TO BE LAID LEVEL. GROUND WATER ELEV.- < 88.63 A 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PROPOSED 1500 GALLON CONCRETE SEPTIC TANK (H-20) CROSS SECTION VIEW 5' MIN. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR A COMMENCING WORK ON SITE AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY LENGTH 11 .0' WIDTH 6.17' DEPTH 6.0' TYPICAL TRENCH PROFILE TYPICAL TRENCH SECTION DISCREPANCIES TO THE DESIGN ENGINEER. DISTRIBUTION BOX DETAIL (H-20) 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE SEPTIC TANK PROFILE(H-20) TRENCH DETAILS STRUCTURES SHALL BE MADE WATERTIGHT. NOT TO SCALE NOT TO SCALE 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR - - - - ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN • • • W` .` • SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. • . ' • ; ' . � -i . � ' ' TEST PIT DATA SHALL WITHSTAND H-10 LOADING UNLESS _,.� . • 12. ALL SEPTIC SYSTEM COMPONENTS • . : ; • ' LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH • �� • • • a ' d • a INSPECTOR: CASE THEY SHALL WITHSTAND H-20 LOADING. • • • • �i. • i �� Q,;'} . Q SOIL EVALUATOR: Samuel Philos Jensen 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND DATE: April 22, 2003 FINES. Si' • •• ' • # . �' !, oil • -•�r //� TEST PIT#: 1 E ALL LOAM SUBSOIL AND • / �'" / 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE , • ] . • .� 5, (< t- ELEV TOP= 99.63' UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES AL • ` . a 1 OF LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN •• .3.• �., ;� -- •`� ELEV WATER = > 11' BGS COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN • •� • . `. �':n ACCORDANCE WITH 310 CMR 15.255(3). PERC RATE _ <2 MIN/IN • ' • J �• 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES • • • . • DEPTH OF PERC = 47"-65" FOUND IN SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. 2j • . ♦ • • ' • TEXTURAL CLASS: 1 16. PROPOSED PROJECT IS LOCATED WITHIN: �� by •'• 3 ASSESSORS MAP 140 PARCEL 139 �� © 1\ \: • •.•. • i•.. + . '. ++ , 0 99.63' FEMA FLOOD ZONE C Q, �r �� y\� ;•\ . : i: • x 4 ♦, �} Fill AS SHOWN ON COMMUNITY PANEL# 250001 0016 D i I • ' • • ' • �• • .• • • • 11. • • r� 9" 98.88 17. OWNER OF RECORD: JOY K. HAMBLY ' • . ; , t� • • • Sandy Loam A 10 YR 414 ADDRESS: 233 WIANNO AVENUE MAP 140 VENT PIPE CB/DH(FN • •• . • . • . 14" 98.46' OSTERVILLE, MA 02655 & HELD) G S j� ; •� 'o •! ' : : • ' •• Loamy Sand __, PARCEL 140 / �< '} � "f r ,�•s ; '•• '• • 11�0� B 2.5 Y 6/6 18. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. PROPOSED 15' LEACHING SECTION TO BE ADDED jp X101.18 �� l �\ ' • * 36" 96.63' c .1Veck 6 - '. .• . 19. DEED REFERENCE: DEEb UK. 141'9J, PG. 015 EXISTING 4' x 91' LEACHING TRENCH v O 11 47" 95.71' � � �,�..1�i� __. •..�,,,..:: �p 4 __�� F-M-C Send 77 1"1J►�u `_ Perc 20. PLAN REFERENCE: PL. BK. 61, PG. 3 101 1 5 - - �= 2.5 Y 6/6 94.21' PS �s OC c� --�' o r-`' "C_0j73se O f� 1'a '� 5"C-1 21 THE FOLLOWING LOCAL UPGRADE APPROVAL PURSUANT TO 310 CMR 15.402-15.405 IS .o t<` ' , '� r REQUESTED: O � \� 96" 91.63 - DISTRIBUTION BOX P �/ �� E. Cr . p ' _ Sand A 1.0'VARIANCE (3.0'TO 4.0') FOR THE DEPTH OF COVER OVER LEACHING TRENCH. H 20 D S o. :. ,o / _ _ +>_ M C C-2 2.5 Y 63 -- EXISTING 15' LEACHING SECTION TO BE REMOVED LOCUS PLAN No Groundwater , �'- �� � po�� � 1�0.74 132" 1 88.63' 100.09 S/ SCALE: 1" = 1000' LEGEND 1500 GALLON H-20 - SEPTIC TANK. _' �� MAP 140 ��� ''G x 50 , EXISTING SPOT GRADES 0� PARCEL 139 100.49 DESIGN DATA 50 EXISTING CONTOUR co �r r1 O \ 0.46 AC. ± Z C a N'�5 ' 83 \ E 50 PROPOSED SPOT GRADES CD PROPOSED ��7 i \ /��� �G ) X101.11 PROPOSED CONTOUR m a ADDITION + 0 / IP(FtVD) NUMBER OF BEDROOMS(ACTUAL) 4 EXISTING OVERHEAD UTILITIES #233w / 9.56 EXISTING ��'y \ .12' INTO NUMBER OF BEDROOMS (DESIGN) 5 TP 99. i R.O.W. \ 4-BEDROOM �10� DESIGN FLOW 110 GAUDAY/BEDROOM GAS- - gas - EXISTING GAS LINE \ EXISTING 99x63 / DWELLING 1.07 TOTAL DESIGN FLOW 550 GAUDAY EXISTING WATERLINE- GARAGE 100.63 TOF. 103.2 �\ DESIGN FLOW X 200 % = 1100 GAUDAY \ TEST PIT LOCATION 9 / \� USE 1500 GA(�NIMUM PER TNTLE V) 7 `9� \ PROPOSED 1500 GALLON SEPTIC TANK (H-20) \ \ 100 1 ` INSTALL 4' X 91' LEACHING TRENCH " 4 SOLID SCHEDULE 40 PVC PIPE \ X 98.47 C �� I \ / SIDEWALL CAPACITY ❑ DISTRIBUTION BOX(H-20) °P C \ MAP 140 91' +4' (LENGTH +WIDTH)X 2.0' (DEPTH)X 2 (SIDES)= 380 SQ.FT. - - 4" PERFORATED SCHEDULE 40 PVC PIPE a CB/DH(FND I \ \ ( \ PARCEL 138 380 SQ. FT. X .74 GAUSQ. FT. = 281.2 GAL. LEACHING/DAY & HELD) \ do XITING PLUMBING BOTTOM CAPACITY 1 12-31-03 JC LEACHING AREA N850 0'40"W � 99.67 TO BE MOVED ' 91- (LENGTH) X 4' (WIDTH)= 364 SQ. FT. MAP 140 16919 REV. DATE BY APP'D_. DESCRIPTION 364 SQ. FT. X 74 GAL/SQ. FT. = 269.4 GAL. LEACHING/DAY PARCEL 136 CB/DH(FN PROPOSED SEPTIC SYSTEM UPGRADE & HELD) TOTALS: PREPARED FOR: EXISTING CESSPOOLS TO BE PUMPED STEPHEN PELLEGRIN AND FILLED WITH CLEAN SAND(TYP.) B.M. � Top of C.B. * PROPERTY NOT LOCATED IN ZONE 2 TOTAL NUMBER OF DISTRIBUTION LINES: 1 MAP 140 LOCATED AT Elev. = 100.00' TOTAL LEACHING AREA 744 SQ. FT. PARCEL 137 Assumed TOTAL LEACHING CAPACITY 550.6 GALJDAY 233 WIANNO AVE OSTERVILLE, MA 02655 - - SCALE: 1 INCH = 20 FT. DATE: MAY 19, 2003 i RESERVED FOR BOARD OF HEALTH USE ��,�HOF o 10 20 ao ao FEET JOHN L. ----- CHURCHILL PREPARED BY: CIVIL JC ENGINEERING, INC. No 41&07 AD 2854 CRANBERRY HIGHWAY EAST WAREHAM, MA 02538 SITE PLAN 508.273.0377 SCALE: 1" =20' -- ------ __..._----------_ -- lZ J�I�U 3 Drawn By: BMB Designed By: BMB Checked By:JLC i JOB No.432