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HomeMy WebLinkAbout0329 WIANNO AVENUE - Health 329 Wianno Aver w-e1 Osterville 140 124 002 ? I TOWN OF BARNSTABLE OCATION .43 a J /�.�N v�p Pyf SEWAGE# 2009—0G 0 VILLAGE 057te ASSESSOR'S MAP&PARCEL 1410- /ay-00a INSTALLER'S NAME&PHONE NO. S-L. A•/ Ito SEPTIC TANK CAPACITY LEACHING FACILITY:(type) 3- ,_OS (size) NO.OF BEDROOMS y OWNER PERMIT DATE: /-,2$-/0 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY rN �—"— T d►- — P}s•, a , . c. . No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Ye iI 2pplication for ;h9pogal *p5tem Con0trtuction Permit Application for a Permit to Construct(.Repair( ) Upgrade( ) Abandon( ) ❑Complete System ©I dividual Components Location Address or Lot No. 3 '( W igrxn G 4vte• Owner's Name,Address,and Tel.No. %krvt��R_ ��1 \JCN ���� Assessor's MaOarcel j L(i) _moo ve;d+r ►0ZQ r Installer's Name,Ad'dr�ess,and Tel No. 1 Desigper's Name,Address and Tel.No. C. l��+ �/, Ga v► f f�vc/r Jh 5+1\�YCr1 LinJ�r�tfu� ?ram P. !� 33`f �9uv's7'�J ,y,!/s �g oa4y� v.� �'� cis 5Q�-42`«3-33'� Type of Building: - 5 Dwelling No.of Bedrooms L l Lot Size 22Z\S sq.ft. Garbage Grinder WOE) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided L1SS gpd Plan Date Rly(-Uc,( Z\t L,cx 8 Number of sheets Revision Date Title 5,-, �� k--, Size of Septic Tank IS60 Type of S.A.S. -Soo (r A a A0 rx 3`S-��Imck Description of Soil 7�rc IZt lZ'�;— (`►-(L�" CQh�t� W Stt.N(?t%f FEu�`e-1 5 ia-1 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this rd Health. Signe Date /-,R Application Approved by Date Application Disapproved by: Date for the following reasons 44 Permit No. fWVKI Date Issued No _ 6 �� _> a r Feet +50 � ' THE'COMMONWEALTH OF MASSACHUSETTS a Entered in computer. 1 I � I / PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Y+ f I } 2pprtcation for �Digooar 6p5tem Cou0truction Permit Application fora Permit to Construct(..Repair O Upgrade O Abandon O ❑.Complete System Individual Components Location Address or Lot No. ''j q t J kr,na NvP—. Owner's Name,Address,and Tel.No. _ EIIev1 �1erk��S � V0� Assessor's Map/Parcellb2+ �1 _p0 � 4 b t� w f Installer's Name,Address,and Tel.No. 1 Desigg�r's Name,Address and Tel.No. f�ti 1f7 Gs� S7`ivc / t)""� VV 4.1 Lr'sy% `r 44-4— P� 339 Moosl.�r .y//s ���a�y� -3�b sS o s s' Snksra--5v4 Type of.Building: SAX ya -y5 i Dwelling No.of Bedrooms Ll Lot Size Z2,Zt S sq. ft. Garbage Grinder (AjO) Other Type.of Building, No.of Persons Showers( ) Cafeteria( ) Other Fixtures l Design Flow(min.required) (4 gpd Design flow provided LI S S gpd Plan Date F6a� Zik LW8 Number of sheets Revision Date Title 5\�C. �n Tco�e� _1^!CXoj fys-Zynk� Size of Septic Tank IS60 Type of S.A.S. lY'Description of Soil ?,et-,r tZt ¢ (O--2L- " K2 LANCCZ IY*�b . ';.. + 'J(o-I`3U � � (A+ik•fZ vhk�t Z�SY Ce �`( Nature of Repairs or Alterations(Answer when applicable) Datelastinspected: Agreement: The undersigned agrees,to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this o rd o ealth. Signe Date Application Approved by ij Date Application Disapproved by: Date for the following reasons ———— Permit No. — Date Issued j ————————————————————=—————————THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On- 'te ewage isposal System Constructed Repaired`( ) Upgraded ( ) Abandoned( )by at SZ"\ W�cvnno !Av e. dS�C-•�\�� has been constr cted in ccordance with the provisio s.o itle 5 and the for Di s osaI System Construction Permit No. /� dated 'I Installer � ,�/ Designer �. #bedrooms Approved design flow J gpd The issuance of this permit shall not be construed as a guarantee that the system will 'uit ti' as designe6. Date �/ 7� w Inspector "�: ��, 1' -------------------------------------------- No. Feet Sv 06(HE COMMONWEALTH OF MASSACHUSETTS - - PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS lwi ool * stern Con5tructiott Permit � p Permission is hereby granted to Construct Repair ( ) Upgrade ( ) Abandon ( ) System located at 3Z S LJ irty e\co Aye-, mg f` and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction .ust-bbe�o pleted within three years of the date of this pe i . Date Approved by O Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 329 Wianno Ave Property Address W EWALD, MICHAEL A & LAURIE H 4 Owner Owner's Name -►] information is � l required for every Osterville ✓ Ma 02655 3/20/17 page. City/Town State Zip Code Date of Inspeetion OD a) 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 S/ /�/9a 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 ah Company Name 8 Johns path Company Address arw, S Yarmouth ___ MA 02664 City/Town State Zip Code 508-364-9587 _ S113522_ Telephone Number License Number B. Certification 4 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 _ __ 3/20/17 I spector'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 r o �. Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 329 Wianno Ave Property Address EWALD, MICHAEL A & LAURIE H _ Owner Owner's Name information is OSterville Ma 02655 3/20/17 _ required for 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: ® 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 1,500 Gallon H2O septic tank as well a concrete distribution box and 3 500 Gallon chambers in stone. 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 r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 329 Wianno Ave Property Address EWALD, MICHAEL A & LAURIE H Owner Owner's Name information is Osterville Ma 02655 3/20/17 required for every _ 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 329 Wianno Ave Property Address EWALD, MICHAEL A & LAURIE H Owner Owner's Name information is Osteryille _Ma 02655 3/20/17 required for every pege. Cityfrown 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 'Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 329 Wianno Ave Property Address EWALD, MICHAEL A& LAURIE H Owner Owner's Name information is Osterville Ma 02655 3/20/17 required for every 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 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 329 Wianno Ave Property Address EWALD, MICHAEL A & LAURIE H Owner Owner's Name information is required for every Osterville Ma 02655 3/20/17 page. Citylrown 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): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 329 Wianno Ave Property Address EWALD, MICHAEL A & LAURIE H Owner Owner's Name information is required for every Osterville Ma 02655 3/20/17 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: Vacant Seasonal 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)): 218 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?s ❑ 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 4 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 329 Wianno Ave Property Address EWALD, MICHAEL A & LAURIE H Owner Owner's Name information is Osteryille Ma 02655 3/20/17 required for every page. CitylTown 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments cwM 329 Wianno Ave Property Address EWALD, MICHAEL A & LAURIE H Owner Owner's Name information is required for every Osterville _ _ _ Ma 02655 3/20/17 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 2/24/08 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.): System is vented through the roof. Septic Tank (locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene El 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: t5ins•3113 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 329 Wianno Ave Property Address EWALD, MICHAEL A & LAURIE H _ Owner Owner's Name information is required for every Osterville Ma 02655 3/20/17 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" 2" Distance from top of scum to top of outlet tee or baffle 4 4 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.): Tee's are in place, Levels are normal 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 329 Wianno Ave Property Address EWALD, MICHAEL A & LAUR.IE H Owner Owner's Name information is required for every Osterville Ma 02655 3/20/17 _ 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.): l , *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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a° 329 Wianno Ave _ Property Address EWALD, MICHAEL A & LAURIE H Owner Owner's Name information is Osterville Ma 02655 3/20/17 required for every _ 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): t If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 329 Wianno Ave Property Address EWALD, MICHAEL A & LAURIE H Owner Owner's Name information is required for every Osterville Ma 02655 3/20/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: 3 ❑ 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.): System is functioning as designed _ 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 l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 329 Wianno Ave Property Address EWALD, MICHAEL A & LAURIE H Owner Owner's Name information is Osterville Ma 02655 3/20/17 required for every _ page. CityFrown 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 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 329 Wianno Ave Property Address EWALD, MICHAEL A & LAURIE H Owner Owner's Name information is required for every Osterville Ma 02655 3/20/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t 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 �M 329 Wianno Ave Property Address EWALD, MICHAEL A & LAURIE H Owner Owner's Name information is required for every Osteryille Ma 02655 3/20/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Test hole data on plan indicates NGE at Estimated depth to high ground water: 130" 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: _2/22/08 -- 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 indicates NGE at 130" 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 i r-- 3/22/2017 Assessing As-Built Cards TOWN OF BARNSTABLE OCATION *3 d 9 W.'„N h o Ay-e SEWAGE N a.04-0G 0 VILLAGE Oster�,:llc ASSESSOR'S MAP&PARCEL IqO- /ay-d0a INSTALLER'S NAME&PHONE NO. ,TZ, Ay/fo SEPTIC TANk CAPACITY ��,lYf ljootl LEACHING FACILITY:(type) ; Soo!., cA.0,4.-d (size)/1'lc"k 33,5 k it. NO.OF BEDROOMS `I OWNER _ PERMIT DATE: /-,2 8-/0 COMPLIANCE DATE: a� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Fcot 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_ i I ! I i Ir"14 i i http://www.townofbarnstabl e.us/Assessi ng/H M displ ay.asp?m appar=140124002&seq=3 1/2 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 329 Wianno Ave Property Address EWALD, MICHAEL A & LAURIE H Owner Owner's Name information is Osterville Ma 02655 3/20/17 required for every _ 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 LOCATION' SEWAGE PERMIT NO. XiLlAGE j p cis Qy- v �' INSTALLER' NAME JL ADDRESS BUILDER OR OWNER t Q -er -� ® ATE PERMIT ISSUED � 3 DATE C0MPLUANCE ISSUED ' Oy Z 4 k ZY 2 4 : .�Jo.� -1.3.....4.......... Fps.....�.�..................... a -` THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 1-(-fin!1�i-------------OF........F `�.A?Z�_L ....................... Appliration for UWposal Workii Tnnitrurtinn Prrutit Application is hereby made for a Permit to Construct (r/) or Repair ( ) an Individual Sewage Disposal System at: c ...... ........--. am---------------- Location-Ad ress or Lot No. ......... .................................................................................................. Owner Address W Installer Address 2.2 2�`Z UType of Building Size Lot---------o_...............Sq. feet ., Dwelling—No. of Bedrooms...................:5....................Expansion Attic ( ) Garbage Grinder (1(q 5 Other—Type of Building No. of persons............................ Showers W g ---•----•----•----------••-• P ( ) — Cafeteria ( ) Otherfixtures -------------------------------•----............------.-----. ........................................................................................ W Design Flow................�-f1-.....................gallons per person per day. Total daily flow_3.YU.1-b...=_7-i-No.....gallons. WSeptic Tank—Liquid capacity.15;. ogallons Length-«?... a"_ Width...5`8." Diameter------------- Depth...~,. " x Disposal Trench—No. ................. Width................. Total Length.................. Total leaching area........._--.......sq. ft. Seepage Pit No.........I.......... Diameter........(..-..... Depth below inlet........ Total leaching area...-.-53 ..sq. ft. Z Other Distribution box (Vl� Dosing tank Percolation Test Results Performed by..b.hXTE!�. __N'�E.� A ?,IDate_..b[=c` Ib� 1�82Z•-•.. ,.a Test Pit No. I...L3......minutes per inch Depth of Test Pit.......1.3....... Depth to ground water....W.o NE...--- (Z4 Test_ Pit No. 2...E_1._....minutes per inch Depth of Test Pit.......1..-W._.... Depth to ground -------------------- ---------- ------------.._...•------� ---------------•-•------------------........---------------.---------------- O Description of Soil.._,.". *1.... ----------moo-Zvi-....-t'of.° ---•-t-----5AE>5p_P�----------------------------•----•-••---------- -:.. U W •--- -----------------------------------------------•------------.......--------------------------------------------------------------------------------------------------------------•------•-------------- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ....••... -•----•--•-•••-••••...••---•••••••-•-•---•----•--•---•--••......•....•••-•....-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT11 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliarice h een issued by the board of health. ned-- ••••---••-•-..........••-•--•••--•...-•-.........-•--•..........-••....._. Z ... . • Date .......Approved B�or rApplication Disapproved t e following easons-.......-...................................................................................................... --------•--------------------------------------------------------------------------------------•--------........-----------------------------------------------------------------------------------•-•_.. Date PermitNo......................................................... Issued....................................................... Date ado.8 �6�.. Fss..... ............. i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..7. . -\\J.:N...----.....OF.........8. ` ' � .. ............................ Appliration for Mipati Fal Works Tontitru rtiun rprutit Application is hereby made for a Permit to Construct ( vj'or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. Owner Address W Installer Address d ' �Type of Building Size Lot...._...J..................Sq. feet Dwelling—No. of Bedrooms.................................____._..Expansion Attic ( ) Garbage Grinder ('Y f)S p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a �5 W Design Flow.--Other fixtures -----:-•.-.---_:gallons per person per�day. Total da>ly flow.: ..�4.1.1_C�.__.....��G'?.....�long. WSeptic Tank—Liquid capacity.-� .gallons Length................ Width._,'._.b._... Diameter................ Depth... x Disposal Trench—No..............._... Width................. Total Length........:"'._..._.Total leaching area........:-........sq. ft. Seepage Pit No.........I.-.____--. Diameter.._....0.pp"��..... Depth below inlet........5i!....... Total l�leaching area...�2��!...sq. ft. Z Other bution ox '-' Percolationr1Test Results Performed byl ' �• .NYt-- 41„S) .� a-, A�tq>a!Date.._��G��� i`��'Z-•__._.. t Test Pit No. I...4:?.....minutes per inch Depth of Test Pit...... ....... Depth to ground water. No_145�....__ GT4 Test Pit No. 2...'!5 '.....minutes per inch Depth of Test Pit...... _�.�........ Depth to ground water14!�%v_ ro R+ ........-•-......----�•........................(•-•-•-•---•--------............................................................ �PL Description of Soil = . ----•-- -- --- U -------------------•-------------------•---------------------------•----------....... .......M �......-A e.l l ------....._..---.._..-------------------------•-------------------- -----•-----------•-•----•.................•------------•------...........-•----•-----•-------------•------------••------•-••----.-------------------------------------•--------- ----------------- V Nature of Repairs or Alterations—Answer when applicable............................................................................................... -----------------------------------•-------------------------------•----.------------------------------------------------------------------•...................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Complia ce h been issued by the board of health. gned •----•-•--•-------•----------------------------------------------•------------- f at ApplicationApproved BY ----------- --------------------------------------------------------------------- j' Date Application Disapproved for t e following reasons----------------------------------------------------------------------------------------------------------------- .....................•------••---•--•----------------------------------------------------..............-----•---•...._...-----•------•••-•-••----•--------------------------------------•---•-•...._.... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS - . BOARD OF HEALTH ...... i.°w. .............OF........... ?.fie 711&i�' is............................... Tntifiratr of To mph aurr I S CERTIFY, That the Individual Sewage Disposal System constructed ) or Repaired ( ) fi - ------------------- ')� Installer at--------------------------•••--•-....••.................---•----•-•------------- •-•--•••••---•••--•-•------------••-----•••••--- ---------- has been installed in accordance with the provisions of T ,F. J The State Sanitary Co /ewin­t.-h;­ ..a lication for Dis osal Works Construction Permit No.... '/PP P -------•-•-------------•--------•- dated ------..... .. THE ISSUANC OF THIS CERTIFICATE SHALL NOT BE CONSTRUE A GUARANTEE THAT THE SYSTEM Wl F CTION SATISFACTORY. DATE.... ..!1.... ............................................................... Inspector-•--• ........ == THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH FEE........................ i 1� k ��anrarr#inn rrutit Permissioereby grante ••••-•-••- -•---.---------•--•-•---•---•--------••---••-••--•----•..................••-•----..............----•- to Const air,'( ) an Individual Sewage Disposal System atN ----- '"'-..........................................................-'.7------- --------------- ------------------------- ...---•--. Street 00 as shown on the pli ion,for Disposal Works Construction Perm _.:oard .___... ated..... c -----•---------------- ------- --------- ------------..----------- of Health � DATE............. ------------•----••---••--------------•-•---------•-••........... FORM 1255 A. M. SULKIN, INC., BOSTON Qj _ m0 i � On i s o I oa Ole r - Town Of Barnstable �oFtHE r Regulatory Services Thomas F. Geiler, Director RARNSrABLF. Public Health Division 1639. 'O�En Ma+A Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-79.0-6304 2©CAB _ Date:`M der_ -k S Sewage Permit# OGO Assessor's Map/Parcel. 11A0 —\-ZA—00 a Installer& Designer Certification Form Designer: SUL-L-\vgou rCc)roirvr vn7 "C. Installer: : � Address: '7 � ��Q. Address: zPa ffa ' 3 3 cI On /— /0 l), jl�, c/0 was issued a permit to install a (date) ` ` (installer) septic system at 329 Y„1 "Lo 4yE �5► `� based on a design drawn by. (address) �u LLA V A&N Gz4 N Lc, dated G,& ?nos (designer) I 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., Stripout (if required) was inspected,and the soils were found satisfactory. 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. Stripout (if`re inspected and the soils were found satisfactory. R sOUWA (Installer's Signature) No. 29733 91LAL ' ` (Designer'sSignature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE' OF.COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. q:\office forms\designercertification form.doc COMPLETE •N COMPLETE THIS SECTIONON g. I A. Si nature I To items 1,2,and 3.Also complete item 4 if Restricted Delivery is desired. X .,3• ❑Agent i ■ Print your name and address on the,reverse;)l ❑Addressee ' so that we can return the card to you:� `` B. Received by`j(Printed Name) f Delivery � I E Attach this card to the back of the mailpiece, Is' C' ' I or on the front if space permits. -,", C. Date o t,°y�( D. Is delivery address different from item 1? ❑Yes I 1. Article Addressed to: If YES,enter de' address below: ❑ No I I Estate of Margaret Schult i 329 WlalmO Avenue 3. service Type `. I MA 02655 ❑Certified Mail Cl Express Mail Osterville ❑ Registered ❑ Return Receipt for Merchandise I ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes I 2._Article Number 7 0 0 5 1160 0000 0191 15 81 (Transfer from service la PS Form 3811,February 2004 Domestic Return Receipt 10 95-02-M-1540 t �', tt tt � tt _ ti ► t 't t �� tttt� tt its l , IKE .°` Town of Barnstable �PsPosp Public Health DivisionBAMSr 1 c 200 Main Street P""E`�5 Hyannis, MA 02601 4 7005 1160 0000 0191 1581 0004606236 MAY11 2006 MAILED FROM ZIP CODE 02601 �. Estate of Margaret Sch It 1st NOTICE. 329 Wianno Avenue , Osterville, MA 02655 . 2nd NOTICE' NIXIE: 029 1 02 05/ 2 0✓06 RETURN TO SENOkt', , NO MAIL RECEPTACLt UNADLE TO FORWARi. 6i 9-6647z-7-i 7-39 0260104002 "1111111IdIII)I11111I III III)IIIIIIII1 oil 11111111111)1)11111 F(S§Momes ostal Se ry i UUTM IFIED M�41LTMic Wil�Only;No Insuran!e1Coverage Provided) tFoidilivery,information,visit our website aat www.usps.como OFFICIAL USE W. TForm 3800,June 2002 See_Reverse for,lnstructions Certified Mail Provides: A mailing receipt (esianay)ZooZ aunp'ooeE Wood Sd o o A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail®or Priority Maile. a Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. �; a For an additional fee;a,Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted-Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not availaltle on mail addressed to APOs and FPOs. Town of Barnstable F THE 1p� o Regulatory Services Thomas F. Geiler, Director 9�A MASS'. •�� Public Health Division tFD MA'S A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 11, 2006 Mr. Henry Klimm 145 Pleasant Street Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located 329 Wianno Avenue, Osterville,MA,was last inspected on April 12th, 2006 by, James M. Ford, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has "Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: A single cesspool automatically fails in the Town of Barnstable. You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder, please feel free to contact the Barnstable Health Department. BARNSTABLE HE TH DEPARTMENT Thomas A. McKean,R.S., C.H.O. Agent of the Board of Health o,. Town of Barnstable ppIHE r o Regulatory Services snxxsrng Thomas F. Geiler,Director MASS 16.39. •�� Public Health Division rED MA'S s Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 11, 2006 Estate of Margaret Schult 329 Wianno Avenue Osterville, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located 329 Wianno Avenue, Osterville, MA,was last inspected on April 12th, 2006 by, James M. Ford, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has "Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: ` " The septic tank is H-10; it is not constructed for heavy duty(H-20) loading You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder, please feel free to contact the Barnstable Health Department. BARNSTABL EAL H DEPARTMENT �1rYb Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health 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: .329 Wiannsp Avenue Osterville. MA'02655 Owner's Name: Estate ofMarzaret Schult Owner's Address: Date.of Inspection:. April 12, 2006 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508)862-9400 , i , CD T7 CERTIFICATION STATEMENT �. I certify that I have personally inspected the sewage disposal system at this address and that the information reported ` below is true,accurate and complete as of_the time of the inspection. The inspection was performed based on m"y training and experience in the proper function and maintenance of on site sewage disposal systems. I m a DEPI rn- approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes NeedsrFurther Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: April26, 2006 The system inspector shall sub i a copy, of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of.10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes condition's at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page.I Page 2 of 11 ; OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 329 Wianno Avenue Osterville, MA Owner: Estate ofMarvaret Schulz Date of Inspection: April 12, 2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: ✓ One or more system components as described in the"Conditional Pass" section heed to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: ✓ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The septic tank was.11-10 and in the driveway. It needs to be made H-20 loading. The system required pumping more than 4 times ayear due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 • Page 3 of 11 i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL_SYSTEM INSPECTION FORM PART A ;CERTIFICATION (continued) Property Address: 329 Wianno Avenue Osterville, MA Owner: _ Estate of Margaret Schulz Date of Inspection: April 12, 2006 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or.privy is within,50 feet of a surface water Cesspool or privy is within:50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank.and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate Nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy.of the analysis must be attached to this form. 3. Other: i 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 329 Wianno Avenue Osterville, MA Owner: Estate ofManzaret Schulz Date of Inspection: April 12, 2006 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded,or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is'less than 6"below invert or available volume is less than ''/2 day flow ✓ Required pumping more than times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high groundwater elevation. ✓ Any portion of cesspool or.privy is within 100 feet of a surface water supply-or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] (.Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is.within 200.feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-.IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in.Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section.E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. � 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 329 Wianno Avenue Osterville MA Owner: Estate of Margaret Schulz Date of Inspection: April 12, 2006 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ _ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) . ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the sitei 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(arid occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ _ Existing information. For example,.a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 329 Wianno Avenue Osterville, MA Owner: Estate o Margaret Schulz Date of Inspection: April 12, 2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):. 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): . No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL 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): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of infonnation: Unavailable Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: .TYPE OF SYSTEM Septic tank,distribution box,soil absorption system - Single cesspool Overflow cesspool Privy Shared system.(yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. 'Attach a copy of the current operation and maintenance contract(to be. obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed on 6111183-per as built card Were sewage odors detected when arriving at the site,(yes.or no): No 6 I t Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 329 Wianno Avenue Osterv_ille, MA Owner: Estate ofMarQaret Schulz Date of Inspection: April 12, 2006 BUILDING SEWER(locate on site plan) Depth below.grade; Materials of construction: _cast iron 40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 8" Material of construction: ✓ concrete _metal _fiberglass _polyethylene other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of. certificate) Dimensions: 1500 t?al. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 6 " Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): The liquid level was even with the outlet invert. Tees were present There did not appear to be any signs of leakage Half of the tank(H-10) was under the driveway. It needs to be made H-20 loading GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffles. Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 r - 5 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 329 Wianno Avenue Osterville, MA Owner: Estate o Mar aret Schulz Date of Inspection: April 12, 2006 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: eallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm.and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): No solids were present. The D-box was under a brick walkway, PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Corn ments(note condition of pump chamber;condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 329 Wianno Avenue Osterville, MA Owner: Estate ofMarzaret Schulz Date of Inspection: April 12, 2006 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) - If SAS not located explain why: Type ✓ leaching pits,number: I -6'x 6'(1000 zaL) 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.): The leach pit was dry. The scum line was 1.5'up from the bottom There did not appear to be any signs o[failure The bottoiu to Qrade was 8'. The cover was 16"below grade. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued). Property Address: 329 Wianno Avenue Osterville, AM Owner: Estate ofMarQaretSchulz Date of Inspection: April 12, 2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate w—here public water supply enters the building. F, IL , 3 3 aS` y ys� ;L-7 aCIJe.WA 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 329 Wianno Avenue Osterville, MA Owner: Estate of Margaret Schulz Date of Inspection: April 12 2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 30+/- feet Please indicate(check)all methods used to determine.the high groundwater elevation: . Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: topographic.and water contours in Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours inaps the snaps were showing approximately 30'+1-to ground water for this site This report has been prepared only for the septic system and components described herein. This septic system has been inspected and conditional passed as,of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees,either expressed,written or implied, relating to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. ' 11 TOWN OF BARNSTABLE �\ .LOC"ATION 3aq� �lC"-, ,ate. SEWAGE# t.V LLAGE OS lerXj Mc ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO.. .ha-CCA I's 1 - 57C-1-4•q _ saq SEPTIC TANK CAPACITY /SOQ r�H-1; WJ LEACHING FACILITY:(type) %� T- T�(�%n (size) NO.OF BEDROOMS .3 OWNER /"'57/-Wj c ,CT " t, TZ PERMIT DATE: S -/a -U(� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Q Q , - 17 X y .. Q TOWN OF BARNSTABLE LOCATION—I Wwm o /HIV°�-' SEWAGE# ',--ILLAGE 0S G(U,I tL ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY �rw LEACHING FACILITY:(type) ! G X G (size) 1401) NO.OF BEDROOMS 3 OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY �nSpi� -T. FO/c A g r ) a 19 ao� y yS` ;nIL y ��JewA No.. (✓1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippYication for Di5po5al �&p!tem Con5truction Verna Application for a Permit to Construct( ) Repair(f)^Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. 3.1 Ct "�/ l A laxi0 Avc Owner's Name gfdress,and Tel.N A46eri77r Tar �.l�c lrSTgCc o- RAC Ar�Zx�..1 - 508-5a8 Assessor's Map/parcel t& V r_k F(, �gb v�r���l f`tA2 �S, 33Y6b Installer's Name,Address and Tel No. Designer's Name,Address and Tel.No. /Z i Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd 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 a plicable) ?v -t YZZI"Gvr -10 1t t n�-T'cl� 1SooGP,�. �-aOTA.�z �clo�c: t�'xtsf'��►r �s oAg- Le414 in �elwcwr» Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this and of Health. Sig Q to / /� w2- 6 Application Approved by ate Application Disapproved by: Date for the following reasons Permit No. Date Issued .� No. Fee AV uter: THE COMMONWEALTH OF MASSACHUSETTS Entered in comp PUBLIC-HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes R ' plication for Migonl *pgtem �Cow6tructiou Permit Application for a Permit to Construct( ) Repair(Vf Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components � Location Address or Lot No. 3 a q (,J 1()J,100 A v C Owner's Name Address,and'_el.No. �16r�r'r CS\i�C a'� t i;a to c k `LIB.` - 3(,&-lY�8 c \�� +o Mai c.T1� c �o"PCl 6/vb Assessor's Map/Parcel S 3 \�t b v.I a �t t rl aR, �, .�3yocb Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. I3 1 i�vrr� 5 i• � �er.;�\� L( fs S`Sa9 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(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank a Type of S.A.S. Description of Soil yx k Nature of Repairs or Alterations(Answer when ap licable) e" c "� f 1SG6G�\• �-�- �U kii. (vir IBC L.0) p Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance-has been issued by this Board of Health. Sig G6r� ., C Date ) 6 Application Approved ate Application Application Disapproved I �' Date for the following reasons Permit No. Date Issued ——_————————————————— THE COMMONWEALTH OF MASSACHUSETTS Q BARNSTABLE, MASSACHUSETTS " b Certificate of Compliance �I THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (Le-r Upgraded Abandoned( )by S HU re ��,•� � CQ 77, _ at J: ; LV t Ar.r A.r U A V P h s been ristruated'n accordance with the provisions of Title 5 and the for Disposal System Construction Permit No ((/ dated Installer r-y L C.6 0.C.Cl-' , e r` Designer #bedrooms 3 Approved.design flow r . gpd The issuance of this permit shalll not be construed as a guarantee that the system will function as designed. Date ✓/af Inspector .. ---------------------- No. Fee ' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Bi5po5a[ *p5tem Con5truction Permit Permission is hereby granted to Construct ( ) Repair (t.�) . Upgrade ( ) Abandon ( ) System located at 3aG (•,, 91 n,n &c 4 t \2.t'v6 \C and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Constru tion ust a completed within three years of the date oftri'ermil Date C// Approved by Town of Barnstable P# Department of Regulatory Services z ``Public,Health Division Date MAM . . 206Main Street,Hyannis MA 02601 Date a '� Time / Fee Pd.`. '/00 Soil Suitability Assessment for Sewage Disposal Performed By: �1�Qr `�+�ir1 r— _ — WitnessedByi J hk!��Mlhr-4 n(A I iC J�) t LU.CATT N H QR T - Location Address Owner's Name. �Z� ,1JVZi�trlrlj Address l�}O �oi rce� I . Assessor sMap/Parcel: 2002.2 Engineer's Name. `'j k�o J('n .ZK� NEW CONSTRUCTION REPAIR Telephone# 6M" 4-2-9".33 14 Land Use � d an A?k�. Slopes(96) 3 Surface Stones. t � A- is ;i J_ Distances from: Open Water Body f iossible Wet Area�� ft Drinking Water Well ft Drainage Way 500 ft Property Line (0 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) o I 3 n10A f ONN VIM I " I' `} Parent material(geologic) a,a 5 Depth to Bedrock Depth to.Groundwater:.Standing Water in Hole:' Weeping front Pit Fa Estimated Season%al High Groundwater-3 t r �L -Z.S �e•^ T d:L� 1Kk�IP 5� HETNAIONIYt SEASOAL: G WT R T LE Method Used: der NtU� Depth.Observed standing in obs.hole: in,..Depth to 1611 mottl s: Depth to weeoine from side of obs hole:_ (around eater Adjustment. - Index Well# Reading Date: Index Well level.,®.�..; A�;factor dro lndwater LeW Observation r Hole# Time at 9.. Depth of Perc Time at 6" Start Pre-soak Time @ ` me( Ti9"•6") End Pre-soak Rate MinAnch, 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 OBSERVA'TION TOLE LOG dole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA). (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) ; 6-3� P 157 C me 2 (Q i i i . - I. Y,;• III DEEP OB�SERVATIO►N TOLL.LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency,%Gra el lo- 3 DEEP Q► SE�V TrON HOLE ., Mille Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (US1jA) (Mansell) Mottling (Structure,Stones,Boulders. I' Consistency, o Gravel) PIS OEEVO$SERVA. HOLE LOG Holy#, 4'. Depth from Soil Horizon Soil exture Soil.Color Soil' Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, r 0 -.Z LAYN F. Flood Insurance Rate Mao: Above 500 year flood boundary No Yes �!f Within 500 year,boundary No .- Yes Within IOU year faun Wandaq Nc;- Yes. Depth of Naturally'Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? �jtr5 If not,what is.the depth of naturally occurring pervious material? ;ertiflcation I certify.that on 114 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above.analysis was performed by me consistent with . the required training,expertise and experience described in 310 CMR 15.017. Signature Date Z 66 Q:\SEPTIOPERCFORM.DOC II C• p C3 . .A 1 0. • .•. rl Q' • F •I Postage $ • 39 ! 'yam Certified Fee �L iS \ 0 FQstmark Return Receipt Fee /JOi\ ti Here (Endorsement Required 7 C3 Restricted Delivery Fee (Endorsement Required)r=I \\[09 r-R Total Postage&Fees i_r7 C3 Sent To o .__=_�+r� �_' Street, No. ---- ------------------- Apt,No.; �/ orPOBoxNo. f"1`j__---- - ------------ �er,�_ S _ City,State,ZIP+4 77 oa 6a I il Certified MPrOVIdeS:receipt (asi r'ooes W;0.1 Sd anea)ZOOZ sun o A unique identifier for your mailpiece a A record of delivery kept by the Postal Service for two years Important Reminders: n Certified Mail may ONLY be combined with First-Class Maile or Priority Maile. o Certified_Mail is not available for any class of international mail. - o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt seance,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. a For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restdctedefivery". . o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. THE Town of Barnstable r ' Regulatory Services sSTnB Thomas F. Geiler, Director 9�A =MASS. •�� Public Health Division rE'D MA'S A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 11, 2006 Mr. Henry Klimm 145 Pleasant Street Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE Title 5 The septic system owned by you located 329 Wianno Avenue, Osterville, MA, was last inspected on April 12th, 2006 by, James M. Ford, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has "Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: A single cesspool automatically fails in the Town of Barnstable. You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTABLE HE TH DEPARTMENT Thomas A. McKean,R.S., C.H.O. Agent of the Board of Health 5—1,42-/��� COMMONWEALTH OF MASSACHUSETTS ID 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: 145 Pleasant Street c Hyannis _z Owner's Name: Henry Klimm Owner's Address: �. /_—� 7 4 Date of Inspection: 4/27/2006 CD -� Name of Inspector: (please print) Patrick T. Sullivan -,. Company Name: Ready Rooter cry Mailing Address: P.O. Box 371 ' 'n Sandwich,MA 02563 Telephone Number: (508)888-6055 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The System: Passes Conditionally Passes Needs Further Evaluation by the Local Authority __IZFails Inspector's Signature: Date: S 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. Notes and Comments �yam'j��,iv�(� C p•J..3 i �5 c�� W �j'v ��S'S l7 �=a.�5 V�..�� ****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. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 145 Pleasant Street Hyannis Owner: Henry Klimm Date of Inspection: 4/27/2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which ' dicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any fai re criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass:�tection need to be replaced or repaired.The system,upon completion of the replacement or repair,as appdved by the Board of Health,will pass. Answer yes,no or not determined (Y,N,ND)in the for the foowing statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the s ptic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or to failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as a roved by the Board of Health. *A metal septic tank will pass inspection if it is structur y sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is avai able. ND explain: Observation of sewage backup or break Zr high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled�qr uneven distribution box. System will pass inspection if(with approval of Board of Health): sbroken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: / The system required pu 7fng more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with appro v of the Board of Health): ' broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 145 Pleasant Street Hyannis Owner: Henry Klimm Date of Inspection: 4/27/2006 C. Further Evaluation is Required by the Board of ealth: Conditions exist which require further evalua'on by the Board of Health in order to determine if the system is failing to protect public health,safety or the env} onment. 1. System will pass unless Board of Hea h determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a mann which will protect public health,safety and the environment: _Cesspool or privy is within 50 eet of a surface water Cesspool or privy is within 5 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Nyater Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: 1 _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 supt3ly. _The system has a septic tank and SAS and the F SAS is within a Zone 1 of a public water supply. r The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _The system has a septic tank and SAS.and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. F= r' 3. Other: r r Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 145 Pleasant Street Hyannis Owner: Henry Klimm Date of Inspection: 4/27/2006 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 and overloaded or clogged SAS or cesspool _ Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped 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 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails. I have determined that one or more of the above 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 syste /musts facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to eaing: (The following criteria apply to large system the criteria above) yes no the system is within 400 feet of a rface drinking water supply _the system is within 200 feet o a tributary to a surface drinking water supply the system is located in a ni ogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water s ply 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 lar a system has failed.The owner or operator of any large system considered a significant threat under Section or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner sh ld contact the appropriate regional office of the Department. r Page 5 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 145 Pleasant Street Hyannis Owner: Henry Klimm Date of Inspection: 4/27/2006 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _ Pumping information was provided by the owner,occupant,or Board of Health _ Were any of the system components pumped out in the previous two weeks? _ Has the system received normal flows in the previous two week period? ,C 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 sep6-.tic 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 than 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 _ v-' Existing information. For example,a plan at the Board of Health. SZ11,_ Determined in the field(if any of the failure criteria related to Part Cis at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] r - Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 145 Pleasant Street Hyannis Owner: Henry Klimm Date of Inspection: 4/27/2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_Q_ Number of bedrooms(actual): _ DESIGN flow based on 310 CMR 15.2.03 (for.example: 110 gpd x#of bedrooms): 0� Number of current residents: (� Does residence have a garbage grinder(yes or no): � Is laundry on a separate sewage system(yes or no): -�[if yes separate inspection required] Laundry system inspected(yes or no): — Seasonal use:(yes or no):,Op Water meter readings, if available(last 2 years usage(gpd)): Sump Pump(yes or no):.�c�- Last date of occupancy: �aL COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203 gpd Basis of design flow(seats/persons/s . etc.): Grease trap present(yes c no): Industrial waste holding tank pres t(yes or no):._ Non-sanitary waste discharged t the Title 5 system(yes or no): Water meter readings, if avail le: Last date of occupancy/use- OTHER(describe): / GENERAL INFORMATION Pumping Records Source of information: JQ." —'Q Was system pumped as part of the inspection(yes or no).-!5��--s If yes,volume pumped: 6�� gallons--How was quantity pumped determined Reason for pumping: V, _ law o.� TYPE OF SYSTEM _Septic tank,distribution box, soil absorption system Single cesspool _Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval _Other(describe): A�Foximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):L—_3(1� Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM : PART C SYSTEM INFORMATION (continued) Property Address: 145 Pleasant Street Hyannis Owner: Henry Klimm Date of Inspection: 4/27/2006 BUILDING SEWER(locate on site plan) Depth below grade: \ I e'I'l Materials of construction:_cast iron_40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: Material of construction:_concrete_/tal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age con ed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from the top of sludge t bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to p of outlet tee or baffle: Distance from bottom of sic to bottom of outlet tee or baffle: How were dimensions det ined: Comments(on pumping commendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet inve ,evidence of leakage,etc.): GREASE TRAP:_(locate on site pl Depth below grade:_ 7Y Material of construction:—concrete/— metal_fiberglass polyethylene_other (explain):_ / Dimensions: Scum thickness: Distance from top of scum to to of outlet tee or baffle: Distance from bottom of scum o bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping rec mmendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert, idence of leakage, etc.): f Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 145 Pleasant Street Hyannis Owner: Henry Klimm Date of Inspection: 4/27/2006 TIGHT or HOLDING TANK: (t must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction:_concret _metal_fiberglass_polyethylene_other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or)no): Alarm level: rm in working order(yes or no): Date of last pumping: Comments(conditionlarm and float switches,etc.): DISTRIBUTION BOX: (if prese must be opened)(locate on site plan) Depth of liquid level above outlet in ert: Comments(not if box is level and istribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): 1 " PUMP CHAMBER: (loc/sin) Pumps in working order(yes or nAlarms in working order(yes or nComments(note condition of pumondition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 145 Pleasant Street Hyannis Owner: Henry Klimm Date of Inspection: 4/27/2006 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensio overflow cesspool,number: innovative/alternative system ype/name of technology: Comments(note condition of soil, igns of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): 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: Q it Depth of scum layer: Q., Dimensions of cesspool: 'T Materials of construction: Indication of groundwater inflow(yes or no):_L� Comments(note condition of soil,signs of hydraulic failurer level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,si s of hydraulic failure, level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 145 Pleasant Street Hyannis Owner: Henry Klimm Date of Inspection: 4/27/2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. -r I � k I 1 � I � J l O Y�4 Ac 4 "J Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 145 Pleasant Street Hyannis Owner: Henry Klimm Date of Inspection: 4/27/2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water>A feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: l Observed site(abutting property/observation hole within 150 feet of SAS) Checked with the local Board of Health-explain: Checked with local excavators, installers-(attach documentation) _,Z-Accessed USGS database-explain: _, �,,�,�,._ c, ,,Z, � You must describe ow you established the high ground water elevation: v ' ; r � I Q Town of Barnstable � p lam"'..uT ' Public Health DivisionRAM 200 Main Street '` 1A0 Hyannis, MA 02601 r wrNEV Bowes _ .: 0 2 1 A $ 04.649 7005 1160 0000 0004606238 PRAY 1 1 2006 �191 16�4 i { MAILED FROM ZIP CODE 02601 �t Mr Henry Klimm 145 Pleasant Street Hyannis, MA P2601, KLIM146 029 1 1 N C 02 OS/19/06 RETURN TO SENDER NO FORWARD ORDER ON FILE UNABLE TO FORWARD RETURN TO SENDER BC: 0260 1401145 PM *0969-06726-17-39 0260109990 111)111 lit L111 III fi1l1ddiI11'!'1 fly;111 17 . � _ ... SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY I ■ Complete items 1,2,and 3.Also complete A. Signature I item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee i so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery I ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No I i I A I I i I Mom:-Henn Klimm y 3. Service Type 145 Pleasant Street ❑Certified Mail ❑ Express Mail 1-1-yannls, MA 02601 ❑ Registered ❑Return Receipt for Merchandise j ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7005 1160 0000 0191 21604 (Transfer from service label) PS Form 3811,February 2004 Domestic Return Receipt V1241111240 isao r Town of Barnstable i OF THE Tp� do Regulatory Services STABLE Thomas F. Geiler,Director BAM9�A 69. •�� Public Health Division QED MA'S A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 11, 2006 Estate of Margaret Schult 329 Wianno Avenue Osterville, MA 02655 Y ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located 329 Wianno Avenue, Osterville, MA,was last inspected on April 12th, 2006 by, James M. Ford, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has "Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: The septic tank is H-10; it is not constructed for heavy duty (H-20) loading You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder, please feel free to contact the Barnstable Health Department. BARNSTABL EAL H DEPARTMENT rYVI Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health f� TOWN OF BARNSTABLE � OG D LOCATION W 3 a 9 W ,0 h� /4✓� SEWAGE# 9000- VILLAGE 05 fer✓.'11 C ASSESSOR'S MAP&PARCEL A/0- I,2` - INSTALLER'S NAME&PHONE NO. T C Al 16 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) /.t'/o NO.OF BEDROOMS `I OWNER PERMIT DATE: f_a 8-/J COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet ' FURNISHED BY I 1 1 . 9 � � 'V✓ five i i i r ----- ---- 112 cn i � I 1 i irACt i4 ^� �rm101 V \' L i. 3 2q . f a � a � \ r i sc•L{r' -Y ..!!� . . / ..�..Crr l." '{�L" `'/fie{ `- �./ ... % 61 rl T�t- �- H. - :} .,"t^o c1:.. N pa 7"ESr LTS '� �O�t•t ���c��j �.F.'�Cs�t. EL gV s L3�9��D c�,t/ f 55�/.� t ,pht ti; �, r �% m . "CcYFurr QUA,U� tJt E'.' SF.uD . Pgo'T. 8.M. =1,A 40j- D7`j ,41 OK I•:- ,v. w, cOP €€ W t AMa1./O .AvC-:,,�.CKY5T-AL �#1'Clr �.u.�?�Y'i4+,o a- _ J. �"•..r....<._,r..�.'s' -�. 9 oR�u E� Ee. MIMMU A (3�ILDtiv�la "N N O L.- To FX , C�u,�►v> 2% WIT41M ONE. FOOT OF or t5N GRo�� O V S9 BEACH AREA ! o� zO of PSA 9Tor V- Faa �sSoy. . - - - �/Vk�V'1 -�`"tovE��•-"�„" _ A. A �EVIM ri w6c* ��'�r.+ !►JFII.T��#Ti1tG-rr NE. - _ M P i of .40f At, 17t 2L1t ` 7 /W�1, ''' r1 Tie A 1H3.�l�fi / STONE GALA—©N � I 1 WaRTALL !' 75' ;;pq�P' r CITY 4 23 3-3 4't7tP 4 �Rv � 5��.iG . l"ANpC. itdV�K,T, .�1��. � c• •� ! � lJ yes C Ai P.AO GRrt.lPS 5EP-rl G 5yST EM CoN`STRUG-toN 5 At-L CONFORM RM -M "'HE .)%ASS. - � • SUM vF ��vu�oMS, P�t,I RorIMeNTAL COPE TITIoe x of 00AW OF u ►VTR-t REcaU t-p►-t►a t5 � S"ORT L EAGN i�1�a RATS, H . No.27li3� 6 ' � ANt7 L ACN.trJl i�tT 'f© aE o:F '� a REG? 0 (. C, . CA AGlT' S3 ��� 2 �. Rt:il�1F'tSRC.�T� GottGRET� �S�x� .4 2 7 x ► �7$ �:p� �G�`j' oc9"F, TAl4m► .rlf . '.2 f ,g G Y /2 tor7'l. 1 E s .... G iQ L OAolk4q PRt-JeNJAY tlor To 8E LocArmv LA wff. W4S*r&A uNLZA J+ 20 OA 1N�• Q�r OF V 6S07 .. ENGINEERING DESIGNI1 BUILDING- INC. rt , D�NNIS,.MAS 385n283 t ----------------- ------ -- --—�-�—-—-—- o. ' A # 1 D^ap io io i� { r 1 Z . . 1 i � I . pi �o � € blip � w WALE1 114*-11-0' aun yams me mmy ne mwoec u m FIRST: FLOOR PLAN AS�'AIHOI AM°°a""""w""& NORTHSIDE CWYMDHT DATE �oHs O I Z 4 6 • - tw meats nE.ro+�un a eiv+mt �1°°o°I amaHWTHSIUEE)0!RE3Y. DESIGN EuVrom �' a D RESERWS ESIGN THESES SHEET N0. IT !'ORI ww xn t�s a owuas wnma No�T mBE REPaoou�ARE - DALE: - .. wle m ewew a w®na w tK ASSOCIATES - DRAWN Rew a 811e1e11eK avmwes M - CHANGED OR COPIED IN ANY TERRA FI RMA PROPERTIES FOMI OR MANNER MHA750E1FR I1/18/07' �BE To DISIBICIIYE ..MIHOUT I=OBTAINING THE " A 29 TERV I I AVENUE mmn ov�xtlsllr on a w�amn � �g COY4EItCUL OE9GN E7�F35 MOM P M MON tat-rVW STREET•YARMOYRIPOW•MA 02M -AND CONSENT OF NORUWW - CHECKED .OSTERVILLE, MA. o sD"�a w elml"f0"1°M°cnww""' G+o»xa-ato G+o»xx-em �y�yy j awe.> wr { lI� _� — —_—_=_— = - LI. i IL I� 5 i I ii II II I _ I II. II ft L jI m'-4' irz irni wil Ing ` 3 I lei wg ®� sCA Z. 1/4••11-0 n.o,� m SECOND FLOOR PLAN' aWLTNo=tK ""°"°`°"°' ` �IGNT DME REVISIONS °'�°��°� °°w� NORTHSIDE ow wmnM�m wrosva�n s Noft7N�E MFA®Ylawxmr DESIGN 0 I Z 4 ' a w°�am nE�x�s rts anwox uw ASIUM NO�O SKM w1 UMWlY DESIGN coaxncNr. � , rwl Mtr�nS4t wOAYmwwAwm ASSOCIATES NOT TO BE cEo _ SHEET N0, k o e m ormas ox owmve w nc DATE aAe«snMc,wAl mm,ofs w wANGm ae cmm w ANY DRAWN. TERRA FIRMA PROPERTIES o «oo�o�•� FORM OR��+ A/� nuT sane mwEwOwo mw�eooK VATHOUT AST o8TNlENO. .2 IZ/IB/07 f 329 WIANNO AVENUE ," o�°:,�;,:.,��p ,,, gsnNcmE r loEmw�s colwN l Drs�N �s wllm=s1loN vm IE1E1 AIw MiPONAL 1®N°NO MR 141 MNN BFRW•rAPMOUNWOff•W1 02178 ANO CONSFNr of NQl1NSIDE - CHE� 05TERVILLE,-MA. vasgwe ors w smuciwK' ( >�x-ago ion)=2_.of AMC { F r / ASSESSORS REF.: a �• - �a w' Map 140, Parcel 124-002 1 OVERLAY DISTRICT. >0. AP - Aquifer Protection District +' ZONE: FLOOD ZONE: r: , RC Zone C `r' G Area (min. 87,1200 SF(RPOD) Community Panel No. PROPOSED ( Y 4t` + ��' 6�. 1 250001 0016 D Fronts a (Tin) 2O � n otbe� S.A.S. 1ti��� �'� o Width min) 100' July 2, 1992 c� Setbac s: 5 O �J Front 20'60 EXISTING PIT Side 10' Location Map: 0, �I oto 161� "Acti ti \ SEE NOTE 10) Rear 10' Scale: 1"-- 2,000'.+ EXISTING SEPTIC `� `~ co �t •--CTANK & D-BOX �' O 2006-224 a,.IT our, all. X cQ r�� \ \ / PERC TEST:12,125 � PEWORMLOBY:0tNo7nu,srr.-sDUIVANn6314131210 Wrl7eesasoeY:DONNAZIMORAMLR..-mV►OFBMWAME FEBWARY21.2009 OCooa �� fZ I \ TEST HOLE-t 335 TEST HOLE-2 BI.33s TEST HOLE-3 m.33s TEST HOLE-4 EL335 S \ LOAM LOAMAL7 LC LOAM LOAM \ p BLAYA16YRSl6 S BLATERI 9 LAM Off-IN BLAYER10YRSA6 O TELtowIss FRurs MFA FB�S 7 MBD WNB4 Y FRas \ CIATM25Y6K CLAYHt2 6N CLATFR25Y61a CLAYM25769 \\ PROPOSED \\\ l LRAITYEL1oWMENO01N LwRryulJOWISBB6OWN LKWTEi AW"Rmtcywm LrcarrvRlloWlsaRRawN �o� , MBD o MRD.III 1 MA SAtD ADD1710N �a !� Noa10UNDwATbRb1i0p1N10t1� F>,ee 3a3 F'ffitC783T x9a rwoRwlmwvArmeamouROM 2SOAMONSINSMB1/SSBC 250A IA INSMRt30SEC 1 PERCRA78<2MR&IN 7 f FEItcRA78<2MRYRr o ,L% © Q J•0 DESIGN DATA rcooaomID,vwtslcm+oorRrtR� NOOa00t®WAT&!&a)011tii®tFD \ W. Single Family-4 Beftoms With NO Garbage Grinder Daily Flow-110 x4-440 GPD Septic Tank:440 GPDx 200%-880 GPD Use Bxisting1500 Gallon Septic Tank \ v �o O`rlo /, tt�tX LEACHING AREA ,xG 7 440 GPD/0.74-595 SF Regoimd v' tQ N 14P Sidewall-2(12.83'+33.5')2'-195 SF 3• �� s ' VGt Bottom Area-(12.83'x 33.5')-430 SF g" ' R•3Lp� ` 1\ ! or 615 SF Total Providedraw hbdo ANDFOR N �Q �`L LEACHING CHAMBER DESIGN �' . 5�°��' All Pipes to be Schedule 40.Use LEAC1tBaG D WOM 10 3-500 Gal.Leaching Chambers in CHAMBER S�>-�►, \\ \\ for IT-10"x 33'-6"Washed StoneTt Ids as Shown O. c9. \ \ a•.10• Lid: \ g CROSS SECTION OF CHAMBER \ SEPTIC NOTES FI Ft 353 NOT TO SCALE 60 1.Location of Utilities Shown on This Phu Ate Apprm AtLew 72 Hours \ Prior to Any Bxcavation For This Project&a Coatt"a Shelf Malre FA,M 33A FA.EL M Deciduous Tree the Required Notification to Dig Safe(1-8&-344-7233} 2.The Contractor is Required to Secure App ropaiete Permits From Town sootJMoa(tin) ' Agencies For Construction Defined by This Plea 3.The Water Line Shall be Constructed in Coordination With Coniferous Tree , ,Q, COMM Water,andShall be inAccordance With CMR i.tq-7.0o c a ilo� tX 0 &310 CMR 15.00.The water Line Shall be Sleeved Where Requirod ttitor b Q 4.Install Risers to Within 6-of Finished Grade(4 Regoitod).. Rdifing ToPEL31A0 ® Water Gate (round) 0� S.All Structures Buried Three Fact or Mom or Subject IS�Wa�Tmk s © Gas Gate (round) '� 0�, 0 to vehicular Trafc to be H-20 Loaf'n&his dw Bagmeer's !i 20 Fro w lI4k°1 Catch Basin a CV0; A.�A& . Recommendation that H-20A1WaysbeUwd. As ® 6.Septic System to be Installed in Accordance With 310 CMR 16.00& ClI mbur .� u u r Mf Q iron Pipe ���,.---- �5�,�"� 248CMR1.00-7.00 Latest Revision and the Town ofBarnstable DOLEL28M El CB/DH �s� c�� Board of Health Regddions. •I-tigers ne e -0 Guys 7.Ail Piping to beSch.40 PVCRVbw s ® S'J...':,:b'f�N -� 1a as PaTitks -0- Utility Pole CIVIL' Ln 8 almumofl BefowthoFbWLiae 0" IWMIL-syt, (SaeNoras89) 7�s.o ro oar rs OHw— Overhead Wires N o,2 7,3 9.An Outlet Tee Shall Extend 14"Below&eFlow Liney 25 Elevation Contour �� �; 0- andShdlbeBgaipedwMaGasBafite DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM ar.ss S 33X9 Spot Shot Elevation t � v 10.Existing Leach Pit to be Removed,errAbandonedby N'•O_ A F.rTAB(IraidW Pumping,Crashing,and Fifflo& TI TLE: Slte PIaan PREPARED BY PREPARED FOR: NOTES Proposed Im YoVementS Sullivan Engineering, Inc. CapeSury 1.) The structures shown were located the ground s �' Ellen Val en tgaS by conventional survey methods on 081JUNE120OZ rn PO Box 659 7 Parker Road . The property information shown hereon was Cb At Osterville, MA 02655 Ostervilie MA 02655 PO BOX 1�26 2 compiled�rom available record information. 329 Wianno Avenue (508,428-3344 (508)428-3115 fox (508)420-3994 (508)420-3995 fox OStervlll e, MA 02655 3.) The datum used is NGVD '29, a fixed mean BARNSMBLE (osterviNe) MA sea level datum. o � � Draft: JOD Field: ►�K/0 20 0 10 20 40 80 4) The intent of this pion is for the permitting DATE. SCALE.• „ Review: Ps Comp/Draft: RRL of a proposed septic leaching area only. February 21, 2008 1 =20, Prof # 27002 Project # C696