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HomeMy WebLinkAbout0391 WIANNO AVENUE - Health 391 WIANNO AVENUE, OSTERVILLK A= 140 173 y 's4 � Sll/l o lam• � UPC 12134Ml N NAITINOI, MN V 1 � � ri I l�j aI � L4 �jt 1 , 1 o Vv ,ot �z?/ "—Si CVaA g .. • s i Commonwealth of Massachusetts = Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M a 391 Wianno Ave. z Property Address Janice Norton Owner Owner's Name information is v required for every Osterville MA 02655 3/25/2016 a page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ® Have large volumes of water been introduced to the system 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): 12 Number of bedrooms (actual): 6+ DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 660 . 1 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 , i Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 391 Wianno Ave. Property Address Janice Norton Owner Owner's Name information is required for every Osterville MA 02655 3/25/2016 � page. City/Town State Zip Code Date of Inspection D. System Information A, Description: ** revised bedrooms and design flow**- Per design plan on file and disscussing with the health department on 1/19/17. Both leach pits were designed for 6 bedrooms each.The septic system is not in the zone of contribution or near any wetlands per health dept. The garbage grinder was removed see permit#P-17-44.This was the health departments decision. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No- Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: unavailable Sump pump? ❑ Yes ® No Last date of occupancy: Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 °Ft" r Town of Barnstable Permit No: P-17-04 ROLM L& IF Building Department 63y.'.�0 200 Main Street ATFO MAC a Tel. (508)862-4038 APPLICATION FOR PLUMBING PERMIT Permit No: P-17-44 Date.Received: d/1312017 Job Location: 391 WIANNO AVENUE, OSTERVILLE Occupany Type: Residential Home Owner's Name: NORTON,JANICE G TR Phone: Home Owner's Address: 57 OAK TREE RD, BLUFFTON, SC 29910 Contractor's Name: Spencer Hallett Phone: (508)428-6080 Contractor's Address: 381 OLD FALMOUTH RD STE 36 E-Mail spencer@hallettplumbing.com MARSTONS MLS, MA 026481588 State Lic. No: 16224 License Type: Master Plumber Location Fixtures Number 1st disposal removal 1 _ Work Description: permanent removal of disposal I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes If yes, Insurance Type: None Specified ; If the licensee does not have insurance, then the Owners Waiver must be signed, and attached to this Permit Application. hearby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowlege and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of hte Massachusetts Stae Plumbing Code Chapter 142 of the General Laws. Company Name: Signed: Spencer Hallett 1113/2017 (508)428-6680 Agent Date Telephone No. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Estimated Construction Costs/Permit Fees ` =....-..............-.._......_.....-- _._.._ .............. _......_ ........__............_............_........................................_._............i.........................__.........._.................................... Total Project Cost: $0.00 Date Paid Amount Paid • Check#or CC# , Pay Type Total Permit Fee: $40.00 1/13/2017 $40.00 12920 Check _........_.._.........__._.._......_..__.........._......_.._....__........_................-.............1......__._._...................._...._.._...__...__.t............._................._....._......_:_................ Total Permit Fee Paid: $40.00 Town of Barnstable a f, . ti�nxsT�s 200 Main Street Tel.(508)862-4038 AIfoMAta`00 INSPECTION REPORT Date: 1117/201711:35 AM Inspector odonnels Permit Number: P-17-44 Name: NORTON,JANICE G TR Address: 391 WIANNO AVENUE, OSTERVILLE Inspection Type Inspection Item •Status Comment Plumbing Final A- Inspection Results PASS „ Inspection Overall Comment: Overall Inspection Status: PASS Re-Inspection Date: I Inspector Initials: Person in Charge Initials: Total Score: 100 � zci o ••� z � i. O w A y LQ ok 11 me -71 tj r Y = + # t �i,• aJO vj On00 77 Y _ f r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 391 Wianno Ave. �D Property Address Janice Norton 'v Owner Owner's Name v information is required for every Osterville ✓ MA 02655 3/25/2016 page. City/Town State Zip Code Date of Inspection m 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 u 5s� on the computer, use only the tab 1. Inspector: key to move your cursor-do not James Ford use the return Name of Inspector key. Ford Septic Services, LLC f ,� Company Name P.O. Box 49 Company Address Osterville MA 02655 City/Town State Zip Code 508-862-9400 S12482 Telephone Number License Number B. Certification 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Furth Evaluation by the Local Approving Authority 3/31/16 Inspect6N SignaturIc Date The s m in sptor 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °�M e,••'• 391 Wianno Ave. Property Address Janice Norton Owner Owner's Name information is required for every OSteNllle MA 02655 3/25/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. 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 i Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,.0 ,•' 391 Wianno Ave. Property Address Janice Norton Owner Owner's Name information is required for every Osterville MA 02655 3/25/2016 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 391 Wianno Ave. Property Address Janice Norton Owner Owner's Name information is required for every Osterville MA 02655 3/25/2016 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑-The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system'has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ .The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow l5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 391 Wianno Ave. Property Address Janice Norton Owner Owner's Name information is required for every Osterville MA 02655 3/25/2016 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. ❑ z 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M a 391 Wianno Ave. Property Address Janice Norton Owner Owner's Name isrequired for every very Osterville MA 02655 3/25/2016 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria'related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 5+ Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): " 550 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 391 Wianno Ave. Property Address Janice Norton Owner Owner's Name information is required for every Osteryille MA 02655 3/25/2016 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: unavailable Sump pump? ❑ Yes ® No Last date of occupancy: unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °�M a 391 Wianno Ave. Property Address Janice Norton Owner Owner's Name information is required for every Osterville MA 02655 3/25/2016 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): I General Information Pumping Records: Source of information: unknown Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval ❑ Other(describe): l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 r Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 391 Wianno Ave. Property Address Janice Norton Owner Owner's Name required for is every Cisteryllle required for eve MA 02655 3/25/2016 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 7/12/89 -as built card Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): i Depth below grade: feet Material of construction: ❑ cast iron ❑ 40 IPVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: e0t Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 2000 Sludge depth: 1 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 391 Wianno Ave. Property Address Janice Norton Owner Owner's Name information is required for every Osterville MA 02655 3/25/2016 page. CitylTown 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 29 Scum thickness 4 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 14 How were dimensions determined? 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.): The Tees were present. The inlet cover was 2"below. Grease Trap (locate on site elan): Depth below grade: n/a 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 u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 391 Wianno Ave. Property Address Janice Norton Owner Owner's Name information is required for every Osterville MA 02655 3/25/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain): N/a Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No (Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 11 of 17 ( Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 391 Wianno Ave. Property Address Janice Norton Owner Owner's Name information is required for every Osterville MA 02655 3/25/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): j Depth of liquid level above outlet invert even Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The D-box was normal 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.): N/a If pumps or alarms are not in working order, system is'a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 391 Wianno Ave. Property Address Janice Norton Owner Owner's Name information is required for every Osterville MA 02655 3/25/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® 2- 1000 gal. with leaching Pits number: 3'stone ❑ 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 Pits were dry and clean.There were no signs of failure. The pit in the driveway had a steel cover to grade. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration n/a Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 391 Wianno Ave. Property Address Janice Norton Owner Owner's Name information is ,required for every Osterville MA 02655 3/25/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l i. i 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.): N/a t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 391 Wianno Ave. Property Address Janice Norton Owner Owner's Name information is required for every Osterville MA 02655 3/25/2016 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 i a `-f 3 O � A Q 30 �S 3 (4 I a� 3S 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 391 Wianno Ave. Property Address Janice Norton Owner Owner's Name information is required for every Osterville MA 02655 3/25/2016 page. CitylTown State Zi Code Date P of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 25' +/- feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: • Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Topo and water contours map ❑ Checked with local excavators, installers-(attach documentation) El Accessed USGS database -explain: You must describe how you established the high ground water elevation: see above i 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 391 Wianno Ave. Property Address Janice Norton Owner Owner's Name information is required for every Osteryille MA 02655 3/25/2016 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 \ TOWN OF BARNSTABLE Lel LC','-ATION J� I' W)Am o AV C. 4A,E 0 333 O S l G(V I ASSES AO LOT OT E � INS T-;, LLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY a'UUD. '4jc'� LEACHING FACILITY: (type) ) 3 � NO.OF BEDROOMS BUILDER OR OWNER �At/ PERMITDATE: .OPLIANCE DATE: Separation Distance Between the: lb 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 leac4g facility) Feet Furnished by -�r�GC lVN �� A O -30 afo y s-l'onQ, 'arwc WAl 1 a TOWN OF BARNSTABLE I, LOCATION ZlJ1*WA-)6 "ACE SEWAGE # #7 - ` �3 VILLAGE �iLC� ASSESSOR'S MAP O INSTALLER'S NAME fz PHONE NO. 70e6W SEPTIC TANK CAPACITY LEACHING FACILITY:(type) L4l (size) &<I /dXmpe NO. OF BEDROOMS PRIVATE WELL O UBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED:_ DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes .3`p lIi Sri A Y . Y .a ' I � I Y i J�G < r - TOWN OF BARNSTABLE LOf"ATION !J M11#1491901' etle SEWAGE # VILLAGE �i ASSESSOR'S MAP & LOT'` L INSTALLER°S NAME & PHONE NO. k� SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER. DATE PERMIT ISSUED: DATE COZIPLIANCE ISSUED: // 11 y S f13. U`� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1---------------oF...: . .R1v�ST �. , _....... - :.... Appliratiun for Disposal Works Tonstrurtiun -ramit Application is hereby made for a Permit to Construct N) or Repair ( ) an Individual Sewage Disposal System at ........»..»_.._» oSr2 ?ion. ! 5 ...................... _... .......... --..................................or Lot....»........................_.».»........ .• Own � ress w EPA. L© .� ( Ocw sT a .... - ... .. ..-• ............. ........................................................................................... Installer Address Type of Building 1 Size Lot............................Sq. feet U Dwelling—No. of Bedrooms....... 5`'� ••--Expansion Attic ( ) Garbage Grinder x Other—Type of Building N of persons............................ Showers — Cafeteria QOther fixtures ................ ..... ._...._ Design Flow.._..._..._ L�................:......gallons per per day. Total daily flow..:_._.... � _ -.�..:.._._._.:.._.. Ions. WSeptic Tank—Liquid capacity?.----•.-.gallons Length..11_.__l. .. Width..G.--G-..-.. Diameter................ Depth-S_..._...... x Disposal Trench—No..................... Width....................Total Length.................... Total leaching area.....:.............sq. ft. 3 Seepage Pit No.......40.-........... Diameter......be........ Depth below inlet...._Ct............Total leaching area.-7-7j6...",fi PP Z Other Distribution box (L-+ Dosin tank ( ) -IperS- 1 �56 (-Pi> 1-4 1 .Percolation Test Results Performed ,.a Test Pit No. 1..4-2.....minutes per inch Depth of Test Pit........ .. ...... Depth to ground water...NgNf.... ... f=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ...............:..........................................,► .............................._....}-�-- O Description of Soil.- = `_�.... �??� t o SU�.�._...3 `"-.13 �,U. :...5141UY......................•-.... V --------------•-------------_-----•-- = ..... W ••••-•••--••---••-••-•-•----.......••-•--•---.....•--•••-••-•-••.....••••--••--••-•-•--•--••-----•-•••-•---•••--•---••----••••••..........................•---_..._.........••--._.::.----._......--•--- UNature 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 iI' 5 of the State Sanitary Code—The undersigned further agrees not to place the system in • operation until a Certificate of Compliance haspbs� ed by t bo d of 1 ealth. Signed. ,. DateApplication Approved By.... -- -•-..._.. .. Date Application Disapproved for the following reasons: ......------••----.......-•............:............:....•-•---........•-------»»» Date 'Permit No................................. ... Issued................:.--•--•-...................»........» .................. Date s .. v � ftt ~-1 ' �� -�" f--r �a. r - �1="' � -• 4 - yl\11. .� THE COMMONWEALTH OF MASSACHUSETTS a. BOARD OF HEALTH -y- � I p r1 ..._.•••I�J.WM.............OF.... .r� .5. ..i .................................. 'Appliration for Disposal Works Tonstrurtion rrrm t Application is hereby made for a`Permit to Construct (\/) or Repair ( ) an Individual Sewage Disposal System at: -Location-Address or Lot No. ...............__� ..._.o`f.) C. .......................... -•---------••--- --•--............ .... Owner • p`t , Address .....................•--t;'0_ .1, lid_ ...... VIN S ........ Installer Address Type of Building Size Lot............................S feet aDwelling—No. of Bedrooms...... ai,.. :Q. l......--Expansion Attic { ) Garbage Grinder ( )E p,t Other—Type of Building ____________________....... No. of persons............................ Showers ( ) — Cafeteria ) • Other fixtures -----•--- ..................... ._._A..._....---...••-•--------------•-------------•----•---•-•® - -----------•---- ,��tit W Design Flow.......... ............... gallons per persona per day. Total daily flow-_=____...: ! ._......_._._.__gallons. WSeptic Tank—Liquid ca.pacity7_.__.____gallons Length... Width.1�-A'­ ._ Diameter________________ Depth. ___. ..._. x Disposal Trench—No:.................... Width.................... Total Length.................... Total leaching area__.._._...._..._..sq. ft. 3 Seepage Pit No......?-.......... Diameter......L.e__.......Depth below inlet...... Total leaching area...7.�8..sq. ftGt�j� M Other Distribution box (y- Dosing tank ( ) ;!_-,i,rt'S- ", 11�56 6-P 17 Percolation Test Results Performed by.... lvlC. .__v...__! -�-a ... Date__..s� l�� 1.4 Test Pit No. I... ;:._..minutes per inch Depth of Test Pit..... _____ Depth to ground water...!`V0NC.-•-•__. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ C�-- Co". �_ c��.,..... ��U��-'_ 1 ..r.-i'�t�_I1 1 U 1^l ............................ O Description of Soil...U ----------------- -- -_-_------......... -----------_--•-•------------- ... ..........................:..............: ._. W s UNature 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 TIT1E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been-issued by the board of health. / ,. ` Signed..��-4e�of �_ ._ ......-•---•----- 7/G7_�_?''-•-`-•`----- J(-' Date Application Approved By-------- \ ` . $ Date Application Disapproved for the f ollowsng reasons:............... ..--•---------•...................................•.....-----•---•---•-------------•-----._.._.__......_.------•------•---......--•---........_..-•-•-•--------.._....-•---....---•--•--..............- Date PermitNo....................................................... Issued.............................0........................- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......TUw.rN..............OF......l., -1 N-S?r ..R124E........................ (Irrtif uttte of Toutpliana THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (Ny) or Repaired ( ) by........ oR J[:.o. l.........cc��vcT -•............................................................•-•.........0.....-•••..... at.........1 _1_.) -� = U-6 .. ......_. /V/- N N .2P..------ ---..Installer... ST &W L ---------------------•-.------....------....... has been installed in accordance with the provisions of TITk7" ! 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._____ ___ _ ... .... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. • „ r i DATE......................... ........... -...... Inspecto .................... r---------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Q� ;� SST L� ......... w- ...........OF......(,�----..1�-------------A. ...........-...._......._.... .....-.. FgE.....7- ....... -- Disposal Works�!Tonstrttrtion Permit Permission is hereby granted... Q 2 a L O 1 T i ••.�u 5 .............................................................--_ to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No.......... UJk?)-U ! 11 F---._...--•n CT� fK Uf '��----- ...... b_._. Street as shown on the application for Disposal Works Construction Permit No._ -;,30 __ Dated.......................................... ......................4J -•-- --------------------------------------------------------- DATE n oard of Health SULLIVAN ENGINEERING INC. 7 PARKER ROADIP O BOX 659 OSTERVILLE, AM 02655 Peter Sullivan P. E.Mass Registration No. 29733 psullpe@aol.com phone 508-428-3344 fax 508-428-3115 November 13, 2006 Public Health Division Town of Barnstable 200 Main Street Hyannis,MA 02601 RE: 391 Wianno Avenue,Osterville Conditional Pass/Title 5 Septic Inspection Dear Board of Health, (" Please be advised that the condition identified in James Ford's septic inspection, on pages 1 &2 of his report for the above referenced property,has been addressed. The existing leach pit under the driveway has been upgraded to support H-20 loading. I trust this meets your�present needs. If you have any questions,please feel free to call. try yours, eter ullivan PE Sullivan Engineering Inc. Cc: Rogers&Marney James Ford Attachments(Pages 1 &2 of an 11 page.Title 5 Inspection Report by James Ford. 10,2006 - y Members of American Society of Civil Engineers,Boston Society of Civil Engineers i syli, , a L $- ,�� •;� .ar 1a 40 �p�)[r�_ f�. •FYI�T�� Y iM • �^ �.� 1 1^4 It, _ k 1 yy �p � J. � L ��=� • f �' f �`�, rt: r 14 y�~ ;E= r t !► x f a �L. �f>;n`Z• 31 :r Fy '�.'� � �. ,� b`� as �.�a i*�larS:Ii+ R Y " 4� 'f' Eid '1 PR � f /+j1 .: tr_' �d t i•�}��� '1 11' ! �_� W k {I�1 � � •� ai {4Ls � ay ♦ -��♦ wV F f f r�� `�� "'� ��y1 i�t ..��� 'a' ♦J L'<�� r ik�� �` • 7y�` i a ""TIP fAl 411 Al, i. ,1 •t>k� 11 1�' n,y� ,ti. 1 ,+ k s'r '� ` 1 '� ,R i�� i /act � ♦ �¢ L.,y 1 •.a. lee �[1P fib. L 1 � ti�k� ' ► � �s f CC3 t� `} t w x 7aA�f "�^ ^111';�.•,.,1. i � a i_ � i4., P {t'', ., �' rN����.��*`* �` `r'�► � � 4-+s .,'� � r �` ,1�� �s?�"s � Y��1 w t 1e's 1 ►, r i`any � 1 ;' 4"' 't' `�f: i' id�.:f r � A4r "• `��' t.} a :7 'c .�Y a.r-i f. S �il'�,'1 ••�' �L s ` ;' iR.a� i�. .-f St t..'! 4 t % cvFMR SULLIVAN In nj 29733 C>--, CIVIL s C C-ov h � l O ' TOWN OF BARNSTABLE 1N 3 LG--ATION Uj),kAA0 Ave,. SWAGE # VII LADE SE R'S & LOT INS i ALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �� ('X v 3 {size) NO. OF BEDROOMS BUILDER OR OWNER �AV . PERMIT DATE: LIANCE DATE: 1 " dZ0 , Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility (If any wetlands exist Feet within 300 feet of leaching facility) Furnished by I O - y_ on� �rWC LjAV TOWN OF BARNSTABLE I LOCATION � /�%ilA,Y� ' SEWAGE # r7 VILLAGE ASSESSOR'S ASSESSOR'S MAP .INSTALLER'S NAME & PHONE NO. �77JCm� � ���� ' SEPTIC TANK CAPACITY LEACHING FACILITY:(type) NO. OF BEDROOMS PRIVATE WELL O UBLIC WATER BUILDER OR OWNER �y '1 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: �- J VARIANCE GRANTED: Yes N . k c� � i i • r r TOWN OF BARNSTABLE LOCATION ��J �1� Ct4e__2 .SEWAGE # VILLAGE �i ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR rJTNEP. DATE PERMIT ISSUED: 1 DATE COMPLIANCE ISSUED: I` ,4t!7" 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: 391 Wianno Avenue Osterville, MA 02655 Owner's Name: Mark Kavanagh Owner's Address: Date of Inspection: August Z 2006OF Name of Inspector: (Please Print) James del. Ford Company Name: James M. Ford �* Mailing Address: P.O.Box 49 `' Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 1 Q\Q?r ; J 17 CERTIFICATION STATEMENT ' I certify that I have personally inspected the sewage disposal system at this address an h t the information reported below is true,accurate and complete as of the time of the inspection. The inspectoo as performed Based on my. j training and experience in the.proper function and mainten ce of on site sewage isposal systems. I am a DEP"' ' approved system inspector pursuant to Sec on Me 5(3 15.00 The system: w Passes 'Conditionally Passes Need rther Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: August 10, 2006 The system inspector shall subm copy of this Lpection 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 Coimnents ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 .r Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 391 Wianno Avenue Osterville, MA Owner: Mark Kavanagh Date of Inspection: August 7, 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 9 described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: ✓ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The leach pit was H-10 and under the driveway. It needs to be made H-20 loading. The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 c Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 391 Wianno Avenue Osterville, MA Owner: Mark Kavanagh Date of Inspection: August 7, 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,perfon-ned at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm;provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 391 Wianno Avenue Osterville, MA Owner: Mark Kavanagh Date of Inspection: August 7, 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 ''/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone I 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: 391 Wianno Avenue Osterville, MA Owner: Mark Kavanagh Date of Inspection: August 7, 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? i ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? _ Were all system components,excluding the SAS, located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles,or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part Cis 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: '391 Wianno Avenue Osterville. MA Owner: Mark Kavanagh Date of Inspection: August 7, 2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms,(design): 5+ Number of bedrooms(actual): S DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Number of current residents: n/a Does residence have a garbage grinder(yes or no): Yes Is laundry on a separate sewage system(yes or no): nla [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: Currently occupied COMMERCIALANDUSTRIAL 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 information: 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 7112189-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 391 Wianno Avenue Osterville. MA Owner: Mark Kavanagh Date of Inspection: August 7, 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: s Comments(on condition of joints,venting,evidence of leakage, etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 20" 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: 2000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 6" Distance from top of scum to top of outlet tee or baffle: -- Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Measuring stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): The liquid level was even with the outlet invert Tees were present There did not appear to be anhsigns of leakage The inlet cover was 2"below grade. GREASE TRAP: None (locate on site plan.) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 391 Wianno Avenue Osterville. MA Owner: Mark Kavanagh Date of Inspection: August 7. 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 alarn 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 level, The D-box was 2'oLhe driveway(H 10) Recommend installinv a riser. PUMP CHAMBER: None (locate on-site plan) Pumps in working order(yes or no): Alarns in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,.etc.): 8 Page 9 of 1 I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 391 Wianno Avenue Osterville MA Owner: Mark Kavanagh Date of Inspection: August 7, 2006 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: ` Type ✓ leaching pits,number: 2-6'x 6'(1000 zal.) each w/3'stone leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number, dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Commnents(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): One pit 04)was dry. The bottom to grade was 9.5. It was H 101oading and under the driveway. The cover was 20"below grade. Needs to be made H-20 loading The ether pit(#S)had]'of liquid on the bottom The scums line was at the same level The nit was in the grass 7'off the driveway There did not appear to be any signs o�failure 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 r Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 391 Wianno Avenue Osterville, MA Owner: Mark Kavanagh Date of Inspection: August 7. 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. it a� FT 30 S-ton7A - orvvC 4,A P S�Esa� 10 Page 11 of 11 f OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 391 Wianno Avenue Osterville, MA Owner: Mark Kavana zh Date of Inspection: August 7, 2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25 +/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topogaryphic and water contours snaps the snaps were showing approximately 25'+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 f 02/15/2007 12:03 5084283115 SULLIVAN ENG INC PAGE 01 SULLIVAN ENGINEERING INC. 7 PARKER ROADIP O BOX 659 OSTERVILLE, MA 02655 Peter Sullivan P.E.Mass Registiation No.29733 psvUpe@aoLcom phone 508-428-3344 f=508-028-3115 November 13,2006 Public Health Division Town of Barnstable 200 Main Street Hyannis,MA 02601 RE: 391 Wianno Avenue,Osterville Conditional Pam/Title 5 Septic Inspection Dear Board of Health, Please be advised that the condition identified in James Ford's septic inspection, on pages 1 &2 of his report for the above referenced property,has been addressed. The existing leach pit under the driveway has been upgraded to support H-20 loading. I trust this meets your present needs. If you have any questions,please feel free to call. truly yours, eter ivan PE Sullivan Engineering Inc. Cc: Rogers&Marney James Ford Attachments(Pages 1 &2 of an 11 page Title 5 Inspection Report by James Ford. 10,2006 LE Members of American Society of Civil Engineers,Boetax Society of Civil Engineers UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box• f PUBLIC H.M. ATHDIVj$103N TOWN CIF BAFNS l 4B'LF: UTAT`G 1'REET H4' NIS. `IVfcz� I SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete I i ature item 4 if Restricted Delivery is desired. // n'Agent ■ Print your name and address on the reverse E/ ❑Addressee so that we can return the card to you. R eived by(Printed Na be) ( C. Date o Delivery ■ Attach this card to the back of the mailpiece, �� J or on the front if space permits. � ✓ ��'� G� D. Is delivery address different from item 11 10 YLI's 1. Article Addressed to: If YES,enter delivery address below: ❑No 34� 07L� Service/ 3. Type ❑Certified Mail ❑Express Mail v ❑Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. C 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer from service label) t �� '.� } PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 ti D � .. • .•. a OFFICIAL US-E 0 �11 Postage $ 3 ,� IVVf{ QI'T M Certified Fee " 5 Plo�tm006 � Return Receipt Fee ®C pH�re O (Endorsement Required) Restdoted Delivery Fee \ (Endorsemer4 Required) r R Total Postage&Fees G USES Lr) L t T C3 ...t----_!&,rrr0 U [+ pt.NO.i ...... ..... or PO Box No. 9/ �0-X.o0 �fi.¢_. �y ,.,� - c�.State,Z���t.GZ O --- :ir rr Certified Mail Provides: s�aney)zooZaunr'ooQ£uliodsd o A mailing receipt a o A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: e Certified Mail may ONLY be combined with First-Class Mail®or Prionty Mail®. a Certified Mail is not available for any class of international mail. c 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 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. e 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-Defivery". e 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. Town of Barnstable ° do Regulatory Services BARNSPABLE, •`: Thomas F. Geiler,Director MASS ,•� Public Health Division Thomas McKean,Director 200.Main Street, Hyannis,MA 02601 Office:, 508-862-4644. Fax:. 508-790-6304 September 25, 2006 Mr Mark Kavanagh 391.Wianno Avenue Osterville,.MA.02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic.system owned by you located 391 Wianno Avenue, Osterville,MA was last inspected September August 1"...2006 by William E. Robinson, Sr,.a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system"Conditionally Passes"' under the guidelines of 1995 TITLE 5.(310.CMR 15.00).due to the.following: Pit#4 is H-10 loading and under the driveway, needs to be made H-20 loading. You haven years from the date of the of the system failure to bring the.system in to- compliance. If there are any.questions.about this.reminder, lease.feel free to contact the Barnstable Yq p Health Department. BARNSTABLE HEALTH DEPARTMENT. 2a�n,.R.S., C.H.O. Agent of the Board of Health CO DATE: . 8/25/.98 PROPERTY ADDRESS:3.91 Wianno Ave Osterville,Mass. 0.2655 On the above date, I Inspected the sceptic system at the above address. This system consJsts of the following: 1 . 1 -2000 .septic, tank. 2 . 1 -Distribution box. 3 . 2-1000 gallon leaching pits. Based bn my insc�actlon, I certify the following conditions: 4 . This is a title five septic system".""( 118 Code ') 5 . The septic system is in proper -working order at' the present time. SIGNATUR!. : Name : J . P , M•acomber Jr•. i -------,--------------- Company:_' • P_Macogber & Son- 'Inc , Address: --Cente�rville , Mass__0.2.632 ' .. Phone: ` ---,5U.3-75-�338------- I THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY XSEPH P. MACOMBER & SON,. INC. Tanka-Csupools-Leschtlelds , Pumped 4 lnst.allsd Town Sewer Connections P.O. Box 5G' Centerville, MA 02632.0066 77.5-3338 775-6412 Lill K SUBSURFACE SE%VAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propenr Addicts: 391 Wianno Ave Osterville,Mass. O,;ner: Mike Hawkey Date of Inspection: 8/25/98 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where Public water supPIY comes into house) ZP -Q _ Is lr.r1..6 Os/)3/f7) Y.y• J of 10 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617.292.5500 WILLIA1111 F.WELD TRUDY CO: Govcmor Sccrct: ARGEO PAUL CELLUCCI DAVID B.STRL'. Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioi PART A CERTIFICATION Property Address:391 Wianno Ave Osterville,Mass Address of Owner: e&' A Date of Inspection: 8/2 5/9 8 (If different) Name of Inspector:,Joseph P Macomber Jr. e1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CM1k,`rCompany Name: J.P.Macomber & Son Inc. Mailing Address: BOX 66 Cent _ yi I 1 P�MAcc 02632 2Telephone Number: Sna-775-133819 98OFSAP",CERTIFICATION STATEMENTEA[rH([rri,°' I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is v , accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function on and maintenance of on-site sewage disposal systems. The system:_/P asses Conditionally Passes Needs Funher Evaluation By the Local Approving Authority _ Fails Inspector's Signature: Date: . The System Inspector s all submit a copy of this inspection report to the Approving Authority within thirty (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 Department of Environmental Protection. The original should be sent to the system owne and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: AI SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below, COMMENTS: B) SYSTEM CONDITIONALLY PASSES: XIP One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upor completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate ye no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If'not determined', explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of �. Compliance (attached) indicating that the tank was installed within twenty(20) years prior to the date of the inspection;,o the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by ,.,e Board of Health. (revised 04/25/97) Dags 1 of 10 DEP on the World Wide Web: http:1twww.mapnet.state.ma:u side p Printed on Recycled Paper r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 391 Wianno Ave Osterville,Mass . Owner: Mike Hawkey Date of Inspection:8/2 5/9 8 BJ SYSTEM CONDITIONALLY PASSES tcontinued) Sewage backup or or high static water r observed distribution box o broken pptfh pipe(s) or due to broken, or unevendistibutonbox. The system will pas nspecton % aroval o e Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: 41 j9_ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM I5 NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: 42Q Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within SO feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the pre se ce of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER AW (revised 04/2s/M . Pag• 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 391 Wianno Ave Osterville,Mass. Owner: Mike Hawkey Date of Inspection: $/25/98 DI SYSTEM FAILS: You rpust indicate eiv.et "Yes" or "No" as to each of the following: _1. I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No !/ Backup of sewage into facility or system romponent due to an 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. �-�,ae1,4, 1 �'�c Liquid depth in eesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of limes pumped 0-- Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. / 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 SO feel from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy,of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] URGE SYSTEM FAILS: You must indicate either 'Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 1W 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please.consult the local regional office of the Department for further information. I I (revised 0{/2S/17) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 391 Wianno Ave Osterville,Mass. Owner: Mike Hawkey Date of Inspection:8/2 5/9 8 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. ZNone of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been Introduced into the system recently or as pan of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. -,L// The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components,kXcluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum. — The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if djfferent from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302130.11 (r.vl..a 04/7s/77) a.y. 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 391 WIanno Ave Osterville,Mass. Owner: Mike Hawkey Date of Inspection:$ 2 5/9 8 FLOW CONDITIONS RESIDENTIAL: Design flow:_220 g p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents Garbage grinder (yes or no): Laundry connected to system (yes or no):- j Seasonal use (yes or no): 61 v2Yo2�avr�t; r y �' qb— )fie ODa-r Water meter readings, if available (last two (2) year usage (gpd): 1 OC�4 '- ew, 7°7 Sump Pump (yes or no):A& 4j j — jr ��y y r Last date of occupancy: ' COMMERCIAUINDUSTRIAL: Type of establishment: AJfI Design flow: AM aallons/day Grease trap present: (yes or no)&/4 Industrial Waste Holding Tank present: (yes or no) /i Non-sanitary waste discharged to the Title 5 system: (yes or no),&& Water meter readings, if available: V Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)A26 If yes, volume pumped: _D allons Reason for pumping: .U/`t`• TYPE O YSTEM /Septic tank/distribution box/soil absorption system NT Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) (revised 04/25/17) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properly Address: 391 Wianno Ave Osterville,Mass. Owner: Mike Hawkey Date of Inspection: 8/2 5/9 8 BUILDING SEWER: (Locate on site plan) �4 Depth below grader Material of construction: _cast iron /40 PVC other (explain) Distance from private water supply well or suction line /6 �- Diameter 1)"_ Comments: (condition of joints, venting, evidence of leakage, etc.) Joints appear tight No evidence of leakage; System is vented fhrnnah the hniica vent. SEPTIC TANKJ o g s (locate on site plan) d Depth below grade: M aterial of construction: concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age " Is age confirmed by Certificate of Compliance.[ (Yes/No) Dimensions: 1`"&(a Sludge depth: Distance from top of sludge to bonom of outlet tee or baffle: Scum thickness:f�— Distance from top of scum to top of outlet tee or baffle:_ Distance from bottom of scum to bottom f outlet tee gn baffle: How dimensions were determined: 0 Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Pump Tank annually• Garbage di Gp ncal i c i raccant� Inlet & Outlet tees are ; n plarn-mhe i-aQk is; stteta�l GREASE TRAP:Z,41 . (locate-on site plan) Depth below grader Material of construction:?MconcretetAmetal/FiberglassX/APolyethylene V 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: Ph- Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,-etc.) Grease trap is not present (revised 04/2S/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 391 Wianno Ave Osterville,Mass. Owner: Mike Hawkey Date of Inspection: 8/25/98 TIGHT OR HOLDING TANK:&2 Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade:kA Material of con struction:.4AconcreteAgmetal4±Fiberglass,(&olyethylene,!gother(explain) A lA - A Dimensions: Capacity: gallons Design flow: &allons/day Alarm level: AJlq Alarm in working order Yes;A1A*- No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) Tiqht or holding tanks are not =rpcpnt DISTRIBUTION BOX:, (locate on site plan) Depth of liquid level above outlet inven:�fJZ Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or,out of box, etc.) Distribution box has two laterals;No evidence of snlirls carry Qypr.;Nn PVi Hpnrp of l eakaga inf-- -r ai-lt of :Lh.A box PUMP CHAMBER:,?(Je, (locate on site plan) Pumps in working order: (Yes or No)—Ay Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) Pump Chamber is not present. (e.vsa.d 04/3s/17) r.90 I of 10 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C SYSTEM INFORMATION (continued) Property Address: 391 Wianno Ave Osterville,Mass. Owner: Mike Hawkey Date of Inspection:8/25/98 SOIL ABSORPTION SYSTEM (SAS):Z (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type. leaching pits, number: leaching chambers, number:0 leaching galleries, number:, leaching trenches, number,length: leaching fields, number, dime ions: overflow cesspool, number: V Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) J,Oamy ganrl to honey moai iim sandjNe signs ef hydyatili CESSPOOLS:Awe- (locate on site plan) Number and configuration: d 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 (cesspool must be pumped as part of inspection) Cesspools are not =rpcant, Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Cesspools are not nrpspnt 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.) Pri viz i q not nrccanl- - (zwissd 04/1S/97) Ds9s S of 10 SUBSURFACE SEWAGE DISPG: --,t SYSTEM INSPECTION FORM P.,i'T C SYSTEM INFORl,t JION (continued) Property Address: 391 Wianno Ave. Osterville,Mass. Owner: Mike Hawkey Date of Inspection:8 2 5/9 8 Depth to Groundwater/ Feet Please indicate all the methods used to determine High Groundwater�Iewation: Obtained from Design Plans on record Observation of Site (Abutting property observation hole, basemtrs'sump etc.) —zoetermine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers —4zuse USGS Data Describe in your own words how you established the High Grounck,rcr•Elevation. Mug be completed) method of determination or approximation: AD OF NDS ------------- T 9 (revised 04/]S/77) • Pr9,,JOof 10 •r.....r.r•A 1•.,.r.T'r••.,11-..R•I.,...,.-,..,...R/T,i.1,..,....,......,/......T,Z,P.....,.Vl lr,. TOWN OF Barnstable BOARD OF 11EALT11 1 SUUSURFACF SEWAGE DISPOSAL SYSTF,M INSPECTION FORM - PART D •- CERTIFICATION JI-•TI'1"►•:'t:t�T.111t�.R1TTR111'.1.1fIT1r1R1fATT1:r17�{VAIY RRfr1'�'I�.�T�T17 1n.1MT.f�TTT1r•TTTa�rTr:rv-I•T'•T1i -TYPL OR PAINT CL¢AAL)'- PROPERTY INSPECTED STREET ADDRESS 391 Wianno Ave. Osterville,Mass. ASSESSORS MAP, BLOCK AND PARCEL OWNER' s NAME Mike Hawkey PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & SOfi *Inc. COMPANY ADDRESS Box 66 Centerville,Mass . 02632. Street Town or C ty State LIP COMPANY TELEPIiONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 -1 578 CERTIFICATION STATEMENT + I certify that I have personally inspected the sewage disposal system a this address and that the information reported is true , accurate , and complete as of the time of * inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on site sewage disposal systems . Check ne : , Systeui PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or .t-he. environment as defined in 310 CMR 16 , 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this for►n . 1. Sys tern FAILEV* The inspection which I have con cted has found that the system fails tc protect the public health and the environment in accordance with Title 5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE C111TERIA of this Inspection form , Ins ector Si nature l P g Date One copy of this rtification must be provided to the OWNER, the BUYER ( Where applicable ) and the 130ARD OF JInALTJJ. IF If the inspection FAILED, the owner or oporator shall upgrade ' the ayetem within o'ne year of the date of the inspection , unless allowed or required otherwise as provide'd in 3.10 C�IR 16 . 306 . partd .doc W In !'I SS bkv THE . COMMONWEALTH OF M.A.SSA.CHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE S SYSTEM INSPECTOR as provided in 310 CMR 15 .340 and Section 13 of Chapter 21A .of the en G eral Laws. Issued ss d by The Department of Environmental Protection. otection. nctmy. Dircctor of tl(c t) i iuli of Watcr Pollution Control DATE:_5,115195____ PROPERTY ADDRESS: 391 Wianno Ave �yb Osterville,Mass. ' ------------------------ 113 02655 ------------------------ ��� p ® On the above date, i inspected the septic system at the abov afidv'ess. I995 �. This system consists of the following: �- �LE A. 1 -2000- gallon septic tank. TOWN y B. 1 -distribution box. C. 2-1000 gallon leach pits. Based on my Inspection, I certify the following conditions: A: This is a title five septic system. ( 78 Code ) B. The septic system is in proper working order at the present time. 4 SIGNATURE: _ `�1� _ T- N a m e: Jj Company: J-P.Macomber & Son Inc. Address:--Box 66 ------------------ Centerville,Mass. 02632 Phone:___ Sos=ZZ��33$_______ THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY • JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775.3338 775.6412 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , Address of property 191 Vjt4 mtoo Ave Owner's name PomOrey Smith : . Date of Inspection MkY 1s 0Sgs PART A CHECKLIST Check if the following have been done: Pumping information was re ° '.' • , Health. Quested of the owner, occupant, and Board of None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during. that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if the are available with N/A. Y not 4 The facility .or dwelling was inspected for signs of sewage back-up. - g k up. The site was inspected for signs of breakout. ' All system components, excluding the SAS, have been located on the a site. t/ The septic tank manholes were uncovered, opened; and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth -of liquid, depth of sludge, depth of scum. The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance Of .SSDS., c U, L I!FG of -7"G: 6Y5-(:?_1�A , 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORDS PART B SYSTEM INFORMATION FLAW CONDITIONS If residential number of. bedroobs onumber of current residents garbage grinder, yes or no, laundry connected to system, yes or no Mrs seasonal use, yes or no If nonresidential, calculated flow: Water meter readings, if available: Last date of occupancy _. GENERAL INFORMATION Pumping records and source of information: Q l�lo Puw��i vV to 2P5 A�V,4( L ES �ilk 2AD5 T�tgcs N� System pumped as part of inspection, or es if yes, volume pumped y no Reason for pumping c Type of system r 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) Other (explain) Approximate age of all components. Date installed, if known. Sourcelof. information: o Sewage odors detected when arriving at the site, yes or no I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued- ' •SEPTIC TANK: 2 ILC.p�JI (locate on site plan) depth below grade: 2 2 � material of construction: K. concrete metal FRP other(explain) dimensions: sludge depth _. distance from top of sludge to bottom of outlet tee or baffle. - scum thickness distance from top of scum to top of •outlet 'tee or baffle distance from bottom of scum to bottom of outlet tee or baffle. Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, . evidence of leakage, recommendations for repairs,_ etc_ . ) tAc> ►.1 it cC7 la t�w�P SZ c-P e- -r-'-wn� eov ee.5 I TZ> °s DISTRIBUTION BOX: (locate on site plan). depth of - liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation fox' repairs, etc.). Loos Coo PUMP CHAMBER:/"Io (locate on site plan) pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, . recommendations for maintenance or repairs,etc. ) r 10 SUBSURFACE SEWAGE DISPOSAL SYSTEH, INSPECTION FORK PART B SYSTEH INFORKATION continued = 4.-` r �:a SOIL ABSORPTION SYSTEM (SAS) : (locate on site plan, if possible; excavation not required,, but• ma lbe approximated by non-intrusive methods) y If not determined to be present,- explain: Type leaching pits and number` leaching chambers and number. leaching galleries and number leaching trenches, "number, length leaching fields, number, dimensions overflow cesspool, number Comments: ` • (note condition of soil, signs of hydraulic failure, - level. .of ondizi condition of vegetation recommendations for maintenance.., or :repairs,etc.c). CESSPOOLS (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 (cesspool' must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level "of pondin condition of vegetation, recommendations for maintenance or repairs,etc. PRIVY: (locate on site plan) materials of construction dimensions depth of solids ------------ Comments: (note condition -of soil, signs of hydraulic failure, - level Of.pondin ` condition of vegetation, recommendations for maintenance or repairs,etc. 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART t SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or 'benchmarks locate all wells within 100' Locus • L7' _ DEPTH TO.- GROUNDWATER - �U, depth to groundwater method of determination or approximation: U S CAS `fpi r J L r2 I 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND ) . Describeof determination in all instances. If "not determined", expliinbwhyasisnot) ' 00 Backup of sewage into facility? Discharge or ondYn' of P g effluent to the surface of the ground or surface waters? �Q- Static liquid level ' in the distribution box above outlet invert? Liquid depth in cesspool <6" below inve flow? rt or available volume< 1/2 day Required pumping 4 times or more in -the last year? number of times pumped, l�U Septic tank is metal?� cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of `the SAS, cesspool or privy: below the high groundwater elevation? within 50 feet of .a surface water? within . 100 feet of a surface water supp water supply? ly or tributary to a surface . within a Zone I of: a public well? within 50 feet of '' .a bordering vegetated wetland or salt marsh' (cesspools and privies only, not the SAS) ? .., � within 50 feet of :a private water supply well? less than 100. feetbut greater than 50 . feet' from` a private" wate supply well with no acceptable water quality analysis? If the well has been analyzed ,to be acceptable, attach copy of well water °analysi: ` for coliform bacteria, volatile Qrganic compounds, ammonia nitrogen and nitrate nitrogen. '05/04/1995 13:41 508-428-3508 C.-.0-MM. WATER DEPT ; .PAGE, 03, All KEY NUMBER <1244 > NAME <SMITH, POMEROY > B-C 1 B-C 2 STREET 3000 NO GARFIELD-SUITE 1280 8-C 3 B-C 4 CITY MIDLAND ST TX ZIP 70705-6400 REF 1 REF 2 PHONE (915) 683-2947 REF 3 REF 4 METER NO.< 1280> DATE READING CONS STREET <WIANNO AVE NO. 391> 12/31/94 . 98 25 . CITY OST T ST LOC 06/30/94 73 0 PHONE ( ) - 12/31/93 73 51 ROUTE NUMBER 13 06/30/93 22 0 ` SERVICE DATE 03/28/51 12/3 11/92 92 21 ., 2 METER DATE 01/28/92 O1 28 92. CAPACITY 7 O1%28�92 843 p STYLE T10 SIZE 1 RATE SCHEDULE KEY PIT PLASTIC NOTE RR RIGHT BY ELEC ADDITIONAL CONS 0 ALTERNATE MIN 0 Y L SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART D CERTIFICATION Inspector : Peter Sullivan PE Location 391 Wiannio Ave. Osterville Date : May 17,1995 Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and maintenance of on-site sewage disposal systems. I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15.303 Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. Please note the summary of recommendations as presented in this form. Lastly please note 310CMR:15.302 Criteria for Inspection(1) "The inspection is not designed to provide information to demonstrate that the system will adequately serve the use to be placed upon it by the new owner. " ruly yours O Peter Sullivan PE Distribution: R Original to system owner suuiv�,� Buyer NO. 29733 Board of Heath _ r , �, „�.: :^F-:-. r }z^•-e-: ,,; �^,� _ �:.,�i'""�d . 'fis" i," _Cn s. tee' `�q P ',•�.,"aP,C`e'a;�-.. E�w..,....n.s�.r'y.,:..vu...: s: „. r _ ,. ..atlw_. ..fi.e..Y.r ,'k.'. �, - :r 5 ,�,........_,..,t. :. ' e.qqrr... n. .A.,e "..W yt.'. u.(�.y. 'J1 P.....}:-�,.:�r!.3..,..-�,, �a.#�v,-4 S�.�..:.__..w k`a'a...-.:aa>...;1<a_.+�-.}.. �C_}f..:.W$ I 7g..>.x-r:�.,.r,x.,.,. s.:+.........N 5".rt...F..:.,�._..,-.".'L_:.:. x>fi r�.....'.:..': .m,.:. .._...'r...,.T,*.,X..:, .L-,? ta.._,}.4, .,__.. .:..^l......4 _-.-:,;,.;• K«.,:'4> ...Y...rnx..k. ,J.,:,^+e,)r.:..>q :.cy;�`?.: iv..}'/•. -� .� .x+.r:;:e',,` .»s. x�7,(�. � . y L }b.a: .. :Y'.,. l W S .:' TES s. ..,..... .. .. .. .. e :....:-�' r,+ _ .,. _e• a ,. ..,. -.::..,. r„_ ,. -R'.V`{ - ... : .: -. .. ........a• ..,, ,». ... _, :.. . „.. #�J .. .o, dr.. ..r.. '..7 a ,. .,.. , ,, r ! i.. ..Wi. way .. 6. .... ,.. .• d - ,°.. 4« _s ...:. .: .. r:.- '. .:: - .. • �•' tea. : a! r.0 ry,. �. �, . :. ... ,- •. � ._.._.. .-. .. ,.. -, a ,.._, ,., :. SOIL x x Pam,. AfOF. SOiL, �r ST , t,,� t•� �_:.< _:, i,�• ANO - ERCO'L A RA E = a.x � ;,_ w�� .., • , - ,..-: _,. - : . 'CLEAN, S `P, P .. . , '[IONMtfi/ INCH' PIPE -' - ,, �Y.. t.,.:;_ . .. I 08SE#�VATt:ON' HQ C . .PER F } F E E iju vli rem N ^ .. . C NCRETE ELEV. - �: 0 �:.� 2 . LAYER OF' -T'-- a rCOVERS , 1/2 WASHED i4 STONE 5,�; � , « l F,:D! 1 , x < e, F• t -/4+4 p. EL •'' r y ' , k.y fry ,,.:: k+�¢• : _. ., Z - LEVEL h EL. 7 •, ,:. _ _ �. WATER AT EL _ WATER AT. �. DIST o !. W, r - .; r EL -B.OX' u. I 1� - p' o : 3%4 — 1 /2 w 0 • °o o tL p o D E S WASHED STONE IGN CALCUL AT(ON S .. - ` {3 NUMBER OF BEDROOMS _,.__ K A a s - Y� `NU PRECAST LE CHING T GARBAGE OtSPOSAL ;U UNIT yam,' BASIN OR EQUIV. - _ q 6 :DIAM §' TOTAL' ESTIMATED`FLOW , u GAL /-OAY µ ,. . ,. �" i i C7: °GA•L.:./BR.,/DAY x 7= BR.) ---� � . , 5�� • ? 0 :SEPTIC TANK CAPACITY' PRO L:E n • 4 STEM a 'REQUIRED S GAL. ,¢ J , t � r ZE LE. SEPTIC TK ., T AL LEACHING UALS'AREAF REQUIREMENTS. M OF TEST HOLE OR USGS ' PROBABLE,WATER: TABLE EL. ;: BOTTOM OF. TEST — SIDEWALL AREA. �?. S L./S.F,. - - - _. ) - OBSERVED WATER TABLE _� rs EL .. �,A } i. / F xc. , 7. - - - , AREA' U GAL S. BOTTOM RE flOT O � g A ) GAL♦ IOEW LL w y LEACHING; C AP' CITY { BOTTOM S z l . _ . ' }�? rf LEGEND . RESERVE LEACHING.NG caPA�T Y� cif GAL ELEVATION aT ELt»v _ EXISTING, SP -G.ONTOUR —— _ "0. i TING = 0-- - � EX IS , s FINAL SPOT ELEVATION . a . y NO.T ES KMA FINAL CONTOUR N , 1: ALL WOR NSHIP.,ANO MATERtA!-S SHALL CONFURtrA TO QE O:E TEST`-LOCATION SOti.. -"x TITLE 5 AND THE.. TOWN OF '�T��LE I IT RULES AN • UTILI'�Y Pa-E -d`• • REGULATIONS FOR THE ,SUBSURFACE 01$pOSAL OF-.SEWAGE TOWN WATER'° w . �� wW 2. ALL COVERS TO SANITARY UNITS SHALL BE- 6ROIJGNT TO - CATCH .BASIN - ®) WITHIN 121P OF FINISH!=O. GRAf7,E I A ,EXISTING AND FINAL''GRADES HAL,I REMAIN ESSENTIALLY 'THE SAME: • r, .4.. ALL COMPONENTS {}F THE SANITY SYSTEM $HALL �E:CAPAt3i.E. OF WITHSTANOWG:N IQ LOAQING. UNLESS THEY. ARE UNDER OR r` ' f k f - WITHIN IQ F:T OF .DRIVES OR PARKING''AREAS. H-20 LOADING' SHAL-L BE USED :UNOER OR WITHIN.IO'FT OF.'ORIV.ES OR PARKWa 3 ' 'ANY_ MASONARY UNIT$ USEDL YO BRING`;COVE RS TO GRADE ��``g` cti SHALL 8E :MORTARED 1N PLACE - B ircE DETERMINATION HAS BEEN 'MADE AS TO .COMPLIANCE WITH . ^ v DEEDED fJR 2014tNG .REGULATIONS. OWNER /APPLICANT `t5 fi0 : :N9 20 FT. MIN. TOP OF FOUND. - SOIL TEST s �- ; 10 FT. M IN L DATE OF SOIL TEST30 WITNESSED BY J j i�,i�-r r CONCRETE r 4"' SCH. 40 PYC PIPE CLEAN SAND PERCOLATION RATE MIN. INCH covERs MIN. PITCH 1/8 PER FT OBSERVATION HOLE I OBSERVATION HOLE 2 CONCRETE E ! i 4 CAST IR N PIPE 12 COVERS 2" LAYER OF ELEV. s ELEV.= (OR EQUAL, MIN. 1/8 - 1/2 WASHED PITCH 1/4 PER FT. STONE 8 J. 1 FLOW LINE _ c.0 :.;D do -EL = MW. = N EL 2,0 EL = LEVEL = EL. = ' DIST EL = ' � . e v o WATER AT ', .� N � EL.= WATER AT EL.= BOX 3/4"- 1 1/2" o op �i o 0 GALLON WASHED STONE o° ° ` I a o° • DESIGN CALCULATIONS 0o SEPTIC TANK W o EL.z NUMBER OF BEDROOMS PRECAST LEACHING BASIN OR EQUIV. GARBAGE DISPOSAL UNIT' 6' DIAM. TOTAL ESTIMATED FLOW SEWAGE DISPOSAL SYSTEM PROFILE F - - ( � GAL./BR./DAY >< BR.) GAL. DAY REQUIRED SEPTIC TANK CAPACITY GAL. NOT TO SCALE ACTUAL SIZE OF SEPTIC TANK GAL. BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE EL.s LEACHING AREA REQUIREMENTS OBSERVED WATER TABLE ( / / ) EL.= SIDEWALL AREA bAL./S.F. BOTTOM AREA : , GAL/SF. N t /--� ACHING CAPACITY ( BOTTOM t SIDEWALL) GAL. AVE _1l tV 1 � f�1 �. ' ,, �. '. '�. f' h . LEGEND: z, P� RESERVE LEACHING CAPACITY _ GAL. EXISTING SPOT ELEVATION OQjP ci E_ a I;; EXISTING CONTOUR — —— —— L.Eft : 1 Y 7 Y f,, 7 t --00—-- t NATION NOTES: FINAL CONTOUR 1. ALL WORKMANSHIP AND MATERIALS SMALL CONFORM TO OE.O.E. j SOIL TEST LOCATION IlsTITLE S AND THE TOWN OF 4, i'' 4� ' RULES AND ` UTILITY POLE REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. - TOWN WATER W -�=saWs�3 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO + CATCH BASIN ®) WITHIN 12" OF FINISHED GRADE. 1 i 3• EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE SAME. 4. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE d - - -- - 3 S OF WITHSTANDING H- 10 LOADING UNLESS THEY ARE UNDER OR i :. ------` WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKWG. �,. �cS`�tN Uf + slab �---� �; S. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE �' ' v -- ►c• -ac" ----fir- - • , y F3RUCE SHALL 8E MORTARED IN PLACE. G. 6• NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING REGULATIONS. OWNER /APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. .2 C .: A APPROVED: BOARD- OF HEALTH 1 r S'f" i� a. �E (�.� i E � .�" is -. f)nJ. . xa DATE AGENT - t)RIVF j _j t1l p PkNL) FILL GEC 'PooLS` rTC, f PROJECT 34 : -W I AIJN0 . . ' ! 6S t `c t.. t:�t� I r= r °ti; 1.r"�t, - !C "€ pL,: 1 _ R V I a_L F M 1�1 APPLICANT 1 BRUCE G. MURPHY f REGISTERED SANITARIAN 77 SPUR LANE 428-3358 MARSTONS MILLS, MASS, 02648 SCAUB Ll 0 Llf _ - REV. LOCATi01141 MAP ''" M0' SHEET I OF�� _