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HomeMy WebLinkAbout0410 WIANNO AVENUE - Health 410 Wianno Vve'��& o , 1 u r I I 1 , ✓1\ �o is f Commonwealth of Massachusetts Title 5 Official Inspection Form h Subsurface Sewage Disposal System Form-Not for.Voluntary Assessments LQ 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/17/2020 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:out f Men en fillip out f A. Inspector Information on the computer, JOHN P GRACI SR use only the tab ` key to move your Name of Inspector cursor-do not GRACI SEPTIC INSPECTIONS LLC use the return Company Name key. , PO BOX 2119 " Company Address °+ TEATICKET MA 02536 City/Town State Zip Code 508-548-7500 S1468 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After-conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes t 3. ❑ Needs Further Evaluatio by the Local Approving Authority 4. ❑ Fails , 02/17/2020 Inspector's Signature Date, . The system inspector shal submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 3 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the spector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/17/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: d ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM SHOWS NO SIGNS OF HYDRAULIC FAILURE AT TIME OF INSPECTION .. 2) System Conditionally Passes:. ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by. the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available., ❑ Y ❑ N ❑ ND (Explain below): NA t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 410 WIANNO AVENUE : ¢ Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE A MA 02655 02/17/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution,box. System will pass inspection if(with approval of.Board of Health): ' ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): , ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑aN ❑ ND (Explain below): NA ' ❑ 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): ` ❑ f obstruction is removed ❑ Yt . ❑ N ❑ ND (Explain below): , NA f Y 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health-in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, h safety and the environment: �t5insp.doc•rev.7/26/2618 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/17/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: NA **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other. NA e r 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"-to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts 119 Title 5 Official ,Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owners Name information is required for every OSTERVILLE MA 02655 02/17/2020 page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cone.) F 4) System Failure Criteria Applicable to All Systems: (cont.) , Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6".below invert or available volume is less than '/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water,supply well. ❑ ® Any portion of a cesspool'or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that,no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.) ❑ ® The system is a cesspool serving a facility with a design.flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of.the following, in addition to the questions in Section CA. - Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 w Commonwealth of Massachusetts 1p Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is OSTERVILLE required for every MA 02655 02/17/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) A If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. , 6. You must indicate"yes"or"no".for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ - Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has ' been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t I , 1 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/17/2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. 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): Description: SEWAGE#2006-5162 4 Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No' Does residence have a water treatment unit? ` . ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ; ❑ Yes ® No Seasonaluse? ® Yes ❑ No Water meter readings, if available last 2 ears usage TOWN 9 ( Y 9 (gPd))� Detail: 201-268,000 2018 336,000 ' Sump pump? ❑ Yes ® No -SEASONAL. Last date of occupancy: Date , t t5insp.doc•rev.7/26/2018 I Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 L q. 2/20/2020 Assessing As-Built Cards TOWN OF BARNSTABLE LOCATION y�O W I'4ns�p q✓� SEWAGE#26W S/6 YILLAGI OS/rrv,Ylc ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PRONE NO._ 3 C_ SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS _ OWNER 44c Ar fA PERMIT DATE: lOZ—`I'04 COMPLIANCE DATE: " Sepbration Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells,exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY d hs eh $E El t s t c - 1. • n https://www.townofbarnstable.us/Departments/Assessing/Property_Values[HMdisplay.asp?mappar-163023&seq=1 1/2 Commonwealth of Massachusetts p Title 5 Official Inspection Form r � , Subsurface Sewage Disposal System Form Not for Voluntary Assessments 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/17/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 2. Commercial/industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): NA Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): NA Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes.❑ No If yes, discharges to: NA Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ .No Water meter readings, if available: NA Last date of occupancy/use: NA Date Other(describe below): NA 3. Pumping Records: Source of information: WARREN CESSPOOL January 2018 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: MAINTENANCE t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form-Not for Voluntary Assessments 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/17/2020 page. Cityfrown State Zip Code ' Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system Single cesspool P ❑ 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. A ❑ Other(describe): Approximate age of all components, date installed'(if known)and source of information:' 2006) NEW SEPTIC TANK Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan):; Depth below grade: +" 21211 Material of construction: ❑ cast iron ®40"PVC i 40 PVC ` .• El (explain): Distance from private water supply well or suction line: 0+ , feet Comments(on condition'of joints,venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments s 410 WIANNO AVENUE •M _ Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/17/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): , Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) SEPTIC TANK IS CONSTRUCTED OF CONCRETE i If tank is metal, list age: NA years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: STANDARD 1500 GALLON ST Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle • 30" .• .a Scum thickness 211 611 Distance from top of scum to top of outlet tee or baffle . I o Distance from bottom of scum to bottom of outlet tee or baffle ' How were dimensions determined? MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition;structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1500 GALLON SEPTIC TANK APPEARS TO BE FUNCTIONING PROPERLY AT TIME OF INSPECTION . RECOMMEND PUMPING EVERY 2-3 YEARS DEPENDING ON USAGE. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 410 WIANNO AVENUE , Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/17/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: NA feet Material of construction: T ❑ concrete El metal ❑fiberglass. ❑ polyethylene ❑ other(explain): NA Dimensions: • NA Scum thickness NA Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA Date of last pumping: NA Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): NA 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan) Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): NA Dimensions: NA NA Capacity: gallons Design Flow: NA gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/17/2020.' page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: NA Alarm in working ord&:' " ` ❑ Yes ❑ No Date of last pumping: NA Date Comments(condition of alarm and float switches, etc.). . NA *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes [--]'No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert' BOTTOM OF PIPE Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into-or out of box, etc.): DISTRIBUTION BOX APPEARS TO BE STRUCTUARLLY SOUND AND FUNCTIONING PROPERLY AT TIME OF INSPECTION . t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form p . ` Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/17/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No*. Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): NA * If pumps or alarms are not in working order,system,is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: NA Type. ❑ leaching pits number: ❑ leaching chambers -number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 4-FLOW ❑ overflow cesspool number: DIFFUSERS ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 t . Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 410 WIANNO AVENUE - Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA 02655- 02/17/2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): LEACH FIELD WAS EMPTY AT TIME OF VIDEO INSPECTION . 'a 12. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): ' Number and configuration s NA Depth—top of liquid to inlet invert NA Depth of solids layer _ NA Depth of scum layer NA Dimensions of cesspool - NA Materials of construction " NA Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): NA M t5insp.doc•rev.7126/2o18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/17/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: NA Dimensions NA Depth of solids a NA Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): NA t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 WIANNO AVENUE • Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/17/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) a 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately . 4 4. 8 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System r Page 16 of 18 410 WIANNO AVE � OSTERVILLE A P. � QQ Al n _ • 4 14 2 1lr . • - _ - _ � �_�__...._. ___--_ � . r ! �� - - �5 .'� � fib- 32 35 -t y . Commonwealth of Massachusetts rp Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/17/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 10+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record , If checked, date of design plan reviewed: Date ❑ Observed site(abutting'property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: . ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: • r You must describe how you established the high ground water elevation: PREVIOUS FILED INSPECTION IN 2018 HAND AUGER AND MINI EXCAVATOR Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form . , ` Subsurface Sewage Disposal System Form-Not for Voluntary Assessments-- 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA 02655 02/17/2020 page. CitylTown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section ® B. Certification: Signed & Dated 'and 1;2, 3, or 4 checked ® C. Inspection Summary: ` 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Ti ht/Holdin Tank—Pumping contract attached 9 9 p 9 For 14: Sketch of Sewage Disposal System drawn on pg. 16 or,attached For 15: Explanation of estimated depth to high groundwater included . • t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is MA 02655 01/17/2020 required for every OSTERVILLE ; page. City/Town x State Zip Code Date of Inspection 1 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. Inspector Information � q on the computer, JOHN P GRACI SR use only the tab key to move your Name of Inspector cursor-do not GRACI SEPTIC INSPECTIONS,LLC use the return Company Name key. BOX 21 Co y � Company Address TEATICKET MA 02536 City/Town State Zip Code 508-548-7500 S1468 Telephone Number License Number B. Certification I certify that: 1 am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 16.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes . 3. ❑ Needs Further Evalu ion by the Local.Approving Authority ` 4. ❑ Fails 01/17/2020 Inspector's Signature Date The system inspector sh I submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 0 days of completing this inspection. If the system has a design flow of .10,000 gpd or greater, th inspector and the system owner shall submit the report to the appropriate regional office of the DE . The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/W018 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA 02655 01/17/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are, indicated below. Comments: SYSTEM SHOW NO SIGNS OF HYFRAUIC FAILURE AT TIME OF INSPECTION. 2) System Conditionally Passes: t. ❑ 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, Nb)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): NA t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA . ' 02655 01/17/2020 page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (coat.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box 9 P 9 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): NA ❑ 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): NA t 3) Further Evaluation is Required by the Board of Health: z ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc-rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form . , . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owners Name information is required for every OSTERVILLE MA 02655 01/17/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) . determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. , Method used to determine distance: NA **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal. coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: NA 4) System Failure Criteria'Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 4 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER - Owner Owner's Name information is required for every OSTERVILLE MA 02655 01/17/2020 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ . ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis . and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be consideredia large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA 02655 01/17/2020 page, City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out.in the previous two weeks? ® ❑ . Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® El available as built plans of the system obtained and examined?(If they were not available note as N/A) Z. ❑ 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: a , ❑ ® Existing information. For example, a plan at the Board of Health. ❑ ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA 02655 01/17/2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. 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): Description: ' Information taken from scanned asbuilt. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ .No Water meter readings, if available last 2 ears usage TOWN g ( y 9 (gPd))� . Detail: , 2019- 288,000 2018- 336,000 > 3 Sump pump? ❑ Yes ® No Last date of occupancy: " SEASONAL Date 1 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 VVIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA 02655 01/17/2020 - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): NA Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): NA Grease trap present? ❑ Yes ❑ No • Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: NA Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: NA Last date of occupancy/use: NA Date Other(describe below): NA 3. Pumping Records: Source of information: JAN 2018 WARREN CESSPOOL Was system pumped as part of the inspection? ID Yes ® No If yes, volume pumped: gallons r How was quantity pumped determined? Reason for pumping: MAINTENANCE t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 I • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for.Voluntary Assessments 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is ILLE MA 02655 01/17/2020 required for every OSTERV ' page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. , ❑ Other(describe): Approximate age of all components, date installed (if known)and source'of information: 2006 Were sewage odors detected when arriving at the site?m ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 21211feet Material of construction: ❑cast iron ®40 PVC 40 PVC ❑ other(explain): , Distance from private water supply well or suction line: 1 feeett Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER ' Owner Owners Name information is 'MA 02655 01/17/2020 required for every OSTERVILLE • page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) fi 6. Septic Tank(locate on site plan): 1 1$n Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) SEPTIC TANK IS CONSTRUCTED OF CONCRETE If tank is metal, list age: NA years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: STANDARD 1500 GALLON ST • _ ' 4" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 30' Scum thickness ,. Distance from top of scum to top of outlet tee or baffle 611 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? MEASURED. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1500 GALLON SEPTIC TANK APPEARS TO BE FUNCTIONING PROPERLY AT TIME OF INSPECTION. RECOMMEND PUMPING EVERY 2-3 YEARS DEPENDING ON USAGE, t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 • q' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 410 VVIANNO AVENUE Property Address , BENJAMIN AND LINDA BUTCHER Owner Owners Name information is OSTERVILLE MA 02655 01/17/2020 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.), , 7. Grease Trap (locate on site plan): Depth below grade: NA feet Material of construction: '' a ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): NA Dimensions: NA Scum thickness NA ' Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom'of outlet tee or baffle NA Date of last pumping: NA s Date 4 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): NA 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):. Depth below grade: 4 NA ' Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): NA Dimensions: NA Capacity: NA p ry' gallons Design Flow: NA gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts , Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA 02655 01/17/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: NA Alarm in working order: ❑ Yes ❑ No Date of last pumping: NA Date Comments(condition of alarm and float switches, etc.): ` NA •Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert BOTTOM OF PIPE Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): DISTRIBUTION BOX APPEARS TO BE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY AT TIME OF INSPECTION. r t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary-Assessments 410 WIANNO AVENUE M . Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA 02655 01/17/2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cant.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ® No" Alarms in working order: ❑ Yes ® No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): NA If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: NS Type: Elleaching pits number: NA ❑ leaching chambers a number: NA ❑ leaching galleries number: NA ❑ leaching trenches number, length: NA 4-FLOW ® leaching fields number, dimensions: DIFFUSERS ❑ overflow cesspool number: NA ❑ innovative/alternative system Type/name of technology: NA t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA 02655 01/17/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cunt.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): LEACH FIELD WAS EMPTY AT TIME OF VIDEO INSPECTION. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): NA Number and configuration . 1 Depth—top of liquid to inlet invert NA Depth of solids layer NA Depth of scum layer NA Dimensions of cesspool NA Materials of construction` NA Indication of groundwater inflow ❑ Yes '❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): NA t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA 02655 '01/17/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: NA Dimensions NA Depth of solids NA Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): NA t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA 02655 01/17/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately S t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 I . f ' ttf ' I 410 WIANN® AVE 4STERVILLE 01/17/202® ; _. �_ .-----� O f 2_ ----- ---_-_-� �W 14 f" ,� 2l A q -V 36 P, 35 'l I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 410 WIANNO AVENUE L Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is 'MA 02655 01/17/2020 required for every OSTERVILLE - ' page. City/Town State Zip Code Date of Inspection D. System Information (cont.) ° 15. Site Exam: ® Check Slope , ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 1 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: ' You must describe how you established the high ground water,elevation- PREVIOUS INSPECTION'IN 2018 WITH HAND AUGER AND MINI EXCAVATOR. { _ BeforeAfiling this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Tdle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 , l_ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 WIANNO AVENUE Property Address BENJAMIN AND LINDA BUTCHER Owner Owner's Name information is required for every OSTERVILLE MA 02655 01/17/2020 page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: , ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Pone:Subsurface Sewage Disposal System•Page 18 of 18 Commonwealth of Massachusetts (o3- va.3 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments = °M 410 WIANNO AVENUE w Property Address, ARTHUR MCCARTHY P�• Owner Owner's Name information is OSTERVILLE MA 02665 01/05/2018 `+ required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not JOHN P GRACI SR use the return Name of Inspector key. GRACI SEPTIC INSPECTIONS LLC Company Name PO BOX 2119 11111 of Company Address TEATICKET MA 02536 Citylrown State Zip Code 508-641-6694 S11468 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Eval n by the Local Approving Authority �. 01/05/2018 Inspector's Signature Date The system inspectors I submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 0 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, t 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 �OJ JMV S Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c�M 410 WIANNO AVENUE Property Address ARTHUR MCCARTHY Owner Owner's Name information is required for every OSTERVILLE MA 02665 01/05/2018 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: AT TIME OF INSPECTION SYSTEM APPEARS TO BE STRUCTUARLLY SOUND AND FUNCTIONING PROPERLY. 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): NA t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I ' Commonwealth of Massachusetts ilIn Inspection Title 5 Official spect o Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 410 WIANNO AVENUE Property Address ARTHUR MCCARTHY Owner Owner's Name information is required for every OSTERVILLE MA 02665 01/05/2018 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): NA ❑ 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): NA 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.doc•rev.6/16 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 ;M 410 WIANNO AVENUE Property Address ARTHUR MCCARTHY Owner Owner's Name information is required for every OSTERVILLE MA 02665 01/05/2018 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: NA ** 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: NA 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 '/2 day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 410 WIANNO AVENUE Property Address ARTHUR MCCARTHY Owner Owner's Name information is required for every OSTERVILLE MA 02665 01/05/2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. . ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, ri r triggered. A co of the analysis provided that no other failure criteria are t gg copy y 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. e 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.doc•rev.6116 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 410 WIANNO AVENUE Property Address ARTHUR MCCARTHY Owner Owner's Name information is required for every OSTERVILLE MA 02665 01/05/2018 page. Cityrrown 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): 673 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 l Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 410 WIANNO AVENUE Property Address ARTHUR MCCARTHY Owner Owner's Name information is required for every OSTERVILLE MA 02665 01/05/2018 page. City/Town State Zip Code Date of Inspection D. System Information Description: 1500 GALLON SEPTIC TANK DISTRIBUTION BOX WITH 3- 4'X 8' FLOW DIFFUSSORS W 4' OF STONE ALL AROUND. Number of current residents: SEASONAL Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d TOWN 9 ( Y 9 (gp ))� Detail 2017- 224,000 2016-284,000 Sump pump? ❑ Yes ® No Last date of occupancy: SEASONAL Date Commercial/Industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): NA Gauons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): NA Grease trap present? ❑ Yes ® No Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Water 9 r meter readings, if available: NA l5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 410 WIANNO AVENUE Property Address ARTHUR MCCARTHY Owner Owner's Name information is required for every OSTERVILLE MA 02665 01/05/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: NA Date Other(describe below): NA General Information Pumping Records: Source of information: WARREN CESSPOOL Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 GALLONS gallons How was quantity pumped determined? SIGHT TUBE Reason for pumping: CHECK INTEGRITY OF THE SEPTIC TANK Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 410 WIANNO AVENUE Property Address ARTHUR MCCARTHY Owner Owner's Name information is required for every OSTERVILLE MA 02665 01/05/2018 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: 2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2;2"feet Material of.construction: ❑ cast iron ® 40 PVC ❑ other(explain): 40 PVC Distance from private water supply well or suction line:. 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK APPEARS TO BE STRUCTURALLY SOUND AND FUNCTIONING PROPERTLY AT TIME OF INSEPCTION Septic Tank (locate on site plan): 1'8" Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) SEPTIC TANK IS MATERIAL IS CONCRETE If tank is metal, list age: NA years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 GALLON Sludge depth: (6) SIX INCHES l5ins.doc-rev.6/16 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 410 WIANNO AVENUE Property Address ARTHUR MCCARTHY Owner Owner's Name information is OSTERVILLE MA 02665 01/05%2018 required for every page. CityTTown 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 (28)TWENTY EIGHT INCHES Scum thickness (4) FOUR INCHES Distance from top of scum to top of outlet tee or baffle (6) SIX INCHES Distance from bottom of scum to bottom of outlet tee or baffle 0 How were dimensions determined? MEASURED Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): AT TIME OF INSPECITON SYSTEM APPEARS TO BE STRUCTUARLLY SOUND AND FUNCTIONING PROPEPLY RECOMMEND PUMPING EVERY TWO TO THREE YEARS DEPENDING ON USAGE. Grease Trap (locate on site plan): Depth below grade: NA p g feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): NA Dimensions: NA Scum thickness NA Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA Date of last pumping: NADate t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 410 WIANNO AVENUE Property Address ARTHUR MCCARTHY Owner Owner's Name information is required for every OSTERVILLE MA 02665 01/05/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): NA Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): NA Dimensions: NA Capacity: NA gallons Design Flow: NA gallons per day Alarm present: ❑ Yes ❑ No Alarm level: NA Alarm in working order: ❑ Yes ❑ No Date of last pumping: NA Date Comments(condition of alarm and filoat switches, etc.):. NA "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 410 WIANNO AVENUE Property Address ARTHUR MCCARTHY Owner Owner's Name information is required for every OSTERVILLE MA 02665 01/05/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert BOTTOM OF PIPE Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): DISTRIBUTION BOX APPEARS TO BE STRUCTUARLLY SOUND AND FUNCTIONING PROPERLY AT TIME OF INSPECTION 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.): NA * 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: NA t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M0 410 WIANNO AVENUE Property Address ARTHUR MCCARTHY Owner Owner's Name information is required for every OSTERVILLE MA 02665 01/05/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: NA ❑ leaching chambers number: NA Elleaching galleries number: NA ❑ leaching trenches number, length: NA ® leaching fields number, dimensions: 3-FLOW DIFFUSERS ❑ overflow cesspool number: NA ❑ innovative/alternative system Type/name of technology: NA Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): LEACH FIELD CONSISTS OF 3-4'X 8' FLOW DIFFUSERS WITH4' OF STONE ALL AROUND SYSTEM WAS EMPTY AT TIME OF INSPECTION. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA Depth—top of liquid to inlet invert NA Depth of solids layer NA Depth of scum layer NA Dimensions of cesspool NA Materials of construction NA Indication of groundwater inflow ❑ Yes ❑ No 15ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c 410 WIANNO AVENUE Property Address ARTHUR MCCARTHY Owner Owner's Name information is required for every OSTERVILLE MA 02665 01/05/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): NA. Privy (locate on site plan): Materials of construction: NA Dimensions NA Depth of solids NA Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): NA t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form,Not for Voluntary Assessments =- z 410 WIANNO AVENUE Property Address — -- ARTHUR MCCARTHY Owner Owner's Name information is OSTERVILLE MA 02665 01/05/2018 requiredd for every _ _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet: Locate where public water supply enters the building. Check one of the boxes below: ® hand-Sketch in the area below. ❑ drawing attached separately F061AF t5ins.doc•rev.6118 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 410 WIANNO AVENUE Property Address ARTHUR MCCARTHY Owner Owner's Name information is required for every OSTERVILLE MA 02665 01/05/2018 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10+feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: HAND AUGUR AND MINI EXCAVATOR Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I .� Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 410 WIANNO AVENUE Property Address ARTHUR MCCARTHY Owner Owner's Name information is required for every OSTERVILLE MA 02665 01/05/2018 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist 19 Inspection Summary: A, B, C, D, or E checked [vj 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 I , No. �� I.' ;�: Fee ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 3.pprication for Migozal .p5tem Cott.5truction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ CComplete System ❑Individual Components Location Address or Lot No. Awo Wi'6snvhp 19✓-P� Owner's Name,Address a, d Tel.No. 71 Assessor's Map/Parcel 1631023 ®sneer"I/e Installer's Name,Address,and Tel.No. og�yaTj_gs-q� Designer's Name,Address and Tel.No. ;✓, C, A4 �O CO^ �7'V'v="fi J"� sf+ �.n ,P c' ntfO< pipA©X 339 �aG�/Ff `!'aZ Gh (✓�0g� Type of Building: E FQ/,0,1/- ,4f,9 oa 5 Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) I '7lO gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) &,gle 0 0-q S'e�1�°e 7�•�LC Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this ar of Health. Sig Date Application Approved by Date Application Disapproved.by: Date i"or the following reasons ,i '` Permit No. � Date Issued 14 No. . Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ./PUBLIC HEALTH DIVISION ;.TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rpplication for ai.5poz.al 6- r5tem Cow5truction permit Application for a Permit to,Con.struct Repair,( Upgrade O Abandon Complete System ❑Individual Components Location Address or Lot No. /-//o W,'4,'?yjV Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 1631,193 05-fYVI-Ile Installer's Name�,�Address,and Tel. Designer's Name,Address and Tel.No. —37'/ FQ 7/1 14,9 0A �734 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers Cafeteria yOther Fixturjs� ODesign Flow(min.required) gpd Design flow provided 6Y Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the`system in operation until a Certificate of Compliance has been issued by thi I bard of Health. Signed (M,1 _1� Date /19- y;�t�Application Approved-by Date 1A1 Application Disapproved by: Date for the following reasons 4 Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed Repaired Upgraded Abandoned by -.0 at q1V W,'4�$19 a ✓t has been constructed in accordance. with the provisions of Title 5 and the for Disposal System Construction Permit No U ateci Installer J, C. A. 1¢o Gv— Syklv C 7�',g 4-1 Designer #bedrooms y Approved design flow gpd ction as designedt The issuance of this permit shall not)be construed as guarantee that the system will un Date 1 4 Inspector No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS Bigpossat �P!5tem cow6truction permit Permission is hereby granted to Construct Repair Upgrade Abandon System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction in t be ompleted within three years of the date of t Date Approved by,VV/ 7,71 No.....�5.....y�..`f F;ms.......``.... ...... . THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF ,HEALTH A,9..............OF............... &RAJ ................ Applira#ion for Disposal Works Tnnstrnr#inn rrmit Application is hereby made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal System at: Al t"N b AV E OJ>E�WcE . ................_.........I.........3............V.............. L UT Lo tion-A ress ` V „ or Lot-No. .........a_. ...� .... ....--•--------------------f�1..!M.41.._... .F.a.....•..OSTF ..... U....... P ..... ......... Owner Address C. _ � Installer Address UType of Building Size Lot...... _¢.e.7........Str-feet Dwelling—No. of Bedrooms.......... _____________________________Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ............................................................. ..-----••----••-----....-•---------------------••--..........•--• W Design Flow............�5......................gallons per person per day. Total daily flow............ ... . gallons. x Septic Tank—Liquid*capacity gallons ��ength..-rO..-.... Width.._... - _.___. Diameter________________ Depth.. _-"K. Disposal Trench—No........./.......... Width.................... Total Length....... ._... Total leaching area..�7-3__...sq-+ft.45PO Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area.............::_:sq. ft. Z Other Distribution box ( V1 Dosing tank ( ) J P-4 JQ. .....1 Date----_....�-� � ._..�_�_�_�_� Percolation Test Results Performed by._.�r�.1LTM�.____ __.._.. Test Pit No. 1..:!5;.9.._minutes per inch Depth of Test Pit...... .......... Depth to ground water.___.'_..._.._.._. Lz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a =•••-•------•--•-•••-•----•-•••...•---•••••-••------------------------------•--•-•-••-••••-----••••••••-•••---•••-•--•-•••............-••••-------... O Description of Soil..........0.... ....Pit ---------------------•--------- -------------•----- W ----••--------------------------------------------------------- ••-•••-•••••......• .......................................-----•-••-••......------. fir€ U Nature of Repairs or Alterations—Answer when applicable--.... .................................................. /GG---•-- .........................h ................................/Sfd6ruGL o..... .�.. ... Agree e Guokrls eote.jTlerit,r1V !iG yr T.. 9d� ��jl c.i ��H��� � 6. !�iu19►'.....��� g s' /� U �k u�s� C olt s rA c.cr/ok — GG�k!'� �i� �/i w O� " The undersigned 6grte to install the aforedescribed Individual Sewage Disposal System i{�accordance with the provisions of iIT?.L 5 of the State nitary Code— The undersigned further agrees not to place the system in oper until a Ce cate of Complian has en issued b �theboardofealth. l i ned ----•----•----•---------------------------------•i t°'-----•-------.. h!.l��--------•-- C �M{s t_$ Q-OAW S`r- tZ t.3-W C� r ate PPlic i n of edBY-----•-- •••••••••.......•-----•---••........................•--- ------------•--•----•----•-------------- Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------••-......----- ••..........•---•-------•----•....................••-•••---------------•------•••......•••••-••-••----••-'•-••---•-----------•-------•---••---•-------•-•----••-----------•••----•---••---••-•-•--•-••••- Date Permit No.....�S�:.y'f.`. Date Issued....................................................... No........................ FE:B........ ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ..::............OF............... ............... ,Application for Disposal Works Tongtrurtion rnmit "A"p*plidation is hereby made for a Permit to Construct (X) or Repair an Individual Sewage Disposal System:at: 0 ­ . I C—As_r ........................ ----------------------------- .. ............................... ----------------------*.................... Location-A r ss or Lot NO. 411A0 A r, ................................................. .........................................rx� f=...... _,?wner Address ..................... ............................I............................................. .................................................................................................. Installer Address . ,97 Type of Building I U Size Lot.. ....................Stu, fee AC Dwelling—No. of Bedrooms...........4...........................Expansion Attic ( ) Garbage Grinder Other—Type of Building .................... -Nol", of persons_..__...__.__._____.___.__._ Showers Cafeteria Otherfixtures .......................................................................................................................... Design Flow.____....... ...5....... ...gallons per person per day. Total daily flow__._...- ---4..0' 0 .....................gallons. P4 Septic Tank- ­'.I L -quid capaci -"A�Q�ailons Length.../42....... Width...... Diameter Depth.4,:n(_,�, ty- Diameter______ Trench No. ........Z.......... Width_..._. ....... Total Length.......Z8.1... Total leaching area_.413......sq-4t. GPO Seepage Pit No_____________________ Diameter.__..._............. Depth below inlet..........._.._._... Total leaching area..................sq. f t. Z Other Distribution box Dosing tank e..... ....1�j._��E.....!?S�... Date........Percolation Test Results Performed Test Pit No. 1...`5...Z.-minutes per inch Depth of Test Pit-------6?......... Depth to ground water_-___ ............. Test Pit No. 2................minutes per inch Depth of Test Pit..__._......_....._. Depth to ground water......................... ............................................................................................................................................................. 0 Description of Soil..........-9-... -------PG' ......................... ....................................................... .. .............. Arc— U n.....&........ ................... ...........•1.02............................................. W ........................................................................................................................................................... ....... 4 IV &..1 r ------------- U Nature of Repairs or Alterations—Answer when applicable-et•...AV-?Ie ............... ...... ....--- -- ;Ao. ...........................................................................X;.... ....;;�w Agree 1,4"64 S j-/ iy . pef 4-00.,r. el PIP &.4? t.,?.c ir- C161O.'s -4, ;�,k N'l 414 ?e undersigned to install th aforedescribed Individual Sewage Disposal System i;(?accordance with TITLE 5 of the State the provisions of L itary Code—The undersigned further agrees not to place the system in he unc ,ers e provisions of opera . until a Ceii1hpate of Complian as been issued by the board of health. ned..................................................................... ........ ...................... ate;,r.7 I— py pp A� ...............7------------------------- ppli a i A .......... -------- Ap pd By_----------�2... ..... ............................................ Application Dis2tppr"dved,for th 61,16wing"reasons :............................................................................................................ ---------------------------- ..................................................................................................................................7........................................ . I -f Date Permit No..... ... ... ...... ............................. Issued.......................................................... Date THE COMMONWEALTH OF MASSACHUSETTS seel, 4(c BOARD OF HEALTH ..............OF. ........................................ N Tatifiratr of Toutpliatta f THIS IS TO�"CERTIFY, That the Individial Sewage Disposal System constructed or Repaired b ........................................................................................................................................................... y ......................................... Installer I . � 1-4,4, �"I." - 0 -? ,,,a -_­e,�ZIv,",��ej ':".Y;`)t C4 4e, 1,5A A at..............Zp..r............................. .... ....... �Z......................... V------------ ....X, ............................................ ......*............ has been installed in accordance with the provisions of TITIE 5 of The State Sanitary'Code as'described in the application for Disposal W onstruction Permit.JNo....-..T, 4_------ ----. .......... dated_ ,� ;1 1. � ----- -- - THE ISSUANCE OF THIS CERTIFICATE SHALL ALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............. ................................. Inspector................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 4,..,e, -fry �;'p JA�/1. , 4., 1 /4Z ........................................OF........... . .................. No... FEE........................ Disposal Workii Tonstrurtion Upamit. Permission is hereby granted. r ..... ........ toSeamy .......................................................L...................................J....... Construct ("() or Repair an Individual Sewage Disposal System at No...........ZV.1. ........ eZo�dT....... .......... Street as shown on the application for-bisposal Works Construction Permit A' ................ No............. �.W Za ...........g...j.... . � . ...................... ....... ......... ........ . Board of Health . ..... .- — FORM 1255 HOBBS & WARREN., IN6:', PUiL1qHER5­, J, CAI'JctiF1 f02 P£PE0LAT10F4 Tr-'.5-r AN"b OBScERy1\1.yLON 11.1'!': y :ATION ST" Ac�rzo�r5 c a Da�i NO P_ /3 8S - �LAGE UST-12../�V(—t' —, DATE2 y� y� FEE ., ?LICANT_ IL l G�Ai2h 1'2�t1 - (Non-refundable DRESS �Tz TELEPHONE NO. JINEER ,/� �1 ( Yb _ TELEPHONE N0. 4ZS- 3 _ ['E SCHEDULED=( � � �• g;�d (Applicant' s signature) . . . . . . o . , , , . o . , , , e . . . . . . . . 000 . , . . . . . . . . o . . . . . . . a . . . . o . . . . . . . . , . a . . . . . o . . . . . . . . . SOIL LOG B-DIVISION NAME / - 7�, DATE TIME PANSION ARVA: YES . NO _.l _ENGINEER 0 < _ -J BOARD OF HEALTH WN WATER PRIVATE WELL \ L EXCAVATOR ETCH: (Street name, etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes ) NOTES : /V ZoI.CD S -- � 1 45 00 S' r V ERCOLATION RATE: EST HOLE NO: —.Loa*'1ELEVATION: TEST HOLE N c ELEVATION: 1 / — w/�7Te 2 m 2 ' -- 2 rYj cD .��0 G�/17e'e— 3 TD C..: 2� 3 / 4 A::14&r 4 / 077� -G'� 5 5 • 6 6 9 9 _ 10 10 11 11 8 �^; 12 12 13 13 14 .. 14 15 15 • 16 16 SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS LEACHING TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE.. REASONS : NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION E .. AND RETURNED TO BOARD OF HEALTH OR-IGINAL: COMPL`ETED IN ENTIR= �Y P , _ DPTATNED BY APPLICANT BAXTER & NYE, INC. Registered Land Surveyors and Civil Engineers 7 Parker Road/Osterville,Massachusetts 02655/Tel. (617)428-9131 WILLIAM C.NYE,R.L.S.-President RICHARD A.BAXTER,R.L.S.-Vice President PETER SULLIVAN,P.E.-Vice President-Engineering November 21, 1985 Town of Barnstable Board of Health 1367 Main Street Hyannis, MA .02,601 RE: Lot 4 East. Bay Road Osterville, MA Gentlemen: In accordance with the Board of Health ' s requirement, a *percolation test was conducted on November 20 , 1985 'on the fill at the East Bay Road parcel . The test was wit-; ' nessed by Mr . . Thomas McKeon agent for the Barnstable Board of Health . ' Within a time span . of 7 minutes 30 seconds, twenty five gallons of ,water was . poured into the perc test hole and completely leached into the sand strata . In accord- ance with Title V Section 15 . 03 ( 5) ( g) a percolation rate of two minutes. per :inch is assigned. Therefore, the fill material meets the requirements for design. I ..trust th1s.,:meets your- present ._needs . - �.f.Veiy` truly"you-r s, Peter Sullivan, P . E. A0" OFh9gs Baxter & Nye, Inc. ems° PETER , PS/fmJ c SULLIVAN r+ . CC: Oman Construction No. 297331 o , A9O,e�s�OIST&R s/ONA l EN MEMBERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS/AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS BAITER & NYE, INC. Registered Land Surveyors and Civil Engineers 7 Parker Road/Osterville,Massachusetts 02655/Tel. (617)428-9131 WMUAM C.NYE,R.L.S.-President RICHARD A.BAXTER,R.L.S.-Vice President PETER SULLIVAN,P.E.-Vice President-Engineering Nobember 21 , 1985 Town of Barnsta-ble Board of Health ,367 Main Street • Hyannis, MA 026,01 RE: Lot 4 ' East- Bay Road Osterville, MA Revised Site Plan Dated 9/26/83 Dear Mr . Kelly:" In accordance with the Boards requirement , I have provided construction supervision during the installation of the septic system at Lot 4-East Bay Road. The septic system has been installed as per the approved Site Plan, with the exception that final grading has not been completed • . at this time. I trust that this meets your present needs. Ver truly yours, � eyy�� Peter .Sullivan, P . E. Baxter & Nye, Inc. PS/fmj OF q qc� CC : Oman. Cosntruction PETER SULLIVAN v, No. 29733 r A?'p IS MEMBERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS J AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSE7TS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS BAXTER & NYE, INC. Registered Land Surveyors and Civil Engineers 7 Parker Road/Osterville,Massachusetts 02655/Tel. (617)428-9131 WILLIAM C.NYE,R.L.S.-President RICHARD A.BAXTER,R.L.S.-Vice President PETER SULLIVAN,P.E.-Vice President-Engineering November 5 , 1985 Town of Barnstable Board of Health 367 Main Street Hyannis, MA 02601 RE: Lot 4 East Bay Road Osterville, MA Dear Mr . Kelly.:, This is to inform you that on November 4 , 1985 a percolation test was performed on the subject lot . The test was witnessed by James Conlon your agent . The test showed that ,the fill on which the septic system is to be placed has a percolation 'rate of 1-inch drop in 7 minutes '10 seconds . I .trust that this meets your present needs . Very truly yours , Peter Sullivan, P . E . Baxter & Nye, Inc. PS/fmj CC: Oman Construction �N OF 414 PETER ; SULLIVAN No. 29-/33 Fss/ONAL r� MEMBERS OF CAPE COD SOCIETY OFPROFESSIONAL ENGINEERS AND,LAND SURVEYORS 1 AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSE7TS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS BAXTER & NYE, INC. Registered Land Surveyors and Civil Engineers 7 Parker Road/Osterville,Massachusetts 02655/Tel. (617)428-9131 WILLIAM C.NYE,R.L.S.-President RICHARD A.BAXTER,R.L.S.-Vice President PETER SULLIVAN,P.E.-Vice President-Engineering April 26 , 1985 Mr . John Kelly Barnstable Board of Health Barnstable Town Hall Hyannis, MA 02601 RE: Lot 4 East Bay Road Land Court 7684 Dear Mr . Kelly: At your request we have contacted the Department of Environmental Quality Engineering to ' review the septic system layout and percolation test procedures for the proposed sewage system shown on a plan for Dr . Richard Prothero dated July 19 , 1983 . A plan of the proposed system is on file under File No. SE-3-1024 at the" D. E .Q. E, and an order of conditions from the Barnstable Conservation Commission .has been issued. Mr . Alan Jones, Design Engineer , spoke with ' Mr . John Sullivan, D. E.Q, E, by phone on Wednesday April 24 , 1985 regarding questions you raised regarding percolation test #P1385 performed on October 1 , 1982 and witnessed by Mr . Ronald Gifford, former Barnstable Health Agent ..,. Mr Sullivan reviewed a copy of the plan with Mr . Jones and expressed an informal opinion that the procedures used to establish soil strata and design percolation rates met the requirements of Section 15 . 03 , Title V.. He, also . stated that in his opinion the sewage disposal . system shown .on the drawing exceeded the design requirements of Title V. Both agreed that a follow `up percolation test in_ the installed fill material must be conducted.' We will perform the test if requested by the current owner . He may have his own engineer test the soil but in any case, the Barnstable Board of Health should receive results of this percolation test . MEMBERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS/AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSE=S ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS 7 Page -2- Mr . John Kelly April 26 , 1985 We hope this letter answers your questions and that you will issue the Board of Health permit on this lot . Should you have any questions or need additional information do not hesitate to contact us . Very truly yours, LL'-O D � e'x'� Richard A. Baxter , L.S. for Baxter & Nye, Inc Alan W. Jones P . E . RAB/AWJ/bc e""Ww ef^e 0/ (e J*iW6 0/ (� .�.ub' �iG�r/ne��crr� PAUL T. ANDERSON A Regional Environmental Engineer 0,2346 807 December 28, 1984 Town of Barnstable RE: HYANNIS--Subsurface.Sewage Disposal, Board of Health. Title 5 Clarification of 310 Cat 367 Main Street 15.01 and 15.03 Hyannis, Massachusetts 02601 '-ATTEMION: John M. Kelly, Director Ronald Gifford, Inspecr-or Gentlemen: The Department of Environmental Quality Engineering is in receipt of your letter (dated 12 December 1984) requesting clarification of Sections 15.01 and 15.03 of the 310 CMR 15.00: "Title 5," of the State Environmental Code. I'n your letter, paragraph. two (2) precisely reiterates the definition of impervious material as. listed in Title 5. The application of this definition to the test hole conditions as outlined in paragraph three, (3) of your letter,- would render the top one and one.-half (11�) feet of loam and subsoil unsuitable, regardless of the observed percolation rate and thereby inadequate to accept an on-site disposal system. If there are any questions relative to the above, please feel free to contact Mr. Ted Kaegael Jr. of my staff. Very truly yours, For the Commissioner Rolkit P. Fagan Deputy Regional Environmental Engineer F/TJK/re i s J 1-9 OWN 0' iiABLE SEWAGE# ASSESSOR'S MAP&PARCEL / zz OW 2 ." A1VIE cis PHONE NO._ , �. } � � Goy g�y„c- �or► SEPTIC T�'_ ''CAPACITY 1500 cy LEACHING FACILITY:(type) k'f�`, (size) NO. OF BEDROOMS OWNER /fie �rl PERMIT DATE: /a ` `/s O!o COMPLIANCE DATE: Y4X Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site.or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet s FURNISHED BY C�1 ry k ry rr, o T v c *EDT y j laCA�TION SEWAGE tPERMIT M0. yl1 LLAGE 054( INSTALLER'S NAME & ADDRESS VVI t4c5 L � BUILDER OR OWNER ®iM oN 1(\ DATE PERMIT ISSUED / 9 / ��� i. --V— - DAT E COMPLIANCE ISSUED ��y �� i �1 Ar Z N 9 i 5y `.� L AS'-O' u'-o- W 7- MH I mg�mo 7`7— .J1J I I � a AMR Q I� �x� Zy�i I I(p �9" j N im r A ' 0• •�z UP 1 YYY I I mm I D ° p8r7cPD I YQ �� F 'Y 'NUIE-I.- Imp" �jx l � .1 i m - j111 $ Z= �_ • __I m _ __ �mgz�gl i i • Fol I z yz p 1 �Q2 0 N� r L i ---- -- I q�_6 10'-$' 1pYO -4 I 1 , _J U ,_, ------------- - - --- - -J ___ __________ _0. � { ___ _ __ mA € 5 r ---------- r __ �_� I C,ONCRlTC.�%WALL ON IGN oI .L--TTTTTTTI < � - 1{ I I DON'T 20'x10'CON0. 1 m I I FOOTING 1 Iypl I u'-e' I �- � 1 iiiiiiiii g�• �� I � p -m1 I I� I U rl L- - m II I oal I L____ r I � II I�ml It • �- � I `' ° �� is L ----1 Z_-------- ---� I I JE y O \ m�0� 'gglmaQ 6` lP - - iP D og 4�4gq U p rl 7�tog Z3. p r m�y_ Fin --------- % " Ji °A z I B_2• 3�_2' mz m LD - t-qh yr_1,• pp D� q'-7• I - X, m \ �P m i j m 7D \ \ P 1 . ��u z8 � I Z„_$ xxxx y I I m_° 'uM !� �< mop7pt 1PZ .a Z3Zr m DLp g flrom �i ° m ° Z m m W�• imO C^ °m m� m -�a1p y 3A rn S,-9, 'y'_q,. 7,_7• p'-q• m c Om0 -1 o g �gg4� Z R ^ Z A m -fir p i Af Z O m X�Om mgDF - O �� aaDD -ZZ _I a ym�� -� mp g M =� _ I A O DZM. c m•€8 Qpp�� Z itL A° i1mD ml o 7 m pm 68- p p.. p it O 4 r m m A C m C ZC Zm Amyl Zy- D �2' �im--n -1 ��r11mmA Ag ir $ ttqq - I DD- Z r� Sim � N > Q3 SO >, "" .zoo r(� I b c m a U- m 02 �� Rlj A m � mm7 D €mad AIAa 016. gD m .m f 1'n -4 � suit �� C��i ,r om uTE AND LDu�sALDNG CCDEs VARY - COPYRIGHT -DATE � REVISIONS � �dAIE: 1 9•=1-D• 5;,� THE„ NORTN_SI.DE DESIGN AM¢�ry?S_ ,f01m"'a's' FOUNDATION PLAN NORTHS S HEREBY EON LAY - RESERVES ITS C0S PLANS S A 0 2 4 B 16 srt IG NOT THESES PLANS ARE NsOL Ero. 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DATE: k Dv°wa[s M PROPOSED PHASE 1 FORMA OR MANN�EREWH TS�YERDRAWN n+ '�""MA McCARTHY RESIDENCE WITHOUT FIRST OBTAINING THE votm LOCAL /� /'� roDISTINCTIVE RESIDENIAL&COMMERCIAL DESIGN EXPRESS WRITTEN PERMISSION CHECKED !� / 2/19/07DEPIR�,�hp p, Np, 410 WIANNO AVENUE 141 MAN STREET•rARVOUTHPORr•MA 0267e AND CONSENT of NORTHSIDE s r�'- OR RE1cYl ARO APPROVAL REOAROMc AN OSY ERV I LLE MA. (608)xx-1210 (eR)e)xz-90M DESIGN. u AL SOIEDDgEs M STRUcnn+ - FIN. FLOCR E:.EV. 11.5E' Finish Grace El. 25"t INV EL 8.65' Rl3FR 2o'Dia. 20 Dia. 10 MIN. Als? INV EL 10--� INV EL U 00'w 7 87' Bel ofv Flu,Line 7 62' S 000 y Liquid Level 48- �6 60 1500 GALLON' SEPTIC TANK Lot e9 1500 GALLON REINFORCED CONCRETE SEPTIC TANK Minimum Construction Materials Per 310CMR 15.226(2) Tees shall be constructed of Schedule 40 PVC and shall extend a b minimum of 6" above the flow line of the septic tank and be on o a S84lI21O the centerline of the septic tank located directly under the ti "E clean--out manhole. 135E ' The inlet pipe elevation shall be no less than 2" nor more than 3" above the invert elevation of the outlet pipe, Septic tank shall be installed level and true to grade on a level, q. stable base that has been mechanically compacted and on which sr .,.� 6 of crushed stone has been placed to ensure stability and to prevent settling. I.- Septic tank shall have a minimum cover of 9 . Two 20" manholes with readily removable impermeable covers o of durable material shall be provided with access ports The outlet tee shall be equipped with gas baffle. EAST BAY N O ' A14 •• � • A13. 60' i o /3 -- ---- 50' 4� V LOCI! '4 Lot 5 Locus Map ............ i ' � 41.5 /'l� -'� j � � � \� \� � Work Limit IA10 _.. SUt Barrier 37 Assessors Map 163 Parcel 23 Zoning District: RF1 A9 -,' ,4-' 50' 1 60 N ; Top of Town Coastal Bank /' , ; '�, , o Building Setbacks: 0 '/ Front 30 _ , Side and+Bear 15 oun do f :•a �`�- A6+' /' '� ' ' 1 / Wetland'1+7ags by 'ENSR Consulting" J r i r f" . J � •• !b Exrstln _. I •. .� \ \ � ?; ,, , ,..._..., ,.. _ r `, 5. La�Dz2 g FEMA koj a Eis� A7 / ' M/� : 1 i , �r: n ', �+ �� BFE = EleY 12.0' �'' Ta% r 9 �+ FIRM Panel- 250001 0016 D — 3 // / .r' �� work Limit y Location ++ + `\ . _. A6 ¢ ' �' + 6 silt Barrier "'-. i Panel Re`F�sedr July 2, 1992 rr/; � Y�� +` i+ ; Ex1 ting d ' Ui 79' slope r 387*41'30'L' -___ � ,�' .S{,1¢� ++� �, ' \\ `y Fo un a t1 on d t A►5 i r 115. 05 ' r l Eli �' .- \ � �� xlstxri� S r r rr r r Sty , i i ,'� c___ \\ ', z Cape „ i N87'41'30" 6 ; l Ep + ,/ '' r meet l n 0 0 52 2 O i i �A2 �, e ;%j B4 ! `\;`�\4'\ ` o �\" . ,\ 6 V. a ,j Erna S76 6 66 5 ............ i r i ``� alp %� T /� /� B6 \ �'27' '9 b �� / 5- 11B3 60 4 1 ; _e, d Cap \ 4�'A3 _ �� �0 %' 87 7 32' �04, tal Lan 6 65' So,_ '' g / BM Top 'B El. 6.98' ! ?o 43,864E sq.ft. �l 42, ame _� 3 A 81.0 r B2 �. Lot I t. 4 yr 85.7 B8 4 `. ' l ...•-'- - cP0-. A i,� off'' ��\ ' 5 --4 -� � ,•'l i ;'' -i 2 4- i \.1 , I BID ; 6 ' i a! `'S ....... •........ i K 5 .l i q B9 Wetland .39�� s B1 v'SQ , 56 an Septic Tank Relocation Plan For 410 T�ianno Avenue Lot 1 GRAPHIC SCALE H In 20 0 10 20 40 e0 ,�►XA AA � 0s t er v ll e, Ma ssa ch use t is �' ► ��tH or ra�sS., 1S g2 ��7Q 1 �� ,yG�� Scale: 1" = 20' Date: November 29, 2006 IN FEET ) sSEPHEN Prepared By 1 inch = 20 it~ ; oonE ; Stephen J. Doyle and Associates "' ; A� " 42 Canterbury Lane, E. Falmouth, MA 02536 Lo 1 3o V Telephone: 508/540 2534 '►...� F2�► v3 s s c� .z-� _E3' 7 c� c NO. 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