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Home My WebLink About0038 BEACH PLUM HILL ROAD - Health 38 Beach Plum Hill Road Marstons Mills A= 097-005-003 / Gr��-w�� COMA! . �� ;�� , TOWN OF BARNSTABLE LOCATION� r CSC; W �; Sl~3E.# rl j'► P ` VILLAGE � ASSESSOR'S/MAP&PARCEL �'S NAME&PHONE NO.�— r�L LAD1 0)i kt.(/ SEPTIC TANK CAPACITY LEACHING FACILITY-(type) r'sS 0-60(size) / NO.OF BEDROOMS `� OWNER !�6 e,.I Lv r PERMIT DATE: COMPMOOWE DATES Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY �f��J s. .!.!.?.{ ..{..{ .f.f.i J r..f ., .i,. r.f..J..f.r .! 4,♦ 4 ♦ \ ♦ \ 4 t 4 .�� r4 t t ♦ t .i4?� \rti�. � ♦ ♦ t o t \ \r . 1 k \ 4r♦r\r 4�4r♦ 4 4 4 ♦ ♦'♦ 1 1 _ f•�f'! f ! f ! f f I f f f f / - ... k t ♦ k l 4 4 4. t ♦ 4 4 4 4 4 - ' 4 i�, t 1 t 1 4 ♦ t 1 \ \ \ \ \ t t t 4 \ \ 4 4 4 6 60' T f f f f { { ! J f ♦ \ \ 4 \ t t \ 4 4 \ f 1 f f { f f J f f 50 43 40 84 t Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 38 Beach Plum Hill Road Property Address Schaller Owner Owner's Name information is Ostelvtlle required for !low r 45 I'V U I I S MA 02655 February 17, 2011 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out A. General Information forms the / computer, r,use 1. Inspector: JWb5,33 only the tab key ; to move vour Patrick w O'C'.o nail cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name r� 189 Cammett Road _ Company Address Marstons Mills MA 02648 Citylrown State Zip Code 508.428.1779 SI 12855 Telephone Number. License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of! Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority V I February 17, 2011 Job# 11-19 _ Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future undt�r the same or different conditions of use. UI t5ins-09/08 f Title 5 Official Inspection Form.Subsurface Sewage Dispose System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 38 Beach Plum Hill Road Property Address Schaller Owner Owner's Name information is Osterville MA 02655 February 11, 2011 required for ry every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310.CMR 15.304+exist. Any fpilure criteria not evaluated are indicated below. Comments: i Recommend pumping tank in next 12-18 months, leaching system shows no evidence of surcharge or saturation. i 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): I I - i - t5ins-09/08 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page!2,)f 17 I I I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 38 Beach Plum Hill Road Property Address Schaller Owner Owner's Name information is Osterville MA 02655 February 17, 2011 required for ry every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): i ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced p ❑ Y ❑ N ❑ ND (Explain below): i ❑ 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): I ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): i i I I C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determinelif the system is failing to protect public health, safety or the environment. I 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 I t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pagel3 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i 38 Beach Plum Hill Road Property Address Schaller i Owner Owner's Name information is Osterville MA 02655 February 17, 2011 required for ry every page. CityrFown 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. ❑ Thy 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: i This system passes if the well water analysis, performed at a DEP certified laboratory, for 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: I I i i D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: I Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments j w 38 Beach Plum Hill Road Property Address Schaller Owner Owner's Name information is required for Osterville MA 02655 February 17, 2011 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) � Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Z Any portion'of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [Phis 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 anal Iysis and chain of custody must be attached to this form.] I ❑ ® 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 CM 15.303, therefore the system fails. Tihe system owner should contact the Board of Health to determine what will bei 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. i 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 I I ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well I 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. 1 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page'5 Df 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 38 Beach Plum Hilt Road I Property Address Schaller Owner Owner's Name information is required for Osterville MA 02655 February 17, 2011 every 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? i ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? i ® ❑ 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 11, 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)] i i D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 — i DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 — i i t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page;6 of 17 I I I Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i 38 Beach Plum Hill Road Property Address Schaller Owner Owner's Name information is required for Osterville MA 02655 February 17, 2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 4 t i Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes Eg No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes No Laundry system inspected? ❑ Yes ❑ No I Seasonal use? ❑ Yes 0 No Water meter readings, if available last 2 ears usage d N/A Irrigation g ( y g (gp )) System. Detail: i I i Sump pump? ❑ Yes [9 No Last date of occupancy: One month:prior to inspection. Commercial/Industrial Flow Conditions: �I Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) i Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No I Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No i Water meter readings, if available: t5ins 09/08 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 38 Beach Plum Hill Road Property Address Schaller Owner Owner's Name information is Osterville MA 02655 February required for 17, 2011 f every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) i Last date of occupancy/use: Date Other(describe below): I I General Information Pumping Records: Source of information: Unknown i Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: I Type of System: j ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool I ❑ Privy I I ❑ 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 I I Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 38 Beach Plum Hill Road Property Address Schaller Owner Owner's Name information is required for Osterville MA 02655 February 17, 2011 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) I Approximate age of all components, date installed (if known) and source of information: 1986 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building,Sewer(locate on site plan): j Depth below grade: 2'feet j Material of construction: ❑ cast iron ® 40 PVC ❑ other :ex lain ( p ) Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): I I I Septic Tank (locate on site plan): 30" i Depth below grade: feet Material of construction: i ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) j If tank is metal, list age: — years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ jNo Dimensions: 10.5' long x 5.8'wide- 1500 gal_ i 5" Sludge depth: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page:9 3f 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments j 38 Beach Plum Hill Road Property Address Schaller Owner Owner's Name information is required for Osterville MA 02655 February 17, 2011 1 every page. Cityfrown 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 27" Scum thickness 3„ Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 10 I How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level was found at bottom of outlet invert, tees were intact and clear. Recommend pumping in next 12-18 months. i t i Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain): i i Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle ` — i Distance from bottom of scum to bottom of outlet tee or baffle — Date of last pumping: — Date I t5ins•09/08 Title 5 Official Inspection form:Subsurface Sewage Disposal system•Page 10 of 17 I I I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 38 Beach Plum Hill Road Property Address Schaller Owner Owner's Name information is required for Osterville MA 02655 February 17, 2011 i every page. Cltyfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: I Capacity: gallons i Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ �No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): I Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11-Df 17 . j Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 38 Beach Plum Hill Road I Property Address Schaller Owner Owner's Name ' information is required for Osterville MA 02655 February 17, 2011 every page. Cltyrrown State Zip Code Date of Inspection I D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover; any evidence of leakage into or out of box, etc.): ,r No solids or high stains present, liquid level was at bottom of both outlet pipes. i i i i Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No i Comments (note condition of pump chamber, condition of and pumps appurtenances, etc.): i i Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: i t5ins-09/08 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 1!2 of 17 f Commonwealth of Massachusetts l Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i M 38 Beach Plum Hill Road Property Address Schaller Owner Owner's Name information is Osterville required for MA 02655 February 17, 2011 every page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: Two 6x6 its. ❑ leaching chambers number: ❑ leaching galleries number: f ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition'of vegetation, etc.): f Leaching pits showed no evidence of surcharge into d-box, due to excessive depth and frozen ground pits were not excavated. i I i Cesspools (cesspool must be purnped as part of inspection) (locate on site plan): Number and configuration i Depth—top of liquid to inlet invert Depth of solids layer I Depth of scum layer Dimensions of cesspool I I Materials of construction ! _ Indication of groundwater inflow ❑ Yes ❑ No il t5ins 09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i 38 Beach Plum Hill Road i Property Address Schaller Owner Owner's Name information is Osterville required for MA 02655 February 17, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i i Privy (locate on site plan): i Materials of construction: Dimensions I Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i i I i i i t5ins•09108 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 38 Beach Plum Hill Road Property Address -------------------- --- — — Schaller Owner Owner's Name ------ -._....----------- -- information is required for Osterville — - — MA - 02655 _ February 17, 2011 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including Ities 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: i ❑ hand-sketch in the area below ❑ drawing attached separately i i i f / l 11 „ , , ff , l , / / 60 'fib+�• / ! /•/ / / / / / \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ I 50 Huh i il. 43 84 40 r t i i i ( I i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Beach Plum Hill Road j Property Address Schaller Owner Owner's Name information is required for Osterville MA 02655 February 17, 2011 every page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar i ® Shallow wells 1 Estimated depth to high ground water: 20 j feet 1 Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record i If checked, date of design plan reviewed: Date j i ® Observed site (abutting property/observation hole within 150 feet of SAS) i I ❑ Checked with local Board of Health -explain: I ❑ Checked with local excavators, installers - (attach documentation) j i ❑ Accessed USGS database -explain: e i You must describe how you established the high ground water elevation: Elevation of marsh at rear of property is considerably lower than SAS. i i i Before filing this Inspection Report, please see Report Completeness Checklist on next page. I t5ins•09/08 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page]6 of 17 i • .� Commonwealth of Massachusetts F W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I w 38 Beach Plum Hill Road Property Address Schaller Owner Owner's Name information is required for Osterville MA 02655 February 17, 2011 every page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater l ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I 1 i I i I I I i i l I I l 1 I I t,ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page t7 of 17 f 1 _ 07--Or-2000 10:49AM CENT CST FIREDEPT 5087302385 P.06 21E SURVEY FORM 'f //ll i STREET ADDRESS OF PROPERTY BEING SURVEYED _ DO�— Vo� OWNER: PHONE: ADDRESS: OCCUPANT: Schap r PHONE: ADDRESS: Boma ply= Hjt1 An a PHONE: I i PRESENT FLAMMABLE PERMITTED STORAGE AT PROPERTY: i TANK SIZE PRODUCT LOCATION AGE CONSTRUCTION 2000pxallon n/a n/a 1985 steel i 1 I TANKS REMOVED FROM PROPERTY: TANK SIZE PRODUCT CONSTRUCTION AGE DATE REMOVED i . f 2000gallcn fuel oil n/a n/a 10/96 i • i , F I SPILLSILEAKS AT PROPERTY: i DATE MATERIAL RELEASED APPROXIMATE SIZE OF RELEASE Our records indicate not spills or leaks at this location INFORMATION PROVIDED BY: L. Zazrelli July 7, 2000 C-O-MN FIRE DEPARTMENT DATE 1875 ROUTE 28, CENTERVILLE. MA 02632 RECORDS OF UNDERORO'UND TANKS ARE ALSO LOCATED AT TOWN HALL, HYANNIS, MA AND BARNSTABLE COUNTY COURTHOUSE, ROUTE 6A, BARNSTAELE MA. C-0-MM FORM SOB TCTAL P.06 i 03 1 H S 7 A LLER'S WANE A AODRCSS R UILOER OR 0WWE r D A T C PERMIT ISSUED BATI COMPLIANCE. ISSUED 1 d O � n C- fleG� Finc C0C)bTH`E COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ ...................OF......................................................................................... Appliratiou for Di-opmal Works Tonotrurtion Prrutit Application is hereby made for a Permit to Construct epairk or �pa, _4an Individual Sewage Disposal System at: 4 . ..... ( ..... . . . .................... ............................................................. Aocation-Address .. or N ..... .. ....... .. ............ . ..................... ......... ................. . .. ... ... ... Owife—r) Ad s .......... ......................... ..... .................. ................... Oa 1.4 Installer Address Type of Building Size Lot...2.Jo..(..AL.c..Sq. feet U ...............4------------------Dwelling—No. of Bedrooms... Expansion Attic Garbage Grinder (\-/0E5 '-4 PL4 Other—Type of Building 9.ES0.FA_.DWF_jNo. of persons..... ................... Showers Cafeteria 04 Other fixtures ------------------------------------------ W ------------------------------------------------------------------------------------------------------------ Design Flow......I.Q.CtY......................gallons per person per day. Total daily flow.............4-±.Q...................gallons. Ix Septic Tank—Liquid capacity_15� gallons Length................ Width.............._. Diameter.........._.___. Depth................ W Disposal Trench—No..................... Width..._................ Total Length.................... Total leaching area....................sq. f t. Seepage Pit No--------------------- Diameter.........._..__..... Depth below inlet.............._..._. Total leaching area............--....sq. f t. Z Other Distribution box ( ) Dosing tank ( ) . Percolation Test Results Performed by.........................................................................' Date.........................**-------------Test Pit No. 1....4Q.....minutesperinch Depth of Test Pit.....va.......... Depth to ground water------M.A------------ Test Pit No. 2.....A.Zt.,.minutes per inch Depth of Test Pit......1.0.......... Depth to ground water........N..A....... ...........................................................................................................................................f�................ 0 Description of Soil........ ��4.k. ....... ......................... ........ .......... ............. ............. U ................ --4 ....... ---- ....3)...................I..!.... ... .............................................................I........................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable............ .....5.YISM ........ ................................ ........................................................................................................................................................................................................ Agreement: 4 The undersigned agrees to install the aforedescribed Individual Sewage.Disposal System.in accordance with the provisions of TL I IE' 5 of the State anitar Code—.The undersigned further agrees not to place the system in ar Co de lian operationy1n)(1 a Certi cat of Cotrip. ha be issued by the boar f health. ne, . .......... r ned.. ........ . ......................... .... 0 ...... ............ . ....... ...... .......................... .... .... cation Approved By........... .... ..... . ...... . ... ---- --- Ap, . .. . ..----------- Date Application Disapproved for the f I wing reasons:............................................................................................................... ..........................................................................................................................................................................*-------------*------------- Date PermitNo....................................................... Issued....................................................... Date ---------------------------- No.35�L.1- Fzx THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF Appliratilln fat Disposal Works Construction Primit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at ..................4-0.-T............... Y�c .......... or 3N A A- ocation-Address ........... ...................... ... -- -- - - -------------------- ....... --- ---------------- .... ------------ Owrrr) d ................................ .. . ............ ..... - ----- Installer dress U Type of Building Size Lot...........................Sq. feet Dwelling—No. of Bedrooms....................4-------------...Expansion,Attic Garbage Grinder V)IE Other—Type of Building lZa.V�f ..AASKo. of persons......*�.................. Showers Cafeteria Other fixtures ..................... ..................................................................................... .................................... Design Flow......1. ......................gallons per person per day. Total daily flow:...._.. I...w% ......gallons. Septic Tank—Liquid*capacity.-1599gallons Length.......I......... Width... 1........... Diameter............... Depth................ Disposal Trench—No....................: Width.......................Total Length.......::........... Total leaching area..................sq. ft. Seepage Pit No..................... Diameter..................... Depth below inlet.................... Total leaching area............-.'...sq. ft. Z Other Distribution box ( ) Dosing tank_(.. ) Percolation Test Results Performed by................................................... Date..........._... ........... Test Pit No. I.....4 2*....minutes per inch Depth of'-Test Pit.....Y?.`.......... Depth to ground water.......&A...... 44 Test Pit No. 2......A.W.--minutes per inch Depth of Test Pit......1P......... Depth'to ground water:._- ...NA...... ti...................... ---------- ......................................................................................... 0 Description of Soil.........- e6.....(VAft....... ....... ................. ....... ..a . ........................... J.j .................. .........--------*................Zk:AR.......��JE4 .... .M.All.....Z.* .............. ---------........................................................................................................................... -----------...................................... U Nature of'Repairs or Alterations—Answer when applicable............ I................................. ....................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual'sewage'Disposal System.in accordance' with the provisions of TITLE 5 of the State St'nitar Code—.-The undersigned further agrees not to place the system:in operation/ny a ertij te of Complianc ! has;bee issued'b,, e h ;Zarr�-) yt f health. ned.. Da Ap cation Approved By................ .. ................ .. ........ ... ... ........................ .... ............................... Date Application Disapproved for the fo I wing reasons:................................................. .. ----------- ................................................................................................................................................ ----------•---------- ------- Date. PermitNo................................................... Issued.- ---•-- ---.:............ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trrtifiratr of Tompliatmt, PY THIS IS TO CERTI 'That the Individual al Dis, osal System constructed e I—: : I p Repaired v U or by......................... ......... V ..................... at...........................................lc-.03........0.. &V CW — ..................................k......e L��M........aoulow fzlot...................... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application.for Disposal Works Construction Permit No......................................... dated...............r..............w.................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUEDAS A GUARANTEE THAT THE "SYSTEM WILL,-EL!!C T)ON SATISFACTORY. it V,\ ....................................... Inspector.. ............ ............DATE............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 'No..... ? ...............................OF..... . ................................................................. Fzz...... Disposal Virks Tonstrurtiott famift Permission is hereby granted..............V!f .-ua.le.ms!A........... .I............................................................ to Construct orj4epair an Individual f wage Disposal System at No............ ..........5 O�WA AoLd)q ....................................... .......................... .. .............. Street 71 k D as shown on the application for Disposal Works Construction Permit I)jo..................... aled.........lk!2 -- ---------- .................... ................ ... ......... . ................................. YYY DATE..........ty— ............ .... .. ..................I....... FORM 1255 A. M. SULKIN, INC.. BOSTON Or WITH 6-ArZUA4Es bRt QOrIZ t;x4t L%4 FLow a 4-1C I 10 4-So 0 GPp EES=wn c TA+-1 V- w- 440v 2cr2��=08 o 6P� utE- 15no 6dL. � �v_osAL PIT usE.'Z- ►c>ao �,ni./2�,`1-oIJ� �..�••- l � L,L,G-, I'�I t�.d.• 311 SF ,c '2.S • 9d2 G.P.U. � , ''c.+,'>'✓�< BVr T0XA Get=...A• I ST= TC$r•AL Vt`SIGW • I09 E3 G•RD. TaTotr r->AtL-( FLOW * i�,60 &PD. Pu2c-7L&Tl01.J .OIhTE : 1"I0 smIu• 00 I�SIS. �t•=`n �P tii Of ryes OF PETER RICHARD SULLIVAN 1 �. BA:cY'ER .� No. 29733 1 :: rn NO 24048 � Tor Iry "re v 32 5 4. c Lori PAJ Oo� I Soo ►+� ' SJg�iv�C.. 2 -Box 'Z 5c�nc o e I►IvI To►t K ilr: l c�0 two •t, GAL- A Pi V� e'er CLt7ilJ W v rU da , 0' WAWtD J ' I PQoT=•t t_t= L' CATI O" 3 12. tJoa,L-tom- 5�1�1-C If - z,UiATC1 l �G, p l�l>ATl�►Z- I PvP ` pL 4 t,l TZr;7 E-► l C� GGfZTIF� T64AT T14G. 41E:�'CiD1J CC.VAPL%,(S W ITEA TNc: 5jVr= t..I"G- Awr> sr'ru-Ac4 I'CQUIcEAAE--uTS OP T14e -To viw of T 007- L c,G AT e-r—> W t r"I W Tr.{E Fc-0c>t::> PLA.I t-•t B Q 'Tr VZ t�A't�_B�-1• Q I� � RCGIS rcRED "WG T'4II5 PUu IS NOT BASED 0 D W t`SE�St�a OSTEv-V%L-LG o Suave`( � Tuts oFFSETS 51 LOT LIW(=S Apr>L-i e:A.I:.1T r .. � 17 ttC �• �r IG-• FecM D 2oco 6AL. U IJDlc`Qdit.d V�b •FVEL � qo ttr�!<6z ti ♦ Ln r TAB\ . S L . • —ATµ ,..�"yiti� to \fib � ♦0 1,�•�� - �� .• � / � S? I ` r '7i�&t 1 I I // ,r �i /� ��'� All -32 � ^ �� 3$ ,r /• �(7s I ` r t.ql rl 1y I ILL r' /�•//��7� -'3L_�_ • 7_ tt,, /� �•� �� G8 V, f as \�••Q R\I I�T Y V./1 1 , 1 ' , , — �'��1� ( Il,'V MA � ♦\ y u,a6•t2;2 I I I I� .N. � � \mil' � i 1 I , 1 1 1 1 I 1 / rtJ• tq!'oAa ---^"^1C.d'- I ' ,�� i 1\ IYnt 1 1 1 1 `t\•tl 74•�.a 11 � + � ; � II\ Y I 1 I 1 � 1 f � � \♦ t7.'i I �V \' lAncFaa 1 ! , ) I 1 1 s 1 I Ig• 1 ,u yH.a Fp 9p IA ♦\ , rrr I I l t, 1 1 1 1 It'Ital � n' /♦ > �� I I w�• \ 11 1 1 I 1 t S /r,/%e') / I I 1, 1, 1 �s.s e�, 1 ws• \ k' D&VA cF oZZ � sr.T /i.:':_/ /� I 1 \ �11 1 i 1 1��{• t` ♦♦ �'IBIS IV-Vt. �/ � r��:I. � 1�'Y111 i 1 � lY1P�l ;,�T •fd. - -- ,se tD It 4�/ '� r ♦ = I r 14'r - tI,S I r Y 'l�• 1 I O ' C,IE7 A a; �� SULLIVAN No. 29733 I . // �� m i ,t a a•A� I;��n;� G ��, ,.cl.. .� v/�� : ' � t t<) i'61 I1P �,�,♦ / y `Y• .� FG �✓i `;',jj,. Dye-r_+�\ ♦``♦o.; `- ^rdGx Vw� !r ♦ .4 T—N '.�.' t `�♦ \\ t4•� /merit�rnnT ai.`;\♦ '`. ap 8 iv 2r=AG�1 P_VM\u;•3 W.,v IvLrl.. 7�t=Ar'Fl Imo. a A I J OF • i'J .. .. " �;,,is- "• MMILLS�� J M L�SS. G6 •,,4``` -.i� S•3o Fog W75 Sq-row smc.__ G0AA scams 1,1, t`30� Cci' 2wld fie' �i 4'/G AUG .Z7,NBS to art aoo� IZ►IDI� Fy4XT� IIJG PIGURp 0517=►'c. It u's n•1aSS• arrTrn �,,.�, .e Y. .. N Zotlo 2 19 .7 1p0 �w s 9p \12 ? RICHARD BAXTER N V1 � QD BQkH PWr1 CERTIFIED -PLOT PLAN N,I,L .IZo,4p , LOCATION I CERTIFY THAT THE Fou►JUA1i'o1J SHOWN HEREON COMPLYS WITH SCALE � DATE THE SIDELINE AND SETBACK ?-Ev%SEL"). .3- s_ g� REQUIREMENTS OF THE TOWN OF PLAN REFERENCE �3Atzt�,dvrA-P t AND IS NOT �e-r I `J LOCATED WITHIN THE FLOODPLAIN. L .G. G . (3la �L DATE : Iv' -05 BAXTER 4 NYE, INC. THIS PLAN IS NOT BASED ON AN REGISTERED LAND SURVEYORS INSTRUMENT SURVEY AND THE OSTERVILLE^- MASS. OFFSETS SHOWN SHOULD NOT BE USED TO DETERMINE LOT LINES, APPLICANT 4F•J� . k�12at- l SS � , TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS C , F��, �� CAI NAME A,)R, J/ (fin ADDRESS -3 X c A 4!�L (✓z2i i L �c� VILLAGE LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: R� (� OR CHEMICAL jam.3 �lz0VQ C> 0C: s s� (Give same information for any additional tanks on reverse side of card) DATE OF PURCHASE OF EACH: 1. 2. 3. 4. DATE OF FIRE DEPARTMENT PERMIT: y 26�2 TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS A P P R O V E D Barnstable Conservation Commi sion Signed Dato --�- S��r:� 4- �sEx�eoo�c ^ g WI i ��-.A�C�i�6 lsRl fLJ0�1Z. �-•-��--Z. ' � 1 G TA*4 K. 16 44o,t 2ct;,76 t 960 L-•,PIG r 1215Po5At.. PIT L-)sel- torn 4A,L-./25-,rcWr �ci�wa�1. Ae 3'T7 377 S Ir •c 'Z.S . T. 942 Bar Tom AZ MA l SL tis=. 1.o ti �"('a 6.. 45 ..RD. TdT'A L. �ESIGN 109 f3 6,M. vt�¢cct.dT:oU ¢e-t•E : CIO 2MIu'o¢ ,•r -� P ZN OF Ma s �' �•�{OF .r.';� �� fir.;�; � •TER RICNARO o� o SULLIVAN -- ci ..'t Nl A. No, 29733 8AXTE R H , No.M48 �o Tor `t-z o s32. o.. uK •P.ve ISO �w. •� + Q0, inn IW GOB. 2 � 'box. `, 'lb,L Sc-•vt�C 10 �: l crw Z!3 �►+v. I1rJ� t� GAL.. 2g.7 2E d. LFacal .A ?ITS C(.L�LJ . 2 1 to • CEC'Ttr%ED PLC) Pl- &I-J p l�{JAT��L I PvPuStrt� pt:4�J RI=� �C►JCE 4 CGIZT�FY T;4AT T14r= l..1r�'G S�iow►J ' -16.Qt�aW Cc vIPL�IS W�•fK T►a�: 51 Vrz U WG AND ScT�;��K t'CQUICEAAcWTS OF TNf~. ?owU of �tai-JtirASLa Q�� Is OoT LaGATE� WIr•a11N T4 G Fl00t::> MATE �-'L7 -8S `r� �*� Fr (� ;c�•�-1 ....� _ BAY'T T'4 1S PLAu IS NOT EASED .o" AW IWSTIZUMEOT OSTt:,QVII.LG O MAS`�. Su2vE`{ t• TLIe's OFFSETS IUWLD UOT ISE V5�ex> TO rpre¢.mjwF.' LoT FeCFOW-� ?vav LAl- ' . t ik y Ct•n { `r� N IO;�oE Dl YZAL • 68 � p.t ?� 5 SFi�{[„YS �•iw � � ��Hl. 12 b �� I /1 �u.�• ' ititi•i� �� ' 'y^,1��'tS.1. ,tL•a �� i � ,' .,ti \ tl•1 / 1', �� I 1 / �� i' ��• i•�.i;.-- -.--Z PILO mil i8 OI \ 1 'L� 1 r I fllfw•�. / i i/ �' + -3zp _ pfT-Str / •a1• V �`\;rr 0r�•12�'l t 1� .N. ' ,� - -' U � : . ..\;1 I,�M 1 i 1 { 'tt.t.� � 1♦♦H.•.' � {{ ; +r �y /� \t n,.I ,�� \' lA�sd 11 � t,� I I ► 1 \ , Iw, , ,uYu•", ,go 9p',,, �\ _ � It,", {1 1\ \ I INN}anl\ q 8&L31 MA/trG cs FP tP O.g u•t •��', � f'<.r It i�•�� ,1 � 1177.TTtPrt,'�, 8 - i A IL Lor • �` � '+{i . Ali 'pt'�,T•C c i� ,.o .� v ♦♦ o�-/oP �� •Dt � ♦�•N' / � 4•'1ZA3 n t0 P:e=A4N IyW1�1�� 'X'�D PW 77vo 4¢Af'Fl 1�, a A 14 OF L A u=> ��\ `♦` .t / MM415 �> M A%. •� . 4S 3a :✓ ` W 75.59•low Fo 2 ��2�� GvM�►A S 1 Scb'.� �,{• 8� ocr 4�iggA aaa'14nct acotrs Itlm1� -P�axriz s I;•/t; iuc. AEG z'1,1985 Ce".IST6L'-) wc+Mo _ mf1t.R 4 a's•t• N PI ,a .� --___. `.'moo_._........_._............ . . . . ,�. � ko 191 ± o zf � _- ? IV >. a . Mq �� RtCHARO J�`"• Ai A. a1f; v BAXTER H': Na 24048 Q�sirE�`�.`to� 1 OD CERTIFIED PLOT PLAN H,Lc- LOCATION /y AZSZS Ok$5 MIL(-5 CERTIFY THAT THE F 1'i()r-J SHOWN HEREON COMPLYS WITH SCALE iL �rj DATE IV-�D'�3S THE SIDELINE AND SETBACK REQUIREMENTS OF THE TOWN. OF PLAN REFERENCE AND IS HOT LOCATED WITHIN THE FL00DPLAIN. L G G L DATE..: cr BAXTER >~ NYE, INC. THIS PLAN IS NOT BASED ON AN REGISTERED LAND SURVEYORS INSTRUMENT SURVEY AND THE r OSTERVILLE^- MASS. OFFSETS SHOWN SHOULD NOT BE z USED TO DETERMINE LOT LINES, APPLICANT 'g . f ,?.r2, SS 4!�o .