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HomeMy WebLinkAbout0135 ACORN DRIVE - Health �135 ACORN DRIVE, OSTERVH LE A= 444 020 o TOWN OF BARNSTABLE LOCATION /3 S 4('O2Al Ar• t" SEWAGE# a O/S- 136 VILLAGE d, /erbr Ile ASSESSOR'S MAP&PARCEL 0 INSTALLER'S NAME&PHONE NO.Z. Mq-CX [J',97rcr 5�8-yd8-s 9 SEPTIC TANK CAPACITY 1-,57o0 41 //- /-1"/O LEACHING FACILITY: (type) ,50-0 1^n �dl (size) Lo?.S� X o25 -/O NO. OF BEDROOMS -3 OWNER PERMIT DATE: I`19y �, oZ0lS COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY ec� �{ .. ............. 5 119 CQIV (9 350) � 56 / ? 4 No. 1 JU , Fee OU THE COMMONwr:41-TH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS application for MI8tl0sal *pstrm Co=stem 3pPrmit Application for a Permit to Construct( ) Repair(K Upgrade( ) Abandon( ) ❑Individual Components Location Address or Lot No. l 3 s ACO&X6Dk. Owner's Name,Addres and Tel.No. 6V-y,20-0 0 t-S-re plc ERrc Sh.�cvr Assessor's Map/Parcel /yy-oao /6% 0,5 -k> Installer's Naam�e Address,and Tel �1 Design 's Name Address and Tel.No. Sc,$-390-3311 >S+'titC MA c�.I L 161"U 4dB,3�. 1 4 0-0—.a.( .M CY a r2 g't t'i'tAd sr: ObTc�%�1<< 'P•p.�a 48 �,S rA.�c�r © s3� Type of Building: Dwelling No.of Bedrooms Lot Size I a-000 ± sq.ft. Garbage Grinder(441 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3'30 gpd Design flow provided 3 K.OZr, a 5 gpd Plan Date 1`1 AY ,�o r5 Number of sheets Revision Date r-7- Title i Size of Septic Tank IS-00 Type of S.A.S. 6-00 G&J. C l+AM ce S- a t A Description of Soil Nature of Re airs or Alterations(Answer when applicable) 10A �:_I 'eiti i t GO 1 C �41V�_ c_3 L4, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board f Health. Si Date // 0! Application Approved by Date Application Disapproved by Date c for the following reasons Permit No. (}_ 130 Date Issued Id I i No. I r ,3U s/ r A�"��`",." ��� Fee (�c� ► " Entered in computer: ✓ THE�CONF�VIONWE�ILTH'OF MASSACHUSETTS Yes PUBLIC HEALTH 61VISION - TOWN OF BARNSTABLE, MASSACHUSETTS 9pplitation for 33ispPsal 6pstrut Construction 30ermit Application for a Permit to Construct( ) Repair(K Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. l 3 S C O(2 N D 2, Owner's Name,Address,and Tel.No. .5-(46-ygo-O 5-9 9 Q S5 ery 1(c E2rc shy e1T Assessor's Map/Parcel I YV— O.�O 16 96 U S • -k�./ /-�O/ Installer's NT,Address,and Tel.�}�q.� Designer's Name,Address,and Tel.No. ✓�V� 34 a - 33 11 'rvc_e c10.CR� IgSTc( )karre ti( t�iCyr2 8 r't A,V\,j S-r. C)_`T 11,l l yd�Ssa 'p.0,1�0�t Q t31 �, 56' )C--"C I-r 0 a s3'> Type of Building: Dwelling No.of Bedrooms Lot Size �Q 0 UU -} sq.ft. Garbage Grinder(A(q Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 G gpd Design flow provided 3�1 5 gpd Plan. Date r`I Ry �, (�/S Number of sheets Revision Date Title, W Size of Septic Tank I,SUO G ( Type of S.A.S. 500 GA I. C tI M bc2 S- a r n I,), Description of Soil PS 7k:-Q j)jYiN Nature of Repairs or Alterations(Answer when applicable) ,U tV) -t ( �I p X l S l v\C C ASS G G(S g1-6 I SLG � �, S�Ttl��h- �i s� ��0 7. �1 'moo sP C�� f1 ` cis (�„ t �f G� 57r,�Ic' Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board f Health. 1 Sigr{e `' / /�/0 Date �/), // G/5_ Application Approved bye U\r Date Application Disapproved by Date for the following reasons Permit No. p ( - I O Date Issued 1 t, / r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(1/f Upgraded( ) Abandoned( )by S`\0 r I;,+ t cry rI S (, at k 3.57 R CO r r,\ Dr. 0,,5 l e r t, �'�� has been constructed in accordance with the provisions of itle 5 and t(her for Disposal System Construction Permit No. 2° 3 u dated V/1 Installers P-U C.C' HCl C CJ 1 r S C Designer r 1 li 1� ii y'C r #bedrooms 3 Approved design flow L a 5 gpd The issuance of this p it s'ltallnot be construed as a guarantee that the system will fun,o)as designed. �( Date , I Inspector No. �� U 1 \ - I ?C1 Fee U(� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposai 6pstent Construction 3permit Permission is hereby granted to Co (/)Construct( ) Repair( Upgrade( ) Abandon( ) System located at 'J J5- A C 61c and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construc ion m},st be completed within three years of the date of this permi. r Date 1 I / Approved by tAlr Town of Barnstable Regulatory Services i Richard V.Scali,Interim Director Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508862-4644 Fax: 508-790-6304 Installer&Designer Certification Form J Dates Sewage Permit# 0 0/f'130 Assessor's MaptParcel a Designer: pAt-Y - g ��C- Installer: wee ho rl^/I�5 m Address: P() t30yC j Address: 8 Z ?ta not On S-//-/5' fTr, was issued a permit to install a (date) (installer) septic system at 1 '" ` W based on a design drawn by �d^ � (address . r - ��';,� dated 7 t S , (designer D. ) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and-or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) -was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the I_a approval letters(if applicable). DARRENz.M. 4 (Installer's mature) MZ'ER No.. i 14C H -(Desliaer's Signature) SAi+tTpRtp� PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DINISIOti. CERTIFICATE OF COMPLIA_rCE «ILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT C-__ ARE RECEIVED BY THE BAR STABLE PI;BLIC HEALTH DIVISION. TILATI K YOU. Q:Septic Designer Certificarion Fonn Rev 3-14-11doc Town of BA nstable P# Department of Regulatory Services ' Public Health Divisions �Date s63y tee$ 200 Main Street;Hydnnis MA 02601 Date Scheduled i Time l I) Fee Pd. u V i Soil Suitability Assesshient,fop Sew ge D S osal Performed By: Witnessed B .._ LOCATION & GENERAL INFORMATION, Location Address .l�5O hd� i - Owner's Name S I`u Fir ` J � ' 1/1�. r) ,,e• �S}e_rvt- (Ie Address Assessor's Map/P4rcel: I LILt ! 0ZLC) I Engineer's Name IeY f On s s r g ' I • NEW CONSIRU i 10N REPAIR I Telephone# J o 0--3o d 3-31 I Land Use " - Slopes(q'o) f7 Surface Stones Ny" Distances from: Open Water Body E[ Possible Wee Area L_ U-;ft Drinking Water Well 7� ft` _ Drainage Way ��J �' ft Proprrty Line aid ft` Other ft SKETCH:(Street name,dimcnsiotis of lot,exaq locations of test holes&perc tests,locate wetlands in proxitnity to holes) I Parent material(geglogic) tl I Depth to Bedrock I Depth to Groundwater: Standing Water in Hole: I Weeping from Pit Face N h Estimated SeasonalVigh Groundwater _ �x DtT`ERMINATION FOR SEASONAL HIGH WATER TALE Method Used: Depth db erved standing in obs.hole: in. Depth tq Sgll m9ttles: p I in. Groundwater Adjustment tk Depth toweeping from side of obs.hole: I Adj:flrauntiwnterl t Vel, o. A ,t10tbr,,._.r.�- Index Well#� Reading Date: � Index Well level - - � , iE COLATION TEST . Dutc�_..._e, '1'Inje Observation I Time flt 9" -- Hole# ®� fly Y Time at O, ,. Depth of Pere .. .1 /�/D Time(9"-6��)_ N. Stan Pre-soak Time.@ -J � F i End Pre-soak I Rate MinJInch Additional Testing Needed(Y/N) Site Suitability Assessment: Site Passed Site Failed; Original:.Public Ir;itth Division Observation Hole Data To Be Completed on Back---- ***If percolafiion test iS to be conducted within 100) of wetland,you must first notify the Barnstable C44servatien Division at least one (1) week prior to beginning. • • + Hole#A— Depth NATION HOLE LOG DEEP�DBSER Color soil other Depth from Soil Horizon Soil Texture (m nsell Mottling (Structure,Stones,Boulders. Surface(in.) (USDA) ( ) Consistent %Gravel I� Il � Q�� •o � � DEEP OBSERVATION HOLE LOG Hole.# _ Other Depth from Soil Horizon Soil Texture Soil Color = Mottling (Structure,Stones,Boulders. Surface(in.) (USDA) (Mansell) g. Consistent %�Gra el r � 30 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel i DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders. Consistency, ravel) Flood Insurance Rate Map: Above 500 year flood boundary+ No— Yes _N- Within 500 year boundary No v Yes a - Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist,in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? . Certification I certify that on 0 `1 (date)I have passed the soil evaluator examination approved by the Department of Environlrienial Protection and that the above analysis was.performed by me consistent with the require ng,expertise and experience described in 3,10 CUR 15.017. Signature Datt Q:\.SEPTIC\PERCFORM.DOC I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ,4U �F�£ CERTIFICATION 0Map Number 144 1 2 n98 Parcel Number 020 I' rOh��ti�pST9B(�J l F PROPERTY ADDRESS: 135 Acorn Dr. Osterville Ma. ADDRESS OF OWNER: DATE OF INSPECTION: 7-21-98 2442 NW Market St. #580 f S 1�.• NAME OF INSPECTOR: W.E. Robinson Seattle,WA 98107 I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 9310 CMR 15.000) COMPANY NAME: W. E. Robinson Septic.Inspections MAILING ADDRESS: 43 Tomahawk Drive Centerville, MA 02632 TELEPHONE NUMBER: (508) 775-7986 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X PASSES CONDITIONALLY PASSES NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY FAILS INSPECTORS SIGNATURE: ��1��iS I� DATE: 7-22-98 The system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: Yes I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: System consist of 1-block cesspool and 1-Lp-1000 overflow in good working condition, inflow cesspool pumped as part of inspection. Note: System is in good working condition but is not up to Title-5 upgrade. 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 b the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or NO). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached) indicating that the tank was installed within twenty(20) Years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank is failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. Page 1 of 10 (revised 04/25/97) DEP on the World Wide Web:http://www.magnet.state.ma.un/d SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (CONTINUED) Property Address: 135 Acorn Dr.Osterville Ma. Owner: Judy Blair Date of Inspection: 7-21-98 B]SYSTEM CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: Broken pipe(s)are replaced Obstruction is removed Distribution box is leveled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): Broken pipe(s)are replaced Obstruction is removed 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 Feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 135 Acorn Dr. Osterville Ma. Owner: Judy Blair Date of Inspection: 7-21-98 D] SYSTEM FAILS: You must indicate either"Yes" or"No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303.The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an over- loaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s) Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: You must indicate either"Yes" or"No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a Significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA)or mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 135 Acorn Dr. Osterville Ma. Owner: Judy Blair Date of Inspection: 7-21-98 Check if the following have been done: You must indicate either"Yes" or"No" as to each of the following: Yes No Yes Pumping information was provided by the owner, occupant, or Board of Health. Yes None of the system components have been pumped for at least two weeks and the system has not been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. Yes As built plans have been obtained and examined. Note if they are not available with N/A. Yes The facility or dwelling was inspected for signs of sewage back-up. No The system does not receive non-sanitary or industrial waste flow. Yes The site was inspected for signs of breakout. Yes All system components, including the Soil Absorption System, have been located on the site. N/A The septic tank manholes were uncovered, opened, and the interior of the septic tank was Inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid Depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: Yes The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. Yes Existing information. Ex. Plan at B.O.H. Yes Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable)[15.302(3)(b)J (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 135 Acorn Dr.Osterville Ma. Owner: Judy Blair Date of Inspection: 7-21-98 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: 2 Garbage grinder(yes or no): No Laundry connected to system es or no): yes Seasonal use(yes or no) No Water meter readings, if available(last two(2)year usage(gpd): 96-76k 97-89k Sump Pump(yes or no): No COMMERCIAUINDUSTRIAL: none Type of establishment: Design flow: gallons/day Grease trap present: (yes or no): Industrial Waste Holding Tank present: (yes or no) Non-sanitary waste discharged to the Title 5 system: (yes or no) Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: N/A TOB System pumped as part of inspection:(yes or no) Yes If yes, volume pumped: 1500 Gallons Reason for pumping Inflow cesspool TYPE OF SYSTEM Septic tank/distribution box/soil absorption system X Single cesspool X Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known)and source of information: Lp installed 6-25-92 Permit#92-269 Sewage odors detected when arriving at the site: (yes or no) no (revised 04/25/97) Page 5 of 10 ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 135 Acorn Dr.Osterville Ma. Owner: Judy Blair Date of Inspection: 7-21-98 BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction x Cast iron 40 PVC _ other(explain) Distance from private water supply well or suction line 25 ft-town water Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: none: (Locate on site plan) Depth below grade: Material of construction Concret metal Fiberglass Polyethylene other(explain) e If tank is metal, list age Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) GREASE TRAP: none (locate on site plan) Depth below grade: Material of construction _ Concrete _ metal _ Fiberglass _ Polyethylene _ other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 04125197) Page 6 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 135 Acorn Dr.Osterville Ma. Owner: Judy Blair Date of Inspection: 7-21-98 TIGHT OR HOLDING TANK: none (Tank must be pumped prior to, or at time, of inspection) (Locate on site plan) Depth below grade: Material of construction _ Concrete _ metal _ Fiberglass _ Polyethylene _ other(explain) Dimensions: Capacity: Design flow: Gallons/day Alarm level: Alarm in working order _ Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:none: (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc,) PUMP CHAMBER: none (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 135 Acorn Dr. Osterville Ma. Owner: Judy Blair Date of Inspection: 7-21-98 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: Leaching pits, number: 1- Lp- 1000 Leaching chambers, number: Leaching galleries, number: Leaching trenches, number, length: Leaching fields, number, dimensions: Overflow cesspool, number, Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Leach pit was%full at time of inspection, no stain line above that markand shows system is in good working condition at time of inspection. CESSPOOLS: none (locate on site plan) Number and configuration: 1- Depth-top of liquid to inlet invert: 12" Depth of solids layer: 61, Depth of scum layer: 2" Dimensions of cesspool: 6'x8' Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments:: (note condition of soil, signs of hydraulic failure, , level of ponding, condition of vegetation, etc.) Block cesspool is working as septic tank with Lp1000 overflow in good working condition at time of inspection PRIVY: none (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 135 Acorn Dr. Osterville Ma. Owner: Judy Blair Date of Inspection: 7-21-98 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100(locate where public water supply comes into house) REAR 40, pecfc 0 L�(oDC (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 135 Acorn Dr. Osterville Ma. Owner: Judy Blair Date of Inspection: 7-21-98 Depth to groundwater 15 plus feet Please indicate all the methods used to determine High Groundwater Elevation: x Obtained from Design Plans on record Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) Obtained frorn°as-built; Board of Health. Permit#�92-269 w �G w U � b s bly 3/71 THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT SOWN THAT Inson septic 43 Tomahawk or. Gem , a M WilliamE. oin , Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15 .340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. April 20, 1995 Acting Director of the - ion of Water Pollution Control ZN ecoN TOWN OF BARNSTABLE t6CATION 13_rj ACORN Dt2 SEWAGE # vT LADE lV ASSESSOR'S MAP &LOT I y INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 1-(J-g6 6F) (size) NO.OF BEDROOMS BUILDER OR:OWNER fy_.Rl/9i2 PERMTTDATE: COMPLIANCE DATE: Separation Distance Betwemthe:_-________- ' j Maximum Adjusted'.Groundwater Table to the Bottom of Leaching Facility Feet t 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 (.v:EQ681&V SPOh� ] ?ecfiorJs pO0 • 1 14LI ®� V/ No.... - .� Fizz....3in......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE � Appliration for Di" mal Works Cnnmi Application is hereby made for a Permit to Construct ( ) or Repair ( -<an Individual Sewage Disposal System at: Lgcation-Address - or Lot No. .....---------------------------------------•-- _._------=-----�-�-�`E ----------.....---------------------.............--- Own dress Installer Address � feet Type of Building Size Lot...........................S q. U Dwelling—No. of Bedrooms...3....................................Expansion Attic ( ) Garbage Grinder ( )' P4 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures ------------------------•-----•. d ---------------------------------------------------- W Design Flow..........755...�.......................gallons per person per day. Total daily flow...7;30___.______._...._________._gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.....I............. Diameter-_. ........ Depth below inlet._-& .......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-� Percolation Test Results Performed by.......................................................................... Date........................................ 14 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ 9 ------------------------------------•-------•-•----------------.....---------.........._------------......................................................... ODescription of Soil............................................................................... ----------------------------------------------------------------•---•-•--•-•.......•--.. W V ---•••••-•-••-•••--••--.._•--••••••---•-----•--•---...•-••••--•----------------•-•••-•---------•-••-••-------•-••---••-••••-•-•-•-----••--------••----••-•••--••------•------------•...._•-•-•----•--••- W UNature of Repairs or Alterations—Answer when applicable...-4.�.1�---_Q�___- k _._ ! ..._Cq�.�._.__.. ..---------- �CD �- .._U. ....... ......ic . ...................................................................................... Agreement: ~J The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be n issu th board of health. Signed .-.. .. .. ........ :. `�2- ---------- --- Date Application Approved By ----------- a,..,.�,,. ..- Da Application Disapproved for the ollowing reasons: ...... ..................................................................................................... .. . .. - -- --- -------------- . --------------..............-------- ........................................ ........................................................................................._ Date Permit No. ------ ----- Issued ............................................................ Date No.. 1:'�.:/9 Fm& - _ .r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE/7` , VVftratiun for Dhipsal Works Tunitrnrtuou ramit Application is hereby made for a Permit to Construct ( ) or Repair (-')an Individual Sewage Disposal System at: .... .........I. S oY !.... ' _t -----............... ..............................................----.------•----------.........................._... ._ --- _ Location-Address _ or Lot No. t> G :I 1� -a t .................................................. .....................!�'.....?.................-----.....--•------............................... Owner Address W (.. V- .............................1 (7 t;t l _ a`r� /,� ------•- Installer r' �/ '' - Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms__3.....................•........__.__..Ex anion Attic a g— p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -----------.•-• ••--••••••••-••-••-•--•-•-••••---••--••••••-•-•----••••-•••-••-••-•-•---••-•••-••-•-•--•-----•••------•......................•------- W Design Flow________ _______________________gallons per person per day. Total daily flow__33 ---------_ ................. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length..._................ Total leaching area....................sq. ft. � o Seepage Pit No.................... Diameter..I-__------_---_- Depth below inlet-_(`?_..._....... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0­" Percolation Test Results Performed by.......................................................................... Date........................................ W Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ a ••••-•-•...•••••••••••••-••••••••••--•-••---••-•-••--••.....••-••---......--•-•-•---••-••-•.................................................................. 0 Description of Soil...............................................................................=........................................................................................ W V -------------------------------------------------------------------------------------------------•------------------------------------•--------------------------•------------------•--------- W U Nature of Repairs or Alterations—Answer when applicable_..._ o___.0 _...c 9 K l...f�.!T �l_�( ............ST _�1,J� ......r "' _ -6-- r_c 7 c /-e-t ce C r •--•••...•-•-•--••••--•.................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued-by-the board of health. `7-77Signed c`'rF `� �I �.. e Application AP roved BY .... `p --- - ---------- Application Disapproved for the 110-w reasons- ------------------......................--------------------------------------------------------------------------------------------- ............................................------------------- ..--....--------..........------------ --------------------------------------------------- --------------------- - ----------------------------------- �y Date PermitNo. ........1...x.-----1-f;.....1q�-'-....................... Issued ----------------------------- ------------------------------------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (fertifirate of Cfomylinurr THIS IS TO CERTIFY, That the Individual) Sewage Disposal System constructed ( ) or Repaired by..................................S.._:.....tl"[..!'.- ..- ./-, 1U.f ... ..`'��. >=1............................................................... staller........................... l .....................`......----.--..................-..-......._....................------. at .. {� C C�i rn f l 'RJY_.$ JC_ 0_`V z"rL.�) ........... - - - ---------------- ------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .......... .- /r 9 dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE -/ -J --... Inspector - `- 7---------------------------------------------------------- Y� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No. - 9,L 2�9 TOWN OF BARNSTABLE FEE ............. • --- - .: n Disposal Works Tungtrnrtiun famit Permission is hereby granted............�.V\�-__LV)�.r-__.:���(_e- •• --• •••••---••••••-•-••••---••-•--•••-•-•........---•..........•-••....__ to Construct ( ) or Repair (�)-atr Individual Sewage Disposal System at No...................}. < 4(0(/w I�,),f tV-'. "5S��V vY{1-. -•-------------•--•--•-----•---------•--•------------•-••-----•- ------_-----------------------------------------------------------••---•---.... Street as shown on the application for Disposal Works Construction Permit No`c ,- ._- Dated.......................................... .............................. � ( Board of Health DATE................................................................................ L.J FORM 36508 HOBBS R WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE I.UCATION 1 ?j 5 SEWAGE f# �a(� V lLAGE ®STt--CQ� ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. �� � SEPTIC TANK CAPACITY e-1 5Z �( G�SS �zSL cl LEACHING FACILITY:(type) pCe-r— pQ�' (size) NO. OF BEDROOMS 43 PRIVATE WE`LL-O.& LIC WAT J/ BUILDER OR OWNER cj'�� �W�l DATE PERMIT ISSUED; DATE COMPLIANCE ISSUED; VARIANCE GRANTED: Yes No c or 1 csp'*o . . OSTERVILLE x ,.. LEGEND .. n ROUTE --[q[ —1 PROPOSED CONTOUR ® . PROPOSED SPOT GRADE N� LOCUS --— 98 —— EXISTING CONTOUR 135 ACORN DR. " 24 + 96.52 EXISTING SPOT, GRADE. I W— EXISTING WATER. SERVICE ' TEST PIT � wBUMPS RIVER ROAD. ' LOT 2.4 z6, BENCH MARK O � AREA = 12000 S f+- \ PLAN BOOK 187 PACE 93, i TOP OF FOUNDATION o \ \ 32.80 _LOCUS MAP N.T.S. 9�i \ ASSR•gA. 4-4-pl PCL-20 ` i,. ♦` J F� \ BARNSTABLE GIS DATU °o LOCUS, INFORMATION O P i p 9J \ 11 22 TITLE REF: 8K 12707 PG 197 PARCEL ID: MAP 144 PAR. 020 32 SEPTIC SYSTEM REPAIR PLAN �� `� .. . LOCATED AT: ` r `"�. w� � `� '� - 135 ACORNDRIVE \ x OSTERVILLE,: MA O \. ..\ PREPARED FOR o _ 24 SH LI FELT \26 MAY 7, 2015 PI�OP. 1 500 GAL /� t <,� :\ 28 EZ VI �ai�r L,.�� �� �F MAssq� O �,�' s. DlApREtI(M. s 5EPT1C� TANK �°o rb,' \"•30 oV 40 CP 32 MN I T00' r ♦l EXIST. CESSPOOLS MEYER & SONS INC. PLAN P. O. Box 981 ,t. _ \�.� see Note 10 SCALE: 1 In — 20 ft f E. SANDWICH , MA 02537 4 _ 0 20 ao r PH. (508)360-3311 0 10 20 j fax (774)413-9468 - � meyerandsonstitle5@gmail.com www.meyerandsons.com SCALE 1"=20' i SHEET 1 OF 2 J#1491 TOP `NbTE: 'PLACE MAGNETIC MARKING TAPE OVER ALL COVERS A FOUNOUNELE DATION - BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE (Existing) ' FINISHED GRADE (32.6)MAX = 32.80 F.G.EL: 32.0 F.G.EL: 31.00 F.G. EL: 32-.0 a MAINTAIN 2% MIN SLOPE OVER LEACHING AREA ; s . a F.G.EL 30.50 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2" I STONE OR FILTER FABRIC DOUBLE WASHED STONE 6 - 4 4" SCH 40 PVC{ 1o"I ®®®®®®®ME A: TEE'S ARE TO BE 363 14" s 0 S= 1% (MIN.) 4'-SCH 40 PVC INV.28.95 2' EFF. DEPTH ®®®®®®®®®®® INV.29.25 � - INV.28.75 1 ' 4' 2 X 8.5' 4' GAS EXISTING OUTLET BAFFLE PROPOSED DB-3 EFFECTIVE LENGTH = -25 I ' :.... ..,. •.; DISTRIBUTION BOX'- a INV. 30.0 INV. 29.50• (H20) INV:: ELEV.= 28.60 PROPOSED 1 ,500 GALLON SEPTIC TANK y GAS BAFFLE TO BE INSTALLED ON P��`� OF '�Ass9 BREAKOUT OUTLET TEE AS MANUFACTURED BY TUF-TITE; ZABEL, OR EQUAL DA; E R TOP CONC. ELEV.= 29.60 ELEV.= 29.60 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING No: 1140 "' INV. ELEV:= 28.60 '®®` '®® PIPE INVERTS PRIOR TO CONSTRUCTION <` ER®®® 2) D-BOX SHALL BE SET LEVEL AND TRUE TO �� �£CiS1 ` ®®®®®®® r GRADE ON A MECHANICALLY COMPACTED SIX NITAR�a� BOTTOM EL.- 26.60 ®®®®®®® INCH CRUSHED STONE BASE, AS SPECIFIED IN \�-. 3.75' 5 FT. 3.75' 310 CMR 15.221(2) \� 3) R�PLAC EXL( 1,000 LON TIC ANK C� 't`� _ WIT o SEP IC TA K IL D .'SEPARATION 8.45 FT. EFFECTIVE WIDTH = 12.5 DA A ED, 2O ADING, UND ►ZED. SEPTIC SYSTEM P RO FI LE SOIL ABSORPTION -SYSTEM (SECTION) 4) INST LL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLE EL: -18.15 r - ) GAS BAFFLE AS REQUIRED (500 GALLON LEACH CHAMBER) GENERAL NOTES: - DESIGN CRITERIA 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL . LOGS P#: 14668 NUMBER OF BEDROOMS: 3 BEDROOOM BOARD OF HEALTH AND THE DESIGN ENGINEER. ' 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE:, APRIL 27: 2015 SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE DESIGN PERCOLATION RATE: <2 MIN/IN LOCAL RULES AND REGULATIONS. SOIL EVALUATOR: DARREN MEYER, R.S., CSE #1614 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR WITNESS: DAVID STANTON, BARNSTABLE B.O.H. DAILY FLOW: 110 G.P.D. X 3 BR = DESIGN FLOW: 330 G.P.D. TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE GARBAGE GRINDER: NO (not designed for garbage grinder) DESIGN ENGINEER. 1 SEPTIC TANK: 330, gpd x 200% 660 gpd, USE NEW 1,500 GAL. SEPTIC TANK 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING Elev. TP.-1 Depth Elev. TP-2 De - FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN - _� - ENGINEER BEFORE CONSTRUCTION CONTINUES. 29.15 A 0" 33.10 A 0" (330) = 445.94 S.F. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. LOAMY SAND LOAMY SAND LEACHING AREA REQUIRED: 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 27.99 10YR 3/2 14" _ 3260 10YR 3/2 6,. .74 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF B L .OAMY SAND B LOAMY SAND HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 10YR 5/8 30.60 10YR 5/8 30 USE TWO (2) -500 GALLON (H20) PRECAST LEACH. CHAMBERS W/ 4' 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 25.57 43" STONE ON ENDS & 3.75' STONE ON 'SIDES: 25' L x 12.5' W x 2'D 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED - C C TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. BOTTOM AREA: 25 x 12.5= 312.5 SF 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE SIDE AREA: (25 + .12.5) X 2 X 2 = 150 SF t THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING " CONSTRUCTION. Perc @ El.29.10 TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94-REQ'D, 10. EXISTING CESSPOOLS TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. MEDIUM SAND MEDIUM SAND DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd 4� 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 2.5Y 6/4 2.5Y 6/4 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY - PROPOSED SEPTIC SYSTEM REPAIR PLAN AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 18.15 1 132" 22.101132" 135 ACORN DRIVE, OSTERVILLE, MA 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. 14. NO WETLANDS WITHIN 100. OF PROPOSED LEACHING. 15. ALL PIPING TO BE 4" SCH 40 ® 1/8-/FT (UNLESS SPECIFIED) PERC RATE <2 MIN/IN. ("C2" HORIZON) Prepared for: Shufelt NO'GROUNDWATER OBSERVED Engineering and Survey by: SCALE DRAWN • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 316 CMR 15.017 MEYER&SONS, INC. N.T.S.' DMM to conduct soil evaluations and that the above analysis has.been performed by me consistent with the PO BOX 981 requirements of 310 CMR 15.017. 1 further certify that6l have passed the Soil Eval. Exam in October, 1999. EASTSANOW/CH•MA02537 DATE CHECKED SHEET NO. 508-362-2922 05/07/15 DMM 2 of 2