HomeMy WebLinkAbout0058 BLANID ROAD - Health 58 Blanid Road
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IN SMEAE
No.2-153LGN
UPC 12134
HASTINGS.MN
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pp-
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01ppliLation for VspoBal 6pstem Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. r, (?IC. ; rQ U Owner's Name,Address,and Tel.No. �.7 8-g4([/- 06 "7C/
Assessor's Map/Parcel O Ds t U• I�C /��✓ �'��� t� t��S(V-C A /
Installer's Name,Address,an Tel.No. Oe" C'e " .S'vS WO - Designer's Name,Address,and Tel.No.
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Type of Building:
Dwelling No.of Bedrooms Lot Size ,Z3 � sq.ft. Garbage Grinder( )
Other Type of Building JZe_S f e. c No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) y 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)
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 issueRign
Board of He t .
Date l/
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. 20 2 — 2 Date Issued
No, t/ Fee
i�17THECOMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
4plitation for Disposal 6pstem Construttion Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. RI N; j Owner's Name,Address,and Tel.No. 7 9 ,ALf[/- Cj pj 7 el
Assessor's Map/Parcel /ll os-f-t U. //f ��i S' s c, vt/ 1���s(V"C'A
Installer's Name,Address,and Tel.No. P—" ye,o Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size 23 81 0 sq.ft' Garbage Grinder( )
Other Type of Building I� r�' r Y�. ,a / No.of Persons Showers( ) Cafeteria( )
Other Fixtures +, n
Design Flow(min.required) ' G/(� d gpd Design flow provided L��/ gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S. f
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 1 ✓ , r
/ (_ '
II�V
Date last inspected: _ "
Agreement:
The undersigned agrees to ensure the constMctio a 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 b}ythis Board of Heat .
igned Date
Application Approved by /,I Date
Application Disapproved by Date /
for the following reasons
Permit No. Date Issued
- - -
TH E COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance.m _THIS IS TO CERTIFY,that the On-site Sewage Disposal system Construu^ctted( ) Repaired( ) Upgraded`/ )
Abandoned( )by f./!1c' 1, A `19-! /A 1 r , ��'tV ! ?' / I � ;.; .
at i has been cons cted in accordant
*►
with the provisions of Title 5 and the for Disposal System Construction Permit No. / ' a, d
Installer /C.T,� "'� . Designer
#bedrooms Approved design-flow L( f - f gpd
The issuance of this permit shaXt
nst ed as a guarantee that the system wi nation as designed.
----7 ,- f
Date Inspector a / t l 1 / , 'L / f
X
�� /
` - NO.
- -,----- - - — - - - - �- - -`_. Fee--
HE COMMONWEALTH OF MASSACHUSETTS,
PUBLIC HEALTH DIVISION-'BARNSTABLE,MASSACHUSETTS
Disposal *pstpm Construction permit
Permission is hereby granted to'Construct( ') nnRepair(n) Upgrade( ) Abandon( )
System located at � _ � "N (''yG, r C, Li -e
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:Construction m+st be �pleted within three years of the date of this permit.
Date Approved by
4
1 �
Town of Barnstable
Regulatory Services
Thomas F. Geiler,Director
Public Health Division
.` Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 � Fax: 508-790-6304
Date: '-ZZ - Sewage Permit# Z Assessor's Map/Parcel��� Z
Installer& Designer Certification Form
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Designer: &,�2_e,_g<= Installer: aeT�cVT,Je�r/. ,
Address: Address: 4
�ZL32
On c�9.� issued a permit to install a
(date) (installer)
septic system at on a design drawn b�
y, (address) 5 o
1
�R.
G-� ', dated O� -3� zc�/Z V)
designer) "> -n
V/1 certify that the septic system referenced above was installed substan sally accojdingo
the design, which may include minor approved changes such as latera relocati& of-4e
distribution box and/or septic tank. Stripout (if required) was inspe ted andvthe s Ms
were found satisfactory. t")
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 Regulati Ian revision or
certified as-built by designer to follow. Stripout(if required)w ~' 'r d the soils
were found ptisfactory.
DAR EN yam,
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Ins er's Signa N 140
�� IGISTS
/0 � SANl.TAR\�'�
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(Designer's Signature) (Affix Designer's Stamp Here)
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PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL ROTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
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CRAWL5PACE --• 3.75'
SLAB Q EL. 31 .5 (Ty'.)
122.08,
INSPECTION
,.M + EX15TING + — I O PORT (7YP.)
DWELLING i v
t i (TO BE RAZED) t 100%
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t , 20.0' So , , AREA (TYP.)
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1 O I DECK ( 1
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l` ;' LOT AREA: PORCH I ® ' I I _---
981 3.3 S.F. $ _ ® -
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Traverse PC
TOWN OF BARNSTABLE
LOCATION_���j�A? `� SEWAGE# [�7
VILLAGE dS'�P�Sd'l�I ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO.'ta- .rye (??a c, Cz,-,�f-tza
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) L E,yC),N C k
indW (size) 51E�Y,1"5'
NO.OF BEDROOMS
OWNER �t _ �lscj � C'CZJ��PI`1C .
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the: 4
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 I
300 feet of leaching facility) Feet ,.
FURNISHED BY
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McKean, Thomas
From: McKean, Thomas
Sent: Tuesday, October 15, 2013 1:45 PM
To: Parvin, Lindsay
Subject: RE: Status of Permit for 58 Blandid Road
According to Donna's e-mail, we are awaiting Darren Meyer to provide the following:
-An original plan
- DWCP permit for moving the septic tank
- Permit fee for a new DWCP
Then an inspection of the new septic tank by this Department must occur.
I
1
Parvin, Lindsay
From: Miorandi, Donna
Sent: Thursday, July 25, 2013 3:13 PM
To: Heath DeptMailbox
Subject: 58 Blanid Road, Osterville
Hi all-just an FYI-that I called Darren Meyer this afternoon and he was unaware that there was no permit taken out for the
tank to be moved. His certification dated 7-22-13 for moving the tank only has the same permit number on it as the
original number so I think he should have realized this but nonetheless he has stated that he will get me an original plan
that is missing from our original permit and will also call to state that they need to pay for the new tank moving permit and
have it inspected by this department to make every thing right.
I shall re-file the street folder and the app for the new unpaid permit. Thanks!
Donna
J 1
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Parvin, Lindsay
From: Miorandi, Donna
Sent: Thursday, May 30, 2013 4:27 PM
To: HeathDeptMailbox
Subject: Northern Paving
Just an FYI-Please do not issue anymore septic permits until they pay for the one I have in my in-box for 58 Blanid Road,
Osterville. They moved a septic tank without this permit from one end of the house to the other and have not paid for the
permit or called for an inspection. Thanks!
Donna
1
TOWN OF BARNSTABLE oP 11KI1
LOCATION S� ���•�� R�b�� SEWAGE# Z()i 7- 3 Z'7
'VILLAGE 0Z+eCYAVt ASSESSOR'S MAP&PARCEL NO / (Z
INSTALLERS NAME&PHONE NO. h\17VV,,:kM RcAY1^
SEPTIC TANK CAPACITY
LEACHING FACILITY: a J;nFi f�Frci�oc(typ ) .J` (size) 58.33 x 3 roWi,r
,NO.OF BEDROOMS Ll Be .f
OWNER Bcw r\'�3
PERMIT DATE: 1'0 2'L I t Z COMPLIANCE DATE: It f 13 t Z
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) Al I� Feet
Edge of Wetland and Leaching Facility(If any wetlands exist N/A
within 300 feet of ledchi acili Feet
FURNISHED BY {.�
A 3o cic 3
A+ C
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AttJ - i7� 5 �
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Sy'
171
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TOWN OF BARNSTABLE D
LOCATION SEWAGE# o r�
VILLAGE _ASSESSOR'S MAP.&PARCEL
INSTALLER'S NAME&PHONE NO.�c-�((Af-t4 QPpVIbSE�
SEPTIC TANK CAPACITY 1 SCrC) �� -
LEACHING FACILITY:(type) L.C.o9G►h C(1 (size)
NO.OF BEDROOMS
OWNER =
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist ori`
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
to
fIOWA, TOWN OF BARNSTABLE
LOCATION SEWA
GE#
VILLAGE D�cw<<� ASSESSOR'S MAP&PARCEL /A 0
-fNSTALLERS NAME&.PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) P•-7 (size)
NO.OF BEDROOMS 3
OWNER t-A 1A.1
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
FURNISHED BY
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03 A 8AUL
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y ys 3S'
f No. ' 771
�-- 3�� t Fee
N-. Z
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUMETTS es \
01ppYication for his*posai 6psteru Construction Permit
Application for a Permit to Construct 60 Repair( ) Upgrade ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. � 1? av,. ( I t Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel I q()I ()CaZ
Installle^er''s Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size o UJ sq.ft. Garbage Grinder( )
Other Type of Building v Q No.of Persons Showers( ) Cafeteria( )
Other Fixtures l
Design Flow(min.required) 4-1 ® gpd Design flow provided 44 86 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)
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 Envir al Code and not to place the system in operation until a Certificate of
Compliance has been issued by eBoar
Date
Application Approved by Date /a 2=.,Z
Application Disapprove y Date
for the following reasons
Permit No. 2-()( Z °- 3 2- - Date Issued to I Z 1 2 cZ
- --------------
61 32-7 Fee 30
l f THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC f�IEALT'H DIVISION'-TOWN OF BARNSTABLE, MASSACHUS&TS
4plication for Misposal 6pstrm Construction 'Vermit
Application for a Permit to Construct t Repa r,,( ) Upgrade ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. ` Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel L () ()U , 1 V ►� S(J�• ✓t �Q'451/1�C� q 7�-114q-125
Installer's Name,Address,and Tel.No. (9
Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size a4r, sq.ft. Garbage Grinder( )
Other - -Type of Building No.of Persons Showers( ) Cafeteria( )All
.
Other Fixtures
Design Flow(min.required) q q O gpd Design flow provided y g 6 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)
/f
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 Envir Bfifal Code and not to place the systein in operation until a Certificate of
Compliance has been issued by this Boar eai
Date
Application Approved by - t Date //I!ZZ Lv,Z i
Application Disapprove y J Date
for the following reasons
Permit No. Z O( Z 32 Date Issued /0
- ---------------------------------------------------------------------------------------------------------------------------------
k _p P TH E COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed(x) Repaired( ) Upgraded( )
Abandoned( )by
at 5a ax t has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.ZU 1Z'37 4 dated /O t 7 L®I z
Installer f' Designer
#bedrooms 4 Approved design fl w O gpd
The issuance f this permit shall not be construed as a guarantee that the system.i on as desit ned.
Date P I�l ?t I Ins VW
----------------- ---------------------------------------------------------------------------------------------------------------------
No.7,0 i 2.^ 3Z Feed 0 5 C op
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal 6pstem Construction jetmit
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 recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit. _
Date��/ Z '7 i�1 Z� Approved by
Town of Barnstable
Regulatory Services
$ Thomas F. Geiler,Director
Public Health Division .
MAM
.`� Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 - Fax: 508-790-6304
Date: 16 -Z Z Sewage Permit# 7 Assessor's Map/Parcel11f9_ r_>,��,`Z
Installer& Designer Certification Form
Designer: c c�� jcSScs�: 7 Installer: ?/fir
Address: 14ozX y /7 Address:
a Z6 s'2-
On -t. was issued a permit to install a
(date) (installer)
septic system at 5-8>> based on a design drawn by
(address)
Ly Gcit� dated 68 -5co
(designer)
l/ I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
were found satisfactory..
I certify that the septic system referenced above was installed with major changes (i.e. -
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Re ations. Plan revision or
certified as-built by designer to follow. Stripout (if requ' cted and the soils
were found satisfactory.
0
nstaller's Signature) No. 1140
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t sr �
\` / S'14 1 T A4��
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+✓( "esi ner's Si nature) (Affix Designer's Stamp Here)
PLEASE RETU TO BARN ABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
gAoffice formsWesignercertification form.doc
--- r- Tgwn Gl'Barnstable -P# ;
Department of Health,Safety,and"Environmental Services
ntr Public Heulth'Division Date 0
SA 367 Main Street,Hyannis MA 02601 "
VURK
b �. . Date Scheduled ' Time `:I : Fee Pd. 4`
Soil Suitabilityy Assessment o� S� a e Dis
f g Performed By: :\ L�Tf Witnessed By:; �L,V
t.00ATI bN &GENMACIX RMAT ON.
Location Address Owner's Name
7 S.ONr D
Address
Assessor's Map/Parcel: Engineer's NameC9c
NEW CONSTRUCTION __� REPAIR . Telephone# \7 2 -
GJsT
Land Use Slopes(%) Suiffice Stones
Distances from: Open Water Body ft Possible Wet Area. ft Drinking Water Well ft -
Drainage Way ft Property Line, ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
77
lt
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1 '
• W i ''� ~ � rota 4 �_�` '
• t ._ . ,,. :� 4'...1 ;tip
Parent material(geologic) Depth to Bedrock
3 ,
Depth to Groundwater: Standing Water inHole-: Weeping from Pit Facei
Estimated Seasonal High Groundwater .. .rw ^
D "�'Y+'ii(1Vl ' A-TW—N—F 5�" 11�A i ll 1''�" i LE
Method Used: s _
Depth Observed standing in obs.hole: ` in. Depth to soil mottles " r in.
Zy I
2V 5
Y DEEP OBSERVATION HOLE LOG Holer#—
Depth from Soil Horizon .' Soil'Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
°
U—toy b6k y� �d
to, - LO
Na 0
"DEEP OBSERVATION HOLE LOG Hole
Depth from I Soil Horizon , I Soil Texture ISOil Color Sotl Other
Surf ce(in.) (USDA) '""ersel!� pq itli.g (S
�•� r� .na � tR:c.t.re,MaJ
ne ,Boulderes.
ni y ° Gravel)
o — t2 /4 �(,, QY
2' U 1(j orm � hrt�
1
0t_ And
No `
DEEP.OBSERVATION HOLE LOG Hole# 3
Depth from Soil Ilorizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
n r n i el2a.% r e
tl :t
1 — Z (,oA�n►
0
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture SII) Mottling
Other
Surfacc(in.) (USDA) ( (Structure,Stones,Boulderes.
it I ° Gravel)
2- f lI 6— 0 Itile
NO j /-,O
Flood Insurance Rate Maw
Above 500 year flood boundary No_ Yes
Within 500 vear houndary No Yes
1
DEEP OBSERVATION HOLE LOG
Depth from Soil Horizon Soil Texture . Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling '�•(Structure,Stones,Boulderes. _.
%
3
r s
-
k hY
'Gig
, y
y s
x -A r r'C' Vasa
�� _ .t DEEP OBSERVATION HOLE LAG Hole# _ °. .
v Depth from I Soil tior►zan Soil Texture ( Soil Color Soil Other
<. Surface(m.) (USDA) (Munsell} MCItling {Stiust4se,Stones,Boulderes::' >
u GraVell
/ z,i• 1
DEEP OESERVATION ROLE LOG l`Iole#
Depth from Soil Horizon• Soil Texture Soil Color Soil `Other
Surface(in.) (USDA) (Munsell) t .Mottling " '(Structure,Stones,Boulderes.
.. ., u
s
r
DEEP OBSERVATION HOLE LOG r Hole,#
Depth from Soil Horizon Soil Texture Soil Color r Soil v! Other ,
# Surface(in.)°. (USDA) r, (Munsell) Mottling (Structure,Stones,Boulderes.:" �.
u
, p. ? 4*"
• - q
m
s»Y
y + 3 q. ,¢
Flood Insurance Rate 11�an• w"
S - -ry Ni a ,� k �air'_ � i ,i..�t�S
Above 500 year flood boundaryl'µNo es , ,� x
Within 500 year boundary' No Yes
Within 100 year flood boundary Ni Yes
' •� `
r depth of Naturally Occarrm`g I?ervious•Material 1 ��
• - 1 Does at'least four feet of naturally occurring perviou, material exist in all areas observed throughout the . .
w . area proposed for the sotl'absorption system? z �
rt
If not,what is the depth of naturally,occurring pervious materials
!Certification
I certify that on �� (date)I have passed the soil evaluator examination approved by the
Department o iron ntal Protection and that the above analysis was performed by me consistent with
the required raining, p;rtise an experience described in 310 CMR 15.01 .
Signature Date
AsBuilt Page 1 of 1
TOWN OF BARNSTABLE
LOCATION SEWAGE#Ze\Z-3 Z 7
VILLAGE OsFe Z V,\�Q ASSESSOR'S MAP&PARCEL /4!o /6 z
INSTALLERS NAME&PHONE NO. Mel�tiM
jTy
• SEPTIC TANK CAPACITY 1 S Sa6-,3-AT-q�
OO c�,�\O„
LEACHING FACILITY.(type) (size) 53.13� x 3 rows
NO.OF BEDROOMS Li QF'�t�c.Ml
OWNER gayS,m�A
PERMIT DATE: i Q 122. t 2 COMPLIANCE DATE: I t 1 i 31 1 Z
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 14 IA Feet
Private Water Supply Well and Leaching Facility Of any wells exist
on site or within 200 feet of leaching facility) N 1A Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leach ili IVIA Feet
FURNISHED BY w '
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http://issgl2/intranet/propdata/prebuilt.aspx?mappar=140062&seq=2 8/12/2015
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF.ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE_ 5
OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 58.Blanid Rest
Osterville, MA'02655
Owner's Name: Charles&Margaret Ka1as
Owner's Address:
Date of Inspection:.: April 2, 2007
Name of Inspector: (Please Print) James M Ford
Company Name: James M.Ford
Mailing Address: P.O.Box 49
Osterville,MA 02655-0049
Telephone Number: 008)862-9400
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information report d ,
below is true, accurate and complete.as of the.time.of the inspection: The inspection was performed baled on mycs9
training.and experience in the proper function and maintenance of on site sewage disposal systems. Iwa a DEP .
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:yl CO
✓ Passes
Conditionally Passes Pw
Nees urther Evaluation by the Local Approving Authority iv
Fail .
Inspector's.Signature: Date: April 4;2007
The system inspector shall sub t a copy of:this inspection report to the Approving Authority(Board-of Health or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design.flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving
authority.
Notes and Comments'
****This report.only describes conditions.at the time of inspection and,under the conditions of use at that
time..This inspection does not address how the system will perform in the future.under the same or different
conditions of use.
Title Inspection Form 6/15/2000 page 1.
Y
Page 2 of I 1
OFFICIAL INSPECTION FORM-. NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 58 Blanid Road
Osterville, MA
Owner: Charles&Marzaret Kalas
Date of Inspection: April 2. 2007
Inspection Summary: Check A,B,C,D or E/.ALWAYS complete all of Section D
A. System Passes:
I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass" section need to be replaced or
repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please
explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial.infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken;settled or uneven distribution box. System will pass inspection if (with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The.system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with.approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
Page 3 of I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 58 Blanid Road
Osterville, MA
Owner: Charles&Margaret Kalas
Date of Inspection: Apri12. 2007
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
_ Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System.will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
The system has aseptic 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 l of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system,has a septic tank and.SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well**. Method used to determine distance
**This system passes if the well water analysis,performed at a DEP certified laboratory, for coli£orm
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be.attached to this form.
3. Other:
3 ,
Page 4 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 58 Blanid Road
Osterville, MA
Owner: Charles&Margaret Kalas
Date of Inspection: April 2, 2007
D. System Failure Criteria applicable.to all systems:
You must indicate either"yes"or"no"to each of the following for all inspections:.
Yes No
✓ Backup of sewage into facility or system component due to overloaded or clogged.SAS or cesspool
✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
✓ Static liquid level-in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than %2 day flow
✓ Required pumping more than 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 coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310.CMR 15,.303,therefore the system fails. The system owner should contact the.Board of
Health to determine what.will be necessary to correct the failure.
E. Large System:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd.
You.must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
_ the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary.to a surface drinking water supply
the system i lo
cated ocated in a nitrog
en ogen 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
significanvthreat under Section.E or failed under Section D shall upgrade the system in accordance with'310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 58 Blanid Road
Osterville, MA
Owner: Charles&MarQaret Kalas
Date of Inspection: , ' April 2, 2007
Check if the following have been done: You must indicate"yes"Or"no"'as to each of the following:
Yes No
p, g provided
y ,
Pumping information was rovided b the owner,occupant,or Board of Health
✓ Were any of the system components pumped out in the previous two weeks?
✓ Has the system received nonnal 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:
Yes. No .'
✓ Existing information. For example,a plan at the Board of Health.
✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [310-CMR 15.302(3)(b)]::
5.
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE.DISPOSAL SYSTEM[INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 58 Blanid Road
Osterville, MA
Owner: Charles&Marzaret Kalas
Date of Inspection: Apri12, 2007
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Number of current residents: 2
Does residence have.a garbage:grinder(yes or no): `n/a
Is laundry on a separate sewage system(yes or no): nla [if yes separate inspection required]
Laundry system inspected(yes or no): No
Seasonal use(yes,or no): No
Water meter readings, if available(last.2 years usage(gpd)): Unavailable
Sump Pump(yes or no): No
Last date of occupancy: Currently occupied
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): , gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes,or no):
Industrial waste holding tank present(yes or no)
Non-sanitary waste discharged to the Title,5 system(yes or no):
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: Unavailable
Was system pumped as part of the inspection(yes or no): No
If yes,volume pumped: _gallons--How was.quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
✓ Septic tank,distribution box,soil absorption.system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or.no) (if yes,attach previous inspection records, if any)
Innovative/Alternative_technology; Attach a copy of the current operation and maintenance contract(to.be
obtained from system owner)
Tight Tank. Attach a copy of the DEP approval
Other(describe);
Approximate age of all components,date installed(if known)and source of information:
Installed on April 9, 1985-per as built card
Were sewage odors detected when arriving at the site(yes or no): No
6
I
Page 7 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 58 Blanid Road
Osterville, MA
Owner: Charles&Margaret Kalas
Date of Inspection: April 2, 2007
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: _cast iron _40 PVC _other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: 26re
Material of construction: ✓ concrete'_metal _fiberglass _polyethylene
_other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 1000 gal.
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: 6"
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: 70"
How were dimensions determined: Measuring stick
Comments(on pumping recoimmendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet.invert,evidence of leakage,etc.):
Tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage.
GREASE ,TRAP: None (locate on site plan)
Depth below grade:..
Material of construction: _concrete metal _fiberglass _polyethylene _other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels
as 'related to outlet invert,evidence of leakage,etc.):
Page 8 of 11
OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM.INFORMATION(continued)
Property Address: 58 Blanid Road
Osterville, MA
Owner: Charles&Mar¢aret Kalas
Date of Inspection: April 2, 2007
TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alann present(yes or no):'
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc,):
DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Even
Comments(note if box is level.and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
The D-box was normal with no solids present.
PUMP CHAMBER: .None (locate.on site plan)
Pumps in working order&s or no):
Alarms in working order(yes or no)
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
8
g
Page 9 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 58 Blanid Road
Osterville, MA
Owner: Charles&Mariwet Kalas
Date of Inspection: April 2, 2007
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
✓ leaching pits,number: 1 -6'x 6'(1000 a� 1.)
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
Innovative/alternative system Type/name of technology: .
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil;condition of vegetation,
etc.):
The leach had 4.5'liquid on the bottom. The scum line was at the salve level .There did not appear to be any signs of failure.
The cover was 10"below grade: The bottom to grade was 9'.
CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer: .
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Commnents (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: None (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
Page 10 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 58 Blanid Road
Osterville, MA
Owner: Charles&Marzaret Kalas
Date of Inspection: April 2, 2007
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building..
A
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io
Page 11 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 58 Blanid Road
Osterville, MA
Owner: Charles&Margaret Kalas
Date of Inspection: APri12 2007
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 30+/- feet
Please indicate(check)all.methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting;property/observation hole within 150 feet of SAS)
✓ Checked with local Board of Health-explain: Topographic and water contours maps
Checked with local excavators,installers—(attach documentation)
Accessed USGS database-explain:
You must describe how you,.establishedahe high ground water elevation:
Using Barnstable topographic and water contours maps the maps were showing approxiniatelV 30'+1-to ground water at this
site
This report has been prepared only for the septic system and components described herein. This septic system has been
inspected,and passed as of the date of inspection. This report is not a warranty or guarantee that the system will
function properly in the future. There have been no warranties or guarantees,either expressed,written or implied,
relating to the septic system, the inspection, this report and/or any components of the septic system,which have not
been.located and inspected.
11 -
a '
L-0.OAT-I N c SEWA G E PERMIT Nt. '
- �
V LIIAGE
' e A ' Igo n � �
INST LLER' NAME i (ADDRESS
Cd Soo A-. I
r a
B U I L D E R OR OWN ER
�CA AS
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
r �
i i r
/*
r
_ 03
No... ............ Fns ............
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
.4 a
rw .. . .-OF........
r �...............................
Appliratioo for Disposal Works Toostrurtion Vrrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( I-) an Individual Sewage Disposal
System at
` Location-Address or Lot No.
---••--••_• --_. ......-••-•-••••••---....._-•-••----•-------•__ __................................................................................................
•:------••.........__----•---------••......---
Owner --------••---------------Addres
a .:.Joke �----.�` .....e iw..-- -.. ........... ...................................................
.................. ....__----------- .............. ..
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling o. of Bedrooms........................................_...Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ---•---------------------------------•-..._...--•-•••••-•:_._..
W Design Flow.............................................gallons per person per day. Total daily flow............................................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.--___._---_-___- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
►-' Percolation Test Results Performed by...................................................•--•--•-•••-•••-••••-_. Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Ra' ---------------•------
0 Description of Soil......... ......... --- .........
-•- ------------------•---------...------...------------------------..............
x
W
x -•--•-•--•-•---------•------••---••••-•----•----••--•--•-•-•--•••••••---•-----------•-•-••••••--••••----•------•••-••••-••••----••••--••----•••• -----------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable_-------�_-X T�
- - ------- ----------...............................................
..•---•-•-••---•••••--•••-•...•-----•---•-•--•••••--•••-•-•-•-•--•-••••-••-•-••.................................. ------------ ...........................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TAI'�LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance h?beenisued by t e bo rd of health.
Signe --• -•-- --e---- "G - r.. -�_._......----•-
D
Application Approved By---...--•--•••--•----- - ---••--•••- �
Date
Application Disapproved for the Vlowing reasons-................................................................................................................
........-•-----------------------•-•-----...------------------....._.......---------------------..:.....----------•-------•-----•••-----••-••--•••---•-•-•----_••--••••••-•-••----••••••••._.....--•--
Q � te
�l Q
Permit No......... .- - ................. Issued a P ...............
...a
•---••-
Date •
L__ — -------------
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH -
.............. .........OF.......�'s„, '��'�. .:x✓.:. .
Appl.iration-rf r Disposal Works Tonstrn.rtilan rjernfit
Application is hereby made for a Permit to Construct ( ) or Repair (tr;,)"an Individual Sewage Disposal
System at
...... t 'r,.E�.. ..... !. � ....tJ $ ........ ........................... :...............................................--.................
/ Location-Address or Lot No.
.............................................................._......_.... _......._.:..........._................_._. ..........................
...._.............._
--------•
�f z Owner Address
Installer Address
Type of Building Size Lot`_: ---------------------Sq. feet
aDwelling ' 10. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons---------_.................. Showers (, ) — Cafeteria ( )
PAOther fixtures ..-'-••'•--"---------•--'----'••--•----•-----"-------•--"--'•-•------"...............'--'-"--"-'---...............•--"--------................----
W Design Flow.:....:.....................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ 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 j Other Distribution box ( ) Dosing tank'( )
aPercolation Test Results Performed by........................................................................... Date........................................
Test Pit No. 1________________minutes per inch Depth of Test Pit----------
......... Depth to ground water----------..............
Gr4: Test Pit No. 2...:............minutes per inch Depth of Test Pit.................... .Depth to ground water........................
..st........................................:....::.............................................
ODescription of Soil--------:. a. ?ij� .: ..-•----•---'---------------------••--'••--------•-----•'-•--------'"""---"""•"---...........__.
U •••-'--'----••------•------•-•--------------------------------------•--•--•--------------------•------------------.....--------•-----•'--'--------•----•---"---'•---"--••-----•-•--•--•"---•"••.--
W
U Nature of Repairs or Alterations—Answer when applicable--------e!.�-_ -��'.-
.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
E the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
t.
operation until a Certificate of Compliance has been issued by the board of health
r r
Signed__ : . :�r.:-'••--..., ,�y :_ P ,;... = ? ..
Date
. Application Approved By-'...""-'--" � --•------ r, .......... M �
Date
Application Disapproved for the lowing reasons:-.:.:--,••'--:------'=---------------------=------------•'-•:----...............................................
----...... .................. '•-"--"•---....- --•-"
t ate
Permit No.....---� ._...... Issued....-----� _._ _.. D.
---------
s Date
F THE COMMONWEALTH OF MASSACHUSETTS
G BOARD OF HEALTH
OF....:J:-..x. ....... .................
V
�� , C�rr�ifirtt�.e�,af �nnt�r�i��trr .
TH.T,S IST,�� RTIFY, That the In vidual Sewage Disposal System constructed ( ) or Repaired+
by.. > �°J'd�'. ) _{.._ ,�,...; ` ................ . •••••----•---•---••-•-•-•-•-........-••-•----- ..........._....•.• --.---
Installer.. r J �
at-' ..... a.. ..... sJ� ip °y�J !, J f`7 ! i S r`.
! 2 s
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as d scr• ed in the
application for`,Disposal Works Construction Permit No.....J9�--- 3e S............ . dated............... -_ ----I
_ __. ?�J ,
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR ED AS A GUARAN 6- HAT THE '
SYSTEM WIL FU TOON SATISFACTORY.
Q
DATE..............1.. 0—------------------------------------- Inspector........------.....M.. ,}.............................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
, � ldGi' ' ,✓ �r , ,d
I Z ' ..................
No. S
. ...='
0.5nnstrnrtion Permit w
—I'ermission'is hereby granted..... ...., R .._..
��
to ConstrUq, ( ) oar epair ( �° an Indi°vidualY)Sewage Disposal System
-•---•- ' . ................ ........................
f
Street
as shown on the application for Disposal Works Construction Permit N)V$-3 _5.. Dated.... .......... ...............
........................... .......... . .._.._______.___._.___._....... _.._..___....__..__..__..
of Health
DATE.........=. ... .
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PHONE: 508-771 -1040 FAX: 508-775-0155
gut INSTALL RISERS COVERS TO PIPES TO BE LAID LEVEL FOR DEEP OBSERVATION HOLE LOGS
WITHIN G" OF FINISH GRADE 2' OUT OF DISTRIBUTION BOX
t IN5PECTION PORT TDEST BY:SD MEYER, RS14 C5E
(5EE PLAN VIEW FOR LOCATIONS)
r, WITNESS: D. DE5MARAIS, HEALTh AGENT
x '� IL.I WATER TEST D-BOX FOR
s� 4"e. LEVELNESS * FLOW PERC RATE: < 2 MIN./INCH
Q EQUALIZATION
0 DEEP OBSERVATION HOLE#I EL. 33.5
Locus n �- EL. 34_3 EL. 3 .8 DE H SOIL SOIL
- - -
F; T.U.F. @ 4"scH - -- - 3 EL 3.8 FROM SOIL COLOR OIL OTHER
5U FA E HORIZON TEXTURE (MUN5ELL) MOTTLING
r Q EL. 35.0 4"SCH 40 PVC 40 PVC TOP @ EL. 30.9 O" - 10" A LOAMY SAND I OYR4/I
�W 4"SCH 40 PVC
PERG 52'70'
10° 10,-39" B LOAMY SAND I OYR5/6 24 GAL5<15 MIN5
32,60 32.3 (3) ROW5 OF (7) INFILTRATOR® EQUALIZER 24 39"- 120" C MEDIUM SAND 2.5YG/4
`]I/ /
0 _ - INSTALL GAS BAFFLE `J ! .00 30.83 'f/ �-,-.• BOTTOM @ EL. 30.00
n,r. BA5EMENT FLOOR
2n IN OUTLET TEE 32.0 -30.50
- � @ EL. 27.
&. W --
cn - DB-5 NOIT: REMOVE ANY IMPERVIOUS MATERIAL FOR A 5'
INSTALL TANK 4 D-BOX DEEP OBSERVATION HOLE#2 EL. 33.5
} Q ON 6" LAYER OF CRUSHED RADIUS AROUND SAS TO EL. 30.0 AND REPLACE G.5 DEPTH
SOIL SOIL SOIL COLOR SOIL STONE WITH CLEAN MEDIUM SAND. PAC OTHER
1500 GALLON PRECAST 5UfE HORIZON TEXTURE (MUNSELL) MOTTLING
SEPTIC TANK 0"- 12" A LOAMY5AND IOYR4/1
BOTTOM TH @ EL. 23.5 1 2'-40" B LOAMY SAND I OYR5/6
,40'- 120' C MEDIUM SAND 2.5Y6/4
DEEP OBSERVATION HOLE#3 EL. 33.5
DEPTH 501L SOIL
FROM HORIZON TEXTURE SOIL COLOR SOIL OTHER
SURFACE (MUN5ELL) MOTTLING
O"- 10.. FILL
DESIGNDATA 10'- 14' A LOAMY SAND I OYR4/I PERC @ 45"-63"
14'.42' B LOAMY SAND I OYR5/6 24 GAL5<15 MIN5
�- .4 2"- 1 20., C MEDIUM SAND 2.5Y6/4
DAILY FLOW: (4) E,EDROOMS x I 10 GAL/BDRM = 440 GPD
SEPTIC TANK: 440 GPD x 200% = 680 GPD
USE: 1 500 GALLON PRECAST SEPTIC TANK DEEP OBSERVATION HOLE#4 EL. 33.5
D15TRI13UTION BOi(: DEPTH SOIL 501L SOIL COLOR 501L
U5E: (9) OUTLET PRECAST DISTRIBUTION BOX FRO"' HORIZON rFxruRE OTHER
SURFACE (MUN5ELL) MOTTLING
0'- 1 2' PILL
SOIL ABSORPTION SYSTEM: 12'- 18' A LOAMY SAND 10YR4/1
18'-40' B LOAMY SAND I OYR5/6
U5E: (3) ROW5 OF (7) INFILTRATOR EQUALIZER 24 = 174.9 L.F. 40°- 120' c MEDIUM SAND 2.5Y6/4
CAPACITY: 175.0 L.F. x 3.7G S.F./L.F. x 0.74 = 48G.9 GPD NOTE: NO GROUNDWATER ENCOUNTERED IN ANY OBSERVATION HOLE
NOTE: EQUALIZER 24 = 1 5" x 1 00" x I I "
34 32 GENERAL NOTES
\ 1 I I
I 1
I I
\ ; i I . SEPTIC SYSTEM 15 TO BE INSTALLED IN ACCORDANCE WITH
' 3 10 CMR 15.00: TITLE V
{ 2. THIS SEPTIC SYSTEM IS NOT DESIGNED FOR THE USE OF A
3 2 GARBAGE D15PO5AIL.
3. THI5 PLAN 15 NOT TO BE U5ED FOR PROPERTY LINE DETERMINATION.
1 i 4. CONTRACTOR SHALL PROVIDE 48 i-IOUR NOTICE TO DE51GN
ENGINEER FOR ANY REQUIRED INSPECTIONS.
/ 5. CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION OF ANY
UTILITY, ABOVE OR UNDERGROUND, PRIOR TO ANY EXCAVATION
TBM = EL. 34.5 / OR CONSTRUCTION.
TOP OF IRON PIPE
CRAWL5PACE --- 3.75'
SLAB @ EL. 31 .5 (NP•)
I
' 1 22.08'
EXISTING ; - ; -INSPECTION
DWELLING ; v LOCATION 1 Q PORT (TYP.)
I
(TO BE RAZED) I OF SEPTIC 1 I 1 00%
I 1 -
_-----.-----WATEkSERVICE _---\� TANK I I I EXPANSION
20.0' I i I AREA (ZYP.)
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' ----------- i i 32.7
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51TE -�- SEWAGE PLAN
� I � I I L I wooD I I I 1 -TRENCH LENGTH = 58.33'
Q DECK FOR
58 ELAN I D ROAD OSTERVI LLE, MA
I I I
C7 1
40
SCREEN ' ' ' ' 3' PREPARED FOR
I i � ASSESSORS MAP 1 PORCH
PARCEL G2 �- 1__ •
i 0.23 AC (I 00 18 J.F.) 13AY51 D E BUILDING , INC .
+ i * y SCALE: DATE: DRAWN BY:
34.5 ; 34. 1 '-'- s9c . I II -
+1 105.82' 33.8 201 OS 30-201 2 TMW
1 ` RUMB /'ql 7 JOB NUMBER: REVISION SHEET NUMBER:
O. 57 G �4rryc�i ��, 1 2-04 1 1 1 - 1 5-201 3 5P- 1
1 ' p f
WELLER ASSOCIATES
'ESSIO�
No. 114J
-k G/r � °, I G45 FALMOUTH RD., SUITE 4C --- P.O. BOX 4 1 7 CENTERVILLE, MA 02G32
2 WINDY WAY, #232 NANTUCKET, MA 02554
34 fs��3 TELEPHONE * FAX: (508) 775-0735
EMAIL: tr15WeIIer@comca5t.net
REGI5TERED LAND 5URVEYOR5 * ENVIRONMENTAL CONSULTANTS
Traverse PC