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HomeMy WebLinkAbout0336 BUMPS RIVER ROAD - Health 336 BUMPS RIVER�ko p,OSTERVILLE A 0 a 0 COMMONWEALTH OF MASSACHUS , S EXEC UTIVE;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: 336 Bumps River Road Osterville,MA 02655 Owner's Name: John Melchiono Owner's Address: it Date of Inspection: February 28. 2013 • 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: (508) 862-9400. " 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.the inspection. The inspection,was performed based on my . training and experience.in the.proper functiop.and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant.to Se"f ipn 15.340 of Title"5(310 CMR 15.000). The system: . 3"r. ✓ asses ',Conditionally Passes eeds Further Evaluation by the Local Approving A,* rity o ails w Inspector's.Signature: Date: March'1 20 N The system inspector shall sub i a copy'of tpis 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 ow of 1040 , gpd or greater,'the inspector and the system owner shall submit the report to the appropriate regionaoffice of tip DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,an the apprO"' authority. F, M Notes and Comments ""This report only describes conditions qt the time of inspection.and under the conditions of.use'at that time. This inspection does not address hb ;the system will perform in the future under the same or different conditions of use. Title 5 Inspection Fonn 6/15/2000 page.1 V I _ Page 2 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 336 Bumps River Road Osterville,MA Owner: John Melchiono Date of Inspection: February 28. 2013 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: r 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. -E� 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 od 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 11 OFFICIAL INSPECTIGN FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: . 336 Bumps River Road Osterville.MA ° Owner: John Melchiono Date of Inspection: February 28. 2013 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303 (1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy.is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary toed surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private°water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compcunds 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: ` r, er Y ki 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 336Bumps'Riv-r.Road Osterville.MA Owner: John Melchiono' Date of Inspection: February 28, 2013 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: ,z Yes No + ' ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS:or cesspool ✓ Discharge or ponding of efluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than%z day flow . ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or�_hrivy is within 100 feet of a surface water supply or tributary to a surface water supply. r ✓ Any portion of a cesspool car privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool of 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 15303;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 systen}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 system;:in addition to the criteria above) Yes No the system is within 400 feet of a'surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question i{l Section E the system is considered a significant threat,or answered . "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact thr appropriate regional office of the Department. S" 4 .y Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 336 Bumps River Road Osterville.MA Owner: John Melchiono Date of Inspection: February 28, 2013 Check if the following have been done: Youimust indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS,located on site? ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information: For example,a plan at the Board of Health. ✓ _ Determined in the-field(if any of the failure criteria related to Part Cis at,issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. s� 5 �l Page 6 of 11 OFFICIAL INSPECTION,FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 336 Bumps River Road Osterville.MA Owner: John Melchiom Date of Inspection: February 28, 2013 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): N/a DESIGN flow based on 310 CMR 15.203 (fort example: 110 gpd x#of bedrooms): 330 Number of current residents: 3 Does residence have a garbage grinder(yes or no): N/a Is laundry on a separate sewage system(yes or no): N/a [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 COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sq/ft etc.)'- Grease trap present(yes or no): Industrial waste holding tank present(yes or lio) Non-sanitary waste discharged to the Title 5 ?ystem(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): r GENERAL INFORMATION Pumping Records Source of information: Pumped last year Was system pumped as part of the inspection;(yes or 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.-kttach 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: Date of installation -3124100 Were sewage odors,detected when arriving at the site(yes or no): No 6 Page 7 of I I OFFICIAL INSPECTIOQN FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 336 Bumps River.Road Osterville,MA Owner: John Melchiono Date of Inspection:.. February 28, 2013 A. 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: 12" i 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: 1500 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 1" Distance from top of scum to top of outlet teP or baffle: 6". Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations;inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.). The 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 cutlet 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 INSPECTIO+w FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 336 Bumps Rivi r Road Osterville,MA Owner: John Melchiono Date of Inspection: February 28. 2:713- TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: {I Material of construction: _concrete _netal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day, Alarm present(yes or no): i Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float swit6hes,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. 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.): s 8 Page 9 of 11 OFFICIAL INSPECTIONN FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:, 336 Bumps River Road Osterville,MA Owner: John Melchion Date of Inspection: February 28, 2013 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: ✓ leaching chambers,number: 3 cullecs with stone 12'x26'per as-built 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 hey draulic failure,level of ponding,damp soil,condition of vegetation,etc.): There did not appear to be any signs of failure:A camera was used for the inspection. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no)-�: Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,'level of ponding,condition of vegetation,etc.): r , 9 Page 10 of 11 OFFICIAL INSPECTIO'-1S FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 336 Bumps Riv:;r Road Osterville,MA Owner: John Melchionc- Date of Inspection:. February 28. 2013 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. 1 . A 0 0 f ak6 32 , 3 a c� ace ' y - • 33 31 3S S S� Sib s LJ 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 336 Bumps River Road Osterville,MA Owner: John Melchiono Date of Inspection: February 28, 2013 +a SITE EXAM Slope Surface water Check cellar , Shallow wells Estimated depth to ground water 40+1- =feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plansi,on record- If checked, date of design plan reviewed:. Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed-USGS database-explain: ._. You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps, the maps were showing approximately 40+/-to ground water at this site. r 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 fiaiction properly in the facture. 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. t: P 1 1 0000 TOWN OF BARNSTABLE V LOCATION���� 00".*h 10 4' /`40 SEWAGE# W-662 VILLAGE CAS Tr r LJ' Ile ASSESSOR'S MAP&LOT o tV3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY f LEACHING FACELIT�Y: (type) CL/TPC i PGAC ti4� (size) I X K�' NO.OF BEDROOMS BUILDER OR OWNER t) �ONST c'T-b.J PERMTTDATE: 'CD COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 ------------- Q67 Elc �22 CP CD a ...................................................................................... pp TOWN OF BARNNSTABLE LOCATION s�CO 00"^f ' ` der /` SEWAGE# V—6e(2 VILLAGE d S Tr r t/ I/�' --{{-- ASSESSOR'S MAP&LOT 3 INSTALLER'S NAME&PHONE NO. �JG rn p S 074 C 7 SEPTIC TANK CAPACITY CCS LEACHING FACILITY: (type) Ct,,/7PG Pam%C�'ti6 (size) 1t�x NO.OF BEDROOMS 3 BUILDER OR OWNER (J CDluST ti a7b") PERMITDATE: © COMPLIANCE DATE: jSeparation Distance Between the: Maximum Adjusted Groundwater Table and 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 _... .. 1 a 7ef >u . -, a i ------------- oe r No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSE.TTS 01pplication for Migo$Af *pgtem Congtruction Permit Application for a Permit to Construct(X)Repair( )Upgrade( )Abandon( ) X Complete System ❑Individual Components Location Address or Lot No. 33(. Gut #;s Rd Owner's Name,Address and Tel.No. 9/0 7,47— /6 Z6 c�st�,,,lt,� .�toar� d�-eptie� �I Assessor's Map/Parcel , m,vp rz.0 PA-Aec.-z_ 3-9-3 Q 6wcoK�r� VC �I(�Giultifl 1 NL-1903 Installer's Name,Address and Tel.No. Designer's Name,Address and Tel.No. 4ZS-Cf131 Q ►�r C a c r Type of Building: Dwelling No.of Bedrooms—rig Lot Size '30,b Z Co sq. ft. Garbage Grinder(A16) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow /40 G p4//� vav„ gamey. Calculated daily flow 330 gallons. Plan Date F>/ai/��' Number of sheets nrtQ Revision Date Title S'. 7/,&.1 /�, .336 auvn,gJ .-ial.r IZ,-..a Size of Septic Tank /—z:bn !9G//uJs, Type of S.A.S. I c•zch,-tj Cl2�.ahecr fZ`,r ZrE'><Z Description of Soil P 1 c-a%e mAzc br soil ici« vr, ra La vt ( WO—ci 5 i 1 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 oJthis le 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been ' edof HealSigned A,)lscJ� Date 3'cat ® Application Approved by e Date /C—7" Application Disapproved for the following reasons Permit No. — ' Date Issued s .. •. • l.y4 t- 71 No. —3 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. ,� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS Yes k ZippYication for ;Diopo.5aY *pgtem Construction Vermit= /076Application for a Permit to Construct(X)Repair( )Upgrade( )Abandon( ) Complete System El Individual Components Location Address or Lot No. / 33� j3.v,p5 t?� 12aP Owner's Name,AddressandTel.No. Cho 762 16 Z6 OsFzvruflu jtAr1 Sfe IteA5 Assessor's Map/Parcel P Installer's Name,Address and Tel.No. Designer's Name,Address and Tel.No. 46-9131 C �►u t P 1�d �e ' Cp "CQ Sw�kr 1v ,=nc, ar j ® y.. -�J9-0416 et2 M-4,, St-. osjmrV rA rn4 oa6.. Type of Building: Dwelling No. of Bedrooms y u Lot Sizes O?o sq. ft. Garbage Grinder(A16) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow A/,i e'_ , ¢allnn�Shy, Calculated daily flow ✓30 gallons. Plan Date Number of sheets g::?a Revision Date Title��—aQJva Size of Septic Tank Type of S.A.S. �,cochiw4 Ch Description of Soil 12l4,3j,, 41 loqa enq Di,._ 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 Certifi- cate of Compliance has been 'ss ed this Board of Health Signed LDate 3"a* gQO" Application Approved by rr' 2&A A :,j Date Application Disapproved for the following reasons Permit No. Date Issued /C , 7— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewye isposal System Constructed( Repaired ( )Upgraded( ) Abandoned( )by r1� /k)-� / 1- - ! 1 at c rN /ehas been constructed in accordance with the provisions of Titl 5 and the for Disposal System Construction Permit No. -1ra dated /6 — / . Installer Designer „( The issuance of this p`eRnit hall q'otfbe construed as a guarantee that the syste�' w l'function des94ed/. � ���`ali Date Inspector 0 1� C No. ! "& —j Fee ,r L� THE COMMONWEALTH OF MASSACHUSETTS -' O. _ PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS igogal *pgtem `Con5truction ermit Permission is hereby granted to Construct( epair( )Upgrade )Abandon( ) System located at 1.36 0 t< L- J -t-t/¢ and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must Ve comp'etefi within three years of the date of this e it. Date: v Approved by �� R r • C ,Inam H.ma,AMm«nd Fi, narydeli,q 14 Pinre Vernier Dri.e,3wdwid,,M<.m,hueeu.O_'Sh7 _ y < - oOr. Imw - 1 0,; r ; } Y Q i I ' ANOW r-I "<M I 1 . �MIOYIn1 1 rs/ 1 �i } .............. /0................- THE COMMONWEALTH OF MASSACHUSETTS 00/ �/��� BOAR® O HEA TH --------OF......... .. ... . . ................. Appliration -fur Bhipoiitt1 Works Towitrurtion Prrniit Application is hereby made for a Permit to Construct ( ' or Repair ( ) an Individual Sewage Disposal n�n System at• R •---------------- -------------- ----- .----.._...----.----- .... .` .. ...1. ....................................................... - 1 Location-Address or Lot No. Owner Address Installer Address d Type of Buildin Size Lot..QJA.�--1-_-.Sq. feet U ..............Ex Expansion Attic Garbage Grinder Dwelling' No. of Bedrooms______ ____________________ p ( ) g ( ) aOther—Type of Building ____________________________ No. of persons............:--------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures --------•-------•--------------- W Design Flow.................................gallons per person per day. Total daily WSeptic 1'utk Liquid capacityf_.Ded___gallons Length________________ Width------.--------- Diameter-----.---------- Depth.__.---._..._. x Disposal Trench—No. .................... Width.................... Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No..4_X1........ Diameter.................... Depth below i let____.________._.... Total leaching area....__...........sq. it. 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-----------............. rZ4 Test Pit No. 2________________minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ ------- ..-•-------••.._...._... ---- ---- ;4 / O Description of`1Soi1 --..•--- -----•-----•---- �-y � �i---"-- . .. _. -------------------------------------------------------------------------------------- W -----------------------------------------=---------------------------------------------------------------------------------------------------•--------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable........................................................................................_-__-- •----•--•-•--------------------------------------------------- --------•---•--------------------•-•---------------------------------•-•-•---•--•------------------------------------------- ----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has een issue by the of health. igned --- -------- ------ ... .......................................... •--1 S--- Da e Application Approved By-- -----6;� ... -- .--- -- -• --••-- � Date Application Disapproved for the following reasons:............................Z.................................................................... -------•-----------------------------------------------------------------------------------------------•-----•-......--••------------•---•---------------------•----------•----------•--•----------•-••- Date PermitNo......................................................... Issued........................................................ Date No,._._........ Fi Fps.` ........................ THE COMMONWEALTH OF MASSACHUSETTS L BOARD gy HE TH OF AVvlir4tia>T -fur Ubiv uttl Works Tuttutrurtion err tit Application is...herebk., made for a Permit to Construct ( pair ( ) an Individual Sewage Disposal System at: . • V __ _________________________________________________________________________________________________ L. orAd s or Lot No. oIl --------•---------------------------•--------- --........------------------------.........------•---.....---- Owner Address .............................................................. ...... .....•-•- F-•-�i. - -` .. r ----_____ Address Q Type of Buil`din Size Loki�-�t-�6___ Sq. feet z Dwellin" r No. f Bedrooms__ ________________________________-__-Expansion Attic ( ) Garbage rinder ( ) aOther—Type oft Building ---------------------------- No. of persons.--------------------------- ( ( ).______.._ SHower�.. ) — Cafeteria 04 Other .fixtures ---------------------------------------------------- ------------------- W Design Flow.._. ...............................gallons per person per day. Total daily flow............................................gallons. WSeptic Tart qui capacifYOtld......gallons Length---•---_______-- Width---------------- Diameter_____--_------ Deptl-----------_---- x Disposal Trend o. .................... Width-------------------- Total Length-------------------- Total leaching area. _______sq. ft. Seepage Pit No___________ ________ Diameter __:_ Depth below ' let_.___ ____..__ __ Total leaching area--____ _-________sq. ft. Z Other Distribution box ( ) ` Dosing tank Percolation Test Results Performed by--_--------- ------- .................................................. Date------------------- ------------ ay Test Pit No. ____________minutes per inch Depth of "Pest Pit-................... Depth to ground water------ ___.:____.--., (S, Test Pit No. 2...............minutes per inch Depth of Test Pit.,................... Depth to ground water-----------.---_____---- .---- G Description of Soil, - .,.. . " { -- 'r�ief / ,�,C 1 -- --- -------- ----------- --------------- -Fw........ `------------------------- : -:---------------------------------------------------------------------"---------------- -------_-_----------;-------••---•--••••-_------------ FFTi, ili Nature, if P.epaih s or Alterations*—'- Answer when applicable.......... ------------------__-.....--. d -------- ---- ..........................•......... --- ----------•-•-------•-------••-.------•-•-------------------- _--- -- - ----- ----------- A ement: „ , The undersigned agrees to: install the redescrib Individ a1,'Sewage-Disposal System in r w tq provisions of Article \I of the State San — ``agrees not to pla e ste it �� � operation until a Certificate of Compliance ha een issue y the board of health. igne --------•- - - 401. ;.. Application Approved By..-- •----------•--- .......... ------------ --------------- Date Application Disapproved for'the following reasons------------=--.................................................A---------------------------------------------- ----------------------------------------------------------------------------------=--------------------•-------------------------------------------- ------------------- -------------------- Date Permit No.................. ........................................ Issued.. ......................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH rL. ..........O F......: !i4'� !(...............°v ..� .......... rutifiratr of f�11MVItaurr T S T; CER Y, t the dividual Sewage Disposal Systr m constructed ( ) or Re aired ( ') G by........ ---- ----- - --- J at.... . ._ , _ ----------_!_�_�........In *r_---.. ........................................ !� ............ has been instal.I n accordance with the,provisions of Articlg� l pf he State Sanitary Gale,$,. ertr j*d in the application for Disposal Works Construction Permit No........................ dated.......:.___-______-________________________--•- THE ISSUANCE OF THIS CERTIFfCATE SHALL NOT BE CONSTRUED AS GU ANTEE THAT TFIE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector-----! THE COMMONWEALTH OF MASSACHUSETTS BOARD HEAL ..........f No-------------------•--•• F EEE F.--_--- .----•• tt�tr�trti�ti- rriatt r 7 . Permission *19ereby gra ted.__.._--- ..................... .... ------ •...---•-----•------------------- ___ to Cons t . ) or p ' ) an In dua`1 Se os y`ste //C[ at No ` -------------- --- -- --•-•- St t as shown on the application for Disposal Works Construction Pe No ated------------------- ----------------- S -.._ • ....__ Board offealth .� FORM 1255 HOBBS•& WARREN.,INC.. PUBLISHERS r` � � f ;BUMA AD t f N s 150.92 �' F F � ZOT. 4 W N s 4s . 994 E 0 w N i j 93107 S7.4-1 ? Scale 1" -40' � r Certified Plot Plan Being lot 3 as shown on a t I, hereby certify that g the existing foundation 1 plan made by Barnstable s location is correc.,t as Survey Consultants, Inc. , shown and does conform ; dated Sept. 1970 and filed with the building setback in Land Court. Petioners requirements of the Town ! # 377$5• { VtN OF MqS of Barnstable. j Nov. 2$, 1975 or may\ I -1 ThomaiA. �' Builder: 1 0 JACKSON +! Lee Jackson 2$ Highland Drive ' Centerville, Mass. 0 } �40 SUkv�y r ,Signed 01 C % ONVII Of ffilrnsta ble l'I: Dcimr•t it,enl of II et!Ith,Safety;mid Environluental services .of'"WE s� J'Jilblic.Health Divislocr` ^r a� J07 Mnln Strccl,I lyannis MA 02601 nArwlFrAOLPAIA A f6lq. �a AfFD►71A1 DinIC Scheduled rune Soil Sr44011 ty f s'sess»>erlit,fv�• Seivrcge Drs���scrl I'cifonned.il)' Si" .. 'mow. Wi(,cssed by: Demvic ._11?o✓r. — LOCATION & CILNER A L 1N FORMATION wncr L,ocation'Address � 0 s Nnme Address iF �. r• Assessor's Map/Parcel: it �� /ZO) pace/. �B - liiiginccr s N.nmc j3�„xlz� Y tiL� NrW CONSTROCITO.N ✓ REPAIR Und.Qlse. SlopesI%) Surfncc•Storics V\.one Dislnoces from. Opco Water Body, Il Possible Wel Arm it Drhiking Water Well Ii Drnionge Way: II I'rcylctl) l,inc: Il Other It 5l(E l CH: (Slrcel onmc,ilnncnslons U.Io(,expel locnlions of icsl imics R perc tests•iocn(c wconods i),proximity to holes) 3 50` F i `.. hs (k G-c7T (8 u�' �C)`is 76 Pnre'nt innlerini(geologic) Depth to 13cdrock Death to Gromid\vnter."Slnnding Writer In 1101e:. 1Vccpii,g from 1'il I rice f'slln,nled Seasonnl,lilglt Gropnd\vnter" ;` _ �� ll 'C�ZM NA" ZC�1V 'C��t SEASONAL 111G;t1.:� h 1'L 1.I A13LL Method Used: . Depth Observed stnoding Iri ohs, sole: lit. Dclilh Io mil l,iollics. Depth to:weeping from side of ohs.hole:, in.: Gn,ugdi4nler Ad.lusGi,cn1 Il. �'t Index Well N _ Rnnd)nR Dnle: _; .irides Well level Aill,fnc(or _^`Atli.Ott nndwoler I,c\,cl I' .ZtCOI`,A'��I(�N '�'�SrS" I)gle I'llll@. /1,3d.. Obscrva(ton . I'iole N z " 'I lii,c nl 9" ' Depth of Perc'.: . I/. 'I'imc nl G', l\� Start Pre soak Time @ Co�teP •vv� Cnd Pre sank.`.. 1 h Rate Min./inch 7S rho rh t Site Sultnbility Assessment ..Silo Pnased , Site I mled., Addilionnl'I'cilhtg Needed(Y/N) Origh,ai> Public Ilcnllh Division 0bServnlivu 1101c D.la 7`u l3c c111111)Icled un 13ic1t: j CoPY;. APplicnnt 013 �VA'I ,ON01e # ' � .: Depth from Soilalorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mtnisell) Mottling (Structure,Stones,Boulderes. nsistency.°°GraVcl !, qlh it cm nLEI )<3ERVAT3ON ROLL LAG Hole# Depth from Soil Horizon So.Texture Soil Color .Soil Other Surface(in) :' (USDA] - (Munsell) Mottling (Structure,Stones,l3oulderes._ CO'nsistency.°' J X. yrce 13 HOL LIOG . : dole# Dcpth from - Soil 1-lorizon Soii Textoie Soii Color :. Soil Other Surface(in) {USDA) (Mulisell) . : Mottling (Structure,Stones,Boulderes. Consistency,° _ravel f " { :<'DF UBSERVt1T101t1IE�L L(�G H>le# Depth from Soil 1iorizon So11 Texture Soil Color Soil Othcr Surface(in) (USDA) (Munsell) Mottling (Structure,Stones;Boulderes. Cohsistency,%Grayel) Tlood Insurance Rate Map: . . Above 500 year flood boundary ;NOL Yes.tr Within 500 year boundary .'No Yes Within 100 year'(lood boundary No Yes Aepth of Naturally Occurt itig Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas throughout the area ro'osed for the soft absor tlpit s steIn7. If not,:what is the depth of naturally`occurring pervious material? Certification<.. 1 certify that on /�' (date)I have passed the soil evaluator exam ation approved by the Department of Environmental.Protection and that the :above analysis was_perfornied by me consistent with the required training,expertise an experience described in 310 CMIt 15:017. Signature r . " �'��/1 .: f Date ' .' -:. _. :. r,.zea..t3V'.�i:V..Y�n•'E^'`-Rad'%,'.M]liitr.Y 1. d.,.,*+."he.,i�"�.�',��.rf : - 12' 3 TOTAL UNITS 1 STARTE:R,1 END, & 1 INTERMEDIATE. C.B. ZONE S o FINISHED GRADE TYP. 3301 FN D.OFF WID (1) REMOVE UNSUITABLE SOILS BENEATH PROPOSED SYSTEM, BACKFILL COMPACTED FILL 330S 330E 49.3 WITH CLEAN GRANULAR MATERIAL"FILL TO BE GRADED AS FOLLOWS: NOT 36"MAX.- 12"MIN. //// / / & 6 MORE THAN 15% RETAINED ON No. 4 SIEVE, NOT MORE THAN 90% RETAINED \\\\\\��\\ ����� ��C�\\"�\\ 3.0 7.5' 6.�5 6.25',3.0 ti RC ON No. 50 SIEVE, OF FRACTION PASSING No. 4, 10% OR LESS TO PASS No. 2 PEASTONE `'1 '`- '-' 100 SIEVE AND 5% OR LESS TO PASS No. 200 SIEVE, SOIL TO BE APPROVED c -1.5 WASHED STONE d s �..i BY ENGINEER FOR COMPLIANCE PRIOR TO PLACING ON SITE. 3�4" TO 1 1/2 " �9 �St- MINIMUMS ti GQ� i .. `i 1 30.5" Q. o �9, 6s C.B. AREA = 43,560 S.F. o P (2) LOCATION OF UTILITIES NOT SHOWN ON THIS PLAN, AT LEAST 72 HOURS '� a a, DOUBLE O BENCHMARK PRIOR TO ANY EXCAVATION FOR THIS PROJECT CONTRACTOR SHALL MAKE d WASHED STONE • • cv x 48.9 FND. FRONTAGE = 20' Z� THE REQUIRED NOTIFICATION TO DIG SAFE (1-888-344-7233) AND APPROPRIATE •:. ,...• 'v 9 g TOP OF C.E. �4 co R/ WATER DISTRICT TO DETERMINE UTILITY LOCATIONS. EL. c '49.87'1 WIDTH 100 � LASS (3) FOR ALL ASPECTS OF THE SEPTIC SYSTEM THE CONTRACTOR �1 FRONT SETBACK = 20' N SHALL COMPLY WITH ALL GOVERNING CODES AND REGULATIONS. SECTION 26.00' IN PARTICULAR 310CMR 15.000 THE STATE ENVIRONMENTAL CODE TITLE 5, �/�1f�f���.1��/� SIDE SETBACKS = 10 T THE TOWN OF BARNSTABLE BOARD OF HEALTH REGULATIONS PART VIII: NO SCALE PJJ!!l� OF 1311AVH 'TRENCH � REAR SETBACK = 10' S�E� ON-SITE SEWAGE DISPOSAL REGULATIONS AND THE BOARD OF HEALTH /\ = Q\'o RECOMMENDATIONS FOR ACCEPTED PRACTICE. SCALE: 1" = 20' 14 .3 I BUILDING HEIGHT 30' Q (4) THE CONTRACTOR IS TO SECURE APPROPRIATE / PERMITS FROM TOWN AGENCIES FOR THE CONSTRUCTION DEFINED BY THIS PLAN. I LOCU S -MAP ALL STRUCTURES BURIED DEEPER THAN 4 FEET OR SUBJECT / \ SUBJECT TO VEHICLE TRAFFIC SHALL BE H-20 I I LOADING. •1 SCALE 1 25,000 f ''r / I I 49.7 S�9° ASSESSORS III I CERTIFY THAT THE PROPOSED FOUNDATION _ 3r' x 48.7 SHOWN HERON COMPLYS WITH THE SIDELINE I �A, MAP 120 PARCEL 38-3 AND SETBACK REQUIREMENTS OF THE TOWN OF f , � BARNSTABLE, AND IS NOT LOCATED WITHIN THE FLOOD PLAIN. D O GRAPHIC .SCALE DATE: 9 i R.L.S. / D -0 0 20 4O 47.8 / cn OFFSETS TO PR OSED BUI INGS SHOULD NOT rn 48.3 \ BE USED TO EST ISH P PERTY LINES. 0 x 50.0 C=� ` x 47.1 20' MIN. \ / > x 48.4 #1 PROPOSED •�, 48.5 SEPTIC _ \ �2 o 2 .o SYSTEM # 2 BOX l x 48.9 DIST. \ WAT - WA R -- WATER 4$,05 N 15 GAL. TANK \ 46.7 TA �' EXPANSION If 4 1 !� � \ c x x47 9. AREA x 47.2 lie48.3:�i \ \ o - `' - C.B. o y\P��� 46.1 \ o I a �, .1- ZOT 3.4FND. 1 P�� A \ _ , ` $ 30,070 S.F, y x ��' \°` A x 45.1 a7.1 14 x 48�2 � � _ � 0,69 A c #29 x 3 4-4.7 ! = 45.E I P S SITE tS NOT LOCATED IN THE FLOOD PLAIN 1� 45.1 i F � 9 • ��� ELEVATIONS ARE BASED ON N.G.V.D. ��, _ -.,� .._.-- , x C.B 44 3 �A. w. 2 .99 ,!�`PLS CF,,qs 9� FND. / . x �� � �`� / � � 9 'c � .EN 43.fl 42. �F, x 45.9 N �++ of y� 42.9 P �G t - I `SO `SSt 2 / / \ 44.7 / n� dOH No 30210 �►/�, 42.5� _ `9st �,S � x S� iS �`. tiffs Gv. o-/ O 41.$ �' P 9�8 �o o E� f �y ,o a9 06,, 45.3 \ / o. 2e87a g : ti o o � COS9 ` 42.9 s '�fC1STEQ C�o� o` 43. ✓ s�O;�� uMa Z� � ' ITE PLAN FOR aa.8 ,'q�'S, TEST HOIES i.P.& sTONEs ` #336 BUMPS RIVER ROAD x4 .9 AS BAXTER & NYE INC. FND. 42.7 LOT 3A 9/0?/99 4�7 #P-9516 DESIGN DATA PLAN REFFERENCE� BK. 393 �0 42 2 PG. 7 I 9� SINGLENOFGARBAGE GRINDER AMILY- 3 MS PLAN SHOWING PROPOSED DWELLING, PIT #1 ELEV. = 48.5' PIT #2 ELEV. = 48.5' DAILY FLOW = 110 X 3 = 330 G.P.D. TITLE 5 SEPTIC SYSTEM, PROPOSED / "0" / "0" SEPTIC TANK = 330 X 200% =660 G.P.D. -2" -3 USE 1500 GAL. SEPTIC TANK AND DRIVEWAY. "A" SANDY LOAM 10YR.5/1 "A' SANDY LOAM 1OYR.7/1 COVERS LOCATED TO WITHIN -7" -9" CmmC �G G. CHAMBER DESIGN BARNSTABLE j TOP OF ELEV.-49'0 F. -48't 6" OF F.G. "B" SANDY LOAM 10YR.5/8 ' "B" SANDY LOAM 1OYR.6/6 , MASS, I FOUNDATION \ a\ \ F.G. 4Tt -32" -28' ER WOR OR EQUIVALENT Nl .\ =INV. 46. F.G.= a7t ALL PIPES TO BE SCHEDULE 40 PVC APPLICANTS = \ , , INV. = 1500 GAL. LEVEL a" DIAMETER C1"MEDIUM SAND JEAN S. STEPHENS 45.8 SEPTIC TANK INV. = 45.5 DIST. cy USE 1 - 4" DISTRIBUTION LINE IN 3 RECHARGER UNITS INV. =45.3 BOx l fOUCf 40 pVC P/Pf LEACHING CHAMBERS �;� 10YR 5/8 IN A 12'X 26' WASHED STONE TRENCH AS SHOWN SCALE: 1"= 20' DATE: SEPT. 21, 1999 INV. =45.1 io.00' �-�6" CRUSHED INV. =45.0 "C" MEDIUM -45„ LEACHING AREA REQUIRED MIN. STONE BASE SAND 330 G.P.D./.74 = 446 S.F. BASEMENT FL. EL. 10.0 2(26 + 12) X 2 = 152 S.F. SIDEWALL AREA BAXTER & NYE INC. 10YR.6/4 'C2"MEDIUM (12 X 26) = 312 S.F. BOTTOM AREA REGISTERED LAND SURVEYORS BOTTOM ELEV. = 43.0 SAND 464 S.F. TOTAL PROVIDED CIVIL ENGINEERS 10YR.7/4 ❑STERVILLE, MASS, PRO ui NO SCALE -11' NO WATER EL. 37.5' -10.5' NO WATER EL. 38.0' CLASS 1 SOIL PERCOLATION RATE 1" IN 2 MIN, OR LESS 99089