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HomeMy WebLinkAbout0030 COCKACHOISET LANE - Health -`'30 Cockachoiset Lane, Osterville A = 116 130 4 � o o i o COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF.ENVIRONMENTAL'PROTECTION :.TITLE S OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM .PART.A , CERTIFICATION Property Address: 30 Cockachoiset Lane Osterville,MA 02655 I Owner's Name: Donald Dillon Owner's Address: Date of Inspection:. November 11 2011 Name of Inspector: (Please Print) Jani M,Ford Company Name: James M.Ford Mailing Address: P.O.Boz 49 Osterville,MA 02655-0049 Telephone Number: ' Y508)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. Tlie inspection was.perforined based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant.to`Section-15.340 of Title 5(310 CMR 15.000),.,The systein:' . 'Passes i t Conditionally Passes eed5 Further Evaluation by the Local Approving Authority ails Inspector's Signatures: ; Date.'; November 14, 2011 The system inspector shall su t a copy o this inspection report to the Approving Authority(Board,of Health or DEP within.30.days of com 1 n this inspection. If the system is a shared system or.has'a design flow.of 10,000 Y p.. g 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.sentto.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 - ti.me. .This.inspection does not address how the system will perform in the future under_the same or different conditions of use. „. Title 5 Inspection F 6/15/2000 page] orm a Page 2 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ; CERTIFICATION .(continued) Property Address: 30 Cockachoiset Lane Osterville,MA Owner Donald Dillon Date of Inspection: November 11, 2011 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. w � t One or more system components as described in the".Conditional Pass"section need to be replaced or " repaired. The system,upon completion.of the replacement or repair,as approved by the Board of Health,will.pass. 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 distributiowbox 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 a' obstruction is removed f �. ND explain. t 2 Page 3 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ry P CERTIFICATION '(continued) • :. Property'Address 30 Cockaclioiset Lane Osten ille.'MA Owner: Donald Dillon Date of Inspection: lyoveniber]1,•20111 4, Y C. Further Evaluation is Required by the Board of4Healthi " s Conditions exist which require further evaluation bythe 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 tt e system is not functioning in a manner wliich will protect public health,safety and the environment Cesspool or privy is within'50 feet of,a surface'water CesspooLor privy is within 50 feet of a bordering vegetated wetland or a salt marsh, f f } - i rb m � 4 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 soiIabsorpt on system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surfaceiwater supply. The system has'a septic tank and SAS and the SAS is within a2one: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 100 feet but 50 feet,or'more from a private water supply well**: Method used to'determine'distance Y _ 47 F ji z **This;systempasses if,the well water analysis,performed ata DER certified laboratory, for coliform ,x bacteria and volatile orgamc,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 sA=copy of the analysis must be attached to this form r3. .Other t Y , y N .r 1 4 { ! Page 4 of 11 2 OFFICIAL INSPECTION FORM`,, NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL"SYSTEM INSPECTION FORM h> PART A CERTIFICATION (continued) i- � y d k ! Property Address $ 3.0 Cockkchorset Lane r k Ostervilk•MA Owner: —Donald Dillon 10 a. Date of Inspection. Novemb&11. 2011 • 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- " � � $•� ,` ., : � ,: ,r £- y ✓ 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 Anoverloaded or clogged AS oncesspool "; ' f} a _ ✓ Static liquid level in the distribution box above outlet invek'due to an overloaded or'clogged SAS or . .cesspool 'e X _ ✓ `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•lmi year NOT due to clogged'or obstructed pipe(s). Number of times pamped=:`_ ' ✓ 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 supplyor tributary to a surface-- water supply:: F ✓ Any portion of a'cesspool.or privy,is within a Zone P'6f a public well ✓ Any portion of a'cesspool or privy iswithin50 feet of,a private water`supply well.. ✓ Anyportion of a cesspool or privy is less than 100 feet but greater than 50`feet from a private water supply weh with no acceptable water qualrty,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 we11 is free from'polfution from that facility a`nd.the presence'of ammonia , nitrogen arid.nitrate mt`r.oge' 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] 4 , No (Yes/No),The system fails I have determined"that one or more.of the above failure criteria eXist as '.described m 31QCMR 15 303;therefore the system* ails.,,The system owner should contact the Board of` Health to'determI what will be necessary to,correctthe failure E. Large system:,, +� & y 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: t: (The following criteria apply to.large systems in addition to the-criteria'abo e) r 'Yes No u' >., ;- .;, +`• , 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 t _ the'system is located in a nitrogen sensitive°area(Interim Wellhead Protection Area=IWPA)or a:mapped Zone II of a public watek supply well If you slave answered"yes"to,any'que't' m Sect}on"E the system is considered a sigmficant_threat,,or answered "yes"in.Section D above the large system has failed';The owner or operator of any large system consdered'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 th. appropriate regional office of the Department. Y ? s A „4 r s r v a Page 5 of 11 4 7 q OFFICIAL INSPECTION FORM- NOT FWVOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEMIJNSPECTION FORM. -PART B CHECKLIST Property Address 30 Cock7 cehoiset Lane Oster-ville,MA A Owner: Donald Dillon g Date of Inspection .November 11 `2011 x` Check if the following have been,done.°You must indicate"yes", or"no'_'as to eacli'of the followmg:y Yes ' No ✓ Pumping information was provided by.the owner,occupant,or Boar d"of Health -y t ✓' 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 Aof water been introduced to the system recently of as-part of this.inspection T x.. ' 'Were as built plans of the system obtained and examined? (If they were riot available note as N/A) ✓ Was the facility or dwelling inspected for.signs of sewage back up. y ✓ Was the site inspected for signs of break out.?, x x*. Were all'ystem components,excluding the SAS,located on'site ✓i Were the septic tank manholes uncovered,'opened,and the interior of the tank inspected for the condition of the baffles or tees,material o f coii4ruction'_4iinensi6ns,depth of liquid,depth of sludge and depth of scum? _ Was th'e facility owner(arid occupantssif different,' owner)provided with information.on the proper maintenance of subsurface sewage'disposal systems ' The size and location of the Soil Ab"sorption System(SAS)on the site has,beeri determined based on: Yes No Existing information ';For example,.a plan at the Board of Health .' E _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)'[310;GMR 15;302(3)(b)] . =e 17 R r 'x , `F t Page 6 of.I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION.FORM PART C ' SYSTEM INFORMATION Property Address: 30 Cockachoiset Lane' Ost6-ville,MA X.' Owner: Donald Dillon Date of Inspection: November 11, 2011 s FLOW'CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example:110 gpd x#of bedrooms): 440 Number of current residents: 0 z Does residence have a garbage grinder(yes or no): Nla Is laundry on a separate sewage system(yes or no): Nla Jif yes.separate inspection required] Laundry system inspected(yes or no): 'no Seasonal use(yes or no): : no Water meter readings,if available'(1ast'2 years usage(gpd)):° Unavailable Sump Pump (yes or.no)' : No Last date of occupancy.: Weekend/surniner 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): . r Industrial waste holding tank present(yes or no),•' Non-sanitary waste discharged to the Title S system(yes or no):. All Water meter readings, if available: d ' Last date of occupancy/use: OTHER(describe): . x ' GENERAL .INFORMATION Pumping Records Source of information: Unavailable - Was system pumped.as part of the inspection(yes or no): Yes ti . If yes,volume pumped:, gallons--How was quantity pumped determined? Reason for pumping: Maintenance' 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 4 Date of installation 3116100 per as-built card Were sewage odors detected when arriving at the site(yes or no): No 6 ,' Page 7 of I I " :M OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ` SYSTEM INFORMATION (continued)`3 t , F,} Property Address 30 Cockaclioiset Lane - .y:.. 4 Osterville,MA- Owner: Donald Dillon y Date of Inspection: Nove»iber 11 2011 x . BUILDING SEWER(locatek on site plan) F Depth below grade. other(expl ~ Materials of.construction cast iron _40,PVC ain). Distance from private water supply well.or suction line. Comments(on condition of joint's',venting,evidence of leakage;`etc) . 3. i tocate onsieSEPTIC TANK: plan) Depth below grade 13" Material of construction: ✓ concrete _metal _fiberglass ._polyethylene _other.(explain) ; If tank is metal.list age:" Is age confirmed by a Certificateof Compliance"(yes or<<no). (attach a copy of certificate)' Dimensions: 1500-Qal; Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 10 Distance from top of scuin to top of outlet tee offl r bae; 6 I ` Distance from bottom of scum to.bottom of outlet te'e or baffle,: •'1.0" s'.. How were-dimensions determined .. Measui-iny 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 weretireserit -Tha liquid level was even with outlet invert. There did not awear tor be ar'zy signs`of leakage. GREASE.TRAP None (locate on site plan) z U Depth below grade f " ` s 't Material of construction:, P—concrete _inetal fiberglass polyethylene other (explain)-+ Dimensions: p 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•purn recommendations;inlet an'd outlet tee orr. baffle condition,structural integrity,�liquid,levels , as related to.outlet invert,evidence of leakage,'`-etc.): 4 ti 7 , M e s t v _ n Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C , SYSTEM INFORMATION(contmued)l. ' . r - i•o ei t Address 30 Cockachoiset Lane r P , P y Osterville.MA Owner: Donald Dillon Date of Inspection: Noveni6er 11,2611 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 Alarm present(yes or no): Alarm level: Alarm in working order(yes'or.no): k 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 solidsIcarryover,any evidence of leakage into or out of box,etc.):. The D-Box was norinal.No solids were present. PUMP CHAMBER: . ✓ (locate on site plan) - Pumps in working order(yes or no): N/a Alarms in working order(yes or no) n/a Comments(note condition of pump chamber,condition-of pumps and appurtenances,etc.):,. The liquid level was normal could not cycle though rio one was home. _. .. - 8 ; Page 9 of 11 OFFICIAL INSPECTION:FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM- PART C SYSTEM INFORMATION (continued) Property Address: > 30 Cockachoiset Lane : Ostertiille.MA Owner: Donald Dillon ' Date of Inspection: November ll, 201) SOIL ABSORPTION SYSTEM(SAS): ✓ (loca.te onnsite plan,excavation not required) If SAS not located explain why:.. Type leaching pits,number: leaching chambers,rumber: leaching galleries,number: leaching trenches,number;length: ° ✓' leaching fields,number,dimensions: 12'x SO'wer�as-built card , overflow cesspool,number: _ Iimovative/alternative system ` Type/name of technology: Comments(note condition of soil,signs of Hydraulic failure,level of ponding,damp soil';'condition of vegetation,etc.): There did not appear to be any signs of failure. 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: 4' Depth of solids: ., Cominents(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,`_etc.): h Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .PART C " SYSTEM INFORMATION (continued) Property Address:, : 30 Cockachoiset Lane Oster vine.MA ">c Owner: Donald Dillon Date of Inspection: November 11, 2011 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two perinaiient reference landmarks or benchmarks. Locate all wells.within 100 feet. Locate where public water supply enters the building. �A(AI C. 3o� aa. C r < Y 3y` 3 4 Page l l of '11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY`ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-FORM PART C SYSTEM INFORMATION (continued)'. Property Address: 30 Cockachoiset Lane. + 0sterville,MA ' Owner: Donald Dillon ` Date of Inspection: November 11, 2011 SITE.EXAM Slope Surface water Check cellar Shallow wells . Estimated depth to ground water 8+1- 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 andwater contours neaps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established%thehigh ground water elevation: Using Barnstable topographic qni l water contours mags the neaps were showing approxin2ately 8'+/-'to Around.1-voter at this, site. .. • j rt .. This report has been prepared only for the septic system and components described herein: This septic system has been inspected andpassed as of the date of inspection. This report is not,a,warranty or guarantee that the system will -• fi,uictioit properly;ire:he f iture. There have been no warranties or guarantees;-'eith�er expressed�written or implied i elating to the septic system, the inspection, this report andlor ariy.comp onerrts of the septic systein which have not been located and inspecte+d a f I TOWN OF BARNSTABLE LOCATION -��= COC-k AC tIwcT( �J okt SEWAGE # VILLAGE S ���i`'c ASSESSOR'S MAP & LOT � uC/ INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY tst)(� -q as LEACHING FACILITY: (type) ��!'+�� Tt�� ( I�( X SO r (size) NO. OF BEDROOMS BUILDER OR OWNER rN ( PERMTTDATE: 8_�Z(9"q COMPLIANCE DATE: .� Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Teaching 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 r• �j o,q TOWN OF B ARNSTAB LE LOCATION 32 C0C- Ar TAG J M V lwt SEWAGE # Ct N TI A.GE � d<<� ASSESSOR'S MAP & LOT 19" 20 INSTALLER'S NAME&PHONE NO. L4'�-t _2S;3-d, SEPTIC TANK CAPACITY LEACHING FACILITY: (type) tSO r NO.OF BEDROOMS BUILDER OR OWNER o PERMITDATE: 8^Z(9 ln 2 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 'DOG 3� "` I ed V-Sy iva- ; T ION � SEWAGE PERMIT NO. © C OCkA C-fJ2 £7 Liu I N S T A. LLER'S NAME. ADDRESS B UILDE R OR OWNER DATE PERMIT ISSUED DATE C 0 M P L I A N C E ISSUED k-1 5T;V 4- HAW v-bick} Pi i No. Fee ma ° " (� 10 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Migozal 6pgtem Conotruction Permit Application for a Permit to Construct(A-)"'Repair( )Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No.,) Coe <a 0 ho 1 Serf Lane_ Owner's Name,Address and Tel.No. G5-fer✓iiIc rnM 0.1&65- Dona./d Oil)ori Assessor's Map/Parcel 9 G ctS't' t.3 rd S-f rc c f M /Ito Pa.rdel /30 ur K N V /OOoI/ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. „a P&4cr SJ11ivah P 0 s` 5 v 11 ra+i er s;rw�r;rrj-L nc. Z Parlecr RX, bSt,r vi'l)c M K D11c55 Type of Building: Dwelling No.of Bedrooms Lot Size a3=sq.ft. Garbage Grinder(N� Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 14� G' gallons. g ��D G/o� gallons per day. Calculated daily flow � Plan Date OC . 151 l 9`1 X Number of sheets I Revision Date Title Si I- P/ar! 30 cueKoeho,Se-+ L'a-ru. Gs+erv,'l)c. MA Size of Septic Tank /$OD gGLll0Y1 ( H ZD) Type of S.A.S. L aichi ne &A (!Z'X 50�) Description of Soil O a a (0)lMm 0 r q&ti,'c me er ia.( a"—!O' C H) e rr] Oo&rse SQn.( /ayr 63 /Od lv" C8) :54rony brn Fcx&nse- sd-)7A, 7.5YrS/4, ay" - Fro° t c ki h 6r., ('oarse. sar7d. to r- 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 beenssu by this Bo=ofHea Signed `� Date 8 a6-9 / Q Application Approved by Date Application Disapproved for the ollowi g reasons Permit No. �l. S.i'h Date Issued NO. Fee f J - - THE COMMONWEALTH OF MASSACHUSETTS ",,,. ..—Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS �l�lYicatfori fOC r ig OgaY *pgtem Congtruction Permit Application for a Permit to Construct( k<Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No._3�) C c.�, Ka c j )i s e f )-a n_e Owner's Name,Address and Tel.No. C>stcrv','U� i»� UdloS.)'- Do„aid D;►1o,� Assessor's Map/Parcel 1 d� CLP /OO'I/ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 5 b$ t�,2� 3 3 tF f e F e r 1 I,'✓a h fit 3 U l -1 Pa r O's to r V 1 I c r11 N 01 } Type of Building: Dwelling No.of Bedrooms _ Lot Size a6, /.36 q.ft. Garbage Grinder( N� Other Type of Building No.of Persons Showers( ) Cafeteria..( ) Other Fixtures ' Design Flow - _ - q 4 D (5-p j) gallons per day. Calculated daily flow 94144/ gallons. Plan Date OCt /5, 1198, Number of sheets f Revision Date Title f/ar7 30 04,CK0e))u1Se+ Lccru , 0S+ erg' ►jc, fnq Size of Septic Tank 1500 c1 a.110-n C H ZO,Z Type of S.A.S. B&A (1 a'X j0') Description of Soil SL r - /y'� � �U" !3) Sarah brn lunrse nano( '7•S�r Ilc7-to h /ern . ('oorsm* Nature of Repairs or Alterations(Answer when applicable) 4 4 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system t' 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 issuq by this BoaA of Heal o Signed /1 � Date Application Approved by Date Application Disapproved for the Yollowi9g reasons Permit No. a Date Issued ------------------------------- --------.t--- THE COMMONWEALTH OF MASSACHUSETTS / 'BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS/TO CERTIFY, that the On-site Sewage Disposal System Constructed( 1/)Repaired( )Upgraded( ) Abandoned( )by t� at 10 COLKoahoi.scf La'Le , 05+e r i ,'1)e i7/it . has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit N_o. - dated Installer T r c e tCsC 1 t',., t e.( Designer -? \c c The issuance of this pe s all not Me construed as a guarantee that the s Zill function a esigii t� ' Date —Inspector r --------------------------------------- No. Fee 8& THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwi5pogar *pgtem Congtruction Permit f Permission is hereby granted to Construct( x)Repair( )Upgrade( )Abandon( ) System located at 30 COOK r4 C h 0 /S Ct 1.a ►� I G s+ e r g,')i t r��►� 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 be completed within three years of the date of this permit, Date: - / Approved by � Y S• � i ssachusetts Department E viron dental Protection ,:.Bureau of Resource protectionOf Conditions `WPA Form 5 Order 131 40 Massachusetts Wetlands Protection Act M.G.L. C. f� f Findings (coot.) debris,including but not limited to lumber,backs,Plaster. wire,lath,paper.cardboard,Pipe-tires,ashes.refrigerators. motor vehicles,or parts of any of the foregoing. Denied because: the proposed work cannot be conditioned to meet the y This Order does not become final until all administrative appeal periods from this Order have elapsed,or it such an performance standards set forth in the wetlands regulations appeal has been taken,until all proceedings before the to protect those interests checked above. Therefore,work on this project may not 9°forward unless and until a new Department have been completed. Notice of Intent is submitted which provides measures which are adequate to protect these interests,and a final S. No work shall be undertaken until the Order has of become or Order of Conditions is issued. final and then has been recorded in the Registry is not sufficient the Land Court for the district in which the land kin the case the information submitted by the applicant within the chain of title of the affected property to describe the site,the work,or the effect of the work on of recorded land,the Final Order shall also be noted in the the interests identified in the Wetlandrso�teo�unless cL Registry's Grantor Index under the name of the Owner of the Therefore,work on this project may g land upon which the proposed work is to be done. In the and until a revised Notice of intent is submitted which case of registered land,the Final Order shalt also be noted provides sufficient Information�nd�s interests.and a final on the Land Court Certificate of Tide of the owner of the which are adequate P land upon which the proposed work is done. The recording Order of Conditions is issued. A description° rypect c information shall be submitted to this Conservation information which is IN and why Commission on the form at the end of this Order,which attached to this Order as per 310 CMR 10.05(b)(c). form must be stamped by the Registry of Deeds,prior to the commencement of the work- General Conditions 9. ' A sign shall be displayed at the site not less than two square 1. Failure to comply with all conditions stated herein,and with feet or more than three square feet in sae bearing the all related statutes and other regulatory measures,shall be words, n Massachusetts Department of Environmental Protectio ' deemed cause to revoke or modify this order. •[or,*MA DEP•J•File Number 2. The Order does not grant any property rights or any exclusive privileges:it does not authorize any injury to SE3-3558 private property or invasion of private rights- Prot FW NOW 3. This Order does not relieve the Penn t ee or any all otherother parson of the necessity of complying with federal,state.or local statutes'ordinances. 10.Where the Department of Environmental Protection Conservationis applicablerequested to issue a Superseding Order,the and bylaws, regulations. Commission shall be a party to all agency proceedings 4. The work authorized hereunder shall be completed within. hearings before the Department three years from the date of this Order unless either of the following apply. 11.Upon completion of the work described herein,the applicant a)the work is a maintenance dredging proi�as Provided shall submit a Request for Certificate of Compliance(YVPA ( Form BA)to tits Conservation Commission. tar in the Act;or (b)the time for completion has been e*ndedut less to a specified date more than three Years,but less than five 12.The work shall conform to the following attached plans an years,from the date of issuance. If tius Order is intended special conditions: to be valid for more than three years,the extention date tin the extended Final Approved Plans(attach additional plan references as . and the special circumstances warranting time period are set forth as a special condition in this needed) Order. Don Dillon 9 East 6 rd t 5.This Order may be extended by the issuing authority for To one or more periods of up to three years each upon Ju 1 12, 1999 revised application to the issuing authority at least 30 days prior to p the expiration date of the Order. Peter Sullivan, PE stpoamasomasDY 6. Any fill used in connection with this proiect shall be clear► Barnstable Conservation fill. Any fill shall contain no trash,refuse,rubbish,or on Me wo Town of Barnstable P it Department of Health,Safety,and Environmental Services �Tt+< Public Health Division y. Date' �1, N 367 Main Street,Hyannis MA 02601 S eARMADrl, Meae +� rFo► " Date Scfieduled ;. .�U n-e.t. `� /9 9 9 Time l a OG, "'Fee 1?tf:' '/06: `Soil Suitability Assessment for Sewage Disposal Performed By:Su IIA'a n En q/h e err?n.hC Witnessed By: .V. 10 Y1� f1. �A, &.;!!1! . ... ....... .:.......:...:... .:.. I ocation Add s Owner's Name,Go na/d yq n�tr y 30 FOe q tasl- �3�d st • G Address �O�steryil/r, �A• OaGSS Assessor's Map/Parcel: lym_p 7/Zi fare e.T /3 O Engineer's Name Pc2i/ �>> ✓ PE NEW CONSTRUCTION REPAIR Telephone N �p 0 • ' Land Use Slopes(%) Surface Stones 0^3 Distances from: Open Water Body `Z.DO R Possible Wet Area �' It Drinking Water Well p—' It Drainage Way —' R Property Line t o + tt Other tt SKETCH:(S amt.'dimensi oft cI IIII leutiouseflMholell''111: is i o holes) N 2329'!e-r •t2a Yr Ivl h� i i �• (' HoLrn r ` 1A , S 24W-1 M `• Y , Parent material(geologic) C:)-r v4 J r45 t.+ Depth to Bedrock Z Oar +. Depth to Groundwater. Standing Water In Hole: 69 I Weeping from Pit Face (1,91( Estimated Seasonal High Groundwater�� \k3 t-%)%N,,o ?M FT;I)F M b4VJ ,T LJLO COC-�GGr%ON Method Used QeiSE2�7�TIE>r=r •`-'l Depth Observed standing In obs.hole: in. Depth to soil mottles: --- n. Depth to weeping from side of obs.hole: In. Groundwater Adjustment .•Index Well N _ -Reading Date: Index Well level = Adj.factor Adj.Groundwater Level X. :::: .::;:.::::::.::.:::::::.:.::::::::.:::.::::::::::::pEItCCJ!LATIUN:T....S....:::.:;•::.:::.::::::::.::. »:::::::::.:�» ..�.:.;:.::.; Erl�6 4.J1c. cc.l.. _L& C /455 .� , Observation Hole N Time at 9" Depth of Perc Time at 6" Start Pre-soak Time @ Mayf.. } Time(9"-6.) is i End Pre-soak Rate MinAnch Site Suitability Assessment: Site Passed YC5 Site Failed:— — Additional Testing Needed(Y/N)... � rlrioiaal• Pnhlir nP,uh nq•ivinn flhcrrvntinri 11nir T)nt�To i3e rmmnlriril on Rnrk CCX' 0135 'VA''XU� (7 X.i(JG: IYtile# . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,%Gravel) per A-o l0- tO Swnvp �� S n E� C-0 Aag6 AO>02,ZS �O coagmtou LOG HoleDYl9 :QkRIOHLE #, :. .. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Gravel) D �.U3SRVA `I4N.U�• �,UC Mole Depth fro S moil Ilorizon Soil texture Soil Color Soil Other Surface(it (USDA) (Munsell) Mottling (Structure,Stones,Doulderes. e I DEEP:OISI•;RVATION HOLI';LOO Hale# .: ::.::. <:..::......:.:.....:........ . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes. Consistency,%Gravel) Flood Insurance Rate Man: Above 500 year flood boundary No X Yes Within 500 year boundary No K Yes Within 100 year flood boundary No_ Yes V Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification, I certify that on AfZt t- 9S (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the require al in ,exp andLpce described in 310 CMR 15.017. �j Date /9Signature __ __ Finish , Oreee NOTES _ I L Wtrter Supply ForThis Lot is Muetetpai Wehsr, 3 Comaded'flll3'Maximum LL Filter �feoflonolUtilitia Shown onThb Plain Am Appral• ��H p fbbric At Least 72 Hours Prior to Any Excavation ForTW o Ark ZONE: N/C Pro ad The ControctorSholl Make The Required tw � G. "' vs-Ile ►I icetbn to D 1p Saie(1-800-322-4844) , I c , r III steno 3 The contractorIsRequired to Secure Approp�� A k2 `�' ply j rj Pic _ e P411C P�Ipt 3M=t V!"Dee>;le Permits From Town Agencies For construefios •t 0 89• � I ey ware Dented byThb Plan o' p O . � � � �•�, - �ti Area (min.) 43,560 SF Install Risen as Requiradto Within 12 of fd'0e of v 0 3=0" -ar Finished Grode. ,,,e f l °ar m bii�, Fran to a (Min) 20 02 All Structwee Boiled Four Feet or More orSubjeet' "'h�`o �^ } IoYJ �d th �m in) 125' to vehicular Traffic lobe H-20 Loading. r E o+ o Setbacks: d 34pile Syyysstemtobe Installed InAccordance WMfi '34 Low F I 1 Barnstable 15. 00 oard of Heallth Rigguul And a The lbwnd 62�6 \• 1 Fron t 20 CROSS SECTION OF LEACHING BED tJ Side .10' Not to Scale 7. An Piping to be Sch40 PVC p/ I o� 1 • I — 1 Q. Rear /0 I ,��� f' _ 6 r V2'm Gohe Pips Fdr 24"ID Opening Above For M.H. Float Support Frome dtowr DESIGN DATA Shglo Family-4 Bedroom / ►r'• .Y1. With no Garbage Grinder Dolly Flown I10x4=440GPD Q' O / Pump Power 9 Float Control To D-Box Septic Tank 1440 GPD x 200%8 890 GPD / Cables Installed in Accordance Use 1500 Gallon Septic Tank / With Local Bldg.d Elec.Codes. - LEACHING AREA / 440 GPD/0.74:595 SF Required rJ 40 From.Septic Precast Pump Use Bottom Area Qnlr � 136.3 Lotrrt J Tank.Sch.40 PVC Chamber p Bottom Area a 12 x go'-600 S.F. N / '' 8_0„ Provided. r0 O / / / tardn rA LEACHING BED DESIGN ODw� 7 .. ... ,,• , Arm REFr• Use a 1000 Gallon,H-20 Septic Tank All Pipes tobe Schedule 40 PVC % ^� ASSESSOR Perforated With Capped Ends.Usl , Q's 4)• PLAN 3-4 0 Distribution Lines in a12>ir50 D (1 Nr 1` D`. 1 / Washed Stone Leaching Bed as Shown. p '`tir ' Map 116, Parcel 130 4"0 Sch.40 PVC Finished (V - .3 — ..• \ `From Septic Tank Grads ' /� r, LB.S f t 0 O `�/ / "� ' �' OVERLAY DISTRICT: ConduitThruChamber !1 NgTF_: WATL'RPROOF SR1� COf,CIttTG �� •` 08 H4M i !00 AP — A Aquifer Protection District Emergency Storage o ForCables. ab Ower9Fbot Chain n ToD•Box n�r►T►c TANK d-PUMP CHAMBER W� / 9 , \ h ► lei q Entitled / • Min.2'Cover 2 COATS OF APPROVED SMALAWT ry / � \ s 'lo`T As Shown on Plan V01.771G01. O \ _ j ! / „Revised Groundwater Protection Alarm n 14. 2"0 Seh.40 PVC ,� \ \ ` `� Puns °nEi.38 Switch$--3°egld ' 1d / / Overlay Districts" — April, 1993 Threaded Pipe `� \ `L Puns off EI 3 Check Valve 9,3'• pRO Secure Pi i `� Ab�s / Bottom of chamber . e r O �O Bottom El.2.5' 4 R �► 6"Watched '� / .%'i; •. t.t;�r one Min. O � '4S / SECTION T- O� �E F REN CES, RE E _ PUMP CHAMBER DETAIL - d __, _ i_�.:� �. �• �.,_ �= w"� n .:;:: i ��.,..h /;i1 r, r °�qt p,�l •. -. r. I tV , Plan Book 99,15 g caw►, Rr ti;°4 :i er n a efi0t. ` . �'A$,� " =� �` `' Plan. Book 259116 F.G.10.0 F.G.9.0 q, o% �V �'' i7�j„ N ,Mo QC f; Firs r e / `\ >"'�� �'� 1�'�i p�ll w, 41g$e h C A1, h`� [1040ZTOJ 171 Sot E1.7.5 0 C 7.S Gol P 8.2 .► � �n`tijs'i 0 ALL.DI'VURf'i ILbARnASTpeptca5.0M A • 1Qb/ � REL.ANOISCAPeqChamber o Legend. . - 14-20 Bedding as Ground Water at El.2.5 ' b GA 1g� 0 `- Per Title S ( i. �. �� 0 DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM 35 '4- 'fro �'' -b- Hydrant Not to Scale p A ry O CB/DH N sj�94.rs+ r AQ �ry -0 Guy o oo�O Utility Pole �. os �, •�,� ;��`' \ � � o��, �� �r�� ,� a Deciduous Tree iota . V I j . • O CST NdLE EL. 6.0 r30• 4- :, ��\ a "t fi ' • • �•• T L A QRG G f,re �G, O \ auto p t,� r i � su > .� o n� ,�NI (�0 n Ra W i Conifereus Tree rk II • 1 Z,t MAT�R1Ae... /a1 \ �1V�saO e r� A RRN. COARSE SAND rrsyJ +4 —v— Sign 10 y R 6/3 ., to B STRONG bRN CC>ARSE1 a Light Post +i - •���� 20'' SAND �.SYRS/L ` ,� � T Gas Gate LT,�(�L l_CW I SH B12N ��.` R�t/jtiC,H d�1�OF p Water Gate ,t GOARSG SAND 1 O`y R VL4 \ ao _ \ �• PET�A Index Contour rL0(',U �� • CXI ST. DWt�LLINCr CLASS Z MATE.RIAL \ �,{ir r, •.t'.. Less THAN 2 MIN iNc+i / SULLIVAI — — — — — — Minor Contour • • o / PL, N VIEW . �.• GRouND WAMR@ II F—L, 2,z6 .�rr p `�• / / O 29733 �, am Overhead wre(s) � ••• Scale f��= 20, / L ends °� Up NO GROUND WATER CORRECTION RRQu1R�0 E vvITH1N 2001 bF,M•HiW, oa,TE: /2v/qq NOT S! Property is Located VYitMnThe 100YeQr Flood Plain Zone A-13 Elevation 11.00 LOCUS PLAN may: P. suLLIVAN, S.E.X. • „ WITH C-Ss : (J,M IpRAND1 M.o. WEALTH, Per FIRM Community Panel Number Scale:I =2000 "7ItZl� 2500010016D.Map Revised July 2,1992. - rtle: PREPARED BY PREPARED FOR: NoteS/Rev.Nlon: t DON D I LLON The property line information shown was compiled Cb SITE PLAN - Sullivan Engineering, gnc. �a (a S I� rd from available record information and does not .., PO Box 659 PO Box 18 9 EAST 63 STREET represent on on the ground survey. 30 COCKAC HOIS ET LANE osfwWle, MA 02655 Hytannts MA 02601--1 18 OSTERVILLE , MA (508)428-MO (&W)428-3115 fox O — O —�� NEW PORK NEW YORK PSu11PEAaaGaem �m� rgee ' The topography and detail shown was obtained o by conventional survey methods. 20 a 0 20 40 ea Feld: M/RM/R L� H Draft: R L'H/M D The datum used is NGVD '29, Based on FEMA Date:. . Scale: Comp.: RLIH Review: PS -benchmark data. OCT. I5, I998 I = 20 Prof, f Drowing C330 1 REVISION -7/12/=b'"150 51_10TiG S1STEIH tam r-&/_ ��-- .gel 3