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HomeMy WebLinkAbout0160 CRYSTAL LAKE ROAD - Health 160 Crystal Lake Road Osterville Pw A A = 139 043 a 4 - r VttV MORMA � g UA Tom! x, JOAA �K te'':1?+l' '�4`,Ai't •+�f M1:i.'7A�7'>�5 TjY,'�1�'A" ��:1rt'firM�+>r .-�: .. ..,,,, � ?�Jt *,iw,4�.�r. �S;1 .I'k�,:,,..., .:...�,r.,;;...-.�,.,, + Y k i + tl� itd L+f "� tt 1r� , rtrCw+i Yf it iti['tt r, "APT ' t4;,11tt1C0.cAt 1$ ru7riFfi� wN. sir+ t*A '�•�'� r"1 �Tit'$: � '1►�Gr"L'ids � e�el!d »Ea�1t - �dvC �rv+� `��:�,}'+� *"' �� rim.a+ ��"� ��• � � 3 t a' ACC 1NF3 04CSry� trttlt�v�l t M1MkM ��" or �i1tw qs ���yt{tt����,��if�rry.�,�i�t,�!.aly.��fi��Al � '��y�,� yy{" •!:'(4�k;.SiM1.}y�y�R""Ui> �'�K��IYE y t�:� '�Z1Kl�'Y,�G6 �'�s�.r '�►'� ' /. .�in:(d91'k�f^`.M�•"s+tf. - ;..,, Y' .i «G1M1�` # J°! i +11 :N1ttp .IMF fa G � { w'n�li+ k � r mac► s+rdiot it ttr +� € ..�., •0 ,�1 Proposed 14 x 30 R- •, - I •C V Ingmund Swimming Pcol - g „ ': Exlstlng Pml �.. . jt Compliant4ft Fence. 3,.. - > - with self dosing and - 15 ft Setback j - - eNd '{ `ed�cA fi T &' a, .Pool equipment 1 , r•rs ._l .: y ACCESS rys - - �y CYl tekho e RD..r" oe 1J k £ tat �y� � :; ,• ��,� • rc :..pyu.. .. ....,�y4N rtt•:..wwrr s..wx. AsBuilt Page 1 of 1 TOWN OF BARNS/TABLE YS l 9 LOCATION �`0 Cr 7AI 4h SEWAGE# vII.LAGE OSTGru�f� ASSESSOR'S MAP& LOT 3q' Q�3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY N LEACH3NG FACILITY: (type) 3 S�D'D 4n(. G�IArh� iize) �pII` X 4' S''• NO.OF BEDROOMS ---�- BUILDER OR OWNER J 06- GUA Gr I PERMITDATE: 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. -rAW IL4 )0^ ar t • ,odr., t Dtgk I 3 3 739 0y 63 http://issgl2/intranet/propdata/prebuilt.aspx?mappar=139043&seq=1 5/9/2012 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: 160 Crystal Lake Road Ostervi_lk. MA 02655 Owner's Name: Carl Thut c�,.� Owner's vL Address: Date of Inspection: January 26, 2006 Name of Inspectom(Please Print) Janes M. Ford Company Name: James M. Ford Mailing Address: P.O.Box 49 I Osterville,MA 02655-0049 Telephone Number: (508)862-9400 zri y CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the infoormation fe�orted> below is true,accurate and complete as of the time of the inspection. The inspection was performe( based on my r— training and experience in the proper function and maintenance of on site sewage disposal systems. I am a WEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The syste : ✓ Passes Conditionally Passes Need urther Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 'February 3. 2006 The system inspector shall)subta 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 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 160 Crustal Lake Road Osterville, MA Owner: Carl Thut Date of Inspection: January 26, 2006 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 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 160 Crvstal Lake Road Osterville, MA Owner: Carl Thut Date of Inspection: January 26. 2006 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 to a 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 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: 160 Crystal Lake Road Osterville. AM Owner: Carl Thut Date of Inspection: January 26, 2006 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 %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 groundwater 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 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 in Section E the system is considered a significant threat,or answered'. "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 160 Crystal Lake Road Osterville. MA Owner: Carl Thut Date of Inspection: January 26. 2006 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ — Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or.dwelling inspected for signs of sewage back up? ✓ _ 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 f Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 160 Crystal Lake Road I Osterville. MA Owner: Carl Thut Date of Inspection: January 26, 2006 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: 4 Does residence have a garbage grinder(yes or.no): Yes Is laundry on a separate sewage system(yes or no): No [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): spd 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: Pumped after inspection for maintenance Was system pumped as part of the inspection(yes or no): Yes 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 Mav 1212000-per as built card Were sewage odors.detected when arriving at the site(yes or no): No 6 r Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) i i Property Address: 160 Crystal Lake Road Osterville. MA Owner: Carl Thut Date of Inspection: January 26, 2006 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 liner Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 22" 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 Qal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: S" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" 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.): Tees were present. No sign ofleakaze. Tank was numbed after inspection 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.): 7 Page 8.of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS NTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM,INFORMATION(continued) Property Address: 160 Crystal Lake Road Osterville MA Owner: Carl Thut Date of Inspection: January 26. 2006 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: allons Design Flow: allons/day Alarm 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 level. There were no signs o solids. 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.): 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: 160 Crustal Lake Road Osterville. MA Owner: Carl Thut Date of Inspection: January 26. 2006 SOIL ABSORPTION SYSTEM(SAS):. ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: ✓ leaching chambers,number: . 3-500 gal. Leach chambers-per as-built card 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.): There did not appear to be any signs of failure The bottom to grade was 6' A Cainera 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.): 9 N _ Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 160 Crustal Lake Road Osterville MA Owner: Carl Thut Date of Inspection: January 26 2006 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 . 3 3 s� 39 O y [Zl 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: 160 Castal Lake Road _ Osterviile. AM Owner: Carl Thut Date of Inspection: January 26, 2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25+/- 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: topojzrgphic 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 topo-araphic and water contours mans and design plan the mans were showing approximately 25'+I to—around water at this site. This report has been prepared and the system 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 system, the inspection and/or this report.. 11 5.T I (� �3 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS _ DEPARTMENT OF ENVIRONMENTAL PROTECTIO(y_ RECEIVED JUL 2 9 2003 TOWN O�H DEPTABLE TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 160 Crystal Lake Road Osterville, MA 02655 Owner's Name: Joe Guarnieri Owner's Address: Date of Inspection: July 16, 2003 Name of Inspector: (Please Print) James M Ford Company Name: James M. Ford Map: 139 Mailing Address: P.O. Box 49 Parcel: 043 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 function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority F , Inspector's Signature: Date: July 20, 2003 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 5 Inspection Form 6/15/2000 page I Page 2 of 11 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) I Property Address: 160 Crystal Lake Road Osterville, MA Owner: Joe Guarnieri Date of Inspection: July 16, 2003 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 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 160 Crystal Lake Road Osterville, AM Owner: Joe Guarnieri Date of Inspection: July 16, 2003 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 to a 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 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 r Page 4 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 160 Crystal Lake Road Osterville, AM Owner: Joe Guarnieri Date of Inspection: July 16, 2003 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 '/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 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 l 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 is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped Zone II of a public water supply well r If you have answered`yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of.the Department. 4 Page 5 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 160 Crystal Lake Road Osterville, MA Ow-ner: Joe Guarnieri Date of Inspection: July 16, 2003 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ _ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ Were as built plans of the system obtained and examined?(if they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ 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 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 160 Crystal Lake Road Osterville, Mil Owner: Joe Guarnieri Date of Inspection: July 16, 2003 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 Does residence have a garbage grinder(yes or no): n1a Is laundry on a separate sewage system (yes or no): No - [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: Unknown 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: None on file-per treatment plant Was system pumped as part of the inspection (yes or no): No If yes, volume pumped: Qallons-- 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) Inn ovat ive/A Item ati ve 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: May 12100-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 160 Crystal Lake Road Osterville, AM Owner: Joe Guarnieri Date of Inspection: July 16, 2003 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: 22" 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: 1" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness: 0" 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: 15" 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.): Tees were present. The liquid level was even with the outlet invert. There were no 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.): 7 Page 8 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 160 Crystal Lake Road Osterville MA Owner: Joe Guarnieri Date of Inspection: July 16, 2003 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: aallons Design Flow: gallons/day Alarm 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 level. No solids were present. There were no signs of failure or backup from the leach field. 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.): ` I 8 f Page 9 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 160 Crystal Lake Road Osterville, AM Owner: Joe Guarnieri Date of Inspection: July 16, 2003 SOIL ABSORPTION SYSTEM (SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits, number: ✓ leaching chambers, number: 3-500gal. leach chambers-per as built card 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.): There were no signs of failure from the leach field. The bottom to grade was approximately 6. 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.): 9 Page 10 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 160 Crystal Lake Road Osterville, MA Owner: Joe Guarnieri Date of Inspection: July 16, 2003 Map: 139 Parcel: 043 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 � Atic �3 0 1 3,1 39 3 3 y G3 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: 160 Crystal Lake Road Osterville, MA Owner: Joe Guarnieri Date of Inspection: July 16, 2003 ' SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 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 established the high ground water elevation: The design plans show no water at 10'when the system was installed. This report has been prepared and the system 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 system, the inspection and/or this report. I1 No. '� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for �Migozal *potem Construction Vertu Application for a Permit to Construct( )Repair(V Upgrade( )Abandon( ) Complete System ❑Individual Components Location ddress or Lot No. G AjgvA L_1A�j Owner's Name,Address Tel.No. lei As es is a /P31 Q'�1a= Installer's Name, ddress,an ,TF1 o. 1 K�11 Designer's Name,Address and Tel.No. 19 ! r3l� Type of Building: �/ Dwelling No.of Bedrooms / Lot Size. ®� sq.ft. Garbage Grinder�� Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow & ® gallons per day. Calculated daily flow L-1210 gallons. Plan Date WMI Number of sheets /i Revision Date Title `V) /l c, Size of Septic Tank :� Type of S.A.S. ? &,JC D sc iption of Soil p h S L ,, 1, Nature of Repairs or Alterations(Answer when applicable) -J t 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 issued by this and Health. Signed Date Application Approved Date Application Disapproved for the following reasons Permit No. l Date Issued zit � Fee THE COMMONWEALTH OF MASSACHUSETTS Entefdincomputer: `\, Yes PUBLICHEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS Zlppficatton for Zigogar *patent Consstruction Permit Application for a Permit to Construct( )Repair/V Upgrade( )Abandon( ) Complete System El Individual Components Location dress r Lot No. / �� fOp Own 's Name,Address Tel.No. Joss �+ 4AXPL16� s es is ap/P0el 0��; ©S��R�GLL Installer's Name t'ddress;an 1'Iyo. Designer's Name,Address and Tel.No. Po� r3 ILA ,M t Type of Building: Dwelling No.of Bedrooms Z/--/ Lot Size -,o I sq.ft. Garbage Grinder Other ,Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures DesiaFlow O gallons per day. Cal c ated daily flow L�7(/ gallons. Plan Date Number f sheets Revision Date Title _ �j Q � 79 A0 Size of Septic Tank Type of S.A.S. p p �, ij i)� .s �S ,.. - D sc i tion of Soil r P . Nature of Repairs or Alterations(Answer when applicable) My ( X -r Z ,+ T , N >E s 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 11 of Compliance has been issued by this and . Health. Signed Date Application Approved Date Application Disapproved for the following reasons N L- Permit No. � Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLEASSACHUSETTS (Certificate of (Compliance THIS IS TO CE TIFY, that the On-si Sewage Disposal System Constructed( )Repaired ( )Upgraded( '�) Abandoned( ) �by �a,A4 tt.Cuv,4-cZT, at W 0 (2 x-q S a a L P)p d Iteq v i l ( e- ha been constructed in acc rda e with the prov'sio s of Titlej�and a for Disposal System Construction Permit N . ;/ d�ated / ,z "/�' Installer Me"^ `� C�r``;�� 1�5 Designer -Q e-ScQ The issuance of this pe it fall n�{be co�strued as a guarantee that the s/t - ill f nctaio asldesigne Date Inspector- t aJI �L�`"' UVt'�✓1�� � V1 r `�_-'--------------------------Fee - _THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migpooar *pgtem Contruction Permit Permission is hereby grantSo to Construct( Re air( )LJ grade( ).A andon( System located at is� 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. t Provided: Construction m be co pleted within three years of the date of thi e i , ✓ Date: Approved bC) y ^'1 v , _ 14 Town of Blarnstable P 4 r � - J Department of Health;Safety,and Environmental Services EVE Public Health Division Date SI 367 Main Street,Iiyannis MA 02601 Date Scheduled 4 Time Fee Pd. ti too— Soil Suitability Assessment for........ Sewage Disposal Performed B 1 h y. � � Witnessed By: —(l/V Y3AflAL, -r LOCATION & GENERAL INFORMATION r' Location Address + © wner s Name O 2 4r i n k9A Address. Assessor's Map/Parcel Engineer's Nan e �n NEW CONSTRUCTION REPAIR V--�, Telephone# Land Use � {��_� %� � Slopes(%)—F% Surface Stones Distances from: Open Water Body ft Possible Wet Area R Drinking Water Well ft Drainage Way R Property Lineb�—ft Other ft r fSKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tes(s,locate wetlands in proximity to holes) 61q,71 LOT 113 VX fA0 F kI Oe YSTA 6A s • Parent material(geologic) w�f�S Depth to Bedrock Depth to Groundwater: Standing Water in Hole: AWE Weeping from Pit Face Estimated Seasonal High Groundwater �14 �T R1VYt }A��'I N FO /S�E�ASON L HIGH WATEtt TABLE Method Used Dept bserved stan r gmob hole: _ in. Depth to sod mottles: Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# _ ,_. ..,.. Reading Date:.__. Index Well level. __ Adj.factor Adj.Groundwater Level PERCOLATION;;TEST DAtc rmc (�. Observation Hole# Time at9" Depth of.Perc Time at 6" Start Pre-soak Time a �j (�,', Time(9"-6") End Pre-soak �}� Rate Min./Inch G Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant .. llEIJP OBSERVATION HOLE LOG IIolc Depth from Soil Ilonzon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.%Gravel) _ _S LS 6 / . Y - SAAAO k w DEEP OBSERVATION HOLt:LOG `' Hole # ' , Depth from Soil Horizon Soil"texture Soil Color Soil t Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.%Qrayell 1 DEEP OBSERVATION HOLE LOG Hole # Depth from Soil Ilonzon Soil Texture Soil Color Soil ' Other Surface(in.) (USDA) (Munsell) Mottling, '(Structure,Stones,Boulderes. Consistency,%Gravel DEEP OBSERVATION HOLE LOG Hole Depth from Soil horizon Soil I enure Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Bouldcres. Consistency.%Gravel i l I Flood Insurance Rate Man: Above 500 year flood boundary No Yes ' Within 500 year boundary No Yes Within"100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervkous material exist in all areas observed throughout the area proposed for the soil absorption system? 4 If not, what is the depth of naturally occurring pervious material? " Certification I certify that onA_AQ (date) I I.laLve passed the soil evaluator examination approved by the Department of nvintal Protection and that the above analysis was performed b me consistent with p Y the required training,expertise and experience described in 310 CMR 15.017. Date Signatur TOWN OF BARNSTABLE LOCATION, «� Cr ) 4k 9 SEWAGE # vs 1 VILLAGE 0 ryJll ASSESSOR'S MAP & LOT 132� 0l 3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACI (type) - S�dD S�. GI��4A� size) 3�,` �C LITY: D, �'• NO.OF BEDROOMS --�-- BUILDER OR OWNER J 06- GuA rri It r i PERMITDATE: 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 Tnf10C idn dr � ptak i � f _ O O 3 3 TOWN OF BARNSTABLE ' .c•' ^..-w. = CAP�„iy LOGATION L&O C►-rStal LaICse SEWAGE # e VILLAGE_ o,}yi lIY ASSESSOR'S MAP & LOTll 3 INS'TALLER'S NAME&PHONE NO. SEMn- TANK CAPACITY I-500 _ LEAC'1t G FACILITY: (type) 3 god e , 1 ni,1,a Lt(size) . . NO.OF BED ,C)OMS q BUILDER OR OWNER U• ( .e �- "PERMITDATE:_S l Z e0 COMPLIANCE DATE: D v ` Separation Distance Between the: a 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) h Feet F.dge bf Wetland and Leaching Facility(If any wetlands exist . within 300 feet of leaching facility) Feet Furnished by-- 16 G,AA w a fie GAS o { TOWN OF BARNSTABLE LOCATION a�� Q cJ1'vslC� �/il�P SEWAGE 1# 7/ VILLAGE_ nA j�1Y/�'l��i ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. � /? .J��C Are- I:Le" 1ac SEPTIC TANK CAPACITY 'LEACHING FACILITY:(type) ,; (size) keno �.e NO. OF BEDROOMS- 3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 17 ::%30 VARIANCE GRANTED: Yes No ((� 9 9S .`6t ASSESSORS MAP NO: .; PARCEL N0: 0�3 No.... - ,��{ Fiz$.? 0.'20....... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �® TOWN OF BARNSTABLE App iration for Uiiipaaal 10orkg Toni # ,9 Application"is hereby made'for a Permit to Construct ( ) or Repair (XX) an Individual Sewage Disposal S s em at: Ib0• Crystal Lake Road 0stervil1e ................_.-----•---................. -----•----•-----------.------............... .-----•---•-•-•--•---•-----•--•-••---------.---•--••---•--••------••------.........-------- Location-Address or Lot No. _Joseph...Gua rni e r i •----•-------------------•--------- •.........-------•--••--------•---------------------•••---••------................................ W J.P.Macomber Jr. Owner Address ,.4 -----•------------------------•-----••••--....I stal.er....._..............---.........--.----•- --•••---------------................-•----••----- es.s.....-----......_........_.............••-- Installer Address d Type of Building Size Lot...........................S q. feet Dwelling X No. 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................ f5 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water________-__-_------_-__. ' Lz, Test Pit No. 2................minutes per inch Depth of.Test Pit---:................ Depth to ground water........................ ......................................--l ----------••-----•----------------•-•-------- --• -----••............................................................ 0 Description of Soil..............Sand & Grave x V W x -------••--•----- --------------------------------------------------------------------••--•--•--•-------•-------------------------•----•----------•-------•-•-------------•-------•-•......-----.------ U Nature of Repairs or Alterations—Answer whet .__ ______ ��H ble_}J`�J ga 1I o n---1 e a cIz--pit--------------------------------------- -•--------------------------•-------------------•----------•---•-------------------••--------......-----••---------------------------------------...----------------•-------------..........._....------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed Jv T .... 7 �742------------ Dace Application Approved By ------------- ..... .. ..rr.� r� ..--7t 7,� '- 9— ._. 1.......--'................................................... Dace Application Disapproved for the following reasons: ................. ........................ .. .... ........................... ................................ ............. . . ......................... -^------------..............---------...-- Dace PermitN --------- ........................ Issued ........------------------------.-------------------- ---- Dace ' •a? � � �t a �3 13 0.00 No...;� :- 7! FEs............................_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE A lira#iou fear Ui og al orkii Tonstrusft� f�an t Application is hereby made for a Permit to Construct ( ) or Repair (XX) an Individual Sewage Disposal System at: 160 Crystal Lake Road Osterville ..... __ - •...........................•--••----------••••-----••-••-••••-••••••. ••._......--•-•-•....._.._........._...••••-•--•...--•••••••-•-•••.....•...........•........--•--- Location-Address or Lot No. ................................................... W J.P.Macomber Jr Owner Address Installer Address Type of Building Size Lot............................Sq. feet Dwelling X. No. of Bedrooms_____________3___________-________________Expansion Attic ( ) Garbage Grinder ( ) Other—T e of 3uildiii No. of persons........ Showers a YP g ------••------•-----•------• P ( ) — Cafeteria ( ) Otherfixtures ------------------------- -----------------------------•••-•-•--••-•------•-•-------•---..-------••--••-•--•-••-•--••-•---•--•....._•---------------- 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 Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................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-------_................ R+ -------••---------------------------•----------------------•---•--------•--.._...-•---------••••_........................................................... Sand- & Gravel Description of Soil ----------------------•------------------------------------••---•••-•-----••-••-- x W U Nature of Repairs or Alterations—Answer when applicable................................................................................................ 1-1000 gallon leach pit. - - - -••- •---•---------•--•--••--••••••-••••••................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed .. :`: ---------------------- 7/27/92 Date Application Approved By ............(��.,�_...�.....-�� �-...,.x . � - -- --------------`..--.....-.....---------.-----...----.-----...-.........-----...................Date Application Disapprove3 for the following reasons- ---------------- ..................... .................................... Permit No. Date - ....................... Issued - ---- --------------------------- -------------- ----- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Trrtifica#e of C�ampliancE THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( XX) by J P Macomber-..Jr-�... Installer at ............1.60-X.r.ya-tal--Lake--Road----O.steryille............................................................................................--------------------- -- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. --.-.-�.'��---..j.-7-1........... dated ------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.. ` - ^= ' ....-..! ------------------------------------ Inspector - �t-•-------.}......:...........................----------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH q �7� TOWN OF BARNSTABLE $ 30.00 No. FEE........................ ittlrk� � a� rlilan rr�ti# Permission is hereby granted.......J.P.Mac oMb.e r _Jr.--------------------------------------------------------------•-...._..._.._...----•-•-•- to Construct ( ) or Repair ( x) an Individual Sewage Disposal System at No.....7.69... rvstA,I.-Ta,ke••Road Osterville -----•--------------��--yy----...-----------------•-•--•-•••••-•-..._._ as shown on the application for Disposal Works Construction Permit No.- Dated Dated.......................................... Street 1--� DATE.................... ---•---- ••• Board of Health FORM 36508 HOBBS Q WARREN,INC.,PUBLISHERS h=1 - BULKHEJID cc �.r 50,-4, 4'-4° — UNFINIS14 - LL!'L (� in UTILITY 2A FINISHED UNFINISHED BASEMENT " _ - UTILITY • r r • i, 21Z b (� ID - - UNFINISHED UTILITY >'i LU L ELBGTRI PAW ul UP 2�. c U. LU uj . . . _2A ° Z - SHEET 1 OF 3 B/'6EI� ENT LAYOUT r_ SC ill E:1/4°=1'-O . rd JOB: d714 DRAWN BY: KW DATE, 9/II/07 �a SCREENED PORCH. , uauNDRr KITCHEN ' ' Y . K • ; • a GARa ' , PANTRY 4 , rq LIVING xz !� d. - , v a W : a lu,. a :y _.. ,,:.... •. .�* �:+" _ ?". .. - + .. ,.. � :* - � C i `ya � .. � - y v , .W _ P i t a, UP ~ If z X , Tit FOYER SWEET 2 OF 3 . 1 \IJ FIRST" FL_OOR,P)AN . .IOB: 0714 DRANIN'HY: KW" DATE: q/11/07 T \"J BEDROOM #3 BAiW#2 I HATH #3 �p BEDROOM #2 ®O ----- BEDROOM.#4F9G 1 LU W MASTER MASTER .V � BA2+4 ]BEDROOM lu up CA! Z LDET (97 SHEET 3 OF 3 SECOND FLOOR PLANJOB: 07714 DRAWN BY: KW DATE: q/11/07 M1 36'-0° CA j j BULKHEAD y tl ` W J W W UNFINIS14ELNEW ART ROOM �n UTILITY r 2� fINISNEp AS M N ` • II. . . _ I uw. Y RNAc II CID s 0 0) W ► w co a m Lu UNFINISHED UTILITY , i �j. Lu LU {' PANEL ELECTRIC z w UP 'U 2� , _ u W Lo w (y W t 2� Z Q Q I Q 12'—Bn W CLOSET N LD .., - SHEET i OF 3 c, Ao, VU ` BASEMENT LAYOUT SGALE 1;4:'_V-0„ 1 , 1 1 1 Nl — JOB: 0714 DRAWN BY: KW DATE: fo/17/08 EXISTING., CONTOURS — — — — — — — - LO.T 24 BARNSTAELE PROPOSED CONTOURS 119 71 �' }. p AUL LOT 20 ` . Nod 3?A68� NORTH BAY �, - � fi LAKE RD LOT. 16 ^ . •� 3 cow � TAL i O j 1 AREA, = 19,501fSQ.FT. WEST BA Y tole _ N tn 3i O ,BUILT) .• .: n AS � YVI , 1 SYSTEM `DE TN SAND LOCUS MAP SVpTIC Flo .. .. - .• . ,w E)� E. 1 ANDS PED pU ,�O ,. r RF ,1481 76vTo DEEDE y io ;` ASSESSORS MAP- ~ 139, LOT 43 O AS/LOT 42 w l®3 PROP N a Ale- GVLOT 15 s PLAN REF' '7685 F' �. 5� lb p GA O o i ZONING.• 'RFI " , ry wo . FLOOD ZONE: O k - - - - _ _ Rpp - \ oSED..�N p -GAR•_ _-o y - A� Of - - _ - - - - - =n O __ 2�I \ PESCE P psi+D. - CIVIL H LAND SURVEYED BY t - - - YAWEE SURVEY CONSUL TANTS - _P.R EDRo�M =_ o w �. P.O. eox 265 Y -=4 •B VS -- s \ \ FS UNIT 1, •408 INDUSTRY ROAD 140- _- N \ \ _ MARSTONS MILLS, MA. 02648 #16 --- O r �' U1 PH.(508)428-0055 - FAX(508)420-555.3 - - - - a' t \ �\ 101. . r i PROJECT. 0 O 12 O \ - . PROPOSED PTPOSED3 4 BEDROOM P �ODS 9 E / \ a \ / BENCHMARK 160 CRYSTAL LAKE ROAD 5 TOP OF CATCH BASIN o.STERVILLE MASS. 33• \ \ ELEV. = 100.0'(ASSUMED) APPLICANT i JOSEPH & ANDREA CUARNIERI O \° GUARNIERI NOMINEE TRUST 1 oAD PESCE ENGINEERING E ASSOCIATES i P.O. BOX 321 y OSTERVILLE. MA. 02655 �� �l� 09,V E N T AX PP.(508)428-3730 ti 153 � �. ° R' p .AT-ALL-. - - SCALE. 1"=20' DA TE.• u124199 p F E �� REV REV G R ' / E D SHEET 1 OF 2 JOB NO. 52770A 70P OF FOUNDATION • t EL =104' I---- 10' MIN. EL= 103.0 .4'SCHEDULE 40 Pr VC. / tr' / / .� r Y/N. PnrH'1/B PER .47: t' 314- D I-JA WASHED S ME s r EL._ l02.O EL= 102.7' 4" CAST IRON PIPE — INVERT �, 1 . . . . MN , / / / . . . (OR EQUAL] MINIMUM EL.=L00 2 P INVERT 1 s - P/7L^I/ I/4 PER FT 4 D/A SCH \ LEVEL. EL.-- .7 CLEAN -SAND FILL 9" 40 PI•C PIPE \ FOR Pt A//N. FLOW LINE _- EL= 100.5' t INVERT INN. 14" .. 4' 24" ° °° o' o o e� o o _o o• EL — 101.2' INVERT INVERT > _ o o o m°° o 0 0 e :F e��' ------- INVERT 101.0 100. 7 EL. 100-'0 — e i DISTRIBUTION B,5' } BOX 4 w i (TYP) ,37 5' j PROPOSED 1,500 GAL 3—500 . GAL:' DRY WELLS o a SEPTIC TANK (H--10) R _ - e •'E a 4 B T = t: " v- ..' L •., • Fie 4Y , Y - HOLE ELEV 91_7 _ _ • " 'BOTTOM OF EST ` - • Y r t - t FILE OF h ±. PRO 4 I - S E.WAG E. D IS P 0 S AL SYSTEM • & r A• • - X v - i NOT TO SCALE t - 2. 7 OBSER LA TION HOLE. 1" ` ELEV. 1 PERCOLATION Rif TE _� _ MIN./ INCH AT BQ"-9.6" INCHES DEPTH ORIZ r TEXTURE ` COLOR MOTT OTHER Y 10" - - VALE — .118.- — — ' NE EL • .IOC 9 0 A LOAMY SAND 1/2 �AR.SH D S7t7 ?t9 I 1 " E = '101.0 10'— B LOAMY SAND lOYB/B D NE • - ' _• a ,�,• u EL= 96.2 20"—7B' Cl. Y714 G o o rry MEDIUM SAND .m 2.5 �B 6$ y — — O O EL-,.94.9 SAND uW GRAVEL .. 7B" 94' C2 � • g g 2 5Y7/2 GENERAL NOTES EL= 93.5 94"-111" C3 MEDIUM M COAA SE " IoYS/B i s•� 4.a' 3' ' _ fo.e' EL- 91. 7 — MEDIUM M FINE Z - , 111" 132 C4 /3 ' 2.5 % ' f 1)' ALL WORKMANSHIP AND MATERIALS SHALL CONFORM.TO D.E P . DRY WELL TITLE 5 AND THE TOWN OF __ BARNSTABLE_ RULES AND , ' NO GROUNDWATER:ENCOUNTERED; REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. , ��� f �; 'END VIEW - 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12" DATE., OF . SOIL =TEST . , 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITNESSED BAY:: DONNA MIORANDI' B.O.H. WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR , WITHIN y 2 a F` ' �r SOIL t TEST DONE BY EDWARD PESCE,, P. 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE DESIGN CALCULIA TIONS' USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. f - - `NUMBER OF BEDROOMS . 4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL k GARBAGE-DISPOSAL . . NO BE MORTERED IN PLACE. -, TOTAL ESTIMATED FLOW 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH ( _llo _cAL./BR/DAY x 4_ BR) 440 GAL/DAY DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO f • F USE 1500GAL SEPTIC TANK 1500 GAL OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. y 6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCA VATION CONTRACTOR F INSTALL' 3— 500 GAL DRY WELLS ( WITH 2' CRUSHED STONE) IS TO CALL DIG— SAFE AT 1-888—344—7233 AT LEAST 72 HOURS ; SOIL CLASSIFICATION . 1 PRIOR TO COMMENCING WORK ON SITE. DESIGN PERCOLATION RATE <' 5 MIN./IN. 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS: EFFLUENT LOADING RATE . . . . . . 74 GAL/DAY/S.F. 8) PARCEL SITE ISITIONS IN FLOODOR TO ZONE_ COMMENCING WORK ON SITE. TOTDEA ALA (lO.IB'G CAPACITY37.5) X 2' X 2 sIDES)(. F 442.s7 GAL/DA Y " " 74)=142.97 CAL/DA Y 9) LOT •IS SHOWN ON ASSESSORS MAP _M AS PARCEL _43__. 4» -;� - BOTMM AREA:(10.e' X 37.5f X (.74)= 299.70 GAL/DAY 10) NO WATER SUPPLY WELL EXISTS WITHIN 150' OF SAS — SHEET 2 OF 2 JOB NUMBER__ 521 TOA------