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HomeMy WebLinkAbout0152 EVANS STREET - Health 1.52 Evans Street Ostenjille r A= W2 - 139 I : COMMONWEALTH OF'MASSACHUSETTS . '`- : a EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION 4 TITLE 5 OFFICIAL INSPECTION FORM-NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM . PART A ;' CERTIFICATION. _. Property Address: 152 Evans Street :. j QV6t vdk,MA 02655 Owners Name: Kathleen 0'Conners Executer Owner's Address. } Date of inspection: February 7, 2012 Name.of:Inspector (Please Print) Janies M,Ford; Company,Name. Jam esM Ford Mailing'Address: A0.Box 49° 1 Osterville.`MA 02655-0049 Telephone Number:.. (508)862-9400' CERTIFICATION STATEMENT. Lcertify that I have personally inspected the sewage disposalsystem at this address and that the mformation rortedy below is true,accurate and complete as of the time of the inspection. The inspection was performed based ofQny training.and experience in the-proper`functioll and maintenance of on site sewage:disposal systems l`am a D.EP : approved system inspector pursuant to Section45.340 of;Title 5(310 CMR 15;000). The,-,system' co passes Conditionally Passes ." : t ! a `eds Further Evaluation.by the.Local Approvinguthority, F ils Inspector's Signature: Date: February 13, 2012 The system inspector shall sub�:iicopy okhis 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 Comunents , ****This report only describes conditimis,4t the time of inspection and under,the:conditions of use at that', timer.This inspection does not address hoyi't¢ie system.wih perform in the<future under the same:or different conditions of use. +. Title'5.lnspection Forin;: 6/15/2000 , page 1 is Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS ' SUBSURFACE SEWAGE DISPOSAL:SYSTEM INSPECTION FORM PART A CERTIFICATION (continued).,, Property Address: 152 Evans Street Osterville,MA Owner: Kathleen O'Conners executer Date of Inspection: October 12,2011 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section.D A. System Passes; ✓ h have not found.any information which indicates that any of the failure.criteria described in 3 10 CMk 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.thaf 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. t: distribution:box is leveled or replaced ti ND explain: The system required pumping more than 4 tiimes.a year due to..broken or obstructed pipe(s) :-'The system will pass inspection if(with,app'oval of the Board of Health) a broken pipe(s).are replaced obstruction is removed ND explain. r Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION.FORM PART A CERTIFICATION (continued) Property Address: 152 Evans Street Osterville.MA - Owner: Kathleen O'Coni ers-&ecutei Date of Inspection: October 12 2011 f C. Further Evaluation is Required by.the Board of Health: .Y Conditions exist which require further evaluation by the Board of Health in order to detennine 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 MO 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`prnvy 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:functionning 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.sup ply or tributary to a surface water supply. : The`system has a septic tank and SAS and-the SAS is within a Zone l'of a public water supply. The system-has a septic tank and SAS and the SAS is within'50 feet of a private water supply.well The system has a septic tatilc and SAS and the SAS.is less than 100 feet but 50 feet or more from aY 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: Page 4 of 11 - OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.A CERTIFICATION. (continued) Property Address: '152 Evans Street 4 _ Osterville MA Owner: Kathleen O'Conners executer Date of Inspection: October 12.2011 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 - ✓ Backup of sewage into facility or system component due to overloaded or clogged'SAS or cesspool ✓ Discharge or pondmg 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" utletirivert due to an overloaded o.rclogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is.less than A%day flow. ✓ Requiredpumping more than 4 times in the last year NOT due to clogged.oi=obstructed pipe(s): Number. = Of times um ed_. . • ` p ...p ✓ Any portion of the SAS;cesspool or privy is below high groundwater elevation. J 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 feetof 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•GMR 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) s k 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 Il 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,an "yes"in Section D above the large system has failed."The owner or operator of any large system-'o5 'dered.a significant threatwider Section E'or�failed under Section D shall upgrade the,system in accordance with310 CNIR• `15.304;..The system owner should'contact the appropriate regional office7of the:Department. • 4 4 Page 5 of 11 OFFICIAL INSPECTION FORM-.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE aSEWAGE DISPOSAL SYSTEM INS PECTION FORM "PART B CHECKLIST" Property Address:, 152 Evans Street" Osterville.MA , Owner: Kathleen O''Conners executer - Date of Inspection: October 12, 2611 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 weelcperiod ✓ Have large volumes of water been introduced to^the system recently or as part of this inspection T' ✓ Were as builtplans of the system obtained and examined?(If they were not available note as.N/A) ✓ Was the facility or dweRing: nspectedfor_signs of sewage backup,? ✓ Was the site inspected for signs of break out Were"ail system,components,yexcludih 'the SAS 'lo'cated on,site ✓ Were:the"septic tank manholes,uncovered,opened,and the interiorof.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 T. ✓ Was the facility owner(and,occupants if.different from owner)provided with info i�iiation on the proper .r maintenance of.subsurface sewage disposal systems 7 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-15302(3)(b)) 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FbRM . PART C SYSTEM INFORMATION Property Address: 152 Evans Street ; Osterville.'MA Owner; Kathleen O'Conners executer Date of Inspection:; October12 2011 FLOW CONDITIONS. . RESIDENTIAL Number of bedrooms(design): 4 Number of.bedrooms(actual): -4 DESIGN flow based on 310 CMR 15.203 (for example: 1'l0 gpd.x#of bedrooms): 440 Number of current residents: 0 Does residence have a garbage grinder.(yes or no): l Nla Is laundry on a separate sewage system(yes or no if es N/a 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(seat, etc.); Grease trap present(yes or no): Industrial waste holding tank present(yes or no) -Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: _ Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection(yes or no): Yes 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) Imiovative/Alternativeaechnology 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: Date of installation 316107 per as-built card Were se wage odors detected when arriving at the site(yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE'DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 152 Evans Street Osterville.MA Owner- Kathleen 0 Conners executer.' ' Date of Inspection: _October 12 2011 �- BUILDING SEWER(locate on site.plan); Depth below grade: Materials of construction: _cast iron _40.P,VC other(explain): Distance from private water supply well or suction line:' ' Comments(on condition of joints,venting,evidence ofleakage,etc.): _ SEPTIC TANK ✓. (lo.cate on site plan) Depth below grade: 20" Material of construction: ✓. concrete _ • metal --fiberglass of eth le ne other(explain) p - If tank is metal list age: Is age confirl-ried,by a Certificate of Compliance(yes orfno). (attach a copy of certificate) Dimensions: 1500 gwl. Sludge depth: 2„ Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 4" Distance from top of scum to top of outlet tee or.baffle: 6" R' Distance-from bottom of scum to bottom of outlet tee or baffle:. 10" How were dimensions determined: Meanirbi g stick Comments(on pumping recommendations,inlet and outlet tee or,baffle condition,structural integrity,'liquid levels as related to outlet invert,evidence of leakage'etc.),. The tees were present The liquid level was even with the`outlet invert There did not appear to be anv signs of leakage. ' The tank ivas vamped after the insyecdon for maintenance The outlet cover was 6"below"grade GREASE TRAP: None ,(locate on site plan) Depth below grade: Material of construction:': concrete,._metal _fiberglass _polyethylene _other (explain): Dimensions Scum thickness; Distancefrom 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. Continents(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 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY'ASSESSMENTS ' . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (con"tinned) Property Address: 152 Evans Street Ostei•ville MA ' Owner: Kathleen 0'Conners execute Date of Inspection: October72 2011 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).: Date.of last pumping: Comments(condition of ala rm and flo at swit ches, e's etc.):' - DISTRIBUTION BOX: ✓ (if present;must be.opened) (locate'ori site plan)' Depth of liquid:level above outlet invert: Ev en' Cotrunents(note if box is level and distribution.to outlets equal;.any evidence of solids carryover, any.evidence of 4 leakage into or out.of box,etc.): . PUMP CHAMBER:''None (locate,on site�plan) Pumps in working order(yes or no):. Alarms in working order(yes or no) Comments(note.condition of pump chamber,condition of pumps and appurtenances,etc.). P, - r 4 ' Page 9 of l l OFFICIAL INSPECTION FORM-'NOT FOR`VOLUNTARY rASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION'F6 M, PART C ` SYSTEM INFORMATION (continued) Property Address:` 152 Evans Street` Osteri ille MA Owner: Kathleen 0'Conners executer Date of Inspection: October 12.'2011 SOIL.ABSORPTION SYSTEM(SAS) ' ✓ '(locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: ✓ leaching galleries,number: _3 500 Qal. drvivells 13'x 32'12er asbuilt leaching trenches,number;length b leaching fields,number,dimensions:: " overflow cesspool,number: Innovative/alternative system Type/name of technology:, Comments(note condition of soil,signs of hydraulic failure,level of ponding,.damp soil,condition of vegetation,etc.):. .` The dn,,vells were dry arid clears. There did riot appear to be'aity signs of failure The bottom to grdde`ivas 5 5' 77te coves ivas 14 below Lade. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site'plan) Number and configuration: ; Depth top of liquid to inlet invert: . t. Depth of solids layer: Depth of scum layer: Dimensions of cesspool: } Materials of construction: s Indication of groundwater inflow(yes or no): Continents (note condition of soil,signs:of hydraulic failure,Jevel,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.. - a Page 10 of 11 OFFICIAL INSPECTION FORM NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIONFORM PART C SYSTEM INFORMATION(continued) Property Address: 152 Evans Strut Osterville MA Owner: Kathleen 0'Conizers executer Date of Inspection: Octobei-12 2011 SKETCH OF SEWAGE DISPOSAL.SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks.or k benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the.building.. A GRrq` 3 C7 1 aS 33 i. 47 . . .,. to s.. Page 11 of !11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY'ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL:SYSTEM INSPECTION FORM PART C . SYSTEM INFORMATION (continued). Property Address: 152 Evans Street Ostetville MA f Owner: Kathleen O'Conners.executer Date of.Inspection: . October 12 2011` SITE-EXAM Slope- Surface water Check cellar Shallow wells Estimated depth to,ground.water ILA, feet Please indicate (check) all methods used to determine the high ground water elevation: i Obtained from system design plans on record- If checked, date of design plan'review ed. Observed site(abutting property/observation hole within 156.feet of SAS) ✓ Checked with local Board of Health=explain: -a hic and water coito g ours ma ps s Checked with local excavators,installers-,(attach documentation). Accessed USGS database=explain: You must describe how you established the high:ground water elevation: Using Barnstable toyoerayhic and water contours mays the tnays were showing anproihnately 35 +/ to Qt ound swatet at this site. This report has been prepared oillyfor the:septic system and components described herein. This septic system lias.been inspected and passed as of the date of uispection. This report is nora warranty or guarantee that the system will fcmction properly.in the f aure. Tliere have.been no warranties or gtra-antees, either expressed, written or implied, relating to the septic system,the.inspection, this report aid/or any components.of the septic,system'which have.not been Iodated and inspected. - T1 . IL U W Jla U1 Ditl'3i sfaDQe �y� $ Department of Regulatory Services >",,BM : Public Health Di y MASS. V1S10ri Date X, 200 Main Street,Hyannis MA 02601 ' rE0 MAt Date Scheduled �/ Ss �f ? Time /l �� Fee Pd. ySoil Suitability Assessment for wage DU p F 5 Z Jam,,Performed By. Witnessed By: LOCATION& GENERAL INFORMATION Location Address i S 2 E V��5 Owner's Name Address /_Z E VA-Ng Assessor's Map/Parcel: A4.. 1 q 2 L 131 �p® Engineer's Name �' M• Me ye__f NEW CONSTRUCTION REP AIR X_ �i Telephone# SQg j Q 2 / ) �o Z Z l Land Use' �IQ'/ Slopes(%) N Surface Stones Distances from: Open Water Body >S�d ft Possible Wet Area 7 Z�b 7 ZUD ft Drinking Water Well ft Drainage Way'`'::� ft ''Property Line Other ft SKETCH:(Street name,dimensions of lot,"act locations of test holes&peic tests,locate wetlands n proximity to holes) » i NO t� g C"7 hi lG1�1 Lr ✓ �I Parent material(geologic Depth to Bedrock coN r S Depth to Groundwater: Standing Water.in Hole:. / Weeping from Pit Face, Estimated Seasonal High Groundwater` /v DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: , In. Depth to soil mottles: Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Dater Index Well level Ad),factor Adj.draundwater Level PERCOLATION TEST We Observation Hole# Time at 4" Depth of Pere 'nine at G'. �02 u Start Pre-soak Time @ ` End Pre-soak Rate Min./Inch L Z Site Suitability Assessment: Site Passed Site Failed *-'s -Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100' of wetland,you m ou ust`tirst notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:SEPTICIPERCFORM.DOC. IV :; `; , T DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) , (Munsell) Mottling (Structure,Stones,,Boulders. Consistency, e it A�Jb vy N q s L cos e- yanular DEEP OBSERVATION HOLE LOG Hole# , ?� Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi %Gravel) .t Z} Lo LA A5a ojZ slg. t5f (_1 inapt UM 2,57 (useamvw kr • S�� DEEP OBSERVATION HOLE LOG Hole# A Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) I DEEP OBSERVATION HOLE LOG Hole# A Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Cons' en I Flood Insurance Rate Man: Above 500 year flood boundary No \_ ;Yes YL Within 500 year boundary No Yes Within 100 year flood boundary No Yes Death of Naturally Occurrine 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? -- LI i If not,what is the depth of naturally occurring pervious material?,.. . Certification I certify that on 9 (date)I have passed the soil evaluator examination approved by the Department of Envir -mental Protection and that the above analysis was performed by me consistent with . the required trr ' In ex rtise and exp �rieencQe described in 310 CMR 15.017. Signatu Date / I/�/ w / re 1 l , No. . �007� 07 ,�,C)1 ;L Fee �� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rpplicatiou for Tigpogal gppztem Cou5tructiou Vermtt Application for a Permit to Construct( ) Repair(<Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. I S a L V A AS ST. Owner's Name,Address,and Tel No. CD STrvix" s (u t r, Sh 91 16 Assessor's Map/Parcel )['QZ139 Osrtc- :11r sb8— 34 38 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �c-ucc Mo�all%slat opwc-c,� he, - 54PS/ol8 - -S-5R o �1.2�ry' ' ,f1 S Type of Building: Dwelling No.of Bedrooms Ll Lot Size W( 7 y sq.ft. Garbage Grinder (All Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) yyd gpd Design flow provided L/y04 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank /S00 GA Type of S.A.S. 506^6 4_ CHaa'I cj 63 Description of Soil Nature of Repairs or Alterations(Answer l(when applicable) Remove Xx t a T,n r U S&I S sgfC 7g t ;i'I Z)jY;rZ A.y sTHI Sbo A�� �c P,%,h ,' � �n �l t,nti m,a�c. e i T�r, � — ✓1,��41 t sT•'aa�( 3- S�C�I-cDa, w,K 4t a-F b 4WL 4 13'i3a' Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt . Signed Date AA&f�,o?DD1j pez ,ApplicationApproved by �t�f1' - Date 07Application0isapproved by: Date 'for'thefollowing reasons ' Permit No. D-7 O-7 Date Issued 3 -1 - 0-7 No. . .L 00 7— 07 1 Fee ,THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIppYication for �igpogal pgtem Congtruction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑'Complete System ❑Individual Components Location Address or Lot No. J C7 V A Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ���/.tea C:;r«,.,�t� a d- �-f:��• ��I>i•; Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. cj•3 6 a- " t �e vcc I`IC�CRI� lr� /- �,_,nT �iarr�,� Ml• er Type of Building: Dwelling No.of Bedrooms L� Lot Size 1/L/`7 y sq. ft. Garbage Grinder (Nt) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) O gpd Design flow provided Li L(O 4 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank /.500 Type of S.A.S. O '�• C fi It I ��) 3 Description of Soil Nature of Repairs or Alterations(Answer when applicable) rr „j v v( r`x,)i,'„( I,Coca C t 1 S N�T( %,+ri h Date las"t inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this ,,�Board of Health. Signed ` , ,,, ) ,/r,,- i`�? Date Application Approved by ._( Date 1 "7 Application Disapproved by: U Date for the following reasons Permit No. .2®0-7 0 7 Date Issued -3 rt. THE COMMONWEALTH OF MASSACHUSETTS x BARNSTABLE, MASSACHUSETTS Certificate of.Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( vl) Upgraded ( ) Abandoned( )by S�Acrc'',\c at E`� C Y ti\ S S 1, C ` t r; !i I 1 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ;�OU7 -- 0 7 &1,- dated Installerl-a�•,c c t Designer �C�.CC. � Desi'1 �`a �r #bedrooms Approved design flow gpd". T The issuance of this permit shall not be/c°onstrruueedd as a guarantee that the s sste`m wi,I-I-func ion as�desi�gned. Date � �(p / Inspector ------------------ ° No. a.p07 - (>7�- Fee -r— THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS x1i5pogal 6p5tem Congtruction Permit Permission is hereby granted to Construct ( ) Repair ( V')r Upgrade ( ) Abandon ( ) System located at f_`i F t AQ) S! 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 mu'st'ab`enco�mpleted within three years of the date of this permit./ Date tti.i� I). "'�\ Approved by 3 ! `y� J TOWN OF BARNSTABLE LOCATION /$� FjVAAJ cS/, SEWAGE# LlcF `0 VILLAGE_ Q, v, IMP ASSESSOR'S M�P&PARCEL /t/a 89 INSTALLERS NAME&PHONE NO. 0.CG SEPTIC TANK CAPACITY k 00641 LEACHING FACILITY: ve ` t f (tYP ); 0 C � �n L-c/ (size) k/3,�>- NO.OF BEDROOMS Ll OWNER L/V j( V+WI S PERMIT DATE: _�J -(cf 1— .� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 36 Gz— A- a � 51000 � - � r - 33 , LV `� k Town ofSBarnstable y A� _ Regulatory S'er C, S Thomas F GeilereDirector hibhc=Health=Di"vision s , ,. .�� x ,,r •�Thomas,McKean,Director. 200 Main Streetannis ,Hy ,MA42601 } v .IF.Srtt.. C, Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form 0� l� Date: �3 Sewage Permit# 0101 Assessor's Map\Parcel 141 k— Designer: f Installer: Brvc,-e_ t1Ar G. L!6S iG2 .,.7.1 Z&Uu_mess: Flo v - ✓I�W)G ��d ess: �Z�td �i"- 'S 11esv�� �D V On 3-/-a cwce C l s er was issued a permit to install a (date) (installer) septic system at � � �VA-rJ S based on a design drawn by (address) Mrq\_h e,4 dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor.approved changes such as lateral relocation of the distribuiion:box and/or septic tank } I certify that the septic system referenced above was installed with major changes (i.e'greater than 10' lateral relocation of the$AS.0r,any vertical relocation of any component of the septic system)but in accpr, State &Local Regulations. Plan revision or certified as bei'f/i� �fie�g Ito follow. L .r ', 4 (Installer's Signature) r r�0. . r 0 r. IM . ' esigner's Signature) (Affix Designer',s.Stamp-Here) PLEASE RETURN TO B LTLE PUBLIC HEALTH D!Vr1SION.C uFRT CAA OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.THANK YOU. Q:.Health/Septic/Desiper Certification Fo m 3-26-04.doc •y LEGEND PROPOSED CONTOUR '�r' 3 - � c PROPOSED SPOT GRADE R GJ�� L BENCH MARK -- 98 -— EXISTING CONTOUR — TOwn S� W _PK NAIL IN DRIVE •;� + 96.52 EXISTING SPOT GRADE $ ~ a ELEVATION = 45.00 ' W— EXISTING WATER SERVICE. a �H1 N � � " BARNSTABLE CIS DATUM I, y o 4 5 - ( ® TEST PIT 120. 15 ft 44 ' V c3Z N " Existing Leach FI•t 1 42 FIN �O 9 (Note 10) \ _� , 40 `\ Existig Septic Tan '' / I OSter'Vllle \ z PAVE EWAY� i / LOCUS MAP N.T.S.._: � TH-2N 1 �/ qq GENERAL NOTES: . . ` I' r� p / 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL W I ft / BOARD OF HEALTH AND THE DESIGN ENGINEER. W 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS f TH 1 OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE Q O o Z I 3 g LOCAL RULES AND REGULATIONS. I .3. THE.SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR N ' / TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE LL 45 O 3' lL I- I DESIGN ENGINEER. t0 WATER O 'J' I 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING / FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN Li GATE O—• 2 ft - I — ENGINEER BEFORE CONSTRUCTION CONTINUES. jj w � INa ter Sere — x a 5. ALL•ELEVATIONS BASED ON ASSUMED DATUM. W O J (" a I Ch 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR~ 4 I I w ER TO NOTIFY THE LOCAL BOARD HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. OF LOT 6 O ! + 0) 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED AREA = 11474 S f �- — �/ / fi TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. // 10. EXISTING LEACHING PR TO BE PUMPED, CRUSHED AND FILLED / 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 1 31 .6 3 f 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY 44 t4 2 4 O , , 38 AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY `�� OF �N \DA RE 1140 V R NG/ O PROPOSED SEPTIC SYSTEM UPGRADE PLAN ©ti 152 EVANS STREET, OSTERVILLE, MA Map. 142 Prepared for: William Sharkey j SURVEY REFERENCE: } LOT-139 Engineering by: Surveying by: SCALE DRAWN JOB. NO. � PLAN OF LAND BY CHARLES N. SAVERY CO. 3 "~ LCP 70365 DARRENM.MEYER,R.S. Reo-Twh AbdroAmentel 1"=20' DMM DATED: MAY 28, 1965 RY EAASTSWDWCt,„A02537 (508) 384-0894 DATE CHECKED SHEET NO. 3 50&W-2= 02/03/07 DMM 1 of 2 r ELEV ,TOPL e FOUNDATION ! / ' (Existing)'; / ri> = 45:42 F.G.EL: 44.5 FINISH GRADE=45.25 .� F.G.EL: 45.0 F.G. EL: 45.0 r . MAINTAIN 2% MIN SLOPE OVER LEACHING AREA COVER OVER LEACHING 4.75. FT. • COVERS TO WITHIN 6 OF GRADE: r •' 2" OF 3/8" DOUBLE k ��L =`25 i' WASHED STONE 3/4" 1-1/2" DOUBLE * `° WASHED STONE s" • 4 SCH 40 PVC L = 5' 4" SCH 40 PVC 10"I i — ® S= 190 MIN. e . ®®®® (MIN.) TEE'S ARE TO BE 14 ( ) ® S= 1% (MIN.) ® ®®®®® ®®®®1I®®®®®® !! 4 SCH 40. PVC . INV.41 .9 2 EFF. DEPTH ®®®®®®®®®®® IN I NV.41 .78 EXISTING OUTLET GAS PROPOSED DB-3 3.25' 3 X 8,5' 3.25' BAFFLE H-10 DISTRIBUTION BOX EFFECTIVE LENGTH = 32' INV. 42.30 PROPOSED 1500 GALLON SEPTIC TANK INV. ELEV. 41 .66 . GAS BAFFLE TO BE INSTALLED ON NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING BREAKOUT OUTLET TEE AS MANUFACTURED BY PIPE INVERTS PRIOR TO CONSTRUCTION ELEV.= 42.30 TUF—TITE, ZABEL, OR EQUAL 2) D-BOX SHALL BE SET LEVEL AND TRUE TO TOP CONC. ELEV.= 42.66 GRADE ON A MECHANICALL COMPACTED SIX INV, ELEV.= 41 .66 ®® ®® INCH CRUSHED STONE BASE, AS SPECIFIED IN ®®® ®®® 310 CMR 15.221(2) ®e®®®®® 3) EXISTING 1,000 GALLON SEPTIC TO BE ®®®®®®® PUMPED, CRUSHED AND FILLED PER BOTTOM EL.= `39.66 Immammumm TITLE V. i 4' 5 FT. 4' - 4) INSTALL INLET & OUTLET TEES AS REQUIRED SEPARATION 5.46 FT. EFFECTIVE WIDTH = 13' i SEPTIC SYSTEM PROFILL BOTTOM OF 'TESTHOLE EL: 34.2 _ SOIL ABSORPTION SYSTEM (SECTION) N.T.S. (500 GALLON LEACH CHAMBER (H-20) LOADING) SOIL . LOGS = _ DESIGN CRITERIA NUMBER OF BEDROOMS: 4 BEDROOM DATE: JANUARY 24, 2007 SOIL TEXTURAL CLASS: CLASS I SOIL EVALUATOR: DARREN MEYER, R.S., CSE DESIGN PERCOLATION RATE: <2 MIN/IN t WITNESS: DONALD DESMARAIS DAILY FLOW: 110 G.P.D. _._ HEALTH AGENT DESIGN FLOW: 440 G.P.D. Elev. TH-1 Depth Elev. TH-2 Depth GARBAGE GRINDER: NO LEACHING AREA REQUIRED: 45.2 0" 45.4 0" A SANDY LOAM A SANDY LOAM 10YR 4/2 10YR 4/2 (440) = 594.6 S.F., 44.29 11" 44.57 10" -.74 B B ' LOAMY SAND LOAMY SAND USE ONE (3) -500 GALLON -PRECAST LEACH CHAMBERS (H-20 LOADING) 10YR 5/8 10YR 5/8 WITH 4 FT. ON SIDES & `3.25 FT. ON ENDS: 32'L x 13'W x 2'D 42.45 C1 33" 42.4 C1 36" - ` BOTTOM AREA: 32 X 13 = 416 SF i SIDE AREA: (16.5 + 13) X 2 X 2 = 180 SF TOTAL SQUARE FEET PROVIDED 596 vs 594.6 REQ'D PERC ®40.87 OF s�9 PROPOSED SEPTIC SYSTEM UPGRADE PLAN o v MED. SAND MED. SAND DARREN M. 2.5Y 6/6 2.5Y 6/6 MEYER 152 EVANS STREET, OSTERVILLE, MA NO. 1140 "' ,,4, Prepared for: William Sharkey 34.2 132" 34.4 132" '�Gl$TE��� Engineering by: Surveying DARRENM.MEYER,R.S. Boo—Tech b SCALE DRAWN JOB. NO. amyjmAmentel �NITA��a N.T.S. DMM _ PERC RATE <2 MIN/IN. ("C" HORIZON) PERC RATE <2 MIN/IN. ("C" HORIZON) Po BOX (508) 364-0894 NO GROUNDWATER OBSERVED NO GROUNDWATER OBSERVED EASTS4NDKICH Ma 02537 DATE CHECKED SHEET No. 508-362--2922 02/03/07 DMM 2 of 2