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Home My WebLink About0071 FIRST AVENUE - Health 71 First Avenue r Osterville F !�► = 116 045 i i_ 6 iq 4 a _ a i TOWN OF BARNSTABLE 001/6 LOCATION �J 7/6 f'vs7` /eve SEWAGE# VILLAGE Q�fiw �, J�; ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. 0az /f v SEPTIC TANK CAPACITY a 00®2 LEACHING FACILITY: (type) _5170y L•a.d, C4f!!�W�size) �D�Xia•�3X,z NO.OF BEDROOMS 4o `0 a) OWNER PERMIT DATE: f 0- RO-06 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 cX 4 A 0 O \C C1 O � � 3 � sj 9� �-- t FEE COMMONWEALTH Of MASSACHUSETTS Board of Health, '► 2,5'ti �,'i MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT � Application for a Permit to Construct( ) Repair( ) Upgrade(/bandon( ) - ff Complete System El Individual Components Location Owner's Name ` JC' tl 'P"^ /'7 o A G N/1 Map/Parcel# Address Lot# Telephone# Installer's Name �� p Designer's Name STEPHEN J.D Address PO 130 3 �/ /ri�erjTo�S �`S Address 42 CANTERBURY LANE Telephone# Telephone# 508/540-2534 Type ilding Lot Size ZZ. '��i"�sq.ft. wellin o.of Bedrooms /y L.® ►rP Garbage grinder( ) Ot er-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures 04 Design Flow(min.required) gpd Calculated design flow Design flow provided gpd Plan: Date 'lei p�f Number of sheets Revision Date Title sib' &,Av d imem :1,4�E r /'►iL Ste' Description of Soil(s) 5 m t2 k 7 Soil Evaluator Form No. Name of Soil Evaluator . �!L �• Date of Evaluation i V—1% �ip to DESCRIPTION OF REPAIRS OR ALTERATIONS ti The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agree t not placg the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date 0-14— G Inspections �j No. :d FEE COMMONWEALTH OF MASSACHUSETTS � ` Board of Health; i /,13 r-i t&r."z k.rl1,71'e ,MA. APPLICATION-FOR DISPOSAL SYSTEM`CONSTRUCTION PERMIT AP lication for a Permit to Construct Repair(O Upgrade(V�) Abandon al/complete System ❑Individual Components Location `1 A "1 i .l�1 t r�.��1t# \t Owner's Name , , n O A G kz n Ma /Parcel# 1r f�✓e p ��.,�� Address Lot# Telephone# Installer's Name r �, �F My Designer's Name Address P0 i30 X 33,5,/04r S /S Address Telephone# (y pJ �� -ys�t� Telephone# Type el �sNo.of Bedrooms�.� 1wlr� � e� �.00�t.t.�e � Garbage grinder( ) Other-Type of Building - �"'�.of persons Showers ( ),Cafeteria ( ) ` Other Fixtures " Design Flow(min.required) e e7 gpd Calculated design flow Design flow provided t*l'� gpd �. _ % .1 Plan: Date AA - I A -®l- Number of sheets Revision Date .may Title �1+ 1'i,.,d1J r_0'00, Y ` Y ..�..�-. Description of Soil(s) C t-r,r-!r, Soil Evaluator Form No. Name of Soil Evaluator -V>W t-rr,. Date of Evaluation I V r DESCRIPTION OF REPAIRS OR ALTERATIONS Y' ! { The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees To not to place the system in operation until a Certificate of Compliance hass been issued by the Board of Health. Signed I��a� �- Date /V' 7VIns ections . /P v Lr v No. �� FEE COMMONWEALTH OF MASSACIIUSETTS l Board of Health, MA. j CE TIEIC TE OF COMPLIANCE °'Description of Work: ❑Individual Component(s) LvJ Com Complete System r P ys The undersigned hereby certify that the Sewage Disposal System; Constructed (v),Repaired ( ),Upgraded ( ),Abandoned ( ) by: e). C. Aa l/er V Oti at -- -7/ '7/)5. has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. QW(A 7.�l� dated f�� /fib Approved Design Flow l! t (gpd) Installer Designer: .,vat%� /7SS oZ. Inspectors t ..� _! .- -------y Date: 1 I '`� } �.- -- — The issuance of this permit shall not be-construed as a guarantee that the system will function as designed. No. l /l /I'w' FEE �- COMMONWEALTH OF MASSACHUSETTS Board of Health, /Jll✓o 57',-,'7/�' MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct(V11-Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at -7/,9 4 "71 8 A e 0,5�A/eV,V"11-e , * as described in the application for Disposal System Construction Permit No_4--- ""4 0 dated Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date /,'V, Board of Health �A l' No. ( FEE COMMONWEALTH OF MASSACHUSETTS Board of Health, �.d(Zs. b�"i ✓ ,MA. APPLICATION FOR DISPOSAL SYSUIM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade(/bandon( ) - W Complete System 0 Individual Components Location A ` Owner's Name Ro A 4 wi Map/Parcel# Address Lot# Telephone# Installer's Name �� f�� -p Designer's Name STEPHEN J.D Address P� 30 3 3 /far S'lU^S .Ll Address 42 CANTERBURY LANE Telephone# St�k� yda-95 5� Telephone# 508/640.2534 Type ilding Lot Size Z'lif'2 43 'L sq.ft. wellin o.of Bedrooms /y L.Q u► + Garbage grinder ( ) Ot er-Type of Building No.�ofpesons Showers( ),Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Calculated design flow Design flow provided gpd Plan: Date 'lei 14-0(,p Number of sheets / Revision Date Title Description of Soil(s) jzL i6ptb1 �j;�►�, (�e�ot Soil Evaluator Form No. Name of Soil Evaluator DYIu L.l r. Date of Evaluation l P i% DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agree not placg the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Inspections /✓ ' No. ' FEE ,COMMONWEALTH OF MASSACHUSETTS Board of Health, 1 S.-,v1 MA. CERTIFICATE OF COMPLIANCIJ Description of Work: 0 Individual Component(s) 9 Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ) Repaired ( ),Upgraded O Abandoned ( ) 5: by: ,. C a�: ;'�:; �'• ; ram �. vim. ` at "'lf/D ^' / has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to Y application No. t '#t r `7, dated .`' r�':} Approved Design Flow tf - (gpd) staller t, :,� In - w. Designer Inspector: 'Date: y Town of:Barnstable .moo .R Regulatory Services Thomas F. Geiler,Director KAM �0 Public Health Division Thomas McKean;Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: di - o4.-p. Sewage Permit#"Z&6 4 S'Y Assessor's Map\Parcel � Designer: STFPHFN .T.DOYT.E ANI)ASSnCUTETPstaller: --�0)�l1� 42 CANTERBURY LANE Address: EAST FALMOUTH,MASSACHUSETTS 02536Address:5087540-2534 �� /✓;,� 3 3 On 1 AA\_:�L:;;> was issued a permit to install a (date) (installer) septic system at 1,4 2 s�AJ -d - )a ed on a design drawn by (address) . - dated w_A-oTrat \y-1:r,0 6 (d signer 4 certify that the septic system referenced above was installed substantially.according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic:tank. Stripout;(if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component tx of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required) was inspected and the soils were found satisfactory. �XnA.AA , OF OF ,�; �►� �V`N OF t 4AS,P�G�STERF�cs` : CHRISTIyE FAIRNENY. (Installer's Signature) STEJ. ; v No. 926 i r j DOYLE o #37559 P G`fSTEEt �e Ip�� SANITAR�P� ►qNo SUF\1\10 ►► t (Designer's Si ture) (Affix De i&er's Stamp Here) PLEASE RETURN TO BARNSTA.BLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BA.RNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 03-09-06.doc Town of Barnstable P# l ' Department.of Regulatory Services _ a Public Health Division Date .rya. s79.a�d� 200 Main Street,Hyannis MA 02601 Date Scheduled Time /A Fee Pd. ` y0 Soil Suitability Assessment for �wag�eD�iosal Performed By: Witnessed By: t.1 LOCATION& GENERAL INFORMATION Location Address ti Owner's Name SAS.%-, �tHAW j r,e Z�) —% v:SMA-,; Address �� r t Assessor's Map/Parcel: , (o d,150, Engineer's Name NEW CONSTRUCTION REPAIR Telephone# Land Use- S N T--;*1'24,"]C:�Avl Slopes(%) L Surface Stones ./` � /t Distances from: Open Water Body Possible Possible Wet Area Try ft Drinking Water Well 1 L o ft Drainage Way. 0 ft Property Line � I D'_ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands proximity to holes) IL :�r, ETA Cb� N ZZt 7 i .rsa i w t-- C= N Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Up t.a j:: Weeping from Pit NCO Estimated Seasonal High Groundwater 1 Co DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Obiervect standing in .hole: I 1A —in. Depth to soil mottles: k tAL In. Depth to weeping from side of obs.hole: In, Groundwater Adjustment Index Well# Reading Date: Index Weil level._ _ ,._.. Adj.&&tor Adj.Gfoufl water Level,R e PERCOLATION TEST gate 'rime Observation Hole# 3 Time at 9" Depth of Perc AA i� AA N� Time at 6" Start Pre-soak Time @ 11:5 D :0 '1'i (9",6") f End Pre-soak Rate Min.Anch Site Suitability Assessmen Site Failed: Additional Testing Needed(YM) Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:ISEPTIMERCFORM.DOC J n DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. ConsistengAv I)TZ 0 5 owi�t y C, \ter Z..s Vj 3 t,.00 s DEEP OBSERVATION HOLE LOG. Hole# Depth from Soil Horizon Soil Texture Soil Color Soil they Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ConsiptencL D-Stir k sG 10 -1 `t _� bt -j. U5 t�`laG lP �-ruaczuz \-C t� G► 1 Z. 1. o s` DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Sal Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C i to p 5Tti \ (N T& Go v L 5, 10 3(g-\GO t DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones:Boulders. 0 Flood Insurance Rate Maa: / Above 500 year flood boundary No_ Yes—V— Within 500 year boundary No= Yes Within 100 year flood boundary No Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occtming pervi us material exist in all areas observed throughout the area proposed for the soil absorption system? Y S If not,what is the depth of naturally occurring pervious material? Certification / I certify that on 3 i (date),I have passed the soil evaluator examination.approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in 310 CMR 15.017. Signature Date Q:\SEPTIC\PBRCFORM.DOC •I Town of Barnstable P# / 1 ' $ Department,of Regulatory Services M r Public Health Division Date 1039.fl�� 200 Main Street,Hyannis MA 02601 Date Scheduled !y l r X(5)' Time Fee Pd. 6 y0 Soil Suitability Assessment for wage A osal Performed By: �� PLT ►.11 O' L �� Witnessed By: t. LOCATION& GENERAL INFORMATION Q� Location Address � Owner's Name SAt.rGu �Y�L J —� 1 1��` c7As�tJls" Address "it Assessor's Map/Parcel: ,e.(o �� Engineer's Name S. 310�(,11 A tea NEW CONSTRUCTION REPAIR Telephone# Land Use Slopes(%) L �' Surface Stones Distances from: Open Water Body D ft Possible Wet Area 415�a ft Drinking Water Wellft Drainage Way 0 ft Property Line >_ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) CFO 1`1 M 'It - _ N S 11 t3 `t► �, - �, r` + Parent material(geologic) Depth to Bedrock h-1149 Depth to Oroundwater. Standing Water in Hole: 1. a 0 jz Weeping ftnm Pit Face, 1�t7iyT� T Estimated Seasonal High Oroundwater DMRNIINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in ofis.hole: IL I 1A In. Depth to soil mottles: .r...,In. Depth to weeping from side of obs.hole: ,_In. Groundwater Ad)ustmen- ft. Index Well# Reading Date: IndexWL41level ., AdJ,factor. Adj.Groundwater level.,,e PERCOLATION TEST Date , Observation Hole# 1 _� 71me at 9" Depth of Peneq/L 'AA.1� Time at 6" Start Pre-soak Time @ 11:5 U :fl 11 (9"-6") f End Pre-soak 1L`.0> �Z'Z� ��` �1n✓� 1,olkrilS '1��1�J LRate Min.Mch Gw�Ml tc.S►�t'uR,a , Site Suitability Assessmen Site Pass Site Failed: 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 must first notify the. Barnstable Consefvation Division at least one(1)week prior to beginning. Q:SEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# . Depth from Soil Horizon Soil Texture Soil Color Soil K77Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Con ieGravel) 0 toy tz b Lct' .' c.--0—s X rr (, eta Z..s Vi 3 ►. oo s� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil then Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ConsiplencL% k. &rruz • � I DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color. Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C i to p 5tr► 1 .,- E). G�r��tst'd-tiE DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure.Stones'.Boulders. 16 Flood Insurance Rate May: Above 500 year flood boundary No— Yes Within 500 year boundary No= Yes Within 100 year flood boundary Nor,: Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi us material exist in all areas observed throughout the area proposed for the soil absorption system? r S If not,what is the depth of naturally occurring pervious material? Certification / I certify that on 3 1 (date),I have passed the soil evaluator examination.approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in 110 CMR 15.017. Signature Date 10 \ti v 0 Q-.\sEr IG\PBRCFORM.DOC i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTI SON INSPECTION Z S y suss FEB 0 9 2005 TOWN OF BARNS' TITLE 5 HEALTH DEPI OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION AP Property Address: 71 First Avenue 2Svstems 'ARCE[, Osterville,MA 02655 ��. Owner's Name: Patricia Finn Owner's Address: Date of Inspection: January 10, 2005 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper 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 (Title V system) Conditionally Passes Needs F er Evaluation by the Local Approving Authority ✓ Fai1s Ingle cesspool) Inspector's Signature: Date: January 12, 2005 y . The system inspector shall sub ' 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 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 71 First Avenue Osterville,MA Owner: Patricia Finn Date of Inspection: January 10, 2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓(Title V system) 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: 71 First Avenue Osterville,MA Owner: Patricia Finn Date of Inspection: January 10, 2005 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: 71 First Avenue Osterville,M.4 Owner: Patricia Finn Date of Inspection: January 10, 2005 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 ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Yes(Single cesspool) (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. NOTE. SINGLE CESSPOOLS AUTOMATICALL Y FAIL IN THE TOWN OF BARNSTABLE. 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: 71 First Avenue _ Osterville. AM Owner: Patricia Finn Date of Inspection: January 10. 2005 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? I Were all system components,excluding the SAS,located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No _ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)). 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 71 First Avenue Osterville.AM Owner: Patricia Finn Date of Inspection: January 10, 2005 RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): n/a 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: I Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): 2004-66.000 2003-52 000 gals Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:__ None on file Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system ✓ Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Altemative`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: The Title V was installed on 1110184-per as built card The single cesspool for the cottage was original Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 71 First Avenue Ostervilk MA Owner: Patricia Finn Date of Inspection: January 10, 2005 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: c — ast iron _40 PVC other .ex lain ( P ) 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: 2' Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: I" 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. The liquid level was even with the outlet invert There did not appear to be any signs of Leakage GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass ,_polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 71 First Avenue Osterville,MA Owner: Patricia Finn Date of Inspection: January 10, 2005 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 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. 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: 71 First Avenue Osterville,MA Owner: Patricia Finn Date of Inspection: January 10, 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1-6'x 6'(1000 gal.) leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): The leach pit had 1'ofliauid on the bottom The scum line was 2'up from the bottom There did not appear to be any suns of failure. The bottom to grade was 8.6. The cover was 12"below Qrade CESSPOOLS: ✓ (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: 1-single(for cottage) Depth-top of liquid to inlet invert: -- Depth of solids layer: -- Depth of scum layer: -- Dimensions of cesspool: 5'W x 4'T x 7.5'bottom to grade Materials of construction: Cesspool block Indication of groundwater inflow(yes or no): None Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): The cesspool was dry. The cesspool serves a cottage in the back ofthe house Single cesspools automatically fail in the Town of Barnstable. 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 11 OFFICIAL INSPECTION-FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 71 First Avenue Osterville, MA Owner: Patricia Finn Date of Inspection; January 10. 2005 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. 138C,k 11a 1c. 1 ,8 a a 3 3 a3 11 Y 3o a3 y E6, guk 10 • Page 11 of 11 a OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 71 First Avenue Osterville,AM Owner: Patricia Finn Date of Inspection: January 10. 2005 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: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps, the ma Ds were showing approximaLlZ 25'+1-to ground water at this site. This report has been prepared and the system inspected and passed/failed 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 i Septic Inspection Information ata En yDate 2/9/2005 Se ticlns peNo; 2734 'Asse sons Ma . 116 Parcel 045 Lot us�n'es N mq 71 P-dd*rLess. First Avenue u,naye Osterville „Inspect James M. Ford Inspectdate 1/12/2005 SystemStafiis F Comments Two systems on property.One i single esspoll which is a fail. The other system Title V passes. Permit# Rparte: � No ific`tionxDate BEng_, llns�talle'r�'. rain„ ��RepDeadlme�Date C. TOWN OF BARNSTABLE LOCATION 7.1 / v S 4 U `e— SEWAGE # VILLAGE y ASSESSOR'S MAP & LOT Z G �yS INSTALLER'S NAME&PHONE NO. �/Yle rYI F=v� of SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 9� 0 a'� (size) NO. OF BEDROOMS HbT:D£R-OR OWNER �+ 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 ASSESSORS MAP NO' 114K � PARCEL N0: ,� No. � Fps.�J....�J..._ _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apphratiou for ilhipoii ai Works Tomitrnrtiun Famit Application is hereby made for a Permit to Construct ( ) or Repair (!/S an Individual Sewage Disposal System at: 7/1 eh Q 1�55� --------- --------------------�::.�'. ...-mil___...�:---------------------- -....------------------------ ---- ----------------------------------------- Location/ress �� or Jot No. .....�.g. .C_'./...G..�7........�C...`..C� ' --.:.......... --.....7 f l._�f..�:.. L/ir(l�P ,� Own C 0- A ress a lJ..,._.._.�y� ._ .r....Q- -•••••.... � 'C , .--4.............................•--------------- Installer Address U Type of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria P4Other fixtures -----•--------.......................................................----•-----------------------•---•-•---------------•----------------------------- WDesign Flow............................................gallons,per person per day. Total daily flow____._....._......_......_....._............gallons. WSeptic Tank—Liquid*capacity._Zj�`,T. allons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width-----�............. Total Length......._.--------- Total leaching area....................sq. ft. Seepage Pit No......./........... Diameter-------f--------- Depth below inlet......Z,o__......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ...........................................................................-................................................................................ 0 Description of Soil................................................................................----•----------------------------------•-----------•---•---•-••---------........._•----- x V ....-----•--------------••-•---------------•----•----•-------•--------------•---.....----.......----------------------------------------------•-------•------------------------------•------.....-------- V Natures of Repairs or Alterations—Answer when ap licable___ ----o'-------Tls- v�------ 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 bee sued b the bo rd of health. Signed Application Approved BY C-` ` .... t.�--m r................................................... -- ��Yf ---CI-- Daw Application Disapproved for the following reasons• -_------------------------------------------------------------------------ ------------------------------------------------------ .....................................--------------------- - -- --------------------------------------------------------------------------------------------------------------------------------------- ........................................ Permit No. r-6� Issued ........../.-7'-9—7�..-..- Date..-... p---................................................... Dare LOT' NO:. ADDRESS OWNERS NAME: SEWAGE PERMIT NO. : NEW: REPAIR: u DATE ISSUEU:_IDATE INSTALLED;s a2^� e HISTALLERS NAME: INSTALLATION OF: /�k ee l O WATER TABLE: FINAL INSPECTION BY: Q h DRAWING OF .INSTALLATION ON REVERSE, SIDEDE: . ` d,1 x i` / 4� FEB THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Ditivos ai Work.6 Tontrurtion thrutit Application is hereby made for a Permit to Construct ( ) or Repair (44'an Individual Sewage Disposal System at: , e -fir_ A .! Location ress rt o. :t' 'T . - f./251.s...T N __ ? O wn e Address ,_l .......... -------------------- -----------------------/l � G ................................................. PQ Installer Address Q Type of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons____________________________ Showers — Cafeteria 04 Other fixtures .................................................... d ----------------------------------------------------------------------------------••---•-•------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid,capacity...lotfjallons Length-------_------- Width................ Diameter----------------- Depth--.;-__--___-_-. II. x Disposal Trench—No. .................... Width.................... Total Length.........r-------- Total leaching area....................sq. ft. Seepage Pit No..__.__/_.......... Diameter........f-------- Depth below inlet_-_....4......... Total leaching area------------------Sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date-----------........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ Li, Test-Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water-_-______-______..._--_- - ti--------------------------------------•------------------------------`•......_..........-----.......................................................... D O escription of Soil ----------------------------- x _...................... ----------------------------------------------------------------------------------------- - •. ------------------------------. Xl --- V Nature of Repairs or Alterations—Answer when applicable �1/ ___../,h d ..._7,<2��........ - — Agreement: .r 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 bee %issued b�the boari- d of health. Signe -------v d ��1 � ''`�� ........- 1 Dare Application Approved By ( ...----------------------------- ---�-- 7 ef Date Application Disapproved for the following reasons- ----------------------------------------.---------------------------......:---- --------------------------------- ............ --------------------------------------------- ------------------------------------- -- ----- --- ------- ------------------------------------------- ---------- .......................... ----------------------------------- c Date PermitNo. .................................................... Issued ............ 7-ee9.7. P....---.............. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (fertif ratr of C antyltana THIS IS TO CERR?IFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ................ -✓t G� ,�-� Installer ' at .------�--!----------�......L_ns-- --------�----------- -----------------��-ST-�/{---�..- j-- --------------------------------------------------------------------------------------------------------- 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- -----------------7.�.:.-C.�-..---- dated --.------ -- .r------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. j DATE--------------------- -.-" ..-... Inspector .------...... ......-_ ..__ _✓ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No........................ FEE. �i��o��t1 oGk� ��rtion rrnti� Permission is hereby granted ------------....-`?--------.--•-------••-••-----•-------------------•---•-------------........•--------•......._........... to Construct ( ) or Repair (4,�an Individual Sev�,age Disposal System at No.........7./..... J j._......^....1. "f c ... ----•----•--..... Street as shown on the application for Disposal Works Construction Per it No.. ...... Dated...... T9- -------------- Board of Health DATE----------- ........................................................ FORM 38808 HOBBS&WARREN.INC.;PUBLISHERS % A TOWN OF BAR�NSTABLE. LOCATION Z/1*1 ._ �QI/r��1�� ' l/�„ SEWAGE # a144. Y�ILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. kf-7D 10 41 �D��7` 27/``93$y' SEPTIC TANK CAPACITY , LEACHING FACILITY: (type) (size) NO.OF BEDROOMS aJ" BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water SupplY Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching_facility-1.,� . Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by A, ,; Iy oz.Z4� Z ® � 3.- 3i a � 3 �dzs iro ` A7.9 9 yb •`3 c 6d.Z&, iL .oho 7 Sap-09-9e 06:3BA DAVID BERNSTEIN 508325380 P 02 t,Q CAT 1o$& $EMiAC � �EE�IT NO• vi tLA6E I PST A LL.ER'S M E i AOD ESS P� r-4vs fi�� SVIL09N OA ONMER IDATE HERMIT IAAYE 'D *AT C4�PLIANCE tgSREO �� too R r� 8O L 01/09/98 05:46 TX/RX N0.0685 P.002 ■ TOWIN OF BARNSTA.BLE L,gr—ATION I l(ST I' ve SEWAGE # Vt1,LAGE OS I tr,�►lux- ASSESSOR'S MAP & LOT t Sr' INSTALLER'S NAME&PHONE NO. . SEPTIC TANK CAPACITY �A I — HOVSt" CDll gst.— Gb LEACHING FACILITY: (type) #"T (9x G (size)CI— g NO.OF BEDROOMS y �' Y BUILDER OR OWNER P. ►-/n�1 S PERMTTDATE: 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 leachi g facility) / Feet Furnished by T45 � o1 , � rD/d . _ a 13AA 8 a a 3 3 03 11 Y 3o a3 �.�ra No....83- JoSL ...........Z....... ... THE COMMONWEALTH OF MASSACHUSETTS BOARD,,PF HEALTH ..........0 F. ....... ------------------------------------ Appliration for Bi!ipwial lVarkii Tonstrurtion Errant Application is hereby made for a Permit to Construct or Repair (�Individual Sewage Disposal System at: ................. ............. ................. ....... ......... ... ...........0.�. ........I................................. I.................... --.-—......-L.-o..ca. lioi��ddress --------------------- -------------------------------- -------o--r Lo.t...N."..o .. er Ac�4 ss . .........---- d .. ................................................n!,aIe Ass .............. Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( ) Other—Type of Building ............................ No. of persons.._.___.___..___.__.__.._._. Showers Cafeteria ( ) Otherfixtures....................................................................................................................................................... Design Flow............................................gallons per.person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity._______.__. allons Length________________ Width__.___._.____... Diameter_______________- Depth_._.___._,_.._.- _.__.W -9 Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. f t. > Se page Pit No..................... Diameter__._..._.___.__..... Depth below inlet__._.:..____________ Total leaching area...................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date______-_____...........__.___________... 4. 0-� Test Pit No. I................minutes per inch Depth of Test Pit._._.____.___._..... Depth to ground water..___.__._....__.___._-. P-4 44 Test Pit No. 2................minutes per inch Depth of Test Pit__.________._______. Depth to ground water........................ 1:4 ............................................................................................................................................................. 0 Description.of Soil........................................................................................................................................................................ x ........................................................................................................................................................................................................ U ...................................................................................................... .............. n��he ------------------- U Nature of X f Rgyrs or Alterations—Answer hen applicable... � , Z� ' 7 ...... . .. ....... X rtl U Agreement: 17 ;P The undersigned agrees to install the aforedescribed. Individual Sewage Disposal System in accordance with the provisions of TLI'IM 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue y the boar health. Signed, ... ... Date Application Approved By............................. -62."...1-35A.'I./......................... ....................Date............... Application Disapproved for the following reasons:................................................................................................................. ......................................................................................................................w.................................................................................. Date PermitNo....................................................... Issued....................................................... Date ---------- ...... No.... THE COMMONWEALTH OF MASSACHUSETTS ...,,�OARD,_PF HEALTH ------------------------------------- Appliratiou for Bhipoiial Works Tontitrurtion romit Application is hereby made for a Permit to Construct or Repair Individual Sewage Disposal System at: 2:5 .................. ............... ?0e ...... ......... /�2- . ......................................... ...... --------- .. Location Add ress or-Lot No. .......... ......... . ................. . .................................................................................................. r .. Add ss -------------------------------------------- ........... .... .. ... ... .......................... ................ .a*7. - t InstallerAddress Type of Building Size Loi............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( ) �4 A4 Other—Type of Building ............................ No. of persons_....__.............._..._.. Showers Cafeteria ( ) Pa Other fixtures ...................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic 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. f t, Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date...............................*-------- Nest 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._._._.............._... ...................................................................................................................................................I......... 0 Description of Soil------------------------------------------- ------ .......................... U ....................................................................................................................................................................................................... ...................... ......................................................................................... ----------- --;;----------------I --------------------------------- U Nature of RWI;*rs or Alterations—Answer hen applicable . ........... .... A ........... �..... 714voo Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T LZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issueP d the boar health V 0, � ...................Signed.. ... ..... ............... Date ApplicationApproved By...................... ......................... ........................................ Date Application Disapproved for the following reasons:.............................................................................................................. ...........................................................I............................................................................................................................................. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. ...............0 F. .................................. (Intifiratr of Tomplituta THIS IS RTIFY That the Individual Sewage Disposal System constructed or Repaired4_T� by....._.. . ..... ... ........................1.........o........................... .............................................................. In at......... . ..... ...... .. ...... .......... ................................................ has been installed in accordance will the provisions of TITLE 5 of The State Sanitary Code as described in the application for Dispqrsal Wo .�,, onstruction Permit No.......493. 1.0.).. ..... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE CS�Mf AONWEALTH OF MASSACHUSETTS BOARD HEA T OF) . . .. . ...... ................................. No.... Diapolial No o idrattWu ramit Permission is hereby granted..... ------------------------------- ............... ...........to Construct or Repair an Individual S ge Dis System 0........7. .... . . . ............... .. ...... .. at N V........It tet- ..............I..................................................... as shown on the application for Disposal Works Construction Permit No........... .......... Ddted......................................... �A4o ................................................... ar o-i_'Health DATE. 01 ..................................... FORM 1255 A. M. SULKIN, INC., BOSTON UO C A"T ION SEWAGE PERMIT NO. Vsa'LLACE INSTA LLER'S NAME i ADDRESS olv I UILL�DEIt OR OWNER tI'cc , L, DATE PERMIT ISSUED DATE C0MPLI-ANCE ISSUED i C 4 1Q y or f ]� I 4-PYC Vent Pipe FOUNDATION ELEV. 34.27' X5 � �° � !L �� V- i - - IV- �L�f nth S°.�ened open,.g 1/8' to 1/2' Mashed Stone 0 3' Thick 36" FFnish Grade 'n 34 f Jk`I Grade AZ 34,5t i-�- 12.83 -i 6" 6' s- I/I Rzz&h Grade m 34f RLSEX , 6"llll llllllll► 34" :d:••, 8.5' (2) 3Z0' /1Vi� RISER RISER RISER OC�t� ��1=7[= 3z.ss' NI 4 0 0 4 24" INV EL ° ° EL 28.17' ---•-, 58" {-�-- 30.17, 3/4' -1 1/2' Vashed stone o 0 31.35 ¢ 3" INV EL � 6' �_ 4 BV EL Li uid Level 48' 14 Min. Number of 7�•enches - 1 to 6 h 4 Below The 31.10 INY EL Sump 0.67' Number of Chambers - 5 6V Flow Line Below The GAS F10W L%Ile 89„± BAFFIE GAS BAFFLE 30.87' ;•s'Stan;. -1 as„} 5" PROPOSED LEACH TRENCH - END VIEW N.T.S. pROPOSED LEACH TRENCH - H2O LOADING c� 6' 660 Gallon DISTRIBUTION BOX - H2O LOADING Install Five 500 Gallon Units ~ 1,320 Gallon d1in. Capacity Min. Capacity with Four Feet of Stone at Sides and Ends. 12' 2" Note: Bottom of Deep Observation Hole El. 22.5' � Remove all unsuitable material 5' around SAS 2000 GALLON TWO COMPARTMENT SEPTIC TANK - H2O LOADING Design Data: down to the C layer and replace with clean High Ground Water <Elev. 16.0' (Area Topography) Minimum Construction Materials Per 310CMR 15.226(2) Six Bedroom = 6 X 110 gpd = 660 gpd Required Flow granular sand per 310 CUR 15.255 Tees shall be constructed of Schedule 40 PVC and shall extend a (Existing 4 Bedroom Hse & 2 Bedroom Cottage) u 1 minimum of 6" above the flow line of the septic tank and be on No Garbage Disposal Allowed 30 the centerline of the septic tank located directl' under the e p � Use: Chamber Trench 50.5E x 12.83 Pl x 2 Eff/Depth 31 a clean-out manhole. The inlet pipe elevation shall be no less than 2" nor more than 3" [50.5' f 50.5' f 12.83 f 12.83� x 2.C = 253 1 ` above the invert elevation of the outlet pipe. 50.5' x 12.83 = 647 SAM �v Septic tank shall be installed level and true to grade on a level, 900 x 0. 74 = 666 GPD Total Design Flow I wAY 29 ,1 POND JosHUA o\° stable base that has been mechanically compacted and on which 33 _ r1G SHED�R1 - , O POND 6 of crushed stone has been placed to ensure stability and 4 EX�s to prevent settling. P SORRY GAP 34_ 87 3 ` Y 32 Septic tank shall have a minimum cover of 9 . �o p Bµ� g4.3S - � 40.3�/.-.� Two 20" manholes with readily removable impermeable covers E�� M. GAS N lR1 of durable material shall be provided with access ports 0 Aw co TP VE N r 50.5o Interior plumbing is required to raise existing pitch to tank. \ \ o The outlet tees shall be equipped with gas baffle. PROPOSED \ ,o SNEp 2000 GAL 28' w O P00\- 0 2 COMPARTMENT 20' / ` P�¢ �9Sr9 EAST PROPOSEO // TANK OPOSED / WSO,? , c�`� qy BAY / 10' o 20'O 9 D/B SAS TRENCH �A� ° W�W O,may o. jpp0 `�� GS \ �� LOCUS 0 / 30 CESSPOOL 39' SPNK o \ l O F� PRECAST REINFORCED CONCRETE DISTRIBUTION BOX 35 8 0• / 18 - 1P O 48' LEACH PIT \ 0 33\ \ 1 Install on a level base - 12 g3 / -o \ 32 1 L,Ca C' U,S MAP Minimum wall thickness = 2" i" /�ii� %%//i// � P� 1 - -,"A Minimum inside dimension = 12 -W -w /EXISTING DWEWNG� y 1 \ 1 ' 11 ASSESSORS DATA.- Outlet inverts shall be equal to each other and at 15 20' Ln �, / 36.7' 115 - 45 2 minimum below inlet invert. �, - x The distribution lines from the distribution box shall all have o dciTt Nc / / REFERENCE DEED. 19746-279 -o COTTAGE �� 14 y equal inverts as determined by flooding the distribution box to 0 (NO BASEMENT) 19" OAK 4 o the height of the distribution line invert after all Imes have %o 0 28, , 1, REFERENCE PLAN 27»135 been sealed in place. 38.5' 0 5 5, /➢ r x oR��wA�c FEMA DATA: ZONE C Invert adjustments shall be made by filling with durable and - DECK lJ� Ex�s�'NG sNEu , PANEL 250001 0016 D nondeformable material permanently fastened to the line or ►� G , MAP REV. DULY 2, 1992 reconstructing the lines until all inverts are of equal elevation. RAC \ \ 1 SPA 50' SEE GEN. NOTES GA \ ZONING DISTRICT• RC #11, #12 AND #13 \ � � \ 1 0 YERLAY DISTRICT \� 1 a" WHi-E PIN I 3 AP & RPOD, / \ � 1 BUILDING SETBACKS.• GENERAL CONSTRUCTION NOTES 1 18 8, / 32 31 1. All the workmanship and materials shall conform to R E.P Title 5 51.2' 24' FRONT - 20' and the Town of Barnstable rules and regulations for the subsurface LOT 4 SIDE & REAR - 10 \ =282fS. . 34 disposal of sewage. 42' 22, / 2. At least one access port over tank tees shall be accessible / LOCUS ADDRESS: within 6" of finish grade, with any remaining access ports brought Ar �95.93 33 71A AND 71B FIRST AVE.., OSTERVILLE to within 6" of finish grade. 3. All components of the sanitary system shall be capable of withstanding H-10 loading unless they are under or within 10 ft GRAPHIC SCALE SITE PLAN O.' LAND of drives or parking. H-20 loading shall be used under or within 20 0 10 20 40 80 Prepared For— 10 ft of drives or parking unless noted. Plastic equals may be used in lieu of all recast units i�1 A & 1 B FIRST AVENUE 4. The excavator contractor shall call dig safe and verify the location Health Agent: D. Stanton >x SET In of all site utilities prior to any excavation, and shall be responsible for all matters relating to electric easements Test Date: 10-12-06 1 inch = 20 ft Os tervzlle Massa eh use t is 5. Sewer pipes shall be 4" Schedule 40 PVC laid at a min. 0.02 slope. c�' Soil E'valua tor.- S. Doyle , r. .,�-, 6. An mason units used to brie covers to grade shall be j' " 'ass , mortared in place. g g PERC <2 MIN/INCH GtiS-cq �y '� Scale: 1 = 20 Date: October 14, 2006 7. Finish grade shall have a minimum slope of 0.02 ft per foot. f7 STEPHEN 8. Pump and abandon old septic systems. TH #1 EL' 34.0' TH #2 EL 32.5' TH #3 EL 34.0' TH #4 EL 34.0' 1 J. s D Prepared By: p p ys 0„ - �~ 0" 0" . DOYLE 1> Stephen J. Doyle and Associates 9. The excavator/contractor shall be responsible to check all grades A A SL 10YR 3/2 A SL 1OYR 3/2 A SL 10YR 3/2 L v-.Yo7^'^�� 42 Canterbury Lane, E. Falmouth, MA 02536 SL 10YR 3/2 „ „ e s Cl- a Telephone: 5081540-2534 and elevations and to contact Doyle Associates about any discepancies, s 6 q,,o UR w� prior to construction. 8" TB LS 1 OYR 5/6 B LS 10YR 5/6 B LS 10YR 5/6 S.Z v c k 10. The excavator/contractor shall be responsible to contact B LS 1OYR 5/6 ' EL 3017* 28" Doyle Associates 24 hours prior to any required inspections EL 30.84' 38" EL 31.0' 36" EL 31.0' 36" 11. Where sewer lines are less than ten feet from water lines, water lines PERC 4e i FlNE FINE -PERC 44" FINE shall be cased in schedule 40 PVC. FINE IC SAND C SAND C SAND S ChRISTINE 12. Whenever sewer lines must cross water lines, both pipes shall be C SAND FAIRNENY CA constructed of class 150 pressure tested pipe to assure water tightness 2.5Y 6/3 2.5Y 6/3 2.5Y 6/3 2.5Y 6/3 No. 92b O or the water line shall be cased in schedule 40 PVC. 120" 1zo" 120' 120" �kl Q 13. Should SAS reserve area be constructed, the water line shall NO WATER ENCOUNTERED NO WATER ENCOUNTERED NO WATER ENCOUNTERED NO WATER ENCOUNTERED SANITARt 1 10-17-06 REVISE DESIGN FLOW be relocated ten feet from system components EL 24.0' EL 24.0' EL 24.0' NO. DATE DESCRIPTION fllgh Ground 'Water <F/ev. -16.0' (Area Topography)