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HomeMy WebLinkAbout0078 FIRST AVENUE - Health 78 First Avenue Osterville P A 116 055 ° ° Is I r r V H ° ° I '.- y ° x, u .. , we No. I �yl Fee too - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es Zipplitation for Disposal *pstem Construttion Permit Application for a Permit to Construct( ) Repair((,Upgrade( ) Abandon( ) kC mplete System ❑Individual Components Location Address or Lot No. Au e- Owner's Name,Address,and Tel.No. cs S�enatc�.¢. S �e r,r �sC� Pln�sa Assessor's Map/Parcel ��(o D$'S OA611 I talle}�'s_Name,Ad less,and Tel.rho ..jv�-9i)/- S Designer'yNa e, ddress,and Tel.No. - YXr1al tc �Or�¢/c�t/0� �nG 1.�'Xv� �'. D• n ! O� o Type of Building: / Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures f�e/ Design Flow(min.required) gpd Design flow provided 7 7� gpd Plan DaAdHvaw,//, �/� Number of sheets /�l Revision`Date Title ti¢���3 �i /"�llir, �� , ��1T�il UP ®�'`�l Ut�l� AMA Size of Septic Tank Type of S.A.S. OL z[ jd �5 Description of Soil /a is'Ve X Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and mainten the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental a and n o place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si Date _.;,Z/ Application Approved by A p Date Application Disapproved by Date for the following reasons Permit No. 20. b �tS.FII Date Issued .V J No. 1 �b U � J Fee .Fee U 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es 2pplication for Disposal *pstem Construction permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) �mplete System ❑Individual Components Location Address or Lot No. qLLe Owner's Name,Address,and Tel.No. / -?e y 5 3 p7 0 c�� ,51�ette C-nnc\ *G Pl�xs�� S>L• Assessor's Map/Parcel /�(, ,5- VUA U e, Installer's Name,Address,and Tel.No. S v:F- '77l �3!9 Desi ner's Nam ,Address,and Tel.No. 3W- Y$-s// aG r i<v lac �Or 5 fic.�r�i't7!t,�i�G iDcevn F o Type of Building: Dwelling No.of Bedrooms d Lot Size /U 6/, sq.ft. Garbage Grinder( ) F Other Type of Building No.of Persons Showers( ) Cafeteria( ) , Other Fixtures �k M Design Flow(min.required) �U gpd Design,flow provided �r �y )gpd- Plan Date4&L AA , Number of sheets Revision Date Title 71*6�C .S S" /c /�;/u � Size of Septic Tank 1St� p 10 Type of S.A.S.4-0,101 14/b I i7y PLI0 e40 lr.S Description of Soil /O x y0 X :I► Nature of Repairs or Alterations(Answer when applicable) i Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance.,o' the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Codeot4b place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed, , � -......�.,�_ Date \� / Le Application Approved by / ~( p Date �v ✓ t. Application Disapproved by Date for the following reasons Permit No. .2 o l L —U 0 l Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ✓� Upgraded( ) Abandoned( )by 8c,/ at U-2 QS� '/I� has been constructed in accordance with the provisions/of Title 5 and the for Disposal System Construction Permit No. U �(,-U(�l dated 3 b I J _ Installer 130116 2Z, ." ��r74�✓���,�, �V r Designer ,f� ( A0.R #bedrooms Y Approved design flow rdesig gpd The issuance of this permit shall not be construed as a guarantee that the system wil func'odDate 47 Inspector `1 - ----- ------------------------------------------------------ _. -- No. �.U l 19 ` U - - ----. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction 3pErmlt Permission is hereby granted to Construct( ) Repair(/)� Upgrade( ) Abandon( ) System located at Q �i`�S A /1 V w G and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. I` Provided:Constructio must be completed within three years of the date of this permit. Date /2 / /�ej Approved by / C)/1,1v 4 - 1 APR-01-2016 23:34 From: To:15097906304 Pa9e:1/1 70wa of Barnstable Tbompa F.Gem,DhTLIWi KAM� Public Ueaa nog. ZOU�iau� �[ya ,14�0�54� gam: 30�-790-63Q�4 pf�ce: .508-8624644 . i Date; ego (�0✓1��-� -�1ria���--- AMaesa. �� _V ass: �• 02C �4 , 0 to p�a.g a /,(, issued a pmMit 10 in8UU a (doft) r� Ave— se ptic systsm at !V /I' based ou a design dYawnby {address) rl,r e E' 6.1' dated V ,effp that th-,BqA c BysWna.zaffatwAd above was iaAgM sabst p acooltng to the desigc,,which Maq Mlude==r apywved&mges such as lateral zelocatian of t3 di5bal±ion boar endlor seplic tffl3k. T cexdy that the septic sY&=zefeteuced above wag stalled avith major changes (i..e. great thtm 10°lgtezalrelacationof ft SAS ax anyyertitcalreloc4on of anp corupozew± 2. �Of the sew s9�t7em , irL ascm*mewith stsfe&Local Uplati=- Plan Misiob or ��to foIlow. OJAASigua# ) CMLCA F c�S:rea NAL (Dedgaeea Suit e) { �eB riE 9 5`tSm� O , 3 N TO s A 1 blC AX+k�9[ k�dVA,•2dU>� Ll[la U ff W ]BY mar' 7D�VI4�1�T. �trbiT f iJ! ...-r'� `/•{�/�/ ((��//]�/��� 'q/�/1�'11/�''y11pr ��D�"��/Iry///��,1■/w/,� Town..of.B., 4r,gs h p Deitartimut of RegWatory.Services x aranr. I?ubJ!c Health.Daylslou Date Pgo 200 lvlain Street,Hyannis MA 07.G01 JM-28'IGPN 1114 Date Scheduled Time V`?M Fee Pd, 6 Performed Hy: �'�� I GG�s"Gty�' Witnessed Sy: v • J4C6 CATION AO $AL'4.Y .a E- y"�� I.il'lf £ �...�%�`V1.0.19� ���/Ca 1 . ca;ar.A dcLess -Fi � ep� Oy .a i/Z ll// t �2sq_'v Address c Assessor's Maly/Parcel: 11 010155 Enginacr's Name wn �Q`"' NNW CONSTRUCTION REPAIR / Telephone* f 'J Land Use: L Ol wI'] Slopes(%) G—�// Surface stones 14 A � Distancesfrom: Open Water Body--- G ft Passlblo'Wct' rea7lGC/ It Drinldng Water Wclr���rr K ft Drainage Way �>/c ft Property L•ina �l ft Other ft SMETC'Ho(Street name,dimensions of lot,exact locations of test holes&port tests;locate wetlands•tn proximity to holes) •4AN28'16P# blkn." /V q G�,c-�wus� l anent material(geologic) �ZO� Depth t0 Badr4cl5 Depth•IoGmundwater. SlandingWaterinHole:JV/' ` _ weeping from pltFflQjr Estimated Seasonal high Groundwater /y Lf� Mothod Used: w Depth Observed standing in abs.hole: _ Iq, ;DeptU tb,sQll rnQttl 1t1, Depth to wcepingfi-om side of obs.halo: in. ©rnundwaterArlJuetm�nk i� Index Well Reading Date: Index Wrlllintel,'.:,•,_,.,,,..�, Act.flaoEtir� ..� F�t�J.,CatY?Ut1tiY,ntel1.eYa1 , Observation jQ!2 y ' Hole#k I lime•at.y" ,. _._ p / Depth of l?erc. L� I Time At 6" { �StartFre-soakTlmo @ /0 0 — Time End Pro-soap hateMindluch Z f-7"n/LnC Sitr'SultabiIlty P,sscssment; 5ifeka55ccl Sit�Fnllod:, — AdditionalTbsUngNeeded ff1N) Original.- Public Health Divislon — Observation Holp Data To Be Cou41cted on Bach—_------ ***jf pe�colati®,a testis to be conducted with 100' of wetland,you must first notify the Barnstable Conselrvataon Division at lust one(1)week prior to beginwng. Q.MEJ TIC\FF_RCFORM DOC VS . _ I LOG Deptlifrom Sall Horizon Sall Taxture Sd1lColor Soil.. 0Mor Surface(in.} , (1:.1 bM (Munsell) Mottling (Structnrc, Stones;Bouldors, • _ o i`ton cy.9�'Gravel) ' ip y-12 A/y t Dopthfmm Solt Horizon . SbiITexture Soil Color Soil Other Surlace(iu) (USDA) (Munsell) Mottling (Structure,Stands,lhulders. onsis ten 90 Grave 7/2 /0Y/e 411jo DEEP OB SERV&TION ROLF,L 0 G Role Drpthfrom SolMorizon SalITexturo Soil Color Soil Other 9 Surface(in.) (USDA) (Munsell) Mottling (Struct�Xg,utoney Boulders. D7C+PIP ONSFIRVALTION 19OLP,Loa Role# Depth from Sail Roelzon SallToxture Soll Color Sall tOthcr Surface(in.) (USDA) (Munsell) Mottling (Structure,Stotm,Boulders, Coll si tcn gy,q& v ' Flood Yns•tvranc'w-RPte'IVC�p.. A6ova506•yea?'fIoodbound* 1do Yes "Within 500 yearboundnry. No 'Yes Within 1.00 ye arfloodboundary No, YdS, Dertla of SJatlrpal��%(�ecnrxyns. ervrxorys Lfttori-aY Does at least four Feet of naturally occurring pervious matMiftl Wdst iti all arelis nbser.ved throughout the area proposed.for the sail absorption systeml If not,What is the depth of naturally occurring pervious matarial'� -- - x certify that on 2 (date)x have passed the soil evaluator examination approved by the Da alt=llt of Environmental Protection and tharthe above analysis was pryrPormed by me consistent with . 'the required training,expertise and experience described in�10 CUR 15.017. Signature Datb y ' Q:iS.�l"l'lCll'L�RCS�OTYM.DDC • TOWN OF BARNSTABLE LOCATION SEWAGE# —10 14 ®9-1 VILLAGE ( �, ( d?Ud'LI:A�� ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 4 S�� 4,1tL- y/d o r � LEACHING FACILITY. (type) —t-4--- (size) 40 X to 4-- NO.OF BEDROOMS OWNER PERMIT.DATE: COMPLIANCE DATE: 3 cl �Io 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) 14 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BYOw✓ r fie` 27 gyp. TOWN OF BARNSTABLE LOCATION ' �7 V Q �I r:7 SEWAGE # VILLAGE O MtrI)-Inc. ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY (Iss W I f LEACHING FACILITY: (type) W1n 6"V (size) NO:OF BEDROOMS --� BUILDER OR OWNER GVri-1AI 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 Dn �' �� O o p Z_M COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION APR 2 7 2004 TITLES N O BAPNSTABLE HEALTH dEPT. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 78 First Avenue MAP , Osterville, MA 02655 PARCEI ri Owner's Name: John&Pat Curtin Owner's Address: LOT --ZIALa Date of Inspection: April 17, 2004 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 Conditionally Passes Needs F her Evaluation by the Local Approving Authority ails Ins pector's s Signature: Date. April 21, 2004 The system inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time-of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 78 First Avenue Osterville, MA Owner: John&Pat Curtin Date of Inspection: April 17, 2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass. Answer yes, no or not.determined(Y,N,ND) in the for the following statements. If"not determined", please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass'inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage:backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The'system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 f Page 3 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 78 First Avenue Osterville, MA Owner: John&Pat Curtin Date of Inspection: April 17, 2004 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 1 I OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 78 First Avenue Osterville, MA Owner: John&Pat Curtin Date of Inspection: April 17, 2004 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS, cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either`yes"or"no"to each of the following: (The following criteria apply to large systems in addition to,the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B ` CHECKLIST Property Address: 78 First Avenue Osterville, MA Owner: John&Pat Curtin Date of Inspection: April 17, 2004 i I Check if the following have been done: You must indicate`yes"or"no"as to each of the following: Yes No ✓' Pumping information was provided by the owner, occupant, or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period ? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out ? ✓ Were all system components, excluding the SAS, located on site? ✓ _ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge and depth of scum ? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example, a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 78 First Avenue Osterville, MA Owner: John&Pat Curtin Date of Inspection: April 17, 2004 FLOW CONDITIONS RESIDENTIAL 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: 0 Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system (yes or no): n✓a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown C OMME RCIALdNDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): pd 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: Unavailable 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/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other, (describe): Approximate age of all components, date installed(if known)and source of information: Original system-no information available. Age unknown. Were sewage odors detected when arriving at the site(yes or no): No 6 f Page 7 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 78 First Avenue Osterv.ille, MA Owner: John&Pat Curtin Date of Inspection: April 17, 2004 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints, venting,evidence of leakage, etc.): SEPTIC TANK: ✓ (locate on site plan) (Cesspool acting as a septic tank) Depth below grade: Cover to grade Material of construction: _concrete _metal _fiberglass _polyethylene ✓ other(explain) Cesspool block If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 5'W x 4'T x 7'bottom to grade Sludge depth: 10" Distance from top of sludge to bottom of outlet tee or baffle: -- Scum thickness: -- Distance from top of cum to top of outlet tee or baffle: -- Distance from bottom of scum to bottom of outlet tee or baffle: -- How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): The cesspool was dry. Only sludge was present. No outlet tee was present NOTE: Recommend installing an outlet tee GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 78 First Avenue Osterville, MA Owner: John&Pat Curtin Date of Inspection: April 17, 2004 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: aaflons/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: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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.): 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 f y Page 9 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 78 First Avenue Osterville, MA Owner: John&Pat Curtin Date of Inspection: April 17, 2004 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: leaching trenches,number, length: leaching fields, number,dimensions: ✓ overflow cesspool, number: 1- 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 overflow cesspool was 5'W x 6'T x 9'bottom to grade and was dry. There did not appear to be any signs of failure The cover was 18"below grade. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth -top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool:. Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 9 Page 10 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 78 First Avenue Osterville, MA Owner: John&Pat Curtin Date of Inspection: April 17, 2004 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. Aa / 30 30 a 10` Page I 1 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 78 First Avenue Ostervil'le, M4 Owner: John&Pat Curtin Date of Inspection: April 17, 2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 20 +/- 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 the Barnstable topographic map and the Cape Cod Commission water contours map the maps were showing approximately 20'+/-to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed.. written or implied, relating to the system, the inspection and/or this report. 11 I • i r `N 41 Cs C' l " °Q -91 i I • I 1 f"! l -. 1 1i11I If eW,u 61 r r I i f 4C. I , ri I n a j 4 t v�n Ao C Tl tz Q� I _ — _ . ... r'S .... . ..... , i ` I i SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES MARKED WITH MAGNETIC TAPE OR PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) COMPARikBLE MEANS FOR FUTURE LOCATION. 1. DATUM IS NAVD88 a eyt o� 0otie5 ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE (OVERS TO WITHIN 3" GRADE 2. MUNICIPAL WATER IS EXISTING o TOP FOUND. EL. 32.0' FILTER FABRIC OVER STONE 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. P \ 30.2' MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM F30T \I, \I, 4. DESIGN LOADING FOR ALL PROPOSED PRECAST " Locus BLOCKS OR UNITS TO BE AASHO H-10 PRECAST H-10 MORTAR ALL PRECAST RISERS o RISERS (TYP.) West,a.. z•m 4"OSCH40 PVC COMPONENTS H-10 INV'S EL. 5. PIPE JOINTS TO BE MADE WATERTIGHT. o � ornar PIPES LEVEL 1ST 2' [�2 � FT\ l 27.0' * I BET. SIDES 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE Bay 29.4'* 10" 1500 GAL H-10 14" ENDS 27.83' WITH 310 CMR 15.000 (TITLE 5.) ° ° 28.2' TEE SEPTIC TANK TEE CM]�o 7 95 °°°°°°° o o o o o o 0 0 0 o o o 0 0 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND GAS BAFFLE.; j1 ' °o°o°o°o°0 6" MIN SUMP o ;00000000 [ NOT TO BE USED FOR LOT LINE STAKING OR ANY 40°0°°°0°°° 12" MIN. INT. DIM. �00000����(] DaDa�aaO(]0� ° OTHER PURPOSE. �:... 4' LIQ. LEVEL (ACME OR EQUAL) ' °° 25.0' 8 PIPE FOR SEPTIC SYSTEM TO SCH 40 VC27. �7.14 °°° o 0000000o°o0o0o0o0o0o°o0o0o0°0°0o000000°0°000 -4' P 000 0 0 0 0 o c o 0 0 0 0 0 0 0 0 0 0 0 10,000020000 �000�0�0,�0000000000010�000„0�0000000. o� LH-10 500 GAL. LEACHING CHAMBERS BY ACME PRECAST 9. COMPONENTS NOT TO BE BACKFILLED OR o 3/4"-1-1/2" DOUBLE WASHED STONE (3) UNITS REQUIRED CONCEALED WITHOUT INSPECTION BY BOARD OF 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 40' X 10' HEALTH AND PERMISSION OBTAINED FROM BOARD COMPACTION. (15.221 [2]) _ OF HEALTH. Sri ( 6 SLOPE) (2.9 % SLOPE) ( 1 % SLOPE) 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP CALLING DIGSAFE (1-888-344-7233) AND FOUNDATION- 20' SEPTIC TANK 22' D' BOX 16' LEACHING VERIFYING THE LOCATION OF ALL UNDERGROUND & NOT TO SCALE FACILITY 19.9' BOTTOM TH-1 OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL NO GROUNDWATER FOUND WORK. ASSESSORS MAP 116 PARCEL 055 UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 11. ANY UNSUITABLE MATERIAL ENCOUNTERED PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN LEGEND SAND. 99 EXISTING CONTOUR SYSTEM DESIGN: X 99.1 EXIST. SPOT ELEV. -[99]- PROPOSED CONTOUR GARBAGE DISPOSER IS NOT ALLOWED 198.4] PROPOSED SPOT EL. DESIGN FLOW: 4 BEDROOMS © 110 GPD = 440 GPD TH1 BENCH MARK - CORNER OF CONC. USE A 440 GPD DESIGN FLOW AIR CONDTIONER PAD. ELEV. = 30.2 TEST HOLE YYY SEPTIC TANK: 440 GPD (2) = 880 2% SLOPE OF GROUND USE A 1500 GAL. SEPTIC TANK UTILITY POLE LEACHING: FIRE HYDRANT NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWINGbo SIDES: ? (40 '10) 2 (.74) = 148 GPD 1�� BOTTOM 40 x 10 (.74) = 296 GPD TOTAL: 600 S.F. 444 GPD TEST HOLE LOGS USE (3) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) WITH 2.25' STONE AT ENDS 5' BETWEEN UNITS AND 2.6' ENGINEER: DANIEL E. GONSALVES, SE #13587 CP 100 AT SIDES WITNESS: DAVID STANTON, RS \ DATE: 2/1 1/16 \ LOT A1-2A O PERC. RATE _ < 5 MIN/INCH 10,613t SF EXISTING DWELLING DECK F FNDN 0�' MA CLASS I SOILS P# 14955 EL TOP32.0 O OF T 2 APPROVED DATE BOARD OF HEALTH ELEV. ELEV. \ i 001 30.4' 0" 30.4' d A A T 1 LS LS 14" 10YR 3/2 12„ 10YR 3/2 �' �% o. TITLE 5 SITE PLAN B g G OF 0/s LS LS G / 78 1st AVENUE / 10YR 4 6 10YR 4 6 LpR\vE P�PN� 34' / 27.6 31 " 27.8' / SN�� o �2 �P�oMP\ goo) OSTERVILLE, MA 1�g PREPARED FOR PERC C _ BORTOLOTTI CONSTRUCTION �P�ZN OF MgSS �� ,�;�C IELAPow DANIEL h , DEMENNA FS FS \ / o D OJIALA 0 O L A u'�'" CIVIL q No. 409&0 DATE: FEBRUARY 11, 2016 2.5Y 6 4 2.5Y 6/4 ` �No.465020 �� SOP �o�P / oIsTER� a`` !q FSS �o� off 508-362-4541 �S8 ON AL ENG\ ND SURE I fax 508-362-9880 downcope.com down cape engifteefi#7 inc. 126 19.9 126 19.9 C civil engineers NO GROUNDWATER ENCOUNTERED Scale: 1"= 20' land Surveyors 939 Main Street ( R to 6A) 0 20 3o ao DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA o2675 LICE # 6- ®34 16-034 BORTOLOTTI DEMENNA.DWG