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HomeMy WebLinkAbout0006 GINGER LANE - Health 6 Ginger Lane �,. Oster ville x 4= 165 —017 . 4 n c , r a a p .. . n , a F • o P F ,r - �.1+ ... • � �. ` � 26 , i ti�,c T .. i. 1, ` .P ' • ^ 9 , 4 5 0 ` TOWN OF BARNSTABLE LOCATION ' Gln / SEWAGE# SY 1�- VILLAGE D S r rV,I ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY ton LEACHING FACILITY:(type) 1 (size) NO.OF BEDROOMS �! OWNER ►"err PERMIT DATE: 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 f-7-5 /019- b� a � � 6 a 3a aa` 3 �c� as { j fat�L -- TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT U-ISTALLER'S NAME & PHONE NO. JUG , f=I & 11; SF,PTIC TANK CAPACITY LEACHING FACILITY:(type) loac (size) d /Do NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER ZX, DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: Ae- Zy-" y VARIANCE GRANTED: Yes No ��® o .�� p A `F � l�plZ/1al' t. � 7 I � � � � I d l J THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Alijifirativit for Diti-VniiMl Work,i Tomitrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: ............... .... .. p _...... -------•--•--- ---•••......---••-•---- Location-Address or Lot No. .................... ;......a....... e •.G`v �O?S..z. ....... .....VK4........................ Owner Address ------••---•----- W __T_ 9�!..4.........114LT0........................................ ------------i a - .......!!( .l.ft....... ............................. Installer Address Type of Building Size Lot----- .........�.......Sq. feet ,., Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ... No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------- - - W Design Flow...............RV.....................gallons per person per day. Total daily flow-------------_-5�Y'9.....................gallons. WSeptic Tank—Liquid capacity-_-OQsI_gallons Length................ Width................ Diameter................ Depth.............. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......Z:.......... Diameter------6........... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 14 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I:...............minutes per inch Depth of Test Pit.................... Depth to ground water........................ L% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 94 ----------------------------------------------------------------------------------------•-•................................................................. 0 Description of Soil........................................................................................................................................................................ x V W ..........................---------------------------------------------------------------------•--------••---•-----------------...----...------------------•-•-•----------..._----••-••-------••....... V Nature of Repairs or Alterations—Answer when applicable.-___._----------------------------------------------------------------------------------------- -------------------------- --------------------------------•-----------------------------------------•----•--------------•-•----••-•-•--•••--------------------------------............................ 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 h ee issued by the board of health. Signed .... L/'�"--*............................. --- --- ------------ - Application Approved - - 11 ......��. � Q.........--------------------'------- Dace Application Disapproved for the following reasons: .... ......:.............. .............. -- ............. .........................................../..1..... ....... .....:.....--------------------------------------------------------------- --------------------------------------- Permit No. ` f�.... ��................... Issued ....� 'G... ''. � Dare 1 7. y N f V/ 'j ` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works Tonotrnrtion Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: / _ �a E --tqE....-.eS_r.T"j ,4--------- --------------------1.-�dr'-.....- -------•--•-------•----...-•---------•----...----- -------------•-•---- Location-Address or Lot No. ..... ) fox Z 7 Osk,-,. Ite�� r%_____-------•-----__•- ------' ----••- - •-•-----•---••-...------ Owner Address a .MR tl.l 6.44 yV1 c.:..c fw c /n ,/i /ZL>q --------------------------•-----•:••-••---••-•------ Installer Address d Type of Building Size Lot-----�?-t-_ :.......Sq. feet Dwelling—No. of Bedrooms________--�_________________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building .._ No. of persons___________________________ Showers ( ) — Cafeteria ( ) dOther fixtures --------------------------------------------------------------------------------------- ----------------------------------•----••-------------------- W Design Flow............... per person per day. Total daily flow_.-....._..__S ........................gallons. WSeptic Tank—Liquid capacity.!�20d_gallons Length................ Width---------------- Diameter---------------- Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No-------z........... Diameter...__l'___-__-__ Depth below inlet____________________ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q+' -----------------------------------------------------------------•--•--------------•........._------......................................................... 0 Description of Soil............................--------------...-•-----....._..--•--•-------------------....-----------------------------._._._....--------------------------....---••-•--- x V ....-----•-•-----------•-------------------•---•--...--•••-----•---•--••----•--•----•--------------•--------•----------•------------------•-------•••-----•---•-•-------•--•----.......-----•-••-------- UW ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--- Nature of Repairs or Alterations—Answer when applicable._____......................................................................................... -•-- •-••-•--------------------•--••-----------------------------•--------------•-•---.....-..--------------------•-----------------------------------•-------------•----••---•-•---•-•........-..----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has-been,issued by the board of health. Signed ........- .a - -.4�"..`.. ........ .......................... . - - ..-.....--....-- - !`�/ � Dace Application Approved B ���V Dve Application Disapproved for the following reasons: ..................................... 11-... ...... - ........................................... ....................... ............--------..------------------------------------------------------------------------------ ---------------------------------------- Permit No. ...............:........... � '`------------------- Issued ...- . . '.. � f.... if r P Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE V Ertifi.rate of TII>r plialare THIS IS TO ER CtT JFY e Individual Sewage Disposal System constructed ( ) or Repaired ( ) -` } That the�l by .........................."1�--.�a. 1..... - -......_ -Insrakr - at ..... .. �` `" '� ...... ... � C 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. ...1_4' . �'�'`.�.. dated ., 3c' .' ...�. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. .Y DATE---- ..... ... I`�� ................................ Ins ect o r ,-c, ==. t*�y>✓f'/. Y - p cam..-_. �...I.......1,--- :..t--------� THE COMMONWEALTH OF MASSACHUSETTS -~ BOARD OF HEALTH TOWN OF BARNSTABLE No............. FEE....................... Disposal Works T,anotrudion Prrmit Permission is hereby granted............... / '-----------------------------------•-----------------...._.-........•.. to Construct orj Repair (,�) an[Individual Sewage Disposal-System at No. ' `"ayl, 't ! -'�� !�" ' " !!. �? ' -�------ . ........................... .� f-' Street as shown on the application for Disposal Works Construction P�f it �N�4__ 'ated r � ��— r -------->r----.. -_ Board of Health �f DATE. � ------------------- / FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS ' COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS R DEPARTMENT OF ENVIRONMENTAL PROTECTION : . TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 6-Cin-aer Lane Osterville, MA 02655 Owner's.Name: David&Ann Riley L% Owner's Address: Date of Inspection: September•9. 2070 Name of Inspector: (Please Print) James R7 Ford Company Name: James M. Ford. Mailing Address: P.O.Box 49 4 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 eeds Further Evaluation by.the Local Approving Authority ils Inspector's Signature: Xr4 Date:. September 13, 2010 The system.inspector shall su it 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 systei'n owner and copies sent to the buyer,.if applicable, and the approving authority. Notes and Comments r ****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 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: 6 Ginner Lane Osterville, MA Owner: David&Ann Riley .Date of Inspection: September 9, 2010 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 compietion.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: 6 Ginger Lane Osterville, MA Owner: David&Ann Riley. Date of Inspection: September 9, 2010 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 l of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less 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 f Page 4 of I 1 OFFICIAL INSPECTION.FORM NOT FOR VOLUNTARY ASSESSMENTS . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 6 Ginger Lane Osterville, MA Owner: David&Aran Riley Date of Inspection: September 9, 2010 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 purnping 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 L Page 5 of I 1 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 6 Ginger Lane Osterville, MA Owner: David&Ann Riley Date of Inspection: September 9, 2010 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ _ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? ✓ Were all system components,excluding the SAS, located on site? ✓ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? ✓ Was the facility owner(and occupants if different from owner)provided with information on the.proper maintenance of subsurface sewage disposal systems? The size.and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in-the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 f Page 6 of I 1 OFFICIAL INSPECTION.FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: b Ginger Lane Osterville. MA Owner: David&Ain Riley Date of Inspection: _ September 9, 2010 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 5 per as-built Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 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 avai lab]e.(last.2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Weekend use COMMERCIAL/INDUSTRIAL Type of establishment: Design.flow(based on 310 CMR 15.M): 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: Unknown 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: added nervier pit 12123194- per as built card Were sewage odors detected when arriving at the site(yes or no): No 6. Page 7 of 1 I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 6 Ginger Lane Osterville, MA Owner: David&Ann Riley Date of Inspection: September 9, 2010 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron _40 PVC other(explain): Distance from private water supply well or suction liner Comments(on condition of joints, venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 30" 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 a� 1. Sludge depth: 2,, Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 6" 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.). Cement tees were present. The lipttid level was even ivith the outlet invert. There did not appear to be any signs ofleakau. The outlet cover ivas 15 below mde. 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 fi-om bottom of sctun to bottom of outlet tee or baffle: 'Date of last pumping: Continents(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 6 Ginger Lane Osterville, MA Owner: David&Ann Riley Date of Inspection: September 9, 2010 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 f Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 6 Ginger L ne Osterville, MA Owner: David&.Ann Riley Date of Inspection: September 9, 2010 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation,not required) If SAS not located explain why: T � ype ✓ leaching pits,number: 2- 6'x 6'(1000 gal.)per as-built card leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number, dimensions: overflow cesspool, number: Innovative/alteitative system Type/name of technology: -Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.) The newer nit was drv. The satin line.was 3'zty Born the bottom. There did not appear to be onv signs offailure The bottom to grade was 10.S'. 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 nq): 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 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 6 Ginger Lane Osterville, MA Owner: David&Ann Riley Date of Inspection: September 9, 2010 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. QL 3 3 A, 39 10 Page I I of I I - OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART C SYSTEM INFORMATION (continued) Property Address: 6 Ginger-Lane Osterville, MA Owner: David&Ann Riley Date of Inspection: September 9, 2010 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 30 +/- feet Please indicate(check)all methods used to determine the;ugh 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 contottis mks Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high groundwater elevation: Using Barnstable topographic and water contours reaps the maps were shownn3z gpproximately 30'+1-to ground water at this site. This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed as of the date of inspection. This report is not a warranh,or guarantee that the`systenz will function properly in the future. There have been no warranties or guarantees, either expressed, i.vritten or implied, relating to the septic system, the inspection, this report and/or any components of the septic system ivhich have not been located and inspected. II r COMMO NWEALTH' WEALTH OF MASSACHUSETTS ,EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROT ECTION OD� TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A. CERTIFICATION Property Address: 6 Ginger Lane y Osterville, MA 02.655 Owner's Name: Steve&Andrea Perry l U S . 0 l Owner's Address: , I Date of Inspection: August 28, 2007 - I Name of Inspector: (Please Print)Janes 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 a'm a DEP_ approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Cn Passes c,� C nditionally Passes , e ds Further Evaluation by the Local Approving AuthQcty w M l a' s G U, Inspector's Signature: Date: Au ust 30 2007 The system inspector shall su it a copy of this inspection report to the Approving Authority(Board of ealth or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design.flow f 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 l Page 2.of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS - SUBSURFACE SEWAGE DISPOSAL-SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 6 Gin—aer Lane Osterville. MA Owner: Steve&Andrea Perry Date of Inspection: August 28..2007 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 detenmined",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: 6"Gin ger Lane Osterville MA Owner: Steve&Andrea Perry Date of Inspection: August 28 2007 C. Further Evaluation is Required b the 9 Board Y of Health: Conditions exist which require further evaluation by the Board of Health in orders 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 Q 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 colifortn 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: n t 3 i Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 6 Ginger Lane Osterville, AL4 Owner: Steve&Andrea Perry Date,of Inspection: _August 28. 2007 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.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as -described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd-to 15,000 gPd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in"Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 o OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWA_GE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 6 Ginger Lane Osterville, MA Owner: Steve&Andrea Perry Date of Inspection: August 28, 2007 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 backup? ✓ _ 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 I 1 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY+AS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATIOiv Property Address: 6 Ginger Lane Osterville MA Owner: Steve&Andrea Per Date of Inspection: August 28 2007 RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): S er as-built Number of bedrooms(actual): S' DESIGN flow based on 310 CMR 15.263 (for example: 110 gpd x.#.of bedrooms): SSO Number of current residents: p Does residence have a garbage grinder(yes or no): n1a Is laundry on a separate sewage system(yes or no): 'n/a [if yes separate inspection required Laundry system inspected(yes or no):. No,. a ] Seasonal use(yes or no): No Water meter readings;if available(last 2 yearn usage d Sump Pump(yes or no): No g �gp )) Unavailable Last date of occupancy: Unknown COMMERCIALANDUSTRIAL . 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: unknown 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 Other(describe) Attach a copy of the DEP approval, Approximate age of all.components,date installed(if known)and source of information: added newer it 12/23/94- er as built card Were sewage odors detected when arriving at the site(yes or no): No - 6 it Page 7 of 11 OFFICIAL INSPECTION FORM . NOT.FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) . . Property Address: 6 Ginger Lane — Osterville MA Owner: Steve&Andrea Perry Date of Inspection: August 28. 2007 BUILDING SEWER(locate on site plan) Depth below grader Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting;evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan). Depth below grade: 3.0" 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 a� 1 Sludge depth: 21' . Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: S" Distance from top of scum to top of outlet tee or baffle: 6 Distance from bottom of scum to bottom of outlet tee.or baffle:. 10 How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.):. Cement tees were present. The li uid level was even.with the outlet invert. There did not d ear to be an si ins o leaka e. The outlet cover was 1 S"below rade. 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: Connnents(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: 6 Ginger Lane Osterville, MA Owner: Steve&Andrea Perry Date of Inspection: August 28, 2007 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.): F . 8 .. 4. Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 6 Ginger Lane Osterville MA Owner: Steve&Andrea Perry Date of Inspection: August 28 2007 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why; --------------- Type ✓ leaching pits,number: 2-6'x 6'(1000 al)ner as built card 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 newer it had Lof 1i uid on the bottom. The scuoi line was' `u rdin the bottom. There did not appear to be any signs o failure. The bottom to grade was 10.5' 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 l0'of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESS SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION FORM PART C. SYSTEMINFORMATION(continued) Property Address: 6 Ginger Lane Osterville MA Owner: ._ Steve&Andrea P.- Date of Inspection:. _August 28 2007 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. AL � O � Q . a 3;I 10 ,., Page 11 of I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C w SYSTEM INFORMATION(continued) Property Address: _" 6Ginger"Lane Osterville MA Owner: Steve&Andrea Perry Date of Inspection: _August 28 2607 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 30+/_ 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:_TonoQradhic and water'contours naps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high groundwater elevation: Using Barnstable topoggryphic and water contours ma s the ma s were-showihg a roxintatel 30'+/-to round water at this site. This report has been prepared only for the septic system and components,.described herein. This septic system has been 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 septic system, the inspection,this report and/or any component;of the,septic system which have not been located and inspected. - 11 Town of Barnstable F THE Regulatory Services BARNSTABLE, Thomas F. Geiler,Director 1639. A�O� Public Health Division Thomas McKean,Director 200 Main Street, Hyannis; MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality.of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. . TOWN OF BARNSTABLE LOCATION (n ---J..'�N� SEWAGE # VILLAGE ®SY ifi?.c-� ASSESSOR'S MAP & LOT ^ INSTALLER'S NAME & PHONE NO. Cko 'i Cc `i�. ILL G,237 �Y SEPTIC TANK CAPACITY LEACHING FACILITY:(type) Pi I— NO. OF BEDROOMS___:� _PRIVATE WELL OR PUBLIC WATER_ Py BUILDER O OWNER DATE PERMIT ISSUED: DATE C011PLIA NCE ISSUED___, VARIANCE GRANTED: Yes No DC } -rawAl CaPy No.1/135 FIm......... . .:.. .. . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works Tonstr ion rrnti# Application is hereby made for a Permit to Construct ( . ) or Repair ( ) an Individual Sewage Disposal System at: ----------- --- -. ........... .. .......- ... ... ----....----------�----- .� Location-Address Ir Lot N Ow r -Address a .....� -5---......./LD s_ �S'Y� �n: - �r'�, t' = E ._/91'. 4 r -- Installer Address Type of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms................ .........................Expansion Attic ( ) Garbage Grinder ( ) `14 Other—T e of Building ............................ No. of persons............................ Showers Cafeteria 04 Other fixtures ------------------------•-•••-••--••--••.............................. WDesign Flow............................................gallons per person per day. Total daily flow.........................................:•_gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter-------------.-. Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No..................... Diameter.................--. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by..................................................•------------------------ Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.......----............. 0z Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P ------------------------------------•---------------------------.--.------------•-----------------.........---•------------••----•-••-----------•------------ 0 Description of Soil...............................................................................-------------•---------•---------------------••-----------------------------•--•-•••---- x V W U Nature of Repairs or Alterations—Answer when applicable.....- -.. ems.. ? 1 _ i?1 lie ._nt: 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 s been issued b the board of health. `� - �.. Signed ------- -- ---- .............................. Application Approved By -------------V ------ -'^-^- _--------------------------- --...------ ........................... UDate Application Disapproved for the following reasons- ............................--------------------------------------------------------------------------------------------------------- --------------------------------------------.................................................................................. .......................... ---------................................. .................. ---------------- PermitNo. .........13--... ' - Issued ......................................................... te...... Dare A No.. FEs........._.._..:......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ?- TOWN OF BARNSTABLE Appliratiun for Disposal Vorkg Tonstrudiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: lercv�Gla � it��a�al�- .r/..- - - --•--......... Location-Address Lot No ............... .-�......_.. - �� � !V_..��SLcU6 Ow r Address ......... ....... --------...... _.....--- !-----........._....*.. } Installer Address QType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms......................_.....___.....___.....Expansion Attic ( ) Garbage Grinder ( ) `CLILI Other—T e of Building No. of persons............................ Showers — Cafeteria 04 04 Other fixtures -------=-----------------------------------------------------•------•------•---------------------•-----•-...--•------•---•---......---.....-•---•---- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length------------y. Width................ Diameter---------------- Depth_-_.-__--_-____. W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area_...................sq. ft. x Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area...................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results ! Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water--__--__-__.____-______- f=t Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------___----____. P+ •--•-•--•-------------------------------•------•---------•-•-•--•---•-•-••-•-----... ................................................................ 0 Description of Soil...............................................................................---------------...---•----••-•-•-----•--•-----------••-••-•---•---••--•-._..........---- x ---------------------------------------------------------------------------------------•-------------------------------------------------------•--................................... . -- - V Nature of Repairs or Alterations—Answer when applicable_.___©its__4�_ +� s_. t9 / ....t-ze--'n-1!✓ i� - L � ---A-,- t 7 5't _ �� Y 2 or � gAL-L1 � _ t®�'{---------------•------------------------•-----................. Agreement: i 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 -^as been issued by the board of health. Signed ------------ /jyq �L S � . ---. - -----�..G�.....q".-. �-------------------_-- .---_---- -..-Date-.-.-----------7 F ApplicationApproved BY - ... ............ .............................._............---------...---'------............ Date Application Disapproved for the ollowing reasons- ------------------------------------------------------------------------------------------- ---------. t Permit No- --------- -- - ---7.3.� Issued...................... � ................. Date------------..-----------Date------ . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Vert irate of (goxnylianu THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( V') by -- - oS.-I --p�---a..--- �--- .....Ciwl �- t,-.. .........(-� Installer�,/_ at ..............(51.......5 ... --------0S YY ....AtA. �........................................-------------------------------------------- has been installed in as ordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ....... >.�_-----7..��:.... dated ----------------------------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......... ................... ------------- -----------------------...------- --- Inspect f�'...... ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No...j?n.726— TOWN OF BARNSTABLE Disposal Vorkv Ounstrudiun orrmit Permission is hereby granted.........&I...... .....�,.S vl/l _._/L� to Construct ( ) or Repair ( an Individual S4rage Disposal System atNo... . --------(�x4 - ---------------------------------•---------------- Street Q? as shown on the application for Disposal Works Construction Permit No..Q.....l�.' ...... Dated.......................................... ..................................... 4. -.....-------------•-••-•--•--.....------. ................................... rd of Health DATE........... � FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS 11 i I i PROPO EXIST. DIST/BOXSED 6' x 6' LEACH PIT W/1' STONE EXIST. 1000 GAL/TANK EXIST. 6' x 6' LEACH PIT x 49.8' x 49.9' 141.51' N 85'14'25" E x00 48.9' DENOTES EXIST/PROPOSED GRADE 48.9' 0 164 uF 10' 18.6' 22.0' \ r, PROPOSED DISCHARGE x N .P X W, PROPOSED N 32 jio cir N� 10. PROPOSED DRIVEWAY GARAGE o 6. EXIST: 0' io x 49.4' ra �' h o, DISCHARGE PIPES v; n EXIST. x 16.2' m 47.52' 13.0' ' No DECK rn PROP. 4' x o ADDITION 49.0' 0 15.0' /EXISTING WOOD FRAME DWELLING _ x 16.3' Za3' l_ 4s.53' LOT 26 13,360 sq.ft. aoME Ir 75.00' N 88'46'20" E OWNER: FREDERICK P. MEADE #6 GINGER LANE OSTERVILLE, MA. 02655 APPLICANT: STEPHEN PERRY L r 4 ZONING DIST: RC I BARNSTABLE ASSESSORS: MAP 165, P-17 I SN�6T" 1 of Z I CERTIFY THAT THE STRUCTURES ARE SHOWN SITE PLAN OF LOT 26 ON THE PLAN AS THEY EXIST ONTHE GROUND. IN DATE PROFESSIONAL NA SURVEYOR GRAPHIC SCALE t - :44 �'" a BARNSTABLE OSTERVILLE MASS. 20 0 10 20 40 ao jo mow, 1 ^ FOR mro I "` STEPHEN PERRY DATE: 9-14-94 SCALE: 1" = 20' _ IN FEET ) i inch = 20 ft. � S.DOYLE AND ASSOCIATES 42 CANTERBURY LANE FALMOUTH, MA. 02536 t�laTe : L--r zco ►.IF— era A FLOQ-o wA-zN-Mo z4tt TELEPHONE: 508/540-2534 i r ,> j PROFILE OF PROPOSED SEWAGE SYSTEM (PROPOSED GARAGE) TOP FOUND. EL -A9Z NOT TO SCALE at DESIGN DATA: STRUCTURE ►aP'4RAVE >=k•5T. 3 '1SEDTLeoM RES\�Elyctc -�a S'S��ayn ' DESIGN FLOW 5 B£DRasT'1S X 11 a 41'1L �BR���ssVn �Z�Y ° 1.0' MIN/COVER s x Ito, = sso ate,ptt y-y—sA*L1'IL°L 1 ` A 4 \ � e1S o INV. EL. 4C.•9 ••' + • L INV. EL M%%Tc4i INV. EL. Mat d i EKtsT Est ° , v SEPTIC TANK S>:O X \.� = 9zs �+Pb - �.►SE \Qos 9"yt T'yk%y, °\ EXISTING • °• u y ••' ��iti\fT��►CS) EXISTING 1000 DIST/BOX e .e GALLON TANK INV. EL. MaT�µ a LEACHING FACILITY Z R `Il 4 x C. x z S = 75-1 x Z= '►SZ 4v� INV. EL. q4•p b °AA ' b . • '�eROh: 'lC 1,T1 x 1.0 5Q x Z - \O0 ZAp"Q ° INV. EL Nw�c µ ' . { e E+c\sj; S •1S?- \00 =857L t•L i 9SZ- 55o = 'lot 4vru \H R�s�titE _� McRE¢.u►\. 1kp lid 4.'x c: s m r, -oNF 1n'&tT . pus ncgpe wb 8 DESIGN STRUCTURES TO BE SET ON A LEVEL BASE NO aTFR ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE ALL PIPES SHALL BE SLOPED 1/4" PER FOOT EXCEPT FIRST TWO FEET OUT OF DIST/BOX WHICH SHALL BE LEVEL 6"DIA. x 6' EFF/DEPTH ALL MATERIALS AND CONSTRUCTION METHODS SHALL CONFORM WITH MASS. TITLE V LEACHING PIT W/1' STONE ENVIRONMENTAL CODE. j (ONE EXISTING - ONE PROPOSED) NOTE: DURING SYSTEM INSTALLATION IF SOILS INCONSISTENT WITH RAPID PERC (2 MIN OR LESS) ARE ENCOUNTERED CONTACT THE BARRNSTASLE HEALTH DEPARTMENT OR S. DOYLE AND ASSOCIATES. ` S1iE'CT '7— -F ZL • i t SITE PLAN OF LOT 26 IN BARNSTABLE (OS TERVILLE) MASS. FOR STEPHEN PERRY A of ar�ss ���� STEPHEN tcyGN +�,�`MtMYff��s DATE: 9-14-94 DOYIE S.DOYLE AND ASSOCIATES Na 37559 v �f ~ 42 CANTERBURY LANE FALMOUTH, MA. 02536 C, TELEPHONE: 508/540-2534