Loading...
HomeMy WebLinkAbout0031 JASON'S LANE - Health 31 Jason' s Lane, Osterville A = 121-123 t a, • � a 4 i F i TOWN OF BARNSTABLE LOCATION 3t ,Qsv& SEWAGE# Z 0 17 - Z 30 VILLAGE d 57'er-(rs/!.2 ASSESSOR'S MAP&PARCEL 1A1 /%"3 (- INSTALLER'S NAME&PHONE NO.L%og Z 0/0 SEPTIC TANK CAPACITY /®®D LEACHING FACILITY. (type)/61„��`�fw�¢�o�S (size) NO. OF BEDROOMS 3 OWNER � —1 Z — 2© 1 PERMIT DATE: `T— ! Z—Z y f c 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) i Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facilit z-0 Feet FURNISHED BY c i Al 27 97 �� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes fipfication for ]Disposal *pstent (Construction 3perndt Application for a Permit to Construct( ) Repair(4 Upgrade( ) Abandon( ) ❑Complete System Mll/ndividual Components Location Address or Lot No.3( JAS-6a1Y " ^r 2- ®slrv- Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 121 /L 3 fArM,2- Installer's Name Address,and Tel.No. Designer's Name,Address,and Tel.No. $cvSFie..lc� SAc�N-4s`1 061-- CNui go Y, 664 Y4A0-0,1a ©as&5 kH 26i0 1 r? fT s*"oweA Ma.- P73 2 /77 Type of Building: Dwelling No.of Bedrooms -3 Lot Size sq.ft. Garbage Grinder(00 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) .3.3- gpd Design flow provided 335 gpd Plan Date (p l l Number of sheets Revision Date /VOA,,"e. Title r Size of Septic Tank 2.,(/S"r JW J Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1 A-Ix- (,.eccA A 7 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed L - Date 7-16 " Application Approved by Date /L l Application Disapprove y Date for the following reasons Permit No. g o l 93 0 Date Issued _ '/ -.�":.,n•.:;_.-.:-«.•'.""'•;^. y....::n.F-e � .ii..'w.-i,.e,_„....�q:-.•.ns.-.:�.;-y.•:w-.:.w...w....-.,..,.--.•,w.-a,,..-. ..,,.....� y ... ,. ..,,,. .•ia�.+rr +ris• -,T+�reNw'^�,'�.rr�-kr+.,.w+.w-�....s,,......-.,.,......-.,e, ..., No. Fee THE COMMONWEALTH OF MASSACHUSETTS `'Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Zisposat Opstem Construction 3permit Application for a Permit to Construct( ) Repair(✓) Upgrade.'( Abandon( ) ❑Complete System V Individual Components Location Address or Lot No. t S on f t A 1.e- 0 S T Owner's Name,Address,and Tel.No. '8or3 N0/A', Assessor's Map/Parcel /Z/ !/- 3 f AM"PE. Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. P,GvS —_jc ( k 5A4 4Ary ()f�< 6 /UV1 dry t ^z .;dA)- 0-1a o25&'5 c7jo 2010 PG J SAr�fj(,,ire-k rt. rti. 13 2 ( 77 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(06) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Y Other Fixtures Design Flow(min.required) Q gpd Design flow provided 335 gpd Plan Date 6- 1 - (( Number of sheets / Revision Date tyaAje Title Size of Septic Tank xl�x l3 t /000 Type of S.A.S. �f �°f j Description of Soil ,c Nature of Repairs or Alterations(Answer when applicable) fl�..P_ft!A e �-4, l z,� L.e4 C A P(7 Date last inspected: Agreement: ,r, .The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in 4 accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date �- /1S t r Application Approved by Date /L Z-0 l Application Disapprove y I Date for the following reasons ,K Permit No. g D l l ' 93 0 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 6 y`'S 7�C !-t ,74/t r A cr J p--yr c,e- 7 At C, at, 3/ �J-4 f 6 A L A,1-_ Of i e,rr"At— has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 01)- Z30 dated ( (Z Zo I l Installer 90,13-ke S P.✓✓rr` :;A C Designer 6A( L/Vt1 #bedrooms ?j Approved design flow 3?0 gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date 491 o Inspector J,'i✓'" IL `'l - - - - - - - - ------------- No. _C7 Z So Fee%//00 a(� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION "BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction Vermit Permission is hereby granted to Construct( ) Repair(v) Upgrade( ) Abandon( ) System located at / 7 A j 6 W .44-e- Of�P/Ur ll� 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. Provided:Construction must be completed within three years of the date of this permit. Date 17-1 Zo i i Approved by Town of Barnstable �tHWE r Regulatory Services ti °,. Thomas F. Geiler,Director MASS. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: to _ Sewage Permit# 2 O 1 '13v Assessor's Map/Parcel 2 /Z Installer&Designer Certification Form . 6(1is Designer _ Installer:.`"' � �•- A51 � tGrl IaP� Address: Address: On (2 ..( � 0 US4 C. d was issued a permit to install a (date) (installer) 1 r9eptic system at ::VA based on a design drawn by (address) dated C� I I i (designer) . a <l,'cartify that the septic system referenced above was installed substantially according to tle_°design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local R '-+.ions. Plan revision or certified as-built by designer to follow. Stripout (if rP ".cted and the soils were found satisfactory. �OF tijgs DAVIDB. 9�y` (Installer's Signature) o MASON j v 9 No.1066 IST P q (Desig is Signature) PLEASE RETURN TO BARNSTABLE PUBL._ fE OF COMPLIANCE WILL NOT BE ISSUED UN t iL nu i n i nia r'ORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice fonnsWesignercertification form.doc �1 Z z)Al e. mAfo, oF�� Town of Barnstable # ] l Department of Regulatory Services MAn Public Health.Division Date �" v 16.19 �'� 200 Main Street,Hy annis MA 02601 �ArF4 MAt A Date Scheduled ) 7 U^. /D Time--F —�_ Fee Pdl VJ Soil Suitability Assessment for z Sewa e"D. �W g sposal Performed By: < Witnessed By; n LOCATION & GENERAL INFORMATION 0 Location Address (j -Tk a,v 5- `A/� - / fJJ'T4.- Owner's Name 130l A o l4✓! Address 31TA-50W S L4 BS7ewjk e— Assessor's Map/Parcel: ) _ I - / Engineer's Name Q.!/(/! - NEW CONSTRUCTION REPAIR Y Telephone# 97 3 Z, 7 7 Land Use Slopes(9oj Surface Stones Distances from: Open Water Body' =ft Possible Wet Area Drinking Water Well ft Drainage Way ft. Property Line Other ft SKETCH: (Street name,dimensions OfMlot,ex ct locations of test holes&Pere tests,locate wetlands in 'Proximity to holes) ..x ' r Z Parent material(geologic)_-_©_L "" �"'_ _ - _ y~Depth to"Bedrock'"� Depth to Groundwater. Standing Water in Hole: 1 Weeping Prom Pit Face Estimated Seasonal High Groundwater Method Used: DETERAUNATION FOR SEASONAL HIGH,WATER{TABLE ' Depth Observed standing in obs.hole: Depth to weeping from side of obs.hole: in, Depth to soil mottles: Index Well# In. aroundwnterAdjustment in, Reading Date: Index Well level Ad.,factor _ ft. Adj.Grauhtlwnter Level is PERCOLATION TEST bt te Fof I `, �~ - I i— Time at 91 '^. Llasoak Time @ _-- . n t Time(9" G') oak/Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YM) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one (1) week prior to beginning. Q:4S EPTICTER CFO RM.DOC DEEP-OBSERVATION HOLE LOG Hole#Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) (USDA) Other (Munsell) Mottling (Structure,Stones;Boulders. llofi istency,% ravel Dept DEEP OBSERVATION HOLE LOG' Hole# Surfs from Soil Horizon Soil Texture Soil Color Soil Surface(in.) (USDA) Other (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel}_ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) Other _ (USDA) (Munsell) Mottling (Structure,Stones;Boulders. 00—ngigtency,% Gravel DEEP OBSERVATION HOLE LOG Hole# Depth frcm Soil Horizon. Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, I Flood Insurance Rate Man: Above 500 year flood boundary No es Within 500 year boundary No� Yes Within 100 year flood boundary No l! Yes . Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious enal exist in a]I areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material'? Certification JO I certify that on (date)I have passed the soil evaluator examination approved by the Department of.Envir nmental Protection and that the above analysis was performed by me consistent with . the required training,e, er ' a experience described in 310 CMR 15.017. Signat Date 0/0 Q:\.SEPTIC\PERCFORM.DOC 1 Commonweatfh of Massachusetts Executive Office of Environmental Affairs Q0 . ,A Department of p 28. Environmental Protection � '0"A�FBA�Nsr 199? N William F.Weld Govemor Trudy Coxe t Sec etary,EOEA A yy David B. Svuhs Commissioner 350 MAIN ST, W. ARMQI3eTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION MAP#121 PAR#123 PROPERTY ADDRESS: 31 Jason Lane, Osterville ADDRESS OF OWNER: DATE OF INSPECTION: July 9, 1997 Rachael Newkirk NAME OF INSPECT,OR'James D. Sears COMPANY NAME, ADDRESS AND TELEPHONE NUMBER: A& B CANCO, 350 MAIN STREET, WEST YARMOUTH, MA 02673 (508)775-2800 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X PASSES CONDITIONALLY PASSES NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY FAILS Inspector's Signature: � a Date: July 15,'1997 The system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, or C A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: N/A One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or NO). Describe basis of determination in all instances. If not determined", explain why not) The septic tank is metal, cracked, structurally unsound,shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (REVISED 11-03-95) One Winter Street Boston, Massachusetts 02108 Fax(617)556-1049 Phone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (CONTINUED) . Property Address: 131 Jason Lane, Osterville Owner: Newkirk, Rachael Date of Inspection: July 9, 1997 ' B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level obsdrvea in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four 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 C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _N/A_ Conditions exist which require further evaluation by the Board of Health in-order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,.unless a well water analysis for coliform bacterial 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. 3) OTHER Y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 131 Jason Lane I ` Owner: Newkirk, Rachael Date of Inspection: July 9, 1997 D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined N/A in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure: Backup of sewage into facility or system component due to an 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 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above' N/A The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exits: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a,tributary to 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the,local regional office of the Department for further information. 3 S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 131 Jason Lane, Osterville . Owner: Newkirk, Rachael Date of Inspection: July 9, 1997 Check if the following have been done: X Pumping information was requested of the owner, occupant, and Board of Health. X None of the system components have been pumped for at least two weeks and the system has not been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection X As built plans have been obtained and examined. Note if they are not available with N/A X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow X The site was inspected for signs of breakout. X All system components, including the Soil Absorption System, have been located on the site. X The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. X The size and location of the Soil Absorption System on the site has been determined based on existing-information or approximated by non-intrusive methods. X The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C Il SYSTEM INFORMATION" Property Address: 131 Jason Lane, Osterville Owner: Newkirk, Rachael Date of Inspection: July 9, 1997 FLOW CONDITIONS RESIDENTIAL: Design Flow: 330 gallons Number of bedrooms: 3 Number of current residents: 0 Garbage grinder(yes or no): NO Laundry connected to system (yes or no): YES Seasonal use (yes or no): NO Water meter readings, if available 94-95 43,000/95-96 17,000. Last date occupancy: UNKNOWN COMMERCIAL/INDUSTRIAL: '` { Type of establishment: r Design flow: gallons/day Grease trap present:(yes or no) Industrial Waste Holding Tank present:(yes or no) Non-sanitary waste discharge to the Title 5 system:(yes or no) , Water meter readings, if available: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: N/A System pumped as part of inspection:(yes or no) If yes, volume pumped: gallons Reason for pumping TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes, attach previous inspection recods, if any) Other(explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: 1981 PERMIT#80-377 Sewage odors detected when arriving at the site:(yes or no)- NO SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 131 Jason Lane, Osterville Owner: Newkirk, Rachael Date of Inspection: July 9, 1997 SEPTIC TANK:_X_ a (locate on site plan) Depth below grade: 16" Material of construction: X concrete metal FRP other(explain) Dimensions: 1,000 GALLON PRE CAST Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 3319 Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 12" fr Distance from bottom of scum to bottom of outlet tee or baffle: 13" Comments: (recommendation for pumping, condition of inlet and outlet tees ;or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc) TANK AT WORKING LEVEL, INLET AND OUTLET BOTH HAVE BAFFLES IN PLACE,COVERS 16" BELOW GRADE. GREASE TRAP: N/A (locate on site plan) Depth below grade: Material of construciton: concrete metal FRP 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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 131 Jason Lane, Osterville Owner: Newkirk, Rachael Date of Inspection: July 9, 1997 TIGHT OR HOLDING TANK:_N/A_ (locate on site plan) Depth below grade: Material of construciton: concrete metal FRP other(explain Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert: 0 Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) D-BOX IS 16"X 21112811 BELOW GRADE, ONE LINE IN, ONE LINE OUT PUMP CHAMBER:_N/A (locate on site plan) Pumps in working order:(yes or no) (note condition of pump chamber condition of pumps and appurtenances, etc.) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 131 Jason Lane, Osterville Owner: Newkirk, Rachael Date of Inspection: July 9, 1997 SOIL ABSORPTION SYSTEM (SAS):_X_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: 1 leaching chambers, number: leaching galleys, number: leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number. Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 1,000 GALLON PRE CAST PIT,PIT AND COVER 3' BELOW GRADE, PIT DRY, NO HIGH WATER MARKS, WALLS ARE CLEAN. CESSPOOLS: N/A (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 cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc) • PRIVY: N/A (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.) 8 -. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 131 Jason Lane, Osterville Owner: Newkirk, Rachael Date of Inspection: July 9, 1997 SKETCH OF SEWAGE DISPOSAL SYSTEM: INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCES LANDMARKS OR BENCHMARKS LOCATE ALL WELLS WITHIN 100' DEPTH TO GROUNDWATER Depth to groundwater: feet method of determination or approximation: LOT HIGH NO GROUND WATER PROBLEM f F, PERMIT NUMBER' DATE COMPLETED BY—. HIGH GROUND-WATER LEVEL COMPUTATION Site Location: 131 Jason Lane, Osterville Lot No. Owner: Rachael Newkirk Address: Contractor: Address: Notes: STEP 1 Measure depth to water,table tonearest 1/10 It. .............................................................................. Date month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well.................................................... © Water-level range zone ....................`...........................:...:.` STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to water level for index well ........................... month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 26) determine water level adjustment ................................................................................:......... STEP 5 Estimate depth to high water by subtracting the water• level adjustment (STEP 4) from measured depth to water level at site (STEP 1) ...................................................... 3 . Figure 13--Reproducible comutation form. _ � 10 90- 3- 77 L_0 C'A T ION SEWAGE PERMIT NO. S 6 ti 5 L-,U, IL LACE / Ile., INSTALLER'S NAME i -ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED q 12-17 -mod Z G Yl JQ r Y pr� . ®!/. 3 No ._...�.� .............. THE COMMONWEALTH.OF MASSACHUSETTS BOAR® OF HEALTH 1 nW.ti...............OF.-.-.Q., .�z� -, , 1 p... ...................... ApplirFation for Dhip a al Works Tomitrnrtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address /, , or t 0' -' �! �G.�...L.. , ..._ ..�: _.e�.NOf��� Owner ddress+ /V W ...'... ��.. 4..... ... /. ...... t 1.... Address /� g Type of Building LC Size Lot ....Sq. feet .. Dwelling—' No. of Bedrooms__________ _______.........................Expansion2ttic (1�' Garbage Grinder ( ) Other—T e of BuildingNo. of person............................. Showers — Cafeteria P4 Other fixtures -------------------------------- -------------------------------- --------- ------ Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid'capacity.....__...._gallons Length................ Width................ Diameter__-____._______. Depth................ 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 t '~ Percolation Test Results Performed by....... _______________________________ Date.__ :. rd.` ............ Aoflest Test Pit No. l ._Z,�_._minutes per inch Dept Pit____________________ Depth to ground water.....................__. fX Test Pit No. 25�:_2_r_O:_minutes per inch Depth of Test Pit____________________ Depth to ground water........................ P6 ..._---••-••-• ••-•----....... Description of Soil-D----2.......- ©-__� _�_____a! ....... ��1 w '----- -' ----'` .SA�V.................................................................................... UNature 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 Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has keen issued, by theboar f th. o Sign d. ` •-••-_. . _ _. _ Dat Application Approved By... — .. V---------•-------------•-•-••-- .................... -7- -- .......... Date Application Disapproved.for the'following reasons--............................................................................................................... ............••••••••••••-•-•-••••.....__...••-•••-•••••--.....••--••••••--------•-•-••---..._..•••••-•-••--••••-••••-•=••-••••••-•--•-•-•••-•-•-•-----••••••-•-••--•-•--•------••-•••••---•--••••-•••--- Date PermitNo......................................................... Issued_....................................................... Date i .� No........ r. �w FEs....:"Q................ THE COMMONWEALTH OF MASSACHUSETTS BOA RDR OF HIEA�Tr ...To W ...............OF.....� t,.kqp....... �- A APV- 11ra#ion for Raposal Workii Tomitrurtinm Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys ......y Location- dress v ^"'^ No pj wner ` �4V__7121 cjrgsj• _....fit . •- r �,r+ Address Type of Building LC Size Lot.. � ....Sq. feet Dwelling—No. of Bedrooms.......... ................................Expansior"kttic (ko � Garbage Grinder ( ) Other—T e of Building g .... ._ . No.. of persons............................ Showers ( .) = Cafeteria ( ) Other fixtures . ........................ ........... W Design Flow..................a........0.. gallons rper 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 fink ( ) Percolation Test Results Performed"by............. ..........:.:.. Date.. .:::......... Test Pit No 1424...minutes per inch D i Test/��'t{� -.----- Depth to grour�r v�tfIr��a............ ' - `e'it'�l....�, Test Pit No. 2.. ..)..minutes per,.mch lath . ............. Depth to ground water........................ Description of Soil .... ..�... •--.w..._... x Lei....� � 4.�u� .Q'! � ��• � �/tt✓�'• ..... ... u �9 : ....... ....................................... W . ............................................................................. 4!Xw 3. U Nature of Repairs or Alterations—Answer when';applicable......:............................................................................................ .......... .........•----------•. .......•--••----------...------------------.............................-- Agreement The undersigned agrees to install the aforedescribed, jndividual Sewage Disposal System.in accordance with the provisions of TITLL 5 of the State Sanitary Code— The undersi ,led fu ther agrees not to place the system in operation until a--Certificate of-Compliance has'been ' ued by the boar lof - lth. ' Signed. . (}y ,.., Date Application Approved By.....:. ...... .. . .. _ Date Application Disapproved for the following reasons:. ............................ ;�............... :.........7.:,�„y� �. ...._ z. ............................••-•-•-•----................_....-----....----........---................__._..._......-----«.......................�.......................... ---...-•Date--•---. ._ Permit No.... ............... issued...........................................:...........-- �4 Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .... ......................OF........ ... . ........................................ 0444trdifiratjr1i�111rr THIS IS TO CERTIFY, Th t he Individ 1 ewa " sal System constructed '( or Repaired ( ) . f by........... :.. ...... .. A" Install � at..... ....:. ...'..... ..... r �� ate' .. "e -s �has bed a cc h ias of The a 3. sc ed ' the application for Disposal orks Construction Permit No.. a......-•-•----------. dated------- ;;: - ' ............ THE ISSUANCE OF-THIS CERTIFICATE SHAL T BR CUSTRUED AS A GBTARAN E THAf THE SYSTERA VIIILL FUNCTION SATISFACTORY. DATE:... :.:.::--• ...................••.......... ...:1:.8-� -- ..:.:: Inspector .----....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH EE. No. � �. O F,........... ......... F . r7-• 3a irrrt Permission is hereby granted... •• „'� ..... •.•••. . •--- • t.. .. e.................................... to Construct ( ) or Repair ( ) a ndi 1 %I i L posal System atNo.............. ... ................... ....... .......... .. ._-•••. ='••... ...//� lrf�/ �1t k is eet as shown appli r fo >, pos or onstructton �: rmit No..................... Date d_....... -.:_ ................... ... . .4... . . .... .... DATE........ a.0..... 1 FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS _ ... r .._.__ ..a.o-.,:..us w-„:r,l.a.6. u,itdeo<MY.J`ui:.:;x. e,�{�.:naxr4�[+. :^i.•:aY '`f.:,�;. z r ,. � t x �•-�• phi � 1, - i ^ x v 1 + LA t 1 OK ol AX 42 z . a { �f. /OUD qAL n ZI 7� 3 24 '.8 l U F, @ �+ k (� 8 NIKES ' No 221 x O L �h t oe t' iLEGEND . t w ` ', 1 a 1 1NC;­ Sp®Tf; EL"EVAThO_N 0,0 - CERT�IFIED � PLQT' d." :-E X15TI CONTOUR P c � i 10 1 �111E� .SpOT; _EL.E'NAT,I::ON 0 �Frjft S¢!E0 C0PlT0UR 0 A sV-E D OF HEALTH AGENT Y. " sCa ;E GE ENGINEERING CO. INC c L►EvT /nw, i- A ` I CERTIFY ' THAT THE $TEREt� REGISTERED ) JOB N`0. Ut) 9,`,- BUILDING SHOWN ON *t w`ar1VIL LAND ,,�f CONFORMS TO THE 20NI } f*4EER I SURVEYORS,] DR. BY M"- OF BARNST LE , AA S o P 1 1.3 } i �VIAIN ST 7!2 MAIN :'T CH BY �`, rf /��/�0 ' �f R1 0a;TH., MASS. HYANNISP LAN® SHEET_. OF -- DATE , � THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) -a *i,' �;r•x,�-} '°, :u,'r .. : ,.... _Kan Y.rti^r„ . rz.:. K. ,.. i rti. z , � . . �:. •:. IJOV. ,1 /0 ''MIx/' t. Ne '' f {.• ,e4C�Ii f cw� I ;q 3 �� AVC- 0 f F ? ♦.',3 �A�I �•- �,~�/A.� •.� 1��:'' s_ CONGIt E; CL p p N.'P/:TCM1L ._ . G'DI�E�S O/Y CoVa�i� c _ /F'/N:1UR/VEJVA y CRE'•T.E 'CO✓E'R UQl!/D LE!!EL CLEAN SANG` a X LL CAST v� MJN.P/TGN CPA4. •• 2 LAYER D/ST. • v o P c e �4 PB/r I7 SEPTiC TA/VJsC o o • • • • • •o.� v o o J�8 - /B" p BOX o e e • • • . •. s s:e .� s o:4 l!/ASHFD S7rINE C e, e •EFFECT/VF .r ► ` 3/ - .�2 o o WASHED STONE .- . EVA v p T/BNS e� a. a, • ♦ e t • •• i; .v. o�j, — PRECAST SEWAGE /NVE/4T AT OU/LDING 7.S L L 1 �_ e o V/Z OR. EQU/v /NLET SEPT/C- TANK 7.3 FT A ttt //ONNEU�.(LLET L/ESATR/B/B!/ �y BB'OOXX_`?C�_..SL`FFFTTT, SELVAGES ECT/ON-OF h�G ROUN-—D—D/.W,— M TLET SEPT-1CTA/VK /f E M_T_E R 7—;4—B�LE -C CS- EE T,BIJLATJOT D O �.4TLETD/STC/! A/ TpT O/S/oOSA N L SYSTEM ILEA CfV//VC, A/T r9 BIILAT/ON ; DE5/6N CR/TER/A SCALE . '%4 " JV41IN9ER OF 6EbROO/`!ST. GARCAGEp/SPOSAL UNiT_-- 017�IENS/ON C =/ F T TOTAL EST/M.4TEb. FLOI-V—J J •SO/L LOG GAL.IDAY SO/L .TES•T`#/' SO/+� TEST9pt2 -� -'WAVER OF LCACNl1v4; ,virs_ l S®/L' TEST I S/OE4-'ACH/JvG PE/2 P/T I fELEV :G'. ELEY, -OA T€60TTOMLE9 OFT EST CN/NG'pERPJT_' ' _ FT n— RESULTS tt/ITNESSEp ,BY v TOTAL LEAC'NI/YG AREA L v✓+w� c y r, - i RFSER{/EGF4CN!/VG AiQEA G -sq FT " ,-iU 3�- ?Sig/�„ '�L`RC4.CAT/ON RATE SQ. FT, AE/eC04A77ON R-4TE A2 y .^. MIN+/JNC}1 T MIN.//NCH' P. 0-7 1 IINo. ►cis cJ _ /a L7 S T Tc- �/•/'L L' 1 �jH7 ,SA9—,D • �FS�ONAI.Erb. :.• ,. E?OR�:'®�i ENG/.NEER/NG CO/NG. 2 /�A/Jy 8r. v .`NO Q4lJND 1 Ni4Tt"R d'NCOU/VT1Sde6r0 HYANNJd 33 N0.M/I IN,ST Q�'011iVp 1w�?Tas�R AT �LL�✓. _ , MAsa SO YARMAt/TN � ASSESSORS MAP : TEST ALE I—O G S NOTES: PARCEL : SOIL EVALUATOR FLOOD ZONE: k/O r;r /Q?�F�'.lG�IBiLE u� �► - — ---- -- - WITNESS . 1) The installation shall comply with Title V and Town of Barnstable Board of REFERENCE: '� ,�, �,�Qnf/�i,�___.,»�!��'__--_-f'.��' __ ___.--- --- -- - DATE• a Health Regulations. �� �A � k,�� PERCOLATION IRATE." . � 2) The installer shall verify the location of utilities, sewer inverts and septic components prior to installation and setting base elevations. `� -- — 0 /97 -- ------____----------- TH- 1 TH-2 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first i w two feet out of the d-box to the leaching shall be level. D1'� '1lL t LP 1✓ 5 4) This plan is not to be utilized for property line determination nor any other purpose other than the proposed system installation. 5) All septic components must meet Title V specifications. LP 6) Parking shall not be constructed over H10 septic components. y ,7 y 7 LOCATION MAP �i, yy' 2�•�� P 7) The property is bounded by property corners and property lines. NJ 0-), � � I }, ! {j� 8) The property owner shall review design considerations to approve of total design flow and number of bedrooms to be considered for design. Receipt 1 1(9�(n'� 2 of payment for the plan and installation based on the plan shall be deemed approval of the design flow by the owner. lr�, �A� t O �O 9) The existing leaching or cesspools shall be pumped and filled with material k W0 Ow0, 4 per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand r - � g P per �✓ _ Title V specs. 10)System components to be 10 feet from water line. Sewer lines crossing the SEPTIC SYSTEM DESIGN water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if applicable. The proposed SAS is being installed below the water service �-- line. The line is to be sleeved as aforementioned and maintained in place. FLOW ESTIMATE 11) If a garbage grinder exists it is to be removed and is the responsibility of the I I� owner to ensure such. BEDROOMS AT GAL/DAY/BEDROOM -�GAL/DAY 12)The installer is to take caution in excavation around the gas line if such exists. SEPTTC TANK— --- - - - 13)The installer shall verifythe location, quantity and elevation of the sewer 9 Y i ICVlines exiting the dwelling prior to the installation. ��GAUDAY x 2 DAYS - GAL 14)The installer is to determine if other sewer lines exiting the structure exist <l USE and if so,to be re-plumbed or tied into the septic tank. MO GALLON SEPTIC TANK � �- �isrivG O I C ABSORPTTO SYSTEM-------.J--.. . , Y MVI CH W Al / W ID g -�2 1T-A d • Al 0 SEPTIC SYSTEM SECTION t, ------------ , to O 0 /000 GAL D-BOX Gj, W, 11 o 0 0 o 1 it ITANK SEPTIC it WO �A-� AGE PLAN W i A SEW, I � 4 r, I'rl op'��� LOC�TION, Ii ;�I11a It I�IGI ��� I' �il',+ � P R E PAR EDP F 0 R��, �C.�. wEi1C� � t ,I SCALE: _ d DAV I'D' B . MASON 9Z 7 pgTE: 1 l� W C I 1 DEC ` V RpNME ,AL DE I GNSI . SAN ITCH M HEALTH AGENT �w P W ( 5 8 3 1 . � ,I DATE 2 i ll I :'III J".l E I i, D II �II'- f tw 'ir IV'