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HomeMy WebLinkAbout0051 OAK LANE - Health 51 Oak Lane Osterville P A = 141 020 v 0 , a , r z s .i , z os . o a A : COMMONWEALTH OF MASSACHUSETTS W EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ¢'DEPARTMENT OF ENVIRONMENTAL PROThCTION N1, MAP2 'I .F+.infi TITLE 5 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: �Q Owner's Name: Owner's Address: � L-14C-L-OV2 RECEIVED Date of Inspection: Name of Inspector- plea e p int ' MAY 14 2.004 Company Name e ? TOWN OF BARNSTABLE Mailing Address:. HEALTH DEPT. Telephone Number:. CERTIFICATION STATEMENT 1 certify that I have personally inspected-the sewage disposal system at this address`and thafthe 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 fimction`and maintenance'of on site sewage disposal systems.I am a D1 P approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority —q Fails Inspector's Signature: /1lU g Date: V The system inspector shall submit 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 ofthe DER The original should be sent to the system owner and copies sent to the buyer,if applicable, and the approving authority. _ a. Notes and Comments -. :r .,r.'.. w.ro. ........<...«. ,. ,_,.. _:... .:..w .:o..,..... y, .r...+w...a wn...... ,n...... .+n.e. ..• ....i. .. -...y... ., x. .- . .. . ....i .a+r . '.Y».. a,S" ,ll ****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/IS/2000 page I Page 2 of I I OFFICIAL INSPECTION FORM.-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: / Date of nspec on: 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: & 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-folio wing statements. If"noti.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 Il OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A, -CERTIFICATION(continued) Property Address / ✓� Owner: Date of Inspect on: V.. M 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 finless Board of Health'deterinincs i. ac-cord � i 31 rren +G.10"' n, .,a�a:.evvr.tr.Ja���t.ir�t♦ 1J:J:VJtt)\J)that t}ie 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 aseptic tank And sail alis'orption 'system(SAS)'and th'e 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'].of a public water supply. - The system has aseptic 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 or`gatiic compounds indicates'thaf the`we11 is free`froni''polWtion from`thaf facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A'copy of the analysis must be attached to this form. 3. Other:. Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR,VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE,-DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: Date.o Inspec i w V&uSC D, System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes Nq� Backup of sewage into facility or system component due to overloaded or,cioggedySAS;;or cesspool_ , Discharge or pondvg 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 _ V Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow 7 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 groundwater elevation. _ :�7 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 iswithin 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.[This system passes if the well water analysis, performed at a.DEP certified laboratory,for coliform bacteria acid volatile organic compounds indicates that the.well is.free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen.is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] (Yes/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 Systems: To be considered a large.systent 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 Il.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. I 4 r , Page 5 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL-SYSTEM INSPECTION FORM PART B , CIIECKLIS'I"" Property Address: L,4� a Z,-1v4 Owner: Oda Date of ignspect#on.- Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No - Pumpinj. nfor-mation.was provided by the owner.oecupant,.or,Board:of Health_ 1Z 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 ? "lave large.volumes of water been introduced to the system recently or as part of this inspection? t✓ Were as built plans of the system obtained and examined?(If they were not available note.as N/A) V _ Was the facility.or dwelling inspected for signs of sewage back up? V Was the site inspected for signs of break out V _ Were all system components, excluding the SAS,located'on site ? ` l/ 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? _V, Was.the owner,(and y and occupants if different fi•ont owner ,( p )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 lias been determined based on: Yes no _Lzl. 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 OFI+ICIAL INSPECTION,FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM IIVNSPECTION FORM PART C SYSTEM INFORMATION, ' Property Address: Owner: t Y&,VAPA ZI 'l Date o Iuspe ion: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 MR 15.203 for example: 11.0 gpd x#of bedrooms): Number of current residents: Does residence.have a garbage grinder(yes or no):/�& Is laundry on a separate sewage systeni (yes or no) if yes separate inspection required] " Laundry system inspected(yes or no Seasonal use: (yes or noavailable Water rrleter readings, i (last 2 years usage(gpd)):®z`s-� � Sump pump(yes or no)' Last date of occupancy✓, COMMERCIALANDUSTRIAL/Xv-- 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):_ Nov-sanitary waste discharged to the Title 5 system(yes or no):^. Water meter readings, if available: Last date of occupancy/use: OTL-IER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of tfie inspection(yW or no If yes, volume pumped: gallons--How was quantity pumped determined? Reason Tor pumping:_ TYI' F SYSTEM optic 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): roximate a e of all e mponents, late ii flied(if known)and sonar�e of inf nation: Were sewage odors detected when arriving at the site(yes or no) 6 T a Page 7 of I I OFFICIAL INSPECTION FORM—,NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOI2NI PART C SYSTEM INFORMATION(continued) Property dress: Owner: Date ofInspe t on: BUILDING SEWER(locate on site plan) Depth below grade: Materials of constn.iction:_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments on condition'of`oints Vehtin( � g, evidence of lealage,`efc.):' ' SEPTIC TANK:�/ (locate on site plan) /r Depth below grade: _ 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) _ y. Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet-tee or baffle: Scum thickness: !� 3 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottorp of outlet tee or baffle: J How were dimensions determined � G ��eL� Comments(on pumping recomme elation , inlet and outlet tee or baffle condition,structural integrity, liquid levels as-related to outlet invert evide ce of leakage, etc.): �. R'6 GREASE TRA -locate on site plan) Depth below grade:_ Material of construction:_concrete metal fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to'bottom of outlet tee or baffle: ' Date of last pumping: Comments(on.pumping recommendations, inlet and outlet tee.:or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL,INSPECTION FORM-NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner:. Date o Inspekn: ' TIGHT or HOLDING TANK:/(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): v Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc:): DISTRIBUTION BOX: t/(if present,must be opened)(locate on site plan) Depth of liquid level above outlet invert(LX1 Comments(note if box is level and distribution to.outlets equal,any evidence`of solids carryover,any evidence of akage into or.out of box tc.): PUMP CHAM$E// (locate on site plan) Pumps in working order(yes or no): Alarms in.working order(yes or no): Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):, ; 8 Page 9 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C .-S'YSTEM INFORMATION'(confinued) Property Address .. Owner: Date o Inspe i n: SOIL ABSORPTION SY EM (SAS):._Izoocate on site plan, excavation not required) -If SAS not located explain why: Type 1 ching pits,number:_ leaching chambers,number: leaching galleries, number: leaching trenches, number, length: leaching fields,number, dimensions: overflow cesspool,number: innovative/a Item ative.system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc i ` f CESSPOOLS-(cesspool must be pumped-as part of ins ection)(locate on site ` an)' ' U11 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]ydraulic failure,le'vel of ponding,`coriditioii of veg'etafion,etc.): PRIVY r(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.): . ,r 9 Page 10 of 11 OFFICIAL INSPECTION FORM—�NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFOIIAIATION(continued) Property Address:. Owner:-9. AAE,,r,—1��-"o�,—, Date o nspect on: ��-�y� 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. O .O �I1nl.lo � f O v , Fla) cj-,)Ct(PL(-T�,S 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C . SYSTEM INFORMATION(c`ontinued) Property Address: Owner: Date o n pec n: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water /7 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: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain:. You must describe how-you established the high ground water elevation: f 113 MR A Y R,3E.`l.p iE2 r 4 f I x 3„ , Fs Permit Number: Date. Completed b y Kit Lgy `iP4 HIGH GROUND-WATER LEVEL COMPUTATION - 'r 3. 5,Ml , ; .. ,.. Site Location: �� ��. i d�51 /Y/i�l P Lot No. 2, ?" u£r s . Owner: r ���f Address: '4 y Contractor: lellll 66%5. Address: 'Notes: ® r is STEP 1 Measure depth to water table to nearest 1/1O.ft. ........ .......:........................................................... .Date -- e month/day/year •.'=a: = . STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: d ..,�..:. OA Appropriate index well..................... 1....... OWater-level range zone............. STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to L 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 2B).. 0, determine water-level adjustment ...................:....................................................................... STEP 5 Estimate mate depth to high water by subtracting the water- level adjustment (STEP 4) ( from measured depth to water _ level at site (STEP 1) ................. �5 Z Figure 13.--Reproducible computation form. 15 1 . I L^N'T�OWN OF BARNSTABLE LOCATION Os)&rVtAe SEWAGE #a0O A-B5 7 NIL,LAGE OS ASSESSOR'S MAP & LOT I q INSTALLER'S NAME&PHONE NO. CAS`i 'S T urbAUg ZiIK SEPTIC TANK CAPACITY OSGbTA�. LEACHING FACILITY: (type) n / AS (siie) aZ;:� X/3 x ' NO. OF BEDROOMS -�/ 41 BUILDER OR OWNER V/ PERMITDATE: —/I'�02 COMPLIANCE DATE: z( U Separation Distance Between the: t, Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility A � Feet Private,Vater Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) IV Q _Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet o 3 /z leaching-f�a^cility). /Y /� Feet Furnished by ASh' ut,4NtJy ZLoc �A-.C_ 3q' A-�=60� S 13-C=a ' D _ 0 d- =Q e a "o 10AL. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:�✓ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 3 ppYication for 33igooar bpztem Cou6truction Permit Application for a Permit to Construct(VRepair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No..s� D.qk Owner's Name,Address and Tel.No. Su*Pwdols k i Assessor's Map/Parcel ® m,e Q 0 ko w/b ANC KAD l'tf 1 C 0d0 A4 SO 8 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. CAs�'s Ti¢uc_/Ei�j Iwc. Q40V Nn��.,ug4ory 1 X , TTA,emov1�►f'�`T 9 AedA Rose lu. Soy MwA:et&w � 0 r g 4 —3842. Type of Building: ) �I 1'IIb� •�rh^ l�"� i a W j '3 :*e'J,aJ. Dwelling No.of Bedrooms a4 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow CW gallons per day. Calculated daily flow � 9�� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable)laplAeC d[141in LgmWfi�(,yl►aEuj 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 Certifi- cate of Compliance has been iss by this Board of alt Signed JDate eZ 11 01 Application Approved Date Application Disapproved for the following reasons Permit No. 27,0 Date Issued _�7, ------------------------------------AL.----- No. Fee a� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rpplfcatfon for Migaar *pgtem Congtructfon Permit Application for a Permit.to Construct( 4,Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot IJo..S/ Oo k' Owner's Name,Address and Tel.No. Sue Aclolski s Assessor's Map/Parcel ®'S rF_Ut//� g 0,4 Pc I Pw G> Au C Mn 1qt Xec' � OA0 fv• E fog, MA>0.14s� C sub a3S-b8s�� Installer's Name,Address,and Tel.No. `�• Designer's Name,Address and Tel.No. CAS STZuc4/&y,T,ue . `�-._. _.-C Jere, NAcrdag4oe,,, -Po, ��X 7 , Y emo,4Apo-4 q A acla Rosc kk, . Cs-o0362-3dA/ I MA,esFaw M013 (S09)4d$-384a. Type of Building: fi Dwelling No.of Bedrooms J Lot Size sq.ft. Garbage Grinder( )y Other Type of Building,''. -No. of Persons Showers( ) Cafeteria( ) Other Fixtures ow`? •- k . Design Fl a4.AU gallons per day. Calculated daily flow gallons. Plan Date "" 4'• Number of sheets Revision Date i Title Size of Septic Tank ._ Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �ie n I rac e. F4r I S+�,uc Lends i'uc� Uv i�eg j ,• i LAI Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordanceYwith the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issup4 by this,Board of Health,. Signed .r Date a i? 4-Z Application Approved b/ _ Date —97 Application Disapproved for the following reasons ' s t Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate"of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed v'f Repaired( )Upgraded( ) Abandoned( )by C4sA s T urki 1;wc . at S/ 04 k St . 669;a- 0 GrV t has been constructed in accordance + with the provisions of Title 5 and the for Disposal System Construction Permit No-w'4:9-'0,5%ted ;9 Installer Desigtier The issuan eof this permit shall not be construed as a guarantee that the Sys w$ll,function esigned. Date oz :�1;u. Inspector lYr�,r%�y - --------------------------------------- No. (� 6 Fee �✓i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwfgpogal *pgtem Congtructfon Peri�f°t Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( 1 System located at S/ OA� 1"1 . t and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of t�his��rinit. Date: / �'" Approved by�� r < 1 �N jOWN OF BARNSTABLE SEWAGE #�d'o0A LOCATION VII,LAGE OS 'evil SIP ASSESSOR'S MAP &LOT )y -010 UC INSTALLER'S NAME&PHONE NO. SIf 'S T.� T SEPTIC TANK CAPACITY S� LEACHING FACILITY: ( pe) �S (size) j? v�.3 �Je NO. OF BEDROOMS BUILDER OR OWNER PERMTf DATE: 61 /I—Oo2 COMPLIANCE DATE: Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any Wells exist */ R Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 310 feet o f chin facility) . Fur ��p� k 'D' ®f o d o 1� �IHE Town of Barnstable Regulatory Services 9 'MASS B'E�" Thomas F. Geiler,Director s6;q. 0tF039.�A Public Health Division Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 17,2002 Jeff Davidson 59 Cushing St. Hingham,MA 02043 RE: 51 Oak Lane, Osterville Dear Sir: After reviewing the septic plans and speaking with the designing engineer, and the assessment department, it is determined that your house located at 51 Oak Lane in Osterville is a three (3) bedroom house. Even though it is in the zone of contribution,the original septic design for the house was for three (3) bedrooms, thus it is grand fathered with three (3) bedrooms. Our files have been corrected to show this. Sincerely, David W. Stanton Health Inspector, Town of Barnstable [Click here and type your name] [Click here and type job title] °PYRE Tp�, Town of Barnstable Regulatory Services 96ARNM SSSB`E'$ Thomas F. Geiler,Director 1639. �ArFo �" Public Health Division Thomas McKean,Director 367 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 3/13/2002 To Whom It May Concern: The address on the disposal works construction permit number 2002-057 dated February 11, 2002 was completed in error. The.permit should read: 51 Oak Lane, Osterville (not 51 Oak Street, Osterville). Sincerely Yours, Thomas A. McKean Health Agent I f I I SITE I. �!. \NG `/n 3-20"NAM. LESS MANHOLES N f V J SCALE: 1 =20' O) V � e SITE Qo�ay`` f CONCRETE STOOP ELEV.=100.00' ASSUMED. BENCH MARK ON CORNER OF 0 0 R— 0. 0 GENERAL NOTES t — 0 //1 74,�9' INLET 1 "\ O TLET a o 0 ry � 1. ADDRESS: 51 OAK LANE o `9 `l 2. ASSESSORS NUMBER. MAP 141, PARCEL 020 e C?� 0 19 r Ssowuteeht La 97,3 96.05' 3. DEVELOPER'S LOT: LOT 18 (Sc 19� 4. TOPOGRAPHIC INFORMATION WAS COMPLIED FORM AN Osterville STEEL REWFAl' PRECAST CONCRETE ON THE GROUND INSTRUMENT SURVEY. Center J� 9 g PLAT VIEW 5. MUNICIPAL WATER IS PROVIDED TO SITE AND "lain 0 I J 3-20"REM LE GONERS Street SURROUNDING PROPERTIES. 101,47' �� 4. 6. REFERENCE PLAN: PLAN BOOK 115, PAGE ET LOCUS U,P, / 3"mfn cleanse 7. NO WETLANDS ARE LOCATED WITHIN 100 FEET OF SAS. INLET B mi.�— r �,,00�11e; INLET-T-• T g, NO POTABLE WELLS ARE LOCATED WITHIN 150 FEET OF SAS, NO SCALE min.n 6"min. OUTLET 0� 4, 4' min. -LU,d level paved 0 5'-0" ' t 1 _ 5'-0 NOTE: LOTS 18 & 19 ARE OWNED BY ONE SINGLE OWNER. THEREFORE, IT IS CONSIDERED \�Q LOT drive `Q E� GAS BAFFLE : 3-B min. ONO CMRILItS292Y. �SH REDT 19HALL SYS EMS ORNOTOLOT ME 18BSISDASBLE IS REMOVED FROM LOT 1UNLESS IT 9S WITH Liquid depth po e �9 5._a.L Design Calculations �, CROSS SECTICJN END-SECTION c S 0 Number of Bedrooms: 2 p�SSeS � �j/ 3�- VPNG \ 97,3 H-1) 1500 GALLON SEPTIC TANK Garbage Grinder: No OP �023 -� NOT TO SCALE Leaching Capacity Required: 220 Gal./Day 0 Q UE ACME PRECAST OR EQUAL Leaching Area Required: 220 Gal./(0.74 Gal./Sq.Ft.)=297 Sq.Ft. � Proposed Leaching Structure: 1-251 X 13'W X 2.0'C> Leaching Trench / Leaching Area Provided: 477 Sq.Ft, NO j—r 0 Proposed Leaching Capacity: 353 god > 220 gpd. req'd. B . B First LING CONSTRUCTION NOTES G elev,- 10 TQF �L _ 0 64' 1. Contractor is responsible for Digsafe notification full -'99.62' and protection of eN underground utilities and .pipes. 9 Cellar 2. The septic tank and distribution box shall be set LyJ L level on 6" of 3 4"-11 2" stone. 9 �l IS 3 stonesBockfil overul3"bin slizen sand or gravel with no T O q — / 4. This system is subject to inspection during installation T.H. #1 o AF'EA 1 1 200± SQ. FT, by Glen E. Harrington, R.S. 5. The contractor shall install this system in accordance G 99,13' NI 97,00' with Title V of the Massachusetts Environmental Code xstin 9 8.3 1 X S I cesspool g e 93 and the Regulations of the Town of Barnstable. C2S pumspo fille 6. Provide a 1500 GAL. H-10 septic tank, 3-500 gal leach chambers 0 / G and a 5 hole H-10 D—Box or equal. C9 7. No vehicle or heavy machinery shoal drive over the 99,01 septic system unless noted as H-20 septic components. J 8. Install gas baffle or equal on septic tank outlet tee end. 97 81' 97,38' — 2 51 X 13 W X 0, D 9. All existing inverts and site conditions shall be verified by contractor. 0 � aching trench using 2 H- 1 0 10. Existing cesspool to be pumped & filled. � ed I 9 N r P ECAST LEACH CHAMBERS With 4' of O D—BOX st ne on sides 8c Lends. 0 G SOIL EVALUATION 0 Z Date of Soil Eval.: January 5, 2002 /< Test Performed By: GLEN E. HARRINGTON, R.S., CSE Excavator: Michael Leary z5 N�L O Percolation Rate: <2 mpi assumed in C!—C3 9 CP ' /> Test Hole No. 1 4' S 4. 0 rPTH SOILS ELEV. 2" OF 1/8" TO 1/4' 99,13' PEASTONE (WASHED)� GT 19 Af. sorely Im 1OYR3/2 98.30' ® EM 24" MIN. 0 AREA = 1 1 , 1 25± SQ. FT. 40' OY rnwd. so95.80' Bw n R6 6Z 2 2 H-10 500 gal. chambers G1 3/4" TO 1 1/2" WASHED CRUSHED STONE novelly,nediu Z o 2.5Y2/4 n 15%f-coed. TRENCH CROSS—SECTION grmel 3%boulders coouldeerss r NO SCALE 138" 87.63' 9 0 G NO GROUNDWATER ENCOUNTERED G� NOFe s ¢ PROPOSED SEPTIC SYSTEM UPGRADE 1 0 EN PREPARED FOR AR T Z40 LEONA NUNNO �1fo 1070 AT G LEGEND �<) 51 OAK LANE *NOTE: ALL PIPES ARE TO BE 4" DIA. SCHEDULE 40 P.V.C. 0 0 EXISTING 1000 GAL. qM/-FAr%' ` BARNSTABLE (OSTERVILLE), MA 10' min. from *NOTE: INSTALL GAS BAFFLE OR EQUAL ON SEPTIC TANK OUTLET TEE. H-10 SEPTIC TANK house to septic tank Septic tank covers must be Finished grade over system=2% slope away X 104.46 DENOTES EXISTING PREPARED BY; ExistingHouse within 6" of finished grade 5 HOLE SPOT GRADE D-Box cover must be DIST. BOX 0 of Fndn. Elev.=99.62' within 6' of finished grade Existing Grade Elev.=98't , R.S. p EXISTI ADE g -9-- .,..... 5 - .,. . . _./ ._/ max. 9LLEDA ROSE (LANE E>listin Inv-9%,le':' 136.12 min.0 02' Min 2"-1 8"-1 2" S=01 Level for 2' washed stone I_� DEEP TEST HOLE � p ((�� QQ full Cellar_ " 20, o 115oo0SAp 24' s=07 To Peastone Elev.=95.50' MARS TONS MILLS, MA 021�4U SEPTIC GTANK v a 14' — = BSmt. fl. Elev.=99.62 M - _ �— Approx, location 00 0 0 GAS BAFFLE a a _ 4•MIN TEL: 508-4 8- 8 2 OR EQUAL II, existI water service o Bottom of Leach g FAX: 508-428-3862 w °' q L.1 25 rench ev.= 0' 0 6" OF 3/4"-11/2" STONE a v LE/-'iCl TRENCH 5.37 PROPOSED 1500 GAL. a o ` c ° SBottom of T.H. 1 Elev.=87.63' 0 0 0 H-10 SEPTIC TANK SCALE: 1 =20 DRAWN BY: GEH FEB. 11, 2002 SYSTEM PROFILE a 6" OF 3/4"-11/2" STONE NO GROUNDWATER ENCOUNTERED Not to scale - DATUM: ASSUMED FILE: OAKLNDP.DWG SHEET 1 OF 1