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HomeMy WebLinkAbout0031 OAK RIDGE ROAD - Health 31 Oak Ridge Road Osterville A= 118 047 I �i I - \ . COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION b 4 ' S�• TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 31 Oak Ridge Road Osterville =s Owner's Name: Joan Twining .,,- Owner's Address: Date of Inspection: 9/23/2005 rt -= Name of Inspector: (please print) Patrick T. Sullivan Company Name: Ready Rooter is.a Mailing Address: P.O.Box 371 ' -� Sandwich,MA 02563 Telephone Number: (508)888-6055 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: i./' Passes Conditionally Passes Needs Further Evaluation by the Local Authority Fails . Inspector's Signature: '� �� '� Date: o 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 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. Page 2 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 31 Oak Ridge Road Osterville Owner: Joan Twining Date of Inspection: 9/23/2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D C. System Passes: ' 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 appr=ved by the Board of Health,will pass. Answer yes,no or not determined (Y,N,ND)in the for the folio `ping 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 appro,ded 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' r ND explain: +3 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 uneen distribution box. System will pass inspection if(with approval of Board of Health): l` broken pipe(s)are replaced obstruction is removed C distribution box is leveled or replaced F ND explain: The system required pumping m,©re than 4 times a year due to broken or obstructed pipe(s).The system will i pass inspection if(with approval of the,Board of Health): ' broken pipe(s)are replaced ` obstruction is removed ND explain: t i ,Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ; CERTIFICATION(continued) Property Address: 31 Oak Ridge Road Osterville Owner: Joan Twining Date of Inspection: 9/23/2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation b the bard of Health-in order to determine if the system q Y Y is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health deter ' es in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner/aurface ll protect public health,safety and the environment: _Cesspool or privy is within 50 feet water _Cesspool or privy is within 50 feeting 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 nvironment: _The system has a septic tank and soil absorption system(SAS)and t1Se 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 alone 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 Y P private water supply well**. Method used to determine distance **This.system passes if the well water analysis,perforfned at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and 11 the presence of ammonia nitrogen and nitrate nitrogenAs 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. I ' P 3. Other: { Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 31 Oak Ridge Road Osterville Owner: Joan Twining Date of Inspection: 9/23/2005 D. System Failure Criteria applicable to all systems: You must indicate"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 _LZ 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 and overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z day flow Required pumping more than 4.times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. _ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. %/ Any portion of a cesspool or privy is 50 feet of a private water supply well. _ �,Z 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.] A,2Z;kYes/No)The system fails. I have determined that one or more of the above 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 system the system must serve a facility w' 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 riteria above) yes no the system is within 400 feet of a surface drinl�ing water supply the system is within 200 feet of a tributary;{o 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 weJ-f 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 f iled under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should Ontact the appropriate regional office of the Department. /f Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 31 Oak Ridge Road Osterville Owner: Joan Twining Date of Inspection: 9/23/2005 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: . Yes No Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks?' _ Has the system received normal flows in the previous two week period? —AZHave 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 than 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)] i Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 31 Oak Ridge Road Osterville Owner: Joan Twining Date of Inspection: 9/23/2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 3C{0 4�;'PX Number of current residents:_4 Does residence have a garbage grinder(yes or no):Yam* Is laundry on a separate sewage system(yes or no):x_-0[if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no):3' o?F_23�3 = S SC 6-P L� Water meter readings, if available(last 2 years usage Sump Pump(yes or no): Last date of occupancy: Z�r 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 n Non-sanitary waste discharged to the Title 5 ystem(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: " Arm- - Was system pumped as part of the inspection(yes or no):,s-)5n If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM , _NZSeptic 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: . �c..� 3 Z2 ar z Were sewage odors detected when arriving at the site(yes or no): i I Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 31 Oak Ridge Road Osterville Owner: Joan Twining Date of Inspection: 9/23/2005 BUILDING SEWER(locate on site plan) Depth below grader / t Materials of construction:_cast iron 40 PVC_other(explain): Distance from private water supply well or suction line: 'A - Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: (locate on site plan) Depth below grade: Material of construction:�oncrete_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: 6 S Sludge depth: ` Distance from the top of sludge to bottom of outlet tee or baffle: 3,P" 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: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert, evidence of leakage,etc.): (� • V S �+`. ''1�\� -.:1 ��1 �L'J� f \�!. 2 `.nKi L+ \ �a✓�U/G�f +L� �11 a�V 6��i '� \..) Tir �a`Y��.J"� �a�a r L►..1�1�. � cb�1_!5R G GREASE TRAP:_(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 t e or baffle: Distance from bottom of scum to bottom 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 yf leakage,etc.): i I i I Page 8ofll OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 31 Oak Ridge Road Osterville Owner: Joan Twining Date of Inspection: 9/23/2005 TIGHT or HOLDING TANK: (tank must be pump at time of inspection)(locate on site plan) m Depth below grade: Material of construction:_concrete metal f erglass_polyethylene_other(explain): Dimensions: Capacity: gallons ; Design Flow: /float Alarm present(yes or no): Alarm level: Alarm inr(yes or no): Date of last pumping: Comments(condition of alarm ahes,etc.): DISTRIBUTION BOX: v/""(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: G3 Comments(not if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): n J.v—i(n �� r— y C-4) PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): /r i Alarms in working order(yes or no): / Comments(note condition of pump chamber/condition of pumps and appurtenances,etc.): 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: 31 Oak Ridge Road Osterville Owner: Joan Twining Date of Inspection: 9/23/2005 SOIL ABSORPTION SYSTEM(SAS):—,L(locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: ,leaching galleries,number:_0 s� leaching trenches,number, length: leaching fields,number,dimensions: j 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.): nn CESSPOOLS: (cesspool must be pumped as pa fins pection)(locate on site plan) Number and configuration: a —Depth to of liquid to inlet invert: P P q Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(y s or no): I Comments(note condition of soil signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic ailure, level of ponding, condition of vegetation,etc.): Page 10 of 1 l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 31 Oak Ridge Road Osterville Owner: Joan Twining Date of Inspection: 9/23/2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. i e O O ice► , , Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 31 Oak Ridge Road Osterville Owner: Joan Twining Date of Inspection: 9/23/2005 SITE EXAM Slope Surface water Check cellar✓ Shallow wells Estimated depth to ground water ? feet Please indicate(check)all methods used to determine the high ground water elevation: I.zo—btained from system design plans on record—If checked,date of design plan reviewed: Q-_%ZZ�3 Observed site(abutting property/observation hole within 150 feet of SAS) Checked with the 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: c-L'...! t� 'd/iw -1_- y-, TOWN OF BARNSTABLE vll 1.,<`':' }':: Oz ►- �� �_ , P � SEWAGE # 03- q-2 a ASSESSOR'S MAP & LOT 119 INSTALLER'S NAME&PHONE NO. ..a`' .ram CA%ea �3©� SEPTIC TANK CAPACITY Z T5X2 LEACHING FACILITY: (size) NO.OF BEDROOMS DUILDER OR OWNER PERMTTDATE: ®3 COMPLIANCE DATE: '2, Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility s 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 � �t �'�.a' �''��.�. —Z -� p ►��. I y O O TOWN OF BARNSTABLE n LOCATION ®��Z x'%i7 f�` SEWAGE # VILLAGE af7f1 4�2214z ASSESSOR'S MAP & LOTS:Ii 04�' INSTALLER'S NAME&PHONE NO. ��AST®�-�• �� - T SEPTIC TANK CAPACITY LEACHING FACILITY: (type);i2�' ®� ��C �-�Lle (size) 'NO.OF BEDROOMS � BUILDER OR OWNER �` ' AS PERMITDATE: y ys�} 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)y), Feet Edge of Wetland and Leaching Facility(If ahy wetlands exit within 300 feet of leaching facility) Feet Furnished by � f A - N � "1 r3i No. 2 V o.� — Fee , THE COMiMONVfEALTH OF MASISACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zf ppriration for Zizpool bpztem Cott.5truction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. 019K R z/Pp,. t Os' &rt Owner's Name,Address and Tel.No. Assessor's Map/Parcel , Mlp OIi6- Pam y 7 Inaller'�S Name,Addre s,and Tel.No. De ' ner's Name,Address and Tel.No. ,pGLtaeot�rn�rv�.�� Type of Building: Dwelling No.of Bedrooms Lot Size 13,6-0 0 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 33 O gallons per day. Calculated daily flow gallons. Plan Date 0(0'I-s=d Number of sheets Revision Date Title Size of Septic Tank IS0 0 5 0 L_ Type of S.A.S.0?' 'Yf Description of Soil; ZO r rn Nature of Repairs or Alterations(Answer when applicable) 0 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 i ed by this th. Signed Date Application Approved by 2.S Date Application Disapproved for a following reasons Permit No. 26 o?, Date Issued U No. �06 Fee ✓" — THE COIV M NVOULTR OF MASS' IitETTS Entered in computer: j" Yes " .eat PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Zipprication for Zioponl bpotem Congtruction Permit 's 10 App'li�atio l.for A ermit to Construct( . )Repair( )Upgrade( )Abandon( ) El Complete System O Individual Components Location�Address or Lot No. 019i<R-rd�g p, ,OS t Owner's Name,Address and Tel.No. i to Assessor's Map/Parcel. Gf In Valer'$�s Name,Addl�ee s,and Tel.No Desi ner's Name,Address and Tel.No. 5 jQ /��lGRti /JN r � G EAJLSde0/1r?7EA.,�?9[_ O�t�T�n/VS t4 SG&_�-��}� 0 sow- �33- d�2 Type of Building:i Dwelling No.of Bedrooms -3 Lot Size' sq.ft. Garbage Grinder( ) Other { Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flo� .330 gallons per day. Calculated daily flow gallons. Plan Date b& IS-0 3 Number o�j sheets Revision Date Title 57 f_ d -! G ACof t-l_AAj Size of Septic Tank ISO () 5 4,4 L Type of S.A.S. a ucf Description of Soil Fx�V- S/Y-AuiJ Nature of Repairs or Alterations(Answer when applicable) 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 i ued by '=alth. Signed> Date ` Application Approved by ATA .S Date 9 Application Disapproved for\l�e following reasons Permit No. .2o o3 , / 7 5' Date Issued 2 y --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed Ir-)Repaired )Upgraded( ) Abandoned( )by at Cs lrrv"l/`e , has beep constructed in accordance with the provisions of T' e 5 and the for Disposal System Construction Permit No. -0 d `t 7dated �--2 LOI Installer Designer rr The issuance of this�p�er�gall not be construed as a guarantee that the system '�� .h�.�ion as��s g d. Date Inspector �(� � --------------------------------------- �03 y7S� f No. 0 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migoal *pgtem Congtruction Permit Permission is hereby granted to Construct( )RepairO Upgrade( )Abandon( ) System located at 39 U F k r , y P dS 'e /�o i 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 tpispa t. Date:� ��� Approved by `` ' � TOWN OF BARNSTABLE LOCATION SEWAGE VILLAG ASSESSOR'S MAP &_LOT_ INSTALLER'S NAME&PHONE NO. 'Y 45 rllp o ter_ y 0® SEPTIC TANK CAPACITY / SOS - LEACHING FACILITY: (type), '7 400 4,0 C e,.e,44: (size) 3 's e2-'Y NO,OF BEDROOMS BUILDER OR OWNER ' PERMITDATE: y f'03 COMPLIANCE DATE: jSeparation 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) o Feet . Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished byTJ_ I 'l 4 C, C/ Y,7 . e 7. . rs , a _ n+ a ` r r v TOWN OF BARNSTABLE LOCATION IOak Rttd v SEWAGE # VILLAGE n, Jt-0yil) ASSESSOR'S MAP LOT INSTALLER'S NAME & PHONE NO.7- /` M, C y( c , ;SEPTIC TANK CAPACITY'*/A-� LEACHING FACI�.ITY:(type) � f '� (sue) pO Le -� OR PUBLIC WATER NO. OF BEDROOMS P BUILDER.OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED! 'VARIANCE GRANTED: Yes No rJ � ' I 7 w F _ . ASS =SOR'S MAP NO. /1F PARCEL 7 LOCATION SEWAGE PERMIT NO. VILLAGE I S� INSTALLER'S NAME i ADDRESS e UIL ER OR NER DATE PERMIT ISSUED DAT E C 0 M P L I A N C E ISSUED ru r.,o . �•� , � ���� .. �- . -�t is - _ ,�� ,. $ 20.00 No................ .•_ Fss.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF I+EAL1'I--� n I 07 -----.....Town . .--..--....OF.....Barnstable .............................................................. Appliration for Uigpnaal Works Tons#rurtion Frruflt Application is hereby made for a Permit to Construct ( ) or Repair �X) an Individual Sewage Disposal System at: 31 Oakridge Road Osterville,Mass . ............ .........-• ........... ............................................... ........••---•-----...._............------•--- • .........._...._. Location-Address or Lot No. -Riley ►.. aS e.. Z�1....SA........................................... Owner Address W J.P.Macomber Jr. Installer Address UType of Building Size Lot............................Sq. feet ., Dwellings—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—Type of Building No. of persons............................ Showers YP g -•----------•--------------- P ( ) — Cafeteria ( ) Otherfixtures ------------------------------------------------•-------...----------------------------------------------•••--•----•---..... W Design 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---------------......---------------.... ,-4 Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ................................... ------------•-•---------•--.......__...-----------------......._....------ ----------...------------------ ODescription of Soil------------------------=--------------------S.a d---&--.GXa eI-----------------------------------•------------------------------------••-•.......... x w ------------------------- -------------------------------------------------------------------------------------------------------------------------•---------------------------------.................. U 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 Sanitary Code—The t dersigned further agrees not to place the system in operation until a Certificate of Compliance has beo issued y e d of heal Signe --- 1111�89... l D e Application Approved By------ --•---- - ----- -- ------------------- .......& �7�C�--------- te Applieation Disapproved for the following easons ...---------•--------•--•------•-•----:...--••------------------------------------Da......-•-•-...-- ---------------------------------------------•-------------------•--...------..._..--------•------------------•----------------•------------------------•-------��-------------------•-.--- Permit No.......... Date_ _...._. .......... Issued _ l._2 ..... ..... Date No�. .... .c� Fxs.Y....2....°............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Z'�Yria....................OF..... _rnst;a le Appliratiott for Diiposa1 Works Tomitrurtiott runfit Application is hereby made for a Permit to Construct ( ) or Repair ('x} an Individual Sewage Disposal System at: 31, Road Os tervi lle j4ass . ...................................................•--.......---•-•--...............---•--........ .......--•---............_.._......------•-•--•............•••••-•---•--------•-•__....---•--•--•- Itl l.e r Location-Address or Lot No. Owner Address a ...aI'. :=pro leer Jr. Installer Address d Type of Building Size Lot............................Sq. feet Dwelling%--No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ------•----•------------------------------------•--......---------•-•------•-----......... W Design Flow.............................................gallons per person per day. Total daily flow..........................................__gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trepch—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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-.----.----__---•----.-. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ----•-•---------------------•-•••-•-•-•-•----•---....•--- -•--....................---•----.......•......................................................... DDescription of Soil.............................................. --------------------------------------------------------------------- W ......................................................•.................................................................................................................................................... W ----------------------------------------------------------------------------------------------•-••-•-------•--••-•----------------•--------------•--••--••-•-•----•-•-----------•......-•--•-----•-_.. V Nature of Repairs or Alterations—Answer when applicable......... .......:................:..-:... ........._.. -------------------------------------- 1-1 rUU o,110,1 p - . ---•------•------•....................•••-••-••---•--•--••-•---••••---••-•-••---•--••---....•••---••--•--••••---.................•--......._•-•_.....•---------_-...._....-••••--•--•--•......••-•-•••-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITTUE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be�e-A issued by the-board of health. SignedA_:� /r_ /_ //e! t�< fL i :,: �� :1 1_. Application Approved B _ D e ! Date Application Disapproved for the following lreasons: ...::`.__..:. --•------------------------------•---•---••--•-------------•-------------...---------.......-------•-•--'--------•------•-------------------------------------------------------------------------•..... '—r Date Permit No......... .�.......----- "�� Issued ... �' Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town BeI rns tab le ..........................................OF..............:...................................................................... Nrdif iratr of (Sootphatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired `(.h ) p� v � �, b 1 �.::,r. m ,,.r. Jr.. � S. Zdc d Oster Per 111_. Installer at .....r.r L r: has been installed in accordance with the provisions of IFT sJ 5 of The State Sanitary Code s described in the application for Disposal Works Construction Permit No -----�^7.................... G--- dated.--.._ .� r1................. THE ISSUANCE OF THIS CERTIFICATE WALL NOT BE CONST_ UED AS A GUARANTEE THAT THE SYSTEM WILL FU TION ATISFACTORY. DATE......1! ..�T.... ...... ............................ Inspector. -• -••--•• .........-•---- �._ t� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................Tn!,TP-...............OF...........l-:a rn.sta lilE .......................................... �,� No........... FEE....Y..._20.O_ �t��o��tl ork� �ott.��riott .rroti� Permission is hereby granted J. .Ma.co lbe.r Jr, .................................'---------------------------•-------------------....----------•------- ........................ to Construct ( ) or Repair)(6 ) an Individual Sewage Disposal System at No...31 Cal,rid�•e Road Ost,er'r_I 11e , ....•. Street r,as shown on the application for Disposal Works Construction Permit ...... Dated....Af Zz.;z.................. � ----- -_•••-• Board of Health DATE.:,t.......... ". ;,„ ifin< ,r FORM 1255,'4,VOBBS & WARREN, INC., PUBLISHERS •� ASSESSORS MAP : _ TEST HOLE LOGS �J PARCEL I v FLOOD ZONE: _ SOIL EVALUATOR,'��rvl0 • m �5� ��. WITNESS : Wit" 'nQLgal, NOTES: \X REFERENCE• 1 �� ��J�ZC�__.� �D- ___- DATE: JV 16 `Qj�171C� ,p._.._ _ PERCOLAT I 0 RATE: VIAL . Ik -- - - - }_ 1) The installation shall comply with Title V and Town of Barnstable Board of \al// Health Regulations. TH- I _ TH-2 2) The installer shall verify the location of utilities, sewer inverts and septic �jv�,SrJ components prior to installation. ����/ I (� 3 All septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. 4) Existing cesspools to be pumped and backfilled per Title V abandonment procedures. `J .r A'v y��� 5) This plan is not to be utilized for property line determination nor any other LOCAT I ON MAPLO.1b) 3�j 1904-!T 1�Gf t j�( purpose other than the proposed system installation. ` 6) All septic components must meet Title V specifications. 7) Parking shall not be constructed over H10 septic components. G 1 8) The property is bounded by property corners and property lines as depicted. 9) The property owner shall review design considerations to approve of total number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed approval of the number of Io Mid, 10)A Garbage Grinder is not to be installed or utilized for the proposed-system. If a garbage grinder exists it is to be removed. iv' SEPTIC SYSTEM DESIGN ° ° p FLOW ESTIMATE r-,E: XEDROOMS AT 110 GAL/DAY/BEDROOM J3D GAL/DAY %.,. c 9 (4EPT i C TANK GAL/DAY x 2 DAYS o� GAL USE 1 ALLON SEPTIC TANK SOI ON SYSTEM Vtr o_ I O S I DE AREA: 7i'lC �l✓ y..fi < �Jt l , BOTTOM AREA: . ( :• ?�� - b� !`7 1C =, SEPTIC SYSTEM SECTION ►�Ts. M - VA ` �ti r0W,(NA Wx j ItAl�.I, T�iKtthN � � q_ o b 10 )IN Z,,or �,p ,�u& llft 5mwru "MAX, 1600 GAL SEPTIC TANK OF AIa S I TE AND SEWAGE PLAN MA t71s FOrAT I PREPARED FOR : I(. TAIM2c ky0 O M A 0 SCALE: I W DAV I D B . MASON DATE: 6 Ne DBC ENVIRONMEN AL DESIGNS s EAST SANDWICH . MA W DATE HEALTH AGENT ( 508 ) 833- 2177 �1