HomeMy WebLinkAbout0039 OAK RIDGE ROAD - Health 39 Oak Ridge RDsterville)
A=118—048
TOWN OF BARNSTABLE
LOCATION _39 OA Rc_J. SEWAGE #
VILLAGE_0 Trt,,J ASSESSOR'S MAP & LOT*1Oi?::
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) 41 "r4 14Ac ol.S (size) /O"X 30 X a
NO.OF BEDROOMS c1—
BUILDER OR OWNER ItkC A
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet oleaching fac � Feet
Furnished by Se � 2i �p/p4r . �f l30�adOf
Al- ►9'
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3
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 39 Oak Ridge Road
Osterville, MA 02655
Owner's Name: Althea Freis, Executor /4
Owner's Address: 4 Midiron Court
Carolina Shores, NC 28467
Date of Inspection: Apri130, 2001
Name of Inspector:(Please Print) James M. Ford o'yFOFe <00
Company Name: James M. Ford
Mailing Address: ` ` '" P.D. Box 49
Osterville,MA 02655-0049 y Map: 118.,
Telephone Number: (508) 862-9400 Parcel: 048
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.:The inspection was performed based.on my
training and experience in the proper function and maintenance of.on site sewage disposal'systems. .I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
✓ Passes
Conditionally Passes -
Nee4KINirther Evaluation by the Local Approving Authority
Fail-
.. r
Inspector's Signature: Date: May 1, 2001
The system inspector shall�ia 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 descrilbes'condiiions at the time of inspection and under the conditions of use at that
time. This inspection does not address low the systeni will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page I
Page 2 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 39 Oak Ridge Road
Osterville, MA
Owner: Althea Freis, Executor
Date of Inspection: April 30, 2001 -
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:
4
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired. .The system;upon completion.of the replacement or,repair,as approved by the Board of Health,will pass.
3 Answer yes;no or not determined(Y,N,NI))in the for the following statements.,;If"not-determined",please
explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
_ . . ... __. The system required pumping more than 4 times a,year_due to broken or obstructed pipe(s). The system will
. __obstructed
inspection.if(with,approval,of the Board.of.Health); .
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
;CERTIFICATION (continued)
Property Address: 39 Oak Ridge Road
Osterville. MA
Owner: AltheaFreis. Executor. _ �_.... ....__..
Date of Inspection: April 30, 2001
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which vrili protect public bealth,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.
2.1 System will fail unless the Board'of Health(and Public Water Supplier;if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
= The system'has"a'septic tank and soil absorption system(SAS)and the SAS;is within°.100.,feet of a
surface water supply or tributary to a surface water supply. .:
The system has a septic tank and SAS and the SAS is within.a Zone 1 of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
;z
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory,. for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
" t
3 �. �,
Page 4 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 39 Oak Ride Road
Osterville. MA .
Owner: Althea Freis, Executor
Date of Inspection: April 30, 2001
D. System Failure Criteria applicable to all systems:
You must indicate either"yes"or"no"to each of the following for all inspections:
Yes No
✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
✓ Discharge or ponding of effluent to the surface of the ground or surface water_s due to an overloaded or
clo„geu I'A i or cesspool
✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow
✓ Required pumping more than 4 times.in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped_.
✓ Any portion of the SAS,cesspool or privy is below high ground water elevation.
✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
✓ Any portion of a cesspool°or privy is within a Zone 1 of a-public well.
✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
_ ✓ Any portion of a cesspool or privy is less than 100 feet but greater.than 50 feet from_a privatewater
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 aad'volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to"or less than 5 ppm;provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large-System: '
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped
Zone II of a public water supply well
If you have answered`yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
Page 5 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
,:. PART B
:.CHECKLIST
Property Address: 39 Oak Ridge Road
Osterville, MA
Owner: Althea Freis, Executor
Date of Inspection: April 30, 2001
Check if the following have been done: You must indicate"yes"or"no"as to each of the following:
Yes No
✓ Pumping information was provided by the owner,occupant,or Board of Health
✓ Were any of the system components pumped out in the previous two weeks?
✓ Has the system received normal flows in the previous two week period? .
✓ Have large volumes of water been introduced to the system recently or as part of this inspection?
✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
✓ Was the.facility or dwelling_inspected for signs-of sewage.back-up
— ;Was the site-inspected for signs of;break out
T ✓ ;: :' Were all;system:components;excluding.the SAS,.located on•site;?; ,
✓' Were the septic tank manholes_uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
✓ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes No
✓ _ Existing information. For example,a plan at the Board of Health.
✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)[310 CMR 15.302(3)(b)].
F
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_
5
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Page 6 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
. .SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM
.. s_ PART C
°SYSTEM INFORMATION
Property Address: 39 Oak Ridge Road
Osterville, MA
Owner: Althea Freis, Executor
Date of Inspection: April 30, 2001
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual): 2
x 110
DESIGN flow based on 310 CMR 15.203 (fore ample: gpd x#of bedrooms): 220
Number of current residents: 0
Does residence have a garbage grinder(yes or no): No
Is laundry on a separate sewage system-(yes or no):. No [if yes separate inspection required]
Laundry system inspected(yes or no): No
Seasonal use(yes or no): No
Water meter readings,if available(last 2 years usage(gpd)): 2000-38,006 gals.; 1999 45,000 gals.
Sump Pump(yes or no): No
Last date of occupancy: Unknown
CONVEVIERCIALIMUSTRIAL
Type of establishment:
Design flow.(based on 310 CM R_1-5.20.3):. gpd
Basis of design.flow(seats/persons/sgft;etc:):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no) .-___- --.``" ;Non-sanitary waste discharged to the Title 5 system(yes or no): ;
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: New system not pumped-per treatment plant
Was system pumped as part of the inspection(yes or no): No
If yes,volume pumped: gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
✓ Septic tank,distribution box,soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)._.
Innovative/Altemative 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
}:.
Approximate age of all components,date-installed(if known)and source of information:
Approximately 1997-per design plans
Were sewage odors detected when arriving at the site(yes or no): No
6
Page 7 of 11
OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE'SEWAGE DISPOSAL'SYSTEM:INSPECTION FORM
PART C
,SYSTEM INFORMATION (continued)
r..
Property Address: 39 Oak Ridge Road
Osterville, MA
Owner: Althea Freis. Executor
Date of Inspection: April 30, 2001
BUILDING SEWER(locate on site plan)
Depth below grade: t.,
Materials of construction: _cast iron _40 PVC other(explain):
Distance from private water supply well or suction.line:_
Comments(on condition of joints,venting,evidence of leakage,etc.):.'
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: 16" _
Material of construction: ✓ concrete _metal _fiberglass polyethylene
_other(explain)
If tank is metal list age: . ._.- .Is.age confirmed by a Certificate of Compliance(yes or.no): (attach;a copy of
certificate)
Dimensions: 1500 gal.
Sludge depth: 1"
Distance from top of sludge to bottom of outlet tee or baffle !31
Scum thickness: 3
Distance from top of scum to top of outlet tee or baffle: 10"
Distance from bottom of scum to bottom of outlet tee or baffle: 10"
How were dimensions determined: Measuring stick
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
The tees were present The liquid level was even with the outlet invert. There were no signs of leakage.
GREASE TRAP: None (locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass polyethylene _other
(explain):
Dimensions:
Scum thickness: _.
:alDistance from:top ofscum: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 pumpingrecommendations,inlet and outlet tee or baffle condition,structural integrity,liquid;levels
as related to outlet invert,evidence of leakage,etc.): _
Tp k
• YT
Page 8 of 11
OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM,INFORMATION (continued)
Property Address: 39 Oak Ridge Road :. .r
Osterville. MA
Owner: Althea Freis, Executor
Date of Inspection: April 30, 2001
TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: _concrete metal fiberglass _polyethylene _other(explain):
Dimensions: µ
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
_ ...DISTRIBUTION,.`BOXi_ %:.`�(ifpiesent.inust_hz opened)(locate on`site
Depth of liquid level above outlet invert: Even
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
The D-box was level There were no signs ofsolids or leakage. The outlet invert was 36"below grade. The cover was 24"below
grade
PUMP CHAMBER: None (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no)
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
g
Page 9 of 11
OFFICIAL INSPECTION.FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
INFORMATION (continued)
Property Address: 39 Oak Ridge Road f w
Osterville. AM
Owner: Althea Freis. Executor
Date of Inspection: April 30, 2001 : .
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type ... .....
leaching pits,number:
✓ leaching chambers,number: 4-high cap. infiltrators(10'x 30'x 29-per design plans
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
__ ... .... overflow cesspool,number:.
w_..._, .. Innovative/alternative system.. Type/name of technology
.. ....
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation;
etc.):
The infiltrators were located but`not-dug up. .There.were no signs of-failure in the D-box:-The bottom to grade was
approximately S'
CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:. _
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: None (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
9
s
Page 10 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM-INFORMATION (continued)
Property Address: 39 Oak Ridge Road ;
Osterville, AM
Owner: Althea Freis, Executor
Date of Inspection: April 30, 2001
Map: 118
Parcel: 048
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.
Roo+
A3- 3a
10
Page 11 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSlt. I'I'NFORM'ATION (continued)
Property Address: 39 Oak Ridge Road
Osterville, MA "
Owner: Althea Freis, Executor
Date of Inspection: April 30, 2001
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:
✓ Obtained from system design plans on record-If checked,date of design plan reviewed: 1212196
Observed site(abutting property/observation hole within 150 feet of SAS)
✓ Checked with local Board of Health-explain: topographic and water contours maps
Checked with local excavators,installers-(attach documentation)
- Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
- The bottom-of the infiltrators to grade was approximately Y Using the Barnstable topographic map'and the Cape Cod
Commission water contours may, the maps were showing approximately 30'+/-to groundwater at this site. A perc test was
done when the system was installed and no water was observed at 10.
This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a
warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees,
either expressed, written or implied, relating to the system, the inspection and/or this report.
11
TOWN OF BARNSTABLE
q
LOCATION ION `7 Oa� g ilye c` SEWAGE #
VILLAGE 9,;Ier v,'11 C ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. 19 4-
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size) � �� �►'
NO.OF BEDROOMS f
BUILDER OR OWNER J /�� �°'>/�'•r� -�`- �.
PERMI TDATE: -�. r IM PLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
f
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1 `l./✓at`�f
/ y
N
1 p nL .
� A _
py �a v
2Y"
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�' 1,
3 ITT T P
4 31 �� 3f .
AV
No. W
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
�1PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
311 Zipplication for Oi5po5ar *Vztem Con.5truction Vermtt
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner' Name,Address and Tel.No194
Assessor's Map/Parcel M-1A0Pff ����
0
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
00 AA L"rO
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder A/O
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank ype of S.A.S. (
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
AT
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 issued by this B d Healt
Signed A Date
Application Approved by &Iaqzp!�L ® Date
Application Disapproved for following reason
Permit No. Date Issued
,`.°' irk " •
No. Fee
THE COMM"ONWEALTtH OF MASSACHUSETTS 'd�: 'iEntt red in computer:
f Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,, MASSACHUSETTS
2pplication for Digogaf *pgtem Cottgtruction Permit
k Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) `-�]Complete System ElIndividual Components
Location Address or Lot No. D Owner' Name,Address and Tel.No.
Assessor's Map/Parcel,
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
v'oNAl AA L-"D
Type of Building:
Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder
Other Type of Building No. of Persons Showers( ) Cafeteria( )
~ Other Fixtures
Design Flow ' gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title 44
Size of Septic Tank ype of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
AT
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 issued by this B d Healt .
- Signed Date
Application Approved by a Date
'Application Disapproved for t following reason s
4
t
Permit No. , Date Issued
" THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERTIFY, that t e Ord-site Sewa�ge1Disposal System Constructed( ) Repaired ( )Upgraded( )
Abandoned( )by��� ,A&,,-r ,�
at s ee constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. "` dated
Installer Designer
The issuance of this permit sh 11 not be construed as a guarantee that the systepl will function as designed.
Date Inspector
--- — ------------------------- — .^.�.
q6Z7
No. — Fee
THE COMMONWEALTH OF MASSACHUSETTS
{ PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
lwigpogar *pgtem (C0
1
1gtr ction Permit
Permission is hereby gr ed o Construct )�7At�epgrade )Abandon G
System located atQjq �77
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 this it.
Date: ,�'"� �~ Approved y
TOWN OF BARNSTABLE
'��>Ir.00ATION
SEWAGE
ASSESSOR'S MAP&LOT
`>VIIrLAGE ' —
:: 11`$STALLER'S NAME&PHONE NO.
TANK CAPACITY
sI:EACHINGFACILITY: (type) `' ,�fv.� (siu) /a XI ---_
NO:OF BEDROOMS
r':::.0t LDER OR OWNER "
Pl✓RMTf DATE: r Q,.NIPLIANCE DATE: �---.—
Separation Distance Between the:
Maumum Adjusted Groundwater Table and Bottom of Leaching Facility
Feet
<private Water Supply Well and Leaching Facility (If any wells exist
Feet
on site or within 200 feet of leaching facility)
`Edge of Wetland and Leaching Facility(If any wetlands exist Feet
-
.:::::.:'::within within 300 feet of leaching facility)
'.:,Furnished by
' #-P
�� Z
GENERAL CONSTRUCTION NOTES
1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5
/�
AND THE TOWN OFci � �;- RULES AND REGULATIONS FOR
P R O F I L_ E O fC S E W AGE DISPOSAL_ SYSTEM THE SUBSURFACE DISPOSAL OF SEWAGE.
2. AT LEAST ONE ACCESS PORT OVER TANK TEES SHALL BE ACCESSIBLE
NOT TO SCALE WHITHIN SIX INCHES OF FINISH GRADE WITH ANY REMAINING ACCESS
PORTS BROUGHT TO WITHIN TWELVE INCHES OF FINISH GRADE.
3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF
WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10'
TOP FOUND. EL. ���s+'• a z ;� OF DRIVES OR PARKING. H-20 LOADING SHALL BE USED UNDER OR WITHIN
10' OF DRIVES OR PARKING UNLESS NOTED.
4. THE EXCAVATOR/CONTRACTOR SHALL VERIFY THE LOCATION OF ALL
SITE UTIL17ES PRIOR TO ANY EXCAVATION.
Iv
5. SEWER PIPES SHALL BE 4" SCHEDULE 40 PVC LAID AT 0.02 SLOPE.
h-3
— - 6. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE
INV. EL. 4X•4 = '--,_ MORTARED IN PLACE.
() [�- I — WATER TIGHT COVER
FLOW UNE 7. FINISH GRADE SHALL HAVE A MINIMUM SLOPE OF 0.02 FEET PER FOOT.
�o' MIN. 19 INV. EL. - 1 �- 2' LEVEL— -�
10' MIN.-74' UQUID DEPTH
IN,
EL a%.o 1 MIN. 6" -`::•.
SUMP
i
INV. EL A6,S INV. EL -A l> >e
a
1500 GALLON PRECAST REINFORCED CONCRETE SEPTIC TANK �� 2" MIN. — 1/8- TO 1/2' WASHED STONE
MINIMUM CONSTRUCTION MATERIALS PER 310CMR 15.226(2) PRECAST REINFORCED CONCRETE
DISTRIBUTION BOX •
TEES SHALL BE CONSTRUCTED OF SCHEDULE 40 PVC AND INFILTRATOR 2,
SHALL EXTEND A MINIMUM OF 6" ABOVE THE FLOW LINE INSTALL ON A LEVEL BASE EFF. DEPTH
OF THE SEPTIC TANK AND BE ON THE CENTERLINE OF THE 3/4- - 1 1/2- WASHED STONE
SEPTIC TANK LOCATED DIRECTLY UNDER THE CLEAN-OUT MINIMUM WALL THICKNESS = 2" \o'
_ MANHOLE.
MINIMUM INSIDE DIMENSION = 12"
THE INLET PIPE ELEVATION SHALL BE NO LESS THAN 2' NOR INV. EL. .-. 4o•U 30 ke' z
MORE THAN 3" ABOVE THE INVERT ELEVATION OF THE OUTLET INVERTS SHALL BE EQUAL TO EACH S.A.S. LONG x WIDE x_EFF. DEPTH
OUTLET PIPE. OTHER AND AT 2- MINIMUM BELOW INL.ET INVERT. WITH �- HIGH CAPACITY INFILTRATOR CHAMBERS VI)
D
SEPTIC TANK SHALL BE INSTALLED LEVEL AND TRUE TO GRADE THE DISTRIBUTION LINES FROM THE, DISTRIBUTION BOX
SHALL ALL HAVE EQUAL INVERTS' AS DETERMINED BY FLOODING
ON A LEVEL STABLE BASE THAT HAS BEEN MECHANICALLY THE DISTRIBUTION BOX TO THE. HEIGHT OF THE DISTRIBUTION
COMPACTED AND ON TO WHICH SIX INCHES OF CRUSHED STONE LINE INVERT AFTER ALL LINES HAVE BEEN SEALED IN PLACE.
HAS BEEN PLACED TO ENSURE STABILITY AND TO PREVENT \'
SETTLING. INVERT ADJUSTMENTS SHALL BE MADE BY FlLUNG WITH DURABLE �
AND NON-DEFORMABLE MATERIAL PERMANENTLY FASTEND TO THE
SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9" LINE OR RECONSTRUCTING THE`LINES UNTIL ALL INVERTS ARE OF
EQUAL ELEVATION. NOTE: CONTRACTOR SHALL VERIFY LOCATION OF ALL UTILITIES
PRIOR TO EXCAVATION.
THREE 20" MANHOLES WITH READILY REMOVABLE IMPERMEABLE
COVERS OF DURABLE MATERIAL SHALL BE PROVIDED WITH ACCESS NOTE: SHOULD SOILS NOT CONSISTANT WITH THOSE SHOWN
PORTS BEING PLACED AT THE CENTER AND OVER THE INLET AND IN THE SOIL OBSERVATION DATA BE ENCOUNTERED THE — 1=1', '`-C`
OUTLET TEES. CONTRACTOR SHALL STOP WORK AND CONTACT THE �o V�pTi_tL�
THE OUTLET TEE SHALL BE EQUIPPED WITH GAS BAFFLE. FALMOUTH HEALTH DEPARTMENT OR DESIGNER.
REFERENCE MAP:
SOIL OBSERVATION DATA: CAPE C00 DESIGN DATA: { /t
WATER TABLE CONTOURS
' AND \\ ��9 .: -� � '•-� 4. �
PUBLIC WATER SUPPLY STRUCTURE CGS. Z
TEST DATE I z - zq-q WELLHEAD PROTECTION AREAS TYPE NO. BEDROOMS GARBAGE DISPOSAL
SEPTEMBER 1995 DESIGN FLOW �} +
SOIL EVALUATOR LIB
S oy! L
S
WATER RESOURCES OFFlCE
CAPE COD COMMISSION
EXCAVATOR
PERC/RATE \_ SEPTIC TANK �3o k -La � = (�t�o c �_�_ l�s�� 1� C.��t���` �� �QN•�'
SHEET 2 OF 2
FL, A3,o� , LEACHING FACILITY (� �Vo 4,-so tmu'�IZ�`�
5L lo�R3 1. p11r b AI�
� C ltD �� � NL„� y. L=F �L�rt•
16 ,
to'IR SCALE: AS SHOWN DATE: 17- -z
STEPHEN J. DOYLE AND ASSOCIATES
saves 42 CANTERBURY LANE, FALMOUTH MA. 02536
TEU`3•0 t`p I' TELEPHONE: 508/540-2534