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HomeMy WebLinkAbout0112 OST.-W.BARN. RD - Health 112 OST� ` �4 V (�.� Ned;` 0 Cv UPC 12143 w� No.53LGN I �S7•CONS� HASTINGS,MN -f pour Lit � P 4 �S w I e 0 ��Y Wc., l 7" Nu! ����!�%�v��''" - � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in cOpte, � PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0(ppYliAtI011 for aI8p080Y 6pStElll COTYBtCULt1011 PPrllllt Application for a Permit to Construct( ) Repair(Y�'Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No,//2' ©yf- IV )2d Owner's l�ame,Address,and Tel.No. ate/V 1))-p NLt'�!L Assessor's Map/Parcel Imialler's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. �.bJ<jI[rSA 17FMAw TNG Type of Building: Dwelling No.of Bedrooms ?j Lot Size 2-1,0g7 sq.ft. Garbage Grinder( ) Other Type of Building �\p V g If No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 5y57;g gpd Plan Date Y/i B/j 3 Number of sheets 2— Revision Date. Title Size of Septic Tank >Sqp Type of S.A.S. A f c 3 G C Description of Soil Nature of Repairs or Alterations(Answer when applicable) T-tiJS tr. /V C y.5 Se q+-1 c L pc-e P►. :.v S v s�c� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has be6n issued byOikBoard of Health. �jAiej-d-�—(5�e Date f' Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued (42 K . . ON Nt» / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,,MASSACHUSETTS 9pplitation for Mis osaY . stern Construction 3permit Application for a Permit to Construct( ) Repair(06pgrade( ) Abandon( ) [:]Complete System ❑Individual Components Location Address or Lot No. //Q C 7cA AV 3," /1 C) Owner's Name,Address,and Tel.No. (obi c-/ -p NUJ L Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. l�vSlc S A '13(owJ Tn+c i S -yM- 71_S Type of Building: Dwelling No.of Bedrooms '?, Lot Size 2 ti',Oq 7 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 2�'�20 gpd Design flow provided 1157,E gpd Plan Date l� R �j Number of sheets 2 Revision Date Title ,mot Size of Septic Tank S # Type of S.A.S. A t c ?L� 1a C Y D ription of Soil 1 - Nature-of Repairs or Alterations(Answer when applicable) S as+�, 1 1 n?A,�J Sew n i i c 1 Of lD RM Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by t ' Board of Health. dT- e5l/� f ;'J -7r Date 7 Application Approved by // Date Application Disapproved by Date for the following reasons r, Permit No. Date Issued ------------ ------------= ------------------------------ --------- ----- -j-------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( 1� Upgraded( ) Abandoned( )by ► /,, ,��,. A 11 (o,kn, T ABC J at /J Q;fi P r u it I r has been cons cted' acc dan e with the provisions of Title 5 and the for Disposal System Construction Permit No Installer rcc, e,,C Designer ,��-i✓i, /.✓/� #bedrooms Approved design flow R -, gpd • ZrOS The issuance of this permit shall no r_ Ie c s- I- (. e)d� a guarantee that the system will cti n as d/s/i/ned. Date F- (. In ector �V 1 ) I p , - L, 1r 1 ----- - -------------------------------------------------------------------------------------------------- No. Fee �— THE COMMONWEALTH OF MASSACHUSETTS /0_0 PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS y Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( IK Upgrade( ) 1 Abandon( ), System located at 51-re G,��r PS and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be comlt�e�din t ee years of the date of this permit. Date // Approved by J 06/2e/2013 14:25 5084775313 ENGINEERING WORKS PAGE 01 'down of Barnstable Re latery Services Thomas F.Geiler,Director { Public H.eaith Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 office: 308-SC 4644 Fax: 50&79"304 ' Date:irQ-2,7 0 Sewage PermitiY 2 1"3,2 G Assessor's Map/Parcel �20—O�3 Im►taller&Desisner ggj1t Mftm FgM War4s, Inc.. Installer: Addren; 1 z W. Cra :s .tan ti Address: MA az(0yy C..^ 1k. "3A rjz6 3C -�4 Qn y 1 ` �' ' `'�'^ t'^ was issued a permit to install a (date (insta ler septic system at 1 Z S_�trd, �E F�. e�e based on a design drawn by . (;"address) ettr mc_ �C,,�a..e (° dated 4— (designer) ,( I oertify that the septic system referenced above was installed substantially according to the desi�a, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with ma'or changes(i.e. greater than 10' lateral relocation of the SAS or any vertical relocation ot-any component of the septic system)but in accordance with State&Local Regulations, Plan revision or certified as-built by designer to follow. Stripout(if required)wa and the soils were Found satisfactory. �jvk pF PETER T. , WENTEt' er's S4natureY CIVIL sn No.38100 a @ (Designers Signature) (Affix Design } PLEASERETUgN TO pAMSTAJILE ZIMLICT F C E L NOT WE I ) U TM HVI Tffi >lL, I B AB LI ON. JUAM YOU. q\office fDnn\de0&rmwrfificWOn form.doc t 2 6 ste,,dIle U�st June 20,2013 RE: 112 Osterville West Barnstable Road,.Osterville To whom it may concern, The above referenced property has been configured and used as a three bedroom single family residence since 1986. Please see the attached sketch. Cordially, Gregory Nowak,Owner Sam Traywick,Owner Go Taman a �ar>dlile . # 1" Department"of Regulatoryets'vices Publicealth:Div>f i rz i3 >: OII Date 200 Mam Street,Hyannis MA 02601 -- Pate.S chedt led Time ee`I �'- `tr IIrv; C .3 F Pd." Soil Suitability Assessment for Sewa a Disposal a ' Perfrnmed By: Witnessed:By: LOCATION$ GENERAL INFQRiTIO2\T " Location Address Owner's Name � . �� 7. ` ►7G�Y�$ � Address Y Assessor's Map%Parcel: r — 3 `" Engineer's Name � ("� �„1 •P NEW CONSTRUCnONp�- REPAIR ' `?� Telephone# .JUf 3 71-q?t��6 Land Use" S�.6n 4-°t0.I Slopes(%) - Surface Stones /VO,• -( ' Distances from: 'Open Water Body j ft Possible Wet Area �� ft Drinking Water Well'C rU ft Drainage Way ft Property Liney ��" ft Other ft SI ET,CI treername,dimensions of lot,exacrlocations of test holes&perc tests,locate wetlands?n proximity tololes) Y, Parent material(geologic) �`� � Depth to Bedrock �AIJ A to Depth to Groundwater. Standing Water in Hole: Weeping ftm Pit fha e Estimated Seasonal Groundwater DETERMINATION FOR SEASONAL ffiGH WATER TABLB '' ^ Method Used- Depth Observed standing in obs.hole: - __W In, Depth to soil-mottles: Depth to weeping from side of obs.hole: in. Groundwater AdJusttnent ft. . Index Well.# Reading Date: index Well lever Adj.Actor At({;drotiffdwafeF level,,,m PERCOLATION TEST' »nsn?1.z '>tvme Observation Z Hole# (, Time at 9" e j�v ......_.._ ; Depth of=Pere • Tlme:ut 6'- �1 v� Start Pre-soak Time® . I S Inme(9"-60�) End Pre-soak Rate MmJlnch - Site Suitability Assessment: Site Passed �( Site:Failed: Additional Testing ceded(Y/1� Original: Public Health Division Observation Hole Data To Be Completed on Back----------- percolation test is to be.conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTICIPERCFORM.DOC DEEPOBSERVATION HOLE LOG Depth from Soil Horizon Soil I Texture Sdil'Color Soil Other Surface(in:) (USDA) (Munse11) MottlinmN g (Structure,Stones;Boulders: r—• L Coo '13 Gi,-. DEEP O �ERVATION 1OLE LOG "77777 Hole# z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulder. s' to I t I.L s3 . SL �o y2 /Xq DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil.Color. Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;'Boulders. Consistency. wq', -TI. 4 - .... DEEP OBSERVATION HOLE LOG Hole# Depthfrom Soil Horizon Soil Texture Soil-Color _ Soil' Other Surface(ia.) (USDA) (Munsell) Mottling (Structure,StoneS'Bouldprs, { mistena 77777777 Flood•Instiranee Rate 1k1an:, Above 500 Year flood boundary. No_ Yes iNitiun`dUn year boi►ndary No Yes, . Within t00 year, boundsrY No Yes • flood boundary � • Depth of lea;- r Occurring,Pervious-IL n ter ial Does at.least four feet of nattImly occurring pervious material exist in all areas observed ihrouglaout the; .., area proposed for the sotl absorption system?' �` If not,what'is&6ep i of naturally occurring pervious mtitorial?' ..... I cerofy.that:on (dated I.have passed the Soil evaluator examination approv1.ed>;y the Department of Environmental Protection and that the above analysis was performed by me consistent wttli .T the r'equired`tr expertise and':experience described in 10 C-Nm 15.017. ,... Date. - Signature Q:�SEP!1'lCU?gRCAORM:DOC J TOWN OF BARNSTABLE LOCATION .I Z C>5'1r4kt�r (N SEWAGE# VILLAGE. ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NOss� ,�-u„� c co�3-�2by�i SEPTIC TANK CAPACITY 1 S®O LEACHING FACILITY:(type) Adc 3G tic 0-20 (size) (,6 %KCrie NO.OF BEDROOMS 3 OWNER PERMIT DATE: / COMPLIANCE DATE: G 29 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 orr _... 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 BYI� �' 1- v TOWN OF BARNSTABLE T� LOGATIOI� ��! GlJ��/t1 SEWAGE # VILLAGE Wi4!�5 �J e, ASSESSOR'S MAP& LOT ®r INSTALLER'S NAME&PHONE NO.V. ,4ee, � 1L VI. SEPTIC TANK CAPACITY Aftle LEACHING FACILITY: (type) �� o' � �d — (size) NO.OF BEDROOMS BUILDER OR OWNER— �e1 PERMITDATE: 6—l- 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) V Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet lg 'n cility) Feet Furnished by �11A, i�a W ixcrn5 �l� C4- s� z �c8' CA3 1 DATE: 5/1 /96 PROPERTY ADDRESS: Judy Vellone CLU n~. LLJ 112 Ost. W.B. Road a � �C&I Osterville ,Mass . 02655 ¢ �z - --- On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 3-61x8' • block cesspools . Based bn my ing:w.ction, I certify the following conditions: 1 . This is not a title five septic system 2. This is a sewage system with cesspools in series. 3 . Main cesspool acts as a septic tan:k. ; Holds solids in place and allows water to flow to the two overflows . 4. The sewage system is in proper working order at the present time . SIGNATUR!-- : Gt� Name : J . P . Macomber -Jr..--- Company: J P . MacoMber & Son Inc .. Address:—,.B-Q.X-66------"------- Centervill.e , Mass__02632 Phone:__ ' 5a8-Z7 -3338--.------- THIS CERTIFICATION DOES NOT CONSTITUTE .A GUARANTY OR WARRANTY 4 • lop JOSEPH P. MACOM ER & SON, INC. Tanks-Csupools-LeachfleIds Pumpad & Installed Town Sewer Connections P.O. Sox 66' Centerville, MA 02632-0066 775-3338 775-6412 • r V��7AfT[IIC�IT VT . Environmental Protection Dj William F.Weld Trudy Coxe Governor gectmary ArQeo Paul Ceiluccl David B.Struhs LL Gowmor Corrwnworwr • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A _ CERTIFICATION PropertyAddress:112 Osterville W.B.Road OstervilleAddreaaotowner. 552 Shootflying Hill Rd Date of Inspeotioub/1 /9 6 (If different) Centerville ,Mass . 02632 Name of Inspector. Joseph P.Macomber Jr. Company Name,Address and Telephone Number. CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: asses — Conditionally Passes — Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signal The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: ." I eve not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: �)11 One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes, no,or not determined(Y, N, or ND). Describe basis of determination in all instances. If"not determined",explain why not) y The septic tank is metal, cracked,.structurally unsound, shows substantial infiltration or exfiltration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street • Boston,Massachf+setts 02108 a FAX(617)556-1009 • Telephone(617)292-55W JPrinted on R"Ied Paper I --�'---i1ay oI iaipeotlon: Bj SYSTEM CONDITIONALLY PASSES (continued) We, Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: -AID Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: ALD The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform 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. 3) OTHER This is a sewage system that has threecesspools ( 61x8l ) in series Main cesspool acts as a septic tank and contains solid waste in place and allows effluent to pass to the 2 remaining cesspools . (revised 11/03/95) 2 r SUBSURFACE SEWAGE DI9P09AL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) ProP,rtyAddross: 112 Osterville west Barnstable Road Osterville ,Mass . Owner. Judy Vellone Dato of I=Pwttou: 5/1 /96 if D) SYSTEM FAILS1 • I have determined that the system viOlntos on,or more of th,following(allure criteria as defined in 310 CMR 15.303. The basis for this determination is id,ntIW below. The Board of Health should be contacted to determins what will be necessary to corrwct the . failure. : j,/P. Backup of sewoge into facility or ryrtem component due to an overloadad or clogged SAS or co,rpcol. Discharge or poading of effluent to the surface of the tround or surface waters duo to an avorload,d or clogged SAS or casspooL &Lve' Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cotspool. Liquid depth in cesspool it less than V below invert or available volume is less than V2 day flow- RaquirodP=Plnl more tl=4 times in the last year NOT duo to clogged or obstructed pipe(s). Number of times pumped d-1.0 Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Amy portion of a cos Pool or privy is within 100 foot of a surface water supply or tributary to a surface water supply. (� Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 60 feet of a private water supply well. Any portion of a cesspool or privy is has, than 100 feet but greater than 60 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of wall water nrm�ysL for eoliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen- El LARGE SYSTEM FAILS: The following criteria apply to largv systems in addition to the criteria above: /VO The system servos a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a slgnitscant threat to public health Lad safety and tha environment bocause one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 f,et of a tributary to a surface drinking water supply IJ9 the system is located in a nitrogen sensitive area (Intonim Wellhead Protection Aran(IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such rystem sha.l bring the system and facility into Anil cetnpl MU with the Mundwater tralttnent prOV= Mulremenu of 314 CMR 5.00 and 6.00. Plow:a consult the local regional ofllce of the Department for further information., S r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM C PART B CHECKLIST PropertyAddressa 112 Osterville West Barbstable Road Osterville ,Mass. Owner. Judy Vellone Date of Inspection: 5/1 /9 6 s Check if the following have been done: ,Pumping information was requested of the owner,occupant,and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. -1,1Aa built plans have been obtained and examined. Note if they are not available with N/A • The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow , The site was inspected for signs of breakout. ZAll system components,a eluding the Soil Absorption System, have been located on the site. N&Q'he septic tank manholes were-uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge,depth of scum. size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. /The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub. Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAddreaa: 112 Ost. W.B. Road Osterville ,Mass . Owner. Judy Vellone Date of Inspection: 5/1 /9 6 FLAW CONDITIONS REBID ' Design flow: Number of bedrooms. Number of current residents:- Garbage grinder(yes or no):_aX Laundry connected to syst, (yea or no): � Seasonal use(yes or no): J�� Water meter readings, if available: IF Last date of occupancy:._,;.,�. i COMMERCIAL NDUSTRIAL: Type of establishment: Design flow:,6)jj_ga2ons/day Grease trap present: (yes or no) Industrial Waste Holding Tank present: (yes or no)_&P Non-sanitary waste discharged to the T'tle 5 system: (yea or no)- Water meter readings, if available: Last date of occupancy:AM OTHER (Describe) Last date of occupancy: AM GENERAL INFORMATION PUMPING RECORD and f information: system pumped as part of' pection: (yes or no)4/0 If yes,volume pumped: (J ____gallons Reason for pumping TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool ,V b - Privy VN' shared system(yes of no) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed(if known) and source of information: LI-4 L�� Sewage odors detected when arriving at the site: (yes or no) (revised 11/03/95) 5 b SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) property Address: 112 O s t. W.B. Road O s t e r v i l l e ,Mass . Owner. Judy Vellone Date of Inspection: 5/1 /9 6 SEPTIC TANK,,d20, e- • (locate on site plan) Depth below grade:z ' Material of construction- _metal_FRP—other(explain) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: scum thickness:k_ Distance from top of scum to top of outlet tee or bslfle:-L-R Distance from bottom of scum to bottom of outlet tee or baffler Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) GREASE TRAP: OiYe (locate on site plan) Depth below grade: N/Q Material of construetion:jl�h'concrete—metal—FRP_other(esplain) 100 Dimensions: Scum thicla►ess: Distance from top of scum to top of outlet tee or baffle:jw. Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level is relation to outlet invert,structural integrity, evid?noex leakage,etc.) - (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) property Address: 112 Ost. W.B. Road Osterville ,Mass . Owner. Judy Vellone Date of Inspeotion: 5/1 /9 6 TIGHT OR HOLDING TANK:A�ei (locate on site plan) Depth below grade: A) - Material of constmction:VA"ooncrets_metal_,FRP_other(ezplain) N Dimensions:- NIP Capacity: )4 gallons Design flow: t Qallons/day Alarm level N A Comments: (condition Pf inlet tee,condition of alarm and float switches,etc.) A GYYYt� � DISTRIBUTION BOX:AiU'V, (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note if level and distribution equal,evidence of solids carryover, evidence of leakage into or out of box,etc.) PUMP CHAMBER�LA"C, (locate on site plan) Pumps in working orden(yes or no) 4/W Comments: etc.) (note condition of pump chamber, condition of pump#and appurtenances, (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontlnuod) Property Address: 112 Ost. W. B. Road Osterville ,Mass . Owner. Judy Vellone Date of Inspootion: 5/1 /9 6 SOIL ABSORPTION SYSTEM (SAS):, (locate on site plan, if possible;excavation not required, but may be approxi—ted by non-intrusive methods) • If not determined to be present,explain: Type: leaching pits,number: leaching chambers, number: lea Ching gallaries, number: leaching trenches, number,length: 0 — 8 fields, number, dimensions overflow cesspool, number:,_,, Comments: (note condition of so s of hydraulic failure, level of n",condition of vagetation,et.c.) Soils; Loamy san To medium sand; ?00 signs og hydraulic failure or ponTl'n—g,-= vegetation is normal. Cesspools are structurally sound. No repairs needed at the present time . CESSPOOLS:z (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: 1 Materials of construction: IQ n Indication of groundwater: nn inflow(cesspool must be pumped as part of inspection) '0'q V Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Soils • Loamy sand to, medium sa • o signs y ' ponding. All vegetation is norms • esspools are s ruc ural y sound. No repairs are needed at the present time. (locate on site plan) Materials of constriction: /lip Dimensions: /U/} Depth of solids: Comments:pwts condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) Al-19 /�B LJJiv1 w/f'�JTS (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) PropertyAddresa; 112 Ost. W.B. Road Osterville ,Mass . Owner. Judy Vellone Date of Inspection: 5/1 /9 6 SKETCH OF SEWAGE DISPOSAL SYSTEM: • include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' Centerville Osterville Marstons Mills Water Company T 428-6691 In l Y) \ d- v DEPTH TO GROUNDWATER Depth to groundwater../feet method of determination or approximation: Installed systems beside this house and across the Street No water was encountered at 121 All cesspools are dry and s;,hg;,xs no SignS of the water tAhl P i (revised 11/03/95) g ��. ••f�b-• SIC . . 7 � � b 11f 3� i THE -CO1\1MON`WEALTH OF" MASSACIHIJSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. June 8, 1995 Acting Director of the Zion of Water Pollution Control f rrtnT*..—}.thy—TT1TTT ZT.rtaTrr--str..r....rr.::Tr•r`T4rRl'i'�".'��tm�Z:rs�Terrr.. . .. . —. .. .TsrtTlr .T.r. .......r � TOWN OF Barnstable BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION \J �:•••s:•t^r•:-:: --.::r.^.-rnrr-n•rt:mr..sr.•.—trrrrrrrz•r,-:rer.-s--rtrrr-rrrr.esaensarrr.e:rrrra isenn�rr�sv�*rrarr•�:rrrr•r.-ter•—s.� -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 112 OQt. W. B. Road Osterville ,Mass ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME jyla3 v -1 l yin P PART D - CERTIFICATION r NAME OF INSPECTOR Joseph P. Macomber Jr. . COMPANY NAME J.P.Macomber & Son Inc. COMPANY ADDRESS Box 66 Genterville �Mass - 02632 Street Town or City State LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 - 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposaj system at this address and that the information reported is true , accurate , and complete as of the time of .inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one: , XXXXXXXSystem PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which. I have conducted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature i. Date _5/3%96 ✓% Qne copy of this ert.ification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, the owner or"" ` erator shall u p pgrade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided in =310 CHR !15 . 305 . TOWN OF BARNSTABLE `� LOCATION ��! GIB � r./ SEWAGE# VILLAGE ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO.V' �. ,� '�^. SEPTIC TANK CAPACITY. �/,W� r LEACHING FACILITY: (type) t � � �dd�is (size)_ �� t NO..OF BEDROOMS BUILDER OR OWNERNa PERMITDATE: COMPLIANCE DATE: �P � 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 I lye 'n cility) Feet Furnished by (15fq��2. s� • Vv L 1f6, rd(Q - �� f. LEGEND EXISTING CONTOUR N .WOoa X Loose EXISTING SPOT'GRADE EXISTING CESSPOOLS BENCHMARK ,SET TO BE PUMPED & FILLED aW EXISTING WATER SERVICE A) °��c EXISTING GAS SERVICE to c o OUTSIDE BULKHEAD CORNER W/SAND AND ABANDONED -G y G�cg g. --0.H.W- OVERHEAD.WIRES - EL.= 'S6:91 (Assumed Datum) � � e +50 TEST PIT o $ °^ ' .; • BENCHMARK s E a r g 173:25' m r { CH fence 49,71 •r • O f ti r as o� N S per. +5.1.06, 49.21 .- ^� / ROad (... ..;; a LOCUS.: R' CB U' ✓ 51.20 \ 000 O '51.69! //' S 34 \ j a L 51.61. of, . . . (. . . .�: LOCUS 'MAP ------ �ge---��� _ NOT TO SCALE e -J \J TP 2 1•�,T / � 52,03 is C P � .,� �',. _ - C�"3P1 �S 0 _ 30' . ' GENERAL NOTES: °. • • I y. a.•. 1. ALL CHANGES- TO'THIS 'PLAN MUST BE APPROVED`•BY THE`LOCAL H • „ " . a� •� ^• - ":.- � BOARD OF HEALTH AND THE DESIGN ENGINEER ��; .;;.,' �l �, `• PROPOSED.SEPTIC TANK 20�' `, 53.71 s3.os 2• ALL WORK.AND' MATERIALS SHALL CONFORM'TO THE:REQUIREMENTS 043 R- 53,80 + ,, ,y500, GALLON CAPACITY* OF THE STATE'"ENVIRONMENTAL CODE, TITLE V, AND ANY.APPLICABLE" • °' I 30•, f LOCAL RULES AND REGULATIONS. 29,0.97fS:F. 3.-THE SEWAGE DISPOSAL` SYSTEM "SHALL .NOT BE BACKFILLED PRIOR - _ 51.54 T �O 0 \ N TO INSPECTION AND APPROVAL BY THE-,BOARD OF HEALTH,AND ,THE sa.95 < y }<, DESIGN ENGINEER. x f 55.07 x.5a:as » • ,�, _ ". 4..ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION :DIFFERING• ° 55.69 55,78 FROM THOSE HEREON SHALL52,22 x,54.55 ry ENGINEER; BEFORE SHOWN,CONSTRUCTION' CON TINUESORT PAT/0 56.91 L 5: ALL ELEVATIONS BASED ON ASSUMED DATUM. ss.6s SEWER CONNECTION s 6. THE. ENGINEER" IS ,NOT RESPONSIBLE FOR THE FAILURE,OF . X ,\ : INV.=52.5f :(VERIFY) THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF »:. , 1 Q: 56.19 - HEALTH yFOR PROPER INSPECTIONS DURING CONSTRUCTION. R' U . x 5568 C¢1 ,EXISTING ;� 7. WATER SUPPLY PROVIDED $Y TOWN WATER SERVICE. A „ '. DECK I r. �V H2OUSE 112 \, t. 8. THERE ARE NO WELLS ,WITHIN' 15'0' OF THE PROPOSED S.A.S. 53;68 .,., .. 4. / 56.34 x: . O.F-Jr6.9f 50,31 `. 56.73,x 4 " 9' ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS- / w AGREED UPON BY AND CONTRACTOR'OR AS OTHERWISE ,, 55. DIRECTED•BY THE APPROVING-AUTHORITIES. w i , `rT , , ; , THE LOCATIONT ONTRA&OR TO VERIFY 1 OF ALLPONDERGROUOND T 56.04 < UTILITIES,-PRIOR •TO BEGINNING -0� �i-_a - ,. ,# ;: � , � -k ;• � . / ,:•, k � _ 'k. . CONSTRUCTION.' - 54.69 56 ' .'. OF M •` 1 1. WHERE` REQUIRED, :CONTRACTOR •SHALL REMOVE ALL UNSUITABLE SOILS x•56,34 5667 = e.'_ �\� ASS T. + O � ) x s�. ,..+56, e"` -, •�Q, 9� S. AND ' \ REPLACE WITH BCLEAN HSAND AS SPECIFIED L N 5310 CMR,T255(3). PETER T. 1'2. AREAS REQUIRING -STRIPOUT OF UNSUITABLE MATERIALS SHALL,BE ' \ / O \ �`. McENTEE r INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL., , • ' o v>, VI L 56.98 N . ,%3 / v pC1 35109 ' 13. THE,ENGINEER-IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC • Q \, � �,,F SYSTEM COMPONENTS NOT SHOWN ON THIS PLAN. , s \\ 57.19 SA SS . ;• ; I ��: ss NG� - OWNER ,OF RECORD DUFF,, CAROL F ., �• +s7� l 112 OSTERVILLE-WEST BARN STABLE. RD 56;49 " 57.5 ' �7:Ot1 ' OSTERVILLE, MA 02655 57J5 W ° PROPOSED SEPTIC SYSTEM UPGRADE PLAN 57.63 r - 00_---- -- 580 4 58,18 112 OSTERVILLE -'V.W. 'BARNSTABLE ROAD, OSTERVILLE, MA a r � 58.38 .. a Prepared for: D.A. Brown, Inc:, P.O. Box 145, Centerville, MA 02632 ;,OST�'�i'V. Z E EBAR1 TABL ' �0141� Enneineerin Works Inc.' SCALE P`�M JOB. N0. 1,, _ = 15-13 ri g g 2 1 « , a estdole, M DATE CHECKED SHEET NO. ' 12 West Crossfield Road, For A 02644• (508).-477-5313 4/18/13 1 , P.T.M. 1 Of 2 r r- r . } NOTE: TO 'PREVENT BREAKOUT, THE".PROPOSED ' FINISH GRADE SHALL NOT BE < -EL.=49.3 60P ' AROUND —— ND —FOR ADISTANCE OF 15 U THE [ PROPOSED D—BOX" PERIMETER OF THE S.A.S. - � z SEPTIC TANK , INSTALL RISERS & COVERS OVER INLET' & PROPOSED S.A:S, OUTLET AND SET TO 6" OF FINISH GRADE COVE'INSTALL RISER & WATERTIGHT INSTALL INSPECTION `'PORT OVER END "U'NIT �,. COVER ,SET TO 6" OF GRADE T.O.F.=56.9t F.G. EL.=56.Of F.G. EL.=52 3(MAX,) . t EXISTING F:G:`EL.=54.Of F.G. EL.=52 3f - .r -� .. ' MAINTAIN 2% GRADE (MIN.) OVER S.A.S. Z L0 i A • ♦ ♦ 4 n , C O ,6 ® S=1% {MIN:)' L 15'. L = 5'(MAX) .• ,, • Ln 4"SCH40 PVC ® S=129 % (MIN:,) D S=.1% (MIN.) '. ,.? INSPECTION PORT-=-�_ N+ s00 4'SCH40 PVC 4"SCH40 PVC r . . is 6 10.75" TO INV.=52.00 '' 48" uGuio ..INV ERT RT Level ADD -< INV.=48.90: GAS BAFFLE INV.=50.67 PROPOSED INV.= 1 TRENCH W/12 ADS Arc 36HC UNITS ® 5'/UNIT 60 D-BOX 50 50 INV.=51' 75 SOIL ABSORPTION SYSTEM (PROFILE)- PATIO PROPOSED SEPTIC TANK. UNITS; MUST BE.,STAMPED H-20: o- ,•. '; 3 — {. ` _ - • . .. ESTABLISH VEGETATIVE`COVER `' '- • � I CONNECT,TO EXISTING SEWER: AT-OUTLET r BACKFILL WITH CLEAN NATIVE OR Q " HOUSE AT, OR ABOVE„ INV.' PERC SAND TO TOP OF CHAMBERS M • -<EX/STING." DECK NOTES: r 3 - „ HOUSE #112 1) CONTRACTOR SHALL VERIFY'ALL EXISTING PIPE TOP ELEV.=49.33 '•! ' — - INVERTS PRIOR TO^INSTALLATION. 4• - w r�•F1-56`9f p ... INV. ELEV.=48.90•.. 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND t s w TRUE ,TO•GRADE ON A MECHANICALLY, COMPACTED ,SIX BOTTOM-:ELEV.=48.00 INCH CRUSHED STONE BASE, AS SPECIFIED IN' 2.83' 310 CMR .15.221(2): -.:. - 5 MIN. ABOVE BOTTOM OF - 3) INSTALL INLET<& OUTLET_,TEES.AS REQUIRED. T P: EXCAVATION OR G:W:_ {` EXI f 4) GAS BAFFLE TO BE1 INSTALLED ON O.UTLET'TEE •.:. STING o -ABLE I5 �;` S.A.S. LAYOUT '* ;BOTTOM.OF TP, EL=:41.0 = . _ x,•' MATERIAL ".r F „a. y AS MANUFACTURED'.BY TUF TITE,- ZABEL'OR EQUAL. ,. . _ w t, a.^^ , s " ADS Arc 36HC UNITS TO BE INSTALLED IN 4 63.25„ . a` .. • __ _. .� *�, � URASTONE­ - ''r SEPTIC SYSTEK PROFILE TRENCH-,CONFIG CONFIGURATION WITH-NO ¢; TYPICAL SECTION' a s-. N.T.S. j"" 16" 34 41; SOIL LOG ,. . DESIGN .'CRITERIA ' . DATE: FEBRUARY 22 2013 (REF#13`;876) SOIL EVALUATOR: PETER McENTEE,PE(SE#1542) TOP VIEW . ' NUMBER' OF BEDROOMS.. " 3 BEDROOMS' '"' WITNESS,' DONALD. DESMARAIS 'R:S;HEALTH AGENT. ELEV. TP— ELEV. T'P.=2 DEPTH , SOIL TEXTURAL CLASS: CLASS. « . D u, EPTH END'CAP; r END CAP 52.0 A 52'0 FRONT VIEW SIDE VIEW 60" DESIGN PERCOLATION RATE: 5 MIN./INCH A ' DAILY F 33O GP ° . SANDY''LOAM SAND LOAM v' '. y .Y LOW. D 'IOYR 4/2 10YR 4/2. END CAP REAR/TOP VIEW 1 DESIGN' FLOW: 330 GPD 50:3 grt 50.3 8„ _ - •} B '� B NOTE:-UNIT CONFIGURATION AND AVAILABILITY,.SUBJECT r SIDE VIEW GARBAGE MAY GRINDER: - NO SANDY LOAM - SANDY LOAM ^ TO CHANGE SLIGH�TLY�ROM ACTUAUT NOTICE. LRRODUCT DETAIL APPEARANCE. 10YR. 5/8 10YR 5/8 DIFFER PROPOSED, SEPTIC `TANK: ;.�1500 GALLON.,CAPACITY 49.0 C1. '*.Y 36" 49.2 C1 34" 4640 rRUEMAri.BLVD ` PE'RC r •HILLIARD,OHIO 43026 ' PROPOSED` DISTRIBUTION BOX 1 INLET, 3 OUTLET (MIN.) - LOAMY SAND LOAMY SAND Arc 36HC DETAIL. ' ", + 3 - ADVANCED DRAINAGE SYSTEMS, INC. r LEACHING AREA REQUIRED:' 330 GPD = 445.9 'SF. 1OYR 5/6 ,. , 10YR 5/6 UNITS MUST BE STAMPED •H-20 6" 48" .74. GPD/SF, .-. C2 C2 e Y _ ,' PROPOSED' SEPTIC SYSTEM UPGRADE SITE PLAN SOIL ABSORPTION SYSTEM:. ; MED. SAND MED. SAND — AD, OSTERVILLE, MA ' r USE'ADS Arc 36HC UNITS. IN STONELESS TRENCH 'CONFIGURATION 2.5Y<6/4 2.5Y 6/4 5 1 1.2 OSTERVILLE ; W. • BARNSTABLE ROAD, ( � . )Y Engineering b for. SCALE DRA MA 02632 r D.A. Brown; -Inc., P.O. Box 145, Centerville, GENERAL USE: APPROVAL .FOR 7:88 SF LF IN TRENCH CONFIGURATION 41.0 '' 132''•' 41.0 �' 1 • ' 9 9 Y DRAWN JOB. N0. 1 TRENCH WITH 12 UNITS 5,0' PER{ UNIT = 60 0' ~' 4 321 NTS P.T.M. 115-13 En ineerin Works, •Inc. 60.0'. x 7.79 NSF/LF = 467.4 SF PERC'RATE •.5 MIN/IN, (''C1" HORIZON):: 9 NO 'GROUNDWATER ENCOUNTERED 12,West"'Crossfield Road,'Forestdole, MA'02644 DATE CHECKED SHEET NO. DESIGN FLOW. PROVIDED: -0.74 GPD/SF(467.4 SF) = 345.8 GPD "�- (508) 477-5313 4/18/13 P.T.M. 2 Of 2