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HomeMy WebLinkAbout0012 PARKER ROAD - Health 12,& 14 Parker Road(Osterville) A=117-106 I i w DATE:5/9/01----- PROPERTY ADDRESS: 12_&- 14—Parker Road—__ Osterville,Mass. ---- ------------------- 02655 - - ---------- On the above date, I Inapeoted the septic ;syit��M at the aboye address. This aya►em conalsla of the followings 1 . 1 -1000 gallon septic tank. 2 . 1 -Distribution box. 3 . 6-Flow Diffussors 28 'X28 ' eaoed on my Inapectlon, I certify the following oondltlons: y. _,-4:"'This is a title five septic system. ( 95 Code ) 5 . The septic system is in proper working order 11 at the present time. 6 . Pumped the septic tank at time of inspection. Heavy scum and soilds layers -were present. ,__f The septic tank should be pumped annually. 2 o Company: Josa.2h-p _ Hacofab.r-b Son , Inc Address:_ Box_66- --_--- _Centery111eL Ne_-02632-0066 Phone.___ 508:775_„7738_-__--„ THIS CeRTIFICATION OOES NOT CONSTITVTC A OVARAKTY OR WARRANTY JOSEPH P, MACOMBER & SON, INC, T+nk+•Ces+pools•heichlleld+ Pumped 1+ Installed Town. Sewer Conneotlons P,O. Box 66 ontorY1114, MA 02632-0066 r COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS -DEPARTMENT OF ENVIRONMENTAL PROTECTION 1 TITLE 5 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 1.2 & 14 Parker Road Osterville,Mass. Owner's Name: Richard MorGP Owner's Address: s fgI n i ' Date of Inspection: Name of Inspector: (please print) 7oGP,ja h R_ MUcomher Jr. Company Name:J P. MacomhPr & son Inc. , Mailing Address: Box FF C'antarui 1 1 e esaeSS Telephone Number: 508-775-3318 CERTIFICATION STATEMENT I certify that 1 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: _L/ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authoriry Fails Inspector S Signature: Date: "4 The system inspector shal mit a copy of this inspection r ort 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. Title 5 Inspection Form 6/15/2000 page 1 r Paee 2 of OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 'CERTIFICATION (continued) Property Address: 12 & 14 Parker Road Os ervi e, ass. Owner: Richard Morse Date of Inspection: 5 9 01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: 1 have not found an information which indicat s that any of the failure criteria described in 310 CMR 15.303'or to MR 15.30 eexist. Any failure criteria not evaluated are indicated below. Comments: System is in working order at tne present ttme. B. System Conditionally Passes: NQ One or more system components as described in the"Conditional Pass"section need to be replaced or, repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass. Answer yes, no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. 4)n The septic tank is metal and over 20 years old* or the septic tarik(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: Wd 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, sealed or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: /�)► The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ,d^ ND explain: 2 4 Page 3 of 1 1 . OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 12 & 14 Parker Road s ervi e, ass. Owner: Richard Morse Date of Inspection: 5 9 01 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. I. 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 will protect public bealtb,safety and the environment: A)0 Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has 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 I 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 b t 50 feet or more from a private water supply well**. Method used to determine distance 'IJGf1 "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volat'iie 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: 1 3 Page 4 of 1 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 12 & 14 Parker Road Os ervi e,Mass. ,. Owner: Richard Morse Date of Inspection: 5 9 01 D. System Failure Criteria applicable to all systems: You must indicate yes"or"no"to each of the following for all inspections: Yes ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Y/Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static Liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool �/ squid depth in ae&spoel-is less than 6"below invert or available volume is less than 1/2day flow equired 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 AS, cesspool or privy is below high ground water elevation. I/ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface /water supply. - �y portion of a cesspool or privy is within a Zone 1 of a public well. An y ponion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (Tbis 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 (Yes/No)The system fails. 1 have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303. therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,o00 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/ , _ f/ the system is within 400 feet of a,surface drinking water supply _ 1/ system is within 200 feet of a tributary to a surface drinking water supply _ nitrogen sensitive area Interim Wellhead Protection Area—IWPA)or a mapped _ the system is located to a og (_ Zone 11 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 r Page 5 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 12 & 14 Parker Road Os ervi e,Mass. Owner:Richard Morse Date of Inspection: 5 .9 01 Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No i Pumping information was provided by the owner,occupant,or Board.of Health ere any of the.system components pumped out in the previous two weeks ? Y = as 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 ? Were all system componentsre•eluding the SAS, located on site? Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of/theTaffles 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 i 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)J 5 Page 6 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 12 & 14 Parker Road s ervi e, ass.. OKner: Richard Morse Date of Inspection: 5/9/01 FLOW CONDITIONS RESIDENTIAL . Number of bedrooms(design):A2&4 Number of bedrooms(actual): AM DESIGN now based on 310 CMR 15.203 (for example: 110 gpd x q ofbedrooms): ':umber of current residents: AM Does residence have a garbage grinder(yes or no):� Is laundry on a separate sewage system(yes or no)� f if yes separate inspection requ•tred) . Laundry system inspected (yes or no): Seasonal use: (yes or no): 41A Water meter readings• if available (last 2 years usage(gpd)): VV Sump pump(yes or.no):AJ,¢ Last date of occupancy: —A)A- COMMERCULMIDUS AL T'\pe of establishment. 6Y'{f1 Design now(based on 310 CMR 15.203): gpd Bans of design now(seats/persons/sgft,etc.): Grease crap present (yes or no): ALC Indusrr:al waste holding tank present (yes or no): kV / Non•sanitary waste discharged to the Title 5 system(yes or no): z7�Z�o/�B u atcr meter readings, if available: QQ �— !ast date of occupancy/use: . 8 ` � _ ;CLYI� 4k4'V= OTHER (describe): /!1 GENERAL INFORMATION Pumping Records t Source of information: fd% i�.jyt , Was system pumped as pan of the inspection (yes or no): Lc es. \olume pu mped-: 6Mq gallons •• How was quantity pumped determined? Reason for pumping: y �+ 5� iC X4�yLo - _ TYP OF SYSTEM Septic tank, distribution box, soil absorption system Single cesspool •tI Overflow cesspool VJ Shared system(yes or no)(if yes,'anach previous.inspection records, if any) ,Vj Innovative/Alternative technology. Attach a copy of the cwTent operation and maintenance contract (to be ootatned from system owner) if/0 Tight tank 4,0 Attach a copy of the DEP approval Other(describe): .1'r Approximate age of all components, date in�stalled(if known)and source of information: ��l Were sewage odors detected when arriving at the site(yes or no): 6 u i I a /* � F 0 ,1'I o a 9 Ijf� oc� ° 0 7 O _ �0' a ao p o 0 F S S 00 \ SFA OLIO lo o� ti A b • .. — O v QO I} �r - I n. 4nI` P41 4. �tA I �t !yN TOWN OF BARNSTABLE LOCATION 'Af2hE1,? SEWAGE # 9 VILLAGE 0.5 1 Cc-v,,I ASSESSORS MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /DOd GA1 LEACHING FACILITY: (type) �O�y 2,, rfWP 2J (size) o?8'x381 NO. OF BEDROOMS /v BUILDER OR OWNER 1-Po-6 2 aas PERMITDATE: �-/U4 �5�1 7 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) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished.by:: CD ... \ S�D r"Li s, Sp sr �21,�,���aa_ f 6� i Page 7 of I OFFICIAL INSPECTION FORM.- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propene Address: 12 & 14 Parker Road _s erv1 e, ass. Owner: Richard Morse Date of Inspection: 5 9 01 > W i Bl_ILDI.N C SEWER (locate on site plan) Depth below grade: _ ,.� Materials of construction: _vast 'iron 40 PVC Wither explain): .UA Distance from private water supply well or suction line: Idrt Comments(on condition of joints, venting, evidence of leaka etc.): Joints aooear ti ht.No evidence or- leakage. System is vented loan� �1rS through the house vent. SEPTIC TANK: (locate on site plan) Depth below grade: Material of construction: concrete drnetal .4.14 fiberglass,12&polyethylene "other(explain) !i unr , is metal Fist age:" Is age confurned by a Certificate of compliance(yes or no);,t&(attach a copy of certificate) 12 Dimensions- Sludge depth: _ Distance from top of sludgc to bosom of outlet tee or baffle:"_ Scum thickness: !stance from top of scum to top of outlet tee or baffle: D:s.ance from bosom of scum to bornm of ou let tee or baffle: Hoµ Acre dimensions determined: 'Comments (on pumping recommendation 9, inlet and outlet tee or baffle condition. srructural integrity, liquid levels a.s.related to outlet invert, evidence of leakage, etc.): Pump septic tank annuallv. Inlet & outlet tees are in ta nk ank is• s r orally sound-and shows no evidence of leakage. GREASE TRAP,'(locate on site plan) Depth below grade: G ' Material of construction:,ej concrete, metali!dfiberglass4Z olyethylene other ;explain): . Dimensions: Scum thickness: ,t�A Distance from top of scum to top of outlet tee or baffle:_ IN Distance from bosom of scum to bosom of outlet tee or baffle: AO Date of last pumping: - A)L Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet inven,evidence of leakage, etc.): 7 Page 8 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:12 & 14 Parker Road O§terville,mass. Owner: Richard Morse Date of Inspection: TIGHT or HOLDING TANK(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: AAf Material of construction:xl,4 concrete metal fiberglass gd polyethylene&d other(explain): 44 Dimensions: 10 Capacity: Alh gallons Desi¢n Flow: A4 gallons/day Alarm present(yes or no): _ f)4 Alarm level: VA Alarm in working order(yes or no): Date of last pumping: VA Comments(condition.of alarm and float switches, etc.): Tight or holding tanks are not present. DISTRIBUTION BOX: Zif present must be opened)(locate on site plan) Depth of liquid level above outlet invert:�L 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.): Distribution box has three laterals_ All are equal. No Pvi rlenr-P of gnl i do carrIz nvPr Nn PVl dPncP of leakage into or out of the box. PUMP CHAMBERek(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.): Pump chamber is not present. j . . .. 8 a Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 12 & 14 Parker Road - Osterville,Mass. Owner: Richard Morse Date of Inspection5/9/01 SOIL ABSORPTION SYSTEM.,6): Zlocate on site plan,excavation not required) If SAS not located explain why: Type leaching pits, number: � leaching chambers, number. l�_Ir�q�v dt Ta fw-,c _L,6a leaching galleries,number: _0_ -. VQ leaching trenches,number, ltw'lh: d A) leaching fields,number,dimen:,ions: 6 overflow cesspool, number: ��.. /J / innovative/alternative systei; y pe/name of tech T>- A' nology: ;e gr GAIyP. Comments(note condition of soil. s`, ns of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): Loamy sand to medium fine sand.No signs of hydraulic failure or ponding.Soils are dry.Clean 'sand still -visible on the bottom of the flow diffussors.No vegetation. Asphalt: CESSPOOLSY✓p (cesspool mus. pumped as part of inspection)(locate on site plan) Number and configuration: D Depth—top of liquid to inlet inven: A1,4 Depth of solids layer: >A Depth of scum laver. Dimensions of cesspool A)A. Materials of construction: Indication of groundwater inflow or no): Comments(note condition of soil ;a of hydraulic failure,level of ponding,condition of vegetation,etc.): Cesspools are not present: PRIVY�j (locate on site plan) Materials of construction: Dimensions: Depth of solids: _ Comments(note condition of soi;. > :, ,;f hydraulic failure, level of ponding,condition of vegetation, etc.): Privy i s not ,present 9 r ' Page 10 of I 1 ' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 12 & 14 Parker Road s ervi e,Mass. Owner: Richard'l4orse Date of inspection: 5 ITTO-1- 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. 2. — 14 Clc�rr 'IZc� 6s4crv"l L ' B / z9 ' � ZI ' 291 zs 10 Page I I of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued] Propem Address: 12 & 14 Parker Road Osterville.Mass. Owner: char: terse Date of lospection; SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water,KgL feet t Please indicate (check)all methods used to determine the high ground water elevation: *Obtained from tem design plans on record • If checked,date of design plan reviewed: $= G ] ,observed site(aburcing proper y bservation hole within 159 feet of SAS) n Checked with local E3oa­.rd--oTF1-eaIdh-expIain: 4$; SChecked with local excavators, installers (attach doctunentation) AiAccessed USGS database•explain: You must describe how you established the high ground water elevation: Used water contours map. Ga re y & Miller Model 12 16 9.4 it • 11 • 1•I•-.1 T^11.I T/�•T- T/I►'I••1I�1.Y PAIN"I.11 r1R.••w�I�A� A'T�/ 'I'I"�•�11�� .�T�T!-l-A� •. � TOWN OF Barnstable BOARD OF 11ZALT11 SUIISURFACF SEKAOP DISPOSAL SYSTEM INSPECTION FORM -' PART D - CERTIFICATION �.�-.••.•:•. —•.:i■-.+er.w.r.w/w•r.w..rw•w.is.—.�.�...wv w.w—T+w�wrw.w.�rn.+rr� ww v...•rr•,--�. _. -T.YPC 0A FAINT CLCAIILY- PROPERTY INSPECTED STREET ADDRESS 12 & 14 Parker Road Osterville.Mass, ASSESSORS HAP, BLOCK AND PARCEL I OWNER' s NAME J. Largays PART D - CE17TIFICATIOH NAME OF INSPECTOR _ Joseph P. Macomber Jr, COMPANY NAME Joseph. P. Macomber &'-`Son, Inc. COMPANY ADDRESS Box 66 Centerville MA. 02632-0066 $tr..t Tovn or city t9 t P COH.PAHY TELEPHONE ( 508 ) 775 - 3338 FAX CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposei`1 system nt >r1ecoinmenda his nddress and that tlie .inrormation reported is true , accurate , and omplete as of the time of .. inspection . The inspection was performed and any t' lons 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 : l _P Sys te6 PASSED !� The inspection which I have conducted has not found any information which indicates that the system fails to ade.quately protect public healLh or the environment as defined in 310 CHR 16 . 303 , Any failure criteria not evalunted are as stated in the FAILURE CRITERIA section of this Corm . System FAILED; The inspection which I have con Ttcted has found that the system fails to protect the j)ublic health and the environment in accordance with Title 5 , - ;110 CHR 15 , 303 , and as specifically noted on 'PART C - FAILURE CRITERIA of this Inspection forma v - Inspector Signature Date at ecopy of this certification must be provided to the OWNER, the BUYER here applio&ble ) and the BOARD OV HEALTH. • If the inspection FAILED , thv owner or operator shall upgrade ' the syetem within' one ,year of the date of the inspection , unless allowed or required otherwise as provided in 3.10 CHR 16 306 partd . doc JOWN-OF BA, NS ABLE, _ t LOCATION IV_.A/#f' SEWAGE # VII.LAGE 51- '� �?'���. "ASSESSOR' & LOTi. INSTALLER'.NAME'&PHONE N0. - `y.x,. � "• ,ram; Y; .:� •'�-� _ �-,z SEPTIC•TkN, CAPACIT LEACHING FACIL.ITY:,(type)' /✓��56�f�s *(size) 'IV NO. OF BEDROOMSAk eft, ZI �-' BUILDER OR OWNERA.= �»' PERMTTDATE: _ 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) Feet. JEdge.of Wetland and Leaching Facility(If any,we 5 exist within 300 i f le chin ility) Feet Furnished by - m ;• P — i tack' VA ®s 4c rv,l — '" B 29 22P,� 2 J `� 2ql. TOWN OF BARNSTABLE /f LOCATION SEWAGE # 6 VMLAGE ..O: I cc-v.I(e ASSESSOR'S MAP & LOT j INSTALLER'S NAME&PHONE NO: a�c,ce � c�.1�.3 cr L(d8dq SEPTIC TANK CAPACITY 14Doo6A1 --LEACHING FACELITY: (type))/6k., YP/'Xjr 2f (size) OW x0181 NO.OF BEDROOMS N BUILDER OR OWNER I-V06C2 / 2,oas�r PERMITDATE: AQ -o COMPLIANCE DATE: Separation Distance Between the: h 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) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 9 a9 31 , M. c � t I (Y)�c B� �j��p� tk/� �� *Fvv,��40 'Y/ a I/� Fee Y I r , THE COMMONWEALTH OF MASSACHUSETTS e6tered-inslomputer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Oigpoal *pgtem Construction permit Application for a Permit to Construct( )Repair(PC)Upgrade( )Abandon( ) ❑Complete System &Individual Components Location Address or Lot No. 12 Fb17 ie6-9- "t> Owner's Name,Address and Tel.No. OsTele v I LA-Z-- F-otiwC2 4• MDeg_ (� Assessor'sMap/Parcel L� ©� "1&SC> 1�i"1°c$a�l�� C'LEN MAP 111 P u Fj= 34-1Za Installer's N We., dre s,and Tel.No. p Designer's Name,Address and Tel.No. s t<1sT- L4,z MA Zpr(i I-3 L Type of Building: Dwelling No.of Bedrooms Lot Size 1S. & sq. ft. Garbage Grinder( ) K_ Other Type of Building OFPic- . No.of Persons Showers( ) Cafeteria( ) Other Fixtures INSAV 6'AI !' Design Flow gallons per day. Calculated daily flow 2!&2 gallons. Plan Date + o Number ok sheets Revision Date Title 1Z t7 t Size of Septic Tank'M6TTJ� jf9W 6A-e1 Type of S.A.S. i j!3vo W/Vir,—Fy4S121Z6 Description of Soil XAI=-;D)'Ovv,. SAWr) Sty E- 221� Nature of Repairs or Alterations(Answer when applicable) V�cAc.9 tit W iJ `D-SaK, :AND l l w; p 11 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 bytis Board of H th. SignedXthe �/� Date Application Approved by Date Application Disapproved fofollowing reason Permit No. Date Issued ....� „. .-�._ �.v -. _. � �f_ :•. � _ ,.x;, .. .F-tom:.,.-.;...._. ,. -..- -_*- vJ/1* rnrc THE COMMONWEALTH OF MASSACHUSETTS Yes. �•� -PUBLIi-HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS"` 0(pprication for Zigogal *pgtem Construction Permit , Application for a Permit to Construct( )Repair(K)Upgrade( )Abandon( ) ❑Complete System Individual Components r �. Location Address or Lot No. Owner's Name,Addres and Tel.No. OSTEIQ-V I LA—E—• Q0 D!�e e 4• /1 oes E Assessor's Map/Parcel -1(or3v w4 oT_'Be11iFr GL,-f4 AAAP11-1 PC-t- 1O(o u A,UM2.i I3d2a Installer's N e,Address,and Tel.No. p Designer's Name,Address and Tel.No. c ,r 11 j�� /n x t E�2 !- IJN s t�►G s: v l u..E MA 02&9 �{Zf'r�l 13� 1 ' Type of Building: Dwelling No.of Bedrooms Lot Size 15,�� sq.ft. Garbage Grinder( ) Other Type of Building nt=t=l GE. No. of Persons i Showers(" ) Cafeteria( Other Fixtures$ Au tv C A 2 CAA t 25 w� l Ny y Design Flow �]'Zip gallonspq er day./Calculated daily flow -]'?.o gallons. Plan Date Number of sheets Revision Date �. Title ' \ d t lti Size of eptic Tank -Vyj�lnDj OItt4-, Type of S.A.S. I j!Ag� tslwo w DI?Fy4sp(1fj Descriptioncription of Soil XAenItIw. skurl) Sly P_1-.12-4/0 Nature of Repairs or Alterations(Answer when applicable) � T c it ash►.v 'D^ C A wo C.t ►.AI N G IP 1 i" r Date last inspected: ,�_ ', Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-sitesewage 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 is Board of Health. Signed C l^ /C/J �� Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued --------------- THE COMMONWEALTH OF MASSACHUSETTS y BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CER.. IFY, that the O -rite Sewa e Pispos 1 tem Constructed ( )Repaired ( )Upgraded( ) Abandoned )by J 1 ��, A ` at s b n constructed in accordance with the provisions of Title 5 and the for Disposal System C nstruction Permit No. "' dated , Installer Designer The issuance f this perit shall not be construed as a guarantee that the sy 1 unc 'on`a`s d0gned� � f Date Inspector F o l VV No. Fee �J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migogal *poem1 Construction Permit Permission is hereby granted to Cons ct( ),Re pair X)U rade( bando System located at r �� F � 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 completedwithin three years of the date of this t. Date: Approved b., i TOWN OF BARNSTABLE LOCATION �'��/ �A�2/1E� /�' SEWAGE # _� VILLAGE 0 S It c-v, � ASSESSOR'S MAP & LOT � INSTALLER'S NAME&PHONE NO. ,)n,ce SEPTIC TANK CAPACITY /Odd 6191 LEACHING FACILITY: (type)1251 v P/ F7yJP QJ (size) 028 X38 NO.OF BEDROOMS IV114 BUILDER OR OWNER 10906h 2 Desd . / COMPLIANCE DATE: PERMITDATE:�U 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) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 613 IV 4 LO CATION ` ' 'SEWAGE PERMIT NO. VILLAGE ler v,/l-c .UNSTA LLER'S .- A'ME & DO ,ESS � BUILDER OR-'`GINNER_- DATE PERMIT ISSIIEO OAT E COMPLIANCE ISSUED �� qr 0 LOCATION ,� SEWAGE PERMIT NO- � C� /a•-�re� �iv� j 'JILLAGE 05 y llx INSTALLER'S _. NAME & ,DD E S S J04 GU Ciro'► d U I L D E R OR OWNER �. DATE PERMIT ISSUED - 9' �0 � . DATE COMPLIANCE ISSUED I i i j ! i M • �c I i r 47, No._.......^...... Fss_... b THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... owt.�...............OF....... .1 4 1. ............................. Appliration for Disposal Monts Tonstrurtion rerun Application is hereby made for a Permit to Construct ( V) or Repair ( ) an Individual Sewage Disposal systemat^^^^ ---- ................ .................................. ....... _..._..............__.........._.... (�,��Lovcati�ony-Address moo+ or Lot No. ......................__...1: 1C?.�.:5s...........�.Z .....•.... ---•-•---•-•.....................•......... ................................ ... w ner ^ •.. Address 94 ........... h1.........h:.! - ................ ....... ...... ............... ............................. Installer Address q� Type of Building Size Lot.. -S} 1...Sq. feet U Dwelling—No. of Bedrooms..............:.............................Expansion Attic ( ) Garbage Grinder ( )�+ 04 Other—Type of Building .-9...... No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixture d .............................................................•-----------•--•............-•------.---•- 5 -.. . .. lons'per'person per day. Total daily flow............................................gallons. I` W Design Flow ......... l P P P Y• Y WSeptic Tank—Liquid ca acity.j .gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No................ Width.......,............ Total Length...... Total leaching area..... sq..... _ ft. 3 Seepage Pit No........I........, iameter.........6..... Depth below inlet....... .. Total leaching area...... ...sq. ft. Z Other Distribution box ( ") Dosing tank ( )'" Percolation Test Results Performed by :f AY9*.....----N.Aq/j* nn-..C..6 Date.-----�.P..JE73.4...... 1,..aTest Pit No. 1..... i ..e.mmutes per inch Depth of. Test Pit...... .... Depthground to water........................ GT. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 --------------------------------------------------------------------------------------•--•--••-•-.--...... ------ •------------------- •--------------------- -.. O Description of Soil..................... -- ............. - altt .l ................ .f 1 ............--.........-----.....--.--------........------------- W x ---------------------------------------------------------------------------------------------------------------------------------------•....------------•............................--•------•••--•-•-. 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 TIT E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beeryisNued b the oard of health. q� ned- ..-------••-• ......................•-•--................ -� Z/ ^.... ApplicationApproved By....... ...... ........... .................................................................^ .. 1.L..-... ............ Date Application Disapproved f o the ollowing reasons:..........................................................................................................--- ........ .... ...................•-•-•------------•---•--••......-------••-.........•---_........-----•--•........................---------...........-- .......---•- Date ^ PermitNo...................................................^.... Issued.................•-----......-•----.................... Date No. n.... / THE COMMONWEALTH OF MASSACHUSETTS BOARD ,OF HEALTH T ...............OF....... ............................. Appliration for Disposal Works Tonshvdiort Permit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal Systemat:»».... . : . :1_f.;2.;..............R41:.:................ ................................. »-•••. �°"" ............_...............»....».... Location_Address / or Lot No. ................»._»»»... `�:! ca f�,7 ,__ -d�,I;l . . ........... ............................................................................... »... ... w Owner a Address � Pa � .................................. - �(..- C�................ ....................-•---..................— ---............._.._...........».......... Installer Address Type of Building Size Lot_l�,;:�r?i.��...Sq. feet U Dwelling—No. of Bedrooms......................... ..._.Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ...... No. of persons............................ Showers ( ) — Cafeteria ( ) p' Other fixtures Design per person per day. Total daily flow............................................gallons. 0� Septic Tank—Liquid ca acity.ICWgallons Length................ Width................ Diameter.___.___.._..... Depth................ Disposal Trench—No.................... Width.................... Total Length............... _ __.... Total leaching area... ........__.sq. ft. ) Seepage Pit No........1...._._._.. iameter........_r. ..__. Depth below inlet.......�� .._.... Total leaching area...... ?_D ..sq. ft. Z Other Distribution box ( � Dosing tank ( ) ''' Percolation Test Results Performed by. �~'_l r ?Z.'. _1 ! : .......... ................'' ...11.0 Date........... a ........................ ,.a Test Pit No. 1..... Z...:.minutes per inch Depth of Test Pit.......L.2::-:_.. Depth to ground water.....___"~.^:".......... (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R. ------------------------ ---... -............... ------...... -.... -.... ___-... .____........... ••----•-----... --------- •-----------•-••-----•........ - 0 Description of Soil................................................................., -__--•----••--•-•-•-------------------_________-•-•-----------_-__---•----••-•-------____--•-•--•-- !�! t—rl . 4 t �' .................- ......---•--------------- W UNature of Repairs or Alterations—Answer when applicable.....................................:......................................................... -•--------------------------•-•-----••-----•--•----....._..........--••-•------•--......--•--•-•--.........-•--•--••----....----•-••----.....---•-••-----.._.._...._....__.............................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b ued by the board of health. � f - Application Approved By......`y..•.. '.... ............•---•--•••-••-•••--•-•--......•-•-•--••-•-•-•••-•-_.._ ..11j fir... ....... Date Application Disapproved f o the ollouting reasons__________________________________________________________________________________________________________»»» .......................................•--........-•-----•--------•--....:..-•---•------•---...._......».-•----•---•-------.........._..----•------•-••--------•------•-•••••••-•....._•-••...........» Date PermitNo...................................................».... Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS 5 BOARD OF HEALTH .......... .d� ..............OF......• !'� Z;J ........................... wn if irate of Toutpliann f. r� 7s CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ----- ..... / 1 /r/ - Installer a .. !.. .... ____-----_•__________________________•----_____......___........... ---- ------------ has been installed in accordance with the provisions of TITIFr of The State Sanitary Code°as ,scribed in the application for Disposal Works Construction Permit No._��___L�t'1�____________________ dated... f�:_....._. __....__......_...... THE ISSU ICTION OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WI F SATISFACTORY. DATE..... .. / .................................................... Inspector...... ...----...................-•-----....................---•---••--•--•- THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HEALTH Y �/ j No.l....3_`_.�P/ - .....To.'.cut.,�...........OF-------------P`L�.�1�l�'�• --....-.....-................. FsE........P...........». �is�rou Tonstrudion rrrtttit Permission i ereb anted.__.. ..»»»» y >n to Constr or Repair,(, ) an ndly ual = ge Disposal System atNo... �:. ..!�=_-_-- ff--•--» . C... �!_..e_e' ............................................................... --••- .. ....... Street as shown on the application for Disposal Works Construction Permit NK_____ Dated�f __. �, ......:.......... .......................... _..... • ---...................................d of Health DATE.............. e .................................. FORM C-1255 CITY& TOWN FORMS, INC.369-9708 ZONES Po GP & AP05. z ZONE BA & RF-1 100. \ MINIMUMS 99 9,��\ BAY ROAD o FRONTAGE = 20' C.B. 100.4 LOCUS ST o FRONT SETBACK 20' FND. 100.2 N BUILDING HEIGHT 30' 99.5 N MAX. COVERAGE OF LOT 35% / o / 100.9 1 LOCUS MAP 1__ / / i a1. SCALE 1 25,000 ���ioo.3 100.6 0 0-/0' zl ASSESSORS �c 999g MAP 117 PARCEL 106 �S o 101.0 GN X 99.8 a pork��S /`STj� N g� 100.8 F� G' T 99.6 Cj 99.8 ,\�L \�\ � F�F��6F�' e J Cj O 100.3 104.9 x O / O 4,k / 3p� tiG Is, 6 S 101. s 100.9 101.1 100.0 a O �?B. 99.8 pp,100.1 �w 101.0 QJ p 100.2 }�O �� ® 01.0 Cj O a w o � 101:2 "�100.3 a 101.1 ° ° a d O 10i.0 VENT °p 100.0 °) O / � 0 6 4' X 8' X 2' HIGH °� • v - a FLOW DIFFUSORS 99.8 WITH 4' OF STONE REPLACE 2p' 100.6 EXISTING100•g D. 80X G � ��-�•,.�01.0 '• 100.2 Existing leach pit � / 100. cb x to be pumped and a,, maple '18 0 rernoved \ I • 100.9 6Le//off c `DQ1.0 maple 10"o 100.4 y / p� C� C� 100.7 oy oy . BENCHMARK C.FND TOP OF C.B. a oo.0 , 2 EL. = 100.00' � ELEVATIONS ARE ASSUMED S �''� 1.P. FND. OFF LOT AREA 14 o �,`O 15,664 &F, VARIANCE REQUIRED FROM SECTION 15.211 (1) OF TITLE 5 TO ALLOW 12' SEPARATION FROM A CELLAR WALL IN LIEU OF REQUIRED 20'. N07o 1. ALLY COMPONENTS ARE TO BE H2O LOADING. THIS PARCEL IS NOT LOCATED IN THE FLOOD PLAIN. 3. THERE ARE NO WETLANDS LOCATED WITHIN 100' OF THIS LOCUS. 4. REMOVE UNSUITABLE SOILS BENEATH PROPOSED SYSTEM, BACKFILL c•. KITH ''!_EA.N GRANULAR MATERIAL FILL TO BE GRADED AS FOLLOWS NO' r, +0��E 7 BAN 15� Ktl - ,^ ED �r.� w 4 SIEVE. NO` MORE H 4N o0/ PF7\ J ' C ' -S '10l OR LESS `,� A V LVL. wo ;0_ iE`vE A`:D % OR-LESS TO PASS No. 200 SiE`✓E, SOIL TO BE APPROVED BY ENGINEER EOP, C_,;,PLIANCE PPIOR TO PLAC1iNG ON SITE. 5. LOCATION OF UTILITIES NOT SHOWN ON THIS PLAN, AT LEAST 72 HOURS _ PRIOR TO ANY EXCAVATION FOR THIS PROJECT CONTRACTOR SHALL MAKE ` THE REQUIRED NOTIFICATION TO DIG SAFE (1-888-344-7233) AND AP?R. 'PR1A' s _ "VIATE7' Dl'-.)I i;C I i\ UL 7._D-77R1VI11`iC U TILT TY LOCA TIONi. PLAN6. SOIL SUITABILITY TO BE VERIFIED AT THE TIME OF iNSTALLA I N 7. INVERTS TO BE FIELD ADJUSTED AS NEEDED TO ACCOMOD TE L (1Sili;G FLU :1 il� GRAPHIC SCALE fi' 8. LEACHING FACILITY TO BE VENTED. 9. FALL STRUCTURES TO HAVE MANHOLE FRAMES & COVERS TO GR,4.I E. 0 10 20 REPLACE PAVEMENT AS NEEDED MANHOLE FRAMES &: COVERS DESIGN DATA ADJUSTED TO GRADE OFFICE BUILDING OF 2,135 S03 FT. X 2 FLOORS 4270 S.F. DAILY FLOW = 4,270 S.F. X 75 GPD/1000 SF = 320 G.P.D. z /i, / /iX / /i� //� BEAUTY SALON = 2 CHAIRS WITH SINKS Q /������������� / COMPACTED FILL<?j� /��COMPACTED FIL��j� // COMPACTED [ILL�� 2 X 200 G.P.D./ CHAIR 400 G.P.D. c� /\ \ \ \ \ \/�\ \/�\�� ✓\\ � \ TOTAL DAILY FLOW 720 G.P.D. 0 O O USE EXISTING 1000 GAL. SEPTIC TANK 24" WATER READINGS INDICATE 247 G.P.D. AS AVERAGE DAILY FLOW. . 247 G.P.D. X 200% = 494 G.P.D. 4' 4' 4' 4' 4' 4' 4' " 3/4' TO 1 1/2" LEACHING FIELD DESIGN I! 3/4 TO 1 1/2 WASHED STONE - WASHED STONE ALL PIPES TO BE SCHEDULE 40 PVC PERFORATED TOPPED WITH 2" OF PEASTONE USE 6- 2' X 4' X 8' FLOW DIFFUSSORS IN A TOPPED WITH 2" OF PEASTONE 28. ---� 28' X 28' WASHED STONE FIELD AS SHOWN 720 G.P,D./ 0.74 G.P.D. / S.F. = 973 S.F. REQUIRED 2�28 + 28) x 2' = 224 S.F. SIDEWALL AREA CROSS SECTION 28' X 28' = 784 S.F. BOTTOM AREA 217'+ 784' 1008 S.F. PROVIDED NO SCALE l SCREENED VENT ELEV.= 103.02 FRAMES & COVERS LOCATED TO GRADE FIRST FLOOR ^` F.G. 100.1' EXISTING COVER F.G. 101.2 SEPTIC SYSTEM REPAIR COMPACTED FILL COMPACTED FILL COMPACTED FILL C. AT #12 PARKER ROAD LEVEL EXISTING P• EXISTING INVERT 2" PEASTONE NEW 4" DIAµ. SCHEDULE 40 P.V.C. 2, E)ISTING 4" DIAMETER SCH• 40 ' INV. - 99.6 1000 GAL. INV. - 99.8 IN .. :; ........... ; ::....: INv. = 9s.4 SEPTIC TANK (OSTERVILLE) r • BARNSTABLE MASS, a� INV. 97.0 INV. 99.2 • •.. t�®lam®® ®®®I�® a . REPLACE EXISTING FOR ®®®® ®®®®® DIST. BOX 617 ;RUSHED BOT. 95.0 STr, 'E BASE 4'x8'x 2' FLOW DIFFussoRs (H-2o) RODGER H. do JAYNE K. MORSE 3/4" TO 1 1/2" WASHED" OF PEASTONE STONE TOPPED WITH 2 SCALE: AS NOTED DATE JULY 28, 1999 ; AXTE 1 . 4' 8' 4' 8' 4' REGIS E RED L AND SURVEYORS w 28' CIVIL ENGINEERS ❑STERVILLE, MASS. �� aF A PROFILE STEPHEN y \l NO SCALE TIE Of1AL E%� DEED REFERENCE: BOOK 10558 PAGE 147. - #99066 &vvu 4- 9q- Y6 "A T" -Z ;V+o EXF FT ;1-7 FIr RIME 711 J 4 I C3 t ' `.,, AzLaA -r--- /Co Tcp "OlL A4p Ao Mv t 0 71\QL- cz)Gs OTA T->V k --4k ILI 1 5 s 4�1