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HomeMy WebLinkAbout0218 PARKER ROAD - Health 218,Parker Road . Osterville P A = 116 060 I No.r Fee$5 0. 00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes, PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pphratton for Miopo�ar 6potem �tCongtruction Permit Application for a Permit to Construct( _ )Repair( )Upgrade( `)Abandon( )X4 Complete System ❑Individual Components Location Address or Lot No.21 8 P a 2 k e/L Road Owner's Name,Address and Tel.No.Tim o t h y 0. t u e h a m A sesso s MapTParcef N a.3.3. 218 P a A k e z Road 0,3te�zv.ie.ee, Na,3.6. 02655 116-60 Installer's Name,Address,and Tel.No.5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No.5 0 8—2 7 3—0 3 7 7 a. l. Nacomf,e,z & Son Inc. ;C, Cny.ineeziny, Inc. 2854 C2angez)zy dox 66 Cente2viiie, llas.3. 02632 K.iyhway E. Gla2eham, Nas.6. 02538 Type of Building: Dwelling XXNo.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 570 gallons per day. Calculated daily flow 5 5 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable)0 m.i t t.i n 9 c e,3.612 o o.e . I n z t a t e.i n g 1- 1500 .6e/21-.ic tank, 1-[7.i.etbc.iFut-ion eox and 4-500 ya.eeon eeachiny cham.geltz hacked .in 4' o/ 1%" ztone. _,Z'A 3.'%X2:' 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=isbyis B d e Signed kl�,rl", Date 6126 0 3 Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued Fee$50. 00 Nil ` v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes h PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for �Digpoal *pgtem Cow6truction Permit Application for a Permit to Construct Repair Upgrade( . )Abandon(( )X,I Complete System El Individual Components DPP ✓ ( ) P ( )UPg P Y Po Location Address or Lot No218 %aake oad Owner's Name,Address and Tel.No.7.t.m6thy It/. Fuiham. - r O.s.t 2v•i.Cie 218 RaAkea Road r Assessor's Map/Parce4 026 5 5 _ O.st eav i C2e, 17a�sz. 60 Installer's Name,Address,and Tel.No.5 0 8—7 7 5 :3 3 3 8 Designer's Name,Address and Tel.No.5 0 8—2 7 3—0 3 7 7 ;. R. Nacom&ea 9 Son Inc. ;C, Eng.ineea•ing,lnc. 2854 Caangeaay [3ox 66 Centeay.iiig, Nah.6. 02632 highway C. 19aaeham, 8a.6.a. 02538 Type of Building: Dwelling XX No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 570 gallons per day. Calculated daily flow 5 5 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 1 v Description of Soil l _ w•" F Nature of Repairs or Alterations(Answer when applicable)0 m•i.t t.i n g e e,3 4 p o o.0 z. I n b t a I •i n g 1-1500 hept.ic .tank, 1-Dihta.igut.ion Sox and 4-500 ga.C2on Peach•ing chamgeazh packed in 4' o,C 1!lz" stone. Date last inspected: Agreement: ) The undersigned agrees to ensure the construction and maintenance of the afore des�cribed�o�ite 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 is uod by this Bd&d o He t . Signed Date 6/2 6/0 3 Application Approved by •N.1 l_ / �_ i L1 /y Date Application Disapproved for the following reasons a l' Daf--ssueld� .� Permit No. ,`- E r`.• , THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS ' Certif trate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal'System ConstructedY(XX)Repaired(/ )Upgraded( ) Abandoned( )by J. R• Nacom'gea 9 Son Inc. at Road- v has bee constructe Sin bcordance with the provisions of Title 5 and the for Disposal System Construction Permit No dated 7 Z 4U 3 Installer I. R. Placomge2 9 Son Inc. Designer 1C. tn-ginegaing, In, The issuance of this "ermi shall not be construed as a guarantee that the system i)1 d� 'g d,/ Date Inspector oFee$5 0. 00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Zigpogal *.pgtem Cougtruction Permit Permission is hereby granted to Construct tx)Repair( )Upgrade( )Abandon( ) Systemlocatedat 218 Paakea Road 0,6teny•ii.2e, Na.a.s. 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:Construct'on musdbe completed within three years of the date of thislpe t / Date:_ �r Approved by 1 ,,-� TOWN OF BARNS-TABLE LOCATION PAR k P A X d SEWAGE # VILLAGE 0 5 ret V 11L Q ASSESSOR'S MAP & LOT L D f INSTALLER'S NAME.&PHONE NO. J'/o ILIA C C_4 .4 EK, SEPTIC TANK CAPACITY S D LEACHING FACILITY: (type) �/ 10oeV W P442 (size)NO.OF BEDROOMS BUILDER OR OWNE Q PERMITDATE: r- 63 COMPLIANCE DATE: � r ©3 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 Eti • I 1 TOWN OF BARNSTABLE LOCATION 2 /T jO AR I< PPN X P SEWAGE #4 0 O �— � VILLAGE 0 5 rfR 1//1L Q ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �"/� eV A C C--n A P Ke S 011/ SEPTIC TANK CAPACITY S O O LEACHING FACILITY: (type) y ie y Lu P1.4's (size) �� / �9' — A NO.OF BEDROOMS BUILDER OR OWNE / Q PERMITDATE: YZ COMPLIANCE DATE: 1 I ©3 - Separation Distance Between the: t 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 r % X f:z G r TOWN OF BARNSTABLE LOCATION,R,/F.�sY' G�" As4,r�- SEWAGE# VILLAGE ASSESSOR'S MAP&LOT INSTALLER'S NAME.&PHONE NO. SEPTIC TANK CAPACITY � �� d.�� / �. e LEACHING FACILITY: (typey4 (size) A0D44*-,-* NO.OF BEDROOMS, BUILDER OR OWNERe /✓ PERMUDATE: - COMPLIANCE DATE: Separation Distance Between the: r Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility `'`v Feet Private Water Supply Well and Leaching Facility (If any wells exist on'site or vithin 200,feet of leaching facility) , Feet Edge'of Wetland and Leaching Facility(If any tlands exist within 300 feet 2fi le n fa ty) Feet Furnished by y 2—ioo ®�{c.a r a� tog D L f DATE: �4/1 8/00__-- S.� tt R l 1 PROPERTY A D D R E S S:,21.8 Parker Road_______ Ile Mass__----- _—� 02655 On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 1 -Field Stone cesspool . V x7 ' o 2 . 2-6 ' x8 ' Red brick cesspools. Based on my Inspectlon, I certify the following condltlons: 3 . This is not a title five septic system. 4 . This is a sewage system. Prior 1960 5. All of the cesspools are dry at this time. 6 . Sch. 40 4 ' PVC pipe to the main cesspool. Orangeberg pipe to the two remaining cesspools. The cesspools are in series. 7 . Presently the sewage system is in working order. House has been vacant for at least one year. SIGNATURE1- 91VA .. _ N a m e:_,l a, ADS.QMk1 r--1 -_--- Company; Joae.Bh_P_Macomber b Son , Inc . Address:_ B3x_66_ _____ Centerville Ha__02632-0066 Phone•___508 775-3338_______ THIS CERTIFICATION oOES NOT CONSTITUTE A GUARANTY OR WARRANTY J61EPH P. MACOMBER & SON, INC, Tsnks•Cis:pools•Loichf rids 11 PUmp:d i, In:ttilsd Town s�w�r Connections P.0. Box 66 75.3338erv775.6 o2632-0066 r • 5 Z000 . 1 �` '�Qtir"d Or BAfthSI'FBi.E • µEALTfI DEPi. .4 COMMONWEALTH OF MASSACHUSETTS, EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY CORE Secretary ARGEO PAUL CELLUCCI DAVM B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Prop,Address: 218 Parker Road Name of owner A. Leonard Osterville,M ss. 02655 AddreasofOwnsr: 63 Leonard Road Data of I ec nsption: 4 1 1 8/0 0 O s t e r v i l l e,Mass. 02655 Name of Inspector: (Please Prim) Joseph P.Macomber Jr. I am a DEP approved system inspector pursuant to Section 15.340 of 71de 5(310 CMR 15.000) Company Name: J.P.Macomb e MaangAddrass: OX 65 Centerviiie,Mass . 02632 Telephone Number: 508-775-3338 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: Passes Conditionally Passes I _ Needs Further Evaluation By the Local Approving Authority _ Fai Inspector's Signature: Date: The System Inspect shall submit a copy of this Inspection report to the Approving Authority(Board of Health or DEP,)wlthin 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 ofr£nvironmentad Protection. The original should'be sent to Vw system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS revised 9/2/98 Page IorII "Printed on R"Ied Paper SUI SURFACE SEWAGE DLSP03AL SYSTEM INSPECTION FORM PART A CFRTIF CAMN (oontirwed) Property Ada*,:21 8 Parker Road Osterville,Mass. owner. A. Leonard D.cm of t►spect!'o": 4/1 8/0 0 04PECTION SUMMARY: Ch"k Al, a, C, oa D. A. SYSTEM PASSES: 111 have not found any information which Indicates that any of the failure condhions described In 310 CMR 16.303 sxlst. Any taawo criteria not syslusted are Indicated below. CO MJAENTS: B. SYSTEM CONDRIONAIIY PASSES: ` V_ One or more system components as described In the 'Conditional Pass'section need to be replaced or repalrsd. Th4 system. upo+ completion of the replacement or repair.*approved by the Board of Health,will pass. Indicate yes, no, or'not determined(Y, N, or ND). Describe basis of determinadon In all kwtanoos. If'not determined',ex;J&Ln why not. The septic tank Is mete, unless the owner or operator has provided the system Inspector with a copy of a Cwttficat• of Compliance (attached)indicating that the tank w*metalled wltNn twenty(20)years prior to the date of the Inapocdon; the aepdc tank, whether or not metal.Is creaked,struaturaliy unsound, shows substantial Infilvsti fit on or exostion. or w faliure is Imminent. The system will pass Inspection If the existing septic tank Is replaced with a complying sepdc wuc u approved by the Board of Health. Sewage backup or breakout or high static water level observed In the distribution box Is due to broken or obsvucud plpei or due to a broken, settled or uneven di&tribution box. The system will pass Inspection If(with approval of the Board of Health). broken pipe(&) we replaced obstruction Is removed distribution box Is levelled or replaced • The ayrtem(squired pumpingmm dwt'four'ttmes-%-yaardus to brollenor obstructed plpe(s). The iystsm ww-pc s--- impectlon If(with approval of the Board of Health): broken pipe(&)are replaced obstruction Is removed revised 9/2/98 Page 2orll SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 21 8 Parker Road Ostervi l le,Mass. Owner: A. Leonard Date of Inspection:4/18/0 0 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH.W1LL.PRQTECT THE PUBLIC HEALTH.AND SAFETY AND THE ENWHONMENT- Cesspool or privy is within 60 feet of surface water �G 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS Is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 60 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. Method used to determine distance (approximation not valid).- 3) OTHER This is a sewage system. The system consists of 1 _6 ' x7 ' f i P1 dstnne cPas nnl Wi f-h 1- 4 6 ' "8 1 red bloG Gesspeels a6 overflows. The cesspools are in sprigs _ revised 9/2/98 Page 3orn I - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A r CERTIFICATION (continued) Property Address: 218 Parker Road Ostervi l le,Mass. owner: A. Leonard Date of Inspection: 4/1 8/0 0 D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: 4�h_ I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is Identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No �/ Backup of-sewage irrlofeciFtyrorv/sftm componerMduslo an overloaded orckgged S,ASor•ceespod. 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 ley I i the di ribution box above outlet invert due to an overloaded or clogged SAS or cesspool. 1� Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more th n 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped. l� Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for »coliform bacteria, volatile organic-compounds, ammonia nitrogen and nitrate nitrogen. - E. LARGE SYSTEM FAILS: 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes. No. _ the system is within 400 feet of a surface drinking water supply the system is-witWn.200 feet of•-e-tfibutary-4oa su►foo"gnkiwg.watw•su'ply " Zthe system is located in a nitrogen sensitive area(Interim Wellhead Protection.Area-1WPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4ortl SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 218 Parker Road Osterville,Mass. Own": A. Leonard Date of Inspection: 4/1 8/0 0 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No 1/ Pumping information was provided by the owner, occupant, or Board of Health. None of the systemocornpoaanta hama:baan puaMmKi4oFatl"st twoaweaka andthe,system hasbaeav0ceiwwgvesso !flow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this inspection. As built plans,have been obtained and examined. Note if they are not available wit 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. _ All system components,J**cluding the Soil Absorption System, have been located on the site. The 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. The size and location of the Soil Absorption System orrthe site has been determined based on: Existing information. For example, Plan at B.O.H. Determined in the field(if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) / 115.302(3)(b)) The facility owner.(and.occupants.Jf differaot frnm owcnerl<+�ere prasridad.wkh iointmatiomon ttha.prolpar ain* f Subsurface Disposal Systems. revised 9/2/98 Page Sof11 SUBSURFACE SEWAGE DISPOSAL SYSTEM,INSPECTION FORM PART C SYSTEM INFORMATION pr.wtyAd,,,,: 218 Parker Road Osterville,Mass. Owner: A. Leonard Date of Inspection: 4/1 8/0 0 FLOW CONDITIONS RESIDENTIAL: Design flow: /Q g.p.d./bedro Number of bedrooms d �gn):y Number of bedrooms(actual): Total DESIGN flow Number of current residents.- Garbage grinder(yes or no):/ Laundry(separate system) ( orn:_; If yes, separmelnspection.required Laundry system inspected ye r no) Seasonal use(yes or no): i /� �/ _ J,, , 67&&� A, spry Water meter readings,if avail ble(last two year's usage(gpd): / 7 y Sump Pump(yes or no):J J AV Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: W,4 QPd-( Based on 15.203) Basis of design flow ArA 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)x� Water meter readings,if available: Last date of occupancy: ZW OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and sou ce f'nformation: System pumped as part of i pection: (yes or no)_ „ If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM _,Q Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspools y Privy VShared system(yes or no) (if yes, attach previous inspection records,if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank 1-"19 Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed40 known)-and source of4rtformation: - — - - Sewage odors detected when,arriving at the site: (yes or no) revised_° 9/2/9.8. Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART C SYSTEM WFORMATION fewdnwd) PmwtyAddreaa:218 Parker Road Osterville,Mass. Owner: A. Leonard Date of Inspection: 4/1 8/0 0 BUUAWG SEWER: (Locate on site plan) Depth below grade: Material of constructi :• cast Iron Z'40 PVC othir(explaln) Distance from Drivate water supply well or auction line r Diameter 101 Comments: (condition of Joints, venting, evidence of h►akage,-etc.) -• a2iptg Oyscemv e throughthe house vent, SEPTIC TANK• (locate on she plan) Depth below grade: APA Material of constructlon,',�A concrete U, metalkaFiberglass%V&Polyethylenei✓�other(explaln) If tank is fnetal, list age Aa Js.age.eonhrmed by Certificate of Compliance_(Yes/No) Dimensions: t/IP Sludge depth: Ahj_ Distance from top of sludge to bottom of outlet tee ortraffie. AA Scum tNckness: AI _ Distance from top of scum to top of outlet tee or baffle: AM Distance from bottom of scum to bottom of outlet tee or baffle. AJ4i How dimensions were determined: 4/14 Comments: (recommendation for pumping,condition of inlet and outlet tees or-baffles, depth of liquid level in relation to outlet Invert, structur§Hntegrity, evidence of leakage,etc.) 'Pump the main cesspool every 2-3 Uparg _Tha cesgnnol s ara g't-ritrtiiZralj y gr%iipc] `i'+i® Q-essp els aEe—presently—dry . GREASE TRAP (locate on site plan) Depth below grader Material of construction:A)Aconcrete*4meto1.t>9 Fiberglass 4lPolyethylono tOothor(explain) A-1A Dimensions: AM Scum thickness: NA Distance from top of scum to top of outlet tee or baffle: A�/1 Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: AIA r 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 ; c not, nreconi- revised 9/2/98 Paer7ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(cortdrwod) ProWtyAddross:218 Parker Road Osterville,Mass. Owner: A. Leonard Dane of Inspection: 4/1 8/0 0 TIGHT OR HOLDING TANK:11<d" (Tank must be pumped prior to, or at time of, Inspection) (locate on site plan) Depth below grade:A Material of construction:41 concroteametalOFlberglasst Polyethylone4dother(explaln) Al It Dimensions: Capacity: gallons Design flow: AJA gallons/day Alarm present Alarm Is, I Alarm In working order:Yes 4�4 No,44 Date of previous pumping: )/ _ Comments: (condition of Inlet tee, condition of alarm and float switches,etc.) Tightor hol di nq tanks__.=c% MGtp z'ASQpt e DISTRIBUTION BOX:A&t- Ilocats on site plan) Depth of liquid level above outlet Invert:_ Comments: (note It level and distribution is equal, evidenoe of solids carryover, evidence of leakage Into or out of box, etc.) — - DiStrihut-i on hnx i c not p rr3S6r i- - PUMP CHAMBER:AINit,' Ilocats on site plan) Pumps in working order:()'as or No) /f�7 Alarms In working ordsr'(Yes or No)�V Comments: Inote condition of pump chamber, condition of pumps and appurtenances,etc.) Pump chamber is nn�l-osont, revised 9/2/98 page iorII SUBSURFACE SEWAGE DISPOSAL SYSTEM,INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAd&"s: 218 Parker Road Osterville,Mass.. owner: A. Leonard Date of kmpect : 4/1 8/0 0 SOIL ABSORPTION SYSTEM(SAS)-2 (locate on site plan, if possible: excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Type. leaching pits, number: leaching chambers, number: leaching galleries,number: leaching trenches,number,length: leaching fields, number,dimensions: overflow cesspool,number: Alternative system: AM Name of Technology: ' 1 Comments: (note condition of soil, signs 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.Soi s are dry.Vegetation is normal _ CESSPOOLS: (locate on site plan) j 2 Number and configuration: 3 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(cesspool must be pumped as part of inspection) Did not pump inflow mess=nnl - rpss nnl c are drjr Comments: (note condition of soil, signs of hydraulic failure,level of pending,condition of-vegetation, etc.) Same as above PRIVY:A�� (locate on site plan) Materjals of construction: iL'/V Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation;etc.) Privy is not present. revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORId PART C , SYSTEM INFORMATION(wnd Lm4 PropwyAd&*": 218 Parker Road Osterville,Mass. Own«: A. Leonard o.v of 4,ap.cdon: 4/1 8/0 0- SKETCH OF SEWAGE DISPOSAL SYSTEM: Include des to at Fait two permanent reference landmarks or benchmarks locate all wells wlthln 100' (locate where public water supply comes Into house) rol / ►Ira 00 revised 9/2/98 PaesloofIt SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C i SYSTIEM INFORMATION (corrtinued) ProWlyAd&a": 218 Parker Road Osterville,Mass. own«: A. Leonard Date of Inspection:4/1 8/0 0 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwsterr�t' Feet Please Indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record ✓ Observed Site (Abutting propert_ , bservadon hole, basemeot sump etc.) Determined from local conditions Checked with local Board of health _Checked FEMA Maps Checked pumping records —.L/—Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Used water contours map. Gahrety & Miller Model 12/16/94 revised 9/2/98 Paer11of11 i • `a•.rnrw rntre>—.•.-r� rn. mr ntenrr•nrtrerl:rer.rn�+�r►r�rn�fftr'n'v w�'wt�rtrtn �T�_'..t-.r... TOWN OF Barnstable HOARD OF IIEALTII SUI)SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION "•T^t�T••••.•e—T.t 1T.�.�T TI'.TI'IT.1SI T1r iRT.I7tTTT:�—t't r71TPT�7tt11�f-9'AT�f R�7-IIII�t�*7 rwm .�1'PT�'1•.T'1. .�..r -TYPE OR PRINT CI.CARLY- PROPERTY INSPECTED STREET ADDRESS 218 Parker Road Osterville,Mass, . ASSESSORS MAP , BLOCK AND PARCEL i OWNER' s NAME A. Leonardo PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Sc1Y Inc. COMPANY ADDRESS Box 66 Centerville,Mass. 02632. Street Town or City state LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 .) 790 - 1 578 t0 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and omplete 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 : _IZZ/System 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 con toted has found that the system fails to Protect the public health and the environment in accordance with Title 6 , 310 CHR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , Inspector Signature Date ae copy of this certification must be provided to the OWNER, the BUYER here applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, the owner or'tho` orator shall u p pgrade ' the ayetem within one year of the date of the inspection, unless allowed or required ' otherwise as provided in 3.10 CMR 16 . 305 . partd .doc PROVIDE PRECAST CONCRETE „ - CHARCOAL FILTER TOF ELEV. - 101 .30' EXTENSION RISER WITH CONCRETE 5 DIA. OUTLET(S) FINISH GRADE OVER CHAMBERS = 9$.4 -98.8 GENERAL NOTE S COVER TO GRADE OVER OUTLET REMOVABLE COVER SLOPE @ 2% MIN. OVER SYSTEM 1- UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE OVER 4"SCHEDULE 40 PVC MIN SLOPE 1% 3/4"TO 1-1/2" DOUBLE WASHED STONE TO CROWN OF PIPE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE TANK EL.= 98.7'-99.0' FINISH GRADE OVER D-BOX= 98.5 ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES. FINISH GRADE @FOUND. EL.= 100.5� 2"OF 1/8"TO 1/2" DOUBLE WASHED STONE 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD 9MIN. 20" MIN. ACCESS COVER • OF HEALTH AND THE DESIGN ENGINEER.(TYPICAL FOR 3) 36 MAX. TOP OF SAS - 9583 PLACE RISERS ON ALL CHAMBERS 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL . �- 36"MAX. 9" MIN TO 6" OF FINISHED GRADE BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. EXISTING 4" 95.00' 36" MAX. ' �CASTRON PIPE BREAKOUT EL = 95.50 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 6" 3" 3„ g" ELEVATION =95.50' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS 2" DROP MIN. PROVIDE WATERTIGHT A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF 10" 3" DROP MAX. JOINTS (TYP.) o ��o ono o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 98.70' 14" 96.25' 4"PVC IN FROM O o �o 0 Q 0 0 0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. SEPTIC TANK 4"PVC OUT TO o 0 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. LEACHING FACILITY I oo 96.50 00 7. LOCAL BOARD OF HEALTH TO BE NOTIFIED PRIOR TO BACK FILLING WHEN OUTLET TEE 12" 2' o o0 0 oo SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS NOT TO 48" 95.75� MIN. 95.5$� : 0 o BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH. 21.3' 22"ZABEL FILTER 6" CRUSHED STONE o 0 0 0 0 0 0 o 0 0 0 0 8 ELEVATIONS BASED ON ASSUMED N.G.V.D. DATUM OF 100.00'MSL MODEL#A1801 HIP (GAS OVER MECHANICALLY o - OBTAINED FROM A NAIL IN A TREE AS SHOWN ON PLAN. BAFFLE ON BOTTOM) COMPACTED BASE 3 0� 8.5' (TYP. FOR 1) �� 4 0 3 0, 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION 4.0' 4 9, 4 0� THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE s"CRUSHED STONE 5 OUTLET DISTRIBUTION BOX 52.0' (TYP.) AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY OVER MECHANICALLY TO BE INSTALLED ON A LEVEL STABLE < $7.50� 12.9' DISCREPANCIES TO THE DESIGN ENGINEER. :J COMPACTED BASE BASE. FIRST TWO FEET OF OUTLET zC3.00� GROUND WATER ELEV= 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE PROPOSED 1500 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 4 - 500 GAL. CHAMBERS 4' MIN. STRUCTURES SHALL BE MADE WATERTIGHT. LENGTH 10.5' WIDTH 5.66' DEPTH 5.58' CROSS SECTION VIEW CHAMBER END VIEW 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL TYPICAL CHAMBER PROFILE CHAMBER DETAILS ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. NOT TO SCALE NOT TO SCALE NOT TO SCALE 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS - f - - �'-.�• �. , ' ♦ LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE TEST PIT DATA THEY SHALL WITHSTAND H-20 LOADING. MAP 116 V 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND g PY • ii�• r r. -7i • • • �� •�• + • /'J FINES. LOT 43 ,�• y • ,._ • . , - AGENT: 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND �••� • •,•' . • .. �M .111 EVALUATOR: Samuel Philos Jensen UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF MAP 116 I$. ' '`• • 1.l. DATE: June 13,2003 LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN LOT 42 � + . COARSE SAND FREE FROM CLAY FINES OR OTHER UNSUITABLE MATERIAL IN • 1 \ TEST PIT#: 1 ACCORDANCE WITH 310 CMR 15.255(3). �/ . • • , ! ELEV TOP= 98.50' 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN MAP 116 ;• ; �{ �►�•. • .• • SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. SB/DH ��, • . w • • 1 �� • r . • �,, • •.: 3 ELEV WATER= > 11'B.G.S. LOT 41 • ' ��• .• •..�C7 ••e • • : 16. PROPOSED PROJECT IS LOCATED WITHIN: _��;`�� ,��• . ' , PERC RATE = 3 MIN/IN ASSESSORS MAP 116 PARCEL 60 (FND) '�<J • •) ��• �V \\+� • +• • • �. • • • • • • •. 'JJ• j!! �', -� • • •; ; b 1• DEPTH OF PERC= 52"-70" 17. OWNER OF RECORD: TIMOTHY W. FULHAM & LISE M. OLNEY SB/DH i "�� t� �r ?� • • •, ADDRESS: 593 WASHINGTON STREET (FND/HELD) O � Ub�I • • �� tr• S; • • +.I •. .J.� 6� TEXTURAL CLASS: 2 ii• WELLESLEY, MA 02482 vE < Landis '� 11 . ' i1• • • FEMA FLOOD ZONE C ST AVEN - W °�'� �x• • • o s8.5o 18. F►R PUg�IC) > F `�;� ! _,�. • • c'� •� �. . • Sand Loam AS SHOWN ON COMMUNITY PANEL# 250001 0016 D 35�WIDE- n CB/DH Q 3 ^�,- -t+� , • • • • ,q y Nat°° 00 E (FND/HELD) i +< T '• " • • 10YR 312 19. PLAN REFERENCE: 140 - ~ , , j'` r` ��� 1. PLAN ENTITLED "TOWN OF BARNSTABLE, MASS. ROADWAY LAYOUT OF FIRST AVENUE" .-. tY i 1 EDGE pF o 1 ��� or ;� Neck 1D �N� 8 97-� DATED JANUARY 31, 1930, SCALED AT 40 FEET TO AN INCH. M / Yr �" ;%-„-- .. 6 I 4 2. PLAN ENTITLED" PLAN OF LAND AT OSTERVILLE, MASS. BELONGING TO JAMES A. rn -� P[rltd �j[ .. ,._..�... ��p Sand Loam i �( L� °:,` B y LOVELL" DATED JANUARY 1909, SCALED AT 60 FEET TO AN INCH. t481°p140 E 1 z_ l MAP 1 16 10YR 516 �� / _ -T- !!QQ . F' 20. DEED REFERENCE: g9.90 �� \r '1� LOT 59 ;-� Q / � 42 95.00 1. BOOK 13022 PAGES 344 �� L� • Q.. pp • �� 4 n f 00 52" Sand Loam 94.17' 21. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. �`L o SB/DH \ l . ( • 1 -��' Pere C-1 2.5Y 6/4 22. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY o (FND/HELD) ( PROPOSED CLEAN-OUT • r " - FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY i 10i� ti I JJ TO GRADE �; .. \ r `.`!• w /i _ FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. ­46- • ' • • 4 __ y7 `. 73" 9�.42' B.M. • �� _' - - - <- - C-2 M-C Sand GARAGE Nail in Tree 2.5Y 7/4 1 SB/DH r/JJ / - EXISTING Elev. = 100.00' 5% Gravel (FND) IJ 1-BEDROOM Assumed J� = APT LOCUS PLAN J No Groundwater SCALE: 1"= 1000' 132" Observed 1 � r #21 s � 12 ���- DESIGN DATA LEGEND 9 EXISTING CESSPOOLS - - -o / ( UP 65-19 EXISTING 12"OAK 33.3' TO BE PUMPED AND EXISTING CONTOUR 4-BEDROOM FILLED WITH CLEAN SAND F5fl PROPOSED SPOT GRADES E/T/C DWELLING O .-- ` NUMBER OF BEDROOMS (ASSESSORS) 4 PROPOSED CONTOUR E/T/C TOF- 101.30' p NUMBER OF BEDROOMS (DESIGN) 5 �� E/T/C 21.3' O P 0 DESIGN FLOW 110 GAUDAY/BEDROOM E/T/C EXISTING OVERHEAD UTILITIES E/T/C O - 12" OAK 4 o TOTAL DESIGN FLOW 550 GAUDAY /• 362, : '= N fitDESIGN FLOW X 200 % = 1100 GAUDAY W EXISTING WATERLINE o m c IG USE PROPOSED 1500-GALLON SEPTIC TANK 1 1"` GAS EXISTING GAS LINE ;13 .-�- MAP 116 m 1 j �'� � 24"OA Wa- TEST PIT LOCATION ° :: O CID LOT 58 C � � <'n_ IC, '�•-r-r-.-.-�.:� SHED ( 03 v o o �I� ` INSTALL 4 - 500 GAL. CHAMBERS O PROPOSED 1500 GALLON SEPTIC TANK GM PROPOSED 1500 GALLON SIDEWALL CAPACITY 4" SOLID SCHEDULE 40 PVC PIPE 0 / SEPTIC TANK m n 1 ❑ DISTRIBUTION BOX 1 PROPOSED (LENGTH +WIDTH)(2)(2' HIGH) (.60 GPD/S.F.) = GAUDAY DISTRIBUTION BOX (52.0 + 12.9) (2)(2') (.60 GPD/S.F.)= 155.7 GAUDAY 0 500 GAL. LEACHING CHAMBER m CID zj PROPOSED 500 GALLON N BOTTOM CAPACITY LEACHING CHAMBERS U, 1 PROPOSED VENT ( LENGTH x WIDTH ) (.60 GPD/S.F.) = GAUDAY 1 6/26/03 DFS JLC 5-BEDROOM DESIGN 1 / LOCATION TO BE FIELD (52.0'x 12.9') (.60 GPD/S.F.) = 402.4 GAUDAY ( REV. DATE BY APP D. DESCRIPTION MAP 116 VERIFIED BY OWNER) - . PROPOSED SEPTIC SYSTEM UPGRADE � UP 65-20 LOT 60 Sa0°44'10"W CB/DH TOTALS: PREPARED FOR: 1 AREA=47,766±sQ.FT. 120 00! (FND) TIMOTHY W. FULHAM TOTAL NUMBER OF CHAMBERS: 4 1 - TOTAL LEACHING AREA: 754.1 SQ.FT. MAP 116 LOCATED AT LOT 62 TOTAL LEACHING CAPACITY: 558.1 GALJDAY 218 PARKER ROAD Sao°4a'1o"W I OSTERVILLE, MA 02655 12°-00' MAP 116 �� RESERVED FOR BOARD OF HEALTH USE LOT 61 SCALE: 1 INCH = 20 FT. DATE: JUNE 20, 2003 `FyTH OF y�_ 0 10 20 40 80 FEET JOHN L�q, + J\ CHURCHILL PREPARED BY: JR CML No JC ENGINEERING, INC. `x, ' \ „�� 2854 CRANBERRY HIGHWAY EAST WAREHAM, MA 02538 SITE PLAN 508.273.0377 SCALE: 1"=20' Drawn By: DFS Designed By:DFS Checked By: JLC JOB No.445