HomeMy WebLinkAbout0046 RAMBLER ROAD - Health 46 RAMBLER ROAD, OSTERVILLE
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O THE COMMONWEALTH OF MASSACHUSETTS
(� AP �, _. BOARD F' H EA T
I /..- i�// .......OF.......... ... . ...................................
Appliration for Diipusal Works Tonotrur#iun Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair (44_)-�an Individual Sewage Disposal
System at, -- - ..A.-
Loc i Addre or Lot No.
._.
n r .Address
. ...............� . ..
Installer Address
dType of Building/ Size Lot............................Sq. feet
U Dwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ..................................
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width_............. Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
1 -----------••--•-••-------•-------•---•----•---------------------------•--.........................................................
0 Description of Soil........... ...-•----------------•=-•-•------............----------------••---•----------------•-----....------------------------...........-•---
"X
U --------••••••----•-••.......................•--•--••-•-----•••...--------•--------............-•---.....-----•--••--------••-••----•---••---•--------••.........
W ------------------------------------------------------------------- ...............................................................jH-••-----•-------••-..................................
UNature of Repairs or Alterations—Answer when applicable_..._f" � :.� ...............:..:..................................
-------------------------------------------•------------•--•------•---•---------------------------••----••.....t-_ --v ...........................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with
the provisions of iITL% 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by t bo d of lth.
Signed
D to
ApplicationApproved By................................................-•..... .................
Date
Application Disapproved for the following reasons:-• ---- •-•--.._......•-•-•---•-----------------•-••-•••------------•-•-----------•--------------...........--
...---••••----•...............................................................•--•---------•---.......-----------------.............----------•--------••--••--•--........-----•-•-•-- -----....---•----
Date
PermitNo......................................................... Issued.--.......................................................
Date
:�.Yl►�L1L� �Y.�Y.�u.�.u�u.a�.�.�.�a aa�aa -a--a--aa-aaaaaa------------------------.
No...................... Ficis.................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
0, OF........i�%. r/, � /
.......................................... ........../....�,............................................
Appliration for Roposal Works Tonstrurtion ramit
Application is hereby made for a Permit to Construct or Repair Individual
di dual Sewage Disposal
System at:
...Lot-/ ClVi IL.L.0........................................................................
. Location-'Addr s or Lot No.
7.2 ..L12 ..........................................
................................ .......Z...ft.l. � ................. ...........................................
pvner Address
...................... ..................... ...................... . ..................................................................................................
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms...........................................Expansion Attic Garbage Grinder
1.4
P4 Other—Type of Building ............................ No. of persons........_.._.___.._......... Showers Cafeteria
A4Other fixtures ...............................................................................................................................
Design Flow.....................................0......gallons per person per day. Total daily flow............................................gallons.
Septic Tank—Liquid'capacity............gallons Length................ Width................ Diameter................ Depth................
................
Disposal Trench—No..................... Width.__............_._._ Total Length...._........_..._.. Total leaching area....0..............sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.._..........._..._. Total leaching area..........0......sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......... .........i......***Pit...........-....._...............*------"---------------*" Date........................................
1.14
Test Pit No. I................minutes per inch Depth of Test Depth to ground water.........................
Test Pit No. 2................minutes per inch Depth of Test Pit............_....... Depth to ground water....._...-..............
iYi ....................................................................................0............0...........................................................
0 Description of Soil.......o.....................!...................................0.......................................................................................................
W
------------ ------------------- --------------------------------------*----------*------"----------------*............. ---------------*----------------------**-"*-------"-------
.........................................................................................................................................................................................................
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
...................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal Systemin accordance with
the provisions of TITLE 5 of the State Sanitary Code—,The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed................ ......................................... .
......... .................
ApplicationApproved By............................................... . ....................... ...............6....................QA
16 Date
Application Disapproved for the following reasons:..........................................................................................................
........................................................................................................................................................................................................
Daft
PermitNo...................................................... Issued-._........------.......---..........................._
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
X........... v..1�........0 F......I.R.A_75........ ........... E...............
THIS ISP9,CE TIFY, That the Individual Sewage Disposal System constructed or Repaired d
..............by- ..... ..... ...... .........................................................................................................................
A J
at.................T .......9P. )..* . . .... ................ . ...............0.3...T.............V....I.Z...—.
. �-.......E.........................................
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code/As described in the
application for Disposal Works Construction Permit No......:: 4,.z.p.... dated .................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL XqVCTION SATISFACTORY.
le- � -go
DATE......................l.j .j................................................. Inspector----.---...0........................................... ................
THE COMMONWEALTH OF MASSACHUSETTS
rr BOARD OF HEALTH
.........OF.......�. ............................
........... .4.... t
No......................... Fn....Z,_ e.,20
Permissionis hereby granted.. . ............ ......................................................................................................
to ConstruLl� or Re ant4ndividual. Sage Disposal System
at I
.................
Street ac G"
as shown on the application for Disposal Works Construction Permit No..................... Data...... (�---------------------
....................................................................................................
Board of He
DATE.......................... r...... ......................................
FORM 1255 A. M. SULKIN, INC.. BOSTON
(� n �� �� TOWN OF B STABLE
A N Ifs
LOCATION2Ad
VILLAGE � � �� ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY /Q®�
LEACHING FACILITY:(type) /Ql9(°a (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER ,
p
BUILDER OR OWNER
DATE PERMIT ISSUED: CO 7
DATE .COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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t DATE:_ 8..A/95 .
PROPERTY ADLDRESS:_:.46 Rambler Road'
ECEI V C®
' Osterville
- - Mass 02655 AUG 2 4 1995
HEALTH
--- -- _ ..---- MVN OFSANsrABLE
On the above date, I inspected the septic system at the above address.
This system consists of the following:
1 . 1 -1000 gallon septic tank.
2.1 -Distribution Box.
3 .1 -1000 gallon Leaching Pit.
Based do my lns:w.ction, I certify the following conditions:
This is a Title Five Septic System-(78' code)Septic system
is„ inrproper working order , at the proS'ent time.
SIGNATUR!?:
Name: d. P .Macomber jr-I..
Company:_J.—P_Macomber & Son- --Inc ..
Address:_-Be.,=bb-----= - -�--
Centervill,e,Mass__02.632. - `
Phone:---548 �Z73338------- • 1
THIS CERTIFICATION DOES NOT CONSTITUTE ,A GUARANTY OR WARRANTY
JOSEPH P. MACOMBER & SON, INC.
Tanks-Ces4poo1a-Leachflelds
Pumped & installed
Town Sewer Connection:
P.O. Box 66" Centerville, MA 02632-0066
775-3338 775-6412
7
"'. SE ACE DISPOSAL SYSTEM 1NES12..7
Address Of Property, 46 Rambler Road Ostervile Ma
Owner ' s name Robert P. Hinckley
Date of Inspection August 14 1995
PART A
C)iECKLIST
Check if the following have been done :
Pumping information was requested of the owner, occupant, and Board of
Health .
]L 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.
As 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 site was inspected for signs of breakout..
_j/ All system components, 4@*cluding the SAS , 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 SAS 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 SSDS.-
Recommendations .
1 , Cover is broken on the leaching pit .
Must be replaced .
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION
FLOW CONDITIONS: ' V
If residential
' number of bedrooms
number of current residents
garbage grinder, yes or no
laundry connected to system, yes or no
seasonal use, yes or no
If nonresidential , calculated flow:
Water meter readings, if available:* 1993 28, 000 gallons 76. 72 .GPD
1994 27, 000 gallons 73.98 GPD
AMeSeAJ Last date of occupancy
GENERAL INFORMATION ,
Pumping rec rds a d ounce of information:
_Ab- System pumped as part of inspection, yes .or no
if yes, volume pumped
Reason for pumping: -
Type of system
YeS Septic tank/distribution box/soil -absorption system
__At_ Single cesspool
' NC Overflow cesspool "
05 Privy
_4 Shared system (yes or no) (if yes, attach previous inspection
records, if any)
Other (explain)
Approximate age of all components. Date installed, if known. Source of
information:. . - _. .
Sewage odors detected when arriving at the site, yes or no
1
_........-- _..
R
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
SEPTIC TANK:�G�
(locate on site plan)
depth below grade: /,V
material of construction: Y concrete metal FRP other(explain)
dimensions: � 6 �� /�!9/l 'y IoJ,��d@
u
sludge depth
�3 rdistance from top of sludge to bottom of outlet tee or baffle
scum thickness
distance from top of scum to top of outlet tee or baffle
distance from bottom of scum to bottom of outlet tee or baffle
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles,
depth of liquid level in relation to outlet. invert, structural integrity,
e idence of leakage, recommendations f
endations for repairs, et . )
.Z. i
717
&4 9&W /Y)17 I-ei&C,9- AlaeA
.,
DISTRIBUTION BOX:.
(locate on site plan)
depth of liquid level above outlet invert
Comments:
.(note if level and distribution is equal, evidence of solids carryover,
e 'den ce ofile age into or .out of box recommendation for repairs, etc.)
PUMP CHAMBER:1�1
(locate on site -plan)
.�Q pumps in working order, yes or no
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, .
recommendations for maintenance or repairs,etc. )
f C/D
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSP
BAAT� B ECTION TORM .
SYSTEM INFORMATION Continued
SOIL ABSORPTION SYSTEM (SAS) :YES I
(locate on site plan, if possible; -excavation not re
approximated by non-intrusive methods) quired, but 'maybe
If not determined to be present, explain:
Type
leaching pits and number one Leaching p-it.
leaching chambers and number 0
leaching galleries and number 0
leaching trenches, number, length 0
leaching' fields, number, dimensions 0
overflow cesspool ,. number 0
Comments:
(note condition of soil , signs of hydraulic failure, level of pondiiig.,
condition of vegetation, recommendations for maintenance or repairs etc.
•No signs of hydraulic failure or ponding ;
_nr repa-its needed at this time .
CESSPOOLS (locate on site plan) :
number and configuration 0
to-
de th
P P of li quid to inlet invert 0
depth of solids layer 0
depth of scum layer 0
dimensions of cesspool
materials of construction
indication of groundwater
inflow (cesspool must be pumped as
part of inspection)
Comments:
(note condition of soil, signs of hydraulic. failure, level 'of ponding,
condition of vegetation, recommendations for maintenance or repair
s,etc.)
NONE
PRIVY: NONE
(,locate on site plan)
materials of construction SwF
dimensions NONE
depth of solids NONE
Comments : NONE '
(note condition of soil , signs of hydraulic 'failure, - level of.ponding,condition of vegetation, recommendations for maintenance or repairs,P'
NONE
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION ,FORM
PART B
SYSTEM INFORMATION continued
SKETCH OF SEWAGE L_SPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 1001 Town Water
I
j
�y
I
i
i
DEPTH TO GROUNDWATER
depth to groundwater
method •of determination or approximation:
No water encountered when Title Five
Sen ,ic S tem was installed 16 vears avn
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C )
FAILURE CRITERIA -�
Indicate yes, no, - or not determined (Y, N, or ND
determination in all instances. If "not determined"Deexplainbas whys noof
t)
Backup of sewage into facility?
. Discharge or ponding of effluent to the surface. of surface waters? the ground or
Static liquid level in the distribution box above Out
let invert.
AS Liquid depth in p6esepeel ' <6" below invert o
flow? r available volume< 1/2 day
-.ALC Required pumping 4 times or more in the last year?
number of times pumped
..dc Septic tank is metal? cracked?structurally unsound? sUibstantial
infiltration? substantial exfiltration? tank failure imminent? .
Is any portion of the SAS, cesspool or privy;
d(('1 below the high groundwater elevation?
within 50 feet of a surface water?
AID within 100 feet of a surface water supply or tributar to
water supply? Y a surface
t within a Zone I of a public well?
within 50 feet of a bordering vegetated wetland or s(cesspools and .privies onlY. ILA o the SAS j ? alt marsh
within 50 feet of a . private water supply well?
. less than 100 feet but greater than 50 feet from a supply well with no acceptable water quality analysis?valf tte heewell
has 'been analyzed. to be acceptable, attach co
for colifer anal!
orm bacteria, . volatile organic compounds, ammoniatnitroge
and nitrate nitrogen, gen
TOWN OF Barnstable BOARD OF HEALTH
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D .- CERTIFICATION
-TYPE OR PRINT CLEARLY-
PROPERTY INSPECTED
STREET ADDRESS46 Rambler Road 0sterviLle -Mass .
ASSESSORS MAP, BLOCK AND PARCEL #
OWNER' s NAME Robert P. Hinckley
PART D - CERTIFICATION
NAME OF INSPECTOR Joseph P.Macomber Jr ,
COMPANY NAME J. P.Macomber & Son Inc .
COMPANY ADDRESS Box 66 Centerville ,Mass . 02632
Street Town or city state lie
COMPANY TELEPHONE (508 775 - 333� FAX (508"a', 790 1587
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposid system al
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:
XXXXX 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
nment 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 tc
protect the public health and the environment in accordance with Title
5 , 310 CHR 15 . 303 , And as specifically noted on PART C FAILURE
CRITERIA of this inspection form.
Inspector Signature Date 8/1.4/95
One copy of this certification must be provided to the OWNER, the BUYER
( where applicable) and the BOARD OF HEALTH.
If the inspection FAILED, the owner or operator shall upgrade ' the system
within one year of the date of the inspection, unless allowed or required
otherwise as provided in .310 CHR 15 . 305 .
partd.doc
C:,mmcnwearn cr Masco^secs
Execurrve Otfice cr Environmentc:nrtc,a
Department of
Environmental Protection
Water Pollution Control Tecnnicci Pssocnce and Training Sections
VAULA n F.WOW
Trudy cc:.
S"w+y.EOEA
Thortus& Powers
Aar"Corw....on�r
06/12/95
ATTN: Joseph P. Macomber, Jr.
seph Macomber and San
PO Box 66
Centerville, MA 02632-
Dear Joseph P. Macomber, Jr. ,
I am pleased to inform you that you have attended training, met
the experience qualifications, and have passed the Title 5 System
Inspector exam, pursuant to 310 CMR 15.340. The passing grade 'for
the exam was 39/52 or 75%.
This is an official notification that you are a Certified Department
of Environmental Protection System Inspector pursuant to 310 CMR 15.340.
You will receive a System Inspector certificate at a later date.
If you have any futher questions, please write to me at the following
address:
Kimball Simpson
D.E.P. Training Center
50 Route 20
Millbury, MA 01527
Thank you very much for your time and consideration in this matter.
3incerelky,
Kimball T. Simpson,
DEP T :aining =rater Director
(2405) ,
Rcs.tm 20 • Millbury, MA 01c77 • FAX 588.755.92i%,.) a T•tepnun• 508-756-7791
i
Water 1`
Conservation
SAVE Tips . . .
ME!
CHECK FOR LEAKS
Water Loss in Gallons Due to Leaks
=thisLoss'Per
DayLoss Per Month
120 3,600
• 360 10,800
• 693 20,790
1,200 36,000
-1,920 57,600
3,096 92,880
® 4,296 128,980
® 61640 199,200
6,984 200,520
8,424 252,720
9,888 296,640
11,324 339,720
12,720 381,600
14,952 448,560 -
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PROJECT:
oI�AL
4(o RAMBLER -F INE LINE A cHITF- TU DES1
OSTERViLLE, MA VILLE i-A 02655
_ 8 WEST BAY i�OAD OSTER ..
a --� ELEVATIONS
pHONE: 508-420-1206
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28'-0' 16'-8 1/4'
O PROJECT:
�€ 46 RAMBLER FINE OSTERVILLE, MAU-NEARCHITECTUPALDESIGN
A 3 eVE-'----)T BAY ROAD OSTERVILL:.E, I IA-02655-
o PLAN PHONE: 50 -42 -1 8 0 23(3
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BUILT-IN
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