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HomeMy WebLinkAbout0036 SHARON CIRCLE - Health 36 Sharon Circle ' Osterville �, .. 00 a o u e Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 36 Sharon Circle ; Property Address , Owner VyasOwner's Name information is required for Osterville V MA 02655 9/25/18 every page. City/Town State Zip Code Date of Inspection 4„ Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. Inspector Information S/ 133::Tq Frank Nunes III Name of Inspector saa Company Name Box 841 a Company Address East Falmouth MA 02536 City/Town State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 9/25/18 Inspector's Wature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5ins .doc-rev.7/28I2018 Title e 5 Official Inspection Form:Subsurface Sewage Disposal System•Page e 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form III Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 36 Sharon Circle Property Address Vyas Owner Owner's Name information is required for Osterville MA 02655 9/25/18 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 36 Sharon Circle Property Address Vyas Owner Owner's Name information is required for Osterville MA 02655 9/25/18 every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND(Explain below): ❑" obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) 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. a. 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 health, safety and the environment: t5insp.doc•rev.7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 36 Sharon Circle Property Address Vyas Owner Owner's Name information is required for Osterville MA 02655 9/25/18 every page. Citylfown State Zip Code Date of inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is'less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate".Yes" or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts ,F Title 5 Official Inspection Fora' Fu Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4' 36 Sharon Circle Property Address Vyas Owner Owner's Name information is required for Osterville MA 02655 9/25/18 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form j Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 36 Sharon Circle Property Address Vyas Owner Owner's Name information is required for Osterville MA 02655 9/25/18 every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for aH inspections: Yes No E ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ 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(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 c� Commonwealth of Massachusetts Title 5 official Inspection Form � Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 36 Sharon Circle Property Address Vyas Owner Owner's Name information is required for Osterville MA . 02655 9/25/18 every page. Citylrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 n 1 R 1 .203 for example: 110 d x#of bedrooms): 330 DESIGN flow based o 3 0 CM 5 m ( p 9P ) Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: . Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? _ ❑ Yes ® No Last date of occupancy:. Occupied Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts r - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 36 Sharon Circle Property Address Vyas Owner Owner's Name information is required for Osterville MA 02655 9/25/18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: = Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Pumped June 2018 per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 f c� Commonwealth of Massachusetts r- - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 36 Sharon Circle Property Address Vyas Owner Owner's Name information is required for Osterville MA 02655 9/25/18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: Original septic tank, new d-box and leach chambers 2002 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 4' Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: >10' feet Comments(on condition of joints, venting, evidence of leakage, etc.):. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form j Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 36 Sharon Circle Property Address Vyas Owner Owner's Name information is r required for Cisterville MA 02655 9/25/18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 3'6" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑polyethylene ❑ other(explain) H-10 tank appears to be structurally sound If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000g Sludge depth: trace Distance from top of sludge to bottom of outlet tee or baffle >1211 Scum thickness trace >2�� Distance from top of scum to top of outlet tee or baffle >2" Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3yrs to prolong the life of the system t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 36 Sharon Circle Property Address Vyas Owner Owner's Name information is required for Osterville MA 02655 9/25/18 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: t feet Material of constructiom ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: 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 Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 - Commonwealth of Massachusetts r= - Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 36 Sharon Circle Property Address Vyas Owner Owner's Name .information is required for Osterville MA 02655 9/25/18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes - ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" 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.): D-box 4' below grade, cover raised to 6", no adverse conditions t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 36 Sharon Circle Property Address Vyas Owner Owner's Name information is required for Osterville MA 02655 9/25/18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: 'leaching fields number,dimensions: ❑ overflow cesspool' number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 - AN, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 36 Sharon Circle Property Address Vyas Owner Owner's Name information is required for Osterville MA 02655 9/25/18 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach chambers were video inspected, they are damp at this time, no indication of past hydraulic failure, soils are compact and dry 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Fora 1. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments /4 36 Sharon Circle Property Address Vyas Owner Owner's Name information is required for Osteryille MA 02655 9/25/18 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): F t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18. i cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 36 Sharon Circle Property Address Vyas Owner Owner's Name information is required for Osterville MA 02655 9/25/18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 1 A R aa6 Aar t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 36 Sharon Circle Property Address Vyas Owner Owner's Name information is required for Osterville MA 02655 9/25/18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: Check Slop e p ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: feet feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record" If checked, date of design plan reviewed: 2002 NGWc 144" Date , ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: 4'seperation per 2002 compliance ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping, site is 40'msl and nearby surface water is 20'msl You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 36 Sharon Circle Property Address Vyas Owner Owner's Name information is ' required for Osterville MA 02655 9/25/18 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ❑ C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached , For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 TOWN OF BARNSTABLE � L� r c�N �� �hGro J ���,• SEWAGE # s . t . . VILLAGE ASSESSOR'S MAP & LOT &STALLER'S NAME&PHONE NO. P-19.2 SEPTIC TANK tAPACTTY / Uc)') 64L LEACHING FACILITY: (type) rev (size) NO.OF BEDROOMS 3 BUILDER OI(OWNER�' iO/ft �✓� PERMTTDATE: 4Y'ov 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 �JF �Pg y ,� � . ` -- y y f �a� d, �� . � .. ys. 53 No. - Fee P� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEs MASSACHUSETTS ZIppYication for Migooar bpztem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(�)Abandon( ) ❑Complete System Xndividual Components Location Address or Lot No. Owner's Name,Address and Tel.,No. 3,� 51Q'�®/� Glr Co &1 9 Assessor's Map/Parcel f B A' ®,,; ,�p�`(/1 1c Installer's Name,Address,and Tel.No. /v `/ Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building UGC° No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow l a gallons per day. Calculated daily flow gallons. Plan Date 912 O Z Nuvi ber of sheets J Revision Da e Title y cFh e lQ�l O Cp'/ /J C//�leK' Size of Septic Tank 1A591Y_QA1 Type of S.A.S. ® 4;W Description of Soil K-3 Ac Z Nature of Repairs or Alterations(Answer when applicable) 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' sued b Bard Heal SignedeV Date Application Approved by Date Application Disapproved for the following reasons Permit No. ao Date Issued No. _ Fee A f fir. a Entered in computer: r` TI ''tOMMONWEAL*H OF MASSACHUSETTS PUBLIC HEALTH.DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS Yes / y 01ppYicatton for Oigpogal �bp.5tem Construction Permit Application for a Pe rtt to Construct( )Repair( )Upgrade(y)Abandon( ) ❑Complete System Individual Components Location Address or'Iot No. 3 Owner's ame,Address and Tel.No. Assessor's Map/Tarcel 'x i.L, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. -7'7i �39� Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building s%tom%Gl� No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow I 0 gallons per day. Calculated daily flow 3�D gallons. Plan Date 1 L/ 2 2 Number of sheets f Revision D to Title �' s J/ 1�i'r1 4 3 L?p/©/�' C_ //C Z Size of Septic Tank 11V01 PA/ of S.A.S. �L �9e,,11 Description of Soil �it Nature of Repairs or Alterations(Answer when applicable) 1-,t-1,0,A-/e a l e',!//%.��' 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 :s B and . Heat . Signe _ / Date 9A 1Z Application Approved by ! Date Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CER_ Y that the On-site,Seewage Disposal System Constructed( )Repaired.( )Upgraded t Abandoned( )b �l (�D at eli C itc, . e,5 E? has-beed constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No ated Installer Designer The issuance of s permit shall not be construed as a guarantee that the syst w ill rfunction d de igne .. Date I '© Inspector A- ------- ------------------------- No. _ .tL3 / Fee �.// !/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS Wood *pmem (Construction Permit Permission is hereby grante}to Cons- ct( )Repair( )U grade(✓Abandon( ) System located at 3 6 Q' !1' 1 YG Doi S�i��// Y� 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 co pleted ithin three.years of the`date of th ermit. PProv Date: A ed b / Y TOWN OF BARNSTABLE c- LOCATION 3(o S��ro� ���s SEWAGE # -2 VILLAGE OSI-����s ASSESSOR'S/ MAP & LOT W / INSTALLER'S NAME&PHONE NO. be/��e1�r� �•✓�� ��`�� 427-Y926 SEPTIC TANK CAPACITY LEACt•E1G FACILITY: (type) f-00 Ga 04gy (size) /0 NO.OF BEDROOMS 3 BUILDER O OWNER . / PERMITDATE: 4%2 p oy 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 ),Ua-j rapt g i i 31 I I L'0 C_A T ION Lo>rY� �/ S E W A G PERMIT NO. S A .� T A/ . �50) 7/3 _ VILLAGE Ile [ 2� -lq7 INSTA LLER'S NAME i ADDRESS 3 UILDE R OR OWNER Aos C, o/V DATE PERMIT ISSUED DATE COMPLIANCE ISSUED I •4 1' 13 alp o' Fms......3d............... \'a` .THE COMMONWEALTH.OF MASSACHUSETTS BOAR® OF HEALTH Application for BaupuuFal Works Tonutrurtion Vamit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual l Sewag? Disposal System at: �O�ec�.�fix .1Qr..Y:9_S'ff"..W.Q1Z.4A�t%4 11h i.CC 44.5.S:...... .................... ....f�.�._. ....... .....- Location-Address or Lot No MA55......................................•--........... ...................................................................--=............................ n Owner Address a �....1�.� ......... ..-•---.. - .... Installer Address UType of Building Size Lot..%F,�749.0..........Sq. feet .-� Dwelling—No. of Bedrooms....-3...................................Expansion Attic ( ) Garbage Grinder (4/4 Other—Type of Building ............. No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ---------------------------------------------------- -------•--------------- W Design Flow.................- ..................gallons per person per day. Total daily flow............ ,?. ?.....................gallons. WSeptic Tank—Liquid capacity/edo...gallons Length.B.".6 _.. Width..J..'_-d.... Diameter................ DepthY.-_.,C."! x Disposal Trench—No..................... Width ....... Total Length.....................Total leaching area._ ©......._sq. ft. Seepage P • r it No.....1............. Diameter..... ............. Depth below inlet... Total leaching area..................sq. ft. Z Other Distribution box (Ye4- Dosing tank (, cy l Percolation Test Results Performed by..__ . ,a�a�_S_..Ric.&h.M.AgXTC.&........... Date..e/.<hp.................... Test Pit No. 1(" .......minutes per inch Depth of Test Pit.................... Depth to ground water............. .------.._. 1-4 rl, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' ---•----•-----------------------s---•--...-•---•---------...------------------•-•----•--------•------------------------------------------...._.......--- - ••---- O Description of Soil........... /h,440.....Jai � x --------•------------ U -----------------------•--•---•....•-------..........------------------•----......---••----••--------•--•-••-----------•--•••----------•••--------•-•------------•-----•-._...------•--•--......._------ W -------------•-----•--•-----•---•--------------•-•----•-----------------•-•-• ..........................---.......................................................................................... 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 iI'112 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 .......v.1 .....1� _(JOA�_1n. ................ ............Date.:gD...------•-- ' l Application Approved BY ' =li�•.__. --------------- ------------•--•------- Date Application Disapproved for the following reasons--------------...................................................... ........................................... --....---•...................•-------•------........•------•••-------•--•---------....--------------...---•-•-•-•---------•----•----------------•--------....-----------------•--------------=-----•--- Date PermitNo.......................................................- Issued-..... ................................................ Date ,.• �� r O ee ... ,� FEB...... d....v..._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...•.......................................OF...........................----........"I................--._.................._....._.. Appliration for Disposal Works Tonstrnrtiun Prrmit Application is hereby made for a Permit to Construct () or epair ( ) an Individual Sewage Disposal System at: ..-•4or Y. _ SffR......._ ............. l :t ...v�.:r:. .. '' - ��...- ..__.1...r...................................................... �f••Lo=ation-Address or Lot No. S 't 6Cv5 sq Mo 2n?Z S . _ --------------••-------•------ ......... Owner Address Installer Address _ Type of Building Size Lot_S.m_:. c)..........Sq. feet Dwelling—No. of Bedrooms.... ...................................Expansion Attic ( ) Garbage Grinder Wc) aa Other—T ype of Building __:> �f_____________ No. of persons-........................... Showers ( ) — Cafeteria ( ) Otherfixtures .----------••-• •-•-•-••-•••...............•-•-••-•--------••••••••-•---•--•--••---•-------•-•••-•-••-•-...--•-•-•...........-•-•-•...._......._.... W Design Flow.................. __.. ...............gallons per person per day. Total daily flow............. ?.f}....................gallons. WSeptic Tank—Liquid capacity V.9.12...gallons Length._E_ r..... Diameter---------------- Depth X`_,._.:.. x Disposal Trench—. No..................... Width.................... Total Length.................... Total leaching area... -G........sq. ft. Seepage Pit No...... ............. Diameter......... Depth below inlet.•-............. Total leaching area..................sq. ft. Z Other Distribution box Dosing tank (A,14 / aPercolation Test Results Performed by....A__�.: t<_ _._ '4'!c�% _/'P /a r . ............ Date_...D_l _-.................... 1.4 Test Pit No. 1! .__----_-__minutes per inch Depth of Test Pit.................... Depth to-ground water........................ 4q Test Pit No. 2................minutes per inch Depth of Test Pit---------'.......... Depth to ground water........................ a ..............................-.....................................................................................•••--•-••••....-•••-------•••-•--........ ODescription of Soil......................A40....:.�_Iki?..-•----••----------------•.---------------------•--------------.........._..----•-•--•-----------•-•-•---....._.. x W ----------------------------------•------------------------------------------------ --•--------------------------------------------------------------------•-----••-•-•-------••----••-•-••-•••--•--••. V 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 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........_S `...._1 .1Ld-t._ l SA.XaL. ................ f "9"PB Z Date Application Approved By...... /-•L njOO s.'p._........ Date Application Disapproved for the following reasons---------------••-----------------•----------------------------•------------------............................ -•.............................••....-•-----••-•••-•-•---••••----•-••-•••...-••-••---------•--------------••----------•-•--•--•- ...................................................................... Date PermitNo......................................................... Issued......"�...........................�? -------.. Date THE COMMONWEALTH OF MASSACHUSETTS 1 BOARD OF HEALTH ......� ................OF........ i!S?!2/v:. ✓i4. � ..........................•• (Irdif iratr of Tnntpliaurr THIS IS O CERTIFY That the Individual Sewage Disposal System constructed (� or Repaired ( ) by----------------�� `. RTIFo'.�s ..............................--------------------- nstaller at ...�0.I ......I............... 1 a.�....------P ! �.....-A...-•----.--------------------------------------.......---------------•--- M_. r has been installed in accordance with the provisions of TIT .1r of The State Sanitary Code as descrik) fi in the application for Disposal Works Construction Permit N & ..._.11................. dated_,/. _`...?__d..........._.�......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............... FEE...I ek........... Disposal Vorks Cavlttsirnrtuan Prrmit Permissio ereby granted........ � ----------------------•---........................................................ to Construct or R`;P 'r ( ) an I dividuaI Sewag Di osal System Street as shown on the application for Disposal Works Constructio it No..................... Dated-J...................................... 4---- � -�----•---------------------- Board ofokreaffh DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS •QO GAtzaAzaE vb Rl Qta Yaa t Lam{ t -4 S yr` - SE-.PT't G TAtt K = 330,i (S O % • 4-9 r7 6- .P.D. U Ste- l OOC::, POSAt.. ;,PiT - usa= loco t, b� � r SUPWA.LL AZE.A = (5o -.-P. e;o sp-. TOTAL VpE-Sl6W = 425 G.P.D. I 4- TW N -roTAL b,4t L�-f F=Low Y, PMr-OL.4TlOQ Q hTE : ( r tU 'Lht l►J OtZ L>=.SAS. Pao by t ►, �.<��.r— "�^E,a3y�(/�A .. p tc 'ARD 1/ f a 1 r V9y`- y .� S � fW U 44i111 j, I 4 k - 1 5) s t:f BATF-R ln� • i i e AG.2 2•. 4Q � '� ,o � OO-ov Tor F'wo z-4'7 esT / 4- �o Ah1 "ape tuv• ell„ 'Box 414 SePnc i 2'I z_ wv. Tc�1 K 10 • 41.4 LtAcN , P' p . t ^�ff Win.l °I WASNED STOWE- PLOT _ r L OCAT1 O tJ r I 3 li I u oATEV- - Ql-v• IZ 14 E30 1 G6lZTIF%41 TWA-r TOG- �Ov►t>A-no#4 SUaww Pit-A1.1 lRL-FCczEV.1CG t-3�Zt=aW GO��L�Is �/1TK TNT 51D�..�.c►�E � -AND SETQACK t'C-QUIIZeAA&.► T,; OFT14r_ LOT s9 DATE - . ctcr;(S•rcrz�.D t-�Na 5vevcYotzs' TI-11,S VLAW IS UOT 25AyEL7 OtJ p�4.1 OS.'TUZV%LLr- o MASSY It.lst-eva�c�JT �yvk:��CY � TNC:, vFt-;��-ram. 51•icw�l.a Al�n�(c_n,r� r o- -ro nr=.rceMta& ►.O'r Co 12v5 �U�iT-'• TOP FNDN EL. 49.3' SYSTEM EM PROFILE M TEST HOLE LOGS ACCESS COVER TO WITHIN 6' OF FIN. GRADE (NOT TO SCALE) ACCESS COVER (WATERTIGHT) TO ENGINEER: BAXTER AND NYE WITHIN 6' OF FIN. GRADE BARNSTABLE HEALTH DEPT. ,. MINIMUM ,75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER; SYSTEM 44 0' WITNESS, 7. 42.2' RUN PIPE LEVEL 2' DOUBLE WASHED,PEAS TONE DATE` 8/1/79 ) y FOR FIRST 2' PERC• RATE - < 2 MIU ZI .CH EXISTING 1000 �. GALLON SEPTIC 40.8't" /// 41 0' CLASS I SOILS P# cnausis s TANK (H- 10 ) GAS coo �40,33'RE-USE BAFFL 40.50t� G� CD 0 M M [ZI CO [ ELEV. �4 ,o 40.16' E] m71m m mQC� m o v SyrQ, o 0 6' CRUSHED STONE OR MECHANICAL m m m M 0 m E1 0 0 COMPACTION• (15.221 121) 2' ,10 0 0 0 0 0 17-1 00 DEPTH OF FLOW = 4' MIN LOAM & Locus TEE SIZES (-1 -% SLOPE) 3/4 TO 1 112 DOUBLE WASHED STONE INLET DEPTH = 10 ( ii SLOPE) SUBSOIL *CONFIRM OUTLET INVERT PRIOR OUTLET DEPTH = 14' TO INSTALLING ANY PORTION OF 30" 42.5' LOCATION MAP NOT TO SCALE SYSTEM EXIST F LEACHING ASSESSORS MAP 122 PARCEL 149FOUNDATION-FOUNDATION- . SEPTIC TANK 16' D' BOX 19� FACILITY 5.16' MED. SAND �h 46.82 /.p 6s8 33.0' a 45.8)3 144" 33.0' + 46•5 APPROXIMATED FROM QUAD 45.09 48\ SEPTIC DESIGN1 (GARBAGE DISPOSER IS NOT ALLOWED ) 1. DATUM IS / 2• MUNICIPAL WATER IS EXISTING �a3, 2 ; � � , DESIGN FLOWS 3 BEDROOMS ( 110 GPO) = 330 GPD S, MINIMUM PIPE PITCH TO BE 1/8' PER F'00T. ` � USE A 330 GPD DESIGN FLOW / 4s.51 4. DESIGN LOADING FOR ALL PRECA T UNITS TP PFv AASH❑ H- 10, TH W SEPTIC TANK; 330 GPD ( 27 = 660 5, PIPE JOINTS TO BE." MADE WA LLtf 1 IUM I. // �► 48 '�?4 USA A 1000 GALLON SEPTIC TANK (EXIST) 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS, ENVIRONMENTAL CODE TITLE V. / cy LEACHING 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE LOT 49 EXISTING + 51.29 SIDES: 2(30 + 9.83) 2 (,74) = 118 USED FOR LOT LINE STAKING. / 15,000 SQ. F DWELLING BOTTOM 30 " 9.83 (•74� - 218 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4' PVC. TF 49.3' �� 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT 41,43 46.96 + 50.2 s TOTAL: 454 S.F. 336 GPD INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED 4a•69 PECK USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR FROM BOARD OF HEALTH. a EQUAL) WITH 2,5' AT SIDES, 4' AT ENDS, AND 5' 10, PUMP & REMOVE (OR FILL WITH SAND) FAILED LEACH PIT sr� 4 48.1s cr BETWEEN UNITS 11. THE INSTALLER SHALL VERIFY THE LOCATIONS • 0 + 52.40 OF ALL UTILITIES AND ALL BUILDING SEWER sr OUTLETS AND ELEVATIONS PRIOR TO INSTALLING a4.06 S GARDEN, ANY PORTION OF SEPTIC SYSTEM 4?, O �©• . 8 � t N N D TITLE 5 SITE PLAN A 4" RUC + 48.07 100.0 PROPOSED SPOT ELEVATION OF 'so 4 a 7° �s 36 SHARON CIRCLE . � p0, 140x0 EXISTING SPOT ELEVATION IN THE TOWN OF: + 43.0 10" OAK p� A0 PROPOSED CONTOUR ( OSTERVILLE) B A R N S T A B L E 0 ,gyp ,gyp + 50.31 100 EXISTING CONTOUR PREPARED FOR: BORTOLOTTI + 45 �h CONSTRUCTION/COPPLESTONE 20 0 20 40 60 BOARD OF HEALTH APPROVED DATE MA SCALE: 1" r 20' DATE: AUGUST 21, 2002 d, off 508-362-4541 fax 508 362-9880 + 46.30 �tN Of M Eq,"1H Of ,yA down cape engineering, Inc, ��a ARNE �� �F4 AfiNE H. �yG Z H. `r OJALA CIVIL ENGINEERS OJALA CIVILti Qr N 26348 v°�Q .o N 30 n: BENCH MARK' - TOP OF CONCRETE BND. LAND SURVEYORS I ELEVATION = -41�.6' TE 02-254 939 vain st. yarmouth, rya 02675 A H. 0JALA, .L.S. .DATE