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HomeMy WebLinkAbout0029 SOUTH STREET - Health E29South Street, Osterville A 67� f 0 0 B A 1 i 4 r No. "C Fee I THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes �� �Mffistruct hration for Bispo4AY 6pste tt Construction 3permit Aolication fora 4Per ( ) Repair k Upgrade( ) Abandon( ) ❑Complete System individual Components \\� Location Address or Lot No. A9 /S- TeEvT Owner's Name,Address,and Tel.No. 05 (j3aL-ree -13ct.C"CQt_ Assessor's Map/Parcel ( xfa Sift Installer's N e,Address,and T o. o. �_ Designer's Name,Address,and Tel.No. 5D6-��jy- �s1eH� 0 r 5 4i?� ` Aft a fly CE A cY�fa� Type of Building: Dwelling No.of Bedrooms 3 Lot Size 1C�,?>S 0 sq.ft. Garbage Grinder(141p, Other Type of Building l PI No.of Persons 3 Showers(&,<C afeteria( Other Fixtures Design Flow(min.required) 3 ,,+2 0 gpd Design flow provided q �A5 gpd Plan Date I � �Number of sheets a, Revisio ate Title t� Size of Septic Tank ppp G G\ Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the const ction n nce of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the viro tali ode nd not to place the system in operation until a Certificate of Compliance has been issued by this Board of ealth. , Date $Application Approved by ff Date ?j ��- lr; Application Disapproved by Date for the following reasons Permit No. Date Issued 3 " ol ` No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF .BARNSTABLE, MASSACHUSETTS Yes q�'Rp lication for MispoSal 6pstrm (Construction Permit Application fora Perm to Construct( ). Repair(X Upgrade( ) Abandon( ) ElComplete System Xndividual Components Location Address or Lot No. aq S6Y_1" fSTe ET Owner's Name,Address,and Tel.No. \ C5 UaLTEe 1aF_Lr_+\Q. Assessor's Map/Parcel a JGicn.e ,i • Installer's N e,Address,and Te. o. �''a44-�y�(S Designer's Name,Address,and Tel.No. ,' •ntQy-�� a_NM" �' CAQ,,C,� se-wo(l () I S o MR5+QX -+-At " , Ua fiS HP A 024.4 Type of Building: Dwelling No.of Bedrooms , Lot Size fl,3 5 a sq.ft. Garbage Grinder Other Type of Building �� No.of Persons. 3 Showers(VIrcafeteria Other Fixtures 7 Design Flow(min.required) �j gpd Design flow provided L r Pi gpd Plan Date I;Ly I Ito o Number of sheets Revisio ate Title -G�c� C� P +CStY� Size of Septic Tank ppU G C0 Type of S.A.S. L C -G C c`5 5_7 Description of Soil �o p\� X O�X�2 4 V Nature of Repairs or Alterations(Answer when applicable) \ Date last inspected: Agreement: The undersigned agrees to ensure the construction an aint Hance of the afore described on-site sewage-disposal system in accordance with the provisions of Title 5 of the viro tal ode nd not to place the system in operation until a Certificate of Compliance has been issued by this Board of ealth. Date r-� �5 Application Approved by Date 3 Application Disapproved by Date ' for the following reasons Permit No. Date Issued 3 -------------------------------------------------------------------------------------------------------------------------------,=------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIF ,that the On-site Sewage Disposal system Constructed( ) Repaired�) Upgraded( ) Abandoned( )by �V_VA F,,\ :�MqY at pZ Ll _ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. cg 611 ! dated 3 Installer �� n S Designer S #bedrooms 3 Approved design flovj 3 gpd The issuance of his permit shall not be construed as a guarantee that the system wi funct�ol�lnj as designed. Date �/� Inspector /t. ______________________________________________________ .Ji No. adt(0 ` V U� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction permit Permission is hereby granted to Construct( ) Repair( ) Upgrade(A Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be corn leted within three years of the date of this permit. \ Date — Approved by / Town of Barnstable Regulatory'Services .� Richard V. Scah, Interim Director • sABNSTABM M` Public Health Division Thomas McKean, Director k 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form a , Date: 1[,p Sewage Permit# Assessor's Map Designer: \Parcel-U 70 F _ Installer: c, .- Address: ,o c t !S73:si� Address: On was{issued a permit to install a (date) c (installer based on a design drawn by septic system at o��1 (address) dated (designer) _ I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. F _ ^ k .• I certify that the 'septic system referenced above was installed with major changes (i.e: greater than 10' lateral relocation of the SAS or any vertical relocation of any component' { of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found'satisfactory. I certify th he,system referenced above was constructed in compliance.with the terms oft p 1 letters.(if applicable) (In gn ' E ( e gner's Signature) (Affix Des ner�s S"tarsi"Here p ) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS' - BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8=14-13.doc , a -. } Town of Barnstable r# Department of Regulatory Services i F Public Health Division Date MASS. telA 200 Main Street,Hyannis MA 02601 • rf0 Mid� 7CI ( n ti Date Scheduled 2' Time • ( I a Fee Pd. ~ f Gi F C OK Soil Suitability Assessment for Sel ge Disposal W. Performed By: Witnessed By: ..V u`. I 5 �11✓� AC'J LOCATION&.GENERAL INFORMATION Location Address Owner's Name Lic M-c-i(A v Address —SCl+M2 Assessor's Map/Parcel: ` I �1 Engineer's Name NBW CONSTRUCTION 11,q BPAIIt �^ n ( Telephone# J !7 1 Land Use. Res i�2i1�=td\ Slopes(96)_ a& Surface Stones - Distances from: 'Open Water Body__ IJTft possible Wet Area AA—ft Drinking Water Well 4 P—$ Dmlhage Way ft Property Line l 5• ft Other PJ I P, ft SKETCH:(Street name,dimensions of lot,exact locations of teat holes&Pere tests,locate wetlands in proximity, to holes) i i Parent material(geologic) t1TW AS U4. Depth to Bedrock I P' z Depth to Groundwater. Standing Water in Hole:_►J009— O V)S Weeping from Pit FOCa Estimated Seasonal High Oroundwater DETERMINATION FOR SEASONALMIGH WATER TABLE. Method Used: A<_M<1,C6X Cb&__WCA+a^1 Depth Observed standing in obs,hole: In, Depth to Sall mottles: lu,' De{lth to weeping from aide of obs,hula: In, .Groundwater AdjuNtmant fY. Index Weil• Roading Datc: Index Well level Adj4actdr ^ Adj.Croundwater•Levol., T PERCOLATION-TEST —Dore 'i'ltnm.�:, Observation Hole# - Time at 9" lffB tt lQh ,l Depth of Pero _ Time at 6" Start Pre-soak Time @ '05 Time(9"•6") End Pro-soak — Rate Min./Inch Site Suitability Assessment: Site Passed . _ SlIr Failed: Additional Testing Needed(YIN) At Original: Public Health Division Observation Hole Data To Be Completed on Back--- - ***If percolation test is to be conducted within 100' of wetland,you must first notify the, Barnstable Conservation Division at least one(1) week prior to beginning. Q:ISBPTIC IIRCFORM.DOC wry,: DEEP.OBSERVATION HOLE LOG Hole'# Depth from Soil Horizon Soil Texture Shcl Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones,,Boulders. • , �slstency.96't3ravell 0 _as '.A as - 3 S'L ��2 GIB DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color ; _ Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. 3 f3 A ' 14 Ak 9L 1415 `)t" S L 1 .i Q 5/,� amiable A8 - Ct DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Stmatura,Stones,Boulders., Con3intanoy. DEEP OBSERVATION-HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color mall Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders, Flood Insurance Rate Map: / Above 500 year flood boundary No— Yes WILWn 500 year boundary No 1� Yes Within 100 year flood boundary No. Yes Depth of Naturally occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed thrpughout the area proposed for the soil absorption system? ye.S If not,what is the depth of naturally occurring pervious material? .. Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental P e ion and that the above analysis was performed by me consistent with . the required trainin xp s n ex erience described in�10 CIVM 15.017. Signature Darts _` Q:WEPTIC\PBRCPORM.DOC co0 COMMONWEALTI-I OF MASSACHUSETTS r EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAI - DEPARTMENT OF ENVIRONMENTAL PRO S r 9� ONE WINTER STREET. UOS•rON. NIA 02108 617-292-. co 4 eZ2 WILLIAM F.WELD �1 Y COXE Governor in l0 4,r 1,99,� Secretary ARGEO PAUL CELLUCCI - yTHO pjTgB[E ~ . Lt.Governor D STRUHSSUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F ommissioner PART A 29 South St. CERTIFICATION ti Property Address: Osterville r IIA Address of Owner: 102 1Ic'�seltlrie St. Date of Inspection: August 2, 1997_ (If different) Haverhill,02Base 1►e Q1i�30 Name of Inspector: Gary and/or Janc 13. Rabesa am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: Warren Cesspool Service Mailing Address: 72 Sandwich Road East Falmouth,MA 02536 Telephone Number: 508-540-7143 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: X Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: 401k_ Date: August 9, 1997 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: This does not certify that the system is adequate for A] SYSTEM PASSES: YES the current use nor the future use of the system. It only certifies conditions on the day of inspection. X I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: __ Title V system in good working order. BI SYSTEM CONDITIONALLY PASSES: NO One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The s stem, upon Y completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic'tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 Warren Cesspool Service Gary Rabesa Owner-Operalor, t Sandwich Road OR� East Falmouth,MA 02536 (C SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) ' Property Address: 29 South St. , Osterville , .MA Owner: • Nordo NiSSi Date of Inspection: August2, 1997 B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than foui times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: O Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT 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 to 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 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 Warren CesspoolOwner-Operator Service Gary Rahesa Owner-Operator OA 72 Sandwich Road East FalmouUt,MA 02536 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 29 South St. , Osterville, MA Owner: NOrdo NiSSi Date of Inspection: August 2, 1997 D] SYSTEM FAILS: NO You must indicate ei:!.er "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined 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 X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. _..)r Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a"surface water supply. _�L Any portion of a cesspool or privy is within"a Zone I of a public well. _y_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ,X• 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: N/A , You must indicate either "Yes" or "No" as 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 god 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 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) The owner or,operaior of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 31-4 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10' Warren Cesspool Service Gary Itabcsa Owner-Operator COPY 72 Sandwich(load East Falinoulli,BM 02536 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Properly Address: 29 South St. , Osterville , MA owner: Nordo Nissi Date of Inspection: August 2, 1997 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No X _ Pumping information was provided by the owner, occupant, or Board of Health. X _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that periotk. Large volumes of water have not been introduced into the system recently or as part of this inspection. ftnoccupied for two weeks / weekend use — n/a— As built plans have been obtained and examined. Note if they are not available with N/A. X _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. X_ _ The site was inspected for signs of breakout. �C— All system components, excluding the Soil Absorption System, have been located on the site. X _ 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. 71 _ The facility owner (and occupants, if different from owner).were provided with information on the proper maintenance c Sub-Surface Disposal System. The size and location of the Soil Absorption System on the site has been determined based on: JC Existing information. Ex. 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) (15.302(3)(b)) (revised 04/25/97) Page 4 of 10 i Warren Cesspool Service Gary Rabesa Owner-Operator tJ 72 Sandwich Road East Falmouth,MA 02536 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 29 South St . , Osterville , MA Owner: Nordo Nissi Date of Inspection: August 2, 1997 .FLOW CONDITIONS RESIDENTIAL: Design flow: -- g.,P.d./bedroom for S.A.S. No engineered plan available. Number of bedrooms: 4 Number of current residents: 5 when last occupied Garbage grinder (yes or no):no Laundry connected to system (yes or no):ye s Seasonal use (yes or no):__�MS Water meter readings, if available (last two (2) year usage (gpd):111,000 gallons in 1995 Sump Pump (yes or no): no 89,000 gallons in 1996 Last date of occupancy: 7f 20/97 COMMERCIAUINDUSTRIAL• NO Type of establishment: Design flow: gallons/day 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)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of i f rm tion: `Wo known pumpings. System pumped as part of inspection: (yes or no) no If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy no Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contracts' Other AP ROXIMATE GE o al1 co one is ate ns Iled (if nown) and sourc of information: owner- 9 yrs old. barnstab�e Voarc? o� ea�ti had no records on file . Sewage odors detected when arriving at the site: (yes or no) 1 O (revised 04/25/97) Page 5 of 10 Warren Cesspool Service 0 G Gary Rabesa Owner-Operator 72 Sandwich Road East Falmouth,MA 02536 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 29 South St. , Oster Ville , MA Owner: Nordo Nissi Date of Inspection: August 2, 1997 BUILDING SEWER: YES (Locate on site plan) Depth below grade: 36TT Material of construction: _cast iron X 40 PVC _ other (explain) Distance from �rivate water supply well orsuction line over 201 Diameter 4' Comments: (condition of joints, venting, evidence of leakage, etc.) good condition SEPTIC TANK: x (locate on site plan) Depth below grade: 1611 — lO r1 Material of construction: X concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: standard 1,000 gallon tank Sludge depth: 611 Distance from top of sludge to bottom of outlet tee or baffler Scum thickness: t3 t Distance from top of scum to top of outlet tee or baffle: r� Distance from bottom of scum to bottom of outlet tee or baffle: rt How dimensions were determined: measured onsite 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.) Appears to be in good condition. DEP recommends pumping every 3 years, GREASE TRAP: 0 (locate on site plan) Depth below grade: Material of construction: 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: 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.) (revised 04/25/97) Page 6 of 10 Warren Cesspool Service G Gary Rabesa Owner-Operator ��JJ 72 Sandwich Road East Faimoutlt,MA 02536 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 29 South St. , Osterville , 14A Owner: Nordo Nissi Date of Inspection: August 2, 1997 TIGHT OR HOLDING TANK: N0 (Tank must be pumped prior to, or 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/day Alarm level: Alarm in working order _ Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:X (locate on site plan) Depth of liquid level above outlet invert: Rolle Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) . No failure signs. Cover 221' below grade . PUMP CHAMBER:NO (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) ' Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 Warren Cesspool Service Gary Rabesa Owner-Operator /o 72 Sandwich Road `J East Falmouth,MA 02536 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 41 SYSTEM INFORMATION (continued) Property Address: 29 South St.', Osterville, IAA Owner: Nordo Nissl Date of Inspection: August 2, 1997 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type. leaching pits, number: leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note cbbnclition ofdoil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) by recast in very good condition. Only 611 1iqiij (j in it. Cover 10" below CESSPOOLS: NO (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 (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:KO (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.) (reviaad 04/25/97) Page a of 10 0 Warren Cesspool Service Gary Rabesa Owner-Operator 72Sandwl Road } East PalmouUi,MA 02536 U SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 29 South St . , Osterville , MA Owner: Nordo Nissi Date of Inspection: August 2, 1997 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) NOT TO SCALE tjLk.r S¢we� 38 ' 3a•�� 566• (revised 04/25/97) Page 9 of 10 Warren Cesspool Service Gary Rabesa Owner-Operator . 72 Sandwich Road East Falmouth,MA 02536 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 29 South St. , Osterville , MA Owner: NOrdO1SS1 Date of Inspection: August 2, 1997 Depth to GroundwaterNGW Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record. X Observation of Site (Abutting property, observation hole, basement sump etc. X Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) Area topography. USGS maps indicate an elevation over 40'MSL (revised 04/25/97) Page 10 of 10 TOWN OF`B,ARNSTABLE LOCATION cs. bO'rN Jt SEWAGE# Q oy(',= 0� ` VILLAGE ASSESSOR'S MAP&PARCEL )/7—07D INSTALLER'S NAME&PHONE NO. ( � - SEPTIC TANK CAPACITY \106c� Ca� LEACHING FACILITY: (type) LC-Ce (f /S-6�size) 12 `X Li f)' X'Q 1 NO.OF BEDROOMS k5 tc-, OWNER C5WY*r is PERMIT DATE: 3 f, S f (� 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) N Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 11 300 feet of leaching facili N I Feet FURNISHED BY SOUS, 2 �eL'.,C 6 �sil�Fr "T'w 3a T°� 3s- 67- L0CATION � SEWAGE PERMIT NO. LOT / :3 SO cJ T/-/ VILLAGE OST�h'V/GCE'' I N S T A LLER'S NAME i. AD-DRESS C L AM P/ e-Wt-L-DfR OR 0 W N ER G N o 4 �S DATE PERMIT ISSUED DATE COMPLIANCE ISSUED r 1 ,- . PT art - 98 9�� S 39D 34' >9 E _�9 g GENERAL NOTES C� - _ 9 1. Contractor is responsible for Digsafe notification, Verification of Utilities , FAILED and protection of all underground utilities and pipes. VEW�- 9 0.00 2. The septic„tank a distri ution box shall be set LEACH PIT PIPE level on 6 of 374'-1 1/2" stone. 8' 14ELEV.= 22' 3. Backfill should be clean sand or gravel with no '�e,w s' \ r e. • stones over 3" in size. LIE 0 O O 0 I 4. This system is subject to inspection during installation O A ' by Carmen E. Shay — Environmental Services, Inc. 5. The contractor shall install this system in accordance TE T HOLE #2 EXIST. al. 0TEST HOLE #1 with Title V of the Massachusetts state code, the approved plan g 99.00 and Local Regulations. + ELEV.= 99.00 Septic Tank 06. If, during installation the contractor encounters any 1 IF \ 2 soil conditions or site conditions that are different C from those shown on the soil log or in our design installation must halt & immediate notification be DECK made to Carmen E. Shay — Environmental Services, Inc. Ilk7. No vehicle or heavy machinery shall drive over the septic system unless noted as H-20 septic components. w iq 8. Install Tuf—Tite gas baffles or equals on all outlet tee ends. EXISTING cz CV 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. 3 BEDROOM q 10. All solid piping, tees & fittings shall be 4" diameter ko p nt C HOUSE w tc�j Schedule 40 NSF PVC pipes with water tight joints. AANDEATONSN full foundation 11. Municipal Water is Connected to ALL OF The Residence and Abutting AND EATON . w I #29 Properties Within 150 Feet. D THE PROPERTY LINES ARE APPROXIMATE AND COMPILED FROM THE SURVEY PLAN BAXTER & NYE. PROJECT BENCH MARK I ENTITLED: "CERTIFIED PLOT PLAN OF 29 SOUTH STREET, OSTERVILLE, MA" Y tr DATED JANUARY 12, 1982 TOP OF FOUNDATION GARAGE w AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN ELEV. = 100.00 (ASSUMED) cn o IT SHOULD BE USED FOR NO PURPOSE OTHER THAN THE SEPTIC SYSTEM INSTALLATION. M. EXISTING SAS TO BE PUMPED OUT AND FILLED IN PLACE NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE LOT #24 FROM THE EXISTING SAS TO BE DISPOSED / OF AS PER BOARD OF HEALTH SPECIFICATIONS. 10,350 Square Feet +/— r, T 99 — —t ASPHALT / 90.00' ( DRIVEWAY PLOT PLAN N MD :34' 19" w J OF PROPOSED SEPTIC SYSTEM UPGRADE PREPARED FOR ,570 LT7' WALTER BELCHER FirstF-�OOI SE'COI'1C� °��OOY' (40 FOOT RIGHT OF WAY) AT 29 SOUTH STREET- Kitchen ASSESSORS MAP 117 LOT 70 Dining Bath OSTERVI LLE MA Bath Office Bedroom < PREPARED BY: Bedroom ` 4 r: C1,2 RIVEN E. SHAY Living Room o c vi;- I Bedrooms Y,_? ENVIRONMENTAL SERVICES to �' � ` P.O. Box 1576 r, GARAGE 0 20 40 50 �a�� 1`"�+ MASHPEE, MA 02649 TEL/FAX : 508-294-7498 SCALE: 1 "=20' DRAWN BY: CES DATE: MARCH 24, 2016 DESCRIPTION BY OWNER' SCALE: 1 "=20' PROJECT#29 South St. FILENAME:29 SouthSt.DWG SHEET 1 OF 2 C�► VENT PIPE (o Least 24 inches tall) 10' min. from *NOTE: ALL PIPES ARE TO BE 4- SCHEDULE 40 P.V.C. Schedule 40 PVC w/Charcoal Odor Filter SECTION A -A EXISTING Foundation house to septic tank wSAS cover rof GRADE Septic tank covers must be D-BOX cover must must have riser and be PROFILE VIEW OF LEACHING SYSTEM f within a in. of finished grade within 6 in. of finished grade , )r Grade over Septic Tank - 99.00 Grade over D-Box'- 99.00 ---C'r de over SAS- 99.00 /e"a r r/e waa,.a C►vAed sae. •N r/s•- r/a• ra•Aed Peeetau NSPE S Q 0.02 Tee to be placed in dbox 3 HOLE H-10 Iwthin 60 n.cof finished grade DIST. BOX TOP OF SAS — 85.50 5=0.01 A. EXIST, PIPE C 15r • EXIST. 1,0D0 GA FROM FOUNDATION n ^ SEPTIC TANK 8 N 20' �eei•� C3 C7 CM Q C3 C7 C7 Blum rn H-10 N o o both•J oM,M.r yw.r.an.aw.r C3 C3 C3 C3 C3 o c118111188111 u7 ui C3 C3 _ O Q C7 j Q CONCRETE FULL FOUNDATio °) II II II IILd SYSTEM PROFILE °d A ri 5' PF OVIDED 7 Units 6 ' 42' Not to Scale c S 2.5 8 in.of 3/4"-1 1/2" c -@ o NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE compacted stone - Effective Width 8' ✓ Effective Length a m - Bottom of Test Hole 1 Elev.= 88.00 SOIL ABSORPTION SYSTEM <SAS) LC-6 H-20 LEACHING UNITS / WIGGINS PRECAST Not to Scale 2-1 B" DIAM. ACCESS MANHOLES P E R C O LAT I O N TEST 8' OAS IB�ONPBOX MALL EIPES FROM E SET LEVEL FOR AT LEAST 2 FT. ACXJTLET .I.. 2" CONCRETE COVER :�'' "' ''-- y— —• ` Date of Percolation Test: MARCH 23, 2016 _ 3 - 5- r' : .1.� 2 Test Performed By: CARMEN E. SHAY, R.S., C.S.E. / KNOCKOResults Witnessed By.DAVID STANTON (BARNSTABLE BOH) - ` _ 5.5• INLETEXCAVATOR: CARMEN SHAY / -ou TPercolation Rate: Less Than 2 MPI ® 48" ` Jfl JINN ` 15.5•'..r 4- - SCH, 40 Te ,7s 41 ° THE ACCESS COVERS FOR THE SEPTIC TANK, Test Hole Test Hole DISTRIBUTION BOX AND LEACHING COMPONENT No. 1 No. 2 PLAN SECTION CROSS—SECTION , SET DEEPER THAN 6 INCHES BELOW FINISHED - , » GRADE ALL BE RAISED TO WITHIN 6' of DEPTH SOILS EL STEEL REINFORCED PRECAST CONCRETE SHED 0 ssEV.ELEV. DEPTH SOILS ELEV,o ss.00 3 HOLE H ' 10 DISTRIBUTION BOX PLAN VIEW INSTALL TUF—TITE GAS BAFFLES OR EQUALS 3-2e REMOVABLE COVERS FILL FILL tl 0"— 16" 97.67 0"— 16" . :... 4. 97.67 PLOT P LAN Sand 3 min clearance Y Sandy 8" mtn.T_l2° min. Inlet to outlet s'min. 13° INLET' % Loam Loam - --- Llq"'d 'eve' °fT - '° '� 3'2 '° '� 3'2 OF PROPOSED SEPTIC SYSTEM UPGRADE 10"mn. µ• s —7" .,� ---- �$ L-- •.� s' -'T- Sandy 16"- 22 Sandy 97.17 PREPARED FOR + E 5 " 4'-0" min. Loam v an e•A• " liquid depth Loam e 10 YR 5/8 00 10 YR 5/8 WALTER BELCHER _ 95 22" �.. � 95.00 : ..:.;.... Med. and 29 SOUTH - STREET AT 8'-0" a' -tD" -Sand Sand , CROSS SECTION END—SECTION 2.5 Y 7/4 88.00 2.5 Y 7/4 as"- 132 -_ 132 �� 88.00 ASSESSORS MAP 117 LOT 70 TYPICAL 1000 GALLON SEPTIC TANK OSTERVILLE MA Number of Bedrooms: 3 Equivalent to 330 Gal. Day 330 Gal. Day per Title V) A A,. Design Calculations Garbage Grinder: No LeachingCapacity y Proposed: 330 Gal. Da Minimum Min. Per Title V t% \ PREPARED BY: Septic Tank P - 2 x330 Gal./Day = 60 USE EXIST. 1.000 GAL. Septic Tank. hG ;� Perc #1 SHA Y L'NVIRONMENTAL SER VICES' SOIL ABSORPTION AREA: Usingpercolation rate of <2 min./inch �� 11 P .Depth to Perc:48 to 66 Bottom Area: 0.74 gal/day/sq. ft. x 384 sq. ft. = 284.16 gallons/day Perc Rate= 2 MPI ASSUMED Sidewall Area: 0.74gal./day/sq. ft. x 224 s ft. = 165.76 Groundwater Not Observed r _ q• gallon/day P.O. Box 1576 I� Providing: =449.92 allons da No Observed ESHWT ® 132' g / y ADJUSTED H2O Elev. = None ® 132 \,�, ,vlr�t�� MASHPEE, MA 02649 Use: (7) LC-6 H-20 CONCRETE CHAMBERS, HAVING A 1' EFFECTIVE DEPTH, TEL/FAX 508-294-7498 (3' W x 6' L) TO BE USED WITH 2.5' OF WASHED STONE ON THE SIDES AND l SCALE: 1 "=20' DRAWN BY: CES DATE: MARCH° 24, '201 6 3' OF WASHED STONE ON THE ENDS AND 1 FOOT OF STONE UNDER ENTIRE SAS PROJECT#29 South St. FILENAME:29 SouthSt.DWG SHEET 2 OF 2