HomeMy WebLinkAbout0399 STARBOARD LANE - Health 399 Starbbard Lane
Osterville
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�---TOWN OF BAIRNSTABLE
L 'CATION 301 SW609irJ /� SEWAGE # 019—
V'IL I.AGE OS`T�rv,��l ASSESSOR'S MAP & LOT i(.'7 0,S
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INSTALLER'S NAME&PHONE NO..
SEPTIC TANK CAPACITY /Sao
LEACI-IING FACILITY: (type) �• �I�I (size)010"x 30 x is
NO.OF BEDROOMS
BUILDER OR OWNER Q CC.0
PERMIT DATE: 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 leac',ng facility) J Feet
Furnished by l�SQtU►On T ForG
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TOWN OF BARNSTABLE
LOCATIO '+Ar bko ct r J bu SEWAGE#
VILLAGE �t �+ e 05'feV0)1JC ASSESSOR'S MAP aGLO
IfiSTALLER'S NAME&PHONE I ko-7-Unta
SEPTIC TANK CAPACITY -lAiO L 6,4 L
LEACHING FACILITY: (type) !r .r --.D (size) Vic;` /.;3''
:10- :OF BEDROOMS 414
IIII,DE) OR OWNER 4e
P RMTTDATE: i.3 `� COMPLIANCE DATE1,1111M
Separation Distan a 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 byx':`
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S—WZ ? Fe./ V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01ppricatiou for Mi5pogar 6pgtem Cow6truction Permit
Y Application for a Permit to Construct V<Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Locatio Address or Lot No. wner's Name,Address and Tel.No.
52�. 1--"l = B.S�eae�
Assessor's Ma /Parc (92 « ,00-a VW
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Installer's Name,Address,and Tel,No. ( Designer's Name,Address and Tel.No.
0,15 e ve CIS f
Type of Building:
Dwelling No.of Bedrooms Lot Size f+c-'LL sq. ft. Gark )
Other Type of Building ku^ta4^ g_ . No. of Persons Showers(LooJ eafetetir't—)
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets .2 Revision Date
Title —S"-IC &� `
Size of Septic Tank (_,�'60 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 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 by this B9ajd Health.
Signed Date 7_ 9
Application Approved by Date `—
Application Disapproved for the following reasons
Permit No. Date Issued "���
�� No. : ..,•i' � —'- ��j� '' O��~ �� ti� _.::� Fee/ ��'
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer..
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Yes
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,i ZIPPYication for Zigool *pgtem Congtruction Vermit
Application for a Permit to Construct Q/�Reppir( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Yu Location Address or Lot No. -t— Owner's Name,Address and Tel.No.
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Assessor's c ® �! -
/ Installer's Name'%dress,and Tel.No. Designer's Name,Address and Tel.No.
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Type of Building:'
Dwelling No.of Bedrooms 14- Lot Size�►t�� sq.ft. Garbage )
Other Type of Building jg-_S1se_,t" No.of Persons Showers(L of Cfff&e ta*( -)
Other Fixtures //tt
Design Flow 4- �* T Q gallons per day. Calculated daily flow 44-0 gallons.
Plan Date --s^-� Number of sheets 2 Revision Date
Title S 1 '1~-C A --''"-nc
Size of Septic Tank .SbO Type of S.A.S.
Description of Soil �-^ {`mil-2 d1a 4
Nature of Repairs or Alterations(Answer when applicable) -e-W H:Q y 5�P, '
Date last inspected: `
Agreement:, r
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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 by this Bgajd 9f Health.:!
Signed :' Date
Application Approved by Gu, Date
Application Disapproved or the following reasons ?
Permit No. _ Date Issued
i
——————————————————————————————— ——————:
THE COMMONWEALTH OF MASSACHUSETTSM
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO CERTIFY, that�the On-site Sewage Disposal System Constructed(�_J Repaired'( )Upgraded
Abandoned( )by -
at . ' i �' rG: � has been constructed in accordance,
with the provisions of Title 5 and the for Disposal System Construction Permit No �' .° d f
P P Y _• ,�� v dated � _-__
Installer Designers A ( + C
The issuance of this permit stroll not bt trued as a guarantee that the sy to rll functiion aAd ignedf�
Date Inspector
V Vy v
--------------------------------- -------
No. l Fee_ ;
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
x1i6poot *pgtem Congtruction Vermit
I'llPermission is hereby granted_to Construct(Repair( )Upgrade( ) abandon( )
System located at" --'
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 completed within three years of the date of t
Date: 12— �` Approved b
TOWN OF BARNSTABLE .
LOCATIO `� SEWAGE #
VILLAGE_- i t( C Q5t L 1 1r- ASSESSOR'S MAP LO Y
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INSTALLER'S NAME&PHONE NO. :rCAx, (� l
SEPTIC TANK CAPACITY /'i L,►
a y ,�c
i LEACHING FACILITY: (type) n a: r r t�y�l� (size) sit`5! c�' X /Q
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NO.OF BEDROOMS
UII.D OR OWNER e
P TTDATE: 7' ' 17 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
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A `
CERTIFICATION
Property Address: 399 Starboard Lane
Osterville, MA 02655
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Owner's Name: John&Carol Recco n CZ)
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Owner's Address: c ',y
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Date of Inspection: Aurrust S. 2005
Name of Inspector: (Please Print) James M. Ford
Company Name: James M. Ford
Mailing Address: P.O.Box 49co
Osterville.MA 02655-0049
Telephone Number: (508)862-9400
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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 the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
✓ Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date: Au ust 8 2005 ,
The system inspector shall sub 't copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of.10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address'how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2060 page 1
Page 2 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 399 Starboard Lane
Osterville, MA
Owner: John& Carol Recco
Date of Inspection: August 5, 2005
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D"
A. 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:
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B. 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.
Answer yes,no or not determined(Y,N,ND)in the 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.
ND explain:
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
obstruction is removed
distribution box is leveled or replaced
ND explain:.
z
The system required pumping more than 4 times a year due to broke_n or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
i
broken pipe(s)are replaced
obstruction is removed
ND explain:
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Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 399 Starboard Lane
Osterville, A1A
Owner: John.& Carol Recco
Date of Inspection: August 5, 2005
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the-system
is failing to protect public health,safety or the environment.
1. 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:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 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 coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
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Page 4 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 399 Starboard Lane
Osterville, MA
Owner: John& Carol Recco
Date of Inspection: August 5. 2005
D. System Failure Criteria applicable to all systems:
You must indicate either"yes"or"no"to each of the following for all inspections:
Yes No
✓ 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
✓ 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 '/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_.
✓ 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 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 coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
No (Yes/No)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.
E. Large System:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
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
If you have answered"yes"to any question in Section E the system is considered a significant.threat,or answered
"yes" in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
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Page 5 of 11
e
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 399 Starboard Lane
Osterville, MA
Owner: John&Carol Recco
Date of Inspection: August 5, 2005
Check if the following have been done: You must indicate"yes"or"no"as to each of the following:
Yes No
✓ 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:
Yes No
✓ Existing information. For example,a plan at the Board of Health.
✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [310 CMR 15.302(3)(b)].
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Page 6 of 1 I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 399 Starboard Lane
Osterville. MA
Owner: John& Carol Recco
Date of Inspection: August 5, 2005
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 4 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
Number of current residents: 2
Does residence have a garbage grinder(yes or no): n/a
Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required]
Laundry system inspected(yes or no): No
Seasonal use(yes or no): Yes
Water meter readings, if available(last 2 years usage(gpd)): Unavailable
Sump Pump(yes or no): No
Last date of occupancy: Currently occupied
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
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/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: Tank was pumped after the inspection for maintenance
Was system pumped as part of the inspection(yes or no): No
If yes,volume pumped: _gallons--.How was quantity pumped determined?
Reason for pumping:
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)
Tight Tank Attach a copy of the.DEP approval
Other(describe):
Approximate age of all components, date installed(if known)and source of information:
Installed on 8/11/99-per as built card
Were sewage odors detected when arriving at the site(yes or no): No
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Page 7 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 399 Starboard Lane
Osterville. MA
Owner: John&Carol Recco
Date of Inspection: August 5, 2005
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: _cast iron 40 PVC _other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: 18"
Material of construction: ✓ concrete _metal _fiberglass _polyethylene
_other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 1500 Qal.
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: 6"
Distance from top of scum to top of outleftee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 10"
How were dimensions determined: Measuring stick
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert, evidence of leakage,etc.):
Tees were Present. The liquid level was even with the outlet invert There did not appear to be anv signs ofleakaze The tank
was pumped after the inspection for maintenance
GREASE TRAP: None (locate on site pIan)
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(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
7
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 399 Starboard Lane.
Osterville, MA
Owner: John& Carol Recco
Date of Inspection: August 5. 2005
TIGHT or HOLDING TANK: None (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/day
Alarm present(yes or no):
Alarm level: Alarm in working.order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches, etc.):'
DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Even
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.):
The D-box was level and clean.
PUMP CHAMBER: None (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.):
}
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r Page 9 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 399 Starboard Lane
Osterville,.MA
Owner: John&Carol Recco
Date of Inspection: August S. 2005
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
i
Type
leaching pits,number:
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
✓ leaching fields,number,dimensions: 20'W x 30'L x 12"D f4-30'rows ofperforated pipe) per as built card
overflow cesspool,number:
Innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.):
There did not appear to be any signs of failure The bottom to grade was approximately 5.
CESSPOOLS: None (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 or no):
Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: None (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.):
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Page 10 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 399 Starboard Lane
Osterville, MA
Owner: John&Carol Recco
Date of Inspection: August 5. 2005
F
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
SGreo.,1 ro to
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Page 11 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 399 Starboard Lane
Osterville, MA
Owner: John& Carol Recco
Date of Inspection: August 5. 2005
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 45'+'- feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
✓ Checked with local Board of Health-explain: topographic and water contours mans
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Using Barnstable topographic and water contours maps the naps were showing approximately 45'+/<to ground water at this
site.
This report has been prepared and the system inspected and passed as of the date of inspection. This report is
not a warranty or guarantee that the system will function properly in the future. There have been no warranties
or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report.
11
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map ID1 Parcel' 15 Oo Z Application# Map [ 1 Parcel 02X00Z Application#
Heath Division Date Issued Health Division Date Issued
Conservation.Division Application Fee / Conservation Division Application Fee
Planning Dept. Permit Fee Planning Dept. Permit Fee
Date Definitive Plan Approved by.Planning Board Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis Historic-OKH Preservation/Hyannis
Project Street Address �¢ LA.) Project Street.Address a S'fz4Qt�ou¢�7 LAJ
Village . SW'eU L: - Village DSzL—eOIZLj_'
Owner Address Owner f�)S uul G-7 �-,D Address
Teleph:Request
�3S—s s Telephone
Permit oo E t oM weZI Permit Request :f t js i k VOL, lh�L 1 :&a .��JTE2ThSiJ41� / ra1ZOam 7i yelz
►,�itiu tX1.4ov a� a G��U- ' f7A�� In}s.M A ''Fur L t.)ku 5 a>x��avY ��sd�� sae ��nra�
v ,� � 1`�LVhC�ir�►�- kIX�A�Y S'N'863�
Square feet:1,st floor:existing_pro sed 2nd.floor:existing proposed 4 K6 Total new� Square feet:1 st floor:existing_proposed 2nd floor:existing proposed 4�6 Total new
Zoning District Flood Plain Groundw er Overlay Zoning District Flood Plain Groundwater Overlay
Project Valuation Construction T Project Valuation Construction Type
Lot Size Grandfathe ❑Yes No If yes,attach supporting documentation. Lot Size Grandfathered: ❑Yes. ❑No If yes,attach supporting documentation.
Dwelling Type: Single Family Qe- Two Family ❑ Multi- amily(#units) Dwelling Type: Single Family CW"' Two Family ❑ Mufti-Family(#units)
Age of Existing Structure - Historic House: es ❑No On Old King's Highway: ❑Yes ❑No Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes O No
Basement Type: ❑Full ❑Crawl ❑Walkout ❑Ot r S Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement nfinished Area(sq.ft) Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full:existing new Half: xisting new Number of Baths: Full:existing new Half:existing new
Number of Bedrooms: existing_ w Number of Bedrooms: existing—new
Total Room Count(not including baths):existing new First or Room Count Total Room Count(not including baths):existing - new First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Oil ❑El c ❑Other Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other
—
Central stove: ❑Y ❑No Central Air: ❑Yes ❑No Fireplaces:Existing New Existing wood/coal stove: ❑Yes ❑No
Central Air: ❑Yes ❑No Fireplaces: ling New Existing wood/ s o es p 9 9
w i Barn:❑existing ❑new size
Attached garage:❑existin ❑new size Pool:❑existin ❑new size Barn:❑existin ❑new size— � Detachedgarage:❑existing ❑new size_Pool:❑existing ❑new size—Ba e s g s
9 9 9 9 — —
'n ❑new size Shed:❑existing ❑new size Other:
Attached garage:❑existing ❑new siz _Shed:❑existing ❑new size—Other: Attached garage:❑existing. e s e_ g — ,
Zoning Board of Appeals Authorizatio ❑ Appeal# Recorded❑ Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If y ,site plan review# Commercial ❑Yes ❑No If yes,site plan review#
Current Use Proposed Use 1'. Current Use Proposed Use
APPLICANT INFORMATION t APPLICANT INFORMATION
(BUILDER OR HOMEOWNER) (BUILDER OR HOMEOWNER) f-
°wJ�GS �j7SToM $JStDG�S ��/6• / JcLS GJSTOH �UfJS2DGQiS 1'�G-
Name �2 Telephone Number SOFT �3'� �' I Name ��2n4� �I..� , L-A,a1� ° Telephone Number .Sow 734- :1 rfI
Addr'e/ss,, .) //E��n.""J �h`� License# ����I Address
)eZ 1�^^//����1 � � License# OIL I
/ W- 0a6o 9 Home Improvement Contractor# 3(, �� (fYfl NN r� /"I�+ Da6o Home Improvement Contractor#
Worker's Compensation# Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE SIGNATURE DATE S O
1 wl a ul baruSlaUlc Y-10 -
x Department of Health,Safety,and Environmental Services.
Public Health Division Date (,.1
367 Main Street,Ilyannis MA 02601
I11ANWAIRIA
-2- 1 Time
AM Fee Pd. i,
Date Scheduled _
Soil Suitability�Assessment for Sewage_Disptosal ;
Pcl`�IE l r- ^CA Witnessed By: J�R-iz`� 1>uNh)�NCr L'3J1i�
Perfopned By: -D
LOCATION & GENERAL tNEORMATIO
Location Address �j Owner's Name J OH ytti1EEAIt='Y
V- (il,- L.N. Address IS-S e,7 JrL .\L
STC-rLVt�C A^ 061�Rv\��C MA
Assessor's Map/Parcel: 16'7/2gi P o rt�'a h o�> Engineer's Name 'Dp w>J
NEW CONSTRUCTION '� REPAIR Telephone p 1 506 ' 3t:Z H Sal l
Lend Use ►`�� Slopes(%) fJ� I Surface Stones
Distances from: Open Water Body R Possible Wet Area R Drinking Water Well R
Drainage Way R Property Line R Other tt
SKETCH:(Street name,dimensions of lot,exact locations of lest holes do pere tests,locate wetlands In proximity to holes)
Gj� 13Z.0'S /S
I.,*T 25 \ \4pr
oP' TI-1 2
a
;v \� e
VV
S+l S 15$,-72.
/
L�/J co L. F*-I- 1 I.4 T?-Y- i—A/1 Tom.
L�tNr i
Gd�� 150/
Parent material(geologic) Depth to Bedrock
Q� t � v,
Depth to Groundwater: Standing Water In Hole: Weeping from Pit Face
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing In obs.hole: N�f� In. Depth to soil mottles: In.
Depth to weeping from side ofobs.hole: In. Groundwater Adjustment R•
Index Well#_ _ •Rrading Date:_ Index Well level„•__ Adj.factor Adj.Groundwater Level
PERCOLATION TEST "'ttinie`'t-`.` :":Tune: ,I p AM
Observation
Hole N ► Z-- Time at 4"'
Depth of Perc
Time at V.
Start Pre-soak Tlme Q 01-0 0 0'00 Time(9"-6')
End Pre-soak }S'00
kale Min./inch
Site Suitability Assessment: Site Passed ✓ Site Failed: Additional Testing Needed(YIN)
Original: Public liea►th Division Observation Hole Data To Be Completed on Back—�
Copy: Applicant
01151;ItVA'1'ION 110LC LOG Soil U,t,cr
tioil'I'cxltrre Soil ColoA
glruclure,
I)cptll from Soil I lorizun (USDA) (Munse Stones,nouldems.
M°ttii"g
Surface(In.)
Ol'cju`y�`L
O—Z— O
2,6 C
I,c-1
-1/
M�� �1
NO Lj
II01e#______H
a,EP OUSC[tVATION 11 LOG sou other
Solt Texture Soil Color Mottling (Structure,Stones,nouldems.
I)eplh from soil Ilorizon (USDA) (Munsell)
Surface(in.)
—71
�o
�.r,a 5 of SPY.Jy
e, l�
(.fj�_ L Z -Alh No INIr►'ER- �N�
UCCI* 011—SE RVATION OLE
OG " soil
Soll'fexlure Soil Color Siruclute,Slone],noulderes.
1)cpih from soil Ilorizon (USDA) (Munsell) Mottling (. •
Surface(in.) .
77�
f
llLla' 013SC1tVA'1'ION 110LC LUG Hole 0
s° -il diner
soil'fexture Soil Color
Dcpih firm i soil I lorizon (USDA) (Munsell) Mottling (Slnrclure,Stones.poulderes
Surface(in.)
i
I I�
z r I
.-• r Inaurence Rate ►'lag
Above 300 year flood boundary No_,..._
Yes
Ycs
Wlthl6 Soo year boundary No._-- —
Within too year flood boundary No ✓ Yes
turally occurring pervious material exist in all areas observed throughout the
Does at least four feet of na
• ,t,h
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring pervious material?
C'ett� �IlIuuw
certify that on Od�1 (date)I have passe above analysisanal evaluator
s stwas performed by me consistent with
Department of Environmental Protection and that theY
Ilir rrrniired If": ' expertise anal rvncrience described in 310 CMR 15.017.
OSTER VILLE
PRO✓EC T L OCA TION<,, o t
LOT 24
OSTER VILLE MA. SCUDDER
JOHN �' , ?�.a G
BAY
NDERS-CALILEY `w" ' : J AU'P' VBR
CIVIL v MERMiEW
APPLICANT.' No.35101 �' � �
9fG�SATE EO C.STARBOARD L L C F90F�55�o�'�''o, • �B. .`E'N. CHMARK
l 0� 1 mo4 TOP OF C.B.
LOT 22 . ELEV.=113.5'(ASSUMED)
YA NKEE SUR I/E Y CONSUL TA N TS PART of '. ,,, g�ivD)K �,I c HIDI K
P. 0. BOX 265 As LOT 28'
i' UPOLE
UNIT 5, 40B INDUSTRY ROAD
MARS TONS MILLS, MA. 02648
PH. (508)428-0055 — FAX(508)420-5553
C B.(FND)
N88 4 44 W
SCALE. 1"=30' -__ --L---- -- --- __ 169.10—
DA TE.• 215199 --\�- ---------
\ DIRT DRIVE tS
C.B.(FND) N LOCUS MAP
L O�.\
REV. REV. `� �� �r--fi-- - --S 4844"E-_85. _ -
`� 1 ' ► r-- SITE & SEPTIC PLAN
JOB NO. 51693 SHEET 1 OF 2 29 ; �, o �pRoa ,N�331;?9 \ OF LAND
�2 B ' 1 o "'jF ��
I ��' 1 51 9 , \�\ PLAN REF 28475H
ZONING.• "RF--1"
% ° I - _ \� FLOOD ZONE. .,C
NG// / o GAR. ° \ w�'y� GROUND WATER PROTECTION
CLEARI�/ / / DISTRICT AP
/ 1"ART OF 30.0'
A6. L T 2.18 / ®
/ / 2.o. I 9.8' 9 0 I , �
06 6 / / , I o 14.6 `\
PROPOSED
/ ) I ------ ---- 9.5' 4 BEDROOM �_ %
90 \ I I I I f 1 \ s 9 6' DWELLING \\
I reserve !ry `9 ' O
\ area �o T.O.F.= 113. C.0 0• w-s_ \\ B.IDISK
` I (FND) :
\ I 30.0'
� TP � .
rn � \
r 1� U
\ o •- ` ) LOT 24 0 \\
o
PART OF UPOLE
\ \ ►-- AS. LOT .28 14.0'
\ 9REA=43,560f S.F C.B./DI jK
(FND
\ \ ¢ L C.B.(FND)
i
— - - __W2YR44'06"E 158. 72'
\ � OF -------------GRA�,L ---------
�rK LANE
JF.F. ELEV.=�13_0
20'm in.
ELEV.= 110.0
4" CAST IRON OR ELEV.=108.0
SCHEDULE 40 P.V.C. CONCRETE COVERS
4" CA. "-IRON OR 4" DIA. SCHEDULE 40 PERFORATED PLASTIC PIPE
END CAPS ON ALL PIPES
SCH' tE 40VP.V.C. 5' ON CENTER A 3" LAYER OF
DIST.=14.6_ SLP:=0:02 T 0.005 12 min.
INVERT CONCR OVER 1 J/ WASHED STONE
FLOW LINE DIST.=2:0' DIST._____
1O6 OO SLP.= 0.02- INVERT °o°o°o°o o°o°o°o°o°o°o°o°o°o°o°o°o°o°o°o°o°o°o°o°o° °o°o°o°o°o°o°o°o°o°o°c
ELEV.=__-_ ELEV.= 105.7 10" MIN. tg" ELEV.= 105.2 °o°°°°°° °°°°°°°°°°°°°°°°°°o°o°o°°°o°o°°0000000°000 o°000°000000000o00000
U ( 6" LAYER OF
GAS BAFFLE ELEV= 105.46 - ELEV.- 105.4 ELEV.= 105.24 0O0. /4" TO 1-1/2"
4" CAST IRON OR �O�OvOuOvOvOvOVOVOVOVOVO�. 0O0OU VOVOVOVOVO0OCWASHED STONE
SCHEDULE O P.V.C. DISTRIBUTION BOX � o 0 0 0 0 0 0 0 o�o�000�-) 010 o_o 0 0-0-0� ELEV.— 104_5
USE STONE A
1500 GALLON SEPTIC TANK TO BE WET ',TESTED IF 'TO LEVEL THE 11.4'f
TO BE PLACED ON MORE THAN ONE OUTLET, BED AS NEEDED.
6" OF STONE .OR TO BE PLACED ON
MECHANICALLY COMPACTED SOIL. 6" OF STONE OR -————————————————————————————————— -----
USE A .TANK WITH THREE COVERS. MECHANICAL'_Y COMPACTED SOIL.
BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE ELEV =93_1 f
SOIL TEST DONE BY: DANIEL A. OJALA
WITNESSED BY: _JERR_Y_DUNNING
PERCOLATION RATE: __2 __MIN/INCH P# 9172 3" VYER OF
/
TEST. HOLE 1 DATE: 0Z02198 ELEV._107_0 �o�o= "°"° "°"°"°"°= 'Mli STONE
• Ooo�00 0o•o�o 6- 4AYEROF _
PROFILE OF DEPTH HORIZON TEXTURE COLOR MOTT. OTHER 0 0 o 0 ASHE10 STONE
SEWAGE DISPOSAL SYSTEM 4 PERFORATED PIPES
0"-2- 0` - ORGANIC SECTION A-A
NOT TO SCALE
2"-6" LS 10YR 7/2
GENERAL NOTES: 6"-36" B Is 1oYR 5/e
1. THIS PLAN IS FOR THE CONSTRUCTION OF A ,NEW SEWAGE DISPOSAL SYSTEM: 36"-84" ti MEDIUM SAND 2.5Y 6/4 HANDS OFSANDY LOAM
2. PLAN REFERENCE Bk Pg LOT 24 BARNSTABLE REG. OF DEEDS. REMOVE Cl
3. THIS PLAN IS FOR THE INSTALLATION /REPAIR OF SEPTIC SYSTEM
AND NOT TO BE USED FOR SURVEYING AND ZONING PURPOSES. 84"-132" 2 M/s 2.5Y 7/4 DESIGN DATA:
4. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. NO H2O
TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS ENC'D NUMBER OF BEDROOMS _FQl��4)___
FOR THE SUBSURFACE DISPOSAL OF SEWAGE. I-
• 06 02 98 . V 105.1
I' TEST HOLE 2 ;.DATE. _�_�__ ELE ._______
5. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN ,, . GARBAGE DISPOSAL _LVQIYI<..(_0)_----
12 OF THE FINISHED GRADE. DEPTH HOR IZON TEXTURE COLOR MOTT. OTHER
6. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE TOTAL ESTIMATED FLOW _ 44Q____ GPD
SAME, UNLESS NOTED BY FINAL CONTOURS. 0"-2" ORGANIC GAL./BR./DAY X _�___ BR. )
7. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE
OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR 2"-6" .�3 IS 10YR 7/2 SEPTIC TANK CAPACITY
WITHIN 10' OF DRIVES OR PARKING AREAS. H-20 LOADING
SHALL BE USED UNDER OR WITHIN 10' OF DRIVES OR PARKING 6"-36" I3 IS 10YR 6/6 LEACHING AREA REQUIREMENTS
AREAS UNLESS NOTED.
8. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL SIDEWALL AREA _0 ___ GAL./S.F.
BE MORTARED IN PLACE. 36"-60" t.1 MEDIUM SAND 2.5Y 6/4 BOTTOM AREA _500___ GAL./S.F.
9. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH BANDS OF
DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO SANDY LOAM
OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. REMOVE Cl LEACHING CAP.(BOT. & SIDEWALL)__ 444 444 GAL.
10. THE EXCAVATOR/CONTRACTOR SHALL VERIFY THE LOCATION OF 60"-144" C:2 M/S 2.5Y 7/4 444
ALL UNDERGROUND UTILITIES PRIOR TO ANY EXCAVATION. I NO H2O RESERVE LEACHING CAPACITY _ GAL.
11. THE ENGINEER SHALL VERIFY THE SOIL CONDITIONS PRIOR TO ENC'D
THE PLACEMENT OF ANY SEPTIC SYSTEM COMPONENTS.
APPLICANT: STARBOARD L.L.C. DATE: 2/5/99
SHEET 2 OF 2 JOB # 51693