HomeMy WebLinkAbout0409 STARBOARD LANE - Health 409 STARBOARD LANE
OSTERVILLE
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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 1 d
Property Address: 514r hca#'d �ua _
reel-- 0165'S' --
Owner's Name: J-o " br Skleeqek: _ c-;i
�3 -n
Owner's Address: 44017
3�ar hoar �ANt —
�� 26 ss .
ost
crv. ' >
O
Date of Inspection: 3'-.Z/-o y
` U1
Name of Inspector:(please print) 1494 , A?Company Name: cd» a o� Serv, v -
Mailing Address: �j rn
/YIyrS oHs M./s /Jilfl oZ6�/8•
Telephone Number: v$• '!�$-7,79
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 S(310 CMR 15.000). The system:
✓Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date: 5— 21-- o 7
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 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
• F
****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 6/15/2000 page l
Page 2 of I I fp
OFFICIAL INSPECTION FORM—NET#ORVOLUNTARY:ASSESSM,ENTS'�"
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
k
Property Address:
M17
Owner: ,OAN 6 .Sw eQh e
Date of Inspection: S-2/— 7
Inspection Summary: Check A,B,C,D or E/ALWAYS complete'aI 4"g D
A. System Passes:
I,111 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:
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 i.f 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)art replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 tunes 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
ND explain:
2
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL:SYSTEM INSPECTION FORM
PART
/, - CERTIFICATION;(continued) x
Property Address: y0q S rhnar H,e. ,
s Ter v>ll -
Owner: 040 5, skleeAAZ
Date of Inspection: C— �2/—D 7
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 aseptic 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 front 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:
3
Page 4 of 11
a i
OFFICIAL INSPECTION FORM—NOT TOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOS I:-SYSTEM INSPECTIONYORI 1,.
PART A
CERTIFICATION(mimed)
Property Address: y0 Sr r hvurc� �6iti
Owner: 3al,n wL-ebt%
Date of Inspection:
D. System Failure Criteria applicable to all systems:.
You must indicate"yes"or"no"to each of the following for all inspections
Yes No
i/ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
v Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
r/ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
i/ 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
t/ Any portion of the SAS,cesspool or privy is below high ground water elevation.
v 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.
_ ri Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet*from aprivate water
supply well with no acceptable water quality analysis. [This system passes if the avail 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 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-
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the crhmia above)
yes no
water 1
the system is within 400 feet of a surface drinking ate y
— — y g anPP
— 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.
4
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: -1/09 S�ar hour/�s,e
0-rTrv.' L . MAY.
Owner:�7ol�wi B Sw Qen��
Date of Inspection:
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
v Were any of the system components pumped out in the previous two weeks '?
I/ 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?
V — 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:
. f
Yes no
— _ Existing information.For example,a plan at the Board-of Health:
r/ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)P 10 CMR 15.302(3)(b))
5
Page 6 of I 1 '
OFFICIAL INSPECTION FORM—NOT FOR'VOLI NTAkY ASSESSMENTS .
SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 11620/ 5ta✓ hga d hand
® 'Ile NO
Owner: TO.4N 0w
Date of Inspection: —7
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x$t of bedrooms): el yD
Number of current residents: 2
Does residence have a garbage grinder(yes or no):�
Is laundry on a separate sewage system(yes or no). [if yes separate inspection required]
Laundry system inspected(yes or no): itl b
Seasonal use:(yes or no):_? ('j 57 Pd: 2 D o 6
Water meter readings,if available(last 2 years usage(gpd)):k"5"5'9'rj=200 S
Sump pump(yes or no):ALv
Last date of occupancy: ece
COMMERCIALIINDUSTRIAL
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: (OkIA A- j
Was system pumped as part of the inspection(yes or no):Ld
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.Anch'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:
JhsA A?
Were sewage odors detected when arriving at the site(yes or no): /VO
6
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
} SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Ds ram," a. 1Nq •
Owner: Tom., J3. S wt-eh �—
Date of Inspection: _S=!2/-07
BUILDING SEWER(locate on site plan) '
Depth below grade:
Materials of construction: cast iron 4 VV other(explain): -
.. Distance from.private.water supply well o. s n line:
Comments(on condition of joints,venting,evidence of leakage,etc.):.
SEPTIC TANK:_(locate on site plan)
Depth below grade:2y"— 12"
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: ic // fS4o Gal TNh k
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle: 3 If"
Scum thickness: o /"
Distance from top of scum to top of outlet tee or baffle: a
Distance from bottom of scum to bottom of outlet tee or baffle: i 4,
How were dimensions determined: Agd %- ?,4 7—er
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of.leakage,etc.):
Tank is Z-eve J M i h u f.e Leve J d Sec c7."t/.r�. he.
GREASE TRAP:_(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(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 l l
OFFICIAL INSPECTION FORM—Nq' �VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM.,
PARS'C , � ....
SYSTEM INFORMATION(continued)
Property Address: y�q S /Cir`JOAv�1:Ay1
owner: 1bHN W e1H f y
Date of Inspection:
TIGHT or HOLDING TANK: (tank must be pumped at time of utapecdmi(latate an 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 oa site plan)
Depth of liquid level above outlet invert:
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.): „
-e -
PUMP CHAMBER: (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.x
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE,DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1/0 9 Mr '
Os775-v,ilte.
Owner U,7 3weln4�
Date of Inspection:
SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required)
If SAS not located explain.why: wy
Type
leaching pits,number: '
leaching chambers,number
leaching galleries,number.
leaching trenches,number,length:
leaching fields,number,dimensions: Jos' x 30 ' x 2' Arrr
overflow cesspool,number:
innovativeJaltemative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.):
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 or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
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.):
Page 10 of 11
OFFICIAL INSPECTION FORM-N61T' k0k VOEUNTA1tY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAI:SYSTEM INSPECTION FORM
PART:C .
SYSTEM INFORR}IATION(continued)
Property Address: qaq 3ra boav h-e
Owner: �64, 13 "lien QY "
Date of Inspection: 4,4,,.1;
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 put'ic water supply enters the building.
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Pagel 1 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: y 0 9 5-rar b..., ® �4,iz
0s Pril1
Owner. foka )3 we g M
,
Date of Inspection: S'—2 1—0 7 -
SITE EXAM
Slope
Check cellar
Shallow wells
Estimated depth to ground water YO 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: mae., at ro wn
Checked with local excavators,installers-(attachdocumentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation: �
w.}t
h✓Lt SUN Q� �S�
t 3 ri
Ct�IUS►l4 �r.a� lL�t�f� 67 �=
y ' GI s"lun c� .t W(srtlr 17�
,�nvty+ of S,fIS Ta Ivor EL y��Q t �
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r 4
11
TOWN OF BARNSTABLE
LOCATION S�L,% ( L V SEWAGE
VILLAGE - _ _ ASSESSOR'S MAP & LOT/6 7—Oz�C10�
INSTALLER'S NAME & PHONE NO._ in _
SEPTIC TANK CAPACITY_!5gLj2_l
LEACHING FACILITY:(type) "' a� . r TY� a (size)_ U l, fir,
NO. OF BEDROOM' _PRIVATE WELL ORPUBLIC WATER.,'
BUILDER OR OWNER
DATE PERMIT ISSUED: J
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes .,--No-
_
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1,33G` 1 tom°
3 W/O
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V
No. 00V FEE V
COMMONWEALTH OF MASSAC14USETTS
Board of Health, `9 9tJS 7 A, L 5,MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for emit to Construct( r r e Abandon L�Com lete System ❑Individual Components
PP p � O P O O P ys P
Location f Owner's Name FjJ �� 1Zu c /e
10
Map/Parcel# �� r 28 Address .9 S (2/✓IC
Lot# Telephone#
Installer's Name L 1 Designer's Name 1jKE,5 UR VE
Address STOAC hl II— Address o --Z:/V.VU.S A D
Telephone# / /,/ Telephone#
Type of Building �PS Ce ot'. �I / /0 Lot Size e4,5 13 sq.ft.
Dwelling-No.of Bedrooms Garbage grinder(j )
Other-Type of Building No.of persons Showers ( ),Cafeteria ( )
Other Fixtures
Design Flow (min.required) " �� gpd Calculated design flow 0+4-0 .Design flow provided 447 gpd
Plan: Date cJ� O a Number of sheets_ 1 Revision Date - Ao D
Title �rl T e ))�L N
Description of Soil(s) �lA P
Soil Evaluator Form No. Name of Soil EvaluatorPAOIQ, C8 ADate of Evaluation 8
DESCRIPTION OF REPAIRS OR ALTERATIONS
The unders' ed agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
furtheras
o pl ce thoperation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date i'ec44 OK(E �'�/�G�-� ® 4400
ENULr_
TOWN OF BARNSTABLE
I
LOCATION !� SEWAGE # r;C`��'- =j
VILLAGE j ASSESSOR'S MAP Sr LOT
INSTALLER'S NAME lCt PHONE NO. n
I
SEPTIC TANK CAP'ACIfY
LEACHING FACILITY:(type)_ ;
NO. OF BEDROOM S
PRIVATE' WELL O�UBI_IC WATER
BUILDER OR OWNER ..�i."i
DATE PERMIT ISSUED: .
DATE COMPLIANCE ISSUED:
`IARIANOE GRANTED. Yes No — r
r
,.
77
No. ow FEE
COMMONWEALTH OF MASSACHUSETTS
1;
Board of Health, /1(ZNS l AE t c, mA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( p YO Up r eO Abandon( 2/complete System ❑Individual Components
Location kzyL Z.5 A N Owner's Name S l vffctJ Con Sla to c /,o)J
Map/Parcel# /6 -:. t 2p Address b S 714R)32(DG C ) 2/✓C
Y
Lot# 5 Telephone#
Installer's Name AL-7 V" Designer's Name NK56 SUR Vey
Address A STory (I- Address 0 --I:NPU..S A
` Telephone# 5 Telephone# OO S
i� I e r)+-. ? e 5 � ..
Type of Building 1 /K7 t'1� 'Lot Size � 3 Z" sq.ft.
Dwelling-No.of Bedrooms Garbage grinder 4 )
• t 5 '
Other-Type of Building No.of persons Showers ( ),Cafeteria ( )
Other Fixtures d t Design'Flow (min.required) 4 1 gpd Calculated design flow +4-6 Design flow provided 4- lr►
gpd
Plan: Date O Number of sheets," .. Revision Date _r 9 �6
Title _C%TC C.Sc W A G 'PL#.4
Description of Soil(s) 'PLA J'J
Soil,Evaluator Form No. Name of Soil Evaluator- 0 0_9"`ADate of Evaluation 6 8
DESCRIPTION OF REPAIRS OR ALTERATIONS
y
The undersi ed agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further a ee to t to place the s
ystem in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed . / DateLim)
ec ns 1 Z t/�-�
7
V V
9 x
No! </l./ FEE
COMMONWEALTH Of MASSACHUSETTS
Board of Health, h�f'�Jy �1 l� �1.(i, MA.
CERTIFICATE COMPLIANCE
Description of Work: ❑Individual Component(s) Q Complete System
The undersigned he eb certify that t , Sewage Disg al System; Constructed ( ),Repaired ( ),Upgraded ),Abandoned ( )
by A
has been installed in accorda wi rfh �pr6visionsfof 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. r dated Ap roved Design Flow 2 (gpd)
Installer Y l An 1 )f�j
Designer: A►J Ktt Qvcy riSu l• Inspector: � vI FJ /f ��f ` Dat to J / / V
The issuance of this permit shall not be construed as a guarantee that the system No function as designed. l
No.% iypr CAI// FEE
`Y COMMONWEALTH Of MASSAC14USETTS
Board of Health,
DISPOSAL SYSTEM CONSTRUCTION PERMIT �
Permission is hereb g"rante to; Znkstruct(/) Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system
at l oT ZS RRTyoJ��LANC OSt&e��L- . 'as described in the application for
Disposal System Construction Permit No.?-dV-A?6 , dated
Provided: Construction'shall be completed within three years of the date of this permit. All local conditions must be met.
Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date 6 �3 Board of Health
t
I Ul 6&iCl►Sl:lUlc
Department of Health,Safety,and Environmental Services Date S'' �l�
Public Health Division
367 Main Street,Ilyannis MA 02601 ,
. - pdKAM , oil.
_ Time i(r�_�- Fee
tesa pate Scheduled
f , a `Assessment for Sewage. Disposa ..
��. Suitability_ ,. .. Burl Surta y ? . . ERZ-I- wC� �3o;I-})
Wltnessed By: ;J
Perresmed By: DA N I I--
LOCATION & GENERAL INFOsRNI ION ` we-cr��t
Own J o N,j 5 ,
Location Address L eT '1-5 (, y ►�� Address 1 es�s �'� '��(rE
BngMeer's Nmw -DOW0 GAS
O SiC—Tt-V Lt-C � �^� �
28 f,�-r.or•oF� Cow '✓bZ �-1c✓'��
Assessor's MeplParcel: ((, Telephone A
',✓'�"�i'cEPAER — -- -
NEW CONSTRUCTION — 0- 10 Surrece Stones
lam Slopes(ye) R
Land Use it Drinking Water Well
n Possible Wet Area Distances from: Open Water Body_�--•-
itProperty Line ------- --R odw A
Drainage Way
me dimensions of lot,exect locations of test holes&perc tests,locate Wet
lmds In proximity to holes)
SKETCH:(Street na ,
o=
• ZZ , fig. i
%
`32-Ais
66,►��
ti\
Depth to Bedrock '
Parent materiel(geologic) Weeping flora Pit Pace
Depth to Groundwater. Standing Water in Hole:
�✓/A N p
Estimated SeasonCHigh Grouadwatcr
FOR SEASONAI 001E1''WA�'ER TADL
DETERMINATIONIn.
Method Uscd: In. Depth to soil mottles: tl
Depth Observed standing in obs.hole: In. Groundwater Adjustment
Depth to weeping from side of obs•hole: —Ad,Groundwater Level_
Reading Date:�_____ Index Well level _ Adj.rector J
Index Well p__....- .. 6,;. r11Nl ,J.�.AM
PERCOLA`I`ION`PEST
Observation ')err ') 1 �1- Timat� x
L'�
Ilole N �Y-�p ►► Tlrtie at 6"
Depth or Pero r ° �Z b /
Start Presoak Time®-. 0, 00 .. D 0 0 Time(9" ----�-
End Pre-soak
Rate Min./Inch N
Site Suitability Assessment: Site Passed
Site Filled: Additional Testing Needed(YIN)
Ori inal: Public Health Division Observation Hole Data To Be Completed on Back------��
B ,
Copy: Applicant
Ih
LOG. • tlole#��
110LE tall Other
I)]I,1'1"i' U�ISI�'�tVA111UtN Sall color mottling
(Structure,Stone'.
nauideres.
Ikplh from (USDA)
Ilorlaun (USDA)le (Mansell)
Surface(in.).
LA .
,ro,j N�
![OLD .�.• Solt Uthet
OISSE WATION Sa,l Cotar (Structure.stone.Iroirla�:rs.
SoILTexturo (Mansell)
Mottling
Ueplh from (USDA)
I loriton (USDA)
Surface(In.)
O,r ,ni L
l o
2.6
1-15
�-3� G` M SAS 2-�� � �o w.�;�j�-•_., r
U1Ircr
110LG L00•}.. Son �
1)I;rp UIISCItVATIO soil Color mottling (structure,stones,nouldera.
Soil Texture (Mansell)
I)cpth from Soil Ilorizon (USDA)
Surface(in.) _�--
UUSL11VATION 1 Sall Other
])CEI Soil Soil Color Mottling (Slnrctute,Stones,nonldeh
Texture (Mansell)
Ucpih hm a •
Sullll IN" (USDA)
Surface(In.)
t
s��e Rate 111i1it
Above 300 year flood boundary No,
Yell
Wilhln 300 year No. No=/ Yes,
'Wllhin 100 year flood boundary No✓ ' Yes _ ..:t..
ervlous
s material exist In all areas observed Throughout the .
Doe at Ieast four feet of naturally occurring p ` t
area proposed for the soil absorption system?
th of naturally occurring pervious material?
Knot,what Is the dep
j 10 tc I have passed the soiPdW Caml evaluator examination approved by the
d V I -(da 1 is wP5 er1'ormed by me consislent with
1 cr.rli('y that on �T,r�lec(ion end(list the above nnalys p
n�[nvirontncnt� ;n I In Cmn, "17
OSTER VILLE
C.B
i 'PLAN REF. 284 75H
o
ZONNING: "RF--I Pp �` BAYS
j FLOOD ZONE: "C" wER Lo
1i GROUND WATER PROTECTION: "AP"
LT 22
PAR OF
\ TZ , \ ti AS LOT 28
o 10.8 10• �
0�
,� BENCHMARK.-
`s�j2, TOP OF CONCRETE BOUND
ELEV=100.O'(ASSUMED)
to
� cry 'cn� ;' •`� � �
TP
/ 1 / LOCUS MAP 0
_ �oN 84 --- 169.10 --------- L
30.0•_ o __I ���`-` _ _ N8 '44"W
0 1N t�v�- O
SLAB EL- 84 J-- —1___— _ ��—�� _ w _85.
W 48'44
ASP. DRIVF, W E-
TPA, g`�• lo.o. W _ - / •
cal0. _ ------- --- - C9"
��I w 2e.o•O / SITE & SEWAGE PLAN \a
LOT 25 o I
zV T OF '� 1• b o f " n �2 I PRO✓EC T L OCA T/ON
/ PAR I cl 4 .�H z a L /
AS._ LOT
8 S F o I 28.0• / / LOT 25 (PORTION) KIRK LANE
` , I AREA 4 CENTER VILLE, MA.
/
14.0 \ 34.0 0_ QOQ ` / ASSESSORS MAP 167 LOT 28-2 (portion)
n /
\- a Aso' APPLICANT.-
TION
p SWEENEY CONSTRUCTION
LOT of t40'32M YA NKEE SUR VE Y CONSUL TA N TS
P. O. BOX 265
0 f AS. LOT 28
5 _ -f �� , �g I REA=43,560E S.F _ UNIT 5, 408 INDUSTRY ROAD
0 MARSTONS MILLS, MA. 02648
9 \2 S PH.(508)428-0055 - FA X(508)420-5553
— �
''� N88'2 TALC ,• L 8. 77 _ ����`N OF y�
_ oa �y` SCALE. 1"=3d' DA TE: 5/4/00
0 66.51 ) I �� ,
h 6. =]
6+.44 (PLAN/ / WILLIAM
�/ LANE
�LIEBERMAN � REV.• 5/9/00 REV
Kjj?K L1
TED)
(NOT COSTR UC _ _ ssaNAt ENc, JOB NO. 52335S SHEET 1 OF 2
EL. =94'_ hJ
POP OF FOUNDATION
20' MIN.
10' MIN. CONCRETE COVERS s
� 4" SCHEDULE 40 P. VC
MIN. PITCH 1/8 PER FT. ,2"LAYER OF
EL= 84.0 FINAL GRADE EL 82.0' 1/8"-112"
MAX / i , CONCRETE COVER WASHED STONE
i / / i i ♦ „ , , / / / ♦ / / / XISTINC & &LN4L EL=82'
4' CAST IRON PIPE ('J, GRAD
(OR EQUAL, MINIMUM
Pl7CH 1/4 PER FT. CLEAN SAND 9
FLOW LINE MIN.
10'INVERT 1Z N 14" 0 0
13' °
o
EL.= 82.8 — 0'— 4• 00
GAS °
INVERT �6 SUM -2-LEVEL 000 0 0
INVERT BAFFLE EL.=8_0. 75 INVERT INVERT 2' EFF 00 0 0
80.25
81.0' 80.50' EL.= ' DEPTH 4 4
_ ° T°° ,
/ (7V BE PLACED ON FIRM BASE) DISTRIBUTION INVERT ° ° ° ° 15 °° °° °o ° � ° ° o = 7_a.o_
MLrHAN/CALLY COMPACTED OR 6" OF SMNE BOX 5 STANDARD BIO DIFFUSERS
EL.= 80_0 38 X 10.8
15QQ__GALLONS 719 BE WATER TESTED
,SEPTIC TANK TRENCH FORMATION
IF MORE THAN ONE OUTLET SOIL ABSORPTION
PLACE ON 6" S7bNE 3 4" 717
PROFILE OF sXED s7n D SYSTEM (SAS
4' ALL AROUND
SEWAGE DISPOSAL SYSTEM
BOTTOM OF TEST HOLE ELEV.__74'_
NOT TO SCALE PERC # 9169 NO OBSERVED WATER TABLE *DIC TO ELEVATION
FOR CONSISTENT SOIL
DATE OF SOIL TEST 6/2/98
WITNESSED BY: JRRY DUNNING (BOH) SOIL TEST PERFORMED BY DANIEL A. OJALA
SOIL EVALUATOR
OBSERVATION HOLE 1 ELEV,=_89_ OBSERVATION HOLE 2 ELEV.=_ 86 _
PERCOLATION RATE �2__ MIN./ INCH AT _5Z" INCHES PERCOLATION RATE �2 MIN./ INCH AT _40—" INCHES
DEPTH HORIZ TEXTURE COLOR OTT. OTHER DEPTH HORIZ TEXTURE COLOR M077 OTHER
" 0-2" 0 ORGANIC 0-2" 0 ORGANIC
2"-6" E LOAMY SAND. 10YR 772 2' 6" E LOAMY SAND IOYR 7 2
GENERAL NOTES
6"-34" B LOAMY SAND IOYR 518 6"-34" B LOAMY SAND 110YR 518
1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.R 34"-132" Cl MED. SAND 2.5YR 7 PERC 34'-144 Cl MED. SAND 12.5YR 714 PERC
TITLE 5 AND THE TOWN OF _BAFN,SLIBLE____ RULES AND NO WATER ENCOUNTERED NO WATER ENCOUNTERED
REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE.
2) ONE COVER ON SEPTIC TANK SHALL BE BRO UCHT TO DESIGN CALCULA TIONS:
WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12" NUMBER OF BEDROOMS . . 4
3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF GARBAGE DISPOSAL . . . . . . . . . NO
WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN TOTAL ESTIMATED FLOW
10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE Il0 CAL/BR./DA Y x _4__ BR.) 440 GAL/DA Y
USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. ( -10--
4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL REQUIRED SEPTIC TANK CAPACITY 1500 GAL
BE MORTERED IN PLACE.
5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH SOIL CLASSIFICA TION . . . . . . . . I
DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO INSTALL 5 STANDARD BIO DIFFUSERS DESIGN PERCOLATION RATE . . . . . < 5 MIN./IN.
OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. WITH FOUR FEET OF STONE SIDES AND EFFLUENT LOADING RATE . . . . . . . 74 GAL/DA Y/S.F.
6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR ENDS AND 15" BENEATH LEACHING CAPACITY (AREA X RATE) 447 GAL/DAY
IS TO CALL "DIG— SAFE" AT 1-800-322-4844 AT LEAST 72 HOURS 38' X 10.8' X 2' OFF. DEPTH RESERVE LEACHING CAPACITY . . . 447 GAL/DAY
r PRIOR TO COMMENCING WORK ON SITE. (38' X 10.8' X . 74)+(38'+38 +10.8 +10.8) X. 74 X 2)
7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS `
SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE.
8) PARCEL IS IN FLOOD ZONE __'C" .
9) LOT IS SHOWN ON ASSESSORS MAP _ 167 AS PARCEL _?8=z LPORTION) 5/9/00
SHEET 2 OF 2 JOB NUMBER__ 52335S --_—_