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HomeMy WebLinkAbout0137 STURBRIDGE DRIVE - Health 137 STURBRIDGE DR06-S' TERVILLE A= 166 100 � � o 0 o V 0 I TOWN OF BARNSTABLE LOCATION �� /�� e �v� SEWAGE # VILLAGE ASSESSOR'S MAP & LOT&L INSTALLER'S NAME&PHONE NO. '�s l cr SEPTIC TANK CAPACITY P 000 Ft 1 �� LEACHING FACILITY: (type) 41 Cali�2� �(�'+o n (size).// ,630 NO.OF BEDROOMS 3 BUILDER OR OWNER k v5ce�t PER MTTDATE: COMPLIANCE DATE: 4 07 S—O 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 G 'Pr �- I �3314�� I % 13- 1 L.O-Z i 3 - 5a `�-3 -so, No. �r �Jt! L ^ '" is Fee ®(/ r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYicatton for ;W5pogar *pztem Com5truction Vermit Application for a Permit to Construct( )Repair((upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 13 STv' -';bJ[ 2 Owner's Name,Address and Tel.No. Assessor's Map/Parcel /6/b//O 0 'S q b�V-+-6 r-,�c 'Dr� $f ae- Q31z�.•t It Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 8Z ioro STD ©!;—Le" Lc, 4' Type of Building: Dwelling No.of Bedrooms 3 Lot Size 10)896 sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3U gallons per day. Calculated daily flow gallons. Plan Date `olG o L( Number of sheets Revision Date Title Size of Septic Tank /60 0 �� Ely-4:7_ i:.y Type of S.A.S. 17-oT�i ' fo 16 �3t1 Description of Soil & 12c--s6 d ��► Nature of Repairs or Alterations(Answer when applicable) -r,,s(tr(( vtCv -tl ` �� �(Tea � e. totem x '3,c 3 (m 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 Certih- cate of Compliance has s d y d of H igned Date—JU-IC - 20 7 Application Approve Date 4 Application Disapproved for the following reasons Permit No. Date Issued 6 7 G / ""''1�"iA—"Iry.. • rZ�- 'Y. _ .-:_ ..4 .r _wi19� C. _ _ -..t +n < ry.. ,a .. .. . ♦•i l..a•ry i fyW..� AJ�'i.,,w}. , r,�?rY � . �:rw Al� '�,r _{ `.A., .tea-.• .- �� .K.It. 1rK No. t,� L ;^ c„r•"",�::, Fee v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS ZIpprication for ;Di.5pogar *pgtem Congtruction Permit t Application for a Permit to Construct( )Repair(k<Upgrade( )Abandon( ) ❑Complete System ❑Individual Component Location Address or Lot No. S/TL r'��r �• Owner's Name,Address and Tel.No. !! �C\l`C.y Assessor's Map/Parcel O C�//O O ��✓ S Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No..;_:. Type of Building: t '` Dwelling No.of Bedrooms 3 Lot Size JO O sq. ft. s` Garbage Grinder Other Type of Building No. of Persons Showers e yP g ( ) Cafeteria( ) Other Fixtures Design Flow 3 c) gallons per day. Calculated daily flow gallons.'. ' Plan Date 14^C 3'3L a Number of sheets Revision Date Title t Size of Septic Tank 110c O (i,,) C_x A 7,,�� Type of S.A.S. Description of Soil }) 0c e Nature of Repairs or Alterations(Answer when applicable) Pc e ��-C t e�Ict E). ( - _r_:, s c (t t c4 >< 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 d y d of H a igned Date fit/it C = 00 y' Application Approve Date tP Application Disapproved for the following reasons , Permit No. 26,__ Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the O -site Sewage Disposal System Constructed( )Repaired(Upgraded( ) Abandoned( )by .S K 6 r C( Z-t.. -k t t- at S t v h^ t C I R GS�cr {�c has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer r cC �1 c�\ , s l�t Designer a," c The issuance of this permit sha no construed a a guarantee that the s e it fu tion as esi ne .P / g ;y�j g t Date Inspector r P/ �� r� t r�C` � No. aoo T— Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS. 'igpogal *pgter^ Cougtruction Permit Permission is hereby granted to Construct( )Repair�P Upgrade( )Abandoo( ) 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:Constru do must be completed within three years of the da e of t ' t . Date: O Approved by 1 luvvu vi L..a ...,- �oFt"ETo,,ti Regulatory Services Thomas F. Geiler, Director BARNSPABLE, MASS. Public Health Division i639• �� Ar 019. Thomas McKean, Director 200 Main Street, Hyannis, MA 02601, Fax: 508-790-63,04 Office: 508-862-4644 Installer &Desiener Certification Form Date: - 7 g - 66 Designer: �o�nv. �e fie- �}ssac�� l�s Installer: ��ce Address: 1 t70 C`oJes �� Address: �Qna S t -- -- - �. was issued a permit to install a On Zv&K. N'1100' (date) (installer) septic system at 13 �e�s Osjr •k�tbased on a,design drawn by dated_vG_4a.OocS (designer) iv I certify that the septic system referenced above was roved changes installed such as lateral iarlelocation of the the design, which may inc to lude minor app distribution box andJor septic tank. ai changes (i.e. I certify that the septic system referenced above was installed relocationnof atny component greater than 10' lateral relocation of the SAS or any vertical of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. �y (Installer's Signature) JOHN` P. . . DOYL:E,In No.33S89 ere (Designer ignature) (Affix e� S a su0yUBLIC HEALTH �° CERTIFICATE PLEASE RETURN TO B ARNST B ISSUED UNTIL BOTH THIS FORM AND AS- OF COMPLIANCE WILL NOT BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Certification Form Q: Health,.Septic'Designer f n 1. 1 1--J EMTOJ& FOMNOATIo/J ' . 1 -_ .• (ram' Al . k�I ,p �•... Cam.\ ■I 1 1 �� . 1T _ - -�--ram,__t_=w•-�-_. .--___._ --- t. __ Ll -[�l �R Y • IY Y i t� N� L:3$f(;p �jT�(Z1llz•C rc TL BELOW. ! OKK GNG�E NYI Wr - `�' BYIt .t011. r3 r it • ( h 7 '~ 12 0 it ri 6 FAmt�y i S y !F ,Tl lvCr w A"5 i 1 f - TOWN OF 13ARNSTA13LE LOCATION 3 r ^ a 1/-46 d SEWAGE # CEO c �Z t _ VII.LAG ASSESSOR'S MAP & LOT "Q INSTALLER'S NAME&PHONE NO.� � -�►Ls r°��� ` j SEPTIC TANK CAPACITY ®(3®® !j C l !� _ .n��IT,on LEACHING FACILITY: (type) C B (size) NO.OF BEDROOMS 3 BUILDER OR OWNER gym` VAC-es-4 PERMITDATE` — �� COMPLIANCE DATE: 6 2 S O Separation Distance Between the: a Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet j 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 e h 41 z 01 , a, STATEMENT JOSEPH P. MACOMBER & SON, INC. 428-5546 Tanks -.Cesspools - Leachfields Pager 3 6 4—4 6 7 8 Pumped & Installed 4/2/9 9 Town Sewer Connections DATE P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 Ed....._Lacey. _ ...r ........ ._L.�............�.. `F ....................................................... 137 Sturbridge Drive ........................................-...............................I..................... .... ......................... ..... ...... .................................................. Osterville ,Mass . 02655 ...........:.... :..........................I........ ...--- ............................................................................................................................................................ Cash 12% interest every 30 days . TERMS: PLEASE DETACH AND RETURN WITH YOUR REMITTANCE $ w�,DATE INVOICC NUMBER/DESCRIPTION I CHARGES I CNUITS I UALANCE � ^^ `,uuVLWWSA,..-ilwuwttiwi�rd.wm � BALANCE FORWARD 9........... e. _t_e_d....._S.e..pa. ....__S.Y_t_e_m...................................... System consists of one _1000.......gal.lon......tank and ................................ ... ....... ..........................................................................._.............. _... _........... .................. .... . ............ ....... . one 1000 gallon precast l e a c h_'-.D_ _t_T he r e is 1-,' of .......................................... .............................................. ........ stone all around the leaching., it Plt is in ............... .. .......... g.......P...................-�.....................................................:........................ ----- ........ operating condition .Was e water is 46" inches below ....... ..... ... ..................................... ..... -- ...............................:.. ...... the invert pipe . Waste water has .never been . ..... :..... ....... ...._., ..................._................................................................................................................................... .... ................................ higher than it s now. $ 85 . 0 $ 85 . 0 ........................... ... ................ ......... ....... ...................... ....................... ....... ............................................. ...............................:.................. . .... ` ..................................... �� � JOSEPH P. MACOMBER & SON, INC. C� PIN HIS COLUMN IN THIS COLUMN C� V/ DATE: K#q On the above date, I Ins cted the ®� Y�Pe septic system at the above wWress,t This system consists of the following: J rtiv, i . 1 -1 000 gallon : UN 1 septic tank. � 819gn 2.' 1 -1000 gallon leaching pit . Based bn my InLROWCtlon, I certify the following conditions: ' 1 . This is a title five septic system. ( 78 Code 2. The septic system is in proper working order at the present time. 51GNATUR!7, ` Name _J_P M`acomber Jr_ / ; -, . C -- ------- acor�ber & Soi�- Inc . Company:_J. P.M__-- Address:_-8-e_c-,66----- -- -- _-Cente�rvil] e Llvlass : 02.632 Phone:---Sa&�7-5-333a__-_-__ THIS CERTIFICATION DC)�S NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tanks-Coupools-Leachfields Pumped L Installed Town Se.w_e:r Connections P 0.. 304 66 ` 'en 6rVi1Ie, MA 02632-0066 77 - 775-6412 , 1.1 Commonwealth of,Massachusetts 14 Executive...Off ice of Environmental Affairs 'Department of Environmental Protection Wtlllam F.Weld aahn,u Trudy COYe /lrgoo Paul Colluacl i 6.u"7 LL crow mor David B.Struhs • Co mn 64orwr SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION w . PropertyAddrroas 137 Sturbridge Drive Oster 'ille, Address of Owner. 3 Randolph Road Date of Inspootion: (If difforont) Name of Inapootor. Stoneham,Mass . 02180 Company Name,Address and Telephone Number. y CERTIFICATION STATEMENT I certify tbAt 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: I passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails ) Inspector's Slgnat � Date: c/,) �6 The System Inspectd submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. It 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: A] 9Y9 i PASSES: I have not found any information which indicates that the system violater any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: rL'G' One or more system components need to be replaced or repaired The system, upon completion of the replacement or repair, passes inspection. Indicate yes no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If'hot determined*, explain why not) !fL� The septic tank is metal, cracked,.structurally unsound, shows substantial infiltration or exMtratio ill _ a,.or tank failure is imminent. The system w Pars inspection if the existing,septic tank is replaced witk'a ponforming septic tank as approved by the Board of Health. ;revised 11/03/95) 1 One Winter Street a Boston, Mataachusotts 02108 6 FAX(617) 556-1049 o Telephone (617)292.5,1m 1, ...•td Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (oontinued) Property Addreaw 137 Sturbridge Drive Osterville ,Mass . Owner. Albert Scarta Date of Inspection: 6/6/9 6 BJ SYSTEM CONDITIONALLY PASSES (continued) r Sewage backup or breakout or h0h static water level observed in the distribution box is duo 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): broken pipe(&)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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: A/d 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: Ndrd+� Cesspool or privy is within 50 feet of a surface water d2dA<- 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 PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. ,LP The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. A10 The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and 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. 3) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 137 Sturbridge Drive Osterville ,Mass . Owner. Albert Scarta Date of Inspection:6/6/9 6 D) SYSTEM FAILS: • 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 contactbd to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an 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. Nd4kj Static liquilevel m the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in oesspe�o}4is less than 6"below invert or available volum8 is leas than W day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Q Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 1 Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. A20 Any portion of a cesspool or privy is less than 100 feet but greater than 60 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`iitrate nitrogen. El LARGE SYSTEM FAILS: 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 gpd 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: . )., 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(IQVPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system&hall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for Auther information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PropertyAddrem 137 Sturbridge Drive Osterville,Mass . Owner. Albert Scarta Date of Inspection: 6/6/9 6 e Check if the following have been done: ,Pumping information was requested of the owner, occupant,and Board of Health. one of the system oomponents have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ZAs built plans have been obtained and examined. Note if they are not available with N/A , The facility or dwelling was inspected for signs of sewage back-up. ZThe system does not receive non4anitary or industrial waste flow /The site was inspected for signs of breakout. ZAII system components,i-eJuding the Soil Absorption System, have been located on the site. ;F—`fie septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baMes or tees,material of construction, dimensions,depth of liquid,depth of sludge,depth of scum. he size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub. Surface Disposal System. (revised 11/03/95) 4 . 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 137 Sturbridge Drive Osterville,Mass . Owner. Albert Scarta Date of Inspection:6/6/9 6 . FLOW CONDITIONS RESIDENTIAL• Design flow: � Y • Number of bedrooms: Number of current residents: Garbage grinder(yes or ao):E e' _ Laundry connected to system(yes or no): 2 S Seasonal use(yes or no): 9 Water meter readings,if available: 9 Or Cf/� QJ 6 Last date of occupancy: ,p' COMMERCIAL NDUSTRIA - Type of establishment: Design flow: .�gallons/day Grease trap present: (yes or no)" Industrial Waste Holding Tank present: (yes or no),IY'. Noa sanitary waste discharged to the Ti lee 5 system: (yes or no" Water meter readings,if available: Last date of occupancy: OTHER(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING WORDS and source of information: System pumped as part of inspection: (yes or no) If yes,volume pumped: I / gallons / Reason for pumping � C i/t/7t B�.Ylf f TYPE Off'SYSTEM Septic tank/distvib%Uca4erlsoil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed(if known)and source of information:'0 Sewage odors detected when arriving at the site: (yea or no) (revised 11/03/95) 6 L SEPTIC TANK: 1—loAOC"•j9l�e'i!/ 7,4—Alt (locate on site plan) Depth below grade:_ Material of construction: oncrete _metal _FRP —other(explain) Dimensions:_ .Q Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:,O Scum thickness:_ _ Distance from top of scum to top of outlet tee or baffler Distance'from bottom of scum to bottom of outlet tee or baffle. I Comments: (recommendation for pumping, condition of inlet and outlet tees�r baf'le�. deptMf li uid IPvfI io relation to ou�j invert, structural inte ray evidence of leakage, etc.) ;pump arirru& y i . ar ppage 1 s�o sal is pre s 8 1xr16t• & outlet tees are in place -The sep c a 11 s n ere is no- evi ence or—leakage. o re irs n e a .. a presen-G tifffu. GREASE TRAP.AOA/P-- (locate on site plan) Depth below grade:;' Material of constr;.,rtion�woncrete _metal _FRP —other(explain) Dimensions, Scum thickness % VIIT Distance from top yr scum to top of outlet tee or baffle:-A4 Distance from bottom n1 chum in bosom or pullet tee or baffle: Comments: (recommendation for pumping, condi—n of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural tegrity,in evi ence of leakage, ✓e/lc i _ . ; ; i • 6 ya (revised 8/15/95) 6 1 ; bdateruu 01 0onstruction4Zatconcrete metal FRP other(explain) - /U Dimensions: A1� Capacity: ors Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) 4�1�/syl,�il DISTRIBUTION BOX:ApIAe, (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if leypl and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box,etc.) PUMP CHAMBER:�,o,e_ (locate on site plan) Pumps in working order:(yes or no)4 Comments: . (note con' ion of pump chamber, condition of pumps and appurtenances, etc. (revised 11/03/95) q Owner. AIDOrt ocarTiat ;, - Dato of I'nspooUoW6/6/96 SOIL ABSORPTION SYSTF—%A (SAS):,Z s t (locato on sit4 plan, if possible; excavation not ll quut+i, Uut utuy tM1 upprvxutAtti by non•intrusivo methods) If not determinod to be proaent, axpluut. Type: loathing pits, number: leaching chambors, number: lenchtn8 gallarios, number: lonching trenches, number,length:_(%- leaching fields, number, dim totu7: ____----_.-.- overflow cesspool, nttatber: 1 Rants: (note co di t on oC oil, ,gilt' of h u fax; rv. le'vi of nding condition of ve tation,etc.) ef'ium sand To fine san( 10 signs o hydraulic failure or pon ing, i is ry. vegeot on is normaj— o repairs needed at the present time. CF99POOLS:dMd' A' (locate on silo plan) , I. Number and configurA' h Depth top of liquid tDepth of solids layerDepth of scum layer:Dimensions of cesspoMaur" of construIndication of ground _—_— inflow (cesspool must be pumped as part of utspvctionl_ l� Cows ( ow condition of soil, s gas oC hydraulic fuilure, level of pondirg, condition of vegetation, etc.) lid �f PRIVY:(locate on situ plan) 1 Material of oonstruction:��--- ' Dimensions: Depth of solids: Commo ts: ( condition of mil aid^ns o!hydraulic failure, level of goading, condition of vegetation, etc.) ' • l I, i l .(revised 11/03/95) b s' P i kkt S: tq >L S T 'f L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued)g PsopertyAdd,,= �',137 Sturbridge Drive Osterville,Mass ,`. Owner. Albert Scarta r Date of Inspection: 6/6/9 6 SIOMH OF SEWAGE DISPOSAL SYSTEM; • inch" tied to at least two permanent references laadmarka or benchmarks locate all wells within 100' Centerville Osterville Marstons Mills Water Company Lj toe • S i DEPTH To GROUNDWATER Depth to groundwater +feet method of dete:minatioa or approximation: No water encountered at 12 No plan on file. (revised 11/03/95) �e l r W � i THE COMMONWEALTH OF MASSACHUSETT DEPA RTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department' s qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15 .340 and Section 13 of Chapter 2 1 A of the General Laws. Issued by The Department of Environmental Protection. June 8, 1995 Acting Director of the ' •ion of Water Pollution Control SUBSURFAU '1,0WN OF Barnstable NJARD OF HEALTH -TYPE OR PRINT CJ.EAnLY- PROPERTY INSPECTED STREET ADDRESS 137 Sturbridge Drive Osterville.,' Mas s. ASSESSORS MAP , BLOCK AND PARCEL # OWNER' s NAME Albert Scarta PART D - CERTIFICATION NAME OF INSPECTOR -Jose-ph P. Macomber Jr.. COMPANY NAME J.P.Macomber & Son Inc. COMPANY ADDRESS Box 66, Centerville ,Mass . 02632 S t Town or City State-zip CERTIFICATION STATEMENT I certify that I have personally inspected the sewage dispos�j system at this address and that the information reported is true , accurate , and complete as of the time of 'iinspection . The inspection was performed and any recommendations regarding Upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of oil- site sewag,e disposal systems , Check one : XXXXXXXX System PASSED The ingpection idlich I have conducted has not found any information which indicates that tile system fails to adequately Protect public criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED The inspectio'n which I have conducted has found that 'the system fails to protect the public healLh and the environment in accordance with ritle. 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . One copy of this certification inust be provided to the OWNER, the BUYER ( where applicable ) and the 130ARD OF 11BALT11. * If the inspection FAILED , ke ^^— ' within one yeur of Lhe dot rnf t»~»�r or «��r«t»r shall �P�rod� � �b� m�otem Otherwise �o provided in Jr0 CHD»e 5inoPect1»o ' unless allowed or required a.. - OWN OF B a STABLE G, LOCATION� � � , 2 SEWAGE# VILLAGE ASS SSOR'S MAP&LOT NAME&PHONE NO. SEPTIC TANK CAPACITY rA4� LEACHING FACILITY: (type) l ��� o% (size) NO.OF BEDROOMS BUILDER OR OWNER � � ` ATE: �'� CON911KNOE DATE: �� Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 xist within 300 fee f leac i`g�e�i�� ,�� Feet Furnished b !!�� x ray ._---=-. ,� _ . _ .. - r --,�s� 1� �. �,�, , I�, vim^- i No....:�.". ./.... ' Fimic..... ............... THE COMMONWEALTH OF MASSACHUSETTS OF............ .............;4 1p�P100 BOARD�ef-H-E- TH 'b I� i i Application is hereby made fora Permit to Construct (�) or Repair ( ) a ry dual Sewage Disposal Syst t: .. .... ... ............................... J Loca n,=Add _ Lot No. • ..... •. ....•...................................... .............................. ------•. r Address �-/� ..................-•---- .. ................ •-----------------•----••----.--_-____--____--__--- -•---•--- Installer Address Type of Build'n // �' Size Lot Sq.`feet aDwelling N"No. of Bedrooms............. _....--....Expansion Attic ( ) Gaf age"Grinder pa Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria Q' Other fixtures --- ------ Design Flow....................t�..... .............gallons per person per day. Total daily flow.--_-- .._ W � �----------------------------gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter......--........ Depth................ x Disposal Trench—No..................... Width.................................. Total Length.................... Total leaching area..............._....sq. ft. Seepage Pit No..................... Diameter.---................ Depth below inlet.................... Total leaching area........_.........sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit......_.._.._...._._ Depth to ground water....................... Test Pit No. 2................minutes per inch Dept of Test Pit..--.--............. Depth to ground water...................... -;1 __-•-------------------- / O Description of Soil---------- x - •••. U ------------------•--•---••-----------------------._._...------••------------•---•-------•-•--•-----------------------------------------------------------------------------•-----••--......-•--------- W •---•-----------------------------------------•---------------- ----------••-••---•-----•---------------------------...-------•----------......--•--•--•---------•---------------------.._...........--- UNature of Repairs or Alterations—Answer when applicable................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of heAlth. igned---- ...... Da Application Approved By........._ ---------- - ^�-- ....... Application Disapproved for the following reasons------------------------------------ •. ..................................................................... ...............................•..-•---------•--•--•------------------•---------...........----------------------•--•--•-••-•---•...------------..._.... . ....................................... Date Permit No.......................................................... Issued --- / zD ............. ---------------------------------- ---------------------------------------------------------------------- No....., : .�.... FEE...., ,. ............ THE COMMONWEALTH OF MAS!;ACi-USETTS BOA RyD "`"H- Y H ..Ap rliration for %Vviial Works otrurtion Prruat Application is hereby made fqr a Permit to Construct ) or Repair ( ) a n ividual Sewage Disposal Syst t -• M ........ ..... ................................. Loca n-Ad s _ :. Lot No. Address a ✓ /.f.. f �.� ! ................................. Add s.............................................. Installer re s Type of Bulldi .•� = Size Lot: q.'feet Dwelling-inff No. of Bedrooms..... ........ ......................Expansion Attic ( ) Garbage Grinder ( ) aOther-Type of Building __:............:............ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures =------------- ...................................--•-•-•-•-......-•------•-----•-•--- r�y W Design Flow.:......:......... /"T --.-.-.-.-.-_-..gallons per person per day. Total dailyflow...... r� �"'' .............gallons. '9' Septic Tank—Liquid capacity gallons Length.... ......._•Width._......_ ..._ Diameter______ ________ Depth... _......... W Disposal Trench—No..........:....:...: Width..,:.::_:::-....._..._. Total Length..........._........ Total leaching area....._..._-......._.sq. ft. x 3 Seepage Pit No..................... Diameter ... ...... Depth:below inlet........ Total leaching area---.__............sq. ft. Z Other Distribution box (, )> Dosing.tank Percolation Test Results Performed by. . ._..:__ ____ ____________________ Date_.__.•_-.__•__------------.._..._-_-___. a . Test Pit No. 1................minutes per.>rich ,Depth'of:;Test Pit ..._..._..._... Depth to ground water........................ f Test Pit No. 2................minutes per inch•; Dep ofj6t—Pit ......_........ Depth'to"ground water........................ a' ----•-• ... D Description of Soil----------------------------- . -------- U .............................-................................................................................................................---•..._........._..-- =----------•-------------....-- ------------------------••--•---•-•----......-----------------------•----•-•--•-••-----. ------. ----------•- -----••--.....--•-------- U Nature of Repairs or Alterations—Answer•when applicable .__._._ .,__.__ ...R ................................................ Agreement The undersigned agrees to install the aforedescribed ,Individual Sewage Disposal System,in accordance with rthe provisions of Article XI of the State San ode= The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the board of h lth. igned __ •• Da Application Approved B Application Disapproved for the following reasons---------------------•-•.......--•- --- •-•-------•..................................... ---•--•••-•..........--•--•-•----•-••-------------------------------•-•-----=----.......--•••---••--......----•-----•----------•-----...--••-----•------•---•--••---•--......---••--••••.....-----•...... Date PermitNo................ :::.:.:.........: :..... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS " BOARD OF HEALTH .."".. /... � ........ OF... ice.... {. . fit THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.............. ...---•..-•- -----............. = e- -_ . Installer at. . _- r-:. I, ,.-� r - .� / (-'� f! .......................••-•---•-----...._....,._r-.._.r .,.. .._..... �l _.._v - has teen installed"in accordance with the.p ovisions of Article XI of The State Sanitary Code as described,in the application for Disposal Works Construction Permit No.___�------ : .......... dated____ . !f f .-- ....... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT RE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...............................................••---...---...::_...-----••--_... Inspector........................•1 THE COMMONWEALTH OF MASSACHUSETTS i . BOA:RD OF HEALTH "J..9�° OF.. '/1".- .tt 7.................................... No.. ''� FEE... ............... --- Rapti V.,orks Omit Permission is hereby granted... . .. . ............ --- !.. .... ...... �• :.......................-•- to Construct ( pr Repair ( �) an Individual Sewage Disposal System � at No.....'' .. ,,, 4/,Eck ............ ....r ' � . ... stfgr as show,ri`on the application for Disposal Works Construction Permit No____._.____ _✓.......... ............... oard of'Health r DATE.. ...... ......... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS: t ' r, J VVV " r / v .� L_ 10 r r� L r" 7 30 G el9tfN S'r/46,�,E G'04)AI7 Yr 62 , e&Al 5�57 13 149 ocr; /5?6.0 • - V CAL AI a .. :T411 , �l o WA6 S L R c M X r � � M _ /_ S-y�p r:.. :. 3 M A _ x w S' .vIP l 2 S V M Jt/ NER E�9 F G G V 3 M �t P_LEI/EL , 1N V. 48 2 8 — _ Y /n�Y D R 10 ! /NV 8 D v ND '� 5 G �f ., / g r 2 T� 4 1 R 4 2- E 2 FF. .b PT N D . 5 0 IV E 4 1 p DEL 6 r s R E � T oN T : .., A E OD 6 L. 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