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HomeMy WebLinkAbout0043 SUNSET POINT - Health 2,'41SUNSET POINT, OSTERVILLE A=; .051011 t 0 L L TOWN OF BARNSTABLE LOCATION `� �u n(a e,� ®�✓� 1 SEWAGE# R�` S Ler<j VILLAGEQ iI LC "Cox i-'&L I ASSESSOR'S MAP &LOT—57/"// INSTALLER'S NAME&PHONE NO.G�/�MOU-S SEPTIC TANK CAPACITY 1,26 LEACHING FACILITY: (type) 41— 1ngc 4t-7;1n S (size) 010 x LI7 NO.OF BEDROOMS BUILDER OR OWNER �E��✓an/ PERMITDATE: 1-3 �COMPLIANCE DATE: r 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 exist within 300 feet of leaching facility) Feet Furnished by t �5 'F �p e Sg F--- H 7----I TOWN OF BARNSTABLE LOCATION -1 ✓ C ��n1� - SEWAGE # VILLAGE ASSESSOR'S MAP & LOT t ®� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY l LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE 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 exist within 300 feet of leaching facility) Feet Furnished by �GCQ� VIM k r S A le3B"Q'Lse� a Li PA q F bl k. &for C_EL_ kk No..... Fizz ...... -k THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for UhnVaiial Works Tomitrurtion ranfit Application is hereby made for a Permit to Construct O or Repair an Individual Sewage Disposal System at: f7N VA 'TE ......... . x)..i ............ . ..........C.k ocation-Address ........ A&A.... .............................. .�n.sy w&E-T .. ................................................ Owner Address . .......... ........................... ... . ... ...................................................... I ............................................ �s aller ns Address QQ U Type of Building Size Lot----- ..........Sq.--*eF Dwelling— No. of Bedrooms............ _-------------------------Expansion Attic (A0 Garbage Grinder Other—Type of Building ---------------------------- No. of persons---------------------------- Showers Cafeteria P4 Other fixtures ----------------------------------- ------------------------------------------------------I...................................... 6-1.............. Design Flow........_.5.6_0_1_50Yo---gallons per person per dy. Total daily flow------ .... ......gallons. 04 Septic Tank—Liquid capa6t.VV�_ gallons Length Width-S-78'.' Diameter W . Disposal Trench No- -------------------- Width___---.-__--___-.... Total Length..__..-_.___......_. Total leaching area....................sq. f t. Seepage Pit No..................... Diameter..............___.__ Depth below inlet..._.........._..._. Total leaching area..................sq. f t. ZOther Distribution box Dosing tank ( ) I(N 0-4 -K_ V-G t Percolation Test Results Performed by.......SAI X .*---1\J.............. Date.... ........ Test Pit No. I... -minutes per inch Depth of Test Pit----il.�........ Depth to ground water.... 44 Test Pit No. 2..../_Z...minutes per inch Depth of Test Pit.....&.......... Depth to ground water.... ............... P4 ................................................................... ---------*---------------*---------------*-------- 0 Description of Soil......O—A...NO-0... ....SU 6'�, �4 ---- -- ----- -----------------------------&7---A.1......VA_r=.0------- ......:n 10m r--Q._—.4.. ......................................................... ........... ....................................................................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable--------------- ................................................................................ ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the- system in operation until a Certificate of Complia has be issue by and of health. Z oo3 9 Signed .....1.�-&. .7............... ...... A�D ---------------- .......... -- ----------------- . ....... . ...... ..... Application Approved By ----------------------------- ..................................... -- -------------------------------- ............ zlo�... .... ----------...... ---/1e ------ Application Disapproved for the following reasonf: ........................................................................................................................................ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------- Dace 1?(A5'_ Issued --------------------------------------------------------- Permit No. ..............................IS--74-------------- Date ------------------------------ ------------------------------ a d2C.0 L_ t ' No..... � o FEs....... ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ap,pliratilan for Di_npnittl Wnrk,i Towitrur#iun rami# -t Application is hereby made for a Permit to Construct (�(,) or Repair ( ) an Individual Sewage Disposal System at:,' L. - - ,5. .`r ©-�.tiZ C' --- s �� -� cz �c2. ..------- ..............................� `/ 111 ..... Addre qS----------------------_........-•-......__.._. .- . --------------------......_._..-• -- --..........-••^-•------•-•-. -----------•-• ........ Owner Address ............................•-----.......... Installer V Address IType of Building �( Size Lot.___.____1_S.. q.-fe-ef= ,.� Dwelling—No, of Bedrooms-"__•___"-__.fir___--_.-_-_"______________....Expansion Attic Garbage Grinder ( ) '14 Other—T e of Building No. of persons............................ Showers — Cafeteria 04 Other fixtures ............................... . . _ W Design Flow........... 1 .5K*...gallons per person per day. Total daily flow...... ......gallons. WSeptic Tank—Liquid capacityl:..57 gallons Length__-k 7jG__-_ Width_.,:; --_9___ Diameter--.-=........._. Depth.s-6..« 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.......!3A_lt..T: _1z.-._.`t.. �..�.... -_- Date...2t/Z9/.g ......... aTest Pit No. I_ _.minutes per inch Depth of Test Pit-----i ---------- Depth to ground water.... gN.E... li Test Pit No. 2....Z.Z...minutes per inch Depth of Test Pit._._!.......... Depth to ground water....-------------- P -----------------------•---------------------•-•---•--...............•-• -•-----------•.....................----:------._...-•------------------ D Description of Soil----- \.ell- ` L 'A � `eta _ !_ s_ ,._ a. ` ........AtV-.t-7•-............... V W UNature of Repairs or Alterations—Answer when applicable----.----------------------------------------------------------................................. r Agreement: l The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia ce has been issued by,the�-board of health. Signed ---- - --- ----- ----- ,,- . .�C .�= �'..` ......------------------- �'� . 4" Application Approved BY ....................... .. .------+%lil-�l ---------------- ll--- ------------------------- -----�-�-- -------- .......... ./D,t.e... Application Disapproved for the following reasons- ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------ 7 — Date Permit No. �r � .. ........r.: �� ------------- Issued ............................................................. Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ter#ifiett#e of C amplian>ce THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by -------------------------------Z.---< a ,---------------------------------------------- ---. ---------------------------------------------------.... . ---------- m�t�uet � � at ............ . ��'........... U -r�....... 'c�../_<:t - f.... (/CJ.I. CP - Z has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .....2- S..------1.-�.7 dated ....ja�c�- ���_7�........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �. DATE--------. '-'-'.... ��' .... ....... InspectorG "��- ----------------------------------- --------------------------v --- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ropaoal 1vorkii Tuni#rudion "Urrntit Permissionis hereby granted............................................................................................................................................. to Construct (,.CT or Repair ( ) an Individual Sewage Disposal, System at No..... `p"-!�!_cl- ------/� t-k/'lJl/ ---------------=-----•---•--•--........... Street Sa� as shown on the application for Disposal Works Construction Permit No.��_�.__.... Dated......../_2_ �.T--------------------------------"---------•----------•-- Board of Health DATE ---- ----- -� • --•-•............................... FORM 38E08 HOBBS&WARREN.INC..PUBLISHERS ~ 1 Commonwealth of Massachusetts Executive Office of EA roinnental AlTairs Dept. of Environmental Protection • One winter Street Boston Ma. 02108 .John Grad ' '. •D.KP. Title V Septic Inspector P.O. Box 2119 Teaticket,MA 02536 WILLIAM F.WELD 5 - 564- 13 Governor9) ARGEO PAUL CELLUCCI Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR PART A ter. A I�,��j CERTIFICATION AUG' 4 wa 1 1998 Property Address: 43 Sunset Point Oyster Harbor 1 `t � Address of Owner: ` Date of Inspection: 7/28/98 (If different) a z/ Name of Inspector: JohnOraci Bemon I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310LCMR 15.000) Company Name,Address and Telephone Number: 16 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: x Pasgubmita This Inspection Is based on criteria dented In Title V _ Conditionallyes code 310 CMR 16.303.My findings are of howthe system Is performing hrtthe thne of the Inspection.My Inspection does — Neealuation By the Local Approving Authority not lmpyenywarrentyorgusrenteearths longevity o/the F81i septic system and any of Its components useful life. Inspector's Signature: Date: s1s198 The System Inspector shall of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared-system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of.Environmental Protection: The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. - INSPECTION SUMMARY: Check A, B, C,or D: r A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: 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 "not determined",explain why not. The septic tank Is metal;unless the owner or operator has provided the system-inspector with a copy of a Certificate of — ;CoMpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exhitration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised04127l97) s- 'One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.A , CERTIFICATION (continued) Property Address: 43 Sunset Point oyster Harbor a Owner: Bernon Date of Inspection:7129198 J , — Sewage backup or.breakout.or high.static water level observed.in`.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced , obstruction is removed distribution box is leveled 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 pipes)are replaced r obstruction is removed 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 the public health,safety and the environment. - 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT-THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT 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 of water supply or tributary to a surface water supply. — The system has a septic tank and soil absorption system and is within a Zone t of a public watersupply well. — 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 the SAS is less than•100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must Indicate either"Yes"or"No"as to each of the following: I have determined that the system violates'one or more`of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage in 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 — cesspool. — — SAS is in hydraulic failure. (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 49 sunset Point oyster Harbor Owner: Bernon Date of Inspection:7128198 D]SYSTEM FAILS(continued) • s Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 112 day flow. + Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). . . Numbers of times pumped 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. Any portion of a cesspool or privy is within 6 Zone 1-of a public well: r 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..If the well has been analyzed to be acceptable,attach.copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.' E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: - fi The following criteria apply to large systems in addition to the criteria: _ The system serves a facility with a design flow of 10,000 god or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions'exist: Yes No the system is within 400 feet of a surface drinking water supply; the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a* public water supply well) The owner or operator of any such system shall 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 further information. ' (revised 04127)87) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM " PART B CHECLIST Property Address: 43 Sunset Point oyster Harbor Owner: Bernon .. Date of Inspection:7128191t t i Check if the following have been done:YOU must indicate either"Yes"or"No"as to each of the following: ti • _c_ — Pumping information was requested of the owner, occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the 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. x As built plans have been obtained and examined. Note if they are?not available with N/A. x The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. -x— — The site was inspected for signs of breakout. x All system components, excluding the Soil Absorption System,have been located on the site: x The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions, depth of liquid,depth of sludge,depth of scum. x _ The size and location of the Soil Absorption System on the site has been determined based on , The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is — — unacceptable)[15.302(3)(b)1- m r t - (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _ PART C w SYSTEM INFORMATION Property Address: 43 Sunset Point Oyster Harbor Owner: Bernon Date of Inspection:7128199 FLOW CONDITIONS , RESIDENTIAL: Design flow: 550 g•p•d./bedroom for S.A.S. f e Number of bedrooms: s Number of current residents: u Garbage grinder(yes or no): Yea Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No _ Water meter readings,if available:(last two(2)year usage(gpd): rda Sump Pump(yes or no): No Last date of occupancy: nla COMMERCIAL/INDUSTRIAL: " Type of establishment: Ne Design flow:0 gallons/day Grease trap present:(yes or no) to " -A Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No.. Water meter readings, if available: nra Last date of occupancy: rd_ OTHER:(Describe) N= Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: nla System pumped as part of inspection:(yes or no)No If yes,volume pumped:0 gallons ; Reason for pumping: Na „ TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system' Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes,attach previous inspection records, if any) - I/A Technology etc,Copy of up to date contract? Other APPROXIMATE AGE of all components,date installed(if known)and source Information: 1996 Sewage odors detected when arriving at the site:(yes or no) No (rev1aed04127197) •. " x SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM „ PART C SYSTEM INFORMATION (continued) Property Address: 43 Sunset Point Oyster Harbor u Owner: Bernon Date of Inspection:7128199 SEPTIC TANK: x (locate on site plan) Depth below grade: V Material of construction:x concreate metal FRP Polyethylene—other(explain) If tank is metal, list age nia . Is age confirmed by Certificate of Compliance N� (Yes/No) Dimensions: t.t0•8••H5•r•w5.8,. T Sludge depth:2" Distance from top of sludge to bottom of outlet tee or baffle: 32^ Scum thickness Distance from top of scum to top of outlet tee or'baffle:8" p Distance form bottom of scum to bottom of outlet tee or baffle:-17'` . How dimensions were determined: Measured '; c Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) I - Septic teak and all components are structurally sound and runctioning property.Recommend pumping every two years. GREASE TRAP: (locate on site plan) Depth below grade: rda Material of construction: concrete metal FRP Poly ethylene_other(explain) Dimensions: rda Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle:We Date of last pumping;,r, Comments: A, (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level.in relation to outlet invert, structural integrity, evidence of leakage,etc.) rda BUILDING SEWER: (Locate on site plan) Depth below grade: re^ p Material of construction: cast iron X 40 PVC other(explain) Distance from private water supply well or suction MOO- Diameter' nia_ . Qe'mments: (conditions of joints,vehting,'evidence of leakage,'etc.) (revised 041271 7)" SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C v SYSTEM INFORMATION (continued) Property Add ress: 43 sunset Point oyster Harbor c Owner: Bemon Date of Inspection:712819tt TIGHT OR HOLDING TANK: (locate on site plan) ; Depth below grade: rda Material of construction: concrete metal_FRP_Polyethylene_other(explain) ' t Dimensions: nfa 4 Capacity: nla gallons Design flow: Na gallons/day Alarm level:era Alarm in working order?—Yes No x Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) rda d; DISTRIBUTION BOX: x (locate on site plan) Depth of liquid level above outlet invert: Liquid level with bottom ofpipe Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.) D$oa la structurally sound. - PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no)No - Alarms in working order(yes or no)�. . Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) rVa (revlsed 04R7197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 43 Sunset Point Oyster Harbor Owner: Bernon Date of Inspection:7128195 SOIL ABSORPTION SYSTEM(SAS):x ' (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: rda Type: leaching pits,number: rda leaching chambers,number:rrra . - leaching galleries,number: rda _ leaching trenches,number,length: 4 leach trenches 26'x47' leaching fields,number,dimensions:No overflow cesspool,number:rda Alternate system: nra Name of Technology:_nra Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) Sae le functioning property. CESSPOOLS: (locate on site plan) Number and configuration: rai Depth-top of liquid to inlet invert: nra Depth of solids layer: nla Depth of scum layer: No r Dimensions of cesspool: nla Materials of construction: rda Indication of groundwater: nla inflow(cesspool must be pumped as part of inspection) t' n1a Comments:(note condition of soil,signs of hydraulic failure,level of ponding;condition of vegetation,-etc.) nra PRIVY: (locate on site plan) Materials of construction: nre Dimensions: nta Depth of solids: rda Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) nra (revised 04ft7197) • � s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 'PART,C SYSTEM INFORMATION(continued) 43 Sunset Point Oyster Harbor f Bernon 7128198 SKETCH OF SEWAGE DISPOSAL SYSTEM: , include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house)t a,) Aar irevrnedoa27197i, Pay 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 43 Sunset Point Oyster Harbor Bemon 7128108 Depth of groundwater T+ s Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. x Observation of Site(Abutting property, observation hole,basement sump etc.) Determine it from local conditions , Check with local Board of Health Check FEMA Maps Check pumping records ` Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) Ground water to be determined by hand auger at 7+feet no water encountered (rev1eed04)2TM7) ]Palo 10 of 10 ASSESSORSMAP °s� �r a ii PARcallo- ----------------....- BOARD OF HEALTH TOWN OF BARNSTABLE Application-for Vel[ Conetructionpermit Application is hereby made for a permit to Construct (v), Alter ( ), or Repair ( )an individual Well at: E,-v 7--------R - ,-----09 tW 0,A - --------------- Location — Address Assessors Map and Parcel /Ij F - - ------------------------------ n Owner Address - - -----------------_----------------------------------------- - Installer Driller Address Type of Building Dwelling------------------------------------------------------------------- Other - Type of Building------------------------------------- No. of Persons------------------------------------------------------ Typeof Well—�/--- ,-- ------------------------- - - Capacity------------------------------------------------------- ----- Purpose of Well `_'_------------------------------------ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Signed A _ -- - -- -- -- - A- ------------ date Application Approved B — - date --------------- Application Disapproved for the following reasons:----------------------------------------------------------------------------------___------____------ ---------------------------------------------------- -- ------------------------------------------------------------------------------------ date Permit No. - ~'--� _'— {—--------------- Issued ---'1-�'j - ------- ---- --------------------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO qRTIFY, That the Individual Well Constructed ( "j Altered ( ), or Repaired ( ) by------- ---------------------------------------------------- ---------------------------------------------------------------------------- Installer at---Z` sS� 5 -has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit N . --!*----9 --- - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----- ---—— --- ------- Inspector--------------------------------------------------------------------------- c.)C� No.-'K--- ---- Fee--------------------�-- BOARD OF HEALTH TOWN OF BARNSTABLE Y Application-*rVe[C CCon5tructionPermit Application is here made f lr a permit to Construct' ter ), or ep it ( )an individual Well at: -----�5��/v.�G� — ---- -------------------------------------= - -- - Location — Address I A `ssors Map and Parcel 1 M! • o w o.,� - - - - ----------------------- --------- Owner { ! Address 1 { /+a G ,�►U - ---_---------------------------------------- .,� ��-------------- -------------- Installjintall Duller Address Type of Building Dwelling----------- -----------------z------------------------ Other - Type o ---------- '—INo.�Z'er"sons----------------------------------------------------- Type of Well—��-- ---------- Purpose - ------ - ------ - Capacity-- - - - - - of Well-_!_�!� ------------- - - r- Agreement: The undersigned agin tall the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Boe 1tN�rivateWell Protection Regulation - The undersigned further agrees not to place the well in operat Certi u'al�'� Compliance has been issued by the Board of Health. oz.__ G- date /DI Application Approved B ,� �7� -/-- ------------ ---------- ----— ------------- date Applic iti`oti-Disapproved for the following reasons:------------------------------------------------------------------------------------------------ --- - ----------------------------------------------- --------------------------- -- - --------------------------------------------------------------------------- date Permit No. - !"— -- -------------------- Issued------� �-�-�-- ----------------------- date BOARD OF HEALTH TOWN OF BARNSTABLE r - C ertif sate ®f Comp[iante = r THIS IS TO CERTIFY, That the Individual Well Constructed ( "1! Altered ( ), or Repaired ( ) by-------- ------------------------------------------------------------ ----------------------------------------------------------------------------------- Installer atz4zi� �— --- ----------------------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of of Health Private Well Protection Regulation as described in the application for Well Construction Permit Nc9. ---_-- Al "J- bated "',;'W*;C(C- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------- - —--— — - ---- - Inspector------------------------------------------— - - ------------ ��.t��-.ram-��.o. BOARD OF HEALTH TOWN OF BARNSTABLE Yell Con5tructionpermit No. ICY_____ �=" Fee Permission is hereby granted A J c,:4�,�---------- -- ---------------------------------------------------------------------- to Construct ( 9 Alter ( ), or Repair a Individual a at: No. �J Su�vS i Street as shown on thth'e;application for a Well Construction Permit No.---------,r' -'� - i --------------------- Dated-- t ------------G-' - �, Board of Health DATE--------=-------------��--=------- �e Is Cc�u<T s a Q y3 ' Su-S e i p r S� -ENVIROTECH LABORATORIES, INC. J MA Cert. No.: M-MA 063 449 Rte. 130 ' Sandwich, MA 02563 (508)888-6460 . 1-800-339-6460 FAX(508)888-6446 _ CLIENT: Mr. Bernon LOCATION: 43 Sunset Point ADDRESS: c/o DA Scannell Osterville MA SAMPLE DATE: 10-3-96 COLLECTED BY: D. Pennini DATE RECEIVED: 10-3-96 TIME: 12:00 LAB I.D. #: E10073 JOB TYPE: New Well SAMPLE I.D. #: DP 1 Irrigation WELL SPECS. : 21' Deep RESULTS OF ANALYSIS: Parameters Units Recommended Limit Result pH pH units 6.0-8.5 5.52 Conductance umhos/cm 500 155 Sodium mg/L 28.0 18.4 Nitrate-N/Nitrite-N mg/L 10.0 0.01 Iron mg/L 0.3 0.56 Manganese mg/L 0.05 0.071 COMMENTS: Iron and Manganese are not a health hazard, but may cause taste, staining, and odor problems. Low pH indicates high corrosive characteristics. YES WATER IS SUITABLE FOR IRRIGA PURPOS FOR PARAMETERS TESTED. XXX Date l R ld J. aari borato Director IT = Less Than ZONES , DESIGN DATA SOIL NAME TIDE RANGE FLOOD INSURANCE RATE MAP 2 X 2 LEACHING TRENCHES SINGLE FAMILY- 5 BEDROOMS RESIDENCE F-1 AQUEFIER PROTECTION COMMUNITY PANEL 2500010018D 4" DIAMETER DISTRIBUTION LINES OYSTER WEST BAY MINIMUMS A.P. CdB MIW-29 O-2 MAP REVISED: JULY 2,1992 HARBORS AREA = IMUMS S.F. CARVER COURSE SAND REMOVE UNSUITABLE MATERIAL FROM BENEATH SYSTEM IF ENCOUNTERED WITH GARBAGE GRINDER LOCUS' ISLAND N FRONTAGE = 20' 3-8% SLOPE DAILY FLOW 110 X 5 = 550 G.P.D. WIDTH = 125 C+DTUIT ' FRONT SETBACK = 30' SEPTIC TANK = 550 X 200% = 1100.P.D. SAY SIDE SETBACKS = 15 USE 1500 GAL. SEPTIC TANK REAR SETBACK = 15' BUILDING HEIGHT = 30' O ./ /. /; /., /. /. .� , �. /. /. / /`� BREAK OUT CALCULATIONS s UIT RIVE (OR 2.5 STORIES IF LESS) /\/\/MIN• 1 MAX. 3 covER�/\j���� \,/\/ �/ NATURAL SLOPE IS 0. v v o Ll m v 2„ 1/8"- 1/2" PEASTONE LEACHING FIELD DESIGN ANTUCKETT SOUNDv v v 4vvv vvvv vvvvo 00 0 0 0 o 0 00 2� ALL PIPES TO BE SCHEDULE 40 PVC PERFORATED vvv vvv vvv WITH VENTED ENDS LOCUS MAP " SEPARATION SEPARATION SEPARATION USE 4" DISTRIBUTION LINES I 1 6_ 6 6 1 25 000 2' "I I 2 -� USE 4 - 2'X 2'X 47' DOUBLE WASHED STONE TRENCHES SCALE ASSESSDRS� ��' `� EXPANSION TRENCH EXPANSION TRENCH AS SHOWN MAP 51 PARCEL 11 , , _ \ APPLICATION AREA REQUIRED 3/4" TO 1 1/2" " f DOUBLE 550 G.P.D. / 0.74 G.P.D.\ S.F. + 50% = 1115 S.F. 1.5 4.5 6 Al ,�• WASHED STONE APPLICATION AREA DESIGN � 50,00 __�r'r ` TRENCHES WITH 4" PERFORATED PIPES C.B. D. SIDEWALL AREA - TRENCH 47 LONG 13 N70.44'00'E - " 1 .0 :0 , 2.7 E�{D SECTION ._ e C.B. FND. GARAGE 4 'TRENCHES' 752 S.F. 12 pine a 125.00' SCALE: 1 5 I o 3.9 s/ot 3 3.3 10" irie po /p 14.9 ! , 1�1•.8. v `$-------_IT BOTTOM AREA 12 pine 4.5 vl lw 14.4 47 X 2 X 4 TRENCHES = 376 S.F. ZONE 8 z 0 TOTAL AREA 1128 S.F. O.K. 3 ^v ° v_I a �w PERCOLATION RATE: 1" IN 2 MIN. OR LESS. zoNE 7 E 11Z3:O DETAIL LEACH TRENCH 1 1 .8 7P3.5 Ql� .4 13.3 $., p i e -- - ---Jk- x .2 *-8._4 3_ 2 TERRACE o o PROP 15.3 15.0 _- - _ TENNIS COURT �? N I 3.9 ti 6 4.1 5. i y► -n ED WA TF -_ -R SER " bench ma k Rb b r x o/ .0 ,. 10" pine6.4 17.5 x 17.5 17.3 m VICL' ydran spi die N76.0 8.2 u 1� C) k 6 p In 10 pine - cn . -.,` 4 4 E o 6.0 �A3 x,0 4 13.3 e14 pine 15.5 �-- 4_ flowering crabappl .77 \;' . 15.0 \ 12. 448'21' d n 1 13.3 4.7 11.0 15 EPz ic � 16 \1 TAL AREA pN D o 0 ( . I 0.00 , 1 - 0.00' I 0rAN 4, S 5 OL ID PIPES ZLA BUFFER STRIP 17.5 o pisT I s rnrn- _ 1 .95 acres a . 0OX I - , 14.9 / ---- -- ---x -\ / 4.1 m 4.5 x 10.6 9.5 B8118/34 .$ ( 17.0 3' 190 6.6 L clr slat rises 4.9 `\~ � c�' to walk .3. ,5.1 � 'PROPOSED x 4.1 _ '" eX - � G.B. FN4 0., i e Pine 5.7 POOL - - x PAVED DRIVE x 13.1 x 2a � � 1,. � \ x 8.2 0 1 p' „ r_ \ 5.6 14 pm pine I �', ram- 3-' rn . i / .2 _ - __ __ _.� 11.0 '�`�- \ 'S7•0& e • --� 13.4 �' 011 W \' 17.1 _ EXISTING FOOTPRI T � _ `6000, 17.0 -. . I 7 .0 I f- " p• c PROPOSED p o 3• t . .5 W 5.0 --''.'`~---w �--- - - GAR,gG`E I I I 14.7 � � 4 .. o: -��. 13.8 WATER = EL V.2.0' a A 12 pine II o L. .B\FN 7.5 / ��' , x •� o 2. 6131 NCHMARK ., 13.4 4.6 Oak 16. w`, ,. o, • , . ` � - I � I O, G / II v1 . ,0.4 12 oa . er 'etain.n 14. x1.4 10pine C ONE A11 p 0). � tennis court ; x 88 Q • , 0 ZONE- B �4 \ J �3.x i � GWIAL NL �lI PIPE,- I - 424 I •# NO WATER "14.7 5.6 moo oil' ' / aa� BfiA6 3.7 IV16. 14.PLAN RErAiNi plP f5-3 11.0 1z.1 _ �• ----- --"1�.9___- --- _ ._-- o GRAPHIC SCALE 16. I _ -- / 0 20 40 4:0 ' ��-_ x 8.2 I9 x 2.3 ?o 3/4" TO 1 1/2" _ 13.6 14.7 _ / DOUBLE 14.7 8.5 6 WASHED STONE 14.7 S31,8 / \ \ 7.8 SCALE: 1 = 20 #17 S8 8 � x t �� • / ELEVATIONS ARE BASED ON N.G.V.D. `20. QQ 100 YEAR FLOOD ELEVATION 13.0' 21 0/NC 5.8 / 8.9 4.7 B4 4.6 r. j 83 ALL COMPONENTS LOCATED IN POTENTIAL VEHICLE TRAFFIC AREAS OR BURIED 4 FEET COVERS LOCATED TO WITHIN OR GREATER SHALL BE H--20 LOAD _CAPACITY. 12 OF F.G. TEST HOLE PLAN OF PROPOSED F.F. ELEV. 19.5 APRIL 29,1995 DWELLING & SEPTIC SYSTEM vent pipe B2 ACME PRECAST H-20 P P BAXTER & NYE INC. 7.9 3.7 ELEV.= 18. IN TOP of F.G.= 17.5't DB9 OR EQUAL FOUNDATION � F.G. =16't F.G.='14f PIT #2 (OSTERVILLE) 4.1 INV. = 14.0 . ELEV. 14.0 B1 I 4" DIAMETER MASS . wv.13.8 15 HZO AL. T DIST gGH � WOOD LOAM INV. = 13.6 _ EQULE 4o SUB SOIL & LOAMY SANDm r.. BARNSTABLE, r SEPTIC TANK INV. -12.0 80X � P G. TOP ELEV. 11.5 --�� Ape -2 FOR , or , 6" CRUSHED INV. =11.8 10.00° ,,. INV. 11.0 vvvvvvvvvvvvvvvvvv gyp; MIN. STONE BASE ' P`eTR A LA N B E R N 0 N SI,IL,.IVA vvvvvvvvvvvvvvvvv : -4 PERK TEST 4k�� vvvvvvvvvvvvvvvv vv No. 29733 n: SCALE: AS NOTED DATE: MAY 11 1995 BOTTOM ELEV.9.0 REV. DATE JUNE 21 ,1995 G Z1 S MEDIUM BAXTER & NYE INC, OF I CERTIFY THAT THE PROPOSED FOUNDATION SHOWN HEREON SAND REGISTERED LAND SURVEYORS q"j„Rp A. COMPLYS WITH THE SIDELINE AND SETBACK REQUIREMENTS OF p CIVIL ENGINEERS ,b THE TOWN OF BARNSTABLE, AND IS NOT LOCATED WITHIN THE PROFILE NO _ EL. 3.0 WATER OBSERVED -11 NO WATER OSTERVIL.LE, MASS, � , ,o FLOOD PLANE. .C' 1.L EL. = 3.0, DATE: R.L.S. NO SCALE #94040-30