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HomeMy WebLinkAbout0108 TANGLEWOOD DRIVE - Health ='i_Q$ Tanglew4oci Drive v Osterville P A 121 060 TOWN F BARNSTABLE 1 a7C�+TIGN �/ / SEWAGE# VILLAGE_ ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: 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 37 ' ' O r c� f rA & L P WoOCLI TOWN OF BARNSTABLE 6s, I EXJ1I�6-, F •a LOC'-X N D�17 SEWAGE #"�jZ 5= IF4 VI�L AGE ®SY'e-XVI U-6 _ A/S�SESSOR'S MAP & LOTT ,�,#` INSTALLER'S NAME&PHONE NO. �✓M / � 6 �Z_D y 2$�� SEPTIC TANK CAPACITY V bO (L Kis 7 i a!'G LEACHING FACILITY: (type) L-C t�-00 N (size) �NO.OF BEDROOMS BUMDER OR OWNER ;Fo er—'XT C-U n1 O 5-riz.®ni PERMITDATE: ' �� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet' Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) �� Feet Furnished by �. t ��A�°al C� A 9 i L 3 0 �r B r 9 No. V O S O 1" . - a Fee/Q 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0[ppYication for ]igpont *pgtem Conotruction Vertu Application for a Permit to Construct( . )Repair Upgrade( )Abandon( ) ED Complete System O Individual Components Location Address or Lot No. %,D �� s ��©� Owner's Name,Address and Tel.No. Assessor's Map/Parcel Ae —O(oO OS Uj 0®� lZ. DSTvtLJ11 LLc Installer's Name,Address,and Tel.No. / Designer's Name,Address and Tel.No. SD$r- 20 62-f(b !2 k10, �oS�S 7 - SULS Type of Building: 2,�4< 'y' &2_ Dwelling No.of Bedrooms Lot Sizesq.ft. Garbage Grinder( ) Other Type of Building 'ate a No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flower gallons per day. Calculated daily flow gallons. P1an Date 14.18 ► D 5- Number of sheets �' Revision Date +� Title 'I-IC- tit S?��-mgep,41 RE 10(P64 r0 Size of Septic Tank 1060 Type of S.A.S. ®ZX -So© Description of Soil.. !sea S V 1 L_ Lo Nature of Repairs or Alterations(Answer when applicable) lJ 61,J 1 Ll 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 En ironmental Code and not to place the system in operation until a Certifi- cate of Compliance has,been iss d by this Board ealth. Signed Date ` 227 ` Application Approved by Date US Application Disapproved for the irollowing reasons Permit No. 2 0 0 S -I V Date Issued No. tlO G i� ,- .r _ .� Fee QU a � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIpprication for Migoar Opziern ton�truction Permit Application for a Permit to Construct( . )Repair( v')Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. I Q T� � �OQ Owner's Name,Address and Tel.No. Assessor's Map/Parcel C)STCY—V l LLC PD B�T LAA Jj 6 SjjZ,0 � 1D0 /LLB Installer's Name,Address,and Tel.No. Jr Lj per_ Designer's Name,Address and Tel.No. �, �P.O► '}3a�C 70 Z. M A-2s-ro/jS m 1 c.Lg Ekxq►J e-e-9_oJC, lJ0/ZKS /2 40, rC-✓4SS Fr�t.� 2� Type of Building: 3 ee -7y-J(o..• Z Lot Size Z��93 7s ft. Garbage Grinder 'Dwelling No.of Bedrooms q. g ( ) Other 'Type of Building :M, No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design.Flow' gallons per day. Calculated daily flow gallons. Plan Date /S D S Number of sheets a- Revision Date 1JTA Title 5E!R le_ Su /ZG?AR ItP�21�DC r Size of Septic Tank /aoo Type of S.A.S. A x GC-SOo 5 Description of Soil 'SEC !SO 1 L (�0 Nature of Repairs or Alterations(Answer when applicable) Ll 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 En ironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss ed by this Board of kealth. Signed Date • �-9 Application Approved by ) e/ Date - - Application Disapproved for the Following reasons Permit No. a 00 S-/ SV(„ Date Issued �c- ��-U S THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that th On-site Sewage Disposal System Constructed( )Repaired ( Upgraded( ) Abandoned( )by A0 ," at ,\ has been constructed in accordance with the provisions Title 5 and the for Disposal System Construction Permit No. (Dr.)C-,iti K6 dated �-G/-a e- Installer r' Designer _�v. The issuance of this permit shall not be construed as a guarantee that the syste ill fu`nctrorn as designed. Date ���o /CJ'S Inspector- . 1 Jam.,___ N No.?oy r-4P6 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Ofi po!ar *pttem Construction Permit Permission is hereby granted to Construct( )Repair(I Upgrade( )Abandon( ) r System located at 1 OK .%,__ 10 Z _ 1,2,; S . and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction Est be completed within three years of the date of this-permit.� Date: C L7 7 Approved by �_��, /�� !< 5 V V, ,J ' d .............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD F H TH rY °h . . ... - ... -- of .-- Applira#ion -for,Ui_qpimal Workii Tomitrurtion Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System a : a ati - W •--•---•-•-- �Insta lle r.�ress J�-- •---i r-,---.� I,ot � - 4-- L ---' --- -7 � ---------•-- A .....N o e --••-------- O er Address Address 99 UType of Building Size Lot__ _ e -. !Sq. feet Dwelling—No. of Bedrooms--."----------- =-- ----------------Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ---- --- No. of persons--------------0--------- Showers (�) — Cafeteria ( ) Q' Other fixtures ...... __.-------------------------------------------- ------------------- ll.._.....___ allons er erson er da Total dail flow-__-___ __ -..n...Design Flow-------------------- P P P Y• Y a-------------------------------- WSeptic Tank Liquid capacityl_._____ gallons Length________________ Width..........- .... lliameter___._...._.__.. Depth._______.._.... . x Disposal Trench—No_ ____________________ Width:.._..,...._p�-�- T,�ota engt Total leaching area.--_-__-------__-_sq. ft. Seepage Pit No.-----/----------- Diameter���....' pt c o *et -'"!----... .. Total le c inga ea__________________sq. ft. Z Other Distribution box ( ) Dosing tank �2���� Percolation Test Results Performed bY------- --P----------------•---• -_••--•....--.....---•-------- ------ Date--------- •- -- Test Pit No. 1----------------minutes per inch Depth of Pest Pit-.-_________ ----- Depth to ground water-------._"-_---_-..._:_-. (� Test Pit No. 2----------------minutes per inch Depth of 7st Pit-------------------- Depth to groun water__._.-_--"_----__----- --------- ----- -------------- t _ �_ Description of Soil----- --" ------ � t?� L------ ®�—.._.._.. -------------- x y::.. W V 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 Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be ue y the f health. igned. .. ................ -------- ----------- --- le Application Approved By-------- - v ...... . ....... - .. ... a e ./ / ..ate 7 . Application Disapproved for the following reasons: �------•---•-----•--•-•_-•. t ---------•-----------------------------=-------------------------------------- --------------------------•------------•••-••...-•---•---•----••-•--•--•------------------------------------------------- Date Permit No......... ............................. Issued.... .3- 7_y...-•-.••- Date E _ o No......................... ............................ THE COMMONWEALTH OF MASSACHUSETTS i BOARD OF HEALTH ......... .. ... ... ......... ..O F........................................ . .....----.......................------ Applirativi n -for Dhipvii ai Workii Towitrurtioaa Vrrnift Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ' P W ��!... //i cK .:_ . /Y� �-- --- .5-!___Qr �h dress Qpr P, No. LA; W d Address Installer Address L Type of Building Size Lot..._ << ?? // UYP g �V ---sl____GSq. feet Dwelling—No. of Bedrooms................:...... ---------Expansion Attic ( ) Garbage Grinder ( ) p0-., Other—Type of Building ----------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) QI44 Other fixtures ------------------------------------------------------- ------------------------- Design Flow....................... !�.___._____ lions er erson er da Total dai] flow__._... Mons. W P P P Y y .... - - gallons. WSeptic Tank-t Liquid capacity gallons Length................ Width------- lliameter__:_.....-._..__ Depth---------------- x Disposal Trench—No..................... Width___.________ Total en = Total leaching area.-.--.-.--.-_-__--sq. ft.. Seepage Pit No------ ----------- Diameter���__.S� e�w et--- __...Total le c of a� .------.___...sq. ft. z Other Distribution box ( ) Dosing tank ( ) � Percolation Test Results Performed by--------------------- .................................................... Date-------•----------------------••-.----- a Test Pit No. I................minutes per Inch Depth of Test Pit-------------------- Depth to ground water-..-_--_--_-._-.--.----- (_, Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to groun water................... r _ D Description of Soil ,�� ,P � " x = -- .�- W 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b u y the- f health. igned. -' L'1...�'t l ......•- ' Da Application Approved By --• -- --- -- te 7_ ', --- a t Application Disapproved for the following reasons----------------------------- -•---- -----•-------•---••---•••----•-------------•--•.........•-•-•--•-•---- ------------------------------------------------------ ----------------------- -----•--••--•-------------............................................................................................... Date PefrriftNo `......f.-4-_' ..: ' --------------n._.... -=---------=.. Issued.------�'-'?a--��-----.t_`�.:.---•--•--••------• - Date l THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH ..........OF............ . ... ................. ................ Orrtifirat of mph r 4HI �4VR�' 1~ hat the.I dividual eposal tr ed ( ) or Repairedby--- ------ -- -- --- •-------•---. --•-- 9 d (� n�st{I1 j-{,�'`,lrfrlP at...........-------• ------------------- f� ----------------------------•------------------ -- ------- -------- has ' 4 _______________________________________________________________•-..-___. been installed in accordance with the provisions of Article XI of The State Sanitary Code as described/ in the application for Disposal Works Construction Permit No---......!� ..' '"................... dated------- _.. .. ._..'_`f___.c_.._..._. _ -- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE � SYSTEM WILL"FUNCTION SATISFACTORY. DATE- y= 1 •------------------------------•----..... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 04 n _ % ' `~... ..OF........... s -S,,f1. ......................................... N o. FEE_...................... Bii 'Permission is hereby granted-------- to Construct ( / or Repair ( ) an Individual Sewage Disposal System at No...... !--".----. « ,` t,, I-,.00d . Ut7 H!e' l<cA "/ - ;ftCt e_<°c=?411ee' -•--- ------------• ---..................------• ••. ......... Street as shown on the application for Disposal Works Construction Per ... ___. t �a `f .. •----- -----------•-•-----....... •-•-------•------------.......---•----• ---•- ......... -Board of Health DATE......t;..-•---------------------------•-----•.•-- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS • - - ;.nY �NOTICF: This Form Ig To Be Used For the Repair Of Faded Septic Systems Onl . PERCOLATION 'PEST AND SOIL EVALUATION EXEMPTION FORM s 1,_ Ff— fi► �.-r%n$-�2�hereby certify that the engineered plan signed by me dated I concerning the property located at 10 � �,.r•�e�reR �r. 5 ��1 meets Id of the fallowing criteria: • This failed system is connected to a residentiai dwelling only. 'here are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to S rriinutes per inch. The applicant may use historical data to conclude this fact or may conduct prelinunar), tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed There art no variances requested or needed. . The bottom of the proposed leaching facility will =be located less than fourteen (M-feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation (using GIS information) '4,r B) G.W. Elevation Z" + adjustment for high C.W. I DIFE � 7- RENCE BETWUN A and B � . +118 lox kk CC— SIGNED DATE: NOTICE Based upon the above information, a repair permit will be ►ssued for bedrooms maxirnurn. No additional bedrooms are authorized in the future without engineered sic system plans. �.. Q:health folder perceamp Town of Barnstable Regulatory Services . a g Thomas F. Geiler,Director MAK Public Health Division b Thomas McKean,Director 200.Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Gertiflcation Form Date: US Serwage Permit# ol-0-05--1010 Assessor's MaplParcel Designer: .s,,, c Installer: J UStAbI.tAgk_ Address: -tM— CA-0.3 ,ram d�o .Address: f0, 8016 W2- On b - q . U J t M H 6 11 e✓' was issued a permit to install a (date) (installer) septic system at �r based on a design drawn by (address,) t a. �.V-E;C t� dated _I ►. Y d (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State &Local Regulations. Plan,revision or certified as-built by designer to follow. 'OF hf4 PETER T. (I&iller'sature) o McEfVTEE CIVIL o No.35109. Q ��F�9FG/STEP�O����' G (Design.er's Signature) (Affix Designer s Stamp Here) PLEASE RETURN TO BARNSTABLE" PUBLIC HEALTH DIVINILW CERTIFICATE OF f,QNPL1ANGE WILL NUT BE 1SStJED UNTIL BOTH THIS FQPUM AND AS-BUILT CARD ,&R REQEI3'ED BY THE BARNSTABLE PUBLIC HEALTH DIVISION, THAN{XOU. Q:Health/Septic/Designer Certification Foam 3•26.04,doc 05/07/2005 11:24 5084775313 ENGINEERING WORKS PAGE 03 I 3 AP Asdwsuitf 4 y T.... i 1 Z C^S I '- Ate. ` � A... • . L : . I � - ( U1 i 1� � � y I r i . . TOWN OF BARNSTABLE LOCATION �d � [.�iop17 SEWAGE# VII.LAGE t7s��'�-iIt l-L ASSESSOR'S MAP &LOT � �-D 4� r: INSTALLER'S NAME&PHOI E NO. J d M /l'iM 6-481 4,W °y Z rO SEPTIC TANK CAPACITY LEACHING FACILITY: (type) tOO �� (size) a X NO.OF BEDROOMS BUMDER OR OWNER �'e&k r L n1 b 6 -o n PERMTTDATF: 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 j 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) AJIA Feet (.-_Furnished by "ice{'E Il9 l fP, - - Al 2- 31 - a" 3 93 -0 f� -0 76-0 7q � � 'V43 DATE:_ '. j-�0/96. PROPERTY ADDRESS: '10fq TanglPwond Drive. , Osterville Mass. On the above date, I Inspected the septic system at the above Address. This system consists of the following: 1 . 1-1500 gb.11on septic tank. 2. 1-�1000 gallon leaching pit packed in stone. � I i Based on my Ins vection, I certify the following conditions: 1 . This is *a title five septic system. ( 78 Code ). 2. TY>ie sgptic "system is in proper workiri'g' order'" • at ifie •prese.nt time. SIGNATUR7-: Name J P Macomber Jr... Company.__ _J P.Macoruber & Son-_Inc B Address _:.g _��---___� RECE41lIEO Centerville .Mass__02.632 FEB 8 1996 ,c) Phone:---SQ8 75..3338 ---- wxTHu r, , r�r 1 j THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR-WARRANTY • JOSEPH P. MACOMBER & SON, INC. Tanks-CsupoolrLeachfleIds • Pumped & InsUllsd Town Sewer Connection: P.O. Box 66' Centerville, MA 02632-0066 77.5-3338 775-6412 J commonweolln of mossoctiusetls Fxeculive Office .of Envilonmeniol Alloifs Department of Environmental Protection VAIII+m F.Wold TrudyCoXQ 8.ust ,ECEA . Oavld D. SUuhs Cortmiulonu SUBSURFACE SE11'AGE•DI5YOSAL SYSTEM INSPECTION FORM , PART A CERTIFICATION ddress of OW11cr; )(operly Address: 108 Tanglewood Drive Os tervil�(e�i((ef1„t) ate of Inspection: 1 /20/96 dame of Inspector: Joseph P. Macomber Jr. company Name, Address and Telephone NUm cn i ERTIFICATION STATEMENT certify that I have personally inspected the sewage dispo,avJs'stem erfo,n ed this b�ed onarrnythat training a information perienceindthe proper true, functionuand nd complete as of the time of inspection. The inspect o P aintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes Needs Funher Evaluation By the'l.pcal Approving Authority Fails Inspector's Sign ature• / ithin ) days of ing is The System Inspector shall submit a copy of this inspection report f lo,000 le prdving of I;eatterority tilewnspe(nortand0the systemcownertshallhsubmit inspedion. if the system is a shared system or has a d.sibn (lo o gP the repon to the appropriate regional office of the Department of Environmental Protection. and ceL)ies sent to the buyer, if applicable and the approving authority. The original. should be sent to the system owner INSPECTION SUMMARY: Check A, B, C, or D: A) SYSTEM PASSES: I have not found any information which :ndi:ates that the system violates any of the failure criteria as defined in. 310 Cn1R 15.303, Any failure criteria not ev aluated are indicated below. Bj 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., ). Describe basis of determination in all instances. If'not determined", explain why not) Indicate yes, no, or not determined (Y, N, or ND ked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is The septic tank is metal, crac imminent. The system will pass inspection if the existing septic Lank is replaced with a conforming septic tank as approved by the Board of Health. _ 1 • trcvlscd 5/15/W On$ Wnt+r Slroot . Eloston, h1+ss+chusvtts 02100 F X(617) -5G IQ49 • T+lophon• (617)292.5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 108 Tanglewood Drive Osterville ,Mass. Owner: Joanne Mulligan Date of Inspection: 1 /2 0/9 6 • B) SYSTEM CONDITIONALLY PASSES (continued) c V0 dox Sewage.backup or breakout or high static water level observed in the is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced i 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 TIIE BOARD OF HEALTH: Conditions exist which require further evalcation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. v1) 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: - A)6 The system nas a seuuf. taiii dIli :,u11 dU)ufptlull systew, and i'i Nithlri 100 fee; to a surface \'later suppi)'or trlbut.aij tC a surface water supply. AJO The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. a The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. AD The system has a sep;ic 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• D) SYSTEM FAILS: _ O 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. 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. (revised 8/15/95) 2 V ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A' CERTIFICATION (continued) Property Address: 108 Tanglewood Drive Osterville,Mass . Owner: Joanne Mulligan Date of Inspection: 1 /20/96 • D) SYSTEM FAILS(continued): Ve • • 1�Sd Static liquid level in the diudbut+en-box above outlet.invert due to.an overloaded or clogged SAS or cesspool. . Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. �i 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 a Zone I of.a public well. t`)A Any portion of a cesspool or privy is within 50 feet of a private water supply well. ALA 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. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design (low of system is 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: AM the system is within 400 feet of a surface drinking water supply 40 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 8/15/95) 3 f (R SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 108 Tanglewood Drive Osterville,Mass. , Owner: Joanne Mulligan , Date of Inspection: 1 /2 0/9 6 'Check if the f Ilowing have been done: the information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates i during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. i 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. _/The system does not receive non-sanitary or industrial waste flow 2The site was inspected for signs of breakout. 2AII system components,;wyicluding the Soil Absorption System, have been located on the site. The septic tank man holes were uncovered, opened, inspected for condition of baffles or and the interior of the septic tank was p tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. • The size and location of the Soil Absorption System on the site has been determined based on existing information or a proximated by non-intrusive methods. The facility ov-ne ;and occuparns, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. f (revised.8/15/95) 4 [Date SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION perty Address: 108 Tanglewood Drive Osterville,Mass . ner: Joanne Mulligan of Inspection:1 /20/96 FLOW CONDITIONS SID_RESIDENTIAL- Design , • Design flow:j aall ns , Number of bedrooms, Number of current residents: Garbage grinder(yes or no):-105J,, ,, Laundry connected to system (yes or no)- ECG Seasonal use (yes or no): 99 `�� �� ) Water meter readings; if available: I Last date of occupancy: 1-.7�-94 COMMERCIALII ND USTRI AL: Type of establishment:* A? Design flow: Ok allons/day Grease trap present: (yes or no)_" Industrial Waste Holding Tank present: (yes or noWA r)-sanitary waste discharged to the Title S system: (yes or WAR meter meter readings, if available: AW i Last date of occupancy: OTHER: (Describe) Last date of occupancy:_ GENERAL INFORMATION PUMPING R Sand sour a of inform n- ECOY System pumped as part of inspection: (yes or no) If yes, volume pumped. 1 allons ) , Reason for pumping: TYPE 9PSYSTEM V Septic tank/4i t+ �soil absorption system U_ Single cesspool Overflow cesspool ' Privy Shared system(yes or no) (if yes, attach;previous inspection records, if any) Other(explain) APPA,OXIMATE AGE of all components, date installed (if known)and source of information: ACK a image odors detected when arriving at the site: (yes or no) (revised 8/15/95) 5 f 'ice i 0 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 108 Tanglewood Drive Osterville,Mass . Owner: Joanne Mulligan Date of Inspection: 1 /20/96 • SEPTIC TANK:L;16000,11" xev-G (locate on site plan) r/ Depth below grade: Material of construction: Zoncrete —metal _FRP —other(explain) Dimensions: TY4r r r Sludge depth: Distance from top o:sludge to bottom of outlet tee or baffle:_ Scum thickness:_ pit Distance from top of scum to top of outlet tee or baffle:—Z1— d; INs�OP 1�(j Distance from bottom of scum to bottom of outlet tee or baffle:_ Comments: a--ommendation for pumping, condition of inlet and'outlet tees or baffles, depth of liquid level in relation to outlet invert, structural ,,rity, evidence of leakage, etc.) Pump tank annually, Garbage disposal is present, outlet & Y/ inlet tees are strut ura ly sound-Septic tank is structurally sound; The septic tank shows no signs of leakage No rex2airs are needed at this time GREASE TRAP4/ (locate on site plan) Depth below grade:, Material of construction:,doncrete _metal _FRP _other(explain) aIIQ Dimensions: Scum thickness.__a Distance from top of scum to top of outlet tee or baffle:�I� Distance from bottom no gjim v%bonnrr of oulle! tee or bail!e- 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, e!c.i (revised 8/15/95) 6 t V"I SUBSURFACE SEWAGE DISPOSAL Symm INSPECTION FORM PART C S)'Si Lm INFORMATION tcuntinued) Property Address: 108 Tanglewood Drive Osterville,Mass. / Owner: Joanne Mulligan Date of Inspection:1 /20/96 - • r TIGHT OR HOLDING TANK: (locate on site plan) Depth below grader Material of construction:aoncrete _metal _FRP _uther(explam) Dirnensions:_JaA lolls Capacity:_�Vgallo Design flo++•: gallons/day Alarm level:_ Comments: (condition of inlet tee, condition of alarm and iloat switches, etc.) bag/ DISTRIBUTION BOX: —19 (locate on site plan) Depth of liquid level above outlet tnven: Comments: 1 C' UIUiC it ie,ii �ni7 G"t;�L i••uC:1C� .:. . .•, �"•:4C: .�. i�'.i1.;U;i uriu or o:a of bux etc ) a �L PUMP CHAMBER: /V'7 (locate on site'plan) Pumps in working order.(yes or no) AAI 11 1 Comments: (note condition of pump chamber, c(ind:uun of pumps an(i appurtenances, etc.) A IDAI Q. tre•::sed 8/:5/55) 7 .' • �\ J 1 SUBSURFACE SEWAGE DISPOSAI..SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) ropertyAddress: 108 Tanglewood Drive Osterville ,Mass . Owner: Joanne Mulligan Date of Inspection: 1 /20;96 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, butm..y be approximated by non-intrusive methods) If not determined to be present, explain: Type. leaching pits, number._ leaching cham')ers, number: 0 leaching gall.:ries, number., leaching trenches, number,length: leaching fields, number, dim sions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) Loamy sand .to medium sand t H raulic failure or pondingl.All vegetation No re air e. Ct.. OOLS: WAX, (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: h) Materials of construction:_AL Indication of groundwater inflow (cesspool must be pumped as pan of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding,'condition of vegetation, etc.) PRIVY: (locate on site plan) Materials of constru ion: /111� Dimensions: AM Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)�� (revised JIAS/ss) B J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C -SYSTEM INFORMATION (continued) Property Address: 108 Tanglewood Drive Osterville,Mass . Owner: Joanne Mulligan r Date of Inspection: 1 /20/96 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' Centerville Osterville Marstons Mills Water Company. I ` '1% 3 7 oG DEPTH TO GROUNDWATER Depth to groundwater: + feet �� method of determ' d � `mooare(Ff0 i 1e. System installed in 1924 , No k[atpr Pnt-o]intPr.Pd' qt. 121. hole was pArfnrmP8 _ (revisdd 645/.i5)1 9 ' .••rnnrr+—R.•rv�.•r,—tis,r.—mr•nrrarrrtr.rrsrr. ::•.•r++!rs'r:srrrcrn+!-na:.c-es rr•--arrsr.mct _ .. arsa+arrict*a-a,tR•t�.T_ •er nrr..r•.' k TOWN OF Barnstable BOARD OF HEALTH SUIISIIIFACF SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART -U • CERTI FI I CATION 1 •••St•l_T••.••.:t—T.117.^•�.�T1TS.�.TIi•R:lTiT.T.�:•,f,TT.}•{!T!•f^!t'ir.'t TTT.ST�T^TT�i:TiR�fSZTTTL . RtR.R'RRi"IT�Zyp, -TYPE OR PRINT CLEARLY- P1?OPERTY INSPECTED STREET ADDRESS 108 Tanglewood Drive Osterville MRG4 . ASSESSORS MAP , BLOCK ANLf PARCEL # OWNER' s NAME Joanne M4. g4'p Joanna M ul 1 i gan PA1?7' D - CERT'IFICAT'ION r NAME OF INSPECTOR Joseph' P. Macomber Jr. . COMPANY NAME J.P.Macomber & Son Inc:. . COMPANY ADDRESS Box 66, Centerville.Mass . 02632 Street Town or City State Lip COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 - 1578 . R CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported ., is true , accurate , and complete as of the time of .inspect.ion . The inspection was performed and any recommendations regardi►Ig upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . " Check one: XXXXX System PASSED The inspection which I have conducted ,has not found any information which indicates that "the system fails to adequately protect public health or the environnent Lis defined in. 310 CMR 1.5 . 303 . Any failure criteria not evaluated a.re as stated in the FAILURE CRITERIA section of this form. , System . FAILED* The inspection which` I have conducted has found that the system fails to Protect the public health and the environment in accordance with 'Title 5 , 3.10 CMR 15 . 303 , and as specifleally noted on PART C - FAILURE CRITERIA of this inspection form , Inspector Signature lr Date 1 /22'/96 One copy of this certification must be provided to the OWNER, "the BUYER ( where applicable ) and the BOARD OF HIZALTII. * If the inspection FAILED, the owner or11,op erator shall u P pgrade ' the systemwithin one ,year of the date of, the inspection, unless allowed or required otherwise as provided in 310 CMR-15 . 305 . ��. ..•t��-. SIC T � Y 01`TWEALTH OF MASSACHUSETTS THE COl\iIM ENVIRO�ENTAL PROTECTIOI, DEPARTMENT OF BE IT KNOWN THATr Joseph P. Macomber, Jr. Department's ualifications as .required`and is hereby Has satisfied the Depart q authorized to use the title- CERTIFIED TITLE 5 SYSTEM INSPECTOR as prove ded' 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 Contro LOC ,T1Ot-,1 :- 5E. _ E P -R.l`/- UO. VILLAGE - - - - - - INS QL ER 5- 1&NlE. � ADDRESS 4 ' �` - - - - - - - - - BUI jD�¢R S. VAE DDRESS DN.TE PERt-AlT ISSUED D ATE CONIPLI WICE ISSUEt] : ��_7'7 8 �� �� �;, �.; ._ ,ti, bt LEGEND 78 °�g PROPOSED CONTOUR 30 °m 79 PROPOSED SPOT GRADE a o� Qm m RebeOo°s /s-97—/`-EXISTING CONTOUR ® TEST PIT W EXISTING WATER MAIN a Goes. l m ROUTE 28 d o O O_ . J • o �� a ➢ o O � Cn 3 39�3 Z T°n9le o CD a ° J �i h LOCUS APN -� LOCUS MAP N.T.S. _ 121 060 25,937±51r (LOT 7) GENERAL NOTES: ---94 O } ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL �+^�� BOARD OF HEALTH AND THE DESIGN ENGINEER. rn 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE •�` �(p / LOCAL RULES AND REGULATIONS. O • �� 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR p��1�G TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE J. DESIGN ENGINEER. 7. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 2 o _; ENGINEER BEFORE CONSTRUCTION CONTINUES. ` pr" ; y 5.- ALL, ELEVATIONS BASED ON ASSUMED DATUM.. lU % 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO' NOTIFY THE LOCAL BOARD OF N3 Q' STLIMP ®Q� HEALTH FOR,PROPER INSPECTIONS DURING CONSTRUCTION. Ln VE T BENCHMARK: OUTER CORNER 7. WATER SUPPLY PROVIDED BY TOWN WATER MAIN. OF TOP BRICK STEP 8. THERE ARE NO PRIVATE WELLS 'WITHIN '150' OF THE PROPOSED S.A.S. fn ELEVATION — 1.00.00'' 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED TO A �•�G "WMED DATUM CONDITION AGREED UPON BETWEEN OWNER-AND CONTRACTOR. EX15TING 5EPTIC,TANK 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE I TOP OF TANK EL: 97.03t THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING INV.(OUT) EL: 95.7:t CONSTRUCTION. 1. 11. WHERE REQUIRED, .CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS EX15TING 5.A.5. IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE S.A.S. TO 5E PUMPED 4 FILLED W15AND AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 255(3). PETER T. hG� SEPTIC SYSTEM REPAIR UPGRADE EDGE' OF PAVEMENT o cENT CIVIL G No. 35109 1'08 TANGLEWOOD DRIVE, OSTERVILLE, MA PrePared for: Robert undstrom, 108 Tang {r q F� L lewood Drive Osterville, MA W L G C) l ��� C�q OD 5 O� F£SSIO L ��'\ Engineering by: Surveying by SCALE DRAWN J08. NO. f �Ich EngineeringWorks HOOD SURVEY GROUP 1 '30.' P.T.M. 122-05 12 West Crossfield Road 18 Route 6A } I• `b� Forestdale, MA 02644 Sandwich, MA 02563 DATE CHECKED SHEET NO. (508) 477-5313 (508) 888-1090 4/18/05 RT.M. 1 of 2 NOTE TO PREVENT BREAKOUT, THE PROPOSED { TOP OF FOUNDATION F.G. EL: 99.5t FINISH GRADE SHALL NOT BE < EL:95.2 EXISTING VENT FOR A DISTANCE OF 15' AROUND THE EXISTING F.G EL: 99.Ot(EXISTING) F.G. EL: 99.2f(EXISTING) PERIMETER OF THE S.A.S. . - , MAINTAIN 2% MIN SLOPE OVER S.A.S. INSTALL RISERS OVER INLET & OUTLET INSTALL RISER OVER D-BOX TO 2-500 GALLON LEACHING CHAMBERS INSTALL RISER OVER CHAMBER TO WITHIN 6" OF FINISH GRADE WITHIN 6" OF FINISH GRADE IN SERIES WITH STONE ALL SIDES SHOWN ON PLAN AND SET COVER/S WITHIN 6' OF FINISH GRADE L =52' L=5' 4" SCH 40 PVC 4" SCH 40 PVC 2" LAYER OF 1 8"'TO 1/2" . 10« / EXISTING. EXISTING 74 ® S= 1% (MIN.) 6 ® S= 1% (MIN.) ®®®�®®® DOUBLE WASHED STONE e 1000 GALLON INV. ELEV. 2' EFF. DEPTH � e®®®® 3/4"_1 1/2" . INV: ELEV.=94.83 EXISTING SEPTIC TANK 4' S.2' 4' DOUBLE WASHED J EFFECTIVE WIDTH 13.2' STONE INSTALL INLET & OUTLET TEES GAS BAFFLE TO BE INSTALLED ON INV.EL: 95.7t INV. ELEV.=94.70 OUTLET TEE AS MANUFACTURED BY TUF-TITE, ZABEL, OR EQUAL D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE TOP CONC. ELEV.=95.70 —BREAKOUT ELEV.=95.2 ON A MECHANICALLY COMPACTED SIX INCH CRUSHED INV. ELEV.=94.70 �®®1 ® STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). Mae,® SEPTIC SYSTEM PROFILE BOTTOM ELEv.=92.70 3' 2 x 8.5' = 17.0' 3' 5' MIN. ABOVE BOTTOM OF EFFECTIVE LENGTH = 2310' N.T.S. T.P. EXCAVATION OR G.W. LEACHING SYSTEM SECTION NO G.W. ENCOUNTERED AT OR ABOVE EL: 87.5 P�10 pF k4S (3) 5" DIA.OUTLETS y PETER T. ✓', 1�. 5s�;1 f•?s -�I2" McENTEE —' DESIGN CRITERIA - �' CIVIL. 7 71 " o, 35109 15.5" C� - SOIL LOG G/S1E�� o $„ r: 8, -- NUMBER OF BEDROOMS: 2 BEDROOMS N £ t0 1- DECK DATE: APRIL 7, 2005 SOIL TYPE: CLASS I H-10 LOADING 2" DESIGN PERCOLATION RATE: 2 MIN../IN. I a ' SOIL EVALUATOR:' PETER T. McENTEE 'P.E., C.S.E." ' D--BOX ,NO. 108 / f�/� INSPECTOR: NOT WITNESSED—CLASS 1 SOILS DAILY FLOW: 220 G.P.D. �' �• „.T.a / I 1/2 STY. ? DESIGN FLOW: 330 G.P.D � /,WD. FRM. .!� �'P GARBAGE GRINDER: NO 'T.O.F. = 99.64' Elev. . Depth .LEACHING -AREA REQUIRED: (330) = 445.9 S.F. 99.5 q LOAMY SAND p1, 74 ®®E 0® ®®®® 10 YR 3/3 = EXISTING SEPTIC TANK: 7000 GALLON CAPACITY`(ESTIMATED) ®® 39" 99:0 B 6 ®®® a LOAMY SAND w 10 YR 5/8 USE 2—.500 GALLON LEACHING CHAMBERS IN SERIES 97.5 24" 102" C - SIDEWALL AREA: 2(13.2' + 23'0') X 2 = 144.8 S.F. ^IV - BOTTOM AREA: 13.2' x 23.0' = 303..6 S.F. 4" KNOCKOUT - TOTAL AREA: 448.4 S.F. . FINE — COARSE 20" 01A. COVER SAND DESIGN FLOW PROVIDED 0.74(448.4) = 331.8 G.P.D. " KNOCKOUT 4" KNOCKOUT fit" ,(`` � 2.5Y 6/6 "s SEPTIC SYSTEM REPAIR UPGRADE 4" KNOCKOUT l��•�`` �S�J ki,. . �� ��3z 108 TANGLEWOOD DRIVE, OSTERVILLE, MA 500 GALLON CAPACITY, H-20 LOADING 87.5 132" Prepared for: Robert Lundstrom, 108 Tanglewood Drive, Osterville, MA S.A.S. LAYOUT .+ Engineering by: Surveying by: SCALE 'DRAWN JOB. NO. CHAMBERS PERC RATE <2 MIN/IN. ( C HORIZON) En ineedn Worb HOOD SURVEY GROUP „,g g g NTS P.T.M. 122-05 NO G.W. ENCOUNTERED 12 West Crossfield Road 18 Route 6A Forestdale, MA 02644 Sandwich, MA 02563 DATE CHECKED SHEET NO. i (508) 477-5313 (508) 888-1090 4/18/05 P.T.M. 2 of 2 (41 .......... le .......... ........... ............ 0,447 A� �,r r) � 1�66 Cl