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HomeMy WebLinkAbout0235 TANGLEWOOD DRIVE - Health 31 Tanglewood Drive A= 121 -087 OstervilleJItl Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 31 Tanglewood Drive Property Address EPSTEIN, DONALD S & DORIS M TR Owner Owner's Name information is required for every Osterville Ma 02655 8/26/2013 page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information Q on the computer,use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of In key. S.M.Jones Title V Septic Inspection my Company Name 74 Beldan Ln. low Centerville Ma 02632 Cltyrrown State Zip Code 774-248-4850 smjonestitle5@gmail.com SI4522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this ad doe sand tha$the information reported below is true, accurate and complete as of the time of the Jqspection. TMe inspection was performed based on my training and experience in the proper function and,mi gintenariMof oFsite sewage disposal systems. I am a DEP approved system inspector pursuant toi.Section-1-9.34( of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails : y ❑ Needs Further Evaluation by the Local Approving Authority (".0 i r,n 8/26/2013 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes'conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same oudifferent conditions of use. Lt5m. /13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 1 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Tanglewood Drive Property Address EPSTEIN, DONALD S & DORIS M TR Owner Owner's Name information is required for every Osterville Ma 02655 8/26/2013 page. Citylrown State Zip Code Date of Inspection S. Certification (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The dwelling located at 31 Tanglewood'Dr Osterville is served by a Title V septic system consisting of a 1500 gallon septic tank, distribution box and 2 500 gallon precast leach chambers. The system was found to be in proper working condition at the time of inspection. B) System Conditionally Passes: One or more system components.as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of , Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 31 Tanglewood Drive Property Address EPSTEIN, DONALD S & DORIS M TR Owner Owner's Name information is required for every Osterville Ma 02655 8/26/2013 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 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 ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Tanglewood Drive Property Address EPSTEIN, DONALD S& DORIS M TR Owner Owner's Name information is required for every Osterville Ma 02655 8/26/2013 page. Cityrrown State Zip Code Date of Inspection B. Certification {cost.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. Ej The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 31 Tanglewood Drive Property Address EPSTEIN, DONALD S& DORIS M TR Owner Owner's Name information is required for every Osterville Ma 02655 8/26/2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Z Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 31 Tanglewood Drive Property Address . EPSTEIN, DONALD S & DORIS M TR Owner Owner's Name information is required for every Osterville Ma 02655 8/26/2013 . .page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 gpd t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts UTitle 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Tanglewood Drive Property Address EPSTEIN, DONALD S &DORIS M TR Owner Owner's Name information is required for every Osterville Ma 02655 8/26/2013 page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes I10 No Last date of occupancy: current/seasonalDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 f L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Tanglewood Drive Property Address EPSTEIN, DONALD S & DORIS M TR Owner Owners Name information is required for every Osterville . Ma 02655 8/26/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (coat.) Last date of occupancy/use: Date Other(describe below): General Information Pumping, Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or.no).(if yes,attach.previous.inspection.records,.if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): 15ins-.3/13 Title 5.Official.Inspection.Form:Subsurface Sewage.DisposalSystem-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Tanglewood Drive Property Address EPSTEIN, DONALD S & DORIS M TR Owner Owner's Name information is required for every Osterville Ma 02655 8/26/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: original system installed 11/2/1999 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Joint were ok, no leaks, vented through the roof Septic Tank(locate on site plan): 101, Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons 6„ Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 31 Tanglewood Drive Property Address EPSTEIN, DONALD S & DORIS M TR Owner Owner's Name information is required for every Osterville Ma 02655 8/26/2013 page. Citylrown State Zip Code Date of Inspection D. System information (cont.) Septic Tank(cont.) 3-1Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 0.1 Distance from top of scum to top of outlet tee or baffle 6" Distance from.bottom of scum.to.bottom of outlet.tee or baffle 10" How were dimensions determined? opened covers, took measurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or-baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 31 Tanglewood Drive Property Address EPSTEIN, DONALD S & DORIS M TR Owner Owner's Name information is required for every Osterville Ma 02655 8/26/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping:. Date Comments.(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Tanglewood Drive Property Address EPSTEIN, DONALD S& DORIS M TR Owner Owner's Name information is required for every Osterville Ma 02655 8/26/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Oil Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was video inspected and found to be in good condition, no rot, water level was even with outlet invert. Stain lines indicate that the box has never been hydraulically overloaded. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms.in working order: ❑ Yes ❑ No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a-conditional_pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 31 Tanglewood Drive Property Address EPSTEIN, DONALD S & DORIS M TR Owner Owner's Name information is required for every Osterville Ma 02655 8/26/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2x500 gals ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching.fields number,dimensions: overflow cesspool El overflow number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil and stone surrounding s.a.s. was dry with no sign of past saturation. Cesspools.(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Tanglewood Drive Property Address EPSTEIN, DONALD S & DORIS M TR Owner Owner's Name information is required for every Osterville Ma 02655 8/26/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Tanglewood Drive Property Address EPSTEIN, DONALD S & DORIS M TR Owner Owner's Name information is required for every Osterville Ma 02655 8/26/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately T NG��4rdo 0 F?d44 a s r©' Y leq=1 1/2 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Tanglewood Drive Property Address EPSTEIN, DONALD S& DORIS M TR Owner Owner's Name information is required for every Osterville Ma 02655 8/26/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If.checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•.Page.16.of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 31 Tanglewood Drive Property Address. EPSTEIN, DONALD S &DORIS M TR Owner Owner's Name information is required for every Osterville Ma 02655 8/26/2013 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 I No. cy FEE 1: PW9- 'i COMMONWEALTH OF MASSAC14USETTS Board of Health, ntrr,5±q 6 MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct4/Repair( ) Upgrade( ) Abandon( ) - W-C-Implete System ❑Individual Components Location o Owners Name s 7a � o v�, Owner's c--600t cd Map/Parcel# 1 Z -- 0-7 f Address Lot# `7 Telephone# L Installer's Name Designer's Name � e>° Sury Co^SU i f-,t�'I 5 Address Address qO 13 -1^4,str OU 0&5 r Telephone# Telephone# Type of Building Lot Size '20,1 9 9 2 sq.ft. Dwelling-No.of Bedrooms 3 Garbage grinder (/Vo Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) 330 gpd Calculated design flow 330 Design flow provided 339 gpd Plan: Date 92 Number of sheets Z Revision Date Title 5 i +e QA CA ow\ c7•r- 3 i a� C Description of Soil(s) 5a& VIC^01\ Soil Evaluator Form No. Name of Soil Evaluator h/��//ean LiebarnianDate of Evaluation 3 23 DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agree o of place a in a ation until a Certificate of Compliance has been issued by the Board of Health. Signed ate nlu, 9 Insp s No," FEE O COMMONWEALTH OF MASgAC14USETTS 3Mi(J . Board of Health, - Act r 5 f1 b )2 MA. s *r APP1ICATION r*DISPOSA . SYSTEM CONSTRUCTION PERMIT r. Application for a Permit to ConstructV""RepairO Upgrade( ) Abandon( - C7 Complete System ❑Individual Components " Location f (�ter` . (V,U��( �, `, Owner's Name j �rrdL Map/Parcel# 1 Z C7� Address Lot# -7 Telephone# Installer's Name O i Designer's Name Y(xn Kee 5,,,yr yfl co,\50 I+-1 , f 5 Address Address qO Q -Tv,4 %t-r jeo( /JAw 3 t-✓As k r/( ' Telephone# Telephone# 412 f?-C)o <—S— Type of Building Lot Size ZO) 9 2?2 sq.ft. Dwelling-No.of Bedrooms -' Garbage grinder (/�/ r Other-Type of Building No.of persons Showers ( ),'Cafeteria ( ) Other Fixtures .Design Flow (min.required) 330 0gpd Calculated e i n flow Design flow provided 3 3 9 gpd Plan: Date 5-�2 O ` Number of sheets Revision Date i Title 51 R rAAcJl .SgLx e r���rr1 Fvt" 31 Description of soils) -P Soil Evaluator Form No. Name of Soil Evaluator ie&er•mwil)ate of Evaluation 3�Z31�1� t DESCRIPTION OF REPAIRS OR ALTERATIONS q.. The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE;5 and further agree o of place a teM in a ation until a Certificate of Compliance has been issued by the Board of Health. Signed ate a `��9 Inspe tyons 1_ ,No. s , FEE too - COMMONWEALTH Of MASSAC14US ETTS Board of Health, (3 a r n S-t�l e- , MA. CERTIFICATE Of COMPLIANCE Description of Work: ❑Individual Component(s) Complete System The undersigne eby ce 11ify that'the e wage /D�'sp sal System; Constructed ( R paired ( ),Upgraded ( ),Abandoned ( ) by: + 1s ! 4 �.�Z at -3 1 TRn\IJa e ru Ivor r t,`J e_ _ �.� "• l has been installed in ac ordance with the ro 'si. spof 310 CMR 15.00 (Title 5) and th approved design plans/as-built plans relating to application No. `� Z- dated / App oved Design Flow 7 31 (gpd) Installer y�ra�X � Designer: Y�uAKff- Sur veer C ns. I-+-nfSInspectoj&K/ lt��( 1 llvi 11 Y�r1`uDa�: I_ /� i'I / E The issuance of this permit shall not be construed as a guarantee that the syste�}n�will function as designed. l No. qQ FEE COMMONWEALTH OF MASSAC14USETTS Board of Health, Brr1S frj 61 e MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is herebygranted to; Construct(v) Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal P Pg g P system I at 1 Tom, c, e w0 as described in the application for Disposal System Construction Permit No. -3Z� , dated Provided: Construction shall be completed within three years of the date of thi ermit. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date// `' '�,Board of Health ; THE TOWN OF BARNSTABLE T o�y0 OFFICE OF IDAH39TA13L : BOARD OF HEALTH y MA86 00 E�A39'� 367 MAIN STREET HYANNIS, MASS.02601 May 4, 1999 John Sweeney 188 Sturbridge Drive Osterville, MA 02655 RE: #31 Tanglewood Drive, Osterville A=121 - 78 Dear Mr. Sweeney: You are granted permission to construct an onsite sewage disposal system at 31 Tanglewood Drive, Osterville. This variance is granted with the following conditions: (1) No more than three (3) bedrooms are authorized. Dens, study rooms, finished attics, sleeping lofts, and similar type rooms are considered bedrooms according to the MA Department of Environmental Protection. (2) The applicant shall submit floor plans and septic system plans for review by the Director of Public Health prior to obtaining a building permit. Permission is granted because it is the Board's policy to grant permission for the construction of three (3) bedroom dwellings on lots of 18,000 square feet or greater. This lot is 20,413 square feet. Also, the proposed septic system meets all of the provisions of the State Environmental Code, Title V. It is the opinion of this Board that the construction of one septic system which meets all of the provisions of the State Environmental Code, should not significantly alter the quality of the groundwater in this area. Sincerely yours, Susan G. Rik, R.S. Chairperson Board of Health Town of Barnstable S G R/bcs sweeney OFtHETp� DATE: FEE: � • BMWSTABLE, • / p MASS. qj 1639• $ REC. BY ' �E�MP�A Town of Barnstable , 4 z999 , SCHE 'O•AT .�� Board of Health A 367 Main Street, Hyannis MA 02601 E ti Office: 508-790-6265 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORM C / LOCATION � ' / Property Address: 3 ( i.J1Q D R I U �-C!7 Assessor's Map and Parcel Number: Size of Lot: ®Z/-7 4c,.-& S' Wetlands Within 300 Ft. Yes Subdivision Name: j No Business Name: APPLICANT CONTACT PERSON Name: L C Name: ! S Address: I P A 0/1 _ Address: 1 tC,8 �STe2ull�e QSTe���/� Phone: Phone: ��— -�� FAX: FAX: VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) —S -7- US A Checklist(to be completed by office staff-person receiving variance request application) Four(4)copies of plan submitted(including septic system plans and/or restaurant floor plans) Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variances only) Variance request application fee collected(no fee for lifeguard modification renewals;grease trap variance renewals[same owner/ieasee only],outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]). Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,R.S.,Chairman NOT APPROVED %' Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Ralph A.Murphy,M.D. Q:/WP/VARIREQ l 13 a!w{ si BOOK M 1.18 s< 1 r .{sra 14 0�nc s 1.39AG �3 t1 12-2 as.� C4.r a es•).: 4a�• `:JG4m. u� _asre v' q Ite `v° aswe 11-s .. OIA y �sAc 35,rl; 11.-31 © .asrC •atrp st ; y0. s� o 3swc r1-44 .. any to \ 1 1-{s �.>° 1 1-33 O -43an ,e r -sSti 1/-43 ^ rim fray'/' 11 ,5 ` % ♦ II-J4 s ►F 3cwc ex0 ► a .ssee- 11-2 .4L wc. �e 11-az $1wC O .54Ad- � o .3G Q i11 n ` eP !sue e © KA v II-35 II-to L7 .34 oc ; .41 rc II-4-t fir° ,ee ® -i .DLwc `,�ovs yo s•96> O ` yp ` -n • .34At_ !� PLC ''ls•i .35wc O C� ' � o I 1-'•Ne ` a � r P • � •3��' � - - 11-40 � 00 !6� 3 \ .4 1K o0 35.c s 1 • 11 11-LO ® � •if * 11-17- ® 11-35 0 �4J ra Y .41 5-7 -95wc•. O 00 Q 13 11-/j 11-58 pe 3�AG O �.J4se .37rt 'O 11-19 ® t0 yf' .+ a 9'►• 41Nc 1n w \ O e o q� Q°ill •s •e 11-14 : a vt y o0 1° 4- `e0 31 14 Y 0 - 1'i CC bQ y © 51 '1�►►� , ,�" a �,� + •{sue• wy labs u `` }� v y ® � �r ti0 ,` 80 4e O ij 1G O o b"ter�< c4 P \ ► 11 ` v ^ T, aho 44 ... SCALE •'•100 � J 1.07 o O rqr 243 •:°'` ,' ` 1 TOWN OF BARNSTA13LE G. LOCATION .'�1 JR,1,- c.J SEWAGE # VILLAGE [� Q ��yy�� ASSESSOR'S MAP & LOT U INSTALLER'S NAME&PHONE NO.-- A 3 SEPTIC TANK CAPACITY /Ta 0 4r¢L (s ) LEACHING FACILITY: (type) J f`. � (size) EDROOMS F . Bi ILDER O 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 c c Q „ Q,o 14. 0 0 i , Lv v o, TOWN OF BARNSTABLE tie LOCATION, W 0rZJ SEWAGE # ' ,S m 'JILLAGE d.S`t��t �� ASSESSOR'S MAP &LOT '� INSTALLER'S NAME&PHONE NO..�A Q2,I SEPTIC TANK CAPACITY 1 a y L LEACHING FACILITY: (type) �/J v (size) EDROOMS !BU7ELDE:R O 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 /vGLAF Cvaoo �.T. Al 10 1 n v . f� ay . 2- & ai T 33'.. GV PEE, i o OSTER T%ILL•E c.B. BENCHMARK Cl �Ac TAGBOLT ON HYDRANT 11Gz _p _ RO UTE 28 ELE 100. 0ASSUMED I_ `moo', �� - LOCUS - lk I e y C) HOUSE 0 / y A-M. 121177 it ,•� / / CB./HIT L LOCUS MAP A. M. .121178 . .� AREA=20,982f S.F. r?�" 06' �� ,CLAN REF L. C. A801B SH.1 GARAGE \ ZONING.' "RC" " o GRO UND WA TER 0 VERLA Y DISTRICT WP TP#1 6, #3 p�f TP#2.01 \ / • �\ , F SDI POLE o C4A �O �•.�s{p, ; ;w; �Q PROJECT L OCA T/ON 131 TANGLEWOOD DRIVE jar < r = OSTER VILLE,, MA. �80 - Q APPLICANT.- ,,4 - _ _ STARBOARD L. L. C. 97 \ — — A.M. 121179 YANKEE SUR VEY CONSUL TAN TS -� �0 P. O. BOX 265 �8 96 UNIT 5, 40B INDUSTRY ROAD r� f i S MARSTONS MILLS, MA. 02648 OF as PH.(508)428-0055 — FAX(508)420-5553 WILLIAM SCALE.• 1--20' [DA TE.• 5120199 {{ LIEBERMAN „ NOTE: � � ice, , No. 23971 VARIANCE GRANTED FOR THREE BEDROOMS 1�l?, '��F �1� REV REV.' GSTE � RE. 031 TANCLEWOOD DRIVE, OSTERVILLE �S�ioNAL ENS A=121178 , DATED MA Y 4, 1999 _ \C B JOB NO. 51838 SHEET I OF 2 99.�`' NOM REMOVE SOIL 5' ALL AROUND DOWN • . ' " 7V Cl AND REPLACE WITH CLEAN GRANULAR ' EL. —____ _ AM7E'RIAL IN ACCORDANCE WITH SffVT 15 255 (3-8) TOP OF FOUNDATION 20' MIN. 10' MIN. CONCRETE COVERS 4" SCHEDULE 40 P. VC } MIN. PI7CH 1/8 PER FT 2"LA YER OF EL=98' EL=112 CONCRETE COVER 1/8"-1/2" WASHED STONE It' MAe 4" SCH 40 PVC (OR EUA�j \_7 PITCH1/4 PERTMUM FT CLEAN SAND AJL' FLOW LINE EL=XV95.4 2' EFFEC77VE " DEPTH INVERT 1 10 14„ 95. 7 MIN. INVERT LEVEL O O O O O O O °0000 0 g FF�' —95 25 INVERT 6 SUM INVERT o °o O O o O O O O o°og o �x INVERT EL.-___ o0 9 0� EL =92.6 EL.=95.5 EL.__95.05 EL.=94.8_ 4 4' (719 BE PLACED ON FIRM BASE) DISTRIBUTION EL•=84.6 3f4" 7i 1 1-112" MECHANICALLY COMPACTED OR 8" OF STONE BOX MASHED S710NE -� 1500__GALLONS TO BE WATER TESTED L2.8' X 25' X 2' TRENCH FORMATION O IC TANK IF MORE THAN ONE OUTLET SL'P T ( LOADING) PLACE ON 6" STONE SOIL ABSORPTION SYSTEM (SAS PROFILE OF BOTTOM OF TEST HOLE ELEV.__ 87 6 SEWAGE DISPOSAL S YS T+�M NO OBSERVED WATER (3123199) NOT TO SCALE k f = 97:6' OBSERVATION HOLE 1 ELEV. PERCOLATION RATE 2 MIN./ INCH AT _20'r+ 18"INCHES OBSERVATION HOLE 2 ELEV. 97:4' - .._ DEPTH HORIZ TEXTURE COLOR MOTT. OTHER PERCOLATION RATE 4�-_ MIN./ INCH AT _i?Q + 18"INCHES 0"-8" AI, DEPTH ORIZ TEXTURE COLOR OTT. OTHER 8"-20" B SANDY LOAM 2.5Y 6/4 N O'-5" O/A N 20'-45" Cl MSE,oDIUME�nS D IOYR 5/8 AVEL .1N 5"-23" B LOAM 10YR5/8 0 5"-120 C2 MEDIUM SAND 2.5Y 6/4 E 3"-120 C MED. SAND 2.5Y 6 4 N / E GENERAL NOTES NO WATER ENCOUNTERED NO WATER ENCOUNTERED 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO DER v" of Af TITLE 5 AND THE TOWN OF —BARNSTABLE____ RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. I 3/23/99 SOIL TEST DONE BY ✓ GANDERS—CAULEY, P.E. 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO DATE OF SOIL TEST t� WILLIAM � WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12" WITNESSED BY' DONNA M. 0 LIEBERMAN 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF p No. 23911 O Q WITHSTANDING H-10 LOADING. DESIGN CALCULATIONS.' �'o�FGIsrE�```�•�``" 4 ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL 3 FSsroivnL ENG ) � NUMBER OF BEDROOMS . . . . . . . . BE MORTERED IN PLACE. GARBAGE DISPOSAL . . . . . . . . . NO 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH TOTAL ESTIMATED FLOW DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO (I10 CAL/BR/DAY x 3 BR) 330 GAL/DAY OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. INSTALL TWO (2) ACME 6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCA VA TION CONTRACTOR 500 GALLON &ACHING REQUIRED SEPTIC TANK CAPACITY 1500 GAL IS TO CALL ODIC— SAFE" AT 1-800-322-4844 AT LEAST 72 HOURS CHAMBERS T 7I H FOUR FEET SOIL CLASSIFICATION . . . . . . . . 1 STONE SIDES IND ENDS DESIGN PERCOLATION RATE . . . . . < 5 MIN./IN. PRIOR TO COMMENCING WORK ON SITE. 12.8' x 25' x 2' 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS EFFLUENT LOADING RATE . . . . . . 74 GAL/DAY/S-F. SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. LEACHING CAPACITY (AREA X RATE) 338 G/D . 8) PARCEL IS IN FLOOD ZONE'__"C_"__—__. RESERVE LEACHING CAPACITY . . . 338 CAL/DAY 9) LOT IS SHOWN ON ASSESSORS MAP AS PARCEL _78 . (12.8 X 25' X .74)+(12.8'+ 25'+ 12.8+ 25)(74)(2) SHEET 2 OF 2 JOB NO. 51838