HomeMy WebLinkAbout0076 TOWER HILL ROAD - Health 16 Tower Hill Road
1 Osterville P
A = 141 032
r 4
TOWN OF BARNSTABLE
LOCATION '7 C =OW Vt. tT I LL Ttp SEWAGE# o!O/a, -
VILLAGE d SG'V.T-UI Li.r ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO.(j_*L� QXft i I'g(1d eS 5L6. 9-N %V
SEPTIC TANK CAPACITY /, CK7 4/7-AM cow
LEACHING FACILITY. (type 60 &A 1-4owplEYwwtaS(size)
NO.OF BEDROOMS
OWNER 05 IZ� Sf4 L'T
PERMIT DATE: " / o/ COMPLIANCE DATE: 1
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on A
site or within 200 feet of leaching facility) I V Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) � � Feet
FURNISHED BY
vJ 5 � ,
)Q Fee VV
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN Of BARNSTABLE, MASSACHUSETTS
01ppliCation for Disposal *pstrm Construrtion Hermit
Application for a Permit to Construct( ) Repair(1�Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 76 7—ow rx Iv.,t-L Own is Name,Address,and Tel.No.
/�s��'j LZ�2�T"Yc o.
Assessor's Map/Parcel J/// - O 3
I ler's Name,Address,and Tel.No. v0'3 T��f!' 3,5'7O Designer's Name,Address,and Tel.No.
d�SfJ�IrF�S C GBU��IU� 4V�GL,��z $° , SSoc�i9��S
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(✓)
Other Type of Building Si No.of Persons Showers( ) Cafeteria
c
Other Fixtures
Design Flow(min.required) 3,30 gpd Design flow provided 7� o 7 gpd
Plan Date ��CZ0 f 6L Number of sheets Revision Date
Title S
Size of Septic Tank �� ua prn� Type of S.A.S.
Description of Soil L'� a A p .L A0S
Nature of Repairs or Alterations(Answer when applicable) `c L O
S �/ �C ►fl L L GL CJ ,S
Ac' P�iz t
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code not to place the system in operation until a Certificate of
Compliance has been issued by this Board Hea JJ
Sign Date
Application Approved by Date 3,
Application Disapproved by Date
for the following reasons
Permit No. l Date Issued eq
------------------------------------------------------------------- -------- ---
No. cl� !� Fee Vl/
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF, BARNSTABLE, MASSACHUSETTS Yes
01ppl cation for MIsposaY,6pstetn Construction Permit
Application for a Perntir't'o Construct( ) Repair w6pgrade(')'Abandon( ) ❑Complete System ❑Individual Components
_ - I
Location Address or Lot No.76 7-o&jrx ,,V,1C L IZ 4) Ow4er's Name,Address and Tel No
Assessor's Map/Parcel /#/- O 3 a
I ler's Name,Address,and Tel.No.�0o �g 3S-70 Des i er's Name,A dress,and Tel No 7 76--G 7 3:S'-
✓ V01/F'3 Cox Lrz
Type of Building:
I
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(-�')
Other Type of Building `Rn-_/'55wce No.of Persons Showers( ) Cafeteria(--)
-)
Other Fixtures
Design Flow(min.required) ��`3 gpd Design flow provided T + gpd
Plan Date J1024�/fJCQ/DL Number of sheets Revision Date
Title S
Size of Septic Tank Type of S.A.S.
Description of Soil $ec- a 6A'd
'I
Nature of Repairs or Alterations(Answer when applicable) S" 6*-140 O o vJ}'
5 FP�i . /t C�3 Alp G-�L L 40 L L t+J s e a/
j r4c .5,0 5 P Fz 7-.rc E ��
�Date,last inspected ! ,
I� Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
iI accordance with the provisions of Title 5 of the EnvironmentalZCodenot to place the system in operation until a Certificate of
I� Compliance has been issued by this Board •€Heal
'Si-gn-ed Date / !/
Application Approved by Date / d1
Application Disapproved by Date
for the following reasons
II�
i
Permit No. Date Issued
- -.---------------- = _ = _=' -_ ---_------_---_--------=-----------------=-------
Ir THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
'i Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(1(1� Upgraded( )
Abandoned( )by I UTLft,t 5 6A94 Guegey".�t/iZfZ
if at :,r " ,oW 1=2 /�"/L L jz /,0,(�JI~'c'v/GL E has been constructed in accordance /-j with the pr isio o itle the for .sposal System Construction Permit N 0149 "�� dated tP /� l((''
/, ;
Installe, Designer 60F44 E7 e- QS`.S-OG
#bedrooms Approved design flow '3 3 y gpd
The issuance of this permit shall of bQ.cou§trued as a guarantee that the sys will fun signed.
Date /� Inspe for
----------------- --------------------------------------------------------------
No. � " -��! Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE,MASSACHUSETTS
;DispoiW 6pstem Construction Permit
Permission is hereby graned to Construct( ) Repair( [� Upgrade( ) Abandon( )
System located at 76'
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction mus be com leted within three years of the date of this permit.
Date bn '� Approved by
4
Town of Barnstable
Regulatory Services
Thomas F. Geiler, Director
' a LAM Public Health Division
1639. Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Date: — ?, —/Z- Sewage Permit# Assessor's Map/Parcel / /—30—
Installer& Designer Certification Form
Designer: Installer:
Address: U �`�� Address: �CyC� !�}�
On /� -�6" was issued a permit to install a
(date) (installer
septic system at 2 _7�e",_)g5;t based on a design drawn by
(address)
dated
(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. Stripout (if required) was inspected and the soils
were found satisfactory.
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. Stripout(if required spected and the soils
were found satisfact XjN 6F 4f4S
�o DARR N GN
A; to
(Installer's Signature)
0. 11
+ PF �°
G/STEM 1
S41VITARk
esi ner's Signature) (Affix DesigAVARWMp Here)
PLEASE RETURN TO B LSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
gAoffice formsWesignercertification form.doc
Town of Barnstable P
Department of Health,Safety,and Environmental Services
Public Health'D>< 6i6n `' , Date
a $ 367 Main Street,Hyannis MA 02601 '
6J9 A Date Scheduled." '- �/ _ Time FeePd..
Soil Suitability Assessment for Sewa a Disposal
Performed By: 1 �%4 µ ' Witnessed By: —
z
,C)CAT`ION &'GEN R�� 1Nt�` RMATIO
Location Address 7� L/L� Owner's Names��a •'/ �r
owl��2C/f LG Address
Assessor's Map/Pareel: -��� (j�'� - Engineer's Name W�GG,Gz
NEW CONSTRUCTION REPAIR _� - Telephone# ; 7 S O'�S.
Land Use Slopes(%) F Surface Stones
Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft
Drainage Way ` •ft Property Line ft' Other fi
F g Y - I
4 SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) .
.:d,s,,y",
C:) -
Parent material(geologic)
Depth to Bedrock �N
(g g — -
Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face {�
Estimated Seasonal High Groundwater,
=standing
Method Used:Dep hole: in. Depth to soil mottles. In•
oz
V .
• - � ,,, it
_ s s
< • r
DEEP OBSERVATION HOLE LOG Mole#^
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. '
%
DEEP OBSERVATION HOLE LOG Hole# ,
Depth from Soil Horizon Soil Texture I Soil Color Soil Other
-Surface(in.) �I- - (USDA.) — ! (Munsell) Witting-- ('Structure,Stones,Boulderes.
%
I' 14 6111A l 3l
►►
a ,
0
BEEP OBSERVATION HOLE L'G
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
%
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil , (her
USDA Munsell Mottling (Structure,Stones,Boulderes.
Surface(in.) (USDA) (Munsell) g
n
Flood Insurance Rate Man•
Above 500 year flood boundary No_ Yes
Within 500 year boundary No I Yes
Within 100 year flood boundary No J Yes
Aeptth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? \119-S ,
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on l-0 b (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with
the require in ,expertis and experiencedescribed in 310 CMR 15.017.
Signature Date t{
ti
t
topCOMMONWEALTH OF MASSAC HUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONME
AUG 2 1 2003
TOWN OF BARNSTABLE
HEALTH DEPT.
TITLE 5
OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 76 Tower Hill Road MAP 1 �Y
Osterville
Owner's Name: Richard Reid PARCEL 3
Owner's Address:
LOT .
Date of Inspection: 8/5/2003
Name of Inspector: (please print) Kevin J. Sullivan
Company Name: Ready Rooter
Mailing Address: P.O.Box 371
Sandwich,MA 02563
Telephone Number: (508)888-6055
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The System:
vo Passes
Conditionally Passes
Needs Further Evaluatipn by the Local Authority
ails
Inspector's Signature:
�---� Date: b
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 76 Tower Hill Road
Osterville
Owner: Richard Reid
Date of Inspection: 8/5/2003
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
C. System Passes:
have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system.components as described in the"Cond!tion#Pass"section need to be replaced or
repaired.The system,upon completion of the replacement or repair, approved by the Board of Health,will pass.
Answer yes,no or not determined (Y,N,ND)in the forth following statements.If"not determined'please
explain.
The septic tank is metal and over 20 years old*or th septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfihration or k failure is imminent.System will pass inspection ifthe
existing tank is replaced with a complying septic tank as proved by the Board of Health.
*A metal septic tank will pass inspection if it is stru ly sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is a le.
ND explain:
Observation of sewage backup or break or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or never distribution box.System will pass inspection if(with
approval of Board of Health):
en pipe(s)are replaced
struction is removed
istribution box is leveled or replaced
ND explain:
The system required pumpin ore than 4 times a year due to broken or obstructed pipe(s).The system will
pass inspection if(with approval of a Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
Page 3 of 11
OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 76 Tower Hill Road
Osterville
Owner: Richard Reid
Date of Inspection: 8/5/2003
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by th Board of Health in order to determine if the system
is failing to protect public health,safety or the environment
I. System will pass unless Board of Health Bete Ines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner whit ill protect public health,safety and the environment:
_Cesspool or privy is within 50 feet of surface water
Cesspool or privy is within 50 feet o bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public ter Supplier,if any)determines that the
system is functioning in a manner that protects the public It ,safety and environment:
_The system has a septic tank and soil absorption syst (SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supp .
T The system has a septic tank and SAS and the S is within a Zone I of a public water supply.
The system has a septic tank and SAS and the AS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and SAS is less than 100 feet but 50 feet or more from a
private water supply well*". Method used to d ine distance
**This system passes if the well water analy s,performed at a DEP certified laboratory,for coliform
bacteria and volatile organic compounds indica that the well is fine from pollution from that facility and
the presence of ammonia nitrogen and nitrate trogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered.A copy of the an ysis must be attached to this form.
3. Other:
I
Page 4 of I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM_ INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 76 Tower Hill Road
Osterville
Owner: Richard Reid
Date of Inspection: 8/5/2003
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 and overloaded or clogged SAS or
cesspool
_ Liquid depth in cesspool is less than 6"below invert or available volume is less than %Z day flow
_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
_ZAny 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.
T _ Any portion of a cesspool or privy is within a Zone 1 of a public well.
_ _AZAny portion of a cesspool or privy is 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. (This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.)
OC)(Yes/No)The system fails. I have determined that one or more of the above 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 se e a facility with a design flow of 10,000 gpd to 15,000
You must indicate either"yes"or"no"to each of th following:
(The following criteria apply to large systems in ition to the criteria above)
yes no
_the system is within 400 feet of a su drinking water supply
_the system is within 200 feet of a 'butary to a surface drinking water supply
the system is located in a ni en sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone H of a public water sup y well
If you have answered"yes"to any estion in Section E the system is considered a significant threat,or answered
"yes"in Section D above the larg system has failed.The owner or operator of any large system considered a
significant threat under Section or failed under Section D shall upgrade the system in accordance with 310 CMR
15304.The system owner sh d contact-the appropriate regional office of the Department.
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 76 Tower Hill Road
Osterville
Owner: Richard Reid
Date of Inspection: 8/5/2003
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)
-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?
_3Z_ 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?
_xZ_ Was the facility owner(and occupants if different than 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:
Yes No
_ 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(3)(b)]
Page 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 76 Tower Hill Road
Osterville
Owner: Richard Reid
Date of Inspection: 8/5/2003
FLOW CONDITIONS
` RESIDENTIAL
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):3.30
Number of current residents:_-_-D
Does residence have a garbage grinder(yes or no):'tD0
Is laundry on a separate sewage system(yes or no):.A)Q f if yes separate inspection required]
Laundry system inspected(yes or no):
Seasonal use:(yes or no): $
Water meter readings,if available(last 2 years usage(gpd)): _�� _ rl/ �,pn = S cam•��,
Sump Pump(yes or no):_kjo
Last date of occupancy: C ,,-
COMMERCIALANDUSTRIAL
Type of establishment:
Design flow(based on/eDn
3): gpd
Basis of design Bow(sft,etc.):
Grease trap present(ye
Industrial waste holdint(yes or no):—
Non-sanitary waste dise Title 5 system(yes or no):
Water meter readings,Last date of occupancy
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: <nL- ,,, �- - ,.,,,�, 7 17 ZJ
Was system pumped as part of the inspection(yes or no :h:;�5n
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)
_Tight tank Attach a copy of the DEP approval
ther(describe): ('5LO
Approximate age of all components,date installed(if known)and source of information:
Were sewage odors detected when arriving at the site(yes or no):,<f)
I
Page 7 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM_INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 76 Tower Hill Road
Osterville
Owner: Richard Reid
Date of Inspection: 8/5/2003
BUILDING SEWER(locate on site plan)
Depth below grade:�el
Materials of construction:_cast iron 40 PVC_other(explain):
Distance from private water supply well or suction line: ?f&/ZG'
Comments(on condition of joints,venting,evidence of leakage,etc.):
C c�.n•arrp.)`r� C�ss �
SE`PY'i��`A-NK: ocate on site plan)
Depth below grade: C-�>r` s
Material of construction: /concrete_metal fiberglass^polyethylene
other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):^(attach a copy of
certificate)
Dimensions:
Sludge depth: t fe r
Distance from the top of sludge to bottom of outlet tee or baffle: (Z
Scum thickness: j '
Distance from top of scum to top of outlet tee or baffle: ,` a
Distance from bottom of scum to bottom of outlet tee or baffle:
How were dimensions determined: VAr-A !;,,'?� Z>-, s y'z /—
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
_ 1 �" ✓�`�'�.L to�.r�r �i r� G���-°
GREASE TRAP: (locate on site plan)
Depth below grade:_
Material of construction:_concrete_ _fiberglass_polyethylene_other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of tlet tee or bale:
Distance from bottom of scum to om of outlet tee or bate:
Date of last pumping:
Comments(on pumping recom ndations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,avid ce of leakage,etc.):
Page 8 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 76 Tower Hill Road
Osterville
Owner: Richard Reid
Date of Inspection: $15/2003
TIGHT or HOLDING TANK: (tank must be ped at time of inspectionxlocate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass_polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: _ gallon ay
Alarm present(yes or no):
Alarm level: Alarm in wor ng order(yes or no):
Date of last pumping:
Comments(condition of alarm float switches,etc.):
DISTRIBUTION BOX: (if present m be opened)(locate on site plan)
Depth of liquid level above outlet invert:
Comments(not if box is level.and distri 'on to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
PUMP CHAMBER: (locate on site p )
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump c ber,condition of pumps and appurtenances,etc.):
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 76 Tower Hill Road
Osterville
Owner: Richard Reid
Date of Inspection: 8/5/2003
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:_
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
_overflow cesspool,number: I
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.):
T
CESSPOOLS: (cesspool must be p ped 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' flow(yes or no):
Comments(note conditio 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,si s of hydraulic failure,level of ponding,condition of vegetation,etc.):
Page 10 of 11
.e
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 76 Tower Hill Road
Osterville
Owner: Richard Reid
Date of Inspection: 8/5/2003
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.
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Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 76 Tower Hill Road
Osterville
Owner: Richard Reid
Date of Inspection: 8/5/2003
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record—If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with the local Board of Health-explain:
Checked with local excavators,installers-(attach documentation)
_ ccessed USGS database-explain: ti: . c
You must describe how you established the high ground water elevation-
— r�
� � � r
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS THE BUSINESS
NAME in town (which you must do by M.G.L.- it does not give you permission to operate.) You must first obtain the necessary
signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FL., 367 Main Street,
Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law.
xxi Fill in please: Date:
APPLICANT'S NAME: P C ;� -'ziyt7 - boS
,..,
YOUR HOME ADDRESS:. } c;f- i
.BUSINESS TELEPHONE # 06-041 HOME TELELPHONE #:Sof? 49D 0 zf
NAME.OF CORPORATION: Nt at2GcZ o
NAME OF NEW'BUSINESS cr=z TYPE OF BUSINESS c
IS THIS A HOMEOCCUPATION? ^ YES. . NO
ADDRESS OR BUSINESS c<<t Nc c.i jl� _ MAP/PARCEL NUMBER (Assessing)
When starting a new business there are several things you must do to be in compliance with the rules and regulations Hof the Town of
Barnstable. This form is to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. (corner of Yarmouth Rd.
& Main Street)to make sure you have the appropriate permits and licenses required to legally operate your business in town.
1. . BUILDING COMMISSIONER'S OFFICE
This individual has been informed of any permit requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
2. BOARD OF HEALTH
This individual has be informed of the p mit requir ents that pertain to this type of business.
uthorized Signature*'
MUST COMPLY WI I Fl ALL
COMMENTS: HAZARDOUS MATERIALS REGULATIONS
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
Hazardous Materials'Inventory Sheet Checklist
t ate
t/ Physical.Street Address-Check database to ensure it exists
=Working Phone Number
ctual Amounts—(i.e.gas being used to fuel machines,thinner to
I glean brushes all count as hazardous materials)
V Storage Information—location of storage,how long is storage for?
` / If none,note that. �St
y Disposal Information—where and who? If none,note that. pJ
�G Applicant Signature—.understand what is listed and noted.
1/ Staff Initial—any questions,know who to ask. '
Vehicle Sig
nature —provide a vehicle washing policy and
explain it—note that it was given.L�Attach the Business Certificate with your sign-off and comments.
"The Inventory form should explain what the business consists of and the procedures
they are doing. Notes need to be left to explain what you discussed with them.
Date: /d /69
TOWN OF BARNSTABLE 7
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS: 44 AX,C167 0
BUSINESS LOCATION: 4K 72 wF2- H►'L-z, (1-& . INVENTORY
MAILINGADDRESS: le, -tQL /LIJA- t, a+—L P- , TOTAL AMOUNT:
TELEPHONE NUMBER: -4 1 L/ Z36 ��-�( i l_5- /y c4z_ -�- /�Z
CONTACT PERSON: 44 AA-(-L-10 10 ' 4 Li P oz if/ --ball ®2,
Nr -
EYVIERGENCY CONTACT TELEPHONE NUMBER: � L MSDS ON SITE?
TYPE OF BUSINESS:- De
INFORMATION/RECOMMENDATI NS: Fire District:
Waste Transportation: Last shipment of hazardous_waste:
Name of Hauler: Destination:
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic
or hazardous characteristics and must be registered regardless of volume.
Observed/Maximum Observed/Maximum
Antifreeze (for gasoline or coolant systems) Misc. Corrosive
NEW USED Cesspool cleaners
Automatic transmission fluid 7 66L Disinfectants
Engine and radiator flushes Road Salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils J�� Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil NEW USED
/ Misc. petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways &garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Misc. Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt & roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, -
Lacquer thinners (inc, carbon tetrachloride)
NEW USED Any other products with "poison" labels
Paint & varnish removers, deglossers (including chloroform, formaldehyde,
Misc. Flammables hydrochloric acid, other acids)
Floor &furniture strippers Other products not listed which you feel
Metal polishes may be toxic or hazardous (please list):
Laundry soil & stain removers
(including bleach) 44,4 tj 7V
Spot removers &cleaning fluids
(dry cleaners)
Other cleaning solvents /
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
ti. N N INSTALL RISERS COVERS TO PIPES TO BE LAID LEVEL FOR 2" LAYER OF DOUBLE WASHED PEASTONE DEEP OBSERVATION HOLE LOGS
WITHIN G" OF FINISH GRADE 2' OUT OF DISTRIBUTION BOX OVER 3/4" - I %2" DOUBLE WASHED STONE
W 12
(SEE PLAN VIEW FOR LOCATION5) ALL AROUND TEST BY04D MEYER RS C5E
WATER TEST D-BOX FOR WITNESS: D. DESMARAIS, HEALTH AGENT
TBM = LEVELNESS � FLOW
EQUALIZATION PERC RATE: 4 MIN. / INCH
— BASEMENT FLOOR
51 d LOCUS ' @ EL. 4G.0 EL. 4G.d DEEP OBSERVATION HOLE#I EL.45:0
_ EL. 45.0 DEPTH SOIL 501L SOIL COLOR SOIL
EL. 45.0 FROM
4"SCH r —' HORIZON TEXTURE OTHER
Q 4"5CH 40 PVC TOP @ EL. 42.0 SURFACE (MUNSELL) MOTTLING
40 PVC 4"SC 40 PVC O"- 18" A LOAMY SAND I OYR3/2
f�+ 42.25 I o 1000 14 (3) 500 GALLON PRECAST DRYWELL5 18"-42" 5 LOAMY SAND I OYR5/8 PERC TEST @
41 .50 IV
42°- 132" C FINE-MEDIUM SAND 2:5Y6/4 42" = GO"
O GALLONS 500 1 .67 ' BOTTOM @ EL. 39.30
(!� GALS. 42.00 41 .30
(s) D5-5
uw
NOTE: INSTALL GAS BAFFLE
IN OUTLET TEE INSTALL TANK D-BC X
;* Q ON G" LAYER OF CRUSHED 5.3 DEEP OBSERVATION HOLE#2 EL. 45.0
I.
1500 GALLON PRECAST STONE
DEPTH SOIL SOIL SOIL COLOR SOIL
(2) COMPARTMENT SEPTIC TANK SURFACE HORIzoN TEXTURE (MUNSELL) MOTTLING OTHER
BOTTOM Th @ EL. 34.0 0"_ 18" A LOAMY SAND I OYR3/2
18"-43" 5 LOAMY SAND I OYR5/8
43"- 132" C FINE-MEDIUM SAND 2.5YG/4
NOTE: NO GROUNDWATER ENCOUNTERED IN ANY OBSERVATION HOLE
/
DESIGN DATA
/ DAILY FLOW: (3) BEDROOMS x 110 GFD = 330 GPD
SEPTIC TANK: 330 GPD x 200% = GGO GPD
USE: 1 500 GAL. PRECAST (2) COMPARTMENT SEPTIC TANK
I DISTRIBUTION BOX: D13-5
' I f 501L A135ORPTION SYSTEM:
i' 50.4 it /' I I USE: (3) 500 GAL. PRECAST DKYWELLS LINED W/4'
+ �� I I OF DOUBLE WA5HED 5TONE
I I /' CAPACITY:
51DEWALL AREA: 103 x 2 x 0.74 = 152.4 GPD
BOTTOM AREA: 13 x 33.5 x 0.74 = 322.3 GPD
/
TOTAL CAPACITY: 474.7 GPD
r
- 50 I
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GO
/ O
GENERAL NOTES
E ' / I . SEPTIC SYSTEM 15 TO BE INSTALLED IN ACCORDANCE WITH
/ isr/Nd / / / / / J 1 I 3 10 CMR 1 5.00: TITLE V
/ D��g / / / / // 2. THI5 SEPTIC SYSTEM 15 NOT DESIGNED FOR THE USE OF A
(3) BF//VG / GARBAGE DISPOSAL.
TorAL OROpMs / / / / / ' 3. THI5 PLAN 15 NOT TO BE USED FOR PROPERTY _INE DETERMINATION.
4. CONTRACTOR SHALL PROVIDE 48 HOUR NOTICE TO DE51GN
r
+52. 1 / / /o, 44.7+ '�` / / // / / / ENGINEER FOR ANY REQUIRED INSPECTIONS.
EXIST./" -� / / // 5. CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION OF ANY
r / CE55PgOL` / UTILITY, ABOVE OR UNDERGROUND, PRIOR TO ANY EXCAVATION
/INSTALL /
1 /IETH#2 / / / // / / OR CONSTRUCTION.
CLEANOUT \\ / / / / / / / / // G. EXISTING CESSPOOLS TO BE PUMPED DRY, CRUSHED IN, +
/ FILLED WITH CLEAN SAND.
Q �TH#I
� EXIST.
CE55POOL
-- 5ITE --- SEWAGE PLAN
FOR
7G TOWER HILL RD., 05TERVILLE, MA
.1000 01 - PREPARED FOR
H05TETTER REALTY CO. , INC.
-_ ---
`� O SCALE: DATE: DRAWN BY:
_ --- "/ D R EN` yG�rn III = 30' 04-2G-201 2 TMW
REVISION:
� .. --.,.___ __—_— 1 ` �� � �� � / � JOB NUMBER: SHEET NUMBER:
- \ -- --- I �c'� i o. 1140 1 2-01 8
8P-
I � o
WELLER * A550CIATE5
�G1STE��
/
\ r i SA'IVITAR\P� I G45 FALMOUTH ---RD., SUITE 4C P.O. BOX 417 CENTERVILLE, MA 02G32
�I r 2 WINDY WAY, #232 NANTUCKET, MA 02554
/ q 26 TELEPHONE 4 FAX: (508)775-0735
\, EMAIL: trl5weller@conca5t.net
REGISTERED LAND SURVEYORS t- ENVIROMENTAL CONSULTANTS
Traverse PC