HomeMy WebLinkAbout0327 TOWER HILL ROAD - Health 327 Tower Hill Road, Osterville
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(/ TOWN OF BARNSTABLE
LOCATION 327 TOWER HILL ROAD SEWAGE # qq-- ft>
VILLAGE OSTERVILLE ASSESSOR'S MAP & LOT
INSTALLER'S NAME PHONE NOELLIS BROTHERS CONST. CO. 362-6237
SEPTIC TANK CAPACITY. I a Deb �►� I �v��
LEACHING FACILITY:(type). (size) 1,oUc�
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
,BUILDER OR OWNER`
DATE PERMIT ISSUED:
., jj
DATE COMPLIANCE ISSUED
VARIANCE GRANTED: Yes No �[
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiou for Divjipoottl Works Tatuitrurtiou Vamit
Application is hereby made for a Permit to Construct ( ) or Repair (;�o an Individual Sewage Disposal
System at:
Lo lion-t\ddr• s or Lot No.
....:.......... .............. `----•• � •-•-••..___..._ •-•--.........
_•--••_-_____-__...___------_--------
",Owner Address
W
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling: No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building .._-_- No. of persons .............. Showers —
a YP g ---------------------- P (/ ) Cafeteria ( )
d Other fixtures ------------------------•-------------------- --...---....----
W Design Flow--------------------------------------------gallons per person per day. Total daily flow.............................-..............gallons.
94 Septic
Disposal Trench iq No capacity.......- gallons Length Total Length Width..........--_.Total leaching area.- Depth-..---:sq. ft.
Seepage Pit No..................... Diameter....... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
`.4 Percolation Test Results Performed by...........-.............................................................. Date........................................
a
a Test Pit No. 1----------------minutes per inch Depth of Test Pit-.-------_--------__ Depth to ground water---------------.--------
µ, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
4.
0 Description of Soil.............................................................................................. ------------------------------------ --------------------••••---••-••----
x
-------------------------- ------------------------------------------------------------------------------------- .. ------------`---��- � --
U Nature of Repairs or Alterations=Answer when applicable.-..--. ....-La------------- --�U1C�C.. .
.--..(�.........j---J..
Agreement: v
The undersigned agrees to install the �®redescridlvl a SI ewage Dispo gatern in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned f agrees not to place the
system in operation until a Certificate of Compii e ha been:-issued th and - ealth._
,�✓d?
Signed . .. .:m..
Application Approved By -- --- ------------------- - -- ----- -------------- .. ..- ----------------
Application Disapproved for the following reaso s• ......................
................. . ............ . ...... -- --------------------------------- - ---------------------------
Date
Permit No. ........... ..... Issued /
Dace
Z-/
r
No.-;—........ -lf Fxs._..` ............. f
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Divi-paml Work.5 Towitrnrtion Vrrmi#
Application is hereby made for a Permit to Construct ( ) or Repair (>0 an Individual Sewage Disposal
System at:
------------------------------------------------------------------------------ ..._-•-•--
Locntion-Addr ss, or Lot No.
y, 1 hilt
s Owner Address
W
Installer Address
Type of Build Size Size Lot............................Sq. feet
Dwelling=No. of Bedrooms........ _______________________-__.-Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons----------- .............. Showers (/ ) — Cafeteria ( )
d Other fixtures ------------------------------•----•------------•-••--------
----
------------------I---•--------••-•----
W Design ,Flow____________________________________________gallons per person per day..-Total daily flow--------------------------------------------gallons.
P4 Septic
dth
x Disposal Trench—Tank—Liquid capacity --Wi`dthns LengthTot tl�l engthl----- =-------ToDtal leaching area-- Depth sq -f�:
Seepage Pit No-------- __ _________ Diameter..................... Depth below inlet.................... Total leaching area_ .__._.___.._.sq. ft.
z Other Distribution box ( ) Dosing tank ( ) r_,..
a �,Percolation Test Results Performed bY-------- ----------------------•-------------��=-- ----------=.---------- Date........................................
Test Pit No. I________________minutes per inch Depth of Test Pit------------------ Depth to.ground water.........................
(i T-est Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
-----------------------------------•-----•--------------------------------------•-----------...-•-•-.........................................................
0 Description,of Soil----------------------------------------------------------------------------------•.---....--------------..----------------------•-------------•---------••-------••-•-
x
U .._..-•-••••--••--•••-•••-•---••--•-•-•...-------•-----•-••••-•--------••----••----••---------••-•••--•••-----•-• •-•-•--••••--•----------•----•---•-••-••-•---------------------••-----•-•...--•-••••--
__________________•-----•. •-----_-_-_----------__•---------------------•---------•-------__-___---------•---- =-------------•-----------_ �+� -
U Nature of Repairs or Alterations—Answer when applicable_._-__,----_/_1j....__- -�o!tiC_.......( !................................. L_
.... •••••--------•-•-•-------•-----•------•-•--•-•-••••-•••---•••-----•----•-•--•-• ''
Agreement:
The undersigned agrees to install the a ores described Indivld a SI ewage Dispo al stem in accordance with
the provisions of TITLE 5 of the State Environmental Code —The undersigned fu her agrees not to place the
system in operation until a Certificate of Compli ce has been issue th"@�ardhea
lthSi ned . '"� d j gy
Application Approved By ..r: ...i//_.��!✓� ------- ..... /_.... �1 /jl/r ------------------ ---- -- ..1.. .._ �
' Dare
Application Disapproved for the following reafo lsl---------------------------------------------------------------------------------------------
................ .. .. ............. -�-.-........ .... ... - ---------------------------------------------- ------------------------------------
Permit --- ------------ --.-_ Issued -;---- % ----.. D--a re
------
V Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
��T1 ertifirate of Grapliance
THIS IS CERTIFY, That the Individua ewage isposal SWem constructed ( ) or Repaired ( )
by ... V ...._ /h... .. rs�'� ----- ----.� 0
- l Installer at ... n Iad inaccordance
.....rd / h .....��Y.-�Lf. -....a. 1� '_.....f�..:�( L=C. - ... .............
has been installed acco ace p TI,E 5 f he St- ekrironmental Code as described in
the application for Disposal Works Construction Permit No. ...�� T_`�_.... .----- dated -------------.._.-----------------_.........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE COI kUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..... � ''� ��J-._..._.. .--_ �. -- :.. Inspector :�- A '�-��/_r �- _.:..._s-_... - -�..,•,
r
THE COMMONWEALTH OF MASSACHUSETTS p
It 1 f I
t e
BOARD OF HEALTH
TOWN OF BARNSTABLE ,---
No......................... FEE...
uiaplifi 411 T 15tr_xudwi , err
Y g
Permission ts'hereb ranted-------- ` .. .---; � >.--_--
to Construct ,_...,. ) Individual Sewage//Disp+ sa1'—Syste� / '
at N.......... / ✓ l ��_ � ( .. Ci Street ().
as.shown on the application for Disposal Works Construction Permit No�_ __.__� Dated...........................................
-----------------•-----------------------------------------------------------------------------•-••_-_...
Board of Health
DATE.---•-••----------•-•---••---------------------------------------•--------------
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS
_.®.
Commonwealth of MassaChusettS
Executive Office of Environmental Affairs
Deportment of
Environmental Protection
William F.VMd om m« Trudy Coxs
At�Paul Wuxl Seam"
c.rld a.Stria
oonrnwionsr
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO
- PART A RECEI 19 Ems®
Pro
per r d+ �. 6 /' 'D�- G'7/ -0 -2-�j� Address of owner. A U G 8 1997
Date of Inspection: `7-t/ 7, at different) HEALTH DEPT.
Name of Inspector. 102�� k.,�
Company Name,Address and�'elephom umbKr. TOWN OF BAN,
ZCA�TIONAt
NT G 3
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
_ Passes
Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
—. F
Inspector's Signature: `! 'Go^v�^_Date: 7
The System Inspector submit a copy of this inspection report to the Approving Authority within thirty(30)days of.campletmg this
faspectioa. 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
:sport to the appropriate regional office of the Department of.Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. .
INSPECTION SUMMARY:
Cheek A,B, C.or D:
A) SYSTEM PASSES:
I have act found any'information which indicates that the system violates any of the&a ue grit rii as defined fn 310 CMIt 15.303.
Any failure criteria not evahasted are indicated below.
8) 8YS7EM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,pasty
inspection- I
Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determina r,explain why not)
The septic tank is metal, cradud,Anxturally unsound,shows substantial i Akmtwn or cdatratwa,•or tank f&m a
imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved
by the Board of Health.
(revised 11/03/95) 1
Ons Wlnt r Street • Boston,Massaehuselts 02108 • FAX(617)SWI049 m • T*Wphons(617)N2-6600
Pmed on Recycled Pep r
Nip r t
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:
Owner.
Date of Inspection:
B)SYSTEM CONDITIONALLY PASSES(continued)
Sswage_baehup or breakout or high static water level observed in the distrilxAon boa it;due to broken or obstructed pipe(s)
or due Ito a broken,settled or uneven distribution boa. The system will pus iaspeetioa if(with approval of the Board of
broken pipe(s)are replaced
�$ obstruction is removed
�( distribution boa is levelled or replaced
The system required pump' more than four times a year due to ken or obstructed pipe(s). The system will pass
inspection if(with approval o Board of Health):
bra n pipe(s)are replaced
obetru 'on is removed
C) FURTHER EVALUATION IS REQUIRED BY THE BO OF HEALTH:
Conditions exist which require further evaluation the B of Health in order to determine if the system is failing to protect the
public health,safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD F HEALTH D INES THAT THE SYSTEM IS NOT FUNCTIONING IN A
MANNER WHICH WILL PROTECT PUBLIC HEALTH SAFETY AND THE ENVIRONMENT.-
Cesspool or privy is within 5 feet of a surface water
Cesspool or privy is wi ' 0 feet of a bordering vegetated d or a salt marsh.
2) SYSTEM WILL FAIL UNLES THE BOARD OF HEALTH LAND P LIC WATER SUPPLIER,IF APPROPRIATE)
DETERMINES THAT THE STEM IS FUNCTIONING IN A THAT P80TECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVI NMENT:
The system has septic tank and soil absorption system and is within 00 feet to a surface water supply or tributary to a
surface water pply.
The system a optic tank and soil absorption system and is within a ne I of a public water supply well.
u a The system h septic tank and soil absorption system and is within 50 f of a private water supply well.
The system has a septic tank and soil absorption system and is less than 100 but'50 feet or more from a private water
supply well,unless a well water analysis for coliform bacteria and volatile compounds Wdicatas that the well is free
from pollution from that facility and the presence of ammonia nitrogen and nitrogen n equal to or less than 5 ppm.
a) OTSER
(revised 11/03/95) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(oontinued)
Property Address:
Owner.
Date of Inspection:
DI SYSTEM FAILS:
I have determined that system violates one or more of the following failure criteria as defined in 310`CMR 15.303. The basis for
this determination is ide tified below. The Board of Health should be contacted to determine what will be necessary to am. 'the
failure.
Backup of sewage is facility or system component due to an overloaded or SAS or m -y Mol.
_ Discharge or ponding of ffiuent to the surface of the ground or.surface rs due to an overloaded or clogged SAS or
cesspool.
Static liquid level in the tion box above outlet invert d to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less 6"below invert or ailable volume is less than 1/2 day Dow.
Required pumping more than 4 tiro in the year NOT due to clogged or obstructed pipe(*).
Number of times pumped
Any portion of the Soil Absorption S m, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or p ' is wit ° 100 feet of a surface water supply or tributary to a surface water supply.
_• Any portion of a cesspoo r privy is within a Zone I of a public well.
Any portion of a pool or privy is within feet of a private water supply well.
Any portion of cesspool or privy is Was than feet but greater than 50 feet from a private water supply well with no
acceptable ter quality analysis. If the well been analyzed to be acceptable,attach copy of well water analysis for
eoliform cteria,volatile organic compounds, onia nitrogen and nitrate nitrogen.
El LARGE SYSTEM IS;
The f criteria apply to large systems in addition to the feria above:
The serves a facility with a design Dow of 10,000 gpd or ter(Large System)and the system is a sigai5caat threat to public
and safety and the environment because one or more of the!folbwing conditions cast:
the system is within 400 feet of a surface drinking.water supply
the system is within 200 feet of a U*utary to a surface drinking water supply
_, the system is located is a nitrogen sensitive area(Intersm Wellhead Protectwa Area(1WPA)or a mapped Zone II of a public
water supply wall)
The owner or operator of any so&system shall bring the system and facility into till compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the Iocal regional ofrm of the Department for further information..
(revised 11/03/95) 3
- Y.
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .
PART B
CHBCKLIST
Owner.
Dale of Iaspeotiow
Cheep if the following have been done:
41 umping information was requested of the owner,occupant,and Board of Health.
Licane of the system components have been pumped for at bast two weeks and the system has been receiving normal flow rates
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
_As built plans have been obtained and examined. Note if they are not available with N/A.
�vT�he facility or dwelling was inspected for sips of sewa®e back-up.
w The system does not receive non-sanitary or industrial waste flow
/The site was inspected for signs of breakout.
system components, excluding the Soil Absorption System,have been located on the site.
_V The septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for condition of baffles or
tees material of construction, dimensions, depth of liquK depth of sludge,depth of scum.
1/_The aise and location of the Soil Absorption_System on the site has been determined based on existing information or
approximated by um-intrusive methods.
L,The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised li/03/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION f�D
Property Address: -- ('C �✓ /c � ��t�`
Owner.
Date of Inspection: .
FLOW CONDITIONS
RESIDENTL4JU
Design now:
Number of bsdrooms:, _ L
Number of current ent residents:
Garbage Wider(yes or no)
Laundry connected to system(yes or no).
�
Seasonal use(yes or no):� f !
Water mete:readiaa,if available: �
Last date of==Wcy:
COMMERCIAL USTRWL•
'type of astablishmen .
Design now: onalday
Gram trap present: (yes or no)--
Industrial Waste Holding Tank present: (yes or
Non-saaitary waste discharged to the Ti system: (yes or no)_
Water meter reading,,if availa
Last date of occu ry:
OTH _ Desrnbe)
Last date of oavpancy:
GENERAL INFORMATION
PUMPING RECORDS and��° irAforma�tio�n-
/
System pumped as part of inspection: (,yes or no)
If yes,volume pumped: sailons
Reason for pumping:
TVPJf.OF$�FSTEM i
Septic tankM&ta'bution boalsoil absorption system
Singe Cesspool {
Overflow oesapo-I
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)
Otber(explain)
APPROXIMATE AGE of all components,date installed(if known)and source of information:
Sewage odors detKtad when arriving at the site: (yes or no) �
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Addreas°
Owner
Dade of Inspection:
SEPTIC TANK:v/
Qoeate on site plan)
Depth below grade: f S_
Material of oonstruetion ��oonerete_metal_I'RP other(explain)
Dimensions:
Sludge depth: �� P
ta Disnce from top of sludge to bottom of outlet tee or baffle:
Sams thickness: //
Distance from top of scum to top of outlet tee or baffle: S -11 .
Distance from bottom of scum to bottom of outlet tee or baflle:_Z.L
Comments:
(recommendation for pumping, c!o!ion of,inlet and outlet tees or baffles,depth o level in rela ' n tlet invert,Ammuual integrity,
evidence of leakgye, etc.) /
IV
GREASE TRAP:_
(locate on site plan)
Depth below grade:
Material of construction:_con to metal_FRP_other(e:plain)
Dimensions:
Scum thicimsss:
Distance from top of scum to top of outlet tee or
Distance from bottom of satin to bottom of tee or baffle:
Comments: _
(recommendation for condition of inlet and outlet tees or baffles,depth of liquid Level mi tioa to outlet invert,structursl integrity,
evidence of lkWe"SkW, )
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Addreew
Owner. G
Date of n:
TIGHT OR HOLDING TANK—
(iooete on site plan)
Depth below grade:
Material of coartruetion._concrete_metal FRP utber(esplaiu)
Capacity:
Design ilow: Qallonr/day ,
Alan level:
Comments:
(condition of inlet tee,condition and float switches,etc.)
DISTRIBUTION BOX:
(locate on site plan)BOX—
(locate
of liquid level above outlet invert: '
Comments:
(note if level and die Zion ' equal,evidence of rlids carryover, ''den of leakage into or out of box,etc.)
PUMP C Y.
Occate an site )
Vamps in working order: )
Comments:
(noes ambtion of pump Chamber, pumps mid a ,etc.)
(revised 11/03/95) 7
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART.0
SYSTEM INFORMATION(enutinued)
Property Address:
Owner.
Date of Inspection: ']— f—j
SOIL ABSORPTION SYSTEM (SAS):
(boats an nice plan,if possible;excavation not required,but may be appr=imated by non-intrusive methods)
If sot determined to be present,explain:
Type:
baehinB pits,aumber:,/-- l G.:�
bashing chambers,number:_
WPM"g galleries,number:
Issehiag trenches, number,length:
bashing fields,number, dimensions:
overflow,oaspool,number:
Comments: (note oil, signs of hydraulic failure, leve pondinfi condition of vegetptioa stew) —
/j/ 2
CESSPOOLS:_
(locate on site plan)
Number and tion:
Depth-top of liquid ' et invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Material of construction:
Indication of groundwater:
inflow(cesspool must be pumped as part of ins
Comments: (note condition of soil,signs ydraulic failure, level of ponding; of Vegetation,etc.)
PRIVY:_
(locate on site )
ofcom Midon
:
soni( e of soil,signs of bydratclic facture,level of pondind,aondition of vaptation,etc)
(revised 11/03/95) g
T
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
DEPTH TO GROUNDWATER
Oepth to groundwater Id feet j
method of dete natig or approximation:
(revised 5/15/9S) 9
I .- .. ..__...-�,�,.,...____ '. .... . _. . ._:. .-=-..... __ •.. -- -. - ter.�-- ;.