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HomeMy WebLinkAbout0065 WATERFIELD ROAD - Health 65 Waterfield Road Osterville A= 119-050 "`'1' ••ALL J ` � TOWN OF BARNSTABLE LOCATION �S �IsAT�G��'i��6 �',P SEWAGE#-4 o-"," VILLAGE ASSESSOR'S MAP&PARCEL 9 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 944 LEACHING FACILITY:(type) (size) /3)!.Z s-x-,7-, NO. OF BEDROOMS 3 OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: mow--I- Maximum Adjusted Groundwater Table to the 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 ` � � �oey/oe � ' st6 0 oil f, p i No. �� t ►Fee THE COMMONWEALTH OF MASSACHUSETTS Entered me omputer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplicotion for Tigponl 6pgtem Cougtructiou Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System Individual Components Location Address or Lot No.����� /fsr�� 0 , Owner's Name,Address,and Tel.No. Assessor's Map/Parcel '01—p =o .7 rw Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building �Z edtP, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3.�® gpd Design flow provided gpd Plan Date —3 — Number of sheets 1 Revision Date Title Size of Septic Tank Type of S.A.S/��C�''� /.��(o'� "Ya Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. - ne Date Application Approved Date Application Disapproved by: Date for the following reasons Permit No. �6 '' Date Issued v No. tie THE COMMONWEALTH OF MASSACHUSETTS Entered}mcomputer: -'Yes PUBLIC HEALTH DIVISION = TOWN OF BARNSTABLE, MASSACHUSETTS . Z[ppr'ication for Migpo5ar *pgtem Construction Permit Application for a Permit to Construct( ) Re air rade Abandon p (.) Upg ( ) ( ) ❑ Complete System Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel X/3 0 rio Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: t Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building �`�� No.of Persons Showers( ) Cafeteria( ) Other Fixtures ,-Design Flow(min.required) � .3© gpd Design flow provided gpd Plan Date —// Number of sheets �' Revision Date Title 1 Size of Septic Tank 11'T/i✓CS O P � TYPe of S.A. oT T ,(.2 4 . Description of Soil Nature of Repairs or Alterations(Answer when applicable) i 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 and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sa ne Date Application Approved b. Date Application Disapproved by: Date for the following reasons i Permit No. �/�"�� Date Issued THE COMMONWEALTH OF MASSACHUSETTS i BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( 110� Upgraded (. ) Abandoned( )by O//W f reOP G/C41:r' at d r .+C�',y{r s � �G"y��ld 1:�Ct,jI p J''; _has been/constructed in a cordance f with the provisions of Title 5 and the for Disposal System Construction Permit No. dated' Installer d��-ff Zeleod l/1-- Designer %J,fkrM —P #bedrooms 3 Approved desiignn flow P''G gpd The issuance of this ermit shall not be construed as a guarantee that the system will tun`cTon as des, ed. Date 3[Arl 1 Inspector Fee , THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Xi,qpO!6a1 *p!5tem Con$truction Permit Permission is hereby granted to Construct ( ) Repair ( Upgrade ( ) Abandon ( ) System located at �, �S` !-�•�T��R /���j p o.!'7 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions Provided: Construction must be completed within three years of the date of this perms Date Approved by i f 31 T6wn'of Barnstable Regulatory Services *. Thomas F,Geiler,Direetor Public Health Division Thomas McKean,Director 200Kain Street,Hyannis,NA 02601 Office:.508-8624644 Tex: 508-7904304 Installer&Aotguer Certification Form ]date: Designer--I J Q B , KAK6 J. Tnstatier: ZIIAel Address.. . AL-, C)IA J Address'. 716 was issued a permit to install a Fdate) (installer) septic system at �, based on a design drawn by (address) mil b�wks dated Y certi y'that'the septic system, referenced above was installed subst al�'arztx �y. acc'ard,pg'to "'t a deli WWch may include minor approved changes such as later,ielocatit of the i tGrbution box and/or septic lank. ; Z cezW:that the septic system xId= aced above was inst afar l0' la7 r aid�wi:th for.chang6a• gm tom, al relocW6xi'ofthe SAS or-any�veaiacal i to-n"s.o f'aay compp��t of the eptr6,,-t latest)but in a�cordanee with State'&Local:ReglY Plan,revisipia oz m-4fi as W*by designer t&follo'w. ID (Iustallerr's Signaliare) ` ?MASON � ( er s Siguature) �Af ' f er's Stazbp a e) PLEt4 F TURN TO JBARNSTAb'i.EisUB]LfC: A ID , SION. ® '. C•' CE TRANK` O—U' . Q:Health/Septic/Designer Cerii�icatipi��oxf'�' :ri.r:.'. ;� -��� •.�_',, �° ; " , Town of Barnstable P# l a gyp'' Department of Regulatory Services ' Public Health Division Date _ XAS&rs, � 16.19. e� 200 Main Street.Hyannis MA 02601 a ' Date Scheduled ,�Aa �(� / Time "Fee Pd. Soil Suitability,As - ssment for Sewage . isposal Performed By­ Witnessed By: � LOCATION& GENERAL INFORMATION 1� Location Address 6�lS Cv�Tc�Ol /C�Jj Owner's Name p �T Address Assessor's Map/Parcel: l/, — p S p Engineer's Name eA v/.O NEW CONSTRUCTION REPAIR y Telephone# Land Use Slopes(%) Surface Stones Distances from: Open Water Body R Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) � �1 OV41ti w09 :@�3 crw I� f Parent material(geologic) Depth to Bedrock 9* 1�� Depth to Groundwater. Standing Water in Hole: V�t Weeping from Pit Rpce "Q14 Estimated Seasonal High Groundwater DETERN 1NATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: ___In. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adl.factor— Adj.-Groundwater Level,9 PERCOLATION TEST �utp xint�. Observation Hole# I Time at 9" ±f Depth of Perc Time at 6" Start Pre-soak Time @ Time(9"-6") r End Pre-soak Rate MinJlnch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Helaltli Division Observation Hole Data To Be Completed on Back----------- ' F ***If percolation test is to be conducted within 100' of wetland,you inusi first notify the Barnstable Conservation Division at least one(1) week prior to beginning. I Q:\SEPTIC\PERCFORM.DOC I • _ `SFr. DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency,% vet Dj AA i ® ►2 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Gravel) Jt- DEEP OBSERVATION HOLE LOG - Hole# Depth from Soil Horizon Soil Texture Soil Color �. Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) y DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Flood Insurance Rate Map: / Above 500 year flood boundary No_ Yes✓.__'__ Within 500 year boundary No Yes Within 100 year flood boundary No,V Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervio terial exist in all areas observed throughout the area proposed for the soil absorption system? --`�I-�-- If not,what is the depth of naturally occurring pervious material? _�_,�_w.__t Certification I certify that on ID (date)I have passed the soil evaluator examination approved by the Department of Envircl, mental Protection and that the above analysis was performed by me consistent with . the required training, exp tise and ex erience described in 310 CMR 15.017. Signature Date Q:\SBPTlQPERCFORM.-6�OC Lo7� LOCATION SEWAGE PERMIT NO. Wit =YI L AG E } I N S T A LLE-R'S NAME A ADDRESS to. U 1 L D E OR OWN ER J ois � DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED �� gs i; I �s Zd 3-7 a i 1,7 TOWN OF BARNSTABLE LOC_'ATION 9" SEWAGE VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY.(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: '. I DATE COMPLIANCE ISSUED: `; VARIANCE GRANTED- Yes Nn I -i ,1 � f Yuis THE COMMONWEALTH OF MASSACHUSETTS BOAR® 9F HEALTH l .. ........................OF......... iv........................................................ Appliration for Disposal Works Tonstrnrtinn runtit Application is hereby made for a Permit to Construct (>> or Repair ( ) an Individual Sewage Disposal system t: ...........-- Location-Address or Lot No. .............. _ 5......... - ................................... ::.. .......................................... ....................... - ....... Owner •...............................Address W V � Installer Address d 4 Type of Building Size Lo�?f..d..®�.==..Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -----•------------------•-----------------------•---------•------------------•-•----•----•.....•--•-•-•--.....---------•----••--.....-•---••-•••----- W Design Flow...........S.S................... _.gallons per person e day. Total dal�j�YY flow........................................ 1��s j WSeptic Tank—Liquid capacityl�� _gallons Length----- Width...y----- Diameter--------------- Depth. C=�l" x Disposal Trench—No. ................... Width........_ _._..... Total Length._.._`. Total leaching area___.... sq. ft. Seepage Pit No.__l0,YZi__.. Diameter./P._� Depth below inlet. .....L�, Total leaching arL_ ° sq. ft.9/•� Z Other Distribution box ( A Dosin tank ( ) O Percolation Test Results Performed by...................... .... Date................................ Test Pit No. 1.... _. .. _minutes per inch Depth of Test Pit-----/3........ Depth to ground water...._..:_ .__.._..._. 4. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water................ Phi ----------- ---- /----- ....... O Description of Soil... =.. ®lam � _... '� e � - /� - --- • •-•--••-•---......- V .................................•-----..........._..-•-••--•--•--•-•-•----•-............................................................. --• -------•----------------------------•-------•. ...._ W UNature of Repairs or Alterations—Answer when applicable............................................................................................... ----------------------------------------------------------------------------------------------------------••-----------------------------------------------...--------------•-------•-............--•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITIU 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate o Complia ce ha/beq issued b he board o ea4h. igned � __ . .....--- ... �'._jY i�� Application Approved By..................... ...�••- ----- •---•--� D -^- Date' Application Disapproved for the f ollo ' g reasons---------------------------------•----------------------•--------------------------------------------...._:-•--•- •••--•••...•••-•••.........................�.-y----••-•-••--�-••--•---•.....----...•-•-•--••-•-------•--•------------- Permit No.. ............. -------------------- Issue(L............ ...................- S.•-•--- Date - --- - - -- -- -- - - -- -- ----- ---- No ... «�. .. .. FEs 5•_ THE COMMONWEALTH .OF MASSACHUSETTS BOAR® QF HEALTH . . . .......... ......OF........, .+�/ .+fl ._................._. ApplirFa#ipu F ear %vaa al Works Tomwurtion ramit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal system t Location'Address or Lot No. --- owner Adress -- -�a ---•--•----•--- tt s Y Installer Address Type of Building . Size Lott, Z.Ajtf .Sq. feet Dwelling—No. of Bedrooms•_-_._ ` ................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of BuildingNo. of persons Showers ( ) — Cafeteria-- Otherfixtures ...............-•-••-••-•-•-•--- •----••. -••--•. .................................................... Design Flow ='K .._._ gallons per person e day. Total dai flow____.__• ' .. :__. lg -' WSeptic-Tank=L>quid capacity/ i�_gallons Length____.__._ Wi`dth, _ _.:__.__ Diameter------------ . Depth____. .. x Disposal Trench No..................... Width .. ........ Total Length Total leachingarea sq. ft. Seepage Pit No. ,w 'Diameter , Depth below inlet ... Total leaching area ft.,��. Z Other Distribution box z. Dosij ftank ( ) Percolation Test Results Performed by.............. ..................... Date__: aTest Pit No 1 eNI minutes per inch Depth of Test Pit _____ Depth to ground water. d' 1 Test Pit No. 2................minutes per inch Dept Y of Test Pit.................... Depth to ground water _........�' ...... P, r D Description of Soil.............. �-•/!..�r9+, ............' ar --- ' .... W .................•----- ---•-...-•_-- _• ......-•-•- -_--•- --• -• _•. ....................------------------------------- ---------- ......•.......................---•-•---------------•----- U Nature of'Repairs or Alterations—Answer"when applicable..................... ............ .. - ... Agreement: The undersigned agr46f install the`aforedescribed ,Individual Sewage Disposal System in accordance,with he provisions o T�" he State Sanitary Code— The undersigned furiher agrees not to place the system in l e_t Ompliatice has be4fn issued b the boar�..hhh�oalhthh,. igned ---�.. -- rr D e Application Approved BY =------------------••--•-•-•--. •--__-- -- - w..X � - Date APPlication Disapproved for the follo ng reasons: -•••--•..................•--•--••••----------••-•••-•-•-----•-----------•-•-� . ---------------------------------------------------------------------------------------------•-----------------------------...............................--------------------------------------------- Date _ Permit No._.� � " "°" . .. w. - - Issued � ` Date THE COMMONWEALTH`OF MASSACHUSETTS '4 BOARD OF HEALTH t, .................................OF...... ....... ............................................................ Is THISIISTOERTIF , That the In {> ual Sewage e D>spo al System constructed ( ) or Repaired ( ) by .. ' �.�''`. •-tj2.t ._ 6.-3 j F::q.1. .............................................. Insta ler at. = _ ------------ -' has been installed in-accordance with the provisions of TITI2 5 of'Th State Sanitary Co has as escribed in the application for Disposal Works Construction Permit No:........:............................... dated---..--___._._____.--,..__..._.__..._.___.__._. THE ISSUANCE OF THIS CERTIFICATE SHALL.NOT BE CO TRUE® AS A GUARANTEE THAT THE SYSTEM WILLFUICTIO14 SATISFACTORY. DATE................ .............. Inspector------ THE COMMONWEALTH OF MASSAC USETTS c� — 4zj3 BOARD OF HEALTH ' ..........................................OF.................................................................................... . No...................:..... FEE._ .........:... Per, i n is re�Y gr -� f�(� . .............................................................................•---._.... to Construct ( ) or�Repair an�Indi di al SevcTag� sposal System atNo............................................................................................................................................................................................... Street pM as shown on ap r�ion for'Di3posal Wo ks Construction Permit N ;; Dated____; _ _ _""" . �' � rd health DATE.... ..................................................... FORM 1255 A. M. SULKIN, INC., BOSTON - T` - DATE: _4/.5/97 PROPERTY ADDRESS: 65 Waterfield Road Osterville ,Mass . •02655 On the above date, I Inspected the septic .system at the above address. This system consists of the following: w : 1 -1000 gallon septic tank. 2; 1 -Distribution box. RECEIVED 3 . 1 -1000 gallon precast leaching pit ' packed in stone. APR 1 5 1997 Based bn my Insrwctlon, I certify the following conditions: 1 . This is a- title five septic.,-s.y,stem. ( .78 Co'de HEAIn:DEPT. 2 . The septic system is in proper working TOWN OFSARNSTA6LE order at the present time . � 51GNATURr : INK41 Name: J. P.Macomber Jr., i Company:_.•P_ & Son­Inc Address Cente�rvi1 ,e Mass : 02-632 ' t Phone:---50.8�75 33.3 ------- . 1 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY. OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachflelds . Pumped & Installed Town Sewer Connections P.O. Box 66' Centerville, MA 02632-0066 775.3338 775-6412 If U Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection WUUam F.Weld aoNmo• Trudy Cox• A Paul GAucel Y David B.struts SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION PropertyAdd,.est 65 Waterfield Road 0sterville ,MasAddrea.ofowner. 79 Canterbury Road Date of Inspection: 4/5/9 7 (If different) Waltham,Mass . Nameoflnapeotor. Joseph P.Macomber Jr. 02154 Company Name,Address and Telephone Number. J. P.Macomber & Son Inc.Box 66 Centerville ,Mass . 02632 508-775-3338 CERTIFICATION STATEMENT I artily 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 fu wtina and maintenance of on-site""wage disposal systems. The system: 1' Passes _ Conditionally Passed _ Needs Further Evaluation By the Local Approving Authority _ Falls 1� Inspector's Sigaaturx at/ /' J% duLd Date: � �J^ The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a ahared system or had a design flow of 10,000 gpd or greater,the Inspector and the system owner shall submit the report to the appropriate regional o!$os of the Department of Environmental Protection. Thu original ahould be seat to the system owner.-ad copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A. B, C, or D: A) SYSTEM PASSES: have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CUR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more system oomponents need to be replaced or repaired. The system,upon completion of the replacement or repair, pa- -inspection. lsdicate yes, no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If'not determined",explain why act) The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exffitratio n,.or tank failure is imminent. The system will pads 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 One Winter Street • Boston,Massachusetts 02106 Is FAX(617)556-1049 • Telephone(617 292-&%0 ��Primed on Recycled Pepe (71 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM -- 4 w PART A CERTIFICATION (oontinued) Property 54���erfield Road Osterville ,Mass . Own" // Date of h,peotwwJohn F. Siracusa B)SYSTEM CONDITIONALLY PASSES (continued) �Q Sewage backup or btaakout or ho static water level observed in the distribution ban is due to broken or obstructad pip,(,) or due to a brokaa,settled or uaewa distrsbtttion boat. The system will pass inspection if(with approval of the Board of Health): broken pipe(&)are replaced . obstruction is removed distribution box Is 1ervelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pea, inspection if(with approval of the Board of Health): broken pipes)are replaced obetruction is removed Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTHr Coaditloa,exist which require Author evaluation by the Board of Health is order to determine if the system is fjLng to protect th, public hoahlur safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM 18 NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONM ENT: Cesspool or privy Is within 60 feet of a surface water Cesspool or privy is within 60 feet-bf a bordering vegetated wetland or a malt marsh. !) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, 1F APPROPRIATE) DETER.MINFS THAT THE SYSTEM 19 FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT`. The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tr0butu7 to a surface water supply. 2-6 The system has a septic tank and&oil absorption system and Is within a Zone I of L public water suppy w.1L AW The system has a septic tank and soil absorption system and is within 60 feet of a private water supply wel Tha system hu a septic tank Lad soil absorption system and is Is"thaw 100 feet but 60 feet or more from&privvu wuar s uPP11 well,unless a well water analysis for coliform,baderi&and volatile orp%k compounds indkates that the wall is bw from pollution from that facWty mad the prewaoe of Ammonia nitrogen and attrate aitrogea is equal to or Les than 6 ppm 3) OTHER LiU6- . (revised 11/03/95) 3 C? SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) PropertyAddresa 65 Waterfield Road Osterville,Mass . Owner. John F. Siracusa Date of Inspection:4/5/9 7 D) SYSTEM FAIL&: e I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 16.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failurs. Backup of"wage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool �Q Static liquid level in the 4istribution b=above outlet invert due to an overloaded or clogged SAS or cesspool ARW* b�'r Liquid depth in ceeipwl.f,leas than 6"below invert or available volume is lees than L2 day Dow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(&). Number of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. AW Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Q[� Any portion of a cesspool or privy is within a Zone I of a public well 4)b Any portion of a cesspool or privy is within 60 feet of a private water supply well. NO Any portion of a cesspool or privy is Ives than 100 feet but greater than 60 feet from a private water supply well with ao acceptable water quality analysis. If the wall has been analysed to be acceptable,attach copy of well water analyais for ooliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design Dow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions wist: 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 suppjy A! the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system&ball bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for Anther information.. (revised 11/03/95) �: 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PropestyAddsem 65 Waterfield Road Osterville,Mass . Owner. John F. Siracusa Date of Inspection: 4/5/9 7 ' Check if the following have been dons Zpumping information was requested of the owner,occupant,and Board of Health. tons of the system components have been pumped for at least two weeks and the system has been receiving normal now rotas during that pariod. Lame volumes of water have not been introduced.kto the system recently or as part of this inspection. ZAs built plans have been obtained and examined. Not@ if they are not available with N/A. -Ths facility or dwelling was inspected for suss of sewage back-up. YThe system does not receive non-sanitary or industrial waste now JTha sits was inspected for suss of breakout. -k All system components,Wkluding the Soil Absorption System, have been located on the site. ZThe septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. ZTha size and location of the Soil Absorption System on the site has been determined based on misting information or ZThap ted by non•intrusivo methods. me e facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAddreaa: 65 Waterfield Road Osterville ,Mass . owner. John F. Siracusa Date of Inspeotiuu:4/5/9 7 FLOW CONDITIONS RESIDENTIAL- Design )a flow:$4O ins p� 6&y • Number of bedrooms. 3 Number of current raaidauts:, Garbage Vinder(yes or no)-AM 1/ Laundry connected to system(yea or no);_&F Seasonal use(yes or no)-." Water meter readings,if available: Last date of oo upancy: COMMERCIAL NDUSTRIAI- Type of establishment: Design flow:_.42g!ggallons/day Crease trap present: (yea or uo)h—/4 Industrial Waste Holding Tank present: (yea or no)_A Noa-sanitary waste discharged to the Title 5 system: (yea or no). Water meter readings, if available: Alp Last data of occupancy; OTHER(Describe) JL�� Last date of occupancy:_ GENERAL INFORMATION PUMPING ORD3�nd�uct fpztoration: e0R& i'/�o Y n91i?Lfd/y`� J��� System pumped as part of ins ion: (yes or no),&6 If yes, volume pumper ns Reason for pumping 7TYPE 0 SYSTEM Septic taWdistnbution box/soil absorption system &agar oesapool Overflow cesspool Privy Shared system(yes or no) (if yea, attach previous inspection records,if any) Other(explain) APPROJQMATE AGE of all components,date iaitalled(if known)and source of information: Sewage odors detected when arriving at the site: (yes or no)!�U (revised 11/03/95) tT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. • . SYSTEM INFORMATION (continued) Property Address: 65 Waterfield Road Osterville ,Mass. Owner: John F. Siracusa Date of Inspection: 4/5/97 SEPTIC TANK:,,DV0 e (locate on site plan) l � Depth below grade:_/W Material of construction: concrete _metal _FRP_other(explain) Dimensions: i' ,: � ! Sludge depth: Distance from top of sl dge to bottom of outlet tee or baffler 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._ Comments: (recommendation for pumping, condition of inlet and outlet tees or baffle. depth of liquid lPve in eta ion to ou let 'nv rt structural •rity, evidence of leakage, etc.) Pump tank 2=3 ears: . In�N outYeT tees- are in -Pia e:Liquid at the outlet inveft is 11 : eptjb ank is strut ura y s_alwd -No sig4G,6 leakage ! GREASE TRAP. A)0 t, (locate on site plan) " Depth below grade:;f/0 Material of cons(ri.irti6nA4zoncrete _metal _FRP _other(explain) i A/J4 Dimensions - -�— Scum thickness:Nfi Distance from top ut scum to top of outlet tee or baffle:-(fh Distance from bottom of srum in honom of outlet tee or batile:_'6'`A Comments: (recommendation for pumping, condi—n of inlet and outlet tees or baffles, depth of liquid level in relation to outlet inven, structural integrity, evidence of leakage, eic.i _ Grease trap ; not present r (revised 8115195) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Add,em 65 Waterfield Road Osterville,Mass . Owuer. John F. Siracusa DaUofInspectlow4/5/97 TIGHT OR HOLDING TANX-&PVt,-- (locate an sit•plea) • Depth below gm&:Z_)d Material of conat:uctlonrO eanc:ete maul_MP_otbar(saplain) Dimea:ians: 010 Capacity: VA Pilo" Design flow: ne/day Alarm level: Comments: (condition of inlet tee,condition of alarm and Host switches,etc.) BY Koling DISTRIBUTION BOX Z (locate on sits plan) i Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of bar;,etc.) 1)4 r.+ri }�n+i nn 11nv i e I e u e I anri hn-g nnI or nnin l af'Pral Tn P iri f3Pnno n f —se- cis—e ;z eve t No evi den .e of leakaee in or out of the box. PUMP CRAM BER..&_P ve— (locate on site plan) Pumps in working order:(yes or no)NA Comments: (note condition of pump chamber,condition of pumps and appurtenances,sto.) Pump chamber is not presen (revised 11/03/95) L SUBSURFACE SEWAGE DISPOSAL SYWMI INSPECTION FORM r PART C SYSTEM INFORILA77ON(oonUnued) PropertyAddrwc 65 Waterfield Road Osterville ,Mass . Owner: John F. Siracusa Date of Iasp.oUoat 4/5/9 7 BOIL ABSORPPION SYSTEM OWy Goats as site pl&z,V possible;nasystloa dot required,but may be appraaiaiated by aaadatruaivs methods) It not d4amined to be prwat,apWa. s zy,P« hifti per,number. L+eAiat ehambas,aumbar 1044 ;PDaries,aumb$r. leechias trsoches,mumber,leaSth: l.+chia j Ealda,aumDar, : wwdaw oesspoal, number :(acts r4 tioa f toil,�of Iydraulie 4flure,Laval of Poadin�,condition of vsgstatioa,etc) Me ium sancgl �o line sane ern ci na of h;Zdranl i (+ failure or ponding i CWSPOOL9s Aocew oa she PUZ) xcmDer dad oOn4uratim /Ifr4 Depth-top of liquid to Jul"invert: Depth cf solid+1WsT__ Depth of scum lVer. / Di—si=-of oaspool: waari.ls of construction ladicatioa of Voundwater VP inflow(ansPool must be pumped a.Part of inspection) Comments (note oanditiaa of 64 siPs of lydrsulk tailuro,level of pondiag condition of vsgatation,ate.) f',essnools are not bresen . PRrWs (� Coasts an site PIW ltatariaL of oon4r dioa NA NA Depth o!solid.:N A Comments:(note ooadWan of soil,&�p+of hydraulic faDurs,bvsl of pon&u&ooadkioa of vsgetatba,itc) Privy is not present. (revised 11/03/95)• SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION .FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE L=SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' t Centerville Osterville Marstons Mills Water Company 428-6691 \a/ I i // y W Ate ic1drd DEPTH TO GROUNDWATER 161 + depth to groundwater r+pthod of determinesion or approximation: No water .-ey.-CCouritered.mt- system waz'-_installed. Plan on file at tie- Barnstable Rod-3rd, #` a tlr - �G W N b - Sb''yy 3r71~ THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Departments qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. 1unc s, 1995 Acting Director of the ion of Water Pollution Control 1 fi SECTION - 'SEWAGE I —SEPTIC TANK — 1 => — "D"80X — LEACH TOP OF FON t 1 112"OF i # D STONE • --- r IN- OUT- IN'- IN OUT- _ / . � SEPTIC 0' ELEV. 3� 32.,�C7/ � •'' TANK -�"` •3- i ELEV. ELEV. r ELEV. o.o G ]r ,Q-1c, ELEV. ELEV. / 1 WA9HEK STONE 21 41 TEST HOLE LOG C - I oar` cR, TEST BY �. a.'rr �ti1 K 7 I✓ 1""1t� "' t�`l 1'S• l"i r. . ; / ` ( �� '`.!- y` r } . ., TEST,DATE WITNESS / 1 r- DESIGN` 3' BEDROOM HOUSE T.H. ,r 1 T.H. x 2 ELEV. �rF^�.G ELEV.. NO - � PERC RATE �Z MIN/IN. DISPOSER_ DISPOSER f FLOW RATES '>(GAL./OAY) � z,� `�7 �* N l^ .� / ~� �^ " `• t,vL%, / — f�a SEPTIC TANK �c� (]?I= I e>ac� /� �U�o �e t e.L.EV. h �.�A a1 REO'D SEPTIC TANK SIZE LEACH FACILITY _ Lb`i" 1 / . Y: SIDE WALLtlo �1'Tt~='1ee.t> .(Z,Q 477 2- G'/D. BOTTOM io 1r = "�fl I ( �:I � _ G/0. TOTAL Z fa I O S•f• _ �, G/ r ^�G t� 1 p • USE: �-= LEACHING i t •.i �) �� WATER ENCOUNTERED ` `\ '. NOTES (U•NLE'SS OTHERWISE NOTED) Y ✓ f �` • 1.DATUM(MSL)L TAKEN FROM, MAP s •`fit 2.MUNICIPAL WATER......_........, AVAILABLE 3.PIPE PITCH:1/4"PER FOOT 4:DESIGN LOADING FOR ALL PRECAST UNITS: AASHO- -44 5.MIN.GROUND COVER OVERALL SEWAGE FACILITIES: (1) FT. '�` � C/.)ALA y� I 6.PIPE JOINTS SHALL BE MADE WATER TIGHT CIVIL 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. NO '�{Q Q SITE PLAN STATE ENVIRONMENTAL CODE TITLE 5 � 1 �c?, (� M� LOCUS. _—• A l $i REG. SIO L ENGINEER -'StrS ARC E I , )i A _ REF: L coi PREPARED FOR41 ' CIVIL ENGINEERS `� I l �+� �Irlov,- �� 'ti-�z-� c�.� '• LAND SURVEYORS VEVOR T I BOARD OF HEALTH " CONTOURS (EXISTING) •----••---- +c, 928 !"lfln$t, (PROPOSED)-D--O-O-O- APPROVED DATE �� i +� CMA Nam" SCALE � ASSESSORS MAP : � � I - TEST HOLE L O G S NOTES: PARCEL : FLOOD ZONE: SOIL EVALUATOR : 10 � G � ��_..���'���� � WITNESS : ,, 1) The installation shall comply with Title V and Town of Yarmouth Board of �- I�If vitro Health Regulations. f � REFERENCE: J g iF _. lil121g.Plq' 1 - '�� DATE: y, �i �( 2) The installer shall verify the location of utilities, sewer inverts and septic i. .. (�II�; G �1 H t�Ll� i3 Sj PERCOLAT I JN RATE: . .L Z�Uli,. , �l. _ components prior to installation and setting base elevations. 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first TH I TH-2 two feet out of the d-box to the leaching shall be level. 4) This plan is not to be utilized for property line determination nor any other ���41-0purpose other than the proposed system installation. jl 5) All septic components must meet Title V specifications. 61 6) Parking shall not be constructed over H10 septic components. 7) The property is bounded by property corners and property lines. LOCATION MA PC 8) The property owner shall review design considerations to approve of total J �✓ 5 design flow and number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed . approval of the design flow by the owner. �b � 2 lD�YLJ/Z., 9) The existing leaching or cesspools shall be pumped and filled with material D per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per �� Title V sp ecs. Z.Z-?� 10)System components to be 10 feet from water line. Sewer lines crossing the f water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if I 0,OL? SEPTIC\ SYSTEM DESIGN applicable. The proposed SAS is being installed below the water service i — line. The line is to be sleeved as aforementioned and maintained in place. 11) If a garbage grinder exists it is to be removed and is the responsibility of the {D \ , FLOW ESTIMATE. �, owner to ensure such. 12)The installer is to take caution in excavation around the gas line if such , BEDROOMS AT GAL/DAY/BEDROOM - GAL/DAY exists. I 13)The installer shall verify the location, quantity and elevation of the sewer � � )D SEPTIC TANK lines exiting the dwelling prior to the installation. o 7j�OGAL/DAY x 2 DAYS - vJ GAL �0 p • USE JODO GALLON SEPTIC TANK EX 15-ITfiJ 4r lop A - SOIL BSORPT I ON SYS T� 404 ' /�y _,_.. SIDE AREA: Sq N J BOTTOM AREA: �C I 4-41 019 / \j -I�` SYSTEM SECT I ON r1:4 ( __ 6 _ M1 s" 1 111� la'' 1'I'' �� fr „wl. OL <;- 200 1� GAL � �� BOX SEPTIC TANK Y. SITE AND SEWAGE PLAN t LOCATION : tI f fj 7 �2oPp P. PREPARED FOR : JI i �-- SCALE o � 11, 9 r o DAV I D B . MASON DATE: 2`f DBC ENVIRONMENTAL DESIGNS z �=t W � - DATE HEALTH AGENT EAST SANDWICH . MA Z ( 508 ) 833- 2177 �Pc