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HomeMy WebLinkAbout0057 WEST BAY ROAD - Health 57 West Bay Road isterville = 117 JJZ I DATE 3/14/06 PROPERTY ADDRESS 57 west say Road Osterville MA 02655 On the above date, the septic system at the address above was Inspected. This system consists of the following: 1.1 1-1000 ga eoa tank., 2.1 1- Di.eta.igut.ion l3ox.- . 3.1 4- 500 ga. eon eeach.ing chamf'ea s.1 Based on inspection, I certify the following conditions: 4., 7h.iz .ih a 7.it2e Five zept.ic .system., 5., Spet.ic byztem .iz in paopea woak.ing oadea at the paezent time., - r Cj SIGNATUR Name: Robert A. Paolini - Company: Joseph P. Macomber & Son Inc . C) Address: P. 0. Box 66 Centerville, Mass 02632 Phone: 508-775-3338 or 508-775-6412 JOSEPH P. MACOMBER & SON, INC. Tan ks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 ; .F.. Y COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PARTA CERTIFICATION Property Address: . 57 West Bay Road Osterville MA 0269; Owner's Name: Paul Ta uec Owner's Address: PO Box 21 6 nSt'PrVI 1 1 A Mn o�tiS� Date of Inspection: 3�1 1 4.106 Name of Inspector: (please print) Robert A Paolini Company Name: 2. P Ma o m g It .S:o.n Inc. Mailing Address: Pox 66 Cen e2v.c e, Razz, 02632 Telephone Number: 5 0 8-7 7 5-3 3 3 8 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 tol Section.15:340 of Title 5(310 CMR 15:000). The system: XXX Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority ails Inspector's Signature: Date: 3J4' 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. ,t Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTIOFORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACEN: SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 57 West Bay Road Osterville, MA 02655 Owner: Paul Jaaues Date of Inspection: 3/1 4/0 h Inspection Sunimary: Check A,B,C,D or.E/ALWAYgf,,eomplete all of Sectiou:D A. System Passes: �e:s NO I have not found any information which indieates'that any of the failure criteria described in 3 10 CMR 15.303.or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: SeRt.ic 3Ubtem i.b :in R2ope2 wo2k-ing olLde2 at the pae,3ent t"ime.� B. System Conditionally Passes: NO One or more system components.as described in the"Conditional'Pass"section need to be. replaced.or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not.determined(Y,N,ND)in the for the following statements.If"not determined"please explain. NO The septic tank is metal and.over 20 years old*or the septic tank(whether metal or not)is;structurally unsound,exhibits substantial.infiltration or exfiltration or tank failure,is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank,as approved by.the.Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: NO. Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken;settled or uneven distribution box.System will pass inspection,.if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled"or replaced ND explain: NO The system requited pumping more than 4 times a year due to broken or obstructed pipe(s),The system will pass inspection if(with approval of the.Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: a, 2: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 57 West Bay Road Osterville MA 02655 Owner: Paul Jaques Date of Inspection: .11 4..1(A C. Further Evaluation is Required by the Board of Health: No Conditions exist which.require further evaluation by the Board of Health,in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: lYQ_ Cesspool or privy is within 50 feet of a.surface water N_Ci_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: No The system has aseptic tank and soil absorption system(SAS).and the SAS is within 100 feet.of a surface water supply or tributary to a.surface water supply. ILQ The system has a.septic tank and SAS and the.SAS is within a Zone 1 of a public water supply. No The system has a septic tank and.SAS and the SAS is within 50 feet of a private water supply well: No The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance visual "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. 3. Other: 3 ,:f Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 57 West Bay Road Osterville MA 02655 Owner: Paul Jaaues Date of Inspection: 3/1 4/0 F D. System Failure Criteria applicable to all systems:. You must indicate"yes"or"no".to each of the following for all inspections: Yes No _ . X Backup of sewage,into facility or system component due to overloaded or clogged SAS or cesspool _ . X Discharge.or ponding of effluent to the surface of the.ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than'/4.day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. _ X Any portion of cesspool or privy is within 100 feet of a surface water supply,or tributary to a surface water supply. X Any portion.of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. . X Any portion of a cesspool orrprivy 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.] No (Yes/No)The system fails. I have determined that one or moreof the above failure,criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner.should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 1:0,000 gpd to 15,000 gPd•. You must indicate either"yes"or"no"to.each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no — _X the system is within 400 feet of a surface drinking water supply X the system is within 206 feet of a tributary to a surface drinking water supply _ X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant.threat,or answered !� "yes"in Section D above the large system has failed.The owner or operator of any large system considered a .- a under Section E or failed under Section D shall upgrade the system in acc ordance with 310 CMRt si nificarit threat Y g Ply 15.304.The system owner should contact the appropriate ro riate reiional office of the Department. 4 I , Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 57 West Bay Road Osterville MA 02655 Owner: Paul Jaques Date of Inspection: 3/1 4/0 6 Check if the following have been done You must indicate`yes"or"no"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,.or Board of Health X 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? X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X Was the facility or dwelling inspected for signs of sewage backup? X Was the site inspected for signs of break.out X _ Were all system components,excluding the SAS, located on site? X _ 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? X_ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X 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)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE,DISP.OSAL;SYSTEKINSPECTION FORM PART C SYSTEM INFORMATION Property Address: 57 West Bay Road Ostervil a MA 02655 Owner: Paul Ja ues Date of Inspection: 3 14 0 6 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#ofbedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system.(yes or no):_ [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)): Sump pump(yes or no):_ Last date of occupancy: COMMERCIAL/INbusTRIAL Type ofestabohment: ►UCH\,S t�' t(.t2 Design flow(#used on 310 CMR 15.203): d Basis of desigd'flow(seats/persons/sgR,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ �. , p'f.5 8- Water-meter readings,if availablev-,=Yy000�Q(JW I .11c(-g-4 6r PD c�C �V/ 1?6k1'`)5 G" � Last date of occupancy/use: . OTHER(describe): GENERAL INFORMATION Pumping Records N/A Source of information: Was system pumped as part of the inspection(yes or no):_ If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: . TYPE OF SYSTEM .Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank s Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: 3 ueaas Were sewage odors detected when arriving at the site(yes or no): n o 6 r - Page 7 of 1 l OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 57 West Bav Road Osterville MA 02655 Owner: Paul Jagues Date of Inspection: 3/1 4/0 6 BUILDING SEWER(locate on site plan) Depth below grade: 2 4" Materials of construction:_cast iron X 40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): ao.tntz appeaa tight. No zings o,E 2eakage., Vented th2ouuh houhe vent., SEPTIC TANK: (locate on site plan) Depth below grade: at glade Material of construction-7 _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:_'zilltLdge lac e Distance from top of sludge to bottom of outlet tee or baffle: t 2a ce Scum thickness:t 2 a c e Distance from top of scum to top of outlet tee or baffle:bt a c e Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: mea.6u2ed Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of.leakage,etc.): Pump tank eveaU 2 ueaa.s , Tnpof rQ nil f Onf J000 4 Qg,12 Tank i.6 .stauc .P.Py Anlzad GREASE TRAP: O (locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert evidence of leakage,etc.): 7 Page 8 of l I. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued). Property Address: 57 West Bay Road ORtP_ryi ll P MA 02655 Owner: Paul Jnquac Date of Inspection: �L-O 6 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes.or no): Date of last pumping: Comments(condition of MOO l.�m?and float wit hes,etc.): �nO CQ.fh `0 DISTRIBUTION BOX y e,6 (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: o Comments(note if box is level and distribution to outlets equal,any evidence.of solids carryover,any evidence of leakage into or out of box,etc.): Box i.6 .�evei., No .0o id ca22yove2.� No leakage., Box hay Z �ate2al?a. PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 57 West Bay Road Ostervil_l-e MA 02655 Owner: Paul Jaques Date of Inspection:—/1.410 ti SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why- Type leaching pits,number:_ X leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system •Type/name of technology: Comments(note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): Loamy to med.z.u.m zand., No .3.ign,3 ol /a.iPu2e. Sof P.s ate d2 y•' CESSPOOLS:(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Co ents(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 0`.fiAi�lS Ct2_/1c7`�' 6Jl�S � - PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS StMSURFACE'SEWAGE-DISPOSAL SYSTEM INSPECTION:FORM PART C SYSTEM INFORMATION(continued) Property Address: 57 West Bay Road Osterville MA 02655 Owner: Paul Jaques Date of Inspection: 3/1 4/0 h SKETCH OF SEWAGE DISPOSAL SYSTEM "Or o,vide 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. zZk � 3 a 10 - Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION,FORM PART C SYSTEM INFORMATION(continued) Property Address: .57 West Bay Road Osteryille MA 02655 Owner: Paul laawas Date of Inspection:_i f, 4.n r_ SITE EXAM . Slope Surface water Check cellar Shallow wells Estimated depth to groundwater feet Please indicate(check)all methods used to determine the high ground water elevation: 'N 0 Obtained from system design plans on record-If checked,date of design plan reviewed: y es Observed site(abutting property/observation hole within 15o.feet of SAS) Checked with local-Board of Health-explain: k u.i f-1- r-a m no Checked:with local excavators,installers-(attach documentation) Accessed USGS database=explains You must describe how you established the high groundwater elevation: 'M /Ized. : Cape Cod Comm.izion !Jatea 7agie Codtouah And Pugiic Uaten Supp.2y Gle2� head aoteet io.n aaeaz map. Se t 1995 lJate� 2esou2ceh o eeice cape cod comm.ihion l 'of Cround Leaching Pit "eet i i GroundwateTL Feet Below Bottom*of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore,the vertical separation distance between the bottom of the leaching pit and the adjusted groundwater table is feet. ' 11 •mfnt•rr.sT1�•+w!•arf•rwsfnsn•o-'wnRrwffr�nRrvR►tif�N.�.���'v�fAf ' `,; 'TOWN OF BBARNSTABLE._� BOARD QF HEALTH INSPECTION' FORM - PART D SUBSURFACE SEWAGE DISPOSAL AYST,F M CERTIFICATION �17"•TW T•:4ff�f Tillf• 7R7TR�f'RIRMYRx• 17•`11+I -TYPE OR PRINT 011900- PROPERTY mmrcTls17 57 West Bay Road Ostervill.e 02655 STREET ADDFaES$ � ._._�._.t.., ---.;. ASSESSORS MAP, BLORK AND OwNER's NAME Paul J,aques PART'.' D CERT'IFICAT;Z;ON ' NAME 'OF IN8PECTOR Ro l of tt P.a.oiin —..- COMPANY NAME Jozaph �'•' ,Macon�8aa'''$' Son Inc ' Box 66 'Can�eay.i.C.2a Na• , ' COMPANY ApD .�SS 6' 02632Town-or City .State LIP COMPANY TELEPHONE ( 508. 1 17.5 ' 3338 FAX (' 508• )190 4 f578., CERT-I'FICATION. STATEMENT ` °\ I certify that I have persoriahly .Inspected. •the sewage 'diaposk. system at this address and that:tlid- information reported I true,. aoc Ura.te•, ohd omplete as of the time ..of.•inspection.,• The insp'ectiQn was performed and any recommendations regarding upgrade•, .maintenance ,- abd repair .are• eon$is'tent with my trainipg and exP.erience in th6 proper function- and maintenance of on- site sewage disposal systems. Check one; PI_Systesi PASBD ; The inspection which •I have •conducted has .,n•ct found any information . which indicates that the systttm' fails to ' adequately. protect .public health or the envlropment as defined in- .310 CMR. 1$' 30.3', Any failure criteria nvt evaluated are as stated in the FAI'LUIM CRIURIA ;see.tio'n of this form. System FAILED* The inspection which I have can 'ted 'ha# •••found that the System fails to Protect the public health and the envl.ronmen•t ' in acoo'rd•ance with Title 61 310 CMR 15 . 303, and as - specifically noted on •PA'RT- C . FAILURE CRITERIA of this inspection .form. ' Inspector Signature* �. : .Date 7: . .� 77 ne copy of this certi,f ioat•i b must -be trovi•ded 'to the .®W82R., trh�9 ,:BUYER where appli•.aable) and th�i 13QARD OV HEA 'ill, •, * if the inspection FAxL'ED.1 t `e .owne.Q'r"'91Rexator -whalJ, . upg•r:ade'•the system• within o•ne year of the da't•e of the inspection, unless, allowed Qr- requi;red n t.harw{se as_ Provided in q;10 CMR 15 , 306t } Fee No. U01 — THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,,Zipplication for 1$ 0$ p$tent ClLOtt$trUcti01YC)LIYYtt Application for a Permit to Construct( . )Repair( Upgrade( )Abandon( ) O Complete System ❑Individual.Components Location Address or Lot No. n r� v� Owner's Name,Address and Tel.No. Assessor's Map/Parcel / 7 Installer's Namel Address,and Tel.No, Designer's}`�ame,,Address and Tel.No. g 2 G/r S T v 5, 1 , vAnJ Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building C®rn. N of Persons Showers( ) Cafeteria( ) Other Fixtures G 11jar -- Design Flow ,rod G gallons pe day. Calculated daily flow.Sy y 6:9- gallons. Plan Date Number of sheets Revision Date Title . Size of Septic Tank Type of S.A.S. Description of Soil Nature of Rep irs 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 Certifi- cate of Compliance has been issue Boaz.gLof Healt Sig Date i Application Approved by Date °l Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired Upgraded( ) Abandoned( )by / e4 e,-p s T t at . Lt'/E"s ? -7 Y 6 -1-7— has been construc d in accordance with the provisions of Title 5 and the for Disposal System Consiruction Permit No. 20 dated tr a Installer 2 e e;3 5 7- Designer The issuance of thi permit shall not be construed as a guarantee that the sy will unction a signed. Date 2 Inspector . --------------------------------------- I) -- -Y14 / C"7) r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired Upgraded( ) Abandoned( )by /Z el Al C S T l at L�'/E S i i' .S"% has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 200 a 7 dated C U 7 Installer 1-9 2,- hr ea Designer The issuance of thi permit shall not be construed as a guarantee that the sy will unction signed. Date I n 1 u 2 Inspector --------------------------------------- No. 2 D D2 , (y��9 Fee � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS )Pigogal *pgtem �tC n0ruct 0n Permit Permission is hereby granted to Construct( )RepairTpgrade( )Abandon( ) System located at 7 , ��,t s 7 / �J / G� S / and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructionrust be completed within three years of the date of this p t. Date: 6 Approved by �vr"Aj/ ti'• TOWN OF BARNSTABLE LOCA 1,01; liL/f.ST&0%/ R6P SEWAGE #a d a� 3 ' I V AGE DS%E.' V/ 'I<' ASSESSOR'S MAP & LOT //7— - INSTALLER'S NAME&PHONE NO.,*Q9,c Y 'Sr ld SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 9oo a,,9,,st ZS (size) 'l x <1d x NO. MSS BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: I n l 0 �- 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 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 i 133 13 ' Q sz TOWN OF BARNSTABLE ,LOC.A,TION �� �� '(�� �� SEWAGE # VIa,►,„AGEE ASSESSOR'S MAP LOT INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY (2(7�C BOCi9 j� � �dC LEACHING FACILITY:(ty )�(�j (size) (( �� NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATE BiIrB£�t-AID OWNER �( ��S (7f-=IIC DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �r wlsltD l3y 6eio .arc0mA r ,i G �. ���� �= a-, -�,� � d _ - _ — — �°-� G� .� � _ � � � �� . i' ��. Ca4S7��� No. U 01 — 3 v( I' .o.:. Fee ✓ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �/� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipphratton for �We; z Y *p!tem Con6truction Vermit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ? Owner's Name,Address and Tel.No. 6/�"57 GS 7 3i9Y 1 0� dY �/�r�Q vi je Aqc- 5195 t1 S' Assessor's Map/Parcel Installer's Name Address,and Tel.No./� Designer's Name,/Address and Tel.No. '49 57 ILO/ 773/ 3d � Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building C- 49 f Persons Showers( ) Cafeteria( ) Other Fixtures Z G N Design Flow =OC) �s gallons pe day. Calculated daily flow .�cJ 6 Rr`� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of nRep 'rs or Alterations(Answer when applicable) A Y7 D RP.A 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 Certifi- cate of Compliance has been issue Boar _of Healt Sig Date Application Approved by Date 1PI 0 2 Application Disapproved for the following reasons Permit No. a 00.� O/ Date Issued '0l No, �'U O 2 — 3 2/ • �, _. 4 - Fee " ✓! THE COMMONWEALTH OF MASSACHUSETTS " - Entered in computer: J PUBLIC HEALTH DIVISION_ TO N-O -SARNSTAB`LE, MASSACHUSETTS, Yes - WON- 01ppYication for ;Dik 5 r 6 5tem �tConotrucz or , ermit Application for a Permit to Construct( )Repatr( )Upgrade( )Abandon( ) El Complete.System '-❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 'e,r..�/�r,. :�� Assessor's Map/Parcel Installer's Namel Address,and Tel.No. Designer's Name,,Address and Tel.No. r .. $% e— C2 773� a362 - Type of Building: f Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building C o m. No.lo Persons 41 Showers( ) Cafeteria( ) Other Fixtures �oc>{i,�r cz ��d Ged i 4,4, ' Design Flow .1'"yd G' /1.D gallons pe day. Calculated daily flow ��d 6r� l� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) P'd D Ae 0 A $�O!7_ �/ •--� Q S T O .t' ST i•-4 l�C�!J Date�last inspected. E Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued.by-tl�i Board of Health ' „� Signed-- Date Application Approved by 4�j, - "" Date 1 0 Application Disapproved for the following reasons " Permit No. Q 00.1—?01 4 Date Issued A 1642 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired Upgraded( ) Abandoned( )by 4/Z! .5/ 'y S T ly at 5"'.;) G616a 5' 7 % 6 S% has been constructy,d in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. a00 2-4 dated Vj U ? Installer 2e, Designer The issuance of thi permit shall not be construed as a guarantee that the sy apki will/function a esigned. I)Date / Inspector 1 AJ)°d✓. No. Uf)7—�9� Fee,0 r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS E 'i.qpogar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( Dade( )Abandon( ) System located at S 2 66-_r s T j3. &2 G 5- and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Cons c p on)nust be completed within three years of the date of this p t. f Date: U/ b/'K Approved by �• i TOWN OF BARNSTABLE LOCATION S-7 ,�Ij ST&O% R SEWAGE # a o VILLAG 17<e- ASSESSOR'S MAP &LOT 117—117 INSTALLER'S NAME&PHONE NO., SEPTIC TANK CAPACITY LEACHING FACILITY: (type,) zf� 5'0o (size) l NO. M$oZ (�ocTd4S >t��"� /�o��o� �� r',�vl BUILDER OR OWNER J , ` PER MITDA'I'E: �` COMPLIANCE DATE: j�ll D i 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 site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by n l l-3 ' a O�� , L1Nt3 To 6� STAI<Ela _ I• •�' �" •�• •?• i}ri •G �• OPERA CT\6N ' ? PR10RT6 CONSTRU ��\.a}.•_ !;;• •u„ a\. 40, LQL,/� -t- EXISTING PAVGA -(• I VS•��• \„- +-. I BL1•�a�� H _ DR�VB.w/A7 A-?A R\< Cr� ems, os. _ RHMA�s`�X1STlW4 ;i ,-. r�'• '� •.l „ Ls�arr PITS O I ! get 1 1 PAV 6 M T `• =i� 00 'OTANK 1 andl g o. a n G 1 ir,' 1 nX\ST•sl=P rIC T0.NKT0 RIsMA\N1 lO LOCUS PLAN • s.�w s-nzuc-rurzr>= '` Scale : It1= 20001 BU o;NC U Assessors Map 117 Parcel 117 l' PARTIAL PLAN (LEACH FIELD) Not to Scale \ DESIGN DATA A. I Doctors Office-2 Doctors,Per Owner a 0 Lr 13.�. vo•o With no Garbage Grinder t o Daily Flow= 250 gpd/Doctor= 500gpd 1 O \_OAht/0ra&00 1C Septic Tank: 500gpdx 200%=I000gpd 4' 1 S sAwoV ;r1" :rt Use a 1000 Gal Ion Septic Tank(Existing) f--- Ex\S-1'1"Aa I 1 tq' LEACHING AREA Ofz1v�WAy I 5 YEL'15M BRN COARSG INo to va, /�,_ 500 gpd/0.74= 676 sf Required I 37 SC. BRNIsN YEL. C,�ARse Sidewall=2(I 2'+40')2= 2 08 s.f. ss SAroo 10 V0.wry Bottom Area= 12'x 40' = 480 s.f. c L_T.v,al'Isu Bala 688 s.f. Total Provided . I CoA.P_sa sAwO \o YR I r 20 LEACHING CHAMBER DESIGN SOT ACiE?° BY 5ULL1VhN at4c.%V G6RING 1NC.. � ` A11 Pipes to be Schedule 40. Use 4 o.•-i Ae. 1 -500 Gal.Leaching Chambers ina Flesh 12'x 40'Washed Stone Field as Shown 1 crod. 2 / Flltcr t .compacted Fill °m n Fabric' WEST . BAY ROAD Pee _ Slone PLAN VIEW _ Lea .,/4"-1 1/2"Double 1 CAo.b.r bar '4 washed Scale i11= 20 I '° 3ULMM _ l PEM �r4 e 1 CROSS SECTION OF CHAMBER NOTES ,t�• Existing Building NOT to scare Sewer Heavy Duty Frame 81 Covers. I. Water Supply For This Lot is Municipal Water. See Note No.5 2.Location of Utilities Shown on This Plan Are Approx. F.G.40.5 F.G.40.0 At Least 72 Hours Prior to Any Excavation For This l 1 yt'BftUMINDUS SURFACE COURSE Project The Contractor Shalt Make The Re wired , IA'ettuWIND1,S BINDER courts£ SITE .PLAN u it 11 p 1 Notification to DIG SAFE-1-888-344-�233. o 00 .o• 3.The Contractor is Required to Secure Appropriate o• �: PROPOSED SEPTIC UPGRADE 370 0 •d. e .. �I d Permits From Town Agencies For Construction 'p•�° $ . °q' IlExist.l000ga1�1 r L Top El.38.0 Defined byThis Plan. , o -o °o 6"Processed StoneAT 1ILptic Tank { 37.6 BoI.Ek 35.0 4.Install Risers as Required to Within 12"of Finished ro • .o;B° oa8� 57 WEST BAY ROAD •o.. o o e o°..o 374 37.2 5, Grade. OSTERVILLE , MASS. Bedding as 5.All Structures Buried Four Feet(4�)or More or FOR Per Titles Bot:T.H.Elev.30.0 Subject to Vehicular to beH-20Loading. eouPAchosueersAae No Ground Water 6.Seotic System to be Installed n.Accordance With DR: PAU L B. JAQ U E$ 310CMR15.00 Latest RevisioNAnd The Town of PAVEMENT DETAIL SCALE: AS SHOWN DATE: FEB. 15,2002 DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Barnstable Board of Health Regulations. Not to scale 7 All Piping to be Sch.4o.PVC. Not to Scale SULLIVAN ENGINEERING INC. OSTERVILLE , MASS. 7 -� r• 7 y — I s TO TPl<ED ' `�^� � 1t\' l -I^� Ceriti'\.r �� • J p`20PET6 t-��ERUG a6N _ !- .1�. f•.3a<.SO:�• :�`I ��;, O 4Ur PRIOR Z 6_ ay a R.�,S. •la • . � ' , ,r 9 d�� yyyy 'ef;, l� lrT,a k��..• �r T..H EX\ST1►•1G PAVG� ,�-? C) lus •• e.e, l•�: '�.;o c• •��w ' _ RtMO�lt3_S.X.1ST 1SJ 4 � � I _.t-- � •� � �'b I ��,,,'-`� -LGPCH - SAVY GUT ` I r—''�-• V E M S.NT / rn I I .e 7✓„\J\ Jf ��•"►• 00 t Z. Uti _ anding-Iu.. a. ) a aG. ••; 11 p•• y , cXIST•SEP'T IG T0.NK 70 RcsMAtnl o v �. PE.r2 p.0.IA, Po,_IC`/ l ' D-E50A `. s� �xiSTIN� wig i µ�N LOCUS PLAN Ek S-Muc-ruRa ` Scale : I11= 20001 T CV SST 2.C,+ M\N1 '�u PaV` C3L',ILl71fJCr Assessors Map 117 M��T \ Parcel 117 1 � n o I PARTIAL PLAN (LEACH FIELD) \ l 1 Not toScale I DESIGN DATA i li Doctors Office- 2 Doctors,Per Owner 1,40L-: aI_. 40•o With no Garbage Grinder 3 o Daily Flow= 250 gpd/Doctor= 500gpd O LOAM OR6FNIC Septic Tank: 500 gpd x 200%=1000 gpd SAND` t=1L.L. Use a 1000Gallon Septic Tank(Existing) EXIST IwIC vel'ISw BRN Cop.RSe: ' Iy' LEACHING AREA o nit✓ew ay a SAND Io vR SIt 500 gpd/0.74=676 sf Required I Bc 6RN'ISN V EL. GOARSG Sldewal I =2(l 2 +40')2= 2 08 s.f. ` BAND 10 YR. (•/L b .sg" Bottom Area= 12'x 40' = 480 s.f. C LT.�—"Sw 300A 68,8 s.f. Total Provided '�• t:?-1; SANG \O YR /-/y Sy suwvAla 6N61N C6RING Iwc. LEACHING CHAMBER DESIGN �oT ACiEt 17ATIn: Al I.Pipes to be Schedule 40. Use 4 0.14 Ae. / -500 Gal.Leaching Chambers Ina ` Flnieh 12'x 40'Washed Stone Field as Shown Grade - / c a f Filter m'n Fabric Compacted FIII WEST BAY ROAD /e°-1/2" Pea Slane I PLAN VIEW =4c � 3/4Scale I — 2OIP 4 Washed 10 I _ - Varies • It. _ NOTES CROSS SECTION OF CHAMBER CWfi' Existing Building NOT TO SCALE Li0 Sewer Heavy Duty Frame 8 Covers. I. Water Supply For This Lot is Municipal Water. See Note No.5 t F.G.40.5 2.Location of Utilities Shown on This Plan Are Approx. F.G.40.0 At Least 72 Hours Prior to Any Excavation,For This I IA'BITUMINOUS SURFACE COURSE SITE PLAN j1 it II II I Project The Contractor Shall Make The Reqquired I +A' BITUMINOUS BINDER COURSE Notification to DIG SAFE-I-888-344-7233. °:: °o. • '°. 37.0 3.The Contractor is Required to Secure Appropriate o ° •o PROPOSED SEPTIC UPGRADE I Permits From Town Agencies For Construction •p�o, • ,o°� 1jExist.l000goll� e Top EL38.0 Defined by This Plan. °, .00 •o a a ,°" 6"ProcessedStone II Septic Tank II 37.6 AT I Il Bot.El. 35.0 4.Install Risers as Required to Within I2"of Finished 57 WEST BAY ROAD 37.4 37.2 5 Grade. 48o Q.o a o` Bedding as 5.All Structures Buried Four Feet(4)or More or OSTERVI LL E t MASS. Per Title 5 BOt.T.H.Elev. 30.0 Subject to VehiculartobeH-20 Loading. COMPACTED suecRAOE FOR No Ground Water 6.Septic System to be Installed in Accordance With I D R. PAU L B. JAQ U E S Revision And T DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Barns ableBoardatest ofH althRegulationseTownof PAVEMENT DETAIL SCALE: AS SHOWN DATE: FEB. 15,2002 Not to Scale 7. All Piping to be Sch.40 PVC. Not to Scale SULLIVAN ENGINEERING INC. OSTERVILLE , MASS. zzo© ..�