HomeMy WebLinkAbout0289 WEST BAY ROAD - Health 289 West Bay Road
Osterville
A = 116 111
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r TOWN OF BARNSTABLE
} SEWAGE # oa
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VILLAGE 4 S T ASSESSOR'S MAP & LOT-114
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INSTALLER'S NAME&PHONE NO. 1 �/c.//� l "UCo /ao
SEPTIC TANK CAPACITY /'r' /'� £ !�t7(v'�.0-1-1 Wlf�c4'/0 OUP-.
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS
BUILDER OR OWNER AIArj/ f,6- M/CAZ £GG
PERMITDATE: COMPLIANCE DATE: U1
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility If an wells exist
PP Y g tY ( Y
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
a b.
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_ TOWN OF BARNSTABLE
LQCA,16N We,ST 64 Rc�• SEWAGE # 90) "
ViLAGE QSTGrVA- ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY I SOd G S.r I Ct� Pumo bsr
LEACHING FACILITY: (type) Plow '61 4} jwS _ (size) 3� STO`ivk
NO. OF BEDROOMS 3
BUILDER OR OWNER l CO I,ArUSS
PEtMITDATE: W99 COMPLIANCE DATE: a-
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 Jeaching facility) Feet
Furnished by S ,c. nlaioh
aa- r3�q,
D3- q3. o
C�
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fro- 0 O .
TOWN OF BARN TABLE
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LOCH.aON �--8 G/ f 1 SEWAGE # % -•S` oL,
VT�,LAGE O S +ti'll/AI`@- ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. a
SEPTIC TANK CAPACITY 1-1-C\2 T-, 6C 60oy �� C{��,rY/►.�.�
LEACHING FACILITY: (type�S )y .� ��oa/ - �{i�►t ,S�lt.p
NO.OF BEDROOMS_
BUILDER OR OWNER L �"p
PERMTTDATE: COMPLIANCE DATE: Z2,Z AT 2
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any.wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
ti� y
r,
33�
3 +
No., / c►v�14'l�►S �� ` Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01ppYication for Oiopaal 6pgtem Cottgtruction Permit
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.
00
Assessor's Map/Parcel 9 w��� o IJSlv6f�•C
Installer's Nam;,Addresf and Tel.No. Designer's Name,Address and Tel.No.
R�ys'- 2 3-5- ® �
Type of Building:
Dwelling No.of Bedrooms Lot Size ° `�< Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow , ®gallons.
Plan Date e" -Number of sheets Revision Date
Tit1eE`^'_cta.9.,- ' Z��'
Size of Septic Tank Type of S.A.S. s'
�-.✓5�� Gs+ ,5�ho
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 Ti le 5 of atfltnmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been'�s d y this ar
Signed Date
Application Approved by A Date
Application Disapproved for the following reasons
Permit No. Date Issued
t
s No.� _ �+� � (� i{- �•� .Fee
' - THE COMMONWE-ALT_-H OF MASSACHUSETTS f'�nteied'in computer:
E b`' F
PUBLIC HEALTH DIVISION =TOWN OF BARNSTABLE, MASSACHUSETTS Yes i
0(ppricat on for nigpo'gat *pgfem Congtrucfion Permit � M
Application for a,Permit to Construct( )Repair( )Upgrade(Abandon El Complete System ❑Individual Components'-
Location Address or Lot No. Owner's Name,Address and Tel.No.
z81 �aY .�
Assessos Map/Parcel 2 t9 9�•V�ST '�'��,F_D,- p�S ,�l�/L
a //
Installer's Nam Addle s,and Tel.No. a Designer's Name,Address and Tel.No.
RA Y
.. tJ ,� 5V/ G •.Js.� /�G EA
+ Type of Building:
=Dwelling No.of Bedrooms " Lot. ize _QA.. Garbage Grinder( )
Other,. Type of Building No.':of Persons -Showers( ) Cafeteria(
)
r ,
O`ther,Fixtures _ <,
��/
Design Flow��� //® gallons per day. Calculated daily how 7C� gallons.
Plan Date�b -
, '•4 t,'23 /�"i 9 Number of sheets Revision Date
Size of Septic Tank ,/ t5 O Type of S.A.S.
--Description of Soil 4�L- " ��-!91
Nature of Repairs or Alterations'(Answer when applicable)
Date last inspected: ,
Agreement: :..
The undersigned agrees to ensure the cons uction an "m •ntenance of the afore described on-site sewage disposal system
in accordance with the provisions of Ti le 5 of e ' vi.o 1 Code and not to place the system in operation until a Certifi-
cate of Compliance has been ss ed y this
Signed 444, Datev-
Application Approved by Date'
Application Disapproved for the following reasons
t
Permit No. 4 Date Issued
.THE COMMONWEALTH OF MASSACHUSETTS 1 "c
BARNSTABLE, MASSACHUSETTS
Certificate of Comptianw -
THIS IS TO CERT t .he Of -site�Sewa a Dis oral System Constructed( )Repaired ( )Upgraded
Abandoned( )by _ i �,�
at ''0 ha bee constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.; ated
Installer Designer e,
The issuance of thispeT�,tt shall 1(abe construed as a guarantee that the satewill function as,:�esign�d. �"/ 1 Inspector / �' �� �6
Date �� _.! t,rr� !
l � � � r �
i
p
---� --------- a �--------------
No. ----p— .
t Fee _ l
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Digpogar pgtem Cott,5truction Permit
Permission is hereby granted to ICo• tru t( Repair( U gra.e( )Abando
System located at �
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.
q
Provided:Construction /ust dcompleted within three years of the date of hi "efnut. \
� (f
Date: .. .. Approved by 1 �• v41il�? -'r
Town of Barnstable PH
Department of Ilealth,Safety,and Envirountental Services
Public Health Division Date L?h A�--q
SI 367 Mnin Street,I Iynnnis MA 02601
9ARNBT ADM
Tt A� Date Scheduled /� / s I }
. � Jfine' �. j� ee I'd.
i
Soil Suitability Assessment for Sewage Disposal
L q
Performed By: Witnessed By:
, T10 v > tz& > NAL INt'orrrntA oN
..
t
Location Address Owner's Name
f�/9CZ Cc7�9/�Us
Address 263 el?
Assessor's Map/Parcel: %/ �l //� Engineer's Nan ������/��
NEW CONSTRUCTION REPAIR m Telephone 9
Land Use Q Slopes(%) f./ ' ( Surface Stones
Distances from: Open Water Body n Possible Wet Area 160 n Drinking Water Well P1 n
Drainage Way ,VPQ n Property Line S n Other n
SKETCH:(Street name,dimensions of lot,exact locations of lest holes&perc tests,locate wellands in proximity to holes)
Parent material(geologic) YjwilloO,!( jtVd o Depth to Bedrock 'V ,A
Depth to Groundwater. Standing Water in hole: "R Weeping from Pit face C�
Estimated Seasonal Iligh Groundwater
D 7' I? NAT'Yt�1 PtJIi 5 - N'ALIJJGH;.'VVAI" k xAT3LL
Method Used:
Depth Observed standing In obs.hole: in. Depth to soil mottles:.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment n.
.In(lex Well# -grading Dole:_ Index Well level-—- Aril.fnclor Adj.Groundwater Level
t'
t .
Observation
Hole H I Time at 9" 11 -42
Depth of Pere J 6 Time at 6"
Start Pre-soak Time® i 1 Time(9"-6") 3.
End Pre-soak
Rate Min./Inch
Site Suitability Assessment: Site Passed Site failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation 11ole Data To Be Completed on linen j
f nnv• Annliranf
r
PP-C1' OI3SI!,IZVA CtdN IZGL
Depth from Soil Ilorizon Soil Texture or Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulderes.
%
1 G Mir:O. SAS
IEEE � UBSEIZVATI ?N.IIO E LOG Ilole'
.... ..
Depth from" I':. -Soil Hoiizon Soil Texture Soil Color Soil Other
Surface(in.).-,.• - (USDA) (Munsell) `Mollling (Structure,Stones,Doulderes.
Consistency,a
..
DIi1 OI3Sl;nVA'>�ICIY I�UC� LOG Depth from Soil l lorizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Slopes,Boulderes.
Consistency,% I
;DELI'.. OISRVf1TI()l'V. IC1L L,Q: `I�ble;'
.
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Ilouldcres.
Flood Insurance Rate Maw
Above 500 year flood boundary No_ Yes
Within 500 year boundary No— Yes
Within 100 year flood boundary No_ Yes
Depth of Naturally Occurring Pervious Material
I
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption systetn7
-U
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by the consistent with
the required training,expertise and experience described in 310 CMR 15.017. In
Signature t Date 1"1
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 289 West Flay Road
Osterville, MA 02655
Owner's Name: Mike Colarusso
Owner's Address: Same
RECEIVED
Date of Inspection: June 30, 2001
Name of Inspector:(Please Print) James M. Ford U L- 0 9 2 O 01
Company Name: James M. Ford-
�. ARNST
Mailing Address-. P.O. Box 49 '` t, ```r`Map: 17 TOWHEOAL BH DEPTABLE
�' Osterville,lllA 02655-0049 Parcel:
Telephone Number: (508) 862-9400
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete.as of the time of the inspection. The'inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
✓ Passes
Conditionally Passes
NjUs Further Evaluation by the Local Approving Authority
r F
Inspector's Signature: Date: —July 2, 2001
The system inspector shall sub 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 C.oniments ' 3- ='
This report only describes conditions at-the'tme of inspection and under the conditions of use at that
time.,Thisinspection does not address.how the system'will"peiform in the future under the same or different
conditions of use:
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of ,I I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
.CERTIFICATION (continued)
Property Address: 289 West Bay Road
Osterville, MA
Owner: Mike Colarusso
Date of Inspection: June 30, 2001
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
3 B. System Conditionally Passes:
>'..t
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..':,'-
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:
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:
_.The_system required pumping more than 4 times a year_due to broken or obstructed pipe(s). The system will
_... __.._.. .pass.inspection if-(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 289 West Bay Road... �"`-#•.° +s`'
z
Osterville, MA " :r''
Owner: Mike Colarusso
Date of Inspection: June 30, 2001
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner.which will protect puuiic health,safety and the environment:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2.. ' System will fail unless the Board ofHealth(and:Public Wafer'Supplier,.if any)determines that the:
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100°feet=of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 ofa public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory, for 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:
r N �
� Y
3
44
if, n
Page 4 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 289 West Bay Road "
Osterville, AM '
Owner: Mike Colarusso
Date of Inspection: June 30, 2001 „
D. System Failure Criteria applicable to all systems:
You must indicate either`yes"or"no"to each of the following for all inspections:
Yes No
✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than%2 day flow
✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped
✓ Any portion of the SAS,cesspool or privy is below high ground water elevation.
✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
✓ Any portion of a cesspool or privy is within a Zone..1,of a public_well.
✓' Any portion of a cesspool or privy is within 50 feet of a private water supply well.
✓ Any portion of a cesspool or privy,is less than 100 feet_but greater than 50.feet from.a private_water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
No (Yes/No)The system fails. 1 have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails, The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large System:
To be considered a large system the system must serve a facility with a design flow of 10,000 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
_ the system is within 400 feet of a surface drinking water supply
_ the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area Interim Wellhead Protection Area-IWPA)or a mapped
Ys g (
Zone II of a public water supply well
If you have answered des to any question inSection E the system is considered a significant ca threat, veered
or answered"yes"in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
Page 5 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
�,, CHECKLIST
Property Address: 289 West Bay Road
Osterville, MA
Owner: Mike Colarusso
Date of Inspection: June 30, 2001
Check if the following have been done: You must indicate"yes"or"no"as to each of the following: .
Yes No
✓ Pumping information was provided by the owner,occupant,or Board of Health
✓ Were any of the system components pumped out in the previous two weeks?
✓ Has the system received normal flows in the previous two week period?
✓ Have large volumes of water been introduced to the system recently or as part of this inspection?
✓ Were as built plans of the system obtained and examined.?(If they were not available note as N/A)
✓ Was the facility,or dwelling inspected;for:gigns of sewage:.back up
✓:;, .i_rs Wasahe.site 4nspected.,for:signs of breakout? ,;•., ;;,,,� _; y,• ;
✓ _ • Were:all system;components„excluding the SAS, located on:site ;
✓ Were the septic tank manholes uncovered,opened,.and the interior of the tank inspected foi the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
✓ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes No
✓ Existing information. For example,a plan at the Board of Health.
✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [310 CMR 15.302(3)(b)].
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Page 6 of I 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
;SYSTEM INFORMATION
Property Address: 289 West Bay Road
Osterville, MA
Owner: Mike Colarusso
Date of Inspection: June 30, 2001
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Number of current residents: 4
Does residence have a garbage grinder(yes or no): Yes
Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required]
Laundry system inspected(yes or no):
Seasonal use(yes or no): No
Water meter readings, if available(last 2 years usage(gpd)): 2000- 118,000 gals.; 1999-204,000 gals.
Sump Pump(yes or no): Yes
Last date of occupancy: Currently occupied
COMMERCLUANDUSTRIAL
Type of establishment:
Design flow_(based on 310 CMR 15.203): gpd
Basis:of design flow(seats/persohs/sgft;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):
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: New system, never pumped-per owner and treatment plant
Was system pumped as part of the inspection(yes or no): 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)
InnovativeJAlternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight Tank Attach a copy of the DEP approval
Approximate age of all components,date installed.(if known)and source of information: ..
Sep. 22 1999-per as built card _
Were sewage odors detected when arriving at the site(yes or no): No
6
Page 7 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
i SYSTEIVI'INFORMATION (continued)
Property Address: 289 West Bay Road_ `_.+:.M.r_E._3Y`_ }•a.,:' t{" ° +_`_
Osterville, MA
Owner: Mike Colarussot'-
Date of Inspection: June 30, 2001
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: _cast iron _40 PVC _other(explain):
Distance from private water supply well or suction line:,
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: 10" u
Material of construction: ✓ concrete metal fiberglass__polyethylene,_.. :3 %.
_other(explain) +i
Iftank is metal list age:., age.confirmed,by.a Certificate 9fCompliance-(yes-or.no):,. •. .' (attach a:copy of
certificate)
Dimensions: 1500 gal. :rx, i`v., :;` :
Sludge depth: 2" r�Y a
Distance from top of sludge to-bottom of outlet tee or.baffle; 30" r .;
Scum thickness: 8" _ x7 i
Distance from top of scum to top of outlet tee or baffle: 8"
Distance from bottom of scum to bottom of outlet tee or baffle: 8"
How were dimensions determined: Measuring stick
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Both tees were present. The liquid level was even with the outlet invert. There were no signs of leakage. The inlet cover was
to grade.
GREASE TRAP: None (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
. _ ..-__ _ _.v.,,...
as related to outlet invert,evidence of leakage,etc.):
7
Page 8 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
r;, s 'SYS,TEM;INFORMATI.ON (continued)
Property Address: 289 West Bay Road
Osterville. kM
Owner: Mike Colarusso
YF',
Date of Inspection: June 30, 2001
TIGHT or HOLDING TANK: None (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 alarm and float switches,etc.):
'DISTRIBUTION BOX:" ✓.: .-..,(if present must be opened).(locate on.site,plan) :... , vt
Depth of liquid level above outlet invert Even
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.):
The D-box was level and there were no signs of leakage or solids. There were no signs of back-up or failure in the flow diffusors.
The D-box was 3"belowgrade.
PUMP CHAMBER: Yes (locate on site plan)
Pumps in working order(yes or no): Yes_
Alarms in working order(yes or no) Yes
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
The pump and alarm were in working order when inspected. The outlet cover was to grade.
8
Page 9 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEWINFORMATION (continued)
Property Address: 289 West Bay Road-___...._.. ` _:` _`' �' '`'.'`- _. j '' •' ;��'';�','_
Osterville, MA
Owner: Mike Colaruss0 xt 4Y i f
f ;_,�.. ,. • .,
Date of Inspection: June 30. 2001 _� __. ....._..� _,� .. _. •
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:
✓ leaching chambers,number: S-flow diffusors with 3'stone(per as built card)
leaching galleries,number:
leaching trenches,number, length:
leaching fields,number,dimensions:
overflow cesspool,number:
- --Innovativelalternative system Type/name.of technology: . .-._
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.):
The flow diffusors were located; b'ut•nof dug up'',A&e'were no s giisWfdilure..in the D box:' Tlie bottom'to'Qiade was
approximately 24". The system was in a raised bed approximately 3'higher than the driveway.
CESSPOOLS: None (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): }
Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
PRIVY: None (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
' v +
Page 10 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM.INFORMATION (continued)
Property Address: 289 West Bay Road
Osterville. MA
Owner: Mike Colarusso
Date of Inspection: June 30, 2001
Map: 116
Parcel. I I I
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
AI-
QI - a � S
A61- 38
as- 3 9
C3 '
`D
.0
O O O O
i a
10
i
Page 11 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM°INFORMATION (continued)
Property Address: 289 West Bay Road
Osterville, MA
Owner: Mike Colarusso
Date of Inspection: June 30, 2001
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water feet
Please indicate (check) all methods used to determine the high ground water elevation:
✓ Obtained from system design plans on record-If checked, date of design plan reviewed: 8126199
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:"
You must describe how you'established the liigh ground water elevation:
The flow diffusors were in a;raised bed. Using the design plans on file, a test hole was done when the system was installed, and
water was observed at 7.0.i:The high groundwater adjustment was 2.4, making the adiusted high groundwater level at 4.6'.
This report has been prepared and the system inspected and passed as of the date of inspection. This report is
not a warranty or guarantee that the system will function properly in the future. There have been no warranties
or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report.
No. ,Zoo+ 30� Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:✓ �
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yes
2pprication for Digpogar *pgtem Congtruction Permit
Application for a Permit to Construct( )Repair( t4pgrade( )Abandon( ) ❑Complete System LKlndividual Components
4-Yf
Location Address or Lot No. ✓1 (,✓F.5 J�1°� /�� Owner's Name,Address and Tel.No. J'�d Jr-111aL6'4 of 170
O` G ST f M /C//ELL Oh F 4/�K P,07—
Assessor's Map/Parcel ( � (f I ��7 w F ST 6,0- 1?3 ( .57--
Installer's Name,Address,and Tel.No. .$'O 8-7 7 l 6 lTd o Designer's Name,Address and Tel.No.
Type of Building: N 9 U.S T
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow 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) .41n/Z /¢d yS F T�
Date last inspected:
Agreement:.
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Board of Hea h.
Signed Date
Application Approved by Date
Application Disapproved for the following reasons
Permit No. 02 VU 2—3�, Date Issued
No. oo Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
" PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,. MASSACHUSETTS
4ir �-
RpAication for.Migool *pgtem Congtruction Permit
`� A`lication pp for a Permit to Construct( . )Repair( .Upgrade( )Abandon( ) ❑Complete_System ®�dividual Components
M Location Address or Lot No. F1 $d Z,5 7�'48,J JV f f) Owner's Name,Address and Tel.No. ���"'VA�4 g�To
Assessor's Map/Parcel / — IIIy,, "?J
.Installer's Name,Address,and Tel.No. 4-or. 9 7X Oro D Designer's Name,Address and Tel.No.
f� 14.*c0
Type of Building: E y ,
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
r Design Flow gallons per day. Calculated daily flow 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) M t4 I/460 k N Z lV a u j E 7v �4*
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 issued by this Board of Health.
_F Signed FDate Ova
Application Approved by Date
Application Disapproved for the following reasons' t
Permit No. `a U0 2 — d 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 A ' A 0,4&ro '3.5o oAw/.,� 57 4' _A4,r_
at e 4 Z" C 5 r' 6.4 JW of 0.T 71- has been constructed in accordance
with the pro 'sions of Title 5 and the for D' posal System Construction Permit No. �?uo� -)0 b dated 7 '7.i
t. Installer "" Designer
The issuance ofrLenn'Iist shall not be construed as a guarantee that the sys em ill fu ctionasd nedDate " 1 Inspector fin„
No. n v) . 0L 3 Fee SQ
o—
a.
THE COMMONWEALTH OF MASSACHUSETTS
X
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
- ligpogaf *pgtem Congtruction Permit
Permission is hereby granted to Construct( )Repair( kjoUopgrade( )Abandon( )
System located at ' 44"0 J S 7 Afi4>-0
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:Construction must be completed within three years of the date of this�rmit.
Date: 7`17' a 2 Approved by
TOWN OF BARNSTABLE '�
LOCATION WZE 40W SEWAGE # -2 Of;
VILLAGE 057
^ ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. / " $A/ N.,Vco 7--- 2 t d0
SEPTIC TANK CAPACITY r`PP14 tP n-4 WISCLd'0 OUC_
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS
BUILDER OR OWNER AmTI llc/fT' M/C& £CC r
PERMITDATE: I7 B 2 COMPLIANCEADATE: 74& 74�
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Welland Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland Xnd Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
r
0 D.
V SS
; a
h
w I
g
ro
TEST HOLE LOG
DATE:�.gacp /Z,
EVALUATOR:'_;i J o Gou C/�✓, «6
' WITNESS: .I>.
PERC RATE• ---
r ,
t -
Z
I µ ►
g DESIGN DATA
M,
k `
' ". wq • ' DAILY FLOW:(5)BDRMS.z 110 GPD=Sao GPD
` F 1 ' •P SEPTIC TANK: 3%S GPD z 200% t
ri USE: /Soo"GALLON PRECAST SEPTIC TANK
LEACHING FACILITY
��. USE.
.. CAPACITY #
SIDEWALL:
BOTTOM. E
TOTAL.
a &
,
L,
Y
- - --s
1. ALL PIPE TORE 4„DIA.SCH 40 PVC.. ""
+ 2: PIPE TO BE LAID LEVEL FOR 2'OUT OF DISTRIBUTION
,
BOX.
3. RAISE ALL APPLICABLE MANHOLE COVERS TO WITHIN -
6 OF FINISH GRADE., ;
4. SEPTIC SYSTEM IS NOT DESIGNED FOR THE USE OF A
GARBAGE DISPOSAL' a
5. SEPTIC TANK AND DISTRIBUTION BOX TO BE INSTALLED
ON A 6»LAYER OF STONE.
i•1.AYYR Oi 31Q•PEASTONE OVER
TEE
6. INSTALL GAS BAFFLE IN OUTLET
a"w A9` "314•-1 1 11ED STONE ALL".
AROUND '
.TOP OF FOUND. .F. $` t
SEPTIC SYSTEM"PROFILE t
,,. .. ,n rr ..;•.• xrp. a ,,, 1
r
C�ENERAL�NOTES
SITE SEy, &GE.PLAN
Y
.. 3,
a4 '8•
1.+CONTRACTOR TO BE RESPONSIBLE POR THE LOCATIION -
FOR z of ALL UTa1TIES, D1ND�PitIOR
A80V8 AND UN T °} a* TO ANY EXCAVATION OR CONSTRUCTION."
3. SEPTIC SYSTI i TO i;E INSTALLEDVIN C0WlJANCE 44RTH
r
` PREPARED.FOR
x .k
310 C1�R 1ST 09:TTf I±E V
,
3..THI3 PLAN IS NOT TO BE USED FOR PROPETZTY LINE
DETERMINATION.
}+ ` „4.;ALL DISTURBED AREAS TO LOANED AND SEEDED:
DATEvo SCALE:
p S. CONTRACTOR TO PROVIDE 24 HOUR NOTICE FORANY
F
REQUIRED INSPECTIONS 7; 4
q' a •..: .a% - 4: V
t'..
s f
J .
WELLER & ASSOCIATES r
.. "b . ..
'7A
of �cl3•� � -.� ,�q�, i
77-
E'►C/5 Tin/! �,
4
/D
1 ,41 1 99 9,g �N --/O SGAGE l / /pp p`
' \ * ' � <
n ow E c c. Oelz
j. 1
)C U yo4=4F
� _�, cFssoo�•� TEST HOLE L
OG
I ` DATE: AUGUST 12, 1999
SOIL EVALUATOR: NL O'LOUGHLIN,CSE
WITNESS: D. NIIORANDI
1 -- PERC RATE: <2 NUN./IN.
0. POYR5/8
NDY LOAM 9.9
lc
91. 0YR4/2 9.1
/ OAMY SAND
M � (I
I{
849' WATER 2.9
N
C=MEDIUM SAND
2.5Y7/8 i
90" 2.4
BASED UPON THE USGS FORMULA, THE PROBABLI
HIGH WATER RISE IS 2.4' TO ELEV. 5.3
DESIGN DATA
�oE,2 T/TG E .S� ��/) ?o TAL F DAILY FLOW: (y)BDRMS.x 110 GPD= 140GPD
,�'po�•!5 /N 17w EGG.in/C,�-� Z = yS SEPTIC TANK: Y110GPD x 200%=-880 GPD
/S USE: 1500 GALLON PRECAST SEPTIC TANK
y ,[3 E,D•2p o.�-I 5 PUMP CHAMBER:
USE: 1000 GALLON PRECAST PUMP CHAMBER
LEACHING FACILITY:
USE: (!;)4'x 8' FLOWDIFFUSSORS LINED W AW451> SA -
_ S'TowlE� 3'c...•!Sio zs�'t'o.v E,vos .
CAPACITY:
SIDEWALL: I I to x 1 x 0.74= 86.8
BOTTOM: loxy8)x 0*74= 355•Z
-TA TAi,
G
y
-- � � PD
_..
- 1171-Zo
)711 �,r,ea. I
0
/
3a 5
2, zS G.GS r�� p�/¢c✓�
A o a EL. 5"3
`G•9a
:SEPTIC SYSTEM PROFILE NOTES:
1. ALL PIPE TO BE 4"DIA.SCH 40 PVC(2"PRESSURE PIPE
i_ FROM PUMP CHAMBER TO DISTRIBUTION BOX).
/ 2. PIPE TO BE LAID LEVEL FOR 2'OUT OF DISTRIBUTION
,�/oTE•• BOX.
3. RAISE ALL APPLICABLE MANHOLE COVERS TO WITHIN
6"OF FINISH GRADE. f
,e��►-�i,�//..ice iv.�cL T .8� -
iyAG�" 4. SEPTIC SYSTEM IS NOT DESIGNED FOR THE USE OF A
GARBAGE DISPOSAL.
MAST/� J�I�//L- i GtJ/✓ �- :+��'�`�*:;' .r 5. SEPTIC TANK,PUMP CHAMBER,AND DISTRIBUTION BOX TO BE
\ INSTALLED ON A 6"LAYER OF STONE.
p 6. INSTALL GAS BAFFLE IN OUTLET TEE. i
7. INSTALL PUMP ON 4"BLOCK IN PUMP CHAMBER
M 8. SEPTIC TANK&PUMP CHAMBER TO BE WATERPROOFED
/Z PUMP SPECIFICATIONS AT THE FACTORY(RECEIPTS TO BE PROVIDED TO THE
p DESIGN ENGINEER).
USE: :"YERS SR.M4 PUMP(OR EQUAL)WITH 9. ELECTRICAL PERMIT REQUIRED FOR PUMP&ALARM.
1JDIIILE & VISIBLE ALARM
";TALL 11 j VOLT SINGLE PHASE LINE
O PUMP
"STALL SEPARATE LINE FOR ALARM
��}/L_ PUMP ELEVATIONS
s
PUMP OFF: 2.98 GENERAL NOTES
PUMP ON: 3.56(150 GAL.)
ALARM: 4.06 1. CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION
III OF ALL UTILITIES,ABOVE AND UNDERGROUND,PRIOR
TO ANY EXCAVATION OR CONSTRUCTION.
_ _ -. -- - ---- --- 100% STORAGE: 735 GAL.
SITESEWAGE PLAN 2. SEPTIC SYSTEM TO BE INSTALLED IN COMPLIANCE�iITH
•� 310 CMR 15.00:TITLE V.
FOR 3. THIS PLAN IS NOT TO BE USED FOR PROPERTY LINE
289 WEST BAD,' RD., OSTERVULLE, MA. � '4 � DETERMINATION.
v rrF
r.SSFSSORS MAP 116 PARCEL I I I �A'' M'I
4. ALL DISTURBED AREAS TO LOAMED AND SEEDED.
bk A.;hAN V'
PREPARED FOR c Civil 5. CONTRACTOR TO PROVIDE 24 HOUR NOTICE FOR ANY
J No.3.^EB6C y REQUIRED INSPECTIONS.
MICHAEL COLARUSSO
�^P�FG' f ("� 6. REMOVE ANY IMPERVIOUS MATERIAL FOR A 5'RADIUS AROUND
i THE LEACHING FACILITY AND REPLACE WITH CLEAN MEDIUM
SAND.
DATE: AUGUST 23, 1999 SCALE: 1"=30' At
Y
7. ERISTING SEPTIC SYSTEM TO BE PUMPED DRY AND BACKFILLED.
i
N OF N�9
-- o) DANIEL it.
j bRA-AN
WELLER & ASSOCIATES `
0 No.32686C y !
1645 FALMOUTH ROAD-SUITE 4C CENTERVILLE,MA. 02632 'pF �� APPROVED BY: - -
TEL: (508) 775-0735 FAX: (508) 775-0754 - - - -
SS/ONAI E�
71 - o S'�