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HomeMy WebLinkAbout0830 RIVER ROAD - Health 830 River R ao d Marstons Mills A =044 - 006 r i i TOWN OF BARNSTABLE �%, ATION 1930 Ri vcr Rck- SEWAGE#0007 - 00`7 XTLLAGE ( cAT'54ons 0) I)SASSESSOR'S MAP&PARCEL $*Alq �# G hey INS'iiALLERS NAME&PHONE NO. $ Q 6xca✓a-1ion SEPTIC TANK CAPACITY aoo !3ml LEACHING FACILITY:(type)330 Cu/-4cc5C3) (size) /Q.S x aS x a NO.OF BEDROOMS 3 OWNER 5-T.D PERMIT DATE: J- $- p`7 COMPLIANCE DATE: 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 Al Z 7'6" AZ" 23 A3 - qL, t B3- 17:G" Ay- Llc e By- 37'c AS' B , s 5l3� t Lq F'r o n p No. Fee 1� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: U PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Ye 3ppItratton for �Dtgooar *pztem Con5trurtton 3pCrmit Application for a Permit to Construct( ) Repair(v�Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 930 Z VCr R&a 0 Owner's Name,Address,and Tel.No. t 4#t)T 2-2. -45 69 A1GrStofls )Itlls ENt-I DA VRNN Assessor's Map/Parcel MA0 44- 'PARCEL (0 r x F0% pl� I.1 NL0LN,RT 0186 5 Installer's Name Address,and Tel.No. 509-►r"17-06s3 Designer's Name,Address and Tel.No. QDQEeT- 61UM/ -BIB 1EXCAVhTl0?,1 DAVIp MASoN - DD6 EwYieo.0MWrAL_ 1'4 TEA MeV LA) 'FoQFSTAA EAST 5hNotuILH 508-933-21- -1 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required)-33 0 gpd Design flow provided gpd Plan Date 12 30 1 01, Number of sheets i Revision Date Title"SlrEt 5FWAE1EPLAW- 2,30 1R1NE2 RoAp Size of Septic Tank 6 00 Type of S.A.S. Description of Soil 5eG SOIL L.U6 Nature of Repairs or Alterationsw p (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. Sign 4 Date Al 8 It?, Application Approved by ® Date p Application Disapproved by: Date for the following reasons Permit No. f Date Issued i .-7 K N0. /J r v Fee 1" THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: vyj U PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zpplication for ai000l 6potem Con5tructiori. Permit Application for a Permit to Construct O Repair(✓j Upgrade O Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. S 3 0 RI V ex'_R(>U 0 Owner's Name,Address,and Tel.No. MGtr�2ions �1015 ENT- 11a/\ \1AtoNj Assessor's Map/Parcel AAA QM4 i-_)ARCEL. a"' 111Uk De, t-INCU4MrR1UlS65 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. kOaLP-► (TILrOy 3 Fxt.AV�1 t ,u�l DA���10 /t50N - I�l3c 1,I�IvIet,A)Nll-uI /t L 14 1 CA3Cf�e.y (-0 ►c,5ef!51 AL ��� y�ce11ct1 6u-S-�33- z111 Type of Building: t Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd i` Plan Date 12 13 U I Ut Number of sheets I Revision Date Title SlTC 1 5L\NACi~ PLAn \,l S3(., 2 N r P P,U10D Size of Septic Tank Q Type of S.A.S. Description of Soil 5 Q e S 0 1 L ` UEa r Nature of Repairs or Alterations(Answer when applicable) Date last inspected: w 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. n Sig d [ ;u?. +F-r. Date 1 f� �� r Application Approved by lj �! © �� s Date Application Disapproved by: / — Date for the following reasons L//7 Permit No. '/j 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 L-r� 61 1 b I f n\l C-a � 1 r` (Z,; a ha at (3 > E' (' I< Uc1•Ct has been constructed in accordance with the provisions of Title-5 and the for Disposal System Construction Permit No. �1�y f-,/�r�1 dated ' Installer 1 vo b eP(z 1 b-1 L V b V Designer_ c 10 !" '1 1�l ' fly! 1 r D nm{'11 CA #bedrooms �3 Approved design flow gpd The issuance of this permit /shaati,not,be le trued as a guarantee that the system will funct�io as designed. Date ( j ( Inspector ----� '(//'—/—��— D -----------------_------ Fee_ -- No. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS tg o.5aC gtem t� � �or�� ructioril Permit � p � Permission is hereby granted to Construct (� ) Repair (1/) Upgrade``( ) Abandon ( ) System located at 9 3 o y P( 6 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: Constru 'on/must be completed within three years of the date of t IF ertn l. Date / / A "roved b n� ��� Pp Y f Town of Barnstable QF fEfE.T Regulatory Services Thomas F.Ceiler,Director � sAItNS!'ABEE, + a Public Health Division Fps Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644_ Fax: 508-790-6304 Installer &Designer Certification Form Date: �ikWJ 1� 1,1 Designer: ` �� Installer: s � Address: . 0 Address: �� TeaS:srr � 1 . ���� � �� �'����d«.r� �-►� On `0-7 '� � � was issued a permit to install a (date) ii►` ,(nsstaller) septic system-at � 'KNCI F based on a design drawn by (address) V-�— dated f- JI, -0-7 (designer) V v.certi that the septic system referenced above w fy ep y as installed substantially according't e design, which may include minor approved changes such as lateral relocation of the c stnbu ion box and/or septic tank- . �, „ --- -- I certifkhat the septic system referenced above was installed with mjear, q, changes e, g_ greater thin.2 0' lateral relocation of the SAS or any vertical-relocation of any,component of the septic�ylstm)but in accordance with State &Local Regulations. Plan revisioxA or certified as-btt�by designer to follow. DAVIEI y ,. B (Installer' Signature) o MASON. . A v 9 W toss: , ANI TARP . (Desi 's Signature) (Affix_ e 1^ ° �'�Stamp Here) PLEASE RET J-P-N TO PARI+ISTABLE PUBLI •HE ALT , DIMSION. CFRTIM'CATE :y ' COliMLIANCE WILL" NOT 'BE ISSUE9-uA TII, BOTH TffiS FORM AND BUILT CARD ARE RECEIVED BY THE BAIL STABLE PUBLIC REA$.TtiDI SIOP1 THANK YOU. Q:HealtMeptic/Designer Certification Farm t Town of Barnstable CF tHE 1p� o Regulatory Services ins Thomas F. Geiler, Director &UM9wA '�. A,•� Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 June 12, 2006 Ms Marion Oldham 830 River Road Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located 830 River Road, Marstons Mills,MA,was last inspected on Mayl6th, 2006 by, Patrick T. Sullivan, certified septic inspector for the State of Massachusetts. ' I The inspection of your septic system showed that your system has "Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: System is in a state of failure. You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder, please feel free to contact the Barnstable Health Department. BARNSTABLE HEALTH EPARTMENT om McKean, R.S., C.H.O. Agent of the Board of Health A 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: 830 River Road Marston Mills Owner's Name: Marion Oldham Owner's Address: 2 Date of Inspection: 5/16/2006 Name of Inspector: (please print) Patrick T. Sullivan Company Name: Ready Rooter Mailing Address: P.O.Box 371 Sandwich,MA 02563 Telephone Number: (508)888-6055 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The System: Passes Conditionally Passes Needs Further Evaluation by the Local Authority Inspector's Signature: _/2�/L,�- Date: 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 oflice'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 CommentsCn r-- C� ****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 , Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 830 River Road Marstons Mills Owner: Marion Oldham Date of Inspection: 5/16/2006 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 indic Zesthat any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure c ' eria not evaluated are indicated below. Comments: B. System Conditionally Passes: 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, approved by the Board of Health,will pass. Answer yes,no or not determined (Y,N,ND)in the for tl �following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank approved by the Board of Health. *A metal septic tank will pass inspection.if it is strut ly sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is av�ilable. ND explain: I Observation of sewage backup or break ut or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settledfir uneven distribution box. System will pass inspection if(with approval of Board of Health): ,/�roken pipe(s)are replaced obstruction is removed Tdistribution box is leveled or replaced ND explain: f" The system required pupiiping 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: Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 830 River Road Marston Mills Owner: Marion Oldham Date of Inspection: 5/16/2006 C. Further Evaluation is Required b/eetermines d of Healt Conditions exist which require fuation the Board of Health in order to determine if the system is failing to protect public health,safetyiro ent. 1. System will pass unless Board etermines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a mich will protect public health,safety and the environment: _Cesspool or privy is within 5 surface water_Cesspool or privy is within 5 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, ety and environment: _The system has a septic tank and soil absorption syste 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 S is within a Zone 1 of a public water supply. The system has a septic tank and SAS and SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used determine distance "This system passes if the well water ysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds . dicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and to nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy a analysis must be attached to this form. 3. Other: •Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 830 River Road Marstons Mills Owner: Marion Oldham Date of Inspection: 5/16/2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or stem component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to and overloaded or clogged SAS or cesspool _ _ Liquid depth in cesspool is less than 6"below invert or available volume is less than'/Z day flow _Z 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 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.] Y<=S (Yes/No)The system fails. I have determined that one or more of the above criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system th/utary ust serve acility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no of the fo owing: (The following criteria apply to largen addi 'on to the criteria above) yes no _ the system is within 400 fee a drinking water supply the system is within 200 feetary to a surface drinking water supply the system is located in a nisitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone R of a public water su If you have answered"yes"to any q stion in Section E the system is considered a significant threat,or answered "yes"in Section D above the large stem has failed.The owner or operator of any large system considered a significant threat under Section or failed.under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner sho contact the appropriate regional office of the Department. r Page 5 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 830 River Road Marstons Mills Owner: Marion Oldham Date of Inspection: 5/16/2006 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? N& 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 signs of sewage back up? -Z _ Was the site inspected for signs of break out? _ Were all system components,excluding the SAS,located on site? Were the septir-IM 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? Was the facility owner(and occupants if different than owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] r -Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 830 River Road Marston Mills Owner: Marion Oldham Date of Inspection: 5/16/2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 2;) Number of bedrooms(actual): D DESIGN flow based on 310 CUR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: 3 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)): Q Qa, P. Sump Pump(yes or no):&,?'J Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203) gpd Basis of design flow(seats/persons/sq., .etc.): Grease trap present(yes or no): Industrial waste holding tank prese (yes or no):_ Non-sanitary waste discharged t Title 5 system(yes or no):_ Water meter readings,if avail le Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: 0Was system pumped as part of the inspection(yes or no):�5 If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval ./Other(describe): C��..vr.- �c�C, ,5��o�� / ��� 'cz Approximate age of all components,date installed(if known)and source of information: (� Were sewage odors detected when arriving at the site(yes or no):L� -Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 830 River Road Marstons Mills Owner: Marion Oldham Date of Inspection: 5/16/2006 BUILDING SEWER(locate on site plan) Depth below grade: q //-- Materials of construction:_cast iron V 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: Material of construction:_concrete metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age nfirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from the top of slud a to bottom of outlet.tee or baffle: Scum thickness: Distance from top of scum o top of outlet tee or baffle: Distance from bottom of to bottom of outlet tee or baffle: How were dimensions termined: Comments(on pumpi g recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet i ert,evidence of leakage,etc.): GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal filerglass polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet t. or baffle: Distance from bottom of scum to bottom outlet tee or baffle: Date of last pumping: Comments(on pumping recommenda ions,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence leakage,etc.): -Page 8 of 11. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 830 River Road Marston Mills Owner: Marion Oldham Date of Inspection: 5/16/2006 TIGHT or HOLDING TANK: (tank must pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete_m fiberglass_polyethylene_other(explain): Dimension: Capacity: gal ns Design Flow: Ions/day Alarm present(yes or no): Alarm level: Alarm' working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present t be opened)(locate on site plan) Depth of liquid level above out inve . Comments(not if box is level and ' tribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no):^�`f Comments(note condition of pump chadiiber,condition of pumps and appurtenances,etc.): J�r t •Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 830 River Road Marston Mills Owner: Marion Oldham Date of Inspection: 5/16/2006 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers, number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimension: _IZ'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.): ` CESSPOOLS: cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: l Depth—top of liquid to inlet invert: 1z' Depth of solids layer: 3 " Depth of scum layer: t " Dimensions of cesspool: ' Materials of construction: Indication of groundwater inflow(yes or no):A.� Comments(note condition condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): t{ PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,sign f hydraulic failure,level of ponding,condition of vegetation,etc.): .Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 830 River Road Marston Mills Owner: Marion Oldham Date of Inspection: 5/16/2006 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. � f L � 0 a o F Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 830 River Road Marston Mills Owner: Marion Oldham Date of Inspection: 5/16/2006 SITE EXAM Slope ✓ Surface water✓- Check cellar Shallow wells Estimated depth to ground water> feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with the local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: Y-.,,,.a, "<,. : r_*C=K.*' -r x-L<,L,,,, , �,,,, ,��z(e-v c You must describe how you established the high ground water elevation: .. rho r�;..�-.,..,SZ. e�...r' �Kru •✓�., TOWN OF BARNSTABLE -°LOCATION 0 Roacp SEWAGE # fir, VII,LAGE ASSESSOR'S MAP & LOT-Q-0Ad�� SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 0 V, (size) NO.OF BEDROOMS WNER PERMITDATE: en COMPLIANCE DATE: Separation Distance Betwee�tP,tl� 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 TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGEq'�.�,s��� ASSESSOR'S MAP&PARCEL © -- C INSTALLERS NAME&PHONE NO. C e-.S.; E CAPACITY (y LEACHING FACILITY.(type) (size) '641 A NO..OF BEDROOMS OWNER �(V�w�a-`�y�. �a �.+.�•�w� PERMIT DATE: COMPLIANCE DATE: 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 k >, . �. ,.� -. . . � .,. _ � i 1 4c - � � ` . . � �= �` � 1 .� �{ O �= lime Town of Barnstable P# // 50 Department of Regulatory Services ' Public He Division • Health Division Date // Z. b 1 9.a�� 200 Main Street,Hyannis MA 02601 Date Scheduled �o�✓� / '. y,( - Time � Fee Pd. �® Soil Suitability Assessm 'n'for ewage D'* osal Performed.B:vv�� �0( -` S Witnessed By: > V-3 LOCATION&GENERAL INF'OItMATION FLL-oc2tionAddress �T5 Q g7r �p C.� Owner's NameAddress ssessors Map/Parcel: / l Engineer's Name NEW CONSTRUCTION REPAIR , ' Telephone# Land Use e-�nen Slopes •� O, . � . 4h ( ) ` / Surface Stones /�/ Distances f m: y /7 ft possible Wet Area!�d —,•T- � Drinking Water Well .eft Drainage Way ft Property Line \ t��' • ` ft ,Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) VQ_ Parent material(geologic) Depth to Bedrock /" 6 Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater . DETERMNATION FOR SEASONAL HIGH WATER TABLE i 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 Adi,factor Adi,Groundwater Level PERCOLATION TEST bate/z Tim1e-Z) Observation Hole# Time at 4" Depth of Perc Time at 6" Start Pre-soak Time @ Time(9"•6") End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed SiteFailed: Additional Testing Needed(Y/N) . Original: Public Health Division Observation Hole Data To Be.Completed on Back----------- ***If percolation test is to lie conducted within 100'of wetland,you must first notify the Barnstable Conseirvation' Division at least one(1)week prior to beginning. Q:SEPTICNPERCFORM.DOC it - f DEEROBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil O er Surface(im) (USDA) , (Munsell) Mottling (Structure,Stones;Boulders. Consistencv.%Gravel) Colo-wl `0Na3 by G G -r G zt 01 DEEP OBSERVATION HOLE LOG 'Hole#• 2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) b-: L004� /ON DEEP OBSERVATION DOLE LOG r:: Hole# Depth from Soil Horizon Soil Texture, .r Soil Color. Soil Other Surface(in.) (USDA) t (Munsell),:' Mottling (Structure,Stones,Boulders. Consistency, o Gravel)- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil-Texture Soil Color - Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consist n Flood Insurance Rate Map: Above 500 year flood boundary No_ 'Yes Within 500 year boundary No v' Yes i Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi us atertal exist in.all areas observed throughout the Wr, area proposed for the soil absorption system? - ' •� •. If not what is the depth of naturally occurring p e oumaterial?' Certification I certify that on �d (date)I have passed the soil evaluator examination approved by the Department of Envir mental Protection and that the above analysis was performed by me consistent with . the required training,exper' nd experience described in 310 CMR 15.017. Signatu Date Q:\.SEVnCIPERCFORM.DOC rat �.PMAlt 7U �d q ©� 4 1 �. 2� LoG��4R. 7l o JI J ` • : I Cy(t5 , C O ASSESSORS ►tAP: PARCEL: TEST HOL-E LOGS NOTES: �o FLOOD ZONE: SOIL EVALUATOR: t aUI ) Mc�yti� L REFERENCE:�tiD $ ��'� .►}l(o'Z_ _ WI TNES9: Jt u2! I) 711e inmi liin,,ii Shall comply with Title Y and Town ett Barnstable Board of .�.A`� n� t, DATE: 00 I flealdt Rcyul �`x t Y +1 G � _/ I /-- t�(qZ PERCOLATION FATE: L Z�I It , 2) The installer shallpliorverify the location ofuhlrtics,sewer inverts and septic { A t? \lilt �f (QI,` _�Ir components prior to instullalion and setting base elevations TH-1 TH-2 3) All gravity <ptio piping In be 4 inch Sch 40 pVC at 1!S"per foot 'file first 7 D two feet om ar the dbox to the leaching shall be level Thls plan is not to be titilized fur property Iin2 determination nor any r,thcr fir. �ptWi 3 W purposeotlierilian the proposed system instailatirrn. ht(1 u1 5) All septiceomponcnls roust meet Title V speviPcaliona LOCATION MAP( T. 5 o h Eosy/` n( 1 �(� 6) Parking shall not be constructed over Pilo sepiic comp riemx 7 The properly is bounded by property camera and Property lines 3) The properly owner shall review Jc:ign eun;iJeratir�ns to a,jto%ti t l e an{,tat �9 p� 5"J1 design Ilow and number ofbedrooms to be cunsidcrtd for dca'I;n. Receipt rf - 06.. :;.-try-''4'+9: ,�• W pnymem for the plan and Installation based on the plan shell be deemed appros'dl(fill;design now by the owner 1 1 r `s) The existng lunching or cesspools shall be pumped and filled with material `a 1�IA per Title V abandonment procedures Those;,:;thin the f,oposed SAS shall be L l removed along with contaminated soil and replaced with clean washe,l land � �°.ou� WIa` ._ L40 401.11),WlilkL per tale V spcap.. 10)System components to be 10 feat Il'um water line Sewef lines cr(,,irnl;the SEPTIC SYSTEM DESIGN water line sliah be sleeved with 4 inch SCI 140 PVC will!ends!;routed if s �7rJ��i applicable !� 11) Ifa garbage grinder exists it is to be r moved and is+I,,respons;biiity ufthe FLOW ESTIMATE Owner to enznre such. Q7 _ 12)Tho insimicr iq to take caution in excavation around the gas line.it appii(:nble S 138EDROOMS AT. ��OGAL/DAY/BEDROOM •-:'�3- AL/DAY 113)A 5'excaw,zion around the proposed SAS is ieouired to an approtim tc tleprif S of 6fi inches ur Viedium Sand and fill will,clean sand pee'ririe V y SEPTIC TANK spocificalim" �O1 L/DAY x 2 DAYS - 666GAL .USE/SODGALLON SEPTIC TANK / (� SOIL RESORPTION SYSTEM ��- w��---�•i 1 ---- /„ ��, �St1�D �- —->,r 'r°�v�a.� 6 Z Slr�_, t r otJ E�tr ;ci 9 2- ` —r—i �.. L_ J7 Q 1.40 ,� Ual t• 1 t ....i_.__! SiDE AREA: 25,3 X 12,ZS X L7i7 23Z ye BOTTOM AREA: 2 X ,7 = )Z r N. 1_1 --5G.S E P T I C S Y S T -GN �'''W-------- • •---• y V' a 0 0 D 11 t q , I Dt) GAL 5�,. ,J ° 5 7$j SEPTIC TANK r'Z� y.I/i'•�ka4Le. w''+tiNeU a-p:Hrar 25 ��VA D ccOr- r�I a ►AASON SITE AND SEWAGE PLAN Oaf 83D f Ilv IZoR D , �o 06 r1►:�.�fbt,�.15 1L1� I I�— PREPARED FOR: i �j Ii.XLk1VA�i 4(r s �lG 5T M�—+-- SCALE: . DAVID B. MASON �C DATE: 12 o Oil DBC ENVIRONMENYAL DESIGNS DAB TE HEALTH AGENT EAST SANDWICH. MA t508) 833 2177 i ASSESSORS MAP : L' TEST H 0 L E' LOGS PARCEL : la _1111- NOTES: FLOOD ZONE: H 6 l { c _ __. ._...__ SOIL EVALUATOR : WITNESS : _ 1�9MWL6. 1) The installation shall comply with Title V and Town of Barnstable Board of REFERENCE T 12ffL- 2JA�1 top R health Regulations. t7� `-t vx �( PERCOLATION RATE : z Z ) "1►�, 1 � 2 The installer shall verifythe location of utilities sewer inverts and septic �K. �. _. . - components prior to installation and setting base elevations. AV �� l� I 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first TH 1 TH 2 two feet out of the dbox to the leaching shall be level. A 5A4r 'I 4)M" This plan is not to be utilized for property line determination nor any other 1J I 'f � Wll other than the proposed system installation. ' purpose p p y 1� ip �0 5) All septic components must meet Title V specifications. 6) Parking shall not be constructed over H10 septic components. LOCATION MAP l RZ,�j, 7) The property is bounded by property corners and property lines. l G �b S) The property owner shall review design considerations to approve of total C) 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. G1•,► �911� 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean washed sand �ti_ �._.u?` •. t�1o° c�• � 5 per Title V specs. -- --- -- 10)System components to be 10 feet from water line. Sewer lines crossing the 1 " water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if S E P TJ C S,Y S T E M DES I G N applicable. 11) If a garbage grinder exists it is to be removed and is the responsibility of the j� FLOW ESTIMATE owner to ensure such. 12)The installer is to take caution in excavation around the gas line if applicable. �1 �3 BEDROOMS AT IIOGAL/DAY/BEDROOM - 3- AL/DAY 13)A 5' excavation around the proposed SAS is required to an approximate depth of 66 inches or Medium Sand and fill with clean sand per Title V S� SEPTIC TANK specifications. t t `'' ti 77GJCp c5 GA(_/DAY x 2 DAYS - 666GAL USE /S,00GALLON SEPTIC TANKZ_j -- , SOIL ABSORPTION SYSTEMii) 0 7W, Ir -- I W ri L;T�i��4 to/ TtI4& -- ... ,I y ..�. �` "-nf '.... ^.""' .�� ✓'ri is �1G y1 s1, s is 1 _ i SIDE AREA: Z.� 3 X /so �i2car j � -- ti BOTTOM AREA: Z.'y 2-N R Z, _. .Zb- ._.-_. ._ � ,f' Iail r' -r ' A SEPT I C S Y S T JUT r Z� ...._ q Lp 1 L P�Al /0 1 W 4 r�\_ I? - 71 DIP \ �� _ ....�� .." ""..`" - , ,, ✓i1 Y� n kt�1 � d. D-BOX 5l� ,J Q 0 o D 0 v 4 0 `° GAL a o v V a IV, SEPTIC TANK ! -1/2_ 70 D ID B. c MASON m No.1066 SITE AND SEWAGE PLAN LOCATION : 1 �I"��, 9DR PREPARED FOR : o SCALE: DAV 1 D B . MASON DATE: IZD DBC ENVIRONMEN 'AL DESIGNS EAST SANDWICH . MA W DATE HEALTH AGENT 3 ( 508 ) 533- 2177 Z