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HomeMy WebLinkAbout0059 POINT ISABELLA ROAD - Health (2) 59 POINT ISABELLA R.04 -- - A= 073 030 Fj i n TO OF BARNSTABLE LOCATlQ,'q -S�' ` ��n r -5�. Ae—II � SEWAGE # r U ILLACi7' 7r ASSESSOR'S MAP & LOT Parac130 INSTALLER'S NAME&PHONE NO. `eOKSe AATeLAD, /A L.�9- SEPTIC TANK CAPACITY oZJ` LEACHING FACII.TTY: (type) 10 l' *4e) NO.OF BEDROOMS �I BUILDER OR OWNER (� filS PERMITDATE: COMPLIANCE DATE: 1 Ul> Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility A114 Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) AM lhk&eFeet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet f leaching facility) Feet Furnished by O 1 No. 77 ' Feet V0 C) ® THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes P a J_ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 2ppricatiou for Zigozal *pgtem Construction Permit Application for a Permit to Construct Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 5 q) FO t i,t-T b548c l_L.A K.Q Owner's Name,Address and Tel.No. Ate,-33,44 Assessor's Map/Parcel Installer's Name,Address,and Tell.NokfC Designer's Name,Address and Tel.No. -AZE5-L-S 44 G6o� LP O Z TususLG Type of Building: GE Dwelling No.of Bedrooms �R E_5C_&1T" Lot Size �'Db A Garbage Grinder*-'r Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 70 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. r� Description of Soil i d" D°06Ad"1,C_S b"--G" Sa.�a 1_OA k� c v LT-4EL_L � Y>eo 1 16 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 I oCthe Environmental Code and not to place the system in operation until a ertifi- cate of Compliance has been'ssued ,y-thts lth. Signed Date , y `�`� Application Approved by '� K Date Application Disapproved for the following reasons j Permit No. Date Issued N / ' ` 7�1 F Fee �O / t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:LL D"" - �P a,t�' PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE Yes S MASSACHUSETTS 01ppYication for Migpoga1 *p5tem Construction Vermit h . LL Application for a Permit to Construct Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location.Address or Lot No. rj'[3 Fo 1 L-LT 5ABELt.A Owner's Name,Address and Tel.No. q�-33,q G c��v 1 T Flo C El 1�1 Ew To �St �%j%L� S Assessor's Map/Parcel --12,/-4,C) FRALvLnOC��� MA'S S Installer's Name,Address, Tel.NoKE Designer's Name,Address and Tel.No. q 2 16- 33 44 LPO Type of Building: 2 t t�ru2 G Dwelling , No.of Bedrooms �ReNT Lot Size �'O� 'aG Garbage Grinder t�1� Other Type of Building No'of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 770 gallons per day. Calculated daily flow _ gallons. "Plan Date Number of sheets Revision Date Title s S'ize of Septic Tank Type of S.A.S. ,''•-' Description of Soil t ' 0 S O '�G d 1..OA� � ""' Z 1> AkS E '5IAha 2 g rZ„ E(— AOS SAX -1 10�J (io -- k2.8 " Y>2Q "E's (toPd2 �6 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: r' Agreement: The undersigned agrees to ensure the construct ion'and maintenance of the afore described on-site sewage disposal system 1 in accordance with the provisions of Tit of'the Environmental Code and not to place the system iri operation unti/aertifi- Ai,cate of Compliance has bee `ssu lth. Signe Datey0Application Approved by Date l —Z 2 Application Disapproved for the following reasons y Permit No. Date Issued THE COMMONWEALTH OF MASS& SETTS BARNSTABLE, MASSACHUSETTS Zertif irate'of Compliance THIS IS TO CERTIFY,th tt O�'sit +ewa ` Disp s I stem Constructed( � )Repaired( )Upgraded ( ) Abandoned( )by �l r at 5 I of EZJ 0 r c V C-(— has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Per�i_tit No. ' dated / -Z-Z 97 Installer Designer ; The issuance of thi p t al of be construed as a guarantee that the a �wii�111fu ction esi Date Inspector e ------------------------------------------ No. ?/ / ! p Fee , Wo THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS '=i2;po!6a1 *pgtem Cou5tructiori Vermit Permission is hereby granted t Construcl:Y.,, )Repair( )Upgrade( )Abando ( ) System located at 9 O I A_k- ' SA�>_ >� �� r7 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 m st be completed within three years of the date of this p it. Date: ZG�7�Cl� Approved by -�. k r j o*THETo TOWN OF BARNSTABLE ep� 0 OFFICE OF BAB.d9T.UL BOARD OF HEALTH 7 NA6d p �0 1639. \g� 367 MAIN STREET 'ED MAY b- HYANNIS, MASS. 02601 September 30, 1999 Peter Sullivan, P.E. P. 0. Box 659 Osterville, MA 02655 RE: 59 Point Isabella Road, Cotuit A=73-30 Dear Mr. Sullivan: You are granted permission, on behalf of your client C. D. Newton Builders, to construct seven (7) bedrooms at the above referenced property. This approval is valid for one year and will expire on October 1, 2000. It is therefore recommended that you obtain a disposal works construction permit prior to the expiration date of this approval. The permit will be valid for three years from the date of issuance. Sincerely yours, Susan G., Rask R.S. Chairperson Board of Health Town of Barnstable SGR/bcs isabella TO OF B[ARNSTABLE c�q j�q LOCATION I / Din T Sa Oe.Ila— SEW �AGE # i viL.LA � �A+SS'E_SSOR'S MAP & LOT Parcc!30 INSTALLER'S NAME&PHONE NO. C�6tbe 1G1elk, SEPTIC TANK CAPACITY 02, LEACHING FACILITY: (type) IO .Sn�_at� (� a NO.OF BEDROOMS 7 ,r 4 J Al / BUILDER OR OWNER C-' /f- /V2GcJl�/n tiJGG( l'S PERMIT DATE: COMPLIANCE DATE: 1 d-7 v lv 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 f on site or within 200 feet of leaching facility) ��Gc11 / Feet Edge of Wetland and Leaching Facility(If any wetlands exist within.300 feet f leaching facility) T" Feet Furnished by �G �j7G— T - 1 04THE T, TOWN OF BARNSTABLE ?y A # OFFICE OF 9AMMUL : BOARD OF HEALTH MAER p °° 1639. 367 MAIN STREET 'C 0 MOf1Y`' HYANNIS, MASS. 02601 September 30, 1999 Peter Sullivan, P.E. P. O. Box 659 Osterville, MA 02655 RE: 59 Point Isabella Road, Cotuit A=73-30 Dear Mr. Sullivan: You are granted permission, on behalf of your client C. D. Newton Builders, to construct seven (7) bedrooms at the above referenced property. This approval is valid for one year and will expire on October 1, 2000. It is therefore recommended that you obtain a disposal works construction permit prior to the expiration date of this approval. The permit will be valid for three years from the date of issuance. Sincerely yours, Susan G.. Flask, R.S. Chairperson Board of Health Town of Barnstable SGR/bcs isabella r Raa.G�VL® DATE: 1 8 1999 "� FEE: gD►yL- 1-6d�ULq—GD� 1 • '"" u °F ^ own of Barnstable REC. BY A%,' Board of Health 367 Main Street, Hyannis MA 02601 Office: 508.790-6265 � Susan 0.Rask,R.S. FAX: 508-790-6304 C �/- Sumner Kaufman,M.S.P.H. J Ralph A Murphy,M.D. VARIANCE REQUEST FORM LOCATION S✓ (P6(�� 6GA g Ec_c�fk T Property Address: ✓ Y ��`� I Assessor's Map and Parcel Number: �3 / 7� Size of Lot: Wetlands Within 300 Ft. Yes K _ Subdivision Name: No Business Name: APPLICANT CONTACTIERSON Name: C.�A KJ r— TO ►- 4 21)U I L L) C'R S kuC- Name: T — S9 Address: �O 1�J0'C• V fi'��.►^1©C� 1 G ZS4 ( Address:. V-or.,o Phone: g2�- S6 Z8 Phone: AM- al44 FAX: S�� 3'c� FAX: A2&— 31 5 VARIANCE FROM REGULATION(List Reg.) $FASON FOR VARIANCE(May attach if more space needed) Checklist(to be completed by o111ce staff-person receiving variance request application) Four(4)copies of plan submitted(including septic system plans and/or restaurant floor plans) Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variances only) Variance request application fee collected(no fee for lifeguard modification renewal,.grease trap variance renewals[same owner/leasee only],outside dining variance renewals(same owner/leasee only),and variances to repair failed sewage disposal systems(only if no expansion to the building proposed)) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Ralph A.Murphy,M.D. Q:/WP/VARIREQ Sullivan Engineering Inc. 7 Parker Road Box 659 Osterville MA 02655 Peter Sullivan P.E . Mass. Registration No. 29733 508-428-3344 fax 508-428-3115 August 16, 1999 Town of Barnstable Board of Health 367 Main Street Hyannis, MA 02601 RE: 59 Point Isabella Road, Cotuit, MA Dear Board, Please find attached copies of a revised site plan. The project is in the construction phase and presently has 5 (five) bedrooms. The owner would like to plan, for 2 (two) future bedrooms by installing a septic system with a capacity for 7 (seven) bedrooms. I trust this meets your present needs. If you have any questions, please feel free to contact me. Very truly yours, f Peter Sullivan PE Sullivan Engineering Inc. cc: David Newton @ C H Newton Builders Members of American Society of Civil Engineers, Boston Society of Civil Engineers f 9 tF1!Ity,_ �E�IVEO 1� DATE: ` 1 8 1999 FEE: qbc �, " own of Barnstable REC. BY 'OrEn ► 4, A ti Board of Health 367 Main Street,Hyannis MA 02601 Office: 508-790-6265 Susan 0.Rask,R.S. FAX: 508-790-6304 I�4®\/A�0—\nor A C E: \z�Q l'ES'�� Sumner Kaufman,M.S.P.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION S✓ 'P®`"T �GA 6Ec_(—P, lZoAa COTU LT Property Address: Assessor's Map and Parcel Number: �3 /c Size of Lot: Wetlands Within 300 Ft. Yes K Subdivision Name: ' No Business Name: Name: C.JA fJ r:w rD► ">< -- UI I U ER S uC Name: C 'Z�> r-.L- V 9 Address: 7D ,JOB AL. Q� O ZS41 Address: - P,-rz -e Phone: 5 28 Phone: AZT-s344 FAX: J�� Sag ' �Jc FAX: A2?�^ 31 VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) Checklist(to be completed by office staff-person receiving variance request application) Four(4)copies of plan submitted(including septic system plans and/or restaurant floor plans) Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variances only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap Variance renewals[same owner/lessee only],outside dining variance renewals[same owna/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) e Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Ralph A.Murphy,M.D. Q:/WP/VARIREQ Sullivan Engineering Inc. 7 Parker Road Box 659 Osterville MA 02655 Peter Sullivan P.E . Mass. Registration No. 29733 508-428-3344 fax 508-428-3115 August 16, 1999 Town of Barnstable Board of Health 367 Main Street Hyannis, MA 02601 RE: 59 Point Isabella Road, Cotuit, MA Dear Board, Please find attached copies of a revised site plan. The project is in the construction phase and presently has 5 (five) bedrooms. The owner would like to plan, for 2 (two) future bedrooms by installing a septic system with a capacity for 7 (seven) bedrooms. I trust this meets your present needs. If you have any questions, please feel free to contact me. Very truly yours, Peter Sullivan PE Sullivan Engineering Inc. cc: David Newton @ C H Newton Builders Members of American Society of Civil Engineers, Boston Society of Civil Engineers or Cotuit Fire Department pT U,1 Fire, Rescue & Emergency Services G �' / 64 High St. - P.O. Box 1632 1916 '�� Cotuit, MA 02635 --- RE Paul A. Frazier -Phone (508) 428-2210 Chief of Department FAX (508) 428-0202 TO: Tom McKean, Director of Public Health Town of Barnstable, Board of Health P.O. Box 534 Hyannis, MA. 02601 FROM: Chief Frazier, Cotuit Fire Department SUBJECT: Tank Removals, et al DATE: December 23, 1998 The following tanks have been removed/abandoned since my letter dated September 15, 1998. If you should have any questions or need additional information, please feel free to call. Thank you. NAME ADDRESS DATE NOTES Johnson 209 Ralyn Rd. 10/30/98 1000 gal. tank removed, Cotuit, MA. 02635 no contamination or odor present. Moore 33 Putnam Ave. .11/08/98 500 gal. tank removed, Cotuit, MA. 02635 no contamination or odor present. Brown 123 School St. 11/12/98 500 gal. tank removed, Cotuit, MA 02635 no contamination or odor present. Pappalardo 176 Cotuit Bay Dr. 11/24/98 500 gal. tank removed, Cotuit, MA _02635 no contamination or odor present. Mikutwizz 5 1 oint Isabella 12/15/98 1000 gal. tank removed, otuit, MA 02635 - no contamination or odor ©73• ©3O present. G Of B 's�, BARNSTABLE COUNTY DEPARTMENT OF HEALTH AND THE ENVIRONMENT U SUPERIOR COURT HOUSE * POST OFFICE BOX 427 ��. BARNSTABLE,MASSACHUSETTS 02630 Phone:(508)362-2511 Ext.330 ACHUS Public Health Administration 333 Environmental Health 383 Water Quality Analysis 337 UNDERGROUND TANK TEST RESULTS FAX(508)362-4136 TDD(508)362-5885 NAME: FDIC 4 TEST DATE: 9/10/97 ' TANK LOCATION: 59 POINT ISABELLA ROAD, COTUIT MAPIPARCEL: 073 030 TAG #: 818 YEAR INSTALLED: 1980 CAPACITY: 1000 The recent check of the vapor monitoring well(s) near your underground storage tank (UST) did not detect any significant contamination. Because-the use of soil vapor monitoring for UST leak detection is a recent and limited technology we cannot, however, guarantee that your tank has not leaked. You should also realize that a "good" result from our test is no indication of how long the tank will remain sound. Due to fiscal constraints, the Barnstable County Health and Environmental Department has instituted a nominal test fee of$30 for one well and $10 for each additional well at a site. Accordingly, would you please send a check for $ 30 , made payable to BARNSTABLE COUNTY to: Barnstable County Health& Environmental Department Superior Court House,,Route 6A Barnstable, MA 02630 - - Attn. Charlotte Stiefel The following items, if checked, also"apply,to your UST: We encourage the removal of older tanks before the expected leak(s) develop. We encourage removal of tanks under 300 gallons as they were not designed to be underground. Your UST doesn't appear to be registered and tagged as required by your Board of Health. It would be advisable to mark your monitoring well to prevent accidental usage. The soil conditions surrounding your tank are not ideal and may accelerate tank leakage. A copy of this letter has been sent to your Board of Health and the records reflect the results of this tank test. If y u have any questions please contact Charlotte Stiefel at(508)-362-2511 extension 334. ` cc: Board of Health: BARNSTABLE Whereas,the escape of fuel from an underground storage tank may result in civil and/or criminal liability of the owner,lessee,licensee, licensor,and/or other persons in control of the premises; Whereas, the use of vapor monitoring procedures is only one of several procedures that may be used to detect leaking or escaping fuel; Whereas,the reliability and experience of the testing procedure is limited;and Whereas, from location to location and soil to soil test results may vary due to a number of factors; The County of Barnstable and the Barnstable County Department of Health&the Environment represent that while the test results give a fairly accurate reading of the vapor content in the well sites at the place and time of the testing,the soil conditions and condition of the tank and connections may be such that.leaks could occur at the time of testing or shortly thereafter without detection. Similarly,the equipment is sufficiently sensitive as to detect fumes when, in fact, no actual tank or piping leaks have occurred at all. Therefore, no party shall rely exclusively on the results of the vapor monitoring test. Neither the County of Barnstable nor the Barnstable County Department of Health& the Environment shall be liable to any person either for the failure of the test to detect a leak when such a leak has,in fact,occurred or for the detection of readings which may indicate that vapors are present in the soil when,in fact,no leak has occurred. Neither the County nor any department thereof shall be liable for any faulty or overly sensitive readings resulting from the taking of such test. Commonwealth of Massachusetts -,a-)L Executive Office of Environmental Affairs , Department of Environmental Protection William F.Weld Gommor Trudy Coxe ecretary S ,ECEA David B. Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 5 ci �dtKT SS b�\�ct C�� Address of Owner: y't 4 Date of Inspection: - \ (If different) Name of Inspector. Company Name, Address and Telephone Number: 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: i" Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: i Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and.the system owner shall submit the repot to the appropriate regional office of the Department of Environmental Protection. The origina! should oe sent iu :re system owner and copies sent to the buyer, if applicable and the approving au:hont). INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: �I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) 1 One Winter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292-5500 Of Printed on Recycled Paper a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: S Owner: 0S'S G pC-Y�E Date of Inspection: B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board oIf Health): broken pipe(s) are replaced obstruction is removed 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ t he wgem has a septic tanK ana soil absorption System anu is willa1 iw foci iu c �uIla 'vdici Suj�j�i'y Gr trl(iuia �' iJ a surface water supply. _ The system ha, a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tan 1 { and son absorption system and is less than 100 feet but 50 feet or more from a private water _ supply well, unless a well water analysis 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. D] SYSTEM FAILS: J ' I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (zevised 6/15/95) 2 k t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 5 r1 -Pptn.% S Sc.bk`c' Owner: ;1]rl r,5, p pctoC t_ Date of Inspection: D] SYSTEM FAILS (continued): tStatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. d- Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. r' Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 1` Any portion of a cesspool or privy is within a Zone I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flo\+ of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the systern is within 400 feet of a surface drinking water supply the system is v.ithin 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 Zone 11 of a public eater suppiy weli; The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 5c1 �p tN rS LJ���r-� (f10 T v Owner: 1V-S O 0 Gwt,'— Date of Inspection: Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. f/None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. (. As built plans have been obtained and examined. Note if they are not available with N/A. . t ` The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow V/The site was inspected for signs of breakout. Z/AII system components, excluding the Soil Absorption System, have been located on the site. V The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. `/The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. _ ;he if f•'): were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: Y\Nv c, Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: �PQ eallons Number of bedrooms: Number of current residents:Q Garbage grinder (yes or no):—,!L4— Laundry connected to system (yes or no):� Seasonal use (yes or no):—Y— Water meter readings, if available: Last date of occupancy: vyn►�e� j COMMERCIAUINDUSTRIAL: Type of establishment: Design flow: gallons/day 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: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: N0kt.-- (Cec�> � -- System pumped as part of inspection: (yes or no)_ If yes, volume pumped gallons Reason for pumping: TYPE OF TEM 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) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or noyy_ (revised 8/15/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Is aI '�)p t.tit- �\Cw_\� Owner: V/\vS oZ>e r_e L L Date of Inspection: SEPTIC TANK (locate on site plan) if Depth below grade: Material of construction: concrete _metal _FRP—other(explain) Dimensions: /y 5 Sludge depth:_ �Stl Distance from top of sludge to bottom of outlet tee or baffler Scum thickness:_ Distance from top of scum to top of outlet tee or baffle: `� f Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: DictZncc from hottnm ni c tl to hnnnm of oiw.1pt tee o, battle- Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) @ - (revised 8/15/95) 6 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: j Gj C7\►`T I S cC77 v 1 i Owner: OA- S p D-e--C e Date of Inspection* _�J TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: Material of construction: _concrete_metal _FRP —other(explain) Dimensions: Capacity: gallons Design flo%+•: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:v (locate on site plan" Depth of liquid level above outlet invert: �— SOv0 Comments: mote rf ievei and distruut-:,,: > ryua:, e,;ci�ncr of so„U., cano,er, evidence of leakage into or out of box, etc.) PUMP CHAM BER: (locate on site plan) Pumps in working order.(yes or no) Co mments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: S`i 3�10, Owner: K\u 5 0 pr r. c-e Date of Inspection:, SOIL ABSORPTION SYSTEM (SAS):\� (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) CESSPOOLS: (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 ground�%ate1. inflow,(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 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.) (revised 8/15/95) B SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: 1 _ f -Cs- SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 33` 13` G 4Sw Si 61 7(TS DEPTH TO GROUNDWATER Depth to groundwater: feet A�\n-" y �� method of determination or approximation: (revised 8/15/95) 9 TOWN OF BA`RNSTABnnL__..E LOCATION S (''6l t " /`0:qEWAGE # 7 2.2 VILLAGE lil 4 ASSESSOR'S MAP & LOT 093" U3o INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1000 LEACHING FACILITY: (type) Q x (size) NO.OF BEDROOMS � BUILDER OR O R ) PERMITDATE: f/ a3' 7� COMPLIANCE DATE: T 3' 72 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 . l . .. a � Y N/f Aferidith•:PVrsaes 2e 46V t _ — _ Q O c �F 9 354.53' _ ^.�— _ O o � ` �• oal , � o 10, eorave j �i v ®a cn r �007• R n TN capT1G __I VOWK u �. is r:-1�� o V �� �� - • p_pox s O 9 _ The Proposed foundation shown hereon complies — with the sideline set back requirements for the Town LOCUS PLAN a !of Barnstable and is not located within the 100 year J `��-- ., o� fro 'floodplain. Scale I'�= 2000' s. � _ 91 o/f franc _ ... _ Zoning RF DESIGN DATA Setbacks , Front:30 Single Family-7 BedroomDesign(5Exist.,2 Future) ::' a;�s PLAN VIEW I With -Garbage Grinder. . Side 15, ` Doily Flow=110 x7=770 GPO , Rear: 15 Scale� I =40 Septic Tank:770 GPDx 200%m1540 Assessors Map 73 Use 2500 Gallon Septic Tank Parcel 30 NOTES ._ LEACHING AREA Lot Area- 1.06 Ac+ i 1 Water Supply ForThis Lot is Municipal Water 770 GPD/0.74=1041 S=+50%=1562 SF Required SidewalI=2(12+96)2 432 S.F- 2 Location of Utilities Shown on This Plan Are Appro3L Bottom Area=12'x9d = 1152 SF. At Least 72 Hours Prior to Any Excavation ForThis 1584 S.F.Total Provided _ -- Project The Contractor Shall Make The Required, LEACHING CHAMBER DESIGN Finch Graft Project to Dig Safe(1-800-322-4844) r All Pipes to be Schedule 40.Use 3 The Contractor is Required to Secure Appropriate lo-500 Gal.Leaching Chambers in 2- io FFilter abric Compacted FlII Permits From Town Agencies For Construction 12�x 48*Washed Stone Fields as Shown. Defined byThis Plan. V9=1/2' 4 Install Risers as Required to Within leof,, . Pea stone Finished Grade. All Structures Buried Four Feet or More or Subject' Leaehtnq to Vehicular Traffic to be H-20 Loading. a � Chamber 3/4 —11/2 7 'T.N EL. 30,5 .,.; P�� Ch R N D,,,,Wew„r�t 4 Septic 3ysleifi lutir;lnslulledInAccordance With ,�1` — SULLIVAN vr�' Stone 310 CMR 15.00 Latest Revision And The Town of O oRGANEMATgERs+%L ca NO.29733 a 4'to 1 Barnstable Board of Health Regulations Ji CIVIL -o I 7. All Piping 10 be Sch.40 PVC. E SANDY 1 H.Septic.Tank Shall bea2500Gal.,2Compartments. b+ t-DAM CROSS SECTION OF CHAMBER The First Compartment Shall Have a Volume of Not Y1ZL ,C3RN COARSE ®N 1 Less Than 1540 Gal.And The Second of Not Less j3� SAND 1OYa 5/G NOT To SCALE Than 770 Gal. DRN. ytaL• COARSE 87- SAND 10 YR L L FG.32.0 F.G.30.7 yq LT. Y M L• C3 S2 N •, 1i (_ COARSE SANp \oYRti/y 30.0 27.0 , � 29.7 29.5 Top E1.28.0 DATE�HS%25�4q•.���'. � SITE SEPTICN 27.4 27.2 Bat.El.25.0 PROPOSEAT SYSTEM " Bedding as 5' 59 POINT ISABELLA ROAD Per Title S i* COTU IT, MASS ' 2500 Gallon,2 Compartment 12� - Septic Tank FOR 1 Bottom of Test Hole El.20.0 C.H. NEWTON BUILDERS INC . f No Ground Water Encountered DATE: MAY 19 DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM 1NCREAs6v BR's.t=Boon sTo-i SCAL SULL VAN: ASWENGINEERING INCH 1999 Not to Scale REvtS10N 6�/6�44 b ADO GARBAr-E OSTERVILLE, MASS. 9901 y 8 354 53' "i { • O att �o ve 441ye � r— 11 D0. 1 ,p07i RIsiRV t - tl N O ,:. „� 9 _ _ - .. _ .. n. \`e: ..�-..—..�..,.,,..._.,_-,-.-•^'"_''"•-- _ ° �,` - i� K C fp ^► i goG-`-� d Zt o•''x _ O - �� Pt=�MwR j The Proposed foundation shown hereon complies - with the sideline set back requirements for the Town LOCUS PLAN_ _ of Barnstable and is not located within the 100 Year % N , -tom _ ,on -floodplain.� Scnin 1RF2000� 1` !s o Rave 1 , �/.�. seT'i •N/f fe„�.� ! _ Zoning ' ,b g -�1-� rs.,•s -` _-_ - OESIGN bATA Setbacks , v. Front:30, _ ..1 ✓ Single family-7 Bedroom Design(5Exist.,2 Future) Side 15 N E With _ Gorbo Grinder '' Rear 15' PLAN VIEW Daily Flow=llox?=770Gpo Scale:1"=40' SepticTonk=770 GPOx 200%=1540 Assessors Map 73 . ,3"4 , Use GollonSepticTank Parce130 LEACHING AREA E Lot Area 1.06 Ac± J ,NQTES- 770 GPD/0.74 i =1041 SF+50%=1562 SF Required L Water Supply Lot is Municipal Water Sldewa =2(12t 96.�2=432 S.F 1 II 2 Location of Utilities Shown on This Plan Are Approx. s Bottom Area=12'x9e = 1152 SF a At Least 72 Hours Prior to Any Excavation ForWm € 1584 SF.Total Provided x ----- --- - g All Pipes to be Schedule O®UseGN Project The Contractor Shall Make The Required t Finish Grade Notification to Dig Safe(1-800-322-4844j ' S The Contractor is Required to Ser-u Appropriate 10-500 Gal.Leaching Chambers in 2- Futer Permits From Town Agencies For Constructloe ! 12'x 48'washed Stone Fields as Shown. io Fabrk Compacted FIII Defined byThis Plan - '� 1/e_ye 4 Install Risers as Required to Within 12~of _ ,lei OF Poe stone finished Grade. PET E R� + 3.All Structures Binned Four Feet or More or Subject a ! SULLIVAN Leaching ao Vehicular Traffic to H`20 Loading. T,WL, 3o.s I sip -t v: 1 ,, � NO.29733 a Chamber Double W-a 14 IL Septic System to be Installed in Accordance With 1 Piws NEEDLES/ a ` CIVIL Stone 310 CMR 15.00 latest Revision And The Town of .. �ISTh�rC 0 ORGAN. MATERA\L .� Q, �. 4-lo I I Barnstable Board of Health Regulations 61 It2-o' T All Piping to be Sch.40 PVC. SANDY S.Septic Tank Shall be a 2500 Gal.,2 Compartments. 91 E t-OAM V CROSS SECTION OF CHAMBER The First Compartment Shall HaveoWlume of Not YeL.13RIv. COAPS NOT TO SCALE j Less Than 1540 Gal.And The Second of Not Less g, SAND 1 OYR 5/4, f — j Than 770 Gal. DRN• yEl... COARSE FG.32.0 f.G.30.7 i19 82 SAND 10 VR G/L L.T. YeL. t3RN COARSE SAND \oYR b/J/ SITE PLAN + ao.0 7. 297 -295 TopEl.28.0 bATE,N %Zs%q9��•z• PROPOSED SEPTIC SYSTEM 27.4 27.2 Bat.E 1.25.0 AT j 59 POINT ISABELLA ROAD Per ing b 5 COTU IT, MASS 2500 Gallon,2 Comportment FOR. Septic Tank Bottom of Test Hole El.20.6 C.H. NEWTON BUILDERS INC . gq No Ground Water Encountered If SCALE: AS SHOWN DATE: MAY 19, ' 999 1 DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM 1NcREASC-V sR'S.t--ROM -TC3 r SULLIVAN ENGINEERING INC REv.nS1oN 8�r6�44 b ADO GARBAGE [rR1NP6Ci OSTERVILLE, MASS. Not to—scale 990194 AV/F MeredllA W.AWSO u j � o o ® A o n 29 469!! 7 40 Ig ate tJ Rcscnvc 1 t)a n � t TH ScvTtc M pt). tit 00 �u _ - N Z r , D-goK. za- O C9 7. : ,� Jb r a �� j PR�MAR • . ..-_ The Proposed foundation shown hereon complies �_ _� with the sideline set back requirements for the,Town LOCUS PLAN % of Barnstable and is not located within the 100 year , ' , floodplain. Scale: 1 = 2000 Fr@Oc P' _ Zoning R F ` Setbacks Co 1--'`•1 -� � _.... .. DESIGN DATA' �_ - , O �e .:9 , Front:30, Single Family Bedroom Design(45Exis4:.,2Future)r ' Side 15 _ PLAN VIEW With -Garbage Grinder ,� = 7= 7 Rear: 15 � Scale: 1 =40 � Flow 110 x . 7 O GPD M SepticTank-7TO GPD x 200%=1540 , _. . ., / - Use2500 Gallon Septic Tank. Assessors Map 73 i 06 Aarcel 30 LEACHING AREA t ` Lot Area: c+_ NOTES Ar 1. _ L 770 GPD/0.74 1041 SF+50%=1562 SF Required Water Su i pply ForThis Lot Is Municipal Wato► Sidewall=2(12't 96.)2=432 S.F. # 2 Location of Utilities Shown on This Plan Are Apprm - 8ottomArea=12'x96'.:= 1152 S.F.': 4 At Least 72 Hours Prior to Any Excavation ForrThis 1584 S.F.Total Provided Finish Grade Probed q The Contractor Shall Make The Required LEACHING CHAMBER DESIGN ` ri Notification to Dig Safe(1-8001-322-4844)- At4 Pipes to be Schedule 40.Use 3.The Contractor is Required to Secure Appropriate 10�-5Q0 Gal.Leaching Chambers in 2- a Filter Compacted Flli Permits From Town Agencies For Construction r 12 x 4e: washed Stone Fields as Shown.. R„ Defined byThis Plan 'm k: �4 % Install Risers as Requiredto Within 12pof,. Pea Stone. Finished Grade. w 9.All Structures Buried FourFeetorMoreorSubject� :t . Leaching _ 3/4"-1 I/a" ' to Vehicular Traffic to be H-20 Loading. ,H EL. 3o,S Chamber , n e'0F � ^ a ooubie washed 1 6 Septic System to be Installed Accordance With 1 �kF -„�.�• + Stone t 310 CMR 15.00 Latest Revision And The Townot Pins tvEEDLMS/ ` ORGAN. MATECZA\L" n^+��v 4-o" 1 I ' Barnstable Board of Health Regulations Oi otm+9 o e� 'ye r 7. All Piping to be Sch.40 PVC. SA DY 9 N MBER f 8_Septic.Tank Shall be o2500 Gal.,2Compartmenis , ti E 1-oAMU. � C"M CROSS SECTION OF CHA TheFiisl Compartment SMII Haveo*lumeof Not ;- yrL,t3Rty; cosRs>= '-:NOT TO SCALE _- Less Than 1540 Gal.And The Second of Not Less Than 770 Gal: gi SAND IOYR 5/G I DR C •N. '1�G(- AR . O SC 9 FG.32.0 F.G.30.7 r fi B2 SAND 10 YR Gle. �� _ I OTC COARSE SANID1oYR6/y ` 30.0 27. SITE PLAN 29.7 Too E1.28.0 "�6sT lao\-E gv 5.C,�,, . 29.5 pATE` S-/25/49 27A 27r Sot.E1.25.0 PROPOSED SEPTIC SYSTEM AT Bedding as 5' 59 POINT ISABELLA ROAD Per.Title 5 2500 Gallon,2 Compartment 12' -' y' COTU IT, MASS Septic Tank k. FOR I - , { , I ' Bottom of Test Hole El 20 O I C H NEWTON BUILDERS INC r No Ground Water Encountered - ` DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM. SCALE: As SHOWN SATE MAY 19; I9s9 NCREASED 13R� FROM .SSULLIVAN {� 1:1s. To-i � ' SU LIVAN ENGINEERING INC., N04toScal@ REVISION. ®�t6�44 b ADD G'ARBA�E CrR1NP6Fi t OSTERVILLE,MASS. r 9 9. y a .._.v.. +_». ..w-.:-- --.,- s.t,: ,:v.v- a ... k,...zr... ..,+ -an...�,.,,.uX.r,':...H.e-..ryw,.--...�...w.w �....w,++4+.::.... ---•.+»+-;..x...- .-.f-..e.+w,.--«s.:,.,-�4yy..,, �-w,.-^'"+r'^'v ^x*:Re+ -:"-+TTi T � • 1 ♦ � � m 4 � , ' ... � �� i NN �V V r , T �� , t � �� , 1 .� /� ��� �� ��� 1 t �� ��� �� � ,. - � � ��. ���y _.. _ a a . - 9{{1 .. .. .J