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0276 BUMPS RIVER ROAD - Health
276 Burlps lR1ver Ro;ac� *.rt� �Ostervillef A= 120=0 3s Commonwealth of Massachusetts Title 5 Official Inspection Form k, - Subsurface Sewage Disposal System Form Not for Voluntary Assessments < r 276 Bumps River Road Property Address Ross and Andrea Balboni Owner Owner's Name information is ✓ MA 02655 April 13, 2016 i page. City/Town required for every Osterville State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Renso Hidalgo use the return Name of Inspector key. PKM CONTRACTORS Company Name 313 Hokum Rock Road Company Address 41 East Dennis MA Zip Code City/Town State Zip Co 508-385-5993 13812 Telephone Number License Number B. Certification 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 ❑ Fails Ys Furth Ev uati n by the Local Approving Authority 13ibInspectors Signature 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 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. ****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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 official Inspection Formsments Subsurface Sewage Disposal System Form Not for Voluntary 276 Bumps River Road Property Address Ross and Andrea Balboni Owner Owners Name MA 02655 April 13,2016 information is Osterville Date of Inspection required for every State Zip Code _ page CitylTown B. Certification (cont.) 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 Anytha any failure ch tenaure notcriteria evaluated are in 310 CMR 15.303 or in 310 CMR 15.304 e Y indicated below. Comments: I i 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, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)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. ❑ Y ❑ N ❑ ND (Explain below): Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 2 of 17 t5ins-3113 r Commonwealth of Massachusetts F Title 5 Official Inspection Form I` Subsurface Sewage Disposal System Form Not for Voluntary Assessments 276 Bumps River Road Property Address Ross and Andrea Balboni Owner Owner's Name information is Osterville MA 02655 April 13, 2016 required for every State Zip Code Date of Inspection page. Cityffown B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ 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 ❑ Y ❑ N ' ❑ :ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ :ND(Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑: ND (Explain below): ;S- 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 public 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 vegetatedwetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ,M 276 Bumps River Road Property Address Ross and Andrea Balboni Owner Owners Name information is Osterville MA 02655 April 13, 2016 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ 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 of a 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 fecal coliform bacteria indicates absent 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: 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 system component due to overloaded.or. clogged SAS or cesspool El ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El El or 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 El ❑ 1 than /2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a 276 Bumps River Road. Property Address Ross and Andrea Balboni Owner Owner's Name information is Osterville MA 02655 April 13, 2016 required for every State Zip Code Date of Inspection. page City/Town B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ )a 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. ❑ /a Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ .)�o 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ The system fails. I 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 Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. 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 Elthe system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes to any question in Section E the system is considered a significant threat, or answered yes" in Section D above the large system has failed.The owner or operator of any large system considered a 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. t5ins-M3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 276 Bumps River Road Property Address Ross and Andrea Balboni Owner Owner's Name information is Osterville MA 02655 April 13 2016 required for every state Zip Code Date of Inspection page Cityrrown C. Checklist Check if the following have been done. You must indicate"yes"or"non 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 ❑ (M this inspection? El Were as built plans of the system obtained and examined? (If they were not available note as N/A) t }tom ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? ❑ Were all system components, excluding the SAS, located on site? ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ' ❑ 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: ❑ Existing information. For example, a plan at the Board of Health. El approximation 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(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): rt DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): — t P t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form " Subsurface Sewage Disposal System Form--Not for Voluntary Assessments r u 276 Bumps River Road Property Address Ross and Andrea Balboni Owner Owner's Name information is Osterville MA 02655 April 13, 2016 required for every State Zip Code Date of Inspection page. City/Town D. System Information Description: f s Number of current residents: ; Does residence have a garbage grinder? El Yes No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Ye4ulNo information in this report.) Laundry system inspected? ❑ Yes.,,) es No Seasonal use? ❑ Yeses No Water meter readings, if available(last 2 years usage(gpd)): Detail Sump pump? ❑ Ye No Last date of occupancy: Date I Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? E1 ,Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 ®fficial Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments H 276 Bumps River Road Property Address Ross and Andrea Balboni Owner Owner's Name information is Osterville MA 02655 April 13 2016 page. C required for every ity/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes)o No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Altemative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 276 Bumps River Road Property Address Ross and Andrea Balboni Owner Owner's Name information is Cisterville MA 02655 April 13 2016 required for every State Zip Code Date of Inspection page. Cityfrown D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): i III Depth below grade: feet Material of construction: ❑ cast iron ;940 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: concrete ❑ metal ❑fiberglass Elpolyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage!Disposal System Form Not for Voluntary Assessments 276 Bumps River Road Property Address Ross and Andrea Balboni Owner Owner's Name information is Osterville MA 02655 April 13, 2016 required for every page Cityrro M State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from to of sludge to bottom of outlet tee or baffle �~ p �y. Scum thickness a Distance from top of scum to top of outlet tee or baffle w Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap(locate on site plan): Depth below grade: feet 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: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form - t for Voluntary As Form No Subsurface Sewage Disposal System rY 276 Bumps River Road Property Address Ross and Andrea Balboni Owner Owner's Name information is Osterville MA 02655 April 13 2016 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No. Alarm level.' Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): I co attached? Yes ❑ No Attach copy of current pumping contract(required). s copy ❑ t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form +� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 276 Bumps River Road Property Address Ross and Andrea Balboni Owner Owner's Name information is Osterville MA 02655 April 13, 2016 required for every page. Cilrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I Commonwealth of Massachusetts t Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 276 Bumps River Road Property Address Ross and Andrea Balboni Owner Owner's Name information is Osterville MA 02655 April 13, 2016 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Jy\ J� S Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 276 Bumps River Road Property Address Ross and Andrea Balboni Owner Owner's Name information is Osterville MA 02655 April 13 2016 required for every page. CTown State Zip Code Date of Inspection ityl D. System Information (cont.) 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.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Q- I 276 Bumps River Road Property Address Ross and Andrea Balboni Owner Owner's Name information is Osterville MA 02655 April 13, 2016 required for every pane. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately /trtir -.J s t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ar ' a. 276 Bumps River Road Property Address Ross and Andrea Balboni Owner Owner's Name information is Osterville MA 02655 Aril 13 2016 required for every P , page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevati n: Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ 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 high ground water elevation: I� Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 f Commonwealth of.Massachusetts Title 5 Official Inspection Form '1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 276 Bumps River Road Property Address Ross and Andrea Balboni Owner Owner's Name information is Osterville re sired for every MA 02655 April 13, 2016 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Inspection Summary:A, B, C, D, or E checked Inspection Summary D.(System Failure Criteria Applicable to All Systems)completed System Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i f t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal Systen•Page 17 of 17 t I I UNITED STATES POSTAL SERVICE. First-Class Mail `Posta LISPSge r Fees;Paidt, Permit No.G-10 • Sender:Please print yourname,address,and ZIP+4.in this box' N I I�r!if?Iilifl.:ftf?if?tfl�F�?f�f�iffliii!fi�i(Ilf!ilii?f?!?!?�� SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A ture Item 4 if Restricted Delivery is desired., ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you, eceiv by(Pri d N e) Date of Delivery e Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address di ferent from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No C►�c- CoG� �-(,a� � ^� I ' ► _1 b 4, y`q 3. Service Type Rcertified Mail ❑Express Mail t ��q 1 IM,1f� OZ.�oS�' ❑Registered Ek Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes I 2. Article Number (Dansfer fiom.seMce babel) 7 0 0 61 0810 ' 0 0 0' 3524 791 5 PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1e40 i r Certified Mail#7006 0810 0000 3524 7915 Town of Barnstable e ' Regulatory Services A 3AIiNSTA6LE, • /� 6 9 g Thomas F. Geiler, Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January 9, 2007 Cape Cod Academy o c/o Margot Bordman P.O. Box 469 Osterville, MA 02655 — NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 276 Bumps River Road was inspected on January 2, 2007 by Timothy O'Connell, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violation(s) of the State Sanitary Code were observed: 105 CMR 410.351 —Owner's Installation and Maintenance Responsibilities— Observed GFCI outlet in master bedroom.bathroom not working. The following violation(s) of the Town of Barnstable Code were observed: §170-7 — Posting of Owner's Information — Owner\Property Manager's name, address and telephone number were not posted inside the dwelling.* You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by fixing or replacing outlet in master bedroom bathroom. QAOrder letters\Housing violations\Rental ordinance\276 Bumps River Road.doc *Note: Once all the other violations have been corrected, you will be issued a certificate of registration for the rental property. The certificate of registration will have all the necessary information to satisfy the requirements of § 170-7 of the Town of Barnstable Code. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. aER OF T E BOARD OF HEALTH . cKean, R.S., CHO Director of Public Health Town of Barnstable Cc: John Gastol, Tenant Cc: Timothy O'Connell; Health Inspector +a QAOrder letters\Housing violationARental ordinance\276 Bumps River Road.doc Certified Mail#0000 0000 0000 0000 0000 ra Town of Barnstable Regulatory Services MASS.� � " Thomas F. Geiler, Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 p date Po e H 1 add e city,state,2i 01 G 5.5 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY o CODE II —MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 17(o ` was inspected (Address) on /-2/ �- by f G , Health Inspector for the Town (date) Inspector's name) of Barnstable, , (Reason for inspection) , The following violation(s) of the State Sanitary Code were observed: State code violation number-violation descri tion 105 CMR 410. 3 51 - - C _-L ,Q,�;� 105 CMR 410. 105 CMR 410. 105 CMR 410. Q:\Order letters\Housing violations\Rental ordinance\template.doc 105 CMR 410. . The following violation(s) of the Town of Barnstable Code were observed : Town code violation number-violation description §170--2- - — -1 c~ §170-_- You are directed to correct the violations listed above within 3 C) ( ) days (written#� (#) �. ,r of your receipt of this notice by [A� 0 -= 170 You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: (Name,tenant,owner,Fire Dept.,Building Dept....) Cc: j 0 (Health inspector's name) (Generic codes located at QAOrder letters\Housing violations\Rental Ordinance\GENERIC CODES.DOC) QAOrder letters\Housing violations\Rental ordinance\template.doc 1 FORM 30 ��w HORBS g WARREN nn THE COMMONWEALTH OF MASSACHUSETTS ;a;;•ys».+c,'•, BOARD CLF HEALTH � CITY/TOW o �V � DEPARTMENT mac°M eye — 'ADDRESS c� ao- > "i 6`'r q - s 0,g �! TELEPHONED i Address 2 Z !`^"'"�-' ' -!� ,_Occupant Floor tv A Apartment No._ _ No. of Occupants__6 No. of Habitable Rooms No.Sleeping Rooms—.3_ No.dwelling or rooming units_Af_A--___No Stor es.-- ---2_ p® �� l Name and address of owner , �,�( _ _ _ S Remarks Reg. Vio. YARD Out Bld > bs.: Fences: 0165 Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen. Sanitation: Dam ness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents.- PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line.- H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Lj f0> 5, Bathroom 9 i Pantry Den Living Room Bedroom 1 Bedroom 2 FtVj 5 Bedroom 3 At Bedroom 4 - Hot Water Facil. Sup. en.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZ s ED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS NE ANP CERTIFIED UNDE THE PAINS AND PENALTIES OF PERJURY." INSPECTOR 1^/ 'TITLE— DATE ` — ©� TIME [ ` P.M. A.M. THE NEXT SCHEDULED REINSPECTION Y P.M. 7 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shali be deemed conditions which may endanger or impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0) shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. Parcel Detail Page 1 of 3 ft " ' t MASS, Logged in As: Parcel Detail Tuesday,Octob. Parcel Lookup Parcel Info 1 € - Parcel ID 120-023 1 Developer Lot I Location I BUMPS RIVER ROAD I Pri Frontage 175 Sec Road . FrontaSec ge Village OSTERVILLE I Fire District C O-MM Sewer Acct _ I Road Index 0194 y- Interactive J Map Owner Info Owner CAPE COD ACADEMY, INC Co-owner j Streets PO BOX 469 I Street2 city OSTERVILLE I state(MA zip i02655 country US !� Land Info Acres 10.20 use fPRI SCHOOL MDLA zoning SRC Nghbd 10105 Topography Level I Road [Paved Utilities 1 Public Water,Gas,Septic I Location L7 Construction Info Building 1 of 1 Year("'_".-___•.---.._..._..-__ - Roof rGable/Hip— Ext _,...___..._ Built 11986 I struct! Wall Wood Shingle I Effect i.___...�. �_...�.u. Roof's-.__ . �_ -__.. AC ...�..__..�_.._.____ ....__ Area i2029 I cover IAsph/F GIs/Cmp I Type None Style;Cape Cod Int E D wall Bed 13 Bedrooms Wall ry I Rooms I Model!Residential Rooms I Floor Carpet Bath 12 Full+ 1 H __r---•--------- Heat;_.__--------_ Total f Grade Average Grade I Type€Hot Water I Rooms€6 Rooms I http://issgl/intranet/propdata/ParcelDetail.aspx?ID=7297 10/31/2006 i v - Parcel Detail Page 2 of 3 Y . �,�: a: Heat Found- .... �_ _ _ stories 1 1/2 Stories Fuel!OBI ation!Poured Conc. �._......_ _...._....._.___-_.._.___._. -__._..... ....._.._...- _____..___.- ................ ...._-___-_ .......... ........................... ______ __..................... . ._....._- ..- Permit History Issue Date Purpose Permit# Amount Insp Date Comm 10/1/1986 B30056 $60,000 1/15/1987 12:00:00 AM OS 11/ 9/1/1986 B29875 $0 1/15/1987 12:00:00 AM OS DV1 ............................- - - Visit History Date Who Purpose 11/6/1998 12:00:00 AM Donna Dacey Meas/Listed 5/15/1987 12:00:00 AM Andrew Machado Sales History Line Sale Date Owner Book/Page Sale P 1 . 2/6/2003 CAPE COD ACADEMY, INC 16359/025 2 7/15/1987 SWIFT, RITA L 5832/285 3 7/15/1986 MCKEON, JOHN C& 5214/230 4 PELLS, SHIRLEY E&BARBARA A 972/164 .._............. _... ......_. ..........._.._._ ------ - - - . . ................---_ ..... ......................................----- Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parce 1 2006 $179,500 $2,700 $0 $141,900 2 2005 $166,200 $2,700 $0 $126,200 3 2004 $142,000 $2,700 $0 $157,800 4 2003 $118,700 $2,700 $0 $50,800 5 2002 $118,700 $2,700 $0 $50,800 6 2001 $118,700 $2,900 $0 $50,800 7 2000 $94;000 $2,900 $0 $30,000 8 1999 $92,900 $2,800 $0 $30,000 9 1998 $95,000 $2,800 $0 $30,000 10 1997 $97,300 $0 $0 $30,000 11 1996 $97,300 $0 $0 $30,000 12 1995 $97,300 $0 $0 $30,000 http://issql/intranet/propdata/PareelDetail.aspx?ID=7297 4 10/31/2006 �7 TOWN OF BARNSTABLE UkATION Uvr.aI di`mod SEWAGE # 200 3- 005 .VILLAGE 0&t�,fyllt ASSESSOR'S MAP &LOT I AO-d,�3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ;rii�� IOOv d�/r`��LLn LEACHING FACILITY: (type) ti �CI�H�^fi!'rJ (size) -2 a".2 NO.OF BEDROOMS 3 BUILDER OR OWNER sw,- PERMTTDATE: Q COMPLIANCE DATE: 6 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 < » > . ........ fece. . .d :....... ..... Permit No.61003—cos Date 1. � L C Owner +LAe L cam? Address o'90 4.3i 4 i 4 R& Engineer z �Gn �,► c Installer Inspected by Date UPGRADES/ALTERATIONS ��� � � �� �� � � �e p� �-�� (3�% 4 � � � � ���� a ���d� �p���; �. f�rwr ,,� I ' f r 2 e No. 3- oc)-s r Fee �— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Migpool *pgtem Conotruction Permit Application for a Permit to o struct( )Repair(grade( )Abandon( ) ❑Complete System 8�dividual Components b Location Address or Lot No. 25P (I�i,iPS � Q.. �S f Owner's Name,Address and Tel.No. i r Assessor's Map/Parcel 1 zo O 71 Installer's NaAddress,and Tel.No. Designer's Name,Address and Tel.No. S Type of Building: Dwelling No.of Bedrooms -3 Lot Size �� 3 75 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 gallons per day. Calculated daily flow 3 S3 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. —tea 9 4Akw ke,,J Description of Soil f�a Nature of Repairs or Alterations(Answer when applicable) (e./J(au 9'6 k �ecr_(, a l"4 w/ kz,l _7*(e �{- /o D- Joy , Z -.S'o® ti ��a �-► �,-1 e�/ ' S>`o ti a rvv n c1, 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 iss_u by this Board o Health. Signed .�Z Date Application Approved by Date / 6 40 Application Disapproved for the following reasons Permit No. '2-W 3 -005- Date Issued 11t, D No. I-CC)5 0015 Fee SOU, THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 411-/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS-- — application for Migogal *p!temc Construction Permit Application for a Permit tV o structt )Repair(�ade( )Abandon( ) ❑Complete System 9151vidual Components r Location Address or Lot No. �.L�v �S �6'� �S ;Owner's Name,Address and Tel.No. Assessor's Map/Pazcel_. � ZD 0Z3 - M Installer's Name Address,and Tel.No. Designer's Name,Address and Tel.No. h S G( (,K rGce9f f� �f1� S-0 r-9 2.7-3 r(, Z-- Type of Building: / I Dwelling No.of Bedrooms Lot Size 1, 3 7 57� sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 O gallons per day. Calculated daily flow 3 s3 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank t�_- Type of S.A.S. Description of Soil 4 1A-" a ' Nature of Repairs or Alterations(Answer when,applicable) r t.,D 4-u 4 rIt jS-/kte 1t' /0 D- dox , Z --"DO C-Ii, qll A /oyn�r 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 issueji by this BoarLot Health. Signed ^ ,�(., Date ,Application Approved by Date 116 d3 'Application Disapproved for the following reasons E Permit No. 12-cr)3 —OoS- Date Issued y I111/01 THE COMMONWEALTH OF MASSACHUSETTS j ZV/O Z3 BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( Upgraded( ) j Abandoned( )by ' at 2 /3v 1 0 S 7hiry has been constructs m cccrdance with the provisions of title 5 and the for Disposal System Construction Permit No. �3 -COS- dated //6 MR I Installer Designer t The issuance df this permit shall not be construed as a guarantee that the system will function as designed. Date 01166104 Inspector fin. •�_ ��- ----------------------------------------- No. 2-co 3` OD 5— Fee THE COMMONWEALTH OF MASSACHUSETTS ZC� 0 Z) PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mitpooar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( Upgrade )Abandon( ) System located at Z- F0 /F� 1 9�, L� 0.SA-e v1/`. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Cons ction must be completed within three years of the date of this p Date: to 0 3 Approved by TOWN OF BARNSTABLE _ t LOCATCN ✓wtlJf f��v�- SEWAGE # '20L)3— 0or VILLAGE S � �I� ASSESSOR'S MAP & LOT AO-0,43 INSTALLER'S NAME&PHONE NO. T _rAg la r 2/yo ' 6 7o 2. SEPTIC-TANK.CAPACITY �x It7n� I6 Uv��,lI�`✓� LEACHING FACILITY: (type) ��� A ti �C hM/�rf (size) .? a".2 NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: B COMPLIANCE DATE: 6 d 3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private W4w&S=Iy 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 ? All oL-G t>L0 uQ C: fir w T r SWIM - Notice: This-Formals To Be Used.For_the Repair Of Failed Septic Systems Only _PERCOLATION:TEST AND SOIL EVALUATION EXEMPTION FORM I,: 6 nv hereby.cerlafyThattfie-engineered plan-signedby;Me, dated I. S C 3 ._�concerning the- property located at Z_p v_!J.i —W, meets all of-lbe- following-criteria_- • This.failed-system-s connected to a residsntial-dweiling only. There-mao commercial-or - -business uses associated with.the.dwelling.. • The-sod:is-classified.as:CLASS.I.and:the.percalation-rate-is less than orequal to 5 minutes per:inch'._The.applicanf may use historical.data to conclude.this-fact-or may conduct- - preliminary tests at the site without a health agent present. • There-is no increase inflow-and/or-change-in-use-proposed • There are no-variances requested or needed. • The bottom of the proposed-leaching-facility-will-.be-.located no-less than five feet_above the -maximum adjusted groundwater table elevation. [Adjust the gcmmdwater table using-the. Frimptor method when applicable] Please complete the following: A) Top of Ground,Surface.Blevation.(using MS information) �6 1 B)-G W._Elevation +adjustment for high G W-. 3 4 — /g DTFTER NCE-BETWEEKAand:B -SIGNET}• DATE: " NOUCK Based=upon-the-above Wormation a repair permit will be.issued for 3 bedrooms maximum. No additional bedrooms are authorized in-the fature°without engineered-septic system plans._ q:hW&folder.percdanp No. ..:_ � Fxs..�.�..,..J.?a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN .....OF..................... ARSTABLE . ............. pApplir� tian for Disposal Works Toustrnrtinn Vrrmit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at:g TU Bumps._River Road, Osterville .... ......................................... -•....---•••-------•-----••••--•-••------•--•---------•••---......-----•-••--•------..........---- Location-Address or t No. John C. Mc Keon P. 0. Box 545 Cen erville ................-...._.......................................................................... ................................................................................................. Owner Address W Robert Our Co., Inc. Great Western Road, N. Harwich a .................................................. --•---..........-----------...........----....----......................•••••..................... Installer Address dType of Building Size Lot...9,375_____________Sq. feet Dwelling—No. of Bedrooms__....Three Expansion Attic (N/� Garbage Grinder (N/� per., Other—Type of Building .........NIA........... No. of persons........N/A.._..______- Showers Cafeteria (N Other fixtures N�A Design Flow............5.`.............................gallons per person per day. Total daily flow.___.._...•..330--__-__.•,.- -------gal Ions. of P4 Septic Tank—Liquid capacity 1000_.gallons Length__$�6...... Width._4'10 if .. DiameterN/A........ Depth....5.�8..�... Disposal Trench—No. .....N_.A....... Width'.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..........1--------- Diameter.......):2........ Depth below inlet.....6............ Total leaching area....266.......sq. ft. Z Other Distribution box ( X) Dosing tank V/4 Percolation Test Results Performed by--------._.I.P.W�/Conlon-___•__________________________ Date......5-14-86................. ,aa Test Pit No. 1..........2...minutes per inch Depth of Test Pit... 12.......... Depth to ground water..none__............. Test Pit No. 2........... ...minutes per inch Depth of Test Pit....12.......... Depth to ground water__none_______._--- W ••-••-••-••••-•••------------•-••-••.................•-••••••--............---••-•-•---..........--•......................................................... O Description of Soil----------THI......(.q'. --.TA.Paoi.2._.&..suba.Qi.l......(.2_1/2' - 2 medium..oand._-. v ...........................................Mat...(Q'- ... wao,i.l... aubzoil.;--(2_.a./.2.'.=.12.. W --••••------------------------------------------•-------••••--------••--•----------••-•-••••-••---••--••---••---•••••••--•-•••-----•......-••-•-•-•---•---.....--...................................... UNature of Repairs or Alterations—Answer when applicable.__............................................................................................. ---------------------------------------------------------------------------------------------• ...............................•-----•-••••--•••-••-••-•••••-•--•-•••......_..--••-•......--..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIL- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. d ------•--•----------- -------------------------- Date Application Approved By--• ��°................. ..Q - Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- --•-•-•-------••••••--••••-•-•-•------•---•....••••••-•••---•.....--•..............................••------••-••••-•••........._...•-----•-•--•-•---•----------•--••-•---•---••-•------•---•--••---•---- Date Permit IV CCJ-------J..0.LYb....._.... Issued....................................................... Date !- a! I / `77 J . FIZZ............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -----_....� .. ..................OF....................BARNSTABLE ApptirFa#ion for MijiusFal Works T=olrnrtiun Permit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: 280 Bumps River Road, Osterville ...............__..................................•---••--••--•----..........-•-•---•--•••-•-• ---•••••--•••-•---•-•-•-••--•--••--•-•-•-•••-----------••-•••--•-•-•--...........•....._•_••------ Location-Address John C. P. O. Box 545 Cefii _ '1 lle --- KeOn eilL@Li7 W Robert Our Co., f c: Great Western Road, N. Harwich ,-� • ---•-- !...... Installer Address 9,375 Q Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.__.-Three Expansion Attic Grinder `k Other—Type of Building A.I YP g --------N/A-.......-••• No. of persons.......��A............. Showers �/A) — Cafeteria �/� � Other fixtures ----------•--•�/ -----------------------------------------------------------------------------------------------•----••---------•--...----------- W Design Flow...........................................gallons per person per day. Total daily flow-------------330 OIons. WSeptic Tank—Liquid capal�ci 10.. o..gallons Length.8_.6....... Width.�.1.1011... A-DiameterN� ......_. Depth...-'_.8�� x Disposal Trench—No. ..................... Width................... Total Length.................... Total leaching area....................sq. ft. 21 Seepage Pit No...____._1-____.__.. Diameter......1 ........ Depth below inlet....rR............. Total leaching area....2......_._.....sq. ft. Z Other Distribution box ( Dosing tan Oft/Conlon 5-14-86 Percolation Test Results Performed by........... ............................................................. Date.---- ................................ Test Pit No. 1....1-_2_...minutes per inch Depth of Test Pit._.12!.......... Depth to ground water.PPn!............. Test Pit No. 2..__.___..2_...minutes per inch Depth of Test Pit___12r.......... Depth to ground water-nine-------.___- -----•---- -----------------------................ --- O Description of Soil.................=-_t0. 2 1 2' To Oil & Subsoil• (2 1 2' .. 12' Medium sand_____ x TH2: (�' -- 2 1/2") Topsoil.& subsoils -(2-112'...-__12'2 Mediwn_sana v ..................................... W -----------------------------------------------------------------------------------•---•---------------------------....----------------------------•-------------------------------------------..--••-- U Nature of Repairs or Alterations—Answer when applicable.................................................................................._......_._.... •-- -------••---------------------•••--•----........_.......-•-•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................................................... ................................ ___--:-i---- Date Application Approved Bye _._ - ----------------------------- rf ' Application Disapproved for the following iLns:----•--------•-----------------------•---------•-•--•--••••-••---------•---••-....-----------•-•....--•---.._.._ .......................................................----------------.....----•--------•-•----...-----............................................................................................... Date Permit I' ------------- Issued-........................ ...._. Date -•--•- ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OWN ............� ...................OF.............BARNSTABLE............................................ TrrtifirFa#le of TOMp iFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed �X ) or Repaired ( ) Robert Our Co., Inc. I tall at_______________________________________________•280 Bumps River Road, bsterville ........................................•••-------------------------------------------•------•--------------------........--------••--------. has been ed in with the provisions of TLE application for11DisposalcWorkseConstru Construction Permit No._Z`-1-5 0' -2''L2te Sanitary Co�i� d i� in the dated I( THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. Y DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH wZ/ Town..-...............OF...............Barnstable....---------------...------------........ No.L FEE.......l. �.. Dispo al 10orkv ToniArnrtilan Permit Permission is hereby granted...........Robert__Our.CO..,---Inc.................................................................................... to Construct ( X) or.Repair (- ) an Individual Sewage Disposal System ,at No.................28®Bums Ri..........................................................r Ro Otrl -----------------------------•----••-----------------------------• ....... ..---•--- -Street -- as shown on th appli -tion for Disposal Works Construction Permit Dated... ?..,-16---------- / - - - '=car ...-.f_. ....................... Board of"Wealth r- ATE.......-•--------• -----------•- �. i FOR4I 1255 A. M. SULKIN, INC., BOSTON - Al LoT j°2 k 7q \ 75, oo \ ' IUO' Ppzot 1TAGE eIo t�eiacH ZO FRON? SF_I �{�G1C eox i3 10' SI�C�ARD _Q1 � � - AD--�100 wT . 0 loco s; Ct suPAV, LOT 14 24 N � ? I PAQGE.L O �g 100 I co ` s 49 q' 5-8 Of,Uq�s�' lP`tN OF 1W ± � DAVID P. UL A. MAR Gu+ �° IoQ 160. :5 0 rn . LEVY c. CIVIL .t1� No. 10617No.31115 O r � i' '�aa�'(.i\• r-� .4� 9 �� v./'fit'/ I LEGEND EXISTING SPOT ELEVATION OAO - - - - EXIVTINQ CONTOUR --- 0 --- -- CERTIFIED LOT FLAN [ FINISHED SPOT ELEVATION __._..__ -- _ -- f Flkf SHED CONTOUR 0 405C A1o.-Z$O} NOTE: The location of anx existing urndergi-ound sewerage, wells, or other utilities shown on this plan is approx- imate I N (OSTE,tZVj L4LF l only as d--termined from records and/or verbal Ti � M S4 LE information. The contractor is responsible for the ' .verification of the existing locations in the field. SCALE, / = 30� DATE 912(0 8(� •LEVY & ELDREDGE A►SOCIATES, INC. : CLIENT.1'� I CERTIFY THAT THE PROPO SED ENGINEERS-LANDSCAPE ARCHITECTS JOB NO. 1J�3 BUILDING SHOWN ON THIS PLAN PLANNERS-LAND SURVEYORS �� M. CONFORMS TO THE ZONI 0 LAWS ®R.®Y ._..,_ OF MA 712 MAIN STREET CH. BYE M H YA IJ N i 8, M A 3. SHEET OF "AT � E LAND SURVEY R } ,--- - _- 20 F'T. M/N. _—.. —_—.._— � , .•G?�� ;�' �'/TNER ?"<+'� _S �:�;:�v..7,n•v � �R. ...�_. _ T _...._.._ f c'.�i DE fa 24 ",D/A M E Tfk rC I i O M/ FT. N. _ B.E fjRDUGNT To G '.e • F .9`P✓C PJPE Al i ` CONCRG"TE rlE.4✓y CA S 7- //20/Y C rJ l/E! EL. /O✓7.5 o. _ ; C DYERS - V8 PER co M/N. �Q�}• Rx'T 4�tA D E _- i _ q..DIR• _ f= ;�•. SCHEDULb40 a n •T n ic. ar_,- 5- 2rLftYER JY.C. Pj FEE � Q 3�8 M J N. P/TGl! �- GAL. ' o e • . • s • ° • o p °cam WA SHF.D STi�NE.vo-P&R /''T SEPTIC TAtVX D/sT. o n • • N • . • • • o •" • o a .q i - a:•. � v D e • •EFFECT'/V.� e ` s � — �i4'.. / �z•• o ' �SNED STONE 115x 2.5=377SGPo ° e °e. • • • . • .• . • . v a //3 x /AO = /i3.O Goo s a. a ; r • • ♦ t° s • • o p _ f?KEG45T 5EFA!5 4GE' 1AlV4° T Zr1-RV iT/®AVS -PrrCAPr+cr-rY 19o. sCTPG o t• o r e •; • o o . r o ' a o P/7 OR U/v. J' /NYERT AT FT 6 FT. D/A_.m INLET SERT/C TANK /oD. "L? FT �-12_ F? O/i4/�7-� t : C I!SEE 7, -AYJQR�> ou7,4E7,SEPTI C TANK boa •�C Fr. �� --� INLET D/STIq/DUj/ON BOX/Oo Y6 FT. SECT/Q/V OF GROUND PVA7-ER -rARLE OcITLETD/5TR/,eITT/ON BOX/ao.20 JET /NLET LEAs.CHING 'c'Y7' /oa.00 JcT .S'��AC•rE O/S/® .4 L .SY���/f3 •TAjUL ATID/V LEACH/MG P/T %�. _ /`- r OIMEN.3'/ON A_. s1�'T.-2A D.ES/6N Sc.aLE o CR/TET1A D/IWIEI Sl�TiJ r fT• NUA9�ER OF&EL>Roo s 3 D// C,4R4dA6A-- D/SP0s44 uJviT oNE SO/L LOG S®/J. 7,"7" TOTAL EST//VIA47-Eb Soli- ?EST 1 / SOIL 7,--e7ST,*2 A(UMBEAP CDF ,40ACHING ,v/rs _ �^FtE✓. 10/.8 �ELEY /01. O ,0A7-E O.P- 50,',L TEST _//Ii4 I I9�SG 5/0E 4.e`ACH//V6 PER PIT ,Sq, ,-T. d,_2AIt' � o'-a•i,•, RF_.SU.LTS .W/T�1/E��D BYr/?i✓,/J_,���f , eo r-roM L r-ACH/NG PLf R PJT_J Ll_ To$ou- t Suesett $Q. �T. ToPsa48SUly5ptL PtRr'fjtt4'7/Q/t✓ J@.9TE#'/ i TOTAZ LEACH//YG AR--A RR5SEMV4r LEACNING AREA SQ. FT. i ME01 UM ,/ � S�}/.JD _T_ESL__.:. - -.--J�7�F q S.�/va� 1�� 3,BvmPS Rives �an DAVID P. -118 CIVIL IJo.31115 z3 b F2 E L -89 2 MA 1 NO OROUNO 1-vATER ENC0UIV 7 ' GATE ' Q GRO UNO 1Yb'-TE'.Q A7' EL-F_v �?c ;i:. 105 Nn. a 4 N - � Design Calculations ' 1 -2S ' � X 13-'W' X 2 .0' 6 Number of Bedrooms: 3 �I ~ .� #6i - Marlon Way leochli,lg tench usingGarbage Grinder: o ROUTE 2 H -- 1 0 r 00 g a �. chambers W I,t h Leaching Capacity Required: 330 Gal./Day 4 of scone an sides W �er~ ! - o o Leach7ing Area Required: 330 Gal./(0.74 Gal./Sq.Ft.)=446 Sq.Ff, Proposed teaching Structure: 1-25'L X 13'W X 2'D Leaching Trench m 75e00 O Leaching Area Provided: 477 Sq,Ft, 3: � Proposed Leaching Capacity: 353 gpd > 330 gpd. req SITE o d. I I I septic Setback O a L T,H, #1 0 Q 99,50' o 0 1 q 25 1 O , Bumps River Road 12' LOCUS M 9 91 _ NO SCALE Ln So d deck O 4' 5' 4' cellar wall I { 2" OF 1/8" TO 1/4" G EN E1 \�j AE NOTES 0 TES - PEASTONE (WASHED) U W E L O N C N 1. ADDRESS: 280 BUMPS RIVER ROAD L� ® ® G7 2. ASSESSORS NUMBER: MAP 120 PARCEL 023 garage T.O.F. elev.= 101 C3 M 0 24 MIN. 3. DEVELOPER'S LOT: O O o O LL' 4. TOPOGRAPHIC INFORMATION WAS COMPILED FROM EXISTING INFORMATION O O 2 H-10 500 gal. chambers BASED UPON AN ASSUMED DATUM. 3/4" TO 1- 1/2" WASHED CRUSHD SONE 5. MUNICIPAL WATER IS PROVIDED TO SITE AND SURROUNDING PROPERTIES. N0. 280 6. REFERENCE PLAN: PLAN BOOK 262 PAGE 60 O , 7. NO WETLANDS ARE LOCATED WITHIN 100 FEET OF SAS. W 8. NO POTABLE WELLS ARE LOCATED WITHIN 150 FEET OF SAS. TRENCH CROSS-SECTION G a N0 SCALE CD CID � Q.� Q) cn W _O CD � O 1-20"DIAM.ACCESS MANHOLE -1 TES �ONSTRU�,TION NO , W C� 1. Contractor is responsible for Digsofe notification a _ •. I and protection of all underground utilities and pipes. ,. 07 6 N p n n R _ n 9 3 75± S Q e FT. i o 2. The septic tank and distribution box shall be set ! J level on 6" of 3/4"-1 1/2" stone. 7 a ;. 3. Backfill should be clean sand or gravel with no / 5"O 0 stones over 3" in size. ® l L' 34 4. This system is subject to inspection during installation W .1 j' © " by Glen E. Harrington, R.S. - - - 5. The contractor shall install this system in accordance - - - _ _ . - g f - _-_- PLAN VIEW and the Regulations of the Town -- --------- --------- -----�---- ------------ 9,7 EN©�SECTIONarrrbers--- sTrEL RE�FORCEp aREcasT coNCRETE _ with Title V of the Massachusetts Environmental Code approx. edge of pavementg of Barnstable. B UM, P-S RNFR ROAD 6. Provide a Acme Precast 5-Hole ual. D-Box with (l��`� H-10 OO GALLON CHAMBER 2 t�-10 500 gal. chambers or equal. 7. No vehicle or heavy machinery shall drive over the NOT TO SCALE septic system unless noted as H-20 septic components. 'USE ACME PRECAST OR EQUAL 8. Install gas baffle or equal on septic tank outlet tee end. 9. Ali existing +rerts and site conditions shall be verified-by contractor. 10. Existing leach pit to be pumped and backfilled. 11. Existing 1000 gal. septic tank to be pumped and inspected for structural SOIL_ EVALUATION integrity prior to rg-use. 12. This design plan is only to be used for tiVe installation of the septic system. - SITE, PLAN Date of Sail Evol.: December 18, 2002 Test Performed,By: GLEN,,E. HARRINGTON, R.S., CSE SCALE: 1 =20 • Excavator: Ken Kline/TMT Construction BENCH MARKON CORNER of Test Hole BULKHEAD ELEV.=1OQ Q0' (ASSUMED) No. 1 C *` DEPTH SOILS ELEV. a 99.5' yA 7" �1 oyF 3/3d 98.92' ` 28" �1pyR5/6d 9�.17' \lk\OFMq PROPOSED SEPTIC SYSTEM UPGRADE PREPARED FOR C 1, med. O oarse sar4 E RITA L. SWIFT o. R T CO, 13 " 2.5Y6/4 88.50 1070 AT • � �' 40 GROtJN!)WATER ENCOUNTERED .�? 280 BUMPS RIVER ROAD *NOTE: ALL PIPES ARE TO BE 4" Di A. SCHEDULE 40 P.V.C. 10' min. from *NOTE: iNSTALL GAS BAFFLE OR EQUAL ON 'SEPTIC TANK OUTLET TEE. N/TAVk\ BARNSTABLE (OSTERVILLE), MA house to septic Conk LEIyTEN - Finished•grade over system=2% slope away �� Septic tank covers must w thin 6"cover finished d grade DIST, BOX e w shin Iharrb rfinished srrn r de e ..9 _ s ` ✓ ,` O\' GLE( IB Y, Existing HOU52 P 9 D-Box cover must dJ grade ,. 1 V EXtSTlwithin 6' of finished lad 5 HOLE g Exisiin Erode Elev-99,5't ;' PUMPIED &EBACKFILLED BE PREPARED E, H A R R I N G T O N, R.S. Mir. 2-_1/8'-1/2" 12" min 9 I�E D A ROSE LAN E f u I 1 S 0,02 washed stone 36" max. EXISTING 1000 GAL, c e l l a r 5-.01 Level for 2' O a H-1 0 SEPTIC TANK 1s.s' EXISTING 12, s=01 Too Elev.=97 1' Taco GAL. MARSTONS MILS MA 02648 1b 12' invert I v.=96.64' TES: 508-428-3862 SEPTC ANK o rn DENOTES EXISTING GAS BAFFLE m °� a m t o ®E3 o ce 24'MIN' g {{o -of Leach' X 104.46 SPOT GRADE N OR EQUAL n n ll 9 25, Trench of. 94:64' w > LEACH TRENCH 6.1'± ---9s--------- EXISTING CONTOUR FAX: 508-428-3862 6" OF 3/4"-11/2" STONE c v VBottom of T,H. #1 Elev.=BB.5' DEEP TEST HOLE SYSTEM PROFILE S SCALE: 1 =20' DRAWN BY: GEH JAN. 5, 2003 6" OF 3/4"-11/2" 'i}bN6 Not to Scale DATUM: ASSUMED FILE: SWIFT.DWG SHEET 1 OF 1 y �