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HomeMy WebLinkAbout0145 EAST BAY ROAD - Health 145 EAST -BAY� A�, OSTERVILLE A 140-160. 002 t i 4 e f n 0 6 F TOWN OF BARNS TABLE- 140 1&0 6 0� k • TLOCATION lolr y- A�90d SEWAGE # ` ILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Air k - LEACHING FACILITY: (type) J j X. (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE; COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to theBottom of Leaching Facility L 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 L aching Facility(If any well ds exist .within 300 feet of chi c"ility) Feet Furbished �k .3 CA A TOWN OF:BARNSTABLE CFI, L6CATION � �13 �l/.� } • SEWAGE # ASSESSOR'S,,MA_P 6T LOT INSTALLER'S NAME PHONE NO."( ?yL .&i& .%PTIC TANK CAPACITY LEACHING FACILITY:(type) 1?CH )iCEMCH,�5 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER ��,'�J BUILDER OR OWNERS 11 &Az i DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: Z " IS'' 16 VARIANCE GRANTED: Yes No i c� S a IZ J v R �� �t !� t1 „ �� ➢� a a4 ii �e 91 � . No.--------------- -- Fee--- BOARD OF HEALTH TOWN OF BARNSTABLE Zipp[ication, forWell Conaruction Permit Application is reby made f r a penmi to Construct (Alter ( ), r Repair ( )an individual Well at: Iq ocation — Address Assessors Map and Parcel Ow r Address ---------------- — -- �- ---sl-O------ -------------- Installer Driller Add s Type of Building Dwelling--------------------------------------------------------- Other - Type,of Building ----------- No. of Persons---- 16--------------------- Gr��c� Type of Well------- -- - -- - Capacity----/ _6 _ _ Purpose of Well---- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation unt' Ce 'ficate . iance has been issued by the Board of Health. Signed --- - -------- - - (!'' -d date Application Approved By ---- - -- —`- `S -— - s Z Z v1 date Application Disapproved for a following reasons:------____________________________—______________________________—--------- ----------—-----__------- - ----- - - - - —-------------------------------------- - ------- date 2-co / �j Permit No. -- __ -®I�— ----- IssuedPLZ -t- - -— --- - date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THISTO RTI '!, That th Individual Well Constructed (Altered ( ), or Repaired ( ) f by ------------------------------- --------------------------------------------------------------------------------------------------------- , Installer at----- � __ . . --------� r�� ------------------------------------------------------------------------------------------ has been installed in ac rdance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. --------------------------Dated------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- --- - - --------------------------- -- Inspector-------------------------------------------- ------------ No.---- ---?- --Oq-- Fee-­ BOARD OF HEALTH TOWN OF BARNSTABLE Z[pp6tation_*r3VeC1 Con0ructiouPermft Application is hereby made f r a permit to Construct (�Alter ( ), o Repair ( )an individual Well at: G ocation — Address Assessors Map and Parcel � Own r .�j ------------------ - --------------- Installer — Driller Address Type of Building Dwelling-----—---------------------------------------------------- Other - Type of Building------------------------------ No. of Persons---__1:;;__/�-----------------___-_-__________ GPc+ Type of Well------- - -- ' - - Capacity---/-->___� _ ` Purpose of Well----�Ajr ='d>=�= -------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health-Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until Cer 'ficate dance has been issued by the Board of Health. Signed -- -------- - ��'d date Application Approved By ------- _ ___----____-- ,S_ _- (p"Z Z -01 date Application Disapproved for a following reasons:----------------=----------------------___----_---_--------_—_________-_________ ---------------------------------------------- ------------------------------------------------------------------------------------------------------ 2-po G( D -- date Permit No. ----------- --e -- -- - Issued---- - Z d-4 - - - -- date P BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS ERTIFY, That th Individual Well Constructed (Altered ( ), or Repaired ( ) c , -------------------- _ - --------Installer -------------------------------------------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection I - Regulation as described in the application for Well Construction Permit No. -----------------_-------Dated----------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS--A GUARANTEE THAT THE WELL "SYSTEM WILL FUNCTION SATISFACTORY. DATE- --- ---------------------------------- - -- Inspector----------------------------------------------------------------------- ---------------------------------------------------- { i , BOARD OF HEALTH TOWN OF- BARNSTABLE Vell Con5truct ion Permit No.f --- ------- --� Fee---------------- Permission is hereby granted- --- _ to Construct (14-<Alter'( ), or Repair ( ) an Individual Well at: ------------------------------------------------------------------------------ 1 , -. - street .as shown on the application for a Well Construction Permit No.--` L_Od O - - - Dated -------------------------------------- ------------------------ ----- --------- ---- 1 B ' DAT oard of Health -----�-----L---�Z Q--------- ------- 4 -- / <v 30 x 29.6 .6 3rr Jr.31.7 29 0 _ 5 � S� B • 8�. ' 7' TBM .O CORNER FISH POND x 29. EL a 27.0'An 0 " IF ENCOUNTERED REMOVE ALL UNSUITABLE MATERIAL FOR 5—FEET AROUND SYSTEM '.. 31 0 ^' �, BACKFILL WITH CLEAN FILL IAW 310 CMR 15.201 — 15.293 ` 31.0" y N o. \ x 29.4 / 30 Zq 0 9 x 28.6 8.3 s x - O 29 �s J Ir. •S lk O. 38.77' w x .y / NA WALTER A. GARDNER. ET UX. Y / 4 , DATE:_ PROPERTY ADDRESS; 14 East_Bay_Road_--__ Osterville ---------------------r-- __- - ---- --- On the above date, I Inspeoted the eeptlo ,ayotfr , at the•aboye address. Th13 3yvem con31313 of the following: 1 . 1 -1500 gallon septic tank. 2. 1 -Distribution box. 3 . 2-Leaching trenches. 3q 'X4 'X� ' ` 883ed on my napect on, I certlfy the following oondltlonv 4 . This is a title five septic system. 5. The septic system is in proper working order at the �`'� present time. - I - �0 6. Pumped the septic tank at time of inspection. No flow back from leaching trenches.Snaked the trenches , and found them to be free of,•sludge or waste water. $10NATURE': ./ _ Company; Jo, .ph_P .,; Hacomb.r �b '$on , rnc , Address :--Box^ 66__� __Centerville, Nay-02632-0066 Phone:___ 508_77S_ 3338------- THIS C✓ATIFICATION QOCS NOT CONSTITVTE A OVARANTY OR WARRANTY C EPH P, MACOMBER & SON, INC, T+nk�•Crit'pool�•l,eichll+ld+ - P�mp�d !, Inttslled Town Sower Conneotlon� a . Box 66 Cen1 11114 MJ, 02632-0066.' ` 775•JJ38 7756112 . • # a le u r i C r;} ,per :. � �'�, • -\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL'PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 145 East hay gnarl OstervillP Owner's Name: Paul Ma 7.7 Mn Owner's Address: Date of Inspection: , 2/o 1 Name of Inspector: (please print)Joseph P Macomber Company Name: 7 P nnar•omhQr- & c)n .inc Mailing Address: Box 66 Telephone Number: r;08 77s-641 2 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).. The system:. Passes T I Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: The system inspector shall ubmit a copy of this inspection r ort to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving . authority. Notes and Comments ****This report only describes'conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 f Paee 2 of I 1 ^� OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) " Property Address: 145 East Bay Road Qatervil_1e Owner: Paul ma 7.7en Date of Inspection: 5/3/01 Inspection Summary: Cbeck A,B,C,D or E/ALWAYS complete all of Section D, '.A SystemDPasses. R 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System is :.in proper `wc ing or er a e pr s 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. Answer yes, no or not determined (Y,N,ND) in the for the follow explain. ing statements. If"not determined"please ` Q The septic tank is metal and over 20 years old* or the septic tart* (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 sepric tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: .dA Observation of sewage backup or break out or high static water level in the distribution box due io broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced • . obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken.pipe(s)are replaced obstruction is removed ,r^ ND explain: 2 Page 3 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 145 East Bay Road nGtprvi11P Owner: pa„l M32 moan Date of Inspection: c4� C. Further Evaluation is Required by the Board of Health:' )6 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 vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any)determines that the` system is functioning in a manner that protects the public health,safety and environment: Atr The system has a septic tank and soil absorption system(SAS)and the SAS is within I00 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 I 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. &p The system has a septic tank and SAS and the SAS is less than l OQ feet b)u 50 feet or more from a private water supply well•'. Method used to determine distance L •. •'This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. „ , 3. Other: T 3 I Page 4 of 1 I a OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:145 East Bay Road Osterville Owner: Paul Mazzeo Date of Inspection: 5/2/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for;all inspections: Yes No/ ✓ ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or /clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS-or cesspool 0 X Af A4rs� 7",wdtig Liquid depth inQeespeoi-is less than 6"below invert or available volume is less than 'h day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number /�f times pumped—L. ✓,fsny 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 , ater supply. �y portion of a cesspool or privy is within a Zone I of a public well. �y portion of a cesspool or privy is within 50 feet of a private water supply well. y portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia . nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] t)O (Yes/No)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 now of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet'of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped , Zone 11 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. 4 Page 5 of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1 45 East Bay Road nc;t-Prvi 1 1 P Owner: pail1 Ma7.7.anL Date of Inspection: S /9 /n Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No Pi mping information was provided by the owner, occupant, or Board of Health 1/ 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? �ave large volumes of water been introduced to the system recently or as part of,this inspection ? !✓ Were as built plans of the system obtained and examined? (if they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up.? Was the site inspected for signs of break out? Were all system components;-@*Cluding the SAS, located on site? Were the septic tank manholes uncovered,opened, and the in 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 ? ` 1"/— Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? ' The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no Existing information. For example,a.plan at the Board of Health. < _�_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(b)j 5 • •. .-.O �i it ' Page 6 of I I ' i OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 145 East'' Bay Road Osterville Owner: Paul Mazzeo Date of Inspection: 5/2/01 ' FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):—4-1 Number of bedrooms(actual): _ DESIGN now based on 310 CV 15.203 (for example: 110 gpd x q of bedrooms):.�X11�= ve �/') Number of current residents: y Does residence have a garbage grinder(yes or no): 44) Is laundry on a separate sewage system es or no)::4,D (if yes separate inspection required) Laundry system inspected(yes or no); Seasonal use: (yes or no): do (ay9.�� Water meter readings. if available (last 2 years usage (gpd)): ,/�c n/rp,/) t4f -O(o Sump pump(yes or no): 1``-"""` T Last date of occupancy: COMM ERCIAUINDUSTRIAL T\pe of establishment: _ Design now(based on 310 CMR 15.203): gpd Basis of design now(seats/persons/sgfl,etc.): Grease crap present(yes or no): Industrial waste holding tank present(yes or no)al�Q Non-sanitary waste discharged to the Title 5 system(yes or no): / Water meter readings, if available:d _ Last date of occupancy/use: �— ' OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as pan of the inspection(yes or no): *I es. volume pumped. gallons •• How was u nti pumped determined?/ Reason for pumping: g�¢yy tf��� rs , TYPE OF SYSTEM ' N Septic tank, distribution box, soil absorption system yQ Single cesspool a t Overflow cesspool * ; Privy ,j,bShared system (yes or no)(ifyes, attach previous inspection records, if any) ,gyp Innovative/Alternative technology.'Artach a copy of the current operation and maintenance contract (to be ' obtained 6'om system owner) �Q Tight tank 'Anach a copy of the DEP approval, /, i Other(describe): Appr=. tea a of all com onents; date installed(if known)and source of information:' • Were sewage odors detected when arriving at the site(yes or no): F *. Page 7 of I I OFFICIAL, INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued). Property Address: 145 East Bay Road' Osterville Owner: PA r 1 MA . .Po Date of Inspection; BUILDING SEWER (locate on site plan) Depth below grade: Materials of construction:4acast iron 240 PVC—VMther(explain): V Distance from private Hater supply well or suction line: 49 70" Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK: locate on site plan) Depth below grade: Material of construction: ZconcretedLmetal, 10fiberglass&L)polyethylene &Oother(explain) Al/g 1 i tan): is metal list age:a Is age confirmed by a Certificate of Compliance (yes or no):&Zd(anzch a copy of D,menstons: Sludee depth: Distance from top of fudge to bosom of outlet tee or baffle: Scum thickness: U Distance from top of scum to top of outlet tee or baffle: D D:s2nce from bottom of scum to boq9m of out t tee or hoµ µere dimensions determined: e Comments (on pumping recommendations, inlet and outlet tee or baffle dondilion. structural integrity, liquid levels as related to outlet inven, evidence of leakage,etc.): - Pump the septic tank every 2-3 years. /Inlet & outlet tees are in place.The tank is .strticturally sound and shows no evidence of leakage. CREASE TRAP44locate on site plan) Depth below grade: Material of construction: JAcohcrete metal,{&fibergIassj!&polyethylentjBother (explain): Jill Dimensions: N Scum thickness: Distance from top of scum to top of outlet tee or baffle: All* Distance from bonom of scum to bonom of outlet tee or baffle: AIW Date of last pumping: AJA _ Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integriry, liquid levels as related to outlet invert, evidence of leakage, etc.): k 7 Page 8 of I I y . OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: . 145 East ..'Bay road Y Owner: Pahl ma7,7.Pn Date of Inspection: 5121ni TIGHT or HOLDING TANK,t(/age, ^(tank must be pumped at time of inspection)(locate on iite plan) Depth below grade: NA Material of consrruction: concrete metal fiberglass dL polyethylene AL other(explain):r• dyh Dimensions: A)19 Capacity: AM gallons Desien Flow: AM gallons/day Alarm present (yes or no): _Ahi Alarm level: V_ Alarm in working order(yes or no): Date of last pumping: n)A Comments(condition of alarm and float switches,etc.): Tight or holding tanks are not present DISTRIBUTION BOX: (if present must beopened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and disrribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distr-ibution box has two laterals,Nb evidence of solids carry over.No evidence of leakage into or out of therbox - PUMP CHAMBERAII&g.(locate on site plan) Pumps in working order(yes or no): 14 Alarms in working order(yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances,etc.): Pump chamber is not present_ s `.. a .. . 8 Page 9 of 1 I , OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1 45 East Bay Road , s�e isle . Owner: Paul .mazzeo L " Date of Inspection: 5 7770-1 SOIL ABSORPTION SYSTEM (S x'S): Zlocate on site plan, excavation not required) If SAS not located explain why: Type leaching pits,number:Q _D leaching chambers, number.p Al/! leaching galleries,number:--0 1 leaching trenches,number, Jews h: i)d X 'Y ,Z 4)6 leaching fields,number,dime❑-,Ions: n ' A)6 overflow cesspool, number. _ r innovative/alternative systen: ype;'name of technology: 7-Ve ? D6 0 _6z9 Comments (note condition of soil. s . :is of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Loamy sand to medium. fine sand.No signs of hydraulic failure pond; nQ_.Spi1G are dry_�getation is normal CESSPOOLS(cesspool rru� pumped'as part of inspect ion)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invent Depth of solids layer: Depth of scum layer. Dimensions of cesspool: Materials of construction: Indication of groundwater inflow 0-::, or no): l Comments(note condition of soil. :•. .0 of hydraulic failure, level of ponding, condition of vegetation, etc.): esent PRIVY(locate on site plar. Materials of construction: Dimensions: Depth of solids: AIV s " Comments (note condition of soil of hydraulic failure, level of ponding, condition of vegetation, etc.): _Privy is not present ;:.__ 9 Page 10 of I 1 N OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1 4-9 F.a_Gt Bay i:?nnd -- 0-,t- ryi 1 1.P Owner: Pail Ma'z-zPn Date of Inspection: st 9.101 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 4 ' �5s f Sa �1 c. + A be , i 19 10 f Page I I of 1 I ti OFFICIAL, INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properr Address: 145 East Bay Road Osterville Owoer: Paul ma .pc) Date of lospection:5 2/ 1 ~ SITE EXAM Slope Surface water Check cellar Shallow wells r Estimated depth to ground water feet Please indicate (check)all methods used to determine the high ground water elevation: O ed from system design plans on record If checked,date of design plan reviewed: - bs to abunin ro a bservation hole within 150 feet of SAS) checked with local Board of Health-explain: _ Checked with local excavators, installers- (anach documentation) Accessed USGS database explain: You must describe how you established the high ground water elevation: ` Used water contours map. ; Gahrety & Mi 1 1 Pr Mndel 12,116,194 II .n-.r+•-n.rr�-rr rr. irn•n.wr�-nn rnrre+n.r+��►iere�inn rnrr•ati r�'w►�n w,� .�'n•r�•+-a--'- _. ._ TOWN OF WARD OF HEALTH SUIISURFACF SFWA(;E DISPOSAL SYSTEM INSIFCTION FORM - PART D •- CEN'I'IFICATION -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 145 -East Bay Road` Osterville ' .ASSESSORS MAP , DLOCK AND PARCEL ;lt OWNER' s NAME Paul Mazzto PART D - CERTIFICATION i NAME OF INSPECTOR _ Joseph P. Macomber Jr. COMPANY NAME Joseph P. Macomber VIS6n Inc. . COMPANY ADDRESS Box 66 Centerville Mass 02632 r ^ ' Street - -Town or City St&t• _ t I P COMPANY TELEPHONE ( 508 ) 775-3338 FAX 1508 ' ) 790-1-578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposa-i system nt 0ecoininendaLions his nddress and that the information reported is true , accurate , and omplete as of the time of .-inspection , The. inspection was performed and any regarding upgrade ,- maintenance , and repair are consistent with my training and experience in the proper" function and maintenance of on- site sewage disposal systems Check one ; . System PASSED The inspection tihich I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in '310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILEU* - The inspection which , 1-,have conducted has• found that the system fails to protect the E)ublic health -and the environment in.. accordance with Title 5 , 310 CMR. 15 . 303 , and as specifically noted on PART C. FAILURE CRITERIA of 'this' inspect,ion form , Inspector' S" gnature Date, ne :copy of this certification must be provided to the OWNER, the BUYER ('where app1.1oabIa and the I30ARD OF HHALT'Il, • 'If the inspection FAILED, the owner or oporator. ehall upgrade ' the ayetem uir.hin one year of the date of the inspection, unless allowed or required otherwise as provided in 310 CMR 16 . 305 . ,' partd . doc ASSESSMSMAPq67N®' 14-0 _ !. PARCEL NO' No.... __.. FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applirativaa for Db3pwi al Warkii Towitrurtiuu runfit Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal System at: -,---15 EA-z,r FbA-f 20� 65-M�0_.4 t L-Le Lo r IS - 1-, c. PL . 1 5 9 .7 � ................... .....►----------'-........_..._........... -•-"----'--------•-'----------------------------"'-•--.....----•------------•---------•--•-----' Location-Address or Lot No. PAvt. M A1zEo �- u�c , 11 c0 W tj a:E Rom )t,(*�� ,+ems M c��� NI A• �Zc�S -•--------- ---------------------------- + Owner Address � d a - VTR !ic_C I5����L�H`lr `71'. ,�A�t t-_kS kAI L-1..5 kAA • v�-5 Installer Address Type of Building'e-«'�^^�� Size Lot_ .......Sq. feet Dwelling— No. of Bedrooms-----------Fa"R---_•-_-.______._.__Expansion Attic Garbage Grinder (wc) per, Other—Type of Building ---- -------- No. of persons--------!77!//----------- Showers (wA) — Cafeteria (N/A) Otherfixtures .......*-!6'� ----------------------------•-----:..------.....---------- ----------""-----------------'-"-------"'-.......------.. w Design Flow............ . ........................gallons per person per day. Total daily flow-----------4 ......................gallons. R: Septic Tank—Liquid capa6ty_15 P.galIons Length__i0'1-'_._ Width_-��'$ Diameter__-i�.lA..... Depth._'S_` _:'.... Disposal Trench—No. _-.-___3_..____.. Width....... `........ Total Length____343`_.._._. Total leaching area......!s?.....sq. ft. Seepage Pit No.-__H/.?�:._._... Diameter._...?- ...... Depth below inlet.... ,[A:....... Total leaching area...)-.JA......sq. ft. Z Other Distribution box (✓j Dosing tank (�4- '-' Percolation Test Results Performed b SAX �-. .r-"! .,.!_ __._-p'. ------- I. Date.....sl�?.t' b� ,.I Test Pit No. 1....`.......minutes per inch Depth of Test Pit---- ............ Depth to ground water__-_ (i, Test Pit No. 2..+:t/A__..._minutes per inch Depth of Test Pit---! 1 ---------- Depth to ground water...-N-I.A__--_____. P4 ----'--"-"-----------=--------•-------------'--'-'--'--------------"---'-"'-'•--........--------......................................................... 0 Description of Soil... •-•=--• `` ` -"T`'P AIL S,,csSo7L. * `-!:1 11'_. --,t.�►.�••f�R cW,-,s� w UNature of Repairs or Alterations—Answer when applicable.____+-JA...........................................................:.................... ........... '---- -----------'"---•==----------------'----'-----"------------------'----------''--'-"--"-''----------------------"'---"'"------------.....------•.....----------.......---_-•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ben is e y ZW, board of health. �� . 7 gned ................ .. ......... Application-Approved BY _ P------- ---------- ---- -- -- -- ---- ---------"Date------_.---- fl Application Disapproved for the following reasons: .. ------------------------ -------------------------------------- .... ---------------------------- -- -- �- - ... Date ---- ----------- �6 `Permit No. �- - Issued ......... No.. .. 1 ! Fas.............................. x THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE • fA Appliration for Bi-nViti tl Worko Tomifrnrtinn Famit Application is hereby made for a Permit to Construct or Repair ( ) an•Individual Sewage Disposal System at: ' /� 1�7 E t;rr f'�f�`Y �c,A-b O 51'�Q-t 1 L_1_[= c�T 2 S _ L , G. P�...............................•-•-•--------••----.._._.......,.------......------......•••........ ...-----------•------............................... Location-Address or Lot No. �n Q Alba->Tc-- - lvt l`�-> AAA. oT t�f S ...:................................... J..._..... ......____i.____._._________._______________ _.__........._._..A.._____..........................................................I........... J _Oyvner Address lhF=E— IGEr I5_0 �OALM��.1T �3T �t/1!�-4t- :1•Z?l-dS kA1 LLS lAA cA___cb a •••-- . �oU---------------•-- --------•-------------------- * •-----------•-----------------•••..............._......_....... Installer c, Address U Type of Building 4� / Size Lot.. s Sq. feet �-, Dwelling—No. of Bedrooms...................Q-'_-__-----_-___.-_-Expansion Attic (-VA-) Garbage Grinder (��) r p.l Other—Type of Building _.- ........ No. of persons--------- ........... Showers (-/A) — Cafeteria dOther fixtures ........ Wit-,c----------------------- --------------------------------------- ---•--........-----------------•-•------.........------------ W Design Flow............ ------------------------gallons per person per day. Total daily flow...........`.....��'_._..........._.._....gallons. WSeptic Tank—Liquid capacitv..l`2.9.a_gallons Length._!a_ ... Width..s_'t'_...... Diameter. ..... Depth__5' ..:._. x Disposal Trench—No. _---__-3......._. Width......fl........_ Total Length-.-__3 ......... Total leaching area------e8a-----sq. ft. Seepage Pit No.....HJA........ Diameter----.-t:i/.A._..... Depth below inlet..... IA....... Total leaching area...ti1A__....sq. ft. Z Percolation Test Results Performed by... r''Axr �-"! , 1 1�: UP........t°�`1� � �'�2c� 57 Other Distribution box ✓ Dosing tank � ~ - - ------ --------•- • ..-•---------. Date..... W ` Test Pit No. L___.!!r.......minutes per inch Depth of Test Pit----- �k............ Depth to ground water......... _ rs, } Test Pit No. 2...t!P)------minutes per inch Depth of Test Pit--.t-^%........... Depth to,ground water.-._-t:�.l.h_._.._.-._. a+ I; ----------------------------------- ------------------------ ...------------------- 1 7, ,`� -A : '- .4- .4 - i., Descriptton of Soll. ............................................................... ...................:--------•-------------------•----------•-•. UM. ...G�f�fSt:-�S---•.•------•--••-•-•........................................ ••-•---------•---•-----••----•-----.......-•-------------.....-•-- W x ..................................................... .•---------------------------------•--------------•------------- ............................................. ................................... 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 Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be��uel�bye)board of health. Signed ... -- ------------ R.....--- ....... ..._..._.... ................ .. ........_./.. ................Dare_...._ Application.Approved BY - --t ---/� ..........- - - ... Jam---- ................ .._:.....:.--- Date-- Application Disapproved for the following' reasons: ... ........ - ....... ...................... - _....... ............._.. - ............- ............. 1. - ---------- --...._............... -....- - - - ---- ...-. Permit No. �` .. Dace . �.�,J.. - - :-...............:.. Issued ....... ��-�-` :-- -- Dace —{I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ` f TOWN OF BARNSTABLE (Ilertif irate of Qlamptianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ✓) or Repaired ( ) --car---- --f�+-A....�a—fl�ltc--io i� sL'_----t c:� + - v �±J..-`-----vT.-_S,-. ,<r1 MILLS ru --------------- by ...... -._... - - ....,. } • Insr,Jlcr at 4`� E�n�� l��>-, Q -a C�s-ram a. t.L f M.n o-LG - ..... ----- _-------------- has been installed in accordance with the provisions of TITLE of The St to ironmental Code as described in the application for Disposal Works Construction Permit No. -........ dated __.._...._._......---------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE`CONSTRUEA A A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. .. DATE.... ... - .......... .. .[. .'./ ............ .__... ...... Inspector ._. .._' ------------------------ --------------------- ------------ ...... . - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (� No. ........ FEE---.................... Riipniial Warkii Tianotrurtion Vaunt Permission is hereby granted------ o+r, A_A_—2=, (?�A-rc- -k:E_•.SEz:Q'4 o`c I . M., AA`. ... .. .............. to Construct or Repair ( ) an Individual Sewage Disposal System �. at No....14-�---L '�s t- f'�A--t...Loa�e� t © ,t�e ....... ..... (�'j'J Street as shown on the application for Disposal ��/orl:s Construction Permit No-_� :1Aa c�d......................................... _--••--•--......_•••------------•--•------.•---••------------------•--------•••-------...-•----•...._..._ Board of Health DATE................................................................................ FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS D�Stt�->. DATA lit OF 4f, all W&LF FAM IL` ' 4 5ED12Cr-AA ,,�� p`�I..1, oN BAGIL uEtzEOF' No GA03A4-,Q 6IZl ID EZ �° TER -VA•ILy FWW = .4 X IIo = 440 SULI.iV.At1 SWne TA14L • 44- )(700%= a o No. 2ZJ133 USA 1500 GAI-. L.RAcwQ6 qs7r-A > slbN E 4TU CA?Iot4.. AMA Ee.Q'A. 4.4o GPD 4 0-74 595 5f-- G � APPu�.TwN A¢6A vEyI6N . r 51DEWALL Ar-A_ I e4 s F) 2 , 32 S sF t)ErAI I., OF LEAe-AlwL Tearaq �IJ•T.S. VbTTOM AMA = 31 a-) 2 2 9 G s F 'Tarn(- AW4 s PEpGoC.AT'IDIJ SATE �- S titiv�tNcK rueac. ,, �. .,OIL ",f6 z +' Al IF kemcr L AIE AL a a 1 A A PL R- AL FOP- s�e wl'M CLEAI-I FILL IAw1 310CMQ 5• d .. S: Is.2o1 ,�la�J�r.H I5.193 to��-5> IoN ow= lYt` t� 1 •51MWALL AREA . oM/L-T I • r �KcAvAncu (iri rin�+0 lnlG�L- / E,�c,, .Z9 F,b. Tl�P:r.rL �Suf`�SoIL 3"M>h-,e i IhN �B•S n 1 (� r 1r.0 rZ��l S IrJV.26.o Y i+td l u pK( �Ml I Nd S LEAG� T1ZEG{} r 2b.F 1115 o � Ta►W- ��nAfG K e,PA•LICL -I e.oP.f LlC 9 "DtCgW-OPT PZOFILC- - . o I r CEETI RGD PLOT PLAN r I1 � EL_ = ISM n � �o ,�,,�,L'e LneATlt�l • oS-IicL�/I�Lc 1 P MR-c Q A7� �L M I u / I/-I c rF 5�A L1✓ � I-IoTE n VATS I 6sT1F'`f 1 PAT "E PaoP o•,,�U. St vN PLAID! IZ ENG� 1}>=¢EDN CaMPL`f S w il-A SI t>EL%W9 Alb Lo-r I s�, -1 r 59MA44 ZW V IZEMEW'T OF Tl-15 To KINI OF AJAP 14 PAIL- I(oo _2 GIJ sr7\Q Lt A► V 1 L o/-ATeD \0 I r4 1 N A 5P6u AL FLZCV HAzA=, ZONE. - BAXT�>Z ! NyE 1 NG � I-RND SUevtr^lor�S • �dJGI ti161' 1� oSTeeylll.res M14fti. - oFPS�S Mom '5u 1 i DI t•11,5 4PC XD, NO'r' SE. u5M TO .%TAbW'S►•.I PWOP�zTy IWQ915. APPueAIyT: PAL M A 22E� � � � 1 � �� �� rT --Ii 5-q }-0 fn �� Q � `� - "p.� � L_ — —0•bl _� .bow "�� i .o;b.o;al — - - ��T 'r�nQ.�.�snQ: . i �• .o-.b"G�,1T z5 bT I��• o;b --- �\ o1b i - .� olxz Eull mi "Al 1 , s �b I I - j _ �'��V•J V��.VVV Rol - F 7 e,, JL s s. 0 lkN ?� 3rO• N/F MICHA 1 T. SULLIVAN Jx 31.1 All R L 0 T , 25 x 31.8 S 373 p0" E' 25,785 SF t 20 38, '� 31.0 31� - sy ,�'`'�� PROPOSED HOUSE/SEP11C SITING ti � 4. 30 o AT h x 29.6 .8 x tot, 0. �6'9 ��O° F �6 °. 145 EAST BAY ROAD �j 1 a2 p s� ° 29 OSTERVILLE MASS. x 31.7 _ 15pp ,� � cp 1 g 7. 7.7' TBM O CORNER FISH POND / 1.3 0. EL = 27.0' FOR x 29, �4 ,$p� ,�� �_ �, / PAUL MAZZEO, ET UX./ p IF ENCOUNTERED REMOVE f� ALL UNSUITABLE MATERIAL FOR 5—FEET AROUND SYSTEM a BACKFILL WITH CLEAN Flu, SCALE: 1 20 NOVEMBER 7, 1995 IAW 310 CMR 15.201 — 15.293 �y BAXTER & NYE, INC. 31.0 x 29.4 5 N 812 MAIN STREET ° OSTERVILLE, MASS., 02655 (508)-428-9131 30 Zq vO 9 x 28.6 QQ� 4 x _ 29 ? 6' � N --.._. OF 1/8" STONE--- FINISH GRADE <� O 7843'3p" w � x� 2" — 1/2" MAY BE REPLACED WITH � l9� 38.77' REMOVE UNSUITABLE MATERIAL m %% v 5 INSURE THE SIDEWALL j ;,a 4" PERF SCHED 40 PVC INSITU MATERIAL AREA OF SYSTEM IS IN CLEAN _ 2 MEDIUM SAND OR FILL PER 2' OF 3 4" REMOVE UNSUITABLE MATERIAL GRAPHIC SCALE x �O� 310CMR15.201 — 15.293 — 11f" O STONE FOR 5—FEET (SEE NOTES) zo o 10 zo 40 so x oi, 5' 4 5. - N/P WALTER A. GARDNER. ET UX. 14' ( IN FEET ) 1 inch 20 !t. REMOVAL DETAIL ' SCALE: 1 INCH = 5 FEET 95076 (PPP02.DWG) Y