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HomeMy WebLinkAbout0150 EAST BAY ROAD - Health a 150� EAST�BAY RDA " , .OSTERVILL'E A 140 i rl`66, ! u �r I� I� IIIn �J�REcvec�o�o� C 12134 No. 23LN NAST{NG$,MW .� C� ��� �� g ��� _ � Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 150 East Bay Rd Property Address r{ James Kelley Owner Owner's Name 1 r=+ information is required for every - (Ostervill Barnstable Ma 10/29/16 page. Cityrrown State Zip Code Date of Inspection �.G 1:. Inspection results must be submitted on this form. Inspection forms may not be altered in any 4n way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your. cursor-do not Chad Hathaway use the return Name of Inspector key. H.P.S. Company Name P.O.Box 151 Company Address r Forestdale Ma 02644 City(rown State Zip Code 774-274-2581 12866 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 16.340 of Title 5(310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs•Further Evaluation by the Local Approving Authority 10/29/16 Inspectors Si ure Date The system inspector shall s mit 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•M3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 150 East Bay Rd Property Address James Kelley Owner Owner's Name information is required for every (Osterville) Barnstable Ma 10/29/16 page. Cltyfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: Existing septic is working as designed. 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): t5ms-3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 150 East Bay Rd Property Address James Kelley Owner Owner's Name information is required for every (Osterville) Barnstable Ma _ 10/29/16 page. Cityfrown State Zip Code Date of Inspection 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): 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 vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 150 East Bay Rd Property Address James Kelley Owner Owner's Name information is required for every (Osterville) Barnstable Ma 10/29/16 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 ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins-3113 Tide 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 < 150 East Bay Rd Property Address James Kelley Owner Owner's Name information is (Osterville) Barnstable Ma 10/29/16 required for every page. Cityrrown State Zip Code Date of Inspection 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: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for 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 15,000 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 ❑ 0 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 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•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 r Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 150 East Bay Rd Property Address James Kelley Owner Owner's Name information is required for every (Osterville) Barristable Ma 10/29/16 page. City/Town state Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or°no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® n 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. ❑ ® 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(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 8 Number of bedrooms(actual): 8 DESIGN flow based on 310 CMR 15.203(for exam le: 110 gpd x#of bedrooms): 880 t5ins-3113 Title 5 Official Inspection Forth: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 M 150 East Bay Rd Property Address James Kelley Owner Owners Name information is required for every (Osterville) Barnstable Ma 10/29/16 page. . Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: seasonal use Date 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? ❑ 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 Forth:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 160 East Bay Rd Property Address James Kelley Owner Owner's Name information is required for every (Osterville) Barnstable Ma 10/29/16 page. Citylrown 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: none Was system pumped as part of the inspection? ❑ Yes ® 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/Alternative 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•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 150 East Bay Rd Property Address James Kelley Owner Owner's Name information is sterve Barnstable Ma 10/29/16 required for every (O ill ) B page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 2001 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 feet Material of construction: ❑ cast iron 0 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 1 Depth below grade: feet Material of construction: ®concrete . _ ❑ metal ❑fiberglass ❑ polyethylene ❑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: 2500 gal Sludge depth- 211 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 150 East Bay Rd Property Address James Kelley Owner owner's Name information is required for every (Osterville) Barnstable Ma 10/29/16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 38" Scum thickness Distance from top of scum to top of outlet tee or baffle 411 Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? tape and sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): pump every 2-3 years as maint. to protect leaching tank in good condition tees in place no visable cracks or leaks 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 e : Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 150 East Bay Rd Property Address James Kelley Owner Owner's Name Information is required for every (Osterville) Barnstable Ma 10/29/16 page. Cityfrown 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.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form , , Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 150 East Bay Rd Property Address James Kelley Owner Owner's Name information is required for every ( )Osterville Barnstable Ma 10/29/16 page. Cityfrown 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.): Dbox is at working level. Dbox is H2O and has speed levelers adjusted to direct flow to all flow defusers as designed 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: located inspection port on a flow defuser and dug up cover. flow defuser was dry and sand was clean at bottom of septic system t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 150 East Bay Rd Property Address James Kelley Owner Owner's Name information is required for every (Osterville) Barnstable Ma 10/29/16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 12 flo diffusors— ❑ 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.): system is dry no ponding or evidence of failure 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 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 150 East Bay Rd Property Address James Kelley Owner Owner's Name information is (Osteryille required for every ) Barnstable Ma 10/29/16 page, Cityrrown State Zip Code Date of Inspection D. System Information (cant.) 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-3/13 Title 5 Official Inspection Forth: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 150 East Bay Rd Property Address . James Kelley . Owner Owners Name information is required for every (Osterville) Barnstable Ma 10/29/16 page.. City/Town 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 ' '22 3'� D2 ' 3� � .o 0 C� 63, 0 0 66- 93y '' 60 G 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 150 East Bay Rd Property Address James Kelley Owner Owner's Name information is Osterville .Barnstable a 10/29/16 required for every ( ) B tbl M i page. Cityrrown 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: no GMI at 12'feet Please indicate all methods used to determine the high ground water elevation: ❑ 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: no GNN at 12' bottom of septic leaching is 6' below grade Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 150 East Bay Rd Property Address James Kelley Owner Owner's Name. information is required for every (Osterville) Barnstable Ma 10/29/16 page. Cityrrown 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Zsk � §n. "xr. .• -, , �, �"`' f �.f. '7y, .:?1 s 7`• Itt %r�„ z - ...j �:� 'a * c s{ .iu �" ..'i17 ( T0WN::0 BARNSTABLE LOCA ON �Sy C. �3. ((3�.4 J�� SEWAGE_- aTOO ASSESSOR'S MAP & LOT 110.11bb , ::)INSTALLER R 5 N' do PHONE NO. 'r o L�' � Cv I• E -_s SEPTIC TANK CAPACITY C)0 '7 LEACHING FACILITY: (II) Fie a �� (size) NO.OF BEDROOMS '! f � `BUII.DER'OR PERMUDATE: r LLJCOMPLLkNCE DATE >. Lul Separation'Distance Betw the: Maximum Adjusted.Groundwater-Table to.the Bottom of Le..aching;Fac!ltty' Fee77 Private Water Supply Welland Leaching,Facility' (If any wells exist r , on life or within 200 feet of leaching.-facility Feet ) Edge of Wetland and Leaching Facility..(If any,wetlands exist r „ witivn 3.t)0 feeE.of leactun ..faciL Feet F: .8 ty) , s Furnished by y I A 6 l , � I 1 ! a b �.N _ -57 t H , •YC r 6 c �t r = I �r � to , r E 1 6 3 TOWN.OF BARNSTABLE LOCATION ISD C= (,,y SEWAGE # a000 —63a VILLAGE f_r3S'� 'V ASSESSOR'S MAP & LOT .IYo I�IO INSTALLER'S NAME&PHONE NO. ir SEPTIC,-TANK CAPACITYf��'� LEACHING FACILITY: (type(Q FIt; i C.Y�` ta✓5 .lfo?v (size.)- It? NO. OF BEDROOMS '1 ,a BUILDER OR OWNER— � � 60,Ir��6C PERMITDATE: I COMPLIANCE DATE: ✓Or al l2a. ) Separation Distance Betwee. 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 a r, N 4 ,ram, No. 2,6,3 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Z(pprication for Migooar *pgtem Con5truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.-A/sd CA�77' 1311Y jra Owner's Name,Address and Tel.No. 7 Z/— /Q Ya Assessor's Map/Parcel `L//)/1/ /_ 10 _/7j/s?�S Installer's Name,Address,and Tel.No. tD �4 ^ 0` -13 Designer's Name,Address and Tel.No. 3 Type of Building: G Dwelling No.of Bedrooms .j1Y Lot Size k3`d ?3 sq.ft. Garbage Grinder(4V) Other Type of Building"_44C44 - No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 1 W gallons per day. Calculated daily flow gallons. Plan Date l0 &8 r' Number of sheets Revision Date Title Tr Size of Septic Tank Adoo Type of S.A.S. f Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: �s The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system . in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b is of floAlth. Signed Date Application Approved by �G Date o z3 ^Zcra� Application Disapproved for the following reasons Permit No. Date Issued No �� `^ _ 4i�.r--`Iff :Fee' �.� THE COMMONWEALTH OF Mi4SSA��HU''SETTS Entered in computer: Yes PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE., MASSACHtlSETTS' 01ppYicatiou for �Digpooar *pgtem Congtruction Virmit - Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) . ❑Complete System O Individual Components Location Address or Lot No. 5(� ,L:dI5 T /J/�`/ R Owner's Name,Address and Tel.No. '7'/' /Q YQ Assessor's Map/Parcel /uO / ` J: Installer's Name,Address,and Tel.No. 11 (O�'rQ �j — Q/ '' Designer's Name,Address and Tel.No. 3 -y 541/Ae �:'� �. �p!"7T to T!' i .!�0�!/A/•Cf1�'t G tiG. ,..�, i✓ Type of Building: DwellingNo.of Bedrooms f- a 3'k93 i( Lot Size sq.ft. Garbage Grinder WO) Other; Type of Building/// , cmu,- No.of Persons Showers( ) Cafeteria( ) Other,,,Fixtures--- may= - Design Flow M 13�f7 - '< gallons per day. Calculated daily flow (0 6 gallons. Plan Date'J n L Ia Number of sheets Revision'Mate- Title li " "-Siz of Septic Tank 1�dod Type of S.A.S. t s_, r Description of Soil '�'^�. . Nature of Repairs or Alterations(Answer,when applicable) Date last fiispected: 1 - Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewagefd''sposal system in accordance with the provisions of Title 5 of the Environmental Code,and not to place the system in operation until a Certifi- Cate-of Compliance has been issued b is o of HpAlth. / Signed Date O IV gr Application Approved by Date o Z 1D Application Disapproved for the following reasons �. 4 t i Permit Noe � _6?$r Date.Issued -.---------.-_-_----------------------- 'x, t THE COMMONWEALTH OF MASSACHUSETTS ' BARNSTABLE, MASSACHUSETTS � � . _ Certificate of- Compliance t THIS IS TO CERTIFY,that th On-site Sewage Disposal System Constructed( V/ Repaired( )Upgraded( ) Abandoned( )by at^10 gd S T ,3 A Y 9Z) n S 742 V(C.L C has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.-r4w- G3 dated I°lZ il-e-vim. Installer MA/bY Designer n17Wd/GA+PC A,16ta/65�'-lA146 The issuance of this�ermit shall not be construed as a guarantee that the system will function::[(dLisigned. Date �f� 2(nl t � a 1 Inspector �' k) T -----/ -------------------------------1--- No. Fee�w qo , /G THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migpoai 6pgtem Congtruction Permit Permission is hereby granted to Construct(V�Repair( )Upgrade( )Abandon( ) System located at /5 0 Ell'S 7 619-1 91). .0 5 T E 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. t t" Provided:Construction must be completed within three years of the date of rmit. Date: r Approved< ,` � % � F F DATE: 12/2.1/98 PROPERTY ADDRESS: 450 ft9t Bay Road Osteryille ,Mass . r U2655 On the above date, I Inspected the septic eystom at the g ss• This system conslsts of the following: 8 1 . 1-1500 gallon septic tank. , ro 2 . 1-Dist'rib:ution box ,/� 3. 2-Precast leaching pits . 41 • Based bn my Ineoaction, 1 certify the following con one 4. This is a title five septic system, f )§ 'Code ) 9 5, The septic system is in' •proper. working order A~ at the present time . ` 6. Pum.ped septic tank .at .ti'me of inspection. 81CNATUM7 Name ' J . P�H:acomber Jr;,_ • i ; . , Company'_' P_ —MacorQber & ;on•`Inc r Address' " __Cent_e�rv,�1LeL1•jgsyi_Q2b32• '' � ' ,, Phone: �Sag� 338------- -- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER '& SON, IN T+nkvC.upooIkL#achflelds Pump+d & InstsllW ' Town Sewer Connections P.O. Box 66' Centerville, MA 02632.0066 77.5.33M M-6412 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY COXE Secretar3 ARGEO PAUL CELLUCCI DAVID B. STRMSF Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Proparty Address: 150 East Bay Road Name of o Dr John Arthur Ostervilla ,Mass. 02655 Address of Owner: O Daft of Inspection: 12/19/9§ s e r v i e , ass . Name of Inspector:(Please Print) o s e ph P.Macomber Jr. 02655 1 am a DEP approved system inspector pursuant to Section 15.340 of T-rtie 5(310 CMR 16.000) CompanyName: J.P.Macomber & Son Inc . MaMVAddress: Box 66 Centerville Mass . 02632 Telephone Number: 508-775-3338 CERTIFICATION STATEMENT I certify that I have personally Inspected the sewage disposal system at this address and that the information reported below,is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: ,Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: Data: �✓`� The System Inspecto shall submit a copy,of this Inspection report to the Approving Authority(Board of Health or DEP)within thirty (30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the Inspector and the system owner shall submit the report to the appropriate regional office of the Department of*Environmental Protection. The original should*be.sent to VV system owner•and copies sent to the buyer,If applicable,and the approving authority. . NOTES AND COMMENTS Detailed information on pages 11A & 11B revised 9/2/98 Pagel of11 0 J Primed on Recycled Paper SUBSURFACE SEWAGE DISPOVI L SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PropeftyAddrers: 150 East Bay Road Osterville ,Mass . Owner: Dr . John Arthur Daft of inspection: 12/19/9 8 INSPECTION SUMMARY: Check A, B, C, of D: A. SYSTEM PASSES: 6l I have not found any information which Indicates that any of the failure conditions described in 310 CMR 16.303 exist. Any failure criteria not evaluated are Indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: A_ 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. Indicate yes,no,or not determined(Y,N,or NO). Describe basis of determination in all Instances. If "not determined", explain why not. The septic tank is metal,unless the owner or operator has provided the system Inspector with a copy of a Certificate of Compliance(attached)Indicating that the tank was Installed within twenty(20)years prior to the date of the inspection; or the septic tank, whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration, or tank failure is Imminent. The system will pass Inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed In the distribution box is due to broken or obstructed pips(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipes)are replaced obstruction is removed distribution box is levelled or replaced - The system-required pumpMg-more then—four—times v yeardue to broken or obstructed pipe(s). The system wiilpass— Inspection If(with approval of the Board of Health): - broken pipes)are replaced obstruction is removed revised 9/2/98 Page 2or11 s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 150 East Bay Road Osterville , :Mass . Owner: Dr . John Arthur Date of Inspection: 12/19/9 8 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING W A MANNER WHICHlMLL.PRQZFCT THE PUBLIC HEALTRAND SAFETY AND THE ENVZONMENT: Cesspool or privy is within 50 feet-of 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 AND SAFETY AND THE 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. �1 The system has a septic tank and soil absorption system and the SAS Is within a Zone I of a public water supply well. 41Q The system has a septic tank and soil absorption system and the SAS is within 60 feet of a private water supply well. �1Q The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 ppm. Method used to determine distance . 414 (approximation not valid).- 3) OTHER revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 150 East Bay Road Osterville,Mass . owner: Dr . John Arthur Date of Inspection: 12/19/9 8 D. SYSTEM FAILS: You must indicate either"Yes" or"No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No/' !� Backup of sewage intofecility.or••aratem compone"due�to en overloaded orcbgged SAS orcesapool. �--' 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 th distribu' nRbox above outlet invert dye to an overloaded or clogged SAS or cesspool. Liquid depth in less than�9"below Invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped�L• Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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 I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for ••coliform bacteria,volatile organio-compounds, ammonia nitrogen-and nitrate nitrogen. - E LARGE SYSTEM FAILS: 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes N iy2 the system is within 400 feet of a surface drinking water supply /Y6 the system-is-within 200(eetof-a4v4mtary4oaaurfoo"gnk4ag•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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4of11 1 I 1 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 150 East Bay Road Osterville ,Mass . Owner: Dr. John Arthur Date of Inspection: 12/19/9 8 Check if the following have been done:You must indicate either"Yes"or"No" as to each of the following: Yes No/ Pumping information was provided by the owner, occupant,or Board of Health. _ None of the system compooants kawbwn purnped4apatJeast two-aweWw aadthe•system hasbaeovsceiaingwasmal flow rates during that period. Large volumes of water have not been Introduced into the system recently or as part of this Inspection. As built plans have been obtained and examined. Note If they are not available with N/A. The facility or dwelling was Inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was Inspected for signs of breakout. _ All system components excluding the Soil Absorption System,have been located on the site. _ The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid,depth of sludge,depth of scum. — The size and location of the Soil Absorption System orrthe site has been determined based on: Existing information. For example, Plan at B.O.H. _ Determined in the field(if any of the failure criteria related to Part C Is at Issue,approximation of distance is unacceptable) 115.302(3)(b)) _ The facility owner.(and.n�-1-11p.nt_e.1 difer pt from.oanerlaeere. rc�idad.wihInfnrmatioa nn t proper_mi t i SubSurface Disposal Systems. I revised 9/2/98 Page 5of11 a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 150 East Bay Road Osterville ,Mass . Owner: Dr . John Arthur Date of Inspection: 12/19/9 8 FLOW CONDITIONS RESIDENTIAL: Design flow: ZI g.p.d./bedroo Number of bedrooms ldesigp? Number of bedrooms(actual): Total DESIGN flow ((�o���p Number of current residents: Garbage grinder(yes or no): Laundry(separate system) (yes or no):,a; If yes,separate inspection,required --. Laundry system inspected (yes or n0) Seasonal use(yes or no)-AL r (� Water meter readings,if available(last two year's usage(gpd): 7 ✓n _� Sump Pump(yes or no): �1G6 �� �. rO i Last data of occupancy: D �' COMMERCIALANDUSTRIAL• Type of establishment: Design flow: a arid ( B��on 15.203) Basis of design flow Grease trap present:(yes or no)10 Industrial Waste Holding Tank present:(yes or no)A�4 Non-sanitary waste discharged to the Title 5 system:(yes or no)A9 Water meter readings,if available: - Last date of occupancy: " OTHER:(Describe) A1,V Last date of occupancy: GENERAL INFORMATION PUMPING RE CO DS and source of inform�aJtion: Al aT�Ol l�s Allso I x /Z=& 9 AwW System pump d as part of ins ection:(yes or no) eS If yes,volume pumped:y-104 allon� Reason for pumping: 97�¢JW�Y Ja�ld sk°I^� TYPE SYSTEM Septic tank/distribution box/soil absorption system N Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) A)4 I/A Technology etc.Attach copy of up to date operation and maintenance contract ,V(j_ Tight Tank Copy of DEP Approval Other ty APPROXIMATE AGE of all components, date installed{if known)-and_ source o 4Rformation: - A19V Sewage odors detected when arriving at the site:(yes or no) revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Mass . Property Address: 150 East Bay Road O s t e r v i l l e , owner: Dr . John Arthur Date of Inspection: 12/19/9 8 BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction:_cast iron Y 40 PVC_other(explain) Distance fro private water supply well or suction line/_ Diameter Comments:(condition of joints,venting,evidence of leakage,-etc.) in System is ve te through SEPTIC TANK-. Q (locate on'site plan) d Depth below grade: 0 Material of construction:_con — —Fiberglass Fiberglass _Polyethylene_other(explain) If tank is Inetal,list age Js.age•confirmed by Certificate of Compliancel9 (Yes/No) Dimensions: M r btl 4r��'�lo',Ioee Sludge depth: _. Distance from top of sludge to bottom of outlet tee orbaffle:—c— Scum thickness:,_ Distance from top of scum to top of outlet tee or baffle:Q Distance from bottom of scum to boltn of outle tee or baffle: How dimensions were determined: Comments: (recommendation for pumping,condition of inlet and outlet tees or-baffles,depth of liquid level in relation to outlet invert, structuret4ntegrity, evidence of leakage,etc.) -Pump Sept i r tank n n n ii a 1 1 u e a r ha ae d' Sp 6 S Q 7 is present Inlet & ontlpt fees are nreeent GREASE TRAP: 17� (locate on site plan) Depth below gradew/1 Material of constructionll#concrete`i metal V FibergiaWV14 Polyethylene( other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle:4)4 Distance from bottom of scum to bottom of outlet tee or baffle:�� Date of last pumping: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) Grease trap is not present -- revised 9/2/98 Page 7orit SUBSURFACE SEWAGE DISPOSAI,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ProwtyAddrww: 150 East Bay Road Osterville ,Mass . Ownw: Dr. John Artur Date of)nspecfm: 12/19/9 8 TIGHT OR HOLDING TANK-yL4 G(Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade: Material of construction:d,concreteametaWA Fiberglass i0 Polyethylene/aother(explain) A!R R Dimensions: Capacity: A/A gallons Design flow: A/A gallons/day Alarm present_ Alarm level: .UA Alarm in working order:Yes A No 0 Date of previous pumping: A/A Comments: (condition of inlet tee, condition of alarm and float switches,etc.) Tight or holding tnnkq are not Pz---„+ DISTRIBUTION BOX:_L/ (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note-if level and distribution is equal,evidenoe of solids carryover,evidence of leakage into or out of box, etc.) — -— Box signs of solid garbage disposal--No evi denra of 1 eakaga into or- eilt: e€ the box. PUMP CHAMBER:L&e (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) umD chamber iq not prPqPUt revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ProWtyAddress: 150 East Bay Road Osterville ,Mass . Owner: Dr . John Arthur Data of Inspection: 12/19/9 8 �y SOIL ABSORPTION SYSTEM(SAS). —LM (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Type: leaching pits,number: leaching chambers,number: —g leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimension overflow cesspool,number: Alternative system: Name of Technology: �. Comments: �ote condition of soil, signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc.) oamy sand to boney meduim sand . No si ns of hydraulic failure F-rponding . Soil is not damn Vegetation is normal - CESSPOOLS: (locate on site plan) Number and configuration: O Depth-top of liquid to inlet invert: Depth of solids layer: A.o Depth of scum layer: A/W Dimensions of cesspool: A/A Materials of construction: A114 Indication of groundwater: A/A inflow(cesspool must be pumped as part of inspection) o Cesspools are not present _ Comments: (note condition of soil, signs of hydraulic failure,.level of-pending,condition of.vegetation, etc.) Cesspools are not present , PRIVY:iL tl — (locate on site plan) Materjals of construction: 1640 Dimensions: low Depth of solids:_Wl?- Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,etc.) Privy is not present revised 9/2/98 Page 9orii z� v � � �i 4ri � 03n.SSl 33NVIldNO3 31VO 0 03nSS1 llWV3d 31VO N3NAA0 VO . V3011n / SS3NOOV t 3 N V N S.V311 VISNI / 35V111n -61 'ON 11MV3d 39VM3S 'i011V301 ( �� P / 'r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:150 East Bay Road Osterville ,Mass . owner: Dr . John Arthur Date of kwpecti°": 12/19/9 8 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Cellar Shallow wells i Estimated Depth to Groundwater // Feet Please Indicate all the methods used to.determine High Groundwater Elevation: Obtained from Design Plans on record Observed.Site(Abutting property nervation hol asement sump etc.) determined from local conditions Checked with local Board of health Checked FEMA Maps �hecked pumping records _.$-/Checked local excavators,Installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Used water contours map . 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AC14 t NC& J THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �C�l�t/l�/................OF.......[JS%? 3�`� .......................... Appliratinn for Uinponttl Works Tonntrur#inn Urrmit Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal System at: lzvi..�� Lo-r 2 Location•All ess `1 or U Nq. U.t..................... ............... !►1.si....�.�At�i... ......................................... Owner Address W Installer Address Type of Buil ' ¢ Size Lot..8._Z.2. O ..---......Sq. feet Dwelling[—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (►�) P4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ---••-•••••--•-•-•-•••......................... W Design Flow..............55..................... per person per day. Total daily flow.......!"..Q........................gallons. WSeptic Tank—Liquid capacityt/-500..gallons Length.lO."6. Width.,. ../d".. Diameter.4.6 Depth..,/,...<3.".. x Disposal Trench—No..................... Width................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......Z.......... Diameter.......6._........ Depth below inlet.../0. ....... Total leaching area..?�..41.......sq. ft. :f Z Other Distribution box (✓) Dosing tank ( ) Percolation Test Results Performed by...... T Date...Z.- 2 ,a Test Pit No. 1.G..Z.....minutes per inch Depth of Test Pit...... Depth to ground water....NOT: t14 Test Pit No. 2.`-.O.....minutes per inch Depth of Test Pit...... ...... Depth to ground water.Dp R' ...........n3 SC.'---....... O • ! 6—4 t.< .. �5 ���c_ Z...... „ LG7y, 5� Sc ,... Description of Soil----------------•----•----._.................----...--�--•--....................-•--•--......... Q.'.-•---............---•--•---- .............................. V .................. '`!2'.M :.CcJ�::s-s_ 5.4..i1> >�'�'.::.�.�::M`:%t>:.�'<s�S�-5.�1.✓t� ... ........••-•.......... W !►gv/5!= S ?✓?�..!3i.... 7773?�!1............................1 ..-lit?` ? � nz!� VNature 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 'TT 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 koard of health. Sig ............ ...... .. ...................... . . Date Application Approved By........ .. - . .. . . .d ={ 'Z.�..-�� ------- Application Disapproved for the following reasons:........................ ....................................................................................Date — •--•----....-•----•••--•-•---.....---•................••••-••--•-------•---...........................---.•--•-•......................-----•.....---•••••-•----..............................•-•-•-•••--- Date PermitNo......................................................... � � Issued_ ---� .................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF........ ....................................................................... Tntifiratr of Tomplianu THIS IS TO CERTIFY, That the Individual Sewage Disposai System constructed ()-Z) or Repaired by.�a......... ... ........................................ ................**........... .......*-----------------*..................... ------------*------ ....... a"e' ......................................... a has been ini/tIlle'd in accordance with, the provisions of 5 rb J 'b d �FT7��T 9 The State Sanitary Code a s e din the application for Disposal Works Construction Perini- No. ... .......... ............ &teO......... ............................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS�T"ED AS A GUARANTEE THAT THE SYSTEM W L.,FUNCTION S TISFACTOR'Y. . . ......... .. . ..... ' 0. ....... .. DATF ......... Inspector...... ....... ............. ....... -—-------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH VIY1 tVI-57-7 ............................. ...........OF...... No............,,?....... MqVnBal Workn Tvmi udixlin "amit Perinissionk i ............................................................. ........................... ....................... is gran:ed... to; Construct or R it an,.Judivi-lual Sawage Ws�osal Sys at No...•t. Z' a-'4,/. .........4J!f ....... .............................................. Street as shown on the application for Disposal Works Construction Perqt No._. Dated... --- ........................ Board of Health DATE.................................................................................. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS 1 T4 >•Trnn.rntTfP•n-n- rnrarrr•nls+rerTrta�rLle,ltr,7+•+1►s.rttr�•*�+'efln nrAlY sa.'RTYfsT •• • � TOWN OF Barnstable BOARD OF HEALTH 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION JI `- �"•Tn-.•:-::.-T.,,.-.-,-Ar,...1•R.,A(,SIN,.r..w•'R„-rS,.,n..R..TOf-•r.,.......A.,.�...R..,.=7 ,.,,.r N,.-=•,•-•r•--•,_,•"' i -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 150 East Bay Road Osterville ,Mass. ASSESSORS MAP, BLOCK AND PARCEL # �(D OWNER' s NAME Dr . John Aorthur PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Sdn *Inc . COMPANY ADDRESS Box 66 Centerville ,Mass . 02632. Street Town or CSty State LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790- 1578 R CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposaj system at this address and that the information reported is true, accurate , and complete as of the time of.-inspection . The inspection was performed and any recommendations 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: Syste6 PASSED The inspection which 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 FAILED* The inspection which I have con tcted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , Inspector Signature e l Date One copy of this Fntdthe ification must be provided to the OWNER, the BUYER ( where applicable DOARD OF H8ALTH. * If the inspection FAILED, the owner or•"hoperator shall u d within one year of the date of the inspection, unless allowed ortrequiredm otherwise as provided in 3.10 Cmn 15 . 305 . partd.doc Nov-25-98 09 :50 BARNSTABLF_ HEALTH DEPT 5087906304 P. 01 DATE: Ns`J\ ' FEE: it 2$ REC. BY � . . RECEIVE y �--� owwrn of Barnstable D EC 1 0 1999 ScxEU. DATE: 9ard of Health TOWN OFBARNSTW b HEALTH DEPT '7 6 ��lAM Street, Hyannis IMA 02601 i Office: Susan G.Rack.R.S. FAX: 338.790-6304 ,--�'"� Sunrer Kaufrran.M.S PH. Raipt A.Murphy.M.D. r VARIANCE REQUEST FORM LOCATION /� P-oper;;Address: �7O L A•C=t YJAC1, go"-� oST�enot VCR/ Assessor's Map and Parcel Number: I jota Size of Lot: 4�Z'3 SF_ Wetlands Within 300 Ft. Yes Subdivision,Name: tLLJA No Business Name" —.— - APPLICAVI' CONTACT PERSON Name: JOjk" wQ�L � Name: _ 5 aA z�w O��L.- Address: t le t�tt �T y ca..-� 1J� yut�.�., Address: S1 P^one: l-�1�j( - tk�r-f- "1 3fL � Phone: �fJ Li 54 I FAX: FAX: 34 \O r7 VARIANCE FRO'd'LR£GiiLATIOt�!.�is res.l REASON FOR VARIANCE(May a-tsch if more spate lesdet) 1�e eJ►t�SSLoP.s__5 - — 1f.l•-A�e a:omP'ere J by e,T%e srgt7-person recen-mg variance requev opplic•ar:on) � l!`iJ� )1L Four(4)copies of plan submitted%including Peptic system;tans ancUor restaurant floor plans) I Applicant::r:derstands that the abutters must be notified by certified mail at least ten days prior to m=grin, date a:apo:icari s expense(for Titte V and/or local selvage regulation variances only) Full menu submitted(for grease trap van ances only) t Variance request application tee collected(,n%n fo,Lfeiwrd Tcdif atioc rc—als.irate trio vananu rex a!;t—e wret:lezee or,+]a✓s.d: an n3 yai Is tsaarc_t7:;mum onH;,ate va—rim;o mair failed sewage dnoo,a:eptrnu t-n!r,r u enpen.io+to the b„iJlag creposed}) Varian- west ubrnitte at least t 5 days prior to meeting date i V.ARIANC- APPROVED Susan G.Rask,R.S.,Chairman ti0T.APP '3 Sumner Kaufman.M.S.P.H. REASON R Dl ROVaL__ _ Ralph A.Murphy-'A.D. tel.(508)362-4541 939 main street rt 6a fax(508)362-9880 yarmouth port mass 02675 down cape engi/leering s civil engineers& land surveyors structural design .a a Arne H.Ojala P.E,.P.L.S. Timothy H.Covell,P.L.S. land court December 7,-1999 Daniel A.Ojala,P.L.S. surveys - Barnstable Board of Health site planning 367 Main Street Hyannis,MA 02601 sewage system Re: 150 East Bay Road, Osterville designs Dear Board Members: ' inspections On behalf of our client,we,hereby request permission to construct a 6 bedroom dwelling on the above-referenced site. ,(The sixth`bedroom"is actually shown as a permits "sitting areaAoft"over the garage.) There exists at present, a 4 bedroom dwelling which is slated for demolition.`-,The lot contains,83,873 square feet(1.93 acres)and lies within an Aquifer Protection District. r application area of 988 ,square feet in conformance Y, The se stem i s designedbased on an PP with the;Board of Health regulation Part VIA Section 10(regulation pertaining to the construction of on-site sewage disposal systems when within 250' of wetland and within 14%to groundwater.) Thank you for your consideration. ry Very'truly yours, Arne H. Ojala,PE,PLS Down Cape Engineering, Inc. cc: John Gallagher �f , l LIP Ep 4 , P 601 046 991 US Postal Service Receipt for,.Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sent to Street& r ost Office;State,&ZI P Cod Postage Certified Fee Special Delivery Fed 2—0 7�' y Restricted Deliver egv rn Return ReceiQt t�1g to > uj Whom&DatAt•• ekd` n Return Receipt ShoGiing Whom, Q Date,&Addressees X�J. J 0 TOTAL Postage&ees Postmark or Date lL a. Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1.if you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service a window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the Q) return address of the article,date,detach,and retain the receipt,and mail the article. u7 3. ff you want a return receipt,write the certified mail number and your name and address co rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article 4 RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee,endorse RESTRICTED DELIVERY on the front of the article. Go M 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. to 6. Save this receipt and present it if you make an inquiry, kA a P 601 046 996 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sentto Street& umber sit Offif ,Stat ,A ZIP C Postage Certified Fee SpeclW Delivery Fee Restricted Delivery Fee u') Return Receipt Showing to Whom&Date Delivered Q Return Receipt Showing to Whom, Q Date,&Addressee's Addr 0 TOTAL Postage .t M Postmark or D tee O a Q � Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1.if you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service m window or hand it to your rural carrier(no extra charge). m 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the Q) return address of the article,date,detach,and retain the receipt,and mail the article. N. 3. If you want a return receipt,write the certified mail number and your name and address °) rn I on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee, or to an authorized agent of the C addressee,endorse RESTRICTED DELIVERY on the front of the article. op M 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. li 6. Save this receipt and present 4 if you make an inquiry, Cl) P 601 046 994= US Postal Service Receipt for Certified Mail No Insurance Coverage Provided.. Do not use for International Mail See reverse Sent to um t0 Off Stat C e /t P Postage Certified Fee Special Delivery Fee �2v Restricted Delivery Fee ,n . Return Receipt Showing for Whom&Date Delivered Io' ih Q Return Receipt Showing to Who Q Date,&Addressee's Address re 0 TOTAL Postage&Fees �$ e ch Postmark or Date o UZ co a. i Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1.If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving.the receipt attached,'and present the article at a post office service m window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return address of the article,date,detach,and retain the receipt,and mail the article. 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee,endorse RESTRICTED DELIVERY on the front of the article. 00 M 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If retum receipt is requested,check the applicable blocks in item 1 of Form 3811. Ui 6. Save this receipt and present it if you make an inquiry. rn a P 601 046 992 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sentto Street fNumber 8 V ti Post Office,State,& IP Cod t?c¢J v— Postage Certified Fee Special Delivery Fee Restricted Delivery Fee/ry, kn _ Whom&Date Receipt redo Retum Recegrt Showing ro YV1iom,, f fate,&Addressee's Addressa 0 TOTAL Postage&Fees CO) Postmark or Date 0 tr_ U) a Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1.If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service m window or hand it to your rural carrier(no extra charge). m 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the m return address of the article,date,detach,and retain the receipt,and mail the article. ' 3. If you want a return receipt,write the certified mail number and your name and address fon a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article �q f` RETURN RECEIPT REQUESTED adjacent to the number. R 4. If you want delivery restricted to the addressee, or to an authorized agent of the C addressee,endorse RESTRICTED DELIVERY on the front of the article. q M M 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested;check the applicable blocks in item 1 of Form 3811. t LE 6. Save this receipt and present it if you make an inquiry. CO)! CL �' 1 P 601 046 998 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Se to &Nujpber � ( Po te,& IP C Postage Certified Fee Special Delivery Fee Restricted Delivery Fee r N� 01 Return Receipt Showing to'- Whom&Date Delivered f a Return Receipt Stowing to y Q Date,&Addressee's Address 0.1 0 TOTAL Postage&Fees M Postmark or Date 0 co a Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1.If you want this receipt postmarked,slick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service y window or hand it to your rural carrier(no extra charge). m i 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return address of the article,date,detach,and retain the receipt,and mail the article. to 3. If you want a return receipt,write the certified mail number and your name and address °) rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. n you want delivery restricted to the addressee, or to an authorized agent of the G addressee,endorse RESTRICTED DELIVERY on the front of the article. co 5. Enter fees for the services requested in the appropriate spaces on the front of this C9 receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. LL 6. Save this receipt and present it if you make an inquiry. rn a __ i W'IV .f� P 601 046 997-', US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sent to Street&Num P Office,State&ZIP C op 9e Certified Fee Special Delivery FeeLO Restricted Delivery Fee ©- Return Receipt Showing to Whom&Date Delivered Rehm Receipt Slowing to Whore, Date,&Addressee's Address TOTAL Postage&Fees $ evf Postmark or Date ti a Stick postage stamps to article to cover First-Class postage,certified mall fee,and charges for any selected optional services(See front). 1.If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service m window or hand it to your rural carrier(no extra charge). m 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the m return address of the article,date,detach,and retain the receipt,and mail the article. LO 3. If you want a return receipt,write the certified mail number and your name and address rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends 9 space permits. Otherwise,affix to back of article. Endorse front of article _ RETURN RECEIPT REQUESTED adjacent to the number. I 4. If you want delivery restricted to the addressee, or to an authorized agent of.the C addressee,endorse RESTRICTED DELIVERY on the front of the article. C CO S. Enter fees for the services requested in the appropriate spaces on the front of this M receipt. If return receipt is requested,check the applicable blocks in hem 1 of Form 3811. o <L 6. Save this receipt and present it If you make an inquiry.' CO a SENDER: v ° ■Complete items 1 and/or 2 for additional services. I also wish to receive the a, ■Complete items 3,4a,and 4b. following services(for an ■Print your name and address on the reverse of this form so that we can return this extra fee): I card to you. ai ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address permit. d ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery « ■The Return Receipt will show to whom the article was delivered and the date a c delivered. Consult postmaster for fee. o d 3.Article Addressed to: C, 4a.Article Number Co.4)iTi3�✓G�. 13egaS 4b.Service Type P Y47 c°+ �s?j�/J�Cew/�2 V/�� ❑ Registered Certified W In ❑ Express Mail ❑ Insured c UJI ❑ Return Receipt for Merchandise ❑ COD rn G 7.Date of Delivery w 5.Rece ad By:(Print Name) 8.Addressee's Address(Only f requested c W and fee is paid) r U 6.Sign t e:(Addressee o gent) ~ 0 T X M Ps Form 3811, D cember 1994 102595-97-6-0179 Domestic Return Receipt UNITED STATES POSTAL SERVICE MAWf�7 First Class Mail P-armit o. G- - • Print your na e, AiI&t 6 nd ZIP Code in h,is��_� THE BSC GROUP-NORWELL, INO, 293 WASHINGTON STREET .NORWELL, MA 02061 � ai SENDER: I also wish to receive the 'a ■Complete items 1 and/or 2 for additional services. m ■Complete items 3,4a,and 4b. following services(for an I EPrint your name and address on the reverse of this form so that we can return this extra fee): card j ■Attach this forth to the front of the mailpieoe,or on the back if space does not 1. ❑ Addressee's Address permit. l m ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery r ■The Return Receipt will show to whom the article was delivered and the date a c delivered. Consult postmaster for fee. 0 3.Article Addressed to: 4a.Article Number 0 ccEI��Cir'C, 4b.Service Type d 0 0 ❑ Registered Certified W U) >" �%`� ❑ Express Mail ❑ Insured o, W / El Return Receipt for Merchandise ❑ COD a ^ 7.Date of Deli e I Z ¢ 5.Received By:(Print Name) 8.Addressee's Agldress(Only if equested c and fee is paid) r g 6.Signature: (Address a or Agent) ~ � 0 X j � PS Form 38fl, December 1994 102595-97-B-0179 Domestic Return Receipt I _ First-Class Mail UNITED STATES POSTAL SERVICE POSta98&F88S Paid- USPS Permit No.G-10 ® Print your name, address, and ZIP Code in this box N I THE BSC GROUP—NORWELL, INC. 293 WASHINGTON STREET NORWELL, MA 02061 I �4 111,����1�1ffi�„ail,�;,�fl„�111►��:l�.i.l���I11�l�,►�iL�1►�I�I d SENDER: I also wish to receive the o ■Complete items(and/or 2 for additional services. m ■Complete items 3,4a,and 4b. following Services(for an ■Print too ou.ame and address on the reverse of this form so that we can return this extra fee): 0 d ■Attach this form to the front of the mailpiece,or on the back if space does not permit. 1. ❑ Addressee's Address v � y ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery to r ■The Return Receipt will show to whom the article was delivered and the date .. iConsdelivered. ult postmaster for fee. a a 3.Article Addressed to: 4a.Article Number d 'WE�2/3i✓,� CU-�rnZv- � rxl -d E 4b.Service Type d u A �j ❑ Registered Certified �c��� ❑ Express Mail " ❑ Insured .E UJI G Re i❑ Return pt hVi OD o 7.Date of D e p 5.'Received By:(Print Name) 8.Addressee's Address(Only if requested W and fee is paid) t 6.Signature:,(Addresse rAgent), { �' rX ; �2 ,l�i iI � CP PS Form 38.11, December 1994 Domestic Return Receipt 1 UNITED STATES POSTAL SERVICE u`f"ER {�LEAS -P IAI u cr E A R L 'P0011o. o Print your name,qcr&e§s d ZIP Co e ' i o THE 13SC GROUP-NORWELL, ING, 293 WASHINGTON STREET NORWELL, MA 02061 a� I1l���„i,{Il��►,{l��,��ll.,�ll1��,f��1,1�,�1!!�l��►�!!,!„I�! N&... THE COMMONWEALTH OF MASSACHUSETTS BOARD ' OF HEALTH -ro AN................oF........� n/� ............................. Appliration for Disposal Workii C oustratrttnat Vantit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ----------------------------------------------- --------------------------------------------- -------------------------------------- .................................... Location-Ad ess or Lo N 1�.A.` ------------ --.:.......-•-- � :f...._W._._`a....------------....-•----.........:---.. Owner Address a ••--••••---•----••..._...--••-•-••--•-----•-------...•------------------------•---------..._------ --•----•----------••••-•--•-•-•-----------.........-•-•-•.....-•-------•--...•--•---•---•---••=••. Installer Address Type of Build No. of Bedrooms_ ................................... ,,// Size Lot. Z�..�..o_.__._Sq. feet U Dwelling __..._._`................................Expansion Attic ( ) Garbage Grinder (✓) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures --------------•_--_------___-__•_. W Design Flow..............55.....................gallons per person per day. Total daily�flow.._...!9 0.........................gallons. W Septic Tank—Liquid capacity-500--gallons Length�0-'6._.._ Width_.5_ ..... Diameter_..f 6.". Depth_ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......Z--_______. Diameter....... _ ----__- Depth below inlet.../L9.�____.. Total leaching area._� . ft. Z Other Distribution box (✓) Dosing tank ( ) '~ Percolation Test Results Performed by_._.,_�=. .:..5 �. ............................... Date.._Z_...Z�.r d_...._.. aTest Pit No. .....minutes per inch Depth of Test Pit------ j_..___ Depth to ground water----N6Y' Test Pit No. 2_G_Z__...minutes per inch Depth of Test Pit...... ........ Depth to ground water.D a -------------------------------------------------------------------- ------••---------------------- ..._......----------------- ---------•- Description of.Soil, 4 F' `�!�3�rJ�(� ...............................Lh-�� �S...............................3 So", —!2' Mv�_-..............................................s� . J /44"N1 G'c3k S S!9r✓� U --------------- W --------------- ...................................................t AD. '...�'.�----7i6!1.-----_------- ^�-- '- --- 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 T-IT p LIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system to operation until a Certificate of Compliance has been issued by the board of health. f Sig ...................... ............................... Date Application Approved By........ . .......----- Date Application Disapproved for the following reasons:........................ --•-----•----------------•--•-----•----•-----•--•---------•----•-•••........._ r' --Datc--`---- PermitNo......................................................... I ! Issued-�...� ......------•---..... Date � 4 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ` OF.........:................................................................................ Apptir�ation for Bii#o,ial Works Tontrurtion ramit Application is hereby made for a Permit to Construct (1/) or Repair ( ) an Individual Sewage Disposal System at: ..... -•------•--.......................................... --- ......-6,--------------------- --------------------------.--...... ------•-----•-•------•-----•-----------•------------------•- Location-Address or Lot No. ....•--•----•.................................•---..............----•-..............._............ ................--•---..•---••--•--•._.....••---..............---................................. Owner Address 14 Pa Installer Address r d Type of Building Size Lot&Z..7.6 Q......Sq. feet Dwelling—No. of Bedrooms........�................•.............Expansion Attic ( ) •,: Garbage Grinder (✓) '_lPL4 Other—T e of Building No. of persons............................ Showers — Cafeteria a � Other fixtures ------------------------------------------------------------------------------------------------------------------------------------=•--------------• W Design Flow.............65......................gallons per person per day. Total daily flow......i-4Q..........................gallons. q p /,500..gallons LengthJO"6" .�"�_. Width.. -2 -_-`� Diameter-4. .?�6.".. Depth._ - .�`.. W Septic Tank—Liquid ca acrty Disposal Trench—No..................... Width................._.. Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No......2---------- Diameter-___---.......... Depth below inlet .�_..__.. Total leaching area. ....... ft. z Other Distribution box (✓) Dosing tank ( ) Percolation Test Results Performed by...... _._r ' _ _{ ? ?`................................ Date... .'. ........ ,aa Test Pit No. .____minutes per inch Depth of Test Pit-----w�z?_-.____-. Depth to ground water----MQr......... Test Pit No. 2 4.9.....minutes per inch Depth of Test Pit.....t��:____: Depth to ground water.�M................. ---------------•---------•--•-------•-•----------•--•--------•------------------:-------------------------------------...... -------------- O Description of Soil J ''"�- r ' !c; �' �Se'r.r 0, = ��------( 6"-��-=n "='-`- �-.S'✓r.3 so/(_ . { 1 tr4 .1~ f>Y t 55. f3.."' � n " W ................................ ---------------- -- -----!1t?...t 'z " G :isrl7 UNature of Repairs or Alterations—Answer when applicable.--___........................................................ ...........:................... = i Agreement: 1A. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of f'1T��^. 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 oard of health. Sig . dlU..>'�--.._..ye-----.*W--.. --•-- - ................................ Application Approved , . � .-Dat-e BY Date-Application Disapproved for the following reasons:.......... -•--••--- .................................................... -----------------•-----------•---•-•----------------------------------------.-----------•-•--------...----•--•---•••--••-•- Date PermitNo....................... ..........••---..........----.. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... ...�".�.............OF...:.....'�`�..: ? /ST = ."'.................... (Irrtifirate of Tomplitanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed,,(( or Repaired by . .... ................. -----------....------------ --------•- -- ..... ----•----------•-•---•------------•-. at1< Yt+ '3 cS 6t �Ge!s ., ------------------------------------------ has been installed in accordance with the provisions of T� > of The State Sanitary Code as desc,r,�'bgd in the application for Disposal Works Construction Permit fro: ..___. _ ............ dated....... "._'x. `'^d.-�. ............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST E® AS A GUARANTEE THAT TIME SYSTEM W L FUNCTIONS TISFACTORY DATE.::.,.. . Inspector- e-- .. ... ------------------ THE COMMONWEALTH OF MASSACHUSETTS y BOARD OF HEALTH .................................... FEE........................ 4 NO(_.....)............... Miy out Works Tqnstrudiou famit Permission is ereby granted.............................................................................. ....................................................... to Construct ( or ReVpair ) an,Lnd victual v�vage s osal Syst . -------;;r.-- -------------------------- Street as shown on the application for Disposal Works Construction Per,'t No._ .:: __...f Dated--- ...................................n - . � .._ .-----••-••.•... Board of Health 1 % DATE.................................................................................. 71 FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS LOCUS _ IA" 11G • PRWD9CD 8VA. �9r CRATWEOARDWAV: LOT 2 , AAILB EAW WE ---v N nasxRACCES59TAIIL7 111 { .0.9 A ``` 'A LOCUS MAP SALT NARSM N1 r a .L; Id pp - 4"MDE TOABER '.CS t,'. 13 L GENERAL NOTES: 'L3T+, lA1IDIMG�9TAR9 no \i .,• •`,� •i o IA`_ LOCUS ADDRESS: .. 9CAll:,'.iao _ •\ p�. - - CENTERVILLISO EAST B[.MA 'S9Y Y ROAD N47.24'-41 T 36.28' �•1" SAIi iu®H• .' •I 3 J_.. i - RO,yo _ - -\ o'\ '.•.•.•. •. •Is ,`'. '.•..-...'.'. - ASSESSORS MAP 140 PARCEL IGG . . . . . . . �D •Q\`,\ 427y '9ALi - 1.4 ,'•\ RLPPJtENCC.LERTIFICA7l':211629 • — NST 22'SSR 134.53'_s M,R9H- . . . - ... ! ••�'- .PLAN REFERENCE:16476-B " - N86'IS'19'E 122.91' - . - r �l •. t e• 1 \ ? .. -•.•.•,, 9;urwWn.• LOT 2 . • . _ ,••\` 17 ZONING DISTRICT:RP-I '° +91 ) �."' \ \�. \ old—om^- OVERLAY DISTRICTS: m m E.I -__id `OMb:__ AP,RPOD AND MR ESTUARY .\\'\ - .. �,_ '• .. - 1 , - - ..'•: rTM , i� � _ i \ -tl�r �. 1 - \ �,,� ',\� i BI11lDMG SETBACKS: -- ' POOL t PATIO AREA I - Ja PROW YARD 4AD I S'SIDE AND REAR YARD \ \ 1- 1,C9 EL 2.6• HEJCAL ANCHORS.ATTACHMENTS AND k, -.I DAW., _ _ TIMBOt 5TRLICTURE'SHALL BE DESIGNED M�t i p \• I-. a \ \` - '�� „�".. ,1 • -_TO 5TRUCTURAL AMC)CDDC:SPECIPICATIONS ry gy OI'c BY OTHERS 0 • I - +17.8 F', \ �\ - .. PEMA ZONE:'AE'(I Z)t VE.(I4) +n.e FIRM MAP:25001 CA563J - - - - t - -•. .. �. _ .,. . .- _ -. - .. .,. ._- - ➢ _ ULY 16,2014 . ... 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' 300 t DOROmS Sr. FT 50_ • - �� DWELLING �'� { \ - - 300 BOYL570N ,APT 507.. --_.'' , - . . . . .- B05TON.MA 021 16 $FORE NAIf• +17.7 I _ _ - +17.9 nMBER ACCe99 STAIRS - i: EACH SEE W1L9[ACe1 sloe Iit Ee� 1 _ LOT 2 ^ ;,;x WETUWD CON-.ULTANT. - ARIENE VALSON A7ES,INC A.M.WRSON A55OCI \ ? 1 .• MARSRASCALLY TO LMILL5,MA 02648- 1 ro SECTIONAL VIEW A-A SECTIONAL, VIEW B-B 506420.9792 SCALE:r'-10' _ 9.2 3• p On) SCALP:I•-20' h° '\ i ¢airnocc%�w as WETLAND PERMIT PLAN z9le•AOISrs PREPARED FOR ' k 150 EA5T BAY ROAD 2Y0 CFD99 BRACE 4'.4•PC6r9 Ock*A L,4 05TERVIUP.MA55ACHU5ETT5 --Hcw,L BRACreP DATE:IANUARY 9,2018 ry -" - ' PR7109eO MIICAI ANCHOR SCALE:1' 20• �H Y PIAM QVBIONS: BOARDWALK DETAIL + N.T.S. .�,w,� s DTe,,.611 • - � � or-zo•zo:e •Awr.Lvuta+cnoR9 a DD:U- • - - ,�,'F 5TEPHEN DOYLE AND A55OCIATE5 . 42 CANTERBURY LAVE • �" EAST FALMOUTH.MA55ACFIU5ETT5 02536 TELEPHONE:508 542534 0.SJDSURVEY®AOL.COM 41 F)E33.Kt� N I L ' — 41 C . 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I s - I __ .w A x P ! f^ �, �r. r r SEP J PROFILE TEST HOLE LOGS LEGEND _ ACCESS COVER TO WITHIN 6" OF FIN, GRADE ( 10T TO SCALE) 100.0 PROPOSED SPOT ELEVATION SEPTIC DESIGN; (GARBAGE DISPOSER IS NOT ALLOWED ) C.I. ACCESS COVER TO ENGINEER; AH OJALA, PE "i FIII. GRADE DESIGN FLOW: 8-.._ BEDROOMS (110 GPD) = 880 GPD 17,0'` MINIMUM .75' OF COVER OVER PRECAST /� 2% SLOPE REQUIRED OVER SYSTEM 17 5 WITNESS: DONNA MIORANDI, IRS 100x0 EXISTING SPOT ELEVATION USE A 880 GPD DESIGN FLOW - I- 880 2 = 1760 16.0' -f;I�R PIPE R T LEVEL 2" DOUBLE WASHED PEASTONE DATE: 10/26/99 I � �c��o. 100 PROPOSED CONTOUR SEPTIC 'TANK: GPD (___) , ,\___ I`� S 2' PERC. RATE 2 M N/INCH 2SOO PROPOSED 2000 100 EXISTING CONTOUR USE A _ V GALLON SEPTIC TANK GALLON sEPT1c 15.55' 8H-20. r H-20 FLO DIFFUSORS 14.5'LEACHING: _ 15;8b' TANK (H- 10 ) GAS CLASS . SOILSp# 9576 � LDSBAFFLE 14.8'J , 0 14.0 � Cl Ir? 3,5" ® SIDES AA = 880/.75 = 1174 SF REOUIRED /'`''-� ( 2 % SLOPE) 6 CRUSHED STONE OR MECHANICAL , 0 0,96' © © / \ Q 13.0' AH AH "o�� ` EAST BAY (1 + 97) x (1 + 11) = 1176 SF �--- \ ELEV. ELEV. 4, COMPACTION. (15.221 [21) ,.. TOTAL: 1176 S,F• 882 GPD P 3/4" TO 1 1/2" DOUBLE WASHED STONE 0 17.5 0 17.0 \ DEPTH OF FLOW r � " � (._1_% SLOPE) (���:�� SLOPE) ..� USE 12 H-20 FLO DIFFUSORS WITH 3.5' STONE AT TEE SIZES: A SL A SL INLET DEPTH = 10r, SIDES AND 0.5 AT ENDS 5" 5 10YR 2/1 " 10YR 2/1 LOCATION MAP NO SCALE OUTLET DEPTH = 19 6' E LS E LS FOUNDATION- 10' SEPTIC TANK 72' - D' BOX 58' LEACHING 1OYR 4/1 / 10YR 4 1 (MAX) FACILITY 7" 7' ASSESSORS MAP 140 PARCEL 166 BW1 LS BW1 LS BOARD OF HEALTH ZONING DISTRICT: RF-1 TH 2 EL. 7.0' 12" 10YR 3/4 12" 1 OYR 3/4 YARD SETBACKS: MAFRONT APPROVED DATE BW2 BW2 NOTE: EXISTING DWELLING k4D GARAGE TO BE DEMOLISHED AND REMOVED IN ITS ENTIRETY FROM SITE TO LS LS SIDE = 15' APPROVED DISPOSAL AREA 36r' 10YR 5/8 14.5' 36" 10YR 5/8 14.0' REAR = 15' -` PLAN REF. - LCP 16476 B C R MARK 5,48 N1GN �P�E MS C FLOOD ZONE: PROP• WORK) .90 6,7 2.5Y 6/4 SOMESCOS COBBLES 6.4 Q 7.34 79 2.5Y 6/4 X 12.68 120" 7.0' 66 NO WATER ENCOUNTERED x 5 ,95 x 13.56 ABOTT. DWELL. x12, PR NT (FINAL PLACEMENT BY NOTES. NTRACTOR WITH HOMEOWNER) 0.51 NOTE: ROOF DRIPLINES TO STONE TRENCHES OR PROP, 6' BOARD FENCE WITH 1' DOWNSPOUTS TO DRYWELLS TO CONTAIN ROOF 1s,ar5 LATTICE TOP RUN-OFF 1 , DATUM IS NGVID X 1 20,51 x 10,87 X 17 2. MUNICIPAL WATER is AVAILABLE 1 PROP. POOL FENCE w 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. x 11.47 1 X 18a0 ^ ENCLOSURE, AS PER '� X 9,14 6.33 APPLICABLE REGULATIONS POSSIBLE REMOVAL OF UNSUITABLE SOIL REQUIRED AROUND 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 0 X 18.3 '92 8 c (ALAI ILA, ON H6,E,v0OiL6 E7Z) � �` � PORTION OF LEACHING FACILITY (INVERT INTO B LAYER). 5. PIPE JOINTS TO BE MADE WATERTIGHT. 20 X 11,64 x 17 X k REPLACE WITH CLEAN MED. SAND. ENGINEER TO INSPECT AND CERTIFY REMOVAL. 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. X 18, _ � x 18.13 � `� ,ter. 7.77 12291' 0.12 0 I ENVIRONMENTAL_ CODE TITLE. V. x 13.53 X 12.64 x 19.25 4 16.00 � 6 °� �. pp16,32 ,s X 18. 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE 17.5' \ ( 2 ® I - 6 _ z USED FOR LOT LINE STAKING. 19 6 20,34\\ AH t \ \ X IC xa / Q So' ° 1f�(.00 8. PIPE FOR SEPTIC SYSTEM , TO SCH, 40�--4" PVC. \ \ lg.t. ). J x 4. J u ,- i X 17,5 4, .. c.. - X 15.16 � X1 ,80 11 ,t . . L.I,.1 M h'L.)I V�I w I ,_ �V U 1 I Ll C:L. .i l X1s.1d`�5 1 \ \ �� / x13. 7 �6 ` N INSPECTION BY BOARD OF HEALTH AND PERMISSION OT�Tt� NEP a1 A 7 0 __ � � x17,70 4 8% 7 FROM BOARD OF HEALTH, 1/5 ?Oo �C \ , SALT MARSH x 10. CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE ��oG�Po X15. 1 X16. 7 \9L q�� \\ G� X1 5 C,s}1LL}G>= PROP. POOL + ' LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR 54, X16,26 52 ` EDGE OF WETLAND TO COMMENCEMENT OF WORK, ]0.83 15 Q W \ ]1. ?30 �o ��� �{LD TH \ �� j 7 PATIO 100, 16.95 \ \\ \\ 1 a, B \ SITE AND SEWAGE PLAN X 19.43 17.99 �128 STATE BANK OF X 1 .66 19,06 5 \ \ EXIST. DWELL. a ? 9.20 \ /�\ �. 20DO6AL SCf (UND:;R FENCE 0 \ 1 9`19.0 0,84 y, 6 1ONLY 150 EAST BAY ROAD X 18.16 x1 CONSfRUCT10N) WITH SELF LATCHING GATE � 9.00 \1 -To c.o7>E 6,- � 26 � 6.57 © 0.00 x 18.33 x 7,53 fly. 39 �7q IN THE TOWN OF: � r, �� xi.1 . t0 9 PATIO 1 7.91 (OSTERVILLE) BARNSTABLE X 19,98 PROBABLE AREA OF EX!STING SEPTIC SYSTEM. PUMP AND REMOVE 0.0 X 18.53 X W X , X. z ALL COMPONENTS AND REMOVE ANY CONTAMINATED SOIL WITHIN 5' X16.52 X 18 X11. 1.12 r� PREPARED FOR: DAMES KELLEY X 20.04 OF PERIMETER OF NEW LEACHING FACILITY. ENGINEER TO INSPECT 0.00 17.94 x 1�. SOILS AT TIME OF CONSTRUCTION OF NEW SYSTEM. x 16,86 6 E X 16.29 8, 40 X 15 OLD 1 Ic, .� 12. 9,97 3.90 ' 30 0 J0 60 90 0.00 x 1 /~ X 15,37 .12 x 1470 % 0 Q�c� 7 7 a 13 I xl � Q X13.38 I \ 1 SCALE: 1'r = 30, DATE: OCTOBER 28, 1999 REV. 12/22/99 XI 43 Q� REV. 1/13/00 (CON-COM) X 14. 0�0 1E,11)4 ABUtt. DWELL REV, 11/2/00 (HSE, SAS) /11843 REV. 9/25/01 (POOL, SAS) 12. 5 Xti 0.00 x 18,73 PROP. 4'x 6' LEACH PIT WITH 2' STONE AROUND FOR POOL DRAWDOWN S X 14,4 X 17.92 NOTE; POOL PIT SIZED BASED ON 1/2 HP PUMP, CONTINUOUS OPCRATION p)��QF \ x 13.33 I ASSUMED. CONSULT ENgN[ER IF LARGER PUMP TO 9E UTILIZED. v /\ \ �� X 1 :':� X 16 15 PROP, ROCK WALL WITH FENCE ATOP FOR POOL DAA 16.L A IEL 0 �,�, 14,22 LOT 2 8 4 ENCLOSURE OJ � 83,873t SF X18 (ROCK WALL DESIGN BY OTHERS) PERFORMED 2 22 80 WITNESSED BY RON GIrrr.ORD 40 0 ._ / (1.93t AC) 16.71 _ \ x 18. OLD TH EXIST. ROCK OLD TH 11 OX 15 f8 X 1 .82 6.78 WALL Q PANIEL , P.L.S. _ A. T._ .9O \ 0„ n d .16,99 x 18 4 \ LOAM AND LOAM AND \ 1 \ X 16129 SUBSOIL 30„ SUBSOIL 48" RECEIVED � I I 15.9 18 era ' SEP 2 7 2001 TOWN OF BARNSTABLE 0.00 16 69 HEALTH DEPT. t I MED, I MED. SAND fax 508-362-4541 362-9880 SAND down cape engineering", inn. 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