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0179 EBENEZER ROAD - Health
179 Ebenezer Road Osterville 5 r A = 146, 073 00 , I o { OfP No.......... 70St �.. Fps.. �..........'" THE COMMONWEALTH' OF MASSACHUSETTS BOAR® F HEAL H ........ F........ .............. ....... ........................................ Applutttion for Dispaii al Works Tonotrnrtion amit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal Syst .. ..1.. ----------------------------------------- �{f� _.Location-, ress or Lod No. ..... ..... ... ......................................... ............... ... ... ........ . ..........•... e• -�-� �',R er ' Add W ........... . .........- -------•-•--------------- Ins Address -�- Type of Building Size•Lot..._ ........ _...Sq. feet aDwelling—No. of Be rooms........,>r.............................Expansion Attic ( ) Garbage Grinder ( ) p., Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ...... . .....------•-•-------- . W Design Flow.............. .......................gallons per person per day. Total daily flow--------.FO.O.......................gallons. WSeptic Tank-Liquid capacity/ Ogallons Length............... Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... W' th•......_................... Total Length--.------- -__.. otal leaching area....................sq. ft. Seepage Pit NoZ.'/�'Di ,,......._ to _..... Total leaching area..................sq. ft. z Other Distribution box ( ) 0 Dosing to /( - o /Oe'^ 1D-/7- 7? a Percolation Test Results Performed by.__ _ y. _,.---- .......... Date..../lJ_._d..7_- ......_... ,.� Test Pit No. 1_., ..a-__.minutes per inch Deptli of Tes Pit.................... Depth to ground water........................ f%4 Test Pit No..2.... .........minutes per inch Depth of Test Pit.................... Depth to ground water........................ - p ODescription of•Soil------------- '--- •'1-a-- --- -1 z - = V --- ------------------------------------------------- ----------------- --------------------------------- --•----------------------------------------------------•----------••---------------------------- W U Nature of Repairs or Alterations—Answer when applicable-•____________________________________________________________________________________•-_-----. ----------------------------------------------------------------------------------•---•--•--•-•-•••---•--.....-----------•------------•------•--•---------•----------------------------•----•....---.-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. igned ' .CA/-a_.. �....--��-at;/ Application Approved By•...-' p�� •.-•---• ... .._ .�._....._.. �!•' � 7 --------- Date Application"Disapproved for.the following reasons--------------------------------------------------------------•----------------------....._..--•---------•--•---- ---•---------------•-----•---•-•--•-......•-•-•---------••-•-•---••--------••-••.._............-•--••••-----••---•---•-•--•-----•-------------•----•----------------••----••-----------------•....._.._. 00 .__Date PermitNo. ............................... Issued_ •. ---------•-•---.••-• -•---- N( ......... ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD) F HE , L .... . ......OF, ....... ... ......... ... ...... . . . .... ....................................... Appliration for Disposal Works Tontitrurtion romit Application is hereby made for a Permit to Construct <r Repair an Individual Sewage Disposal sy t . . ... ...... ........................................................ ...... ocation -----f.. ............ ad te or Lo$ No. L..... 0.4 .... .................................. ............... . ............... e IL J 4 AW er Ad ........... ................... .............. ...... ......... ....................................... ................... io Ins I Address Type of Building Size Lot............ ....Sq. feet U r Dwellinj—No. of Bedrooms---------r.............................Expansion Attic Garbage Grinder ( ) Other—Type of Building ................ .......... No. of persons............................ Showers Cafeteria ( ) Otherfixtures .....4*10"IN4.,........................................................................................................................... Design Flow...... __ --------- .4. -- ...gallons per person per day. Total daily flow.._..... . ........................gallons. �4- ------ --------7-- 9 Septic Tank—Liquid*capacity00.4gallons Length_............. Width._. ........ Diameter................. Depth................ Disposal Trench No. ............ ._,r% h Total Length Xt .............**v4— -------- ------ �,'otal leaching area....................sq. f t. D, J15tWIM10'�&oi..........�4! Seepage Pit Nor;z. 'V......�.i. Total leaching area..................sq. ft. 71 Z Other Distribution box Dosing tank Percolation Test Results Performed b ......... Date..... ........ 0��-A �Vj R. ._.. Test Pit No. --minutes per inch Depth of Test it.................... Depth to ground water.._._..____..._......._.. Test Pit No. 2................mint tes per inch Depth of Test Pit____.._........_.__. Depth to ground water.._..........._....._... .......... .......................................................................... .........................-A........ -------------- 0 Description of Soil................6..... ........ SAI'k. ------------------------ U ----------------------------------------------7.................................................................................................................................................... --------------------------------------------- ----------------------------------------------------------------------------------------- ---------------------------------------------------------- U Nature of Re airs or Alterations—,Answe� when applicableklliL..---------------------------------------!................................................ ..........................................................................................0..............................I.................................................................................. Agreement: The undersigned agrees to install the afo.redescribed- IndMdual.Sewa e 1. Disposal System in accordance with the provisions of TLITY, , 56f the State Sanitary Code—The undersig.ne f u!.-ther agrees not to place'the system in operation until a Certificate of Compliance has beeR issued by the,bbard 'h igned . . ......... ........*_ ...... ...... .......... . ... ... ....... D to Application Approved By.........;?V0 ---77-------- Ia ............ Date V Application Disapproved for the following reasons:.............................................................................. .............................. ........................................................I................................................................................................................................................. Date PermitNo..............................................w.......... Issued..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL.TH ............................w......................................... Tntifirab of Tomptiatta THIS ;,TO CfIRTIFY a e Individual Sewage Disposal System constructed or Repaired by .............. ........................ - ---------------- - ........................................ S,---- ------ .... ... ..........at .....400... .... .......... .................................................. has been installed in accordance with th provisions of rr 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No----------- A!It................. dated--- ....................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Insp ector................................................................................... - THE COMMONWEALTH OF MASSACHUSETTS BOARD o F HEj ... 1. ..OF...p "... .................. No. FEE/j ....................... ioos t or r t ton prrafit ................... ........................... -- ------------ Permission is h a&yy granted....... ---- -- ---------- ..... .... ........... ... .. .. . . to donstru,ct or Repair ),,an-Individual Sewage.0 al Pp at No ..... ---_------------------------ Street as showh on the application for Disposal W�7rks A�Constructioft, Per giit,7NO. Dated../j_y_.27................. .......................... 7 7 ------------�/ ' .0 Aad of"Health" DATE................................................................................ FORM 1255 HOBBS &, WARREN, INC., ;PUBLISHERS ►moo Garcra.nc�� �r�t��. / t>&t Lam( PLOW Z. t o 5 = '5 5O G.P.D. �EPT-IG TAa•tIC = 55O a (SC °/o = 8 Z�y G.P.D. .1 so© 641 . 9 Z ISPo�AL PITS- I.)SE )Vao G4"-. °� t_x P,, -SrMt,c/At_L Arr--A. _ (So IC-,O SF ).( 2.S = 3 7S G.P.b. MN C.:o Sri. I .o _ SC7 ts.R D. 9k r°'. .- Dj TOT,&L -F_>E.Sl6Q = d25 X 2 '=.85 P.p ♦ �° v r IOTA t_ tj,�t L`f -L.��c/ = 5S0 6 PU o G, �`� / i 7 f1GULQTtO�I Ql�TE. : � tr.f htl►J o2 L�S<,. Qp vit A. tk BAXTER ER A. D • Q -reST FG.yL.4 Tor rwo T.,oc.o a ,7 LOA r1 Poi. t 5o p tuv• `� t.7. lame. 1"67.3o 2' cue soa.t.., 4'pp� IW. (SAL. 87.0$ 2 taty fox Sc-Qr ic 10 T a►:t,C o00 ED'Z 8 tW LsAcN 83 5`► a PITS MffOtVrti Wire SANS 1,/���t���� •r WASHED . STONE _ 4.Z CC.CCTtt=11vD pl.b'T' - PL.fa1�1 0,S7 Q u s �L Nt . 7©,7 moo . ScQ,t.t= lsc�� � ''� .�U' bA.TC— ► 0% ! -7/77 No wA-re tZ I Gt_tZ-rl P-j T1-.A-r T14c-- 5uou/14 t 1�,1;t ts1J G lr'►-`!S W I,Tt� TW gt DG ►�Cw #,oT 3.0� �k t1uL-> °>E't'It,/��i`�, �'G�iJtC:CNtcf.l�"y O� T"Ct 'Tower ct=$AR.�.KTA3c. 4o l4e, .Peopma t01''lis l; 'I tZGGtSt"l' IZGD L&wc.) 5U2�i�Yc�t�� TI-!l� C7i._At-! 1!, 6..1Z>T •LAc,E='G7 Ub..�. p�.J. OSTE�'.�/�L� v /LCr�S��, QJ v^tl:W 7 lZPtll 1 GA.tiJT t '.,� c,r� a C�.> 1'c., t�r_rLc�na�►1 LvT (_tt-tL�� CAPE1t>E. DE.V CO, %aY L0, AT IONSEWAGE PERMIT NO. j VILLAGE 1 0?3F I N S T A LLER'S NAME & ADDRESS B UIIDE R OR OWNER D A T E PERMIT ISSUED DATE COMPLIANCE 'ISSUED ® �,� � r 9�J i 1 1 � `3 �n No. C ' ,5 r� i , a �+ �I`' ' Fee t/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppfication for Migogar 6pgtem Construction Permit Application for a Permit to Construct( )Repair(p.)Upgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot No. Nd /f c!'f-P.p4c P,4 Owner's Name,Address and Tel.No. rog- Assessor's Map/Parcel �(D PaAx 26, Installer's Name,Address,and Tel.No. SW 8 134 ' 0 S 3 V Designer's Name,Addres and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size Yf 44/,k sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow Sa.. P1 CAI_ gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Sig � Date S�,a �o �- Application Approved b Date Application Disapproved for the following reasons Permit No. Date Issued — ',{{�„f J��! i No. G7 K� 1 , of Fee f U THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH.DIVISION�,,;TOWN OF BARNSTABLE., MASSACHUSETTS ;es i ZIppYicotion for Miopooar 6potem Construction Permit 4 » Application for a Permit to Construct( .')Repair Upgrade( )Abandon( ) ❑Complete System ❑Individual Components ao- Rc� Owner's Name Address and Tel.No. ���- 79 Q- A r Location Add 1.ress or Lot No. al J / G!' /;' , , .37 Assessor's Map/Parcel R. Installer's Name,Address,'and Tel.No. !U 8 '`t�4 ' ' � Designer's Name,A.d/d�res and Tel.i&o. '>'�r� ��o�C+�.��'l�s.O.i.u.C�,l w , 'v ry e•'� <,., ���1�� L=:G%y�.i� � ��,�'�+✓'"-� j 9-`7 .�' Type of Building: ~ Dwelling No.of Bedrooms Lot Size All q« sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures i - Design Flow gallons per day. Calculated daily flow gallons. t Plan Date .� kk�.r c '2` Number of sheets Revision Date )� Size of Septic`. ank i Type of S.A.S. ; Description of Soil Nature of Repairs or Alterations(Answer when applicable) i Date last inspected. 1 e� Agreement:-.- The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system j 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 by this Board of Health. Signed- ',o - a si, `��tu,�S ,"� _� . Date '/ `lrcjr�'� Application Approved b ., 'I Date Application Disapproved for the following reasons ' Permit No. r"J '` Date Issued ——————————————— ------------- -- �� THE COMMONWEALTH OF MASSACHUSETTS I BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO Y CERT- that the On-si,iF ta Sewage g Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned1 )by "{ at ! '�J�2- -'2_9�' has been constructed in accordance with the provision Title 5 and the for Disposal System Construction Permit No.i�.0 rJa�1 dated l S Installer s Designer- The issuance of this e t shall not be construed as a guarantee th�to the sy t� 1 fu cNn as designed. Date � 5 Inspector t. 5:� .g t�(� —/ No. � � CJ'`"'l 1 ----- �------Fee 1� 1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS j0i5po5at *pstem Construction Permit Permission is hereby granted to Construct( )Repair(X)Upgradd, Abandon System located at I A (64 n turn v J�' J be and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. ' Provided:Construction st be co/�pleted within three years of the datQ of�tlus p t Date: f Wo Approve _ r! � 06/08/05 WED 12:47 FAX 5084327057 � Z 002 REC � � V l Town of Barnstab SEP � o D .5 2�p Board of Health Z Coastal En 200 Mai street, Hyawxis MA 026 9!neerj� Cc, one. Office: 508-962-4644 Susan G.RasIS ILS. PAX: 508.790.6304 Stunner ICs ufinen.MSPI1 Wayne Miller,NIM. August 29, 2002 Mr. Robert M. Fitzgerald, P.E. Coastal Engineering, Inc. 260 Cranberry Highway Orleans, MA 02653 a.0 .:I:• il. ,-l: 0 .1 d;'..0 Dear Mr. Fitzgerald, You are granted conditional variances on behalf of your client, Peter J. Tibbetts, to construct an onsite!sewage disposal system at 179 Ebenezer Road, Osterville. The variances granted are as follows: 310 CMR 15.211: The leaching facility will be located only 3.25 feet away from the property line, in lieu of the ten (10) feet minimum separation distance required. 310 CMR 15.211: The leaching facility will be located only five feet away from the slab foundation, in lieu of the ten feet minimum separation distance required. These variances aregranted with the following conditions: (1) No more than five (5) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department 4 Environmental Protection. (2) The applicant shall record a properly worded deed restriction, signed by the owner of: the property, at the Barnstable County Registry of Deeds restricting the properly to five (5) bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. Fiagcraldl C00 ] OOL9 SSZ 802 XVJ CC:TT 900Z/9Z/50 06/08/05 WED 12:47 FAX 5084327057 16 003 (3) The septic system shall be installed in strict accordance with the engineered plants dated revised July 9, 2002. (4) The condition of the existing septic tank shall be inspected for soundness and any signs iof ex-filtration by the designing engineer at the time of construction. The inlet and outlet tees shall also be inspected at that time. (5) The designing ;engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the systemi was installed in substantial 'compliance with the submitted revised plans dated July 9, 2002. These variances are. granted because the physical constraints at the site severely restrict the loication of the soil absorption system due to the proximity of -the wetlands adjoining the property. It is the opinion of this Board that the proposed new soil absorption system is designed to meet the maximum feasible compliance standards!contained within the State Environmental Code, Title V. Since ly yourol �tXnVlMiller, M.D.airan Clrigemldl too ooL9 99Z SOS kH3 CC:TT 2OOZ/9Z/SO 06/08/05 WED 12:49 FAX 5084327057 009 08/12/:000 o8: 46 FAX 506 77S L4 � 4w�a�iLAYVAi ��r +••�••• r_ CIA 02-043 Massachuse't5 Department of Environment8l Protection Bureau of Resource:Protection -Wetlands s a WPA Form 2i — Determination of Applico bility Massachusetts Wetlands Protectlon Act M.G.L. c. 131, P4 and Town of Barnstable Ordinances;Article XXvll A. General Inforination Important: From: whon filling out forms an the Barnstable computor.use Eonzervatlon CQrM nle9l0n only the tab key to move Toy Applicant Property Own®r(If different from applicant): your cursor- do not use the Peter J, Tibbetts - Name return key. Name 179 Ebenezer Road Mailing pddr� Mailing Address OsterviUe MA 02655 stafo ail Code Clgrrown slate ZIp coda CityRawn 1C° True and Date (or 1,7evised Date if app IicabIG)of Final Plans and Other Documents: 1. Sewage Disposal $ stem Repair Plan June 19 2002 Oats T1C8 • ---------------- Date Title Date rrr6 ' 2. Date Request Fled: June 21 2002 �. Determinatibn Pursuant to tha authority of M.G.t,. c. 131, §40,the Conservation Commission considered your Request for Detegrnination of Applicability,with its supporting documentation, and made the following peterminaticn. Project Description (if-applicable): Abandon or remove existing leach 0itS. Construct new Title v leaching chamber outside the 100' Buffer zone. Work within the buffer zone limited toe ui ment access to re wired work. Project Location: 179 Ebenezer Ro©d Oeterville Sveet Address cltyrr°wn 146 073 Assessors Mepl?lartNurrlw ParceR of Number PaB•1 ere v�BkvTlaaee-reor.IMZIQZ �S 7-2 S5I U OT02 nNIxaal iDMa "Id,LMD OOL9 SSZ 80S Xyd SC:TT SOOZ/9Z/So ,06/08/05 WED 12:48 FAX 5084327057 16008 o8i.12/2ooZ 06:47 FAX soS 778 9412 �Y DA 02k043 !Massachusetts Deparim®nt of Environmental Protection Bureau of Resource Protection -Wetlands WPA Form 2 _ Determination of Applicability ibl4 a� Massachusetts Wetlands Protection Act M.G.L, c. 131, §40 and Town of Barnstable Ordinances, Article XXvll D. Appeals The applicant, owner, any person aggrieved by this Determination, any owner of land abutting the land upon which the proposed!work is to be done, or any ten residents of the city or town^vironmentaln which h land is p Department of E located, are hereby notified of their right to request the appropriateP Protection Regional Ciffice (see Appendix A)to issue a Superseding Determination of Applicability.The roqudst must be made b�ceffed mail or hand delivery to the Department,WM the appropriate filing fee and Fee Transmittal Farm (Sae Appendix E;di RequesE for Departmental Action Fee Transmittal Form)as "this Determination.A provided in 310 CMR 10!03(7)within ten business days from the date of issuance a copy of the request shall at the same time be sent by certified malt or hand delivery to the Conservation Commission and to the pp{icant If he/she is not the appellant. The request shall state clearly and concisely the objections to the Determination which is being appealed.To the extent that the ordinance or law and not on the Massachusetts Wetlands based On a municipal o y Determination is bas P bet isdiction- Protection Pict or regulations,the Department of Environmental Protection has no appellate lur 6 J Pop%6 Qr 5 4pofu�:.dee•IC�.7n21a2 600[ 9NINSVIDN3 'Iy.LSyOD o0L9 SSZ 805 YVJ tC:TT SooZ/9Z/90 06/08/05 WED 12:48 FAX 5084347057 Z 007 08l12/2002 08:47 FAg 509 iiB 2AlZ REGULATORY sERVICES t;auu4 DA 022--043 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands WNPA Form 2 - Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 �a and Town of Barnstable Ordinances, Article XXvll B. Determination i(cont.) ❑ 5.Th®area described in the Request is subject to protection under the Act.Since the work onsets the r uiremPnts for the following exemption, as specified in the Act and described therein eq the regulations, no Notice of Intent is required: Ezcmpt ActAty($Its appllc$ble 5t2tuatofyha9ulatory provL4ions) [] 6. The ereo and/or work described in the Request Is not subject to review and approval by: name of Municip-mlity Pursuant to a municipal wetlands ordinance or bylaw. Ordlnar,re or Bylaw Citation =3 Name C. Authoftation This Determination Is isstued to the applicant and delivered as follows: ❑ by hand delivery!on ® by certified mail. return receipt requested on JUL 1 5 2002 �� Dabe This Determination is valid for three years from the date of issuance(except Determinations for Vegetation Management+Plans which are valid for the duration of the Plan).This Determination does not relieve the applicant from complying with all other applicable federal,state,or local statutes, ordinances. bylaws,or regulations. This Determination mush be signed by a majority of the ConseNation Commission.A copy must bo sent to the appropriate DEP Regional office (see Appendix A)and the property owner(if different from the applicant). ❑OSignatures: On this day of J 2,g� �beforn me parsonally appeared = _7 l z5 G: ,to me knoom itolo the pemon 4. de=ibad In ane who ezeaubed the foregoing irotninlent and acknowledged that hel3Rc ozeeirled fho samo a;his/Frerfraa act d deed, Notary Public My comm6AIssion xpirll Pjpq G Cf D SOO[n Ol•1aaaNI5N3 JVZSV00 OOL9 SSZ SOS XVA f£:TT SOOZ/9Z/20 ,06/08/05 WED 12:48 FAX 5084327057 2006 08/12/2002 08:47 FAX G08 778 24-12: REGULATORY SERVICES tqj u u j DA02-043 Tibbatm Spedal Conditions of Approval; 1. Stake straabales backed by tr=chj:6 in cilTzton teuaing rba1L be eet alon0 the appsovcd warp limit 1U%e. Fffortive sediiuSent watrols sbaa remain un14 The site is str�ta7i�xd with vegetation' 2. The work limit shoaia oil the approved plat shell be st»tly observed. 3. Thcre sba11 be no distnrbance of the siU.inslndmg=di'ng of vep-latioa,beyond the work limit This Testsiction ShR11 conlfT=over t=- 4. AU areas disturbed duzmg conMotiou sha11 be sovegetated imm ately following eo=plction of work at the site. No areiS 9ba11 be left uavegetatd for mare rhea 30 days. Mulcting eb M mot serve as a substitute for rtquitemeRt to sevegetu�dist>�be3 areas at t�conelv,siaa of work. I R,. r LOOQ� 0MI HaK1JKS rlvjg oo 0oL9 SSZ 909 XVa VV:TT SOOZISZ/90 06/08/05 {RED 12:48 FAX 5084327057 ' 0005 03/:12%'2oo2. 08:46 PAb 509 778 2412 REGULATO-Ky S-KIKY10ES cuvz DA 02-043 Massachusetts Department of En-Wronmental Protection Bureau of Resource Protection -Wetlands FL s WPA Form 2 - Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c, 131, §40 and Town of Barnstable Ordinances, Artiete XXvll B. Determination (cont.) ❑ 6. The following area and/or work,if any- is subject to a municipal ordinance or bylaw but not subject to the Massachusetts Wetlands Protection Act El 7. If a Notice of Intent is fled for the work in the Rivtirfivnt Area described on referenced pien(s) and document(s);which includes all or part of the work described in the Request,the applicant must consider thq following alternatives. (Refer to the wetland regulations at 10.58(4)c,for more Information about the scope of alternatives requirements): ❑ Alternatives limited to the lot on which the project Is located. ❑ Alternatives limited to the lot on which the project is located, the subdivided lots,and any adjacent lots formarly or presently owned by the same owner. ❑ Alternatives limited to the original panel on v6ch the project is located,the-subdivided parcels, any iadjaeent parcels, and any other land which can reasonably be obtained within the municip> IRy. ❑ Altemab%fes jaxtend to any sites which can reasonably be obtained within the appropriate region of the'.state. Negative Determinatlon Note: No further action under the wetlands Protection Act is rpquirbd by-the applicant However,if the Department is requgsted to issue a Superseding Determination of Applicability,work may not proceed on this project Unless the Department fails to act on such request within 35 days of the date the request is post-marked for certified mail or hand delivered to the Department.Work may then proceed at the owner's risk only upon notice to the Department and to the Conservation Commission. Requirements for requests for Superseding Determinations are listed at the end of this dor_umont. ❑ 1.The area described In the Request is not an arse subject to protection under the Actor the Buffer Zone. ❑ 2.The work dp6crlbed in the Request area.Thln an-area erefore, sa6dhjee worktdor�;not�equi a thc the fil ng of abut will not remove, fill,idredge, or-alter at Notice of Intent: ® 3.The work described in the Request is within the Buffar$on®, as defined in the regulations,but will not alter an;Area subject to protection under the Act.Therefore.said work does not require the filing of a Notice of intent, subject to the following conditions(if any). See attached. ❑ 4.The work defirslbed in the Request is not within an Area subject to protection under'the Act urnleasrandhu gusaeldZwork)aITh sre�or�a subje work attodoes p tech n under the-Art.f a Notice of Intent, �aorc 402f v"_d=.rw.7112m2 9001z "I'dHaRIDma qV:SF00 0oL9 22Z Eo5 kK3 CC:TT 90OZ/9Z/20 06/08/05 WED 12:47 FAX 5084327057 0 004 t , Y 08.L12/.2Do 08:4o FAX 308 776 2412 'REGLTL4TORY sh�gVitgg:s ' e - DA 02-043 Massachusetts Department of Environmental Protection Bureau of Resource P,roteclien -Wetlands a WPA Form 2 -- Determination of ApplicabilityLl , Massachusetts Wetlands Protection Act M_G.L. c, 131, +DLO and Town of Barnstalale Ordinances, Article XXv11 A. General Information ImporEatrt:When filling out .From: forms on the Barnstable comput®r.use Gonsq Votlon commission, only the tab Property Owner(If different from appilcant): Key to move To: Applicant your cursor- do not'use the Peter J. Tibbetts Name return key. Name 179 Ebenezer.Road : Mailing Add---S ndallinp oddrPss 02655 Osierville MA ft�, Zip Code city Own State 210 coda atyrrown 1, Tstle and Date or ReNised Date if applicable)of Finel Plans and Other Documents: June 19 2002 Sewage Disposal System Repair Plan Data TlCW Date Tile Date Title 2. Date Request Filed: Junes 21 2002 B. Determination . Pursuant to the authority of M.G.L.C. 131, §40,the Conservation Commission consider your Request for Deterrniination of Applicability,with its supporting documentation,and made the folio4ng Determin3lion. Project Description'01'applicable): abandon or remove=19UT19 leach ofts. Construct new Titls v leaching chamber outside the 100' Buffer zone_ Work;within the buffer zone limited toe ui ment access to re uir®d Work. Project Location: 179 Ebenezer Road Ostsn+ille SU QtAAdress r cadRoum 073 146 ,4ssessors Map/Plat Narmbw Parse -g)k mumber ' F4pa 1 Or6 wpe+orn,zax•rv•.�nar�rz ' 5oo[�j sixty mKioxa IFZSYoO 00L9 SSZ 90S YVz1 ce:TT 500Z/9Z/S0 r , L BARNSTABLE LAND COURT REGISTRY DISTRICT JOHN F. MEADE, REGISTER LC425RP: Land Court ATTESTED copy request Delivery: Pickup Dated: 6-08-2005 @ 13 : 56 : 33. Wkstn: LCU01_A Req by: PATRICIA Local Trans #: 209557 ------------------------------------------------------------------------------ Document # : 921, 835 Pages requested: F-L # of pages printed: 1 Copies: 2 Fee: 2 . 00 Customer will pick up ------------------------------------------------------------------------------ **** ATTESTED COPY **** *** ATTESTED COPY *** **** ATTESTED COPY **** ------------------------------------------------------------------------------ [V C= �. f.M +K: .... r C= En y .1 1=' N co 1 , F Doc:92i,e35 es-z�- a=�e BpN WAEIE LAIC CMX" REGISTRY RESTRICTION PATRICIA TIBBETTS DiCENSO, of 179 Ebenezer Road, Osterville, Massachusetts, being the owner of the premises of 179 Ebenezer Road, Osterville, Barnstable County, Massachusetts, which premises is more particularly shown as Lot 43 on Land Court Plan No. 37432-D and described in Certificate of Title No. 165707 hereby imposes the following restriction on said premises: There shall be no more than five (5) bedrooms (four (4) bedrooms plus the family room, as currently constructed) located on the premises This restriction is imposed pursuant to a condition of the approval by the Barnstable Board of Health: of Sewage Disposal System Repair Plan for the premises. For title see Certificate of Title No. 1-65707. Witness my hand and seal this;O day of n'ZC'�.� { 2003 . PATRICIA TIBBETTS DiCENSO COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. �'�/ 2003 Then personally appeared the above named PATRICIA TIBBETTS DiCENSO and acknowledged the foregoing instrument to be her free act and deed, before me, f 1l 7y. 1 Notar Public My commission expires: ec:forms\dicenso.restriction B%-STABLE COUNTY ST{�OF DEEDS SARNSTABLE REGISTRY OF DEEDS A/IE..bPY,ATTEST V JO N Fs MIA I RInA OASTAL NN"INEERIN Tl ' n = . MLA OMPANYJNC. ' 50 -260 Cranberry Highway Orleans,MA 02653 s a v.Orleans 508.255.6511, e Provincetown 508.487.9600 Hyanats 508 778:•9,60ff6 Fax 568.255.6700 o www.eeccapecodcom Project No. C15725.00 July 15,2005 . Thomas A.McKean,R.S:; C:H.O.,Director" Barnstable Public Health Division x. - .200 Main Street Hyannis,MA 02601 {r ` Re: 179 Ebenezer Road V Oster' We,MA Map•146,Parcel 73' ` Dear Mr.McKean: „ Coastal Engineering made an inspection of the sewage disposal system installation at the above referenced property on July-13,2005,prior to it being backfilled.Our inspection found the distribution box and soil absorption system to be'installed in substantial compliance with the approved plan with respect to location and elevation,except as noted. The deviation'is the soil absorption is.5.2 feet from the property line. See the enclosed plan for recorded location. Please note that at time of,our inspection final grading had not yet been completed.The, 'installer must grade properly to,have a maximum of three feet of cover over,the sewage,-disposal system. M 4 If you have any.questions or need further information,please contact me:' Very tru yours, AST ENG • 4 .� Joh c aibl S. JGS/, .. i••� 9 m .. Y " Enclo rest cc: Peter Tibbetts '. Robert Our Inc. a w.=•«- W ;_ . .. ., .,, D:000C15700V5725[80H1tr7-15-05.doc t ■Providing solutions for the benefit of our clients and community■ 11/28/2005 09:55 FAX 508 255 6700 COASTAL ENGINEERING 1@ 002 11/14/06 XON 13:07 FA% 5084324 85 Robert D. our Co. IZ002 Town of Barnstable Regulatory Services Thomas F. Geiler,Director 8A8AiS1'A�LE � . Public Health Division Thomas McKean,Director 200 Main.Street,Hyannis,MA 03601 Offive; 508462.4644 Fax: 508-790-6304 [nstaller&Designer Certification Form Date: 13 n5 Se i,-age PermiV � Assessor's Map\Parcel �� 3 Designer: tf-r - 'i Installer: a, r G Address- Q 40 cerc k,.rs b sy Address: a4 C�✓ea.�__V,��.�dcX r-� Q-o� 0 V, 1,e4�r Is, MIN w c rn Oa.�s3 o>C.-as on 0 v.,Nr Go InGwas issued a permit to install a ((late) — (installer) septic system at, �a112 cn e_� v based on a design drawn by (a,ddres IN,a ex-4"e dated ? L (design 1 certify that the se,-)tic system referenced above was installed substantially according to the desigr4, Which e,lay ictalude minor approved changes such as lateral relocation of the distribution box anc/or septic tank. X certify that the sv ptic system referenced above was installed with Major changes (Le- greater than 10' lalil sal relocation of the SAS or any vertical relocation of any component of the septic systat )but in accordance with State &Local Regulatiorss. flan revision or certified as-built b;r designer to follow. Sig11 SM OF 4fgs� c ( ' JOHN G. / cs SCHMAISLE j ' u Na. 1017 (DesitAOV igna i4) _ ( ° amp eTe) 'P E SL RETTMIN TO7 IARNSTABLE LiJBIAC BEAT TH I) SION. CERTIFICATE OF Oy1PLLkNCE WrLL NOT BE ISSUED UNTIL 'BOTH THIS EOMM AND -BUILT" CARD ARE RECEIVED BY TWE BA3kX8(CABLE PUBLIC aE 6.LT11 DIVISION. THAN&XQU. ion romil ter,. i7=JSiC 11/14/2005 RON' 12:11 [Tx/RX NO 53021 Q 002 TOWN OF BARNSTABLE LO!--A.TIONL � /'' eSEWAGE # V1I ZAGE ASSESSOR'S yMAP & LOT INSTALLER'S NAME&PHONE NO. �/ ie— SEPTIC TANK CAPACITY ���f✓� LEACHING FACILITY: (type) <RP WWI �_ (size) `f !X NO.OF BEDROOMS '�" 1 BUILDER OR OWNER Ad TO / / oAe 49 7- PERMITDATE: COMPLIANCE DATE: i - Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet vhi Feet ng ility) Furnished by O 0 S S 1 t n � � 0 o � k Doc i 92!,S35 03-23-2603 . S s 2S DAMMAILE LAW CIRMY NES)STRY RESTRICTION PATRICIA TIBBETTS DiCENSO, of 179 Ebenezer Road, Osterville, Massachusetts', being the owner of the premises of 179 Ebenezer Road, Osterville, Barnstable County, Massachusetts, which premises is more particularly shown as Lot 43 on Land Court Plan No. 37432-D and described in Certificate of Title No. 165707 hereby imposes the following restriction on said premises: There shall be no more than five (5) bedrooms (four (4) _bedrooms plus the family room as currently constructed) located on the premises This restriction is imposed pursuant to a condition of the approval by the Barnstable Board of Health of Sewage Disposal System Repair Plari for the premises. For title see Certificate of 'Title No. 165707. Witness my hand. and seal this pO `day of nja 2003. 1 67 PATRICIA TIBBETTS DiCENSO Y c COMMONWEALTH OF, MASSACHUSETTS Barnstable, ss `�- i .7� 2003 Then personally appeared the above named PATRICIA TIBBETTS DiCENSO and acknowledged the foregoing instrument to be her free act and deed, before me, 4125 �`._7, / 149 I�JY-, NotarXPublic My commission expires: ( l? C l wo-3 ec:forms\dicenso.restriction BARNSTABLE COUNTY REGISTRY OF DEEDS A TRUE COPY,ATTEST " OWN F.MEADE REC,ISTER BARNSTABLE REGISTRY OF DEEDS i :Cwr.�a....r..�d f :.- � y '•�r" �.� _ ,. >� �� r t . Jt. �. _'�� ,r ',::��`�i r, s� ._..,... __.._.....i Town of Barnstable Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. August 29, 2002 Mr. Robert M. Fitzgerald, P.E. Coastal Engineering, Inc. 260 Cranberry Highway Orleans, MA 02653 RE: 179 Ebenezer Road, Osterville, MA 02655 A= 146-073 Dear Mr. Fitzgerald, You are granted conditional variances on behalf of your client, Peter J. Tibbetts, to construct an onsite sewage disposal system at 179 Ebenezer Road, Osterville. The variances granted are as follows: 310 CMR 15.211: The leaching facility will be located only 3.25 feet away from the property line, in lieu of the ten (10) feet minimum separation distance required. 310 CMR 15.211: The leaching facility will be located only five feet away from the slab foundation, in lieu of the ten feet minimum separation distance required. These variances are granted with the following conditions: (1) No more than five (5) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to five (5) bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. Fitzgerald) (3) The septic system shall be installed in strict accordance with the engineered plans dated revised July 9, 2002. (4) The condition of the existing septic tank shall be inspected for soundness and any signs of ex-filtration by the designing engineer at the time of construction. The inlet and outlet tees shall also be inspected at that time. (5) The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the submitted revised plans dated July 9, 2002. These variances are granted because the physical constraints at the site severely restrict the location of the soil absorption system due to the proximity of the wetlands adjoining the property. It is the opinion of this Board that the proposed new soil absorption system is designed to meet the maximum feasible compliance standards contained within the State Environmental Code, Title V. Since ly your W yn�Miller, M.D._ r--- C air an Fitzgerald 1 �1 rf Y �S RECEIVED -ey JUL 1 0 200Z 91E DATE:. TOWN OF BARNSTABLE _ HEALTH DEPT. FEE:: REC.. BY: Town of Barnstablg DATE:- Board of Health 200 Main Street,Hyannis MA 02601 Officer 508-862 4644 Susan-G.Rask,R.S. FAX: 508-790-6304 Sumner Kau fman,M.S.P.H. Wayae-A.Miller,-M.D. VARIANCE REQUEST FORM LOCATION Property Address: 179 Ebenezer Road, Osterville, MA Assessor's Map and Parcel Number- Map 146 Parcel 73 SizeofLot 41,912 s.f. Wetlands-Within 300 Ft. Yes. X Business Name- N/A No Subdivision-Name:N/A APPLICANT'S!NAW-- Peter J. Tibbetts Phone (508) 432-0530 Did the ownerofthe:property authorize you to representhim or.her?- Yes _y No PROPERTY OWNER'S NAME CONTACT PERSON Name: Peter J. Tibbetts Name: Robert M. Fitzgerald, Coastal Engineering Co.. Address: 179 Ebenezer Road, Osterville, MA 02655 Address:.260 Cranberry Highway, Orleans, MA 02653 Phone: (508) 432-0530 Phone: (508) 255-6511 VARLANCE FROM REGULATION([ist P g.) REASON FOR VARIANCE(May attach if more space needed) 310 CMR 15.211 Slab Foundation Setback (5') RanuirPd to maintain 100' wptlanrlSetback Property Line Setback (3.251�RPAuirPtl to maintain 100' wetland setback 310 CMR 15-249 No racarva nrea Remove and replare if nereccary NATURE OF WORK House Addition ❑ House Renovation ❑ Repair of Failed.Septic System KI Chec (to be completed by gfflce staff-person receiving variance request application) Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans)(See Plan) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulata4 variances only) Full menu submitted(for grease ti variance requests only) UJA Variance request application fee collected (no fee for lifeguard,modification renewals, grease trap variance renewals [same owner/leasee only],outside dining variance renewals(same owner/leasee only],and variances to repair failed sewage disposal systems (only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,R.S.,Chairman NOT APPROVED Summer Kauffman,M.S.P.H. REASON FOR DISAPPROVAL Wayne A.Miller,M.D. C15725:00:RNF C:\Documents and Settings\decollik\Local Settings\Temporary Internet. Files\OLKFB\VARIREQ.DOC s ��B..OURCO �,(, 40 COMPLETE SEPTIC SYSTEMS. GREATWESfERN ROAD•P.O.BOX 1539 WATER AND SEWER-MAINS•EXCAVATION. NO. 0530HAR -Fti, 508)4 2 (508)432-0530-FAX(508)432-7057 cc • ; j • S June 27, 2002 JUN . 8 2002 3 s Bob Fitzgerald .:: � � : :net-.. Coastal Engineering Co., Inc: 260 Cranberry,Highway Orleans, MA 02653 Dear Bob, Thank you for the.update regarding test pit inspection within the design stage of the proposed Title V system repair at 179 Ebenezer Road, Osterviile. Pursuant:to our-telephone conversation on June 26, 20021 am authorizing.you to represent me atthe:Board of Health meeting:on August 13 2002, and any other meetings regarding the above,mentioned "Sewage Disposal System Repair Plan", necessary to prepare- said plan-ta meet all.requirements fora final plan for installation of the disposal system repair. Since9el , P r ibbetts July 10, 2002 C15725.00 Public Health Division Hand Delivery Attn: Thomas McKeon _ Barnstable Town Offices 200 Main Street ' Hyannis, MA 02601 '§lIVEI " x- Re: Board of Health Variance Request Proposed Sewage System Upgrade For An Existing Single Family Residence Peter J. Tibbetts 179 Ebenezer Road Osterville, MA ` Piro µ Map 146 Parcel 73 V7083 em Dear Board Members: �, ,` On behalf of our client, Peter J. Tibbetts, we are requesting a variance from the State Environmental Code Title V, and/or the Barnstable Board of Health Regulations to install a Sewage Disposal System Upgrade to replace an existing system at the above referenced The re uested variances are: property. q We are requesting a variance from 310 CMR 15.00(Title V) ,25:6Z 310 CMR 15.211 Slab Foundation Setback: (5'variance requested) Property Line Setback: (3.25'variance requested) 310 CMR15.248 No Reserve Area (remove and replace if necessary) r The above variances are requested in order to repair an existing failed septic system. 4 Please schedule this request for the August 13,2002 public hearing. If you have any questions Fa►vironmeiital: or require additional information, please contact our office. "Sine _ I Very truly yours, COASTAL EN INEERING CO., INC. Co� i Robert M. Fitzgerald, P.E. CUAs�At�F�VffitIlVG } di° rtacievetheu' RMF:jah Enclosures i " cc: Peter J.Tibbetts,Owner/Applicant pra�cxs,:an�by. �aPP�P d:\doc\C15700\15725.00\permitting\BOHV 7.02\Tibbetts BOHV Board Ltr 7.10.02 . aiid.sutveymg�