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HomeMy WebLinkAbout0090 EEL RIVER ROAD - Health 90 Eel River Road, Osterville -_ A= 116 - 093 - , No. l�.d` _ �P FeAU THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYfcatiou for 33i!6p0a1 *pgtem Construction Permit Application for a Permit to Construct( )( (X )Upgrade( )Abandon( ) ❑Complete System 0 Individual Components Location Address or Lot No. q0 EEt-'RIVER l eAb Owner's Name,Address and Tel.No. OS-rekV tl t_.6,MA; TODD W ETZBL_ Assessor'sMap/Parcel 11 Dy tls WEST STA'esr- (o" 3 No�t j3oRD fY1t4 ot532. Inst er's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Sob-4 V6--S'-%4 y P� SUt1tVAW EN6W6ERkJJ(o 2WL. _Po Lox (,Sq 7 PARKFA,%LpAb �A 11r omevo-LE,mA oz(sS Type of Building: Dwelling No.of Bedrooms L Lot Size I.5Z. 4C sit. Garbage Grinder QU0) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow `l55 gallons per day. Calculated daily flow 54 0 gallons. Plan Date SQPCEMIE1Z 1Z. 100% Number of sheets I Revision Date AJA Title ?Ro1po58iJ S6?TIL S`I byEm 0 1(O P M)c Size of Septic Tank 150b (AIK. Type of S.A.S. ( GA4111U(a EIELD`CAhM&E2 Description of Soil TEST 1101.E 9111101 CLEAN GIZIA)v Alk. MMI IM- GRoJubuk-Tek ErVc0j)jTEkeb AT G L, 1.5' Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agr7esoto ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the pr isions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance ha en issuecMy this Boardifleatz, Si ed �c Date - I A Application Approved by vV�i ,L� Date Application Disapproved for the following reasons Permit No. (,a Date Issued LS FeAb ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS l Z(pprication for ]igpont *pgtem Construction Permit Application for a Permit to Construct( . )Repair(X )Upgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot No. 90 C E(-Rlvc-R R°AD Owner's Name,Address and Tel.No. 01�1TE:AV MA TODD WCTZEL- �Assessor'sMap/Parcel 11(r_ `I� 11 WEST Xs No;,IwIoRo MA o153Z + i Installer's Name Address,and Tel No. Designer's Name,Address and Tel.No. V Type of Building: Dwelling No.of Bedrooms L— Lot Size I Z A C sift. Garbage Grinder(Q 0) Other Type of Building No.of Persons Showers( ) Cafeteria( ) r• Other Fixtures Design Flow `{55 gallons per day. Calculated daily flow, q4 0 gallons. Plan Date G M i E 1 1 Z. 2001 Number of sheets I Revision Date f� Title 4�t�01�U5t� SETT IL S�I`,TEa+1 �1�LRA�t `Size of Septic Tank 1506 CoA, . Type of S.A.S. LGAfh1)W6 Description of Soil; TEST ++OTC: 9111101 (LEAN (off OJUCA(R M AT C K I AL CrROJ�.J�W���12 EV�/C.IIJI�T!�E� AT CL. 1.5 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 y_ 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 ha bbn issue this Board f eal _ Sidede �J ---1� Date Z a Application Approved by \ C�1. . X Date Application Disapproved for the following reasons + Permit No. c`�C��� t4211 Date Issued q I� -----------------------------—------------ .t . . THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS��'�� CE FY, qiat the On- ite Sewage Disposal System Constructed( )Repaired( )U graded ) Abandoned( )by p y P p at 9 El SZ.we_Q i(A �'1 v�` has been constructed in accordance with the provisiq�of Title Sid the for Disposal System Construction Permit No.�1C �-��_'I dated q )131 U Installer ;6 Designer v The issui t�per t shall not be construed as a guarantee that the system(�will function as designed. Date '6 Inspector t e Fee �U 4 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS MIsspogal *potem CousStruction Permit Permission is hereby granted to Construct( )Repair( )Upgrade )Abandon( ) System located at �1`('� �-C �'� t U Z Q-ck . Q-5 U SZ 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 must be completed within three years of the date of thhi ,,e�t. �_y / Date: / Approved I t � .. C� IflVVIst OFBARNSTAB:LE � LOCA g TION �` A- L ( ! - SEWAGEiJ # f VILLAGE' ASSESSOR'S MAP & LOT�� INSTALLER'S NAME&PHONE NO. t�iC��CY raos �. SEPTIC TANK CAPACY I Y ., f s'r rr LEACHING_FACILITY: (type) (size) ld 1{ 331 NO.OF BEDROOMS - BUULDER OR OWNER PERMITDATE COMPLIANCE DATE: 1� Separation Distance Between:the Maximum Adjusted Groundwater Table to the Bottom of Leaching Faci ity Feet , Private Water Supply Well and Leaching Facility (If any wells exist on site or withtn'200 feet ofleaching facility)` Feet n Edge of Wetland and Leactung Facihty (If any wetlarids exist within 3Q0 feet of leachin facile ) " Feet g h , Furnished by T. 1 1. aed d 't 1 �s I t TOWN OF BARnnNSTABLE LOCATIONC SEWAGE# VILLAGE ASSESSOR'S MAP.&PARCEL B 3 NAME&PHONE NO. �.��.1 SEPTIC TANK CAPACITY LspO ���5. -e© LEACHING FACILITY:(type)C,e�c,-c�c. G��nyc 6 (size) 3 a`(.. is l Q`CD K oo z <.V� e NO.OF BEDROOMS y y 2; OWNER �'�cS,►.,s�.� `�le �� PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on` site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY1�. n. T3 . a i C- (-- TOWN OF BARNSTABLE LOCATION lm FYY 1149,keg )q/` SEWAGE # C I— • VILLAGE d /% ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. tT�C��CY L Ohs SEPTIC TANK CAPACITY -ea ea• LEACHING FACILITY: (type) ���1���/ '��� (size) /P ld & 33,` NO.OFBEDROOMS BUILDER OR OWNER PERMITDATE: 7 �� ®! COMPLIANCE DATE: Separation Distance Between the: . ., Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �� l .� � - � a �� � �� �� _ .�� . . ,�. 0 ''F , _ . �.� � , r J� Z 203 498 889 Yam; US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sent to Street& umber � r P ce, fz e Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee L Return Receipt Showing to Whom&Date Delivered Return Receipt Showing to Whom, Date,&Addressee's Address CDTOTAL Postage&Fees $ r Postmark or Date € LL U) 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 C window or hand it to your rural carrier(no extra charge). I 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. cc rn 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 a RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the O O addressee,endorse RESTRICTED DELIVERY on the front of the article. M it 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. ti iI 6. Save this receipt and present it if you make an inquiry. t o2595-97-B-ot 45 d i ! I Town of Barnstable Department of Health, Safety, and Environmental Services RAMMBIA MASS. Public Health Division A'Eo � P.O. Box 534,Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health April 6, 1998 Todd Wetzel 158 West Street Northborough,MA 01532 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 90 Eel River Road, Osterville was inspected on November 21, 1996 by Bruce Macallister,a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of j 1.995 TITLE 5 (310 CMR 15.00)due to the following: • A basement sink drain discharges into a pit located near a wetland You are directed to hire a licensed professional engineer(PE)to design a system that will bring the septic system in compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within twenty-one(21)days of your receipt of this letter. You are also directed to hire a licensed septic system installer to install the system components within forty-five(45)days of your receipt of this order. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground,or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF TH BOARD OF HEALTH as A. McKean,R.S.,C.H.O. Agent of the Board of Health, q/db/title5e:doc cc: Robert Gatewood PAR ] Real Estate System - General Property Inquiry] Help [ ] Parcel Id: 116 093 - Account No: 56708 Parent : Location: 90 EEL RIVER RD OST Neighborhood: 25AB Fire Dist : CO Devel Lot : 11 LC16162-F Lot Size : 1 . 52 Acres Current Own: WETZEL, TODD H State Class : 101 158 WEST ST No. Bldgs : 1 Area: 3992 Year Added NORTHBOROUGH MA 1532� Deed Date : 120196 Reference : C143164 January 1st : WETZEL, TODD H Deed MMDD: 1296 Deed Ref : C143164 Comments : Values : Land: 373200 Buildings: 188300• Extra Features : Road System: 90 Index: 482 (EEL RIVER ROAD ) Frntg: 206 Index: ( ) Frntg: Control Info: Last Auto Upd: 020997 Status : C Last TACS Update: 020497 Land Reviewed By: Date : 0000 Bldgs Reviewed By: Date : 0000 Tax Title : Account : Taken: Account Status : Hold Status : Cancel [ ] Press XMT for more data Next screen [PAR ] Action [ ] Owners Name [ ] Road Index [ ] Road Name [ ] Parcel Number [116] [094] [ ] [ 1 [ ] Town of Barnstable Department of Health, Safety, and Environmental Services Health Division 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A McKean FAX: 508-775-3344.. Dirodw of Public Health /MA18!'Af�l�, MARS. MIS [ENGINEER LETTER] TO: I.z1 i�Lr�-^�► y.� ^I �. (Date) /4- �� ORDER TO COMPLY WITH 310 CMR l 5.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at C) Ee( 120&_ lk-oIJ 6#T4vas inspected on 0�M(o by guc e, a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15:00) due to the following: j You are directed hire a licensed professional a gineer (PE) to design a system7that �willing t e septic system in compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within twenty-one (21) days of your receipt of this letter. You are also directed to hire a licensed septic system installer to install the system components within forty- five(45) days of your receipt of this order. You are further directed to maintain the system b hiring a licensed se toe hauler to um the septic stem Y g P g pump P Y to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER.OF THE BOARD OF HEALTH Thomas A. McKean, R.3., C.H.O. Agent of the Board of Health Town of Barnstable Q ' I Commonweafth of'Massachusetts 4 m a: ; Executive Office.of Environmental Affdirslt 7 .Department of y° Environmental Protection tfllllllam F.Weld Governor a Trudy Coxe 1 y9 Secn:ary,EOEA v ti : l Davld B.Struhs CoMMISSIOnef SUBSURFACE SEWAGEDISPOSAL SYSTEM INSPECTION:FORM{ PART A , CERTIFICATION ;J 1 - ��. 1,;�� Property Address: q 0 Cel�l���L �- p s"1 er`u c(I a '` i` €"Address of-Owner: i;> `�rp - t ;� O r (If different) f 4 Date of Inspection: f`[Ol'i ai'��`-l'�Ej si:v't � xy;x?yit "`+ ... t.wf�u -r• i r i Name of Inspector: Company Name,Address and Telephone Number. # CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate ' and complete as of the time of inspection. The inspection was performed based on my ttraining and experience in the proper function and maintenance of on-site sewage disposal systems. The system: } k.�. t..• ''a i, iv�i�. '3#'}i-�yif w, �3.:t!�, { :' r'i{JzT , .yisk Ia• .y (; .<v Passes Conditio IIy PPasses t' , _'`Needs FuRh&r`Valuation^,By,'the,Local Approving�Authority f Fails Inspector's Signature: A lite- The System Inspector shalNui binh,a'copy"of this iospection report.to the Approving Authority within thirty (30) days of comp letingTthis inspection. If the system is:a`'shared system has;` design,flow of,I0,00.Q-gpd or greaiei,'the inspector and the.system owner shall submit the report to the appropriate regional office of the Department of Environmental Profect}on: ' The original should be sent to the system owner and copies sent to the buyer; if applicable and the approving authority. iJ } (:'ar L!3i +Gt, o t i>SJfi ? d1 nsl?a1��i?a v:t t "f ..`i.F:-r• INSPECTION SUMMARY,', Check A. B,C or,D. s c`n�f=�-moo d1�4�ubl eryrn-b eeA �c A )�Hth A) SYSTEMrPASSES. a ., .�5 s`� ^r:y:>=: ` �. .< f2�hni�► T� ��-i�i�ei'?/ `11�5 �Zltr�pl, 1 have not found any information which indicates that the system violates any of the failure criteria as defined in'31'0 CMR 15.303. Any failure criteria not evaluated are indicated below. BI SYSTEM'CONDITIONALLY'PASSES t Sit 1..sir One`or more system components need to be replaced or repaired.'The system;upon complebon�of the.replacement or'repair, - passes inspection: Indicate yes, no, or not determined (Y, N, or ND). Describe basis•of determination in all instances..; If"not;determined", explain why not) The septic iank'is metal,=:.cracked, structurally unsound, shows substantial infiltration or exfiltration,'or tank'failure is imminent. The system will pass inspection if the`existing:septic'tanklis replaced,with a conforming septic tankas approved by the Board of Health. r•';K, (revised 8/15/95) 1 One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 �,Printed on Recycled Pape, if v/ SUBSURFACE,SEWAGE DISPOSAL SYSTEM':1NSPECTI9N'FORM PART : > CERTIFICATION A (continued) �,,. \zpl. •'V cS�CCV.\�C •c a �'�� t j ai -s�..+•;q t-S. .F T4 Property Address• �o Ee� ,�'2- Owner. A Date of Inspection: 3t�0(9L6 B]SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed of the pipe(s) or due to a broken,settled or uneven distribution box. The system wil pass inspection if(with app Board of Health): t" broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ ar due to broken or obstructed pipe(s). The system will pass,.. The system required pumping more than four times a ye inspection if(with approval of the Board of.Health): broken pipe(s) are replaced obstruction is removed • C) FURTHER.EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:' Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the Co ,. public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEAA'IS'NOTFUNCTlONING IN,A MANNER, WHICH WILL PROTECT THE PUBLIC HEALTH.ANd SAFETY AND THE ENVIRONMENT: Cesspool or privy-is within 50 feet of a surface water Cesspool or privy is within 50 feet%of a border�oCg vegetated well or a salt marsh. -2) SYSTEM WILL FAIL UNLESS THE BOARD,OF HEALTH (AND.PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY,AND THE'. ENVIRONMENT: . _ the wstem nas a septic tanK and soil absorption system and is within 100 feel iv surface water Supply or tiibulary to a surface water supply. The system hay a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption sy The system liar a septic tank.and soil absorption system and is essm and is within than0100tfeet but 50 feeta privateter or morel fromlla private water sis for coliform bacteria and volatile organic compounds indicates that the well is supply well, unless a well water analy free from pollution from that'fauldya andjthe presence of ammonia nitrogen and nitrate nitrogen is equal to or less than S jj DI SYSTEM FAILS: or R 15.303. The basis I have determinedne that the system violates ohe Boa drof Health shouldrbe e of the following 1contac teO to determiinlure criteria as de in will be necessary to correct for this deterinination`is tdentiUed below. 7 :,. �. , ;. , ...,,a>a., .. ,:;: the failure. Backup of sewage into facility'or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or'ponding of effluent to the surface of the ground or surfaceiwaters•duetotan overloaded or clogged SAS or cesspool. s` . 2 (revised 8/15/95) �--` . :strati L'•::ad:. a.,"..�.., _#,., tr 3•�;%' . _ J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: q0 E�`'2,uc2 t 1 ®let�+�`�c, Owner: Date of Inspection: DJ SYSTEM FAILS(continued): 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 112 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). ` Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. 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 organic compounds, ammonia nitrogen and nitrate nitrogen. T - 4 El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design floes, of system is 10,000 gpd orgreater (Large System) and the system is a+significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public water supply welts The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 •-� r SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 10 L e 2wc2 at. - 0 Owner: fz_ tv.11� Date of Inspection: Check if the following have been done: Z'P_umping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. large volumes of water have not been introduced into the system recently or as part of this inspection. .�/As built plans have been obtained and examined. Note if theyire not avai)ablg with N/A. /%eZh �� ,q�.sa+f�b c The facility or dwelling was inspected for signs of sewage back-up. i,ZThe system does not receive non-sanitary or industrial waste Flow The site was inspected for signs of breakout. All system components, e�*e�the Soil Absorption System, have been located on the site. \nClv�in� 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. I,"'The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods: V1117he facility o�,ncr (and occupants, if diffcrcn.t from owner) were provided with information on the proper maintenance of Sub- surface Disposal System. F (revised 8/15/95) 4 • I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C (( ,���(� SYSTEM INFORMATION (continued) Property Address: 90 eZe\i2�. �`a� OS a Owner: Date of Inspection: f�ou.ate (S�6 SEPTIC TANK: /�-rCess Al S� �c�� (locate on site plan) Depth below grade: Material of construction: Zoncrete _metal _FRP _other(explain) vc'o Dimensions: 6 X�.1 Sludge depth:_ - Distance from top of sludge to bottom of outlet tee or baffle: 3 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: /a Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth gf liquid level relation to outlet invert, structural integrity, evidence of leakage, etc.) /�G�J'J�0�0 f�5 /Jf9rT arrl,DeeTioh f GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP—other(explain) Dimensions: Scum thickness. Distance from top of scum to top of outlet tee or baffle: Distance from bottom ni crurn to bottom of outlet tee or battle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 8/!5/95) 6 a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: qQ Ee:,�wC2\Col. 'Qgleru�\'c Owner: r Jl2_ Date of Inspection: IVov_at j lgR6 FLOW CONDITIONS RESIDENTIAL: Design flow: q 4 allons Number of bedrooms: Number of current residents:4 Garbage grinder (yes or no):� Laundry connected to system (yes or no))� Seasonal use (yes or no):_,n!!2�> Water meter readings, if available: 0063S8 Last date of occupancy: COMMERCIAUINDUSTRIAL: Type of establishment: Design flow:_gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no) Non-sanitary waste-discharged.to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)-��s If yes, volume pumped. /SUS% gallons Reason for pumping: PC/p-- 11 F�� �c'EGv/�lidns 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) Other(explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: Me—1"Id i /tesT os�s%M %s o 2rJlrld l Sewage odors detected when arriving at the site: (yes or no)Ar (revised 6/15/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) rty Address: ,Property ti Owner: Date of Inspection: I�(ou _a(J(C� ` , SOIL ABSORPTION SYSTEM (SAS):_ approximated b non-intrusive methods) locate on site plan, if possible; excavation not required, but may be Y if not determined to be present, explain: 1 , Type. tn2eeR�l ear..`h SR��e `' �X�i leaching pits, number:J— leaching chambers, number:_, leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil sins of hydraulic failure, level of ponding, ndition of vegetation,etc.) TiYI E ECTo^ll r Zrl oo 2 COAO ` CESSPOOLS: _ (locate on site plan) Number and configuration: �n2 /Avr+sL17 �F� Depth-top of liquid to inlet invert: Depth of solids layer: / Depth of scum layer: Dimensions of cesspool: 6`X8 Materials of construction: Y) .eC/.eT jqrrc B a 1 _1 indication of groundwater: N/f} r-\ t` inflow( spool must be pumped as part of inspection) S(nc C.eSS o0 � e W a Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) S �blct PRIVY:= (locate on site plan) Dimensions: Materials of construction: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 8/15/95) 8 1 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: O Eel Rzvc2 lzok- Q Eve, erg Owner: Date of Inspection: c TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Capacity: eallons Design flow: Rallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX. (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribu!'.e ;, eq_:a' evidence of solids car\,m,er, evidence of leakage into or out of box. etc.) PUMP CHAMBER:_ (locate on site plan) - Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:. Owner: 'IX Date of Inspection: \vL6 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 11 i CellA 34 5 0 To 01 � � Bess f6-`Act N,RN SeTcVA�R g 3 s3'0Sces5�l _ a7 '. F. 53 DEPTH TO GROUNDWATER i I , Depth to groundwater: _feet ro rY) J C6crf� P 10v2r 7f.h method of determination-or approximation: (revised 6/15/95) 9 ai SENDER: I also wish to receive the ,v_ ■Complete items 1 and/or 2 for additional services. m ■Complete items 3,4a,and 4b. following services(for an d ■Print your name and address on the reverse of this torn so that we can return this extra fee): card to you. d ■Aettramc?this form to the front of the mailpiece,or on the badr'd space does not 1. ❑ Addressee's Address p d d ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2.❑ Restricted Delivery fn t ■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: 4 Article Number � � c E (C.JJ _!/�- '{r 4b.Service Type t° ❑ Registered 10 Certified rn ❑ Express Mail ❑ Insured 5 LU �I � I 4 ❑ Return Receipt for Merchandise ❑ COD ` Date of Deli w 7. Z 5.Received By:(Print Name) 8.Addressee's Address(Only if requested ¢ and fee is paid) r t— g 6.Signature:(Addressee or Agent) PS Form 3811,December 1994 102595-97-13-0179 Domestic Return Receipt r First-Class Mail UNITED STATES POSTAL SERVICE Postage&Fees Paid USPS Permit No.G-10 • Print your name, address, and ZIP Code in this box• Public Health Division TOM of Bamstabie P P0.Box 534 Hyannis, Massachuse#s 02601 j I i 1��iftil�t�l1�1[I�tt11111�113�t� No......rf':11.' THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF . HEALTH Town........................OF.............Barnstable -------------------------------------------------- --- AVVIiration for �axk C�nn� xnr iun �ernti Application is hereby made for a Permit to Construct ( ) or Repair )(X)� an Individual Sewage Disposal System at: • -......90.E 1...Rix. T-.Rad.d...Qa.teXY.i..11,.eL------• ---------------------------•--------...--------.....--•-----------•------•-----------••----------- Location-Address or Lot No. ......................Holli .................................................. ......-- Owner Address J.P__Macombgr...6T.iz,. ........................ Installer Address Type of Building Size Lot----------------------------Sq. feet U ,�.., Dwelling-No. of Bedrooms...........3...............................Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type T e of Building .............. No. of ersons.....__..................... Showers C4 YP g -------------- P ( ) — Cafeteria ( ) a' Other fixtures .--•-••-•-------••----------•--. - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Ix Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 4 Percolation Test Results Performed by.......................................................................... Date---------------------------------------- W Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GTq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------_................. a' --••-•-•--••-----------•----•••-•-----••--•-•••••••••••••----•---••-•-•-•-----------•--...---•---------------•-••••-••..._...-----••-••--••--•-----•-••_---•. ODescription-of Soil........................................................................................................................................................................ U ---------------------------------------•--••--------------------------------rand W UNature of Repairs or Alterations—Answer when applicable___________________________________________•------_______-__-•_-___...._................._.... --------1---1-0.0D--.ga-1-1.on---ILi-t-------------------------------------•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with !-1T I'1�•-' the provisions of iT t:_. of the State Sanitary Code—The undersigned further agrees riot to place the system in operation until a Certificate of Compliance has been issuo b Wthe board o /ealt Signed _ --- -- •- .----------•-------------- -•-- /.3/.8L9.......... Date Application Approved B --• - ----•---------------•-- - ---- Date Application Disapproved for the following reasons:-------•-----------------------•--------•--------...--------------------------------------------------........ ....•-••-•-••---•-•-........•-•••---------••---••-•---•----•-------•-••-•....-••-----•-•-....-----••••---••••-•••••••••••••••---•••---•--•--••-••••------••-------•••••-•••-•--•----•••---••-••••-•-•--- Date Permit No.......F.1=119.f ------------------ Issued....................................................... Datz No.....iJ I-�. .�-- Fps.. ~............... � '.f.. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Applira#ilan for Uhipoii al Workii Tomitrnrtiun runfit Application is hereby made for a Permit to Construct ( ) or Repair''(' At) an Individual Sewage Disposal System at: d Location-Address or Lot No. , Owner Address at ; j ,. DnICar Jr. Installer Address Type of Building Size Lot............................Sq. feet U �-, Dwelling—No. of Bedrooms........... ..._-_....•....................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria Otherfixtures -----------------------------------------------------------------------------------------------------•---_--------•------------.--------------------. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Gd Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. fI. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date....................................... a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ...-...........................................................................0............................................................................. 0 Description of Soil........................................................................................................................................................................ �,. • .. to W ---------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------..0........--- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ---------------••--•------ _.--_ u % __.._c3 1.�z9a Fri. .......................................... Agreement: - The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with flT rlX^ LE the provisions of 'T: i 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 theboard of health. Signe U Date Application Approved By.................. 111/// -• -------- ......_.. ate Application Disapproved for the following reasons-------------------------------------------------------------------------------------------•--••--••-•----...---- -----------------•••-----•-...-•-••-•-------•-•-•--•••-•-•------------•-••....••----.........------•...•-•-•---------•----•••--- •-----••----------•------•••----•---•••...-••---••--•-•-----•...------. Date PermitNo....... ---------------------- Issued....................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............I...........................OF.......................... ......................................................... TntifirFatr of Toutph anrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by---------- -------------------.......................................................... ------------------------.._.._..----------------------------------------.......---------•-•------..... v Rlad OnLr--rv7.1lee Installer at-•_....`•------•-.--•- has been installed in accordance with the provisions of T I T IE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...._.___.�'0T_'_.rt�./,?.�... dated................................................ • THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................ .... .......................... Inspector-----------....... A .................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnvt;able ...........................OF..................................................................................... $ 20. or ! No......................... FEE........................ Disposal Vorkp T-LnnvIrnr#ion Virrmit J.P Maco.m.ber Jr Permission is hereby granted .. ... .........• --............to Constru t ( ) or Repair ( j an Individual Sevcrage Disposal System at No 0 Ec:1 Ki. rar Roae--Ost ervi tl Street as shown on the application for Disposal Works Construction Permit No(2�� Dated.......................................... ................................ ---- ----------------------------------------------------- oard of Health DATE..................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS Directions to Site: From Hyannis-Take Route 28 toward Osterville;Take a left at the lights onto °a `,_ •�% ? - Osterville West Barnstable Road and follow to the end;Take a left onto Main Street;Take a right onto ,;; Parker Road;Take a right onto West Bay Road;Take a left onto Eel River Road house is on the left#90. Ad .y '�'� `,1�. • ;•, LOCUS.• .,t r�'• MON .L.. y `a �. _.jja`4 - ' '� f�1'tfl'1 IV.e4•• I,•f'.r'` IN,NOTE: PLAN DRAWN FROM TOWN GIS. Y. LOCUS PLAN Scale: 1:12,000 i Assessors Map 116 Parcel LOT SIZE: 1.52 ACRES �`r� F. I Groundwater Protection Zone: AP Flood Zones: A11.B, C Zoning:RF-1 \ �Y � 0 - �j•4 I NOTE:IF ENCOUNTERED REMOVE&REPI:4CF. ALL UNSUITABLE SOILS WITHIN 5'OF THE, — �` -_ Finish G.ede OUTER PERIMETER OF THE SYSTEM. Filter "� \�. / �t =3 F4 Qo i �•r f / Fabric Compacted Fill $ _ I/89t-Ile Pea Stone to �. Leachin Chamber 3/4"-1 1/2". N Douce rYosited Stone 4-10 '' HovsE CROSS SECTION OF CHAMBER NOT TO SCALE. ••.. F��.c., °J� .t' Sic �� �• ,P' PRoPa ED / PLUMBING�TO BE REDIRECTED VIA ,,,�' �►L ��1� ,� GRAVITY OR EJECTOR PUMP NOTE: EXISTING SEPTIC SYSTEMS TO BE PUMPED & FILLED W/CLEAN MATERIAL, n�. ��� F.G. ' •5 FG. ly' NOTE: EXISTING GARBAGE GRINDER .— SCALE: 1�� = 30' ► .�' TO BE R.EMOVED. 1500 G Slott Top El. 11.7' Septic Unk it.3 H zo c :s Bot.El. 8.-7 Bedding as _ c Pet Title 5 1=-3•Z Co RA. DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM I Not I)Scale W6Ll. MtW29 NIGTES P=--t.�7 arss: '.Water Supply ForT:is Lot is Municipal Waller DESIGN-DATA 4 Bedrooms E` roc ban �'tilities shown on This Ran Are Approx. Daily Flow 0"0 GPD Hours Prior to An Exccyaiior,l=orThi: o r y Septic Tank:440 GPD x 200%=880 GPD Nrojec� y:t ContractorShall Make The Required Use 1500 091lon Septic Tank Notification to Dig Safe(1-888-344-7233) 3. The Contractor is Required to Secure Appropriate Leaching Area Permits From Town Agencies For Construction ' "0 GPD/0.74=595 SF Required Defined byThis Plan. Sidewall= 202.83'+ 33.5')2= 185 SF 4. Install Risers as Requiredto Within d'of Bottom Are&= 12.83'x 33.5'=430 SF Finished Grade. 615 SF Totof Provided 5.All Structures Buried Four Feet or More or subject" PROPOSED SEPTIC SYSTEM to Vehicular Traffic tobe H-20 Loading. beaching Chamber Design r UPGRADE All Pipes to be Schedule 40. Use � € � M . Septic System to be Installed in Accordance With 3-500 Gal. Leaching Chambers in a i'E7ER ', 310 CMR 15.00 Latest Revision And The Town of �� AT Barnstable Board of Health Regulations 12'-10"x 33'-6"Washed Stone Field as Shown ' SUtlly,'�lil °� 7. All Piping to be Sch.40 PVC. �� G ' 90 EEL RIVER ROAD OSTERVILLE, MA BY 0 SULLIVAN ENGINEERING OSTERVILLE, MA DATE: SEPTEMBER 12, 2001