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TOWN OF BARNSTABLE
LOCATION SEWAGE# Z00- 109
VILLAGE 0 ASSESSOR'S MAP&PARCEL q 3 g
INSTALLER'S NAME&PHONE NO. ftrLj 7Q6/c-,,JL &SknA 7714-Z37-71 F30
SEPTIC TANK CAPACITY I QO
LEACHING FACILITY: (type) S ar,.- (size)
NO.OF BEDROOMS
OWNER r + Mrs k e
PERMIT DATE: 4-19-177 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 5,0 Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) N/A Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) N/A Feet
FURNISHED BY
kouz-
y r
� 3 q
y0
No. 90 `3 i 0 9 Fee [ v
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
4plicatlon for NspoBAY *pstrm Construction Permit
Application for a Permit to Construct( Repair( ) Upgrade( ) Abandon�; ) ❑Complete System ❑Individual Components
Location Address or Lot No. t Own is Name,,,Adc�ress,and"del. o;g,,
' �Q•V
Assessor's Map/Parcel
Installer's Name, ddre s,and Tel.N� Designer's N e,Address,and Tel.No.
,end ✓ o✓
Type of Building:
Dwelling No.of Bedrooms Lot Size �j�� sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date 2 2 V 117: Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil [2 ^_ —3 5
of
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected: r
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 Certificate of
Compliance has been issued by this Board of Health.
Signed Date G- 1—1-7
Application Approved by 1 Date
Application Disapproved by Date
for the following reasons
Permit No. 0%1 Date Issued 'f� /
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
IM ^�CC
DATA
fit.'" f .
No. �0 1 -7 Fee f V
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
9ppl cation for DIspos4*pBtrm Construction permit
Application for a Permit to Construct Repair( ) PUpgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. .�� (7 r l Owner's Name,_Address,and Tel o.. .--
Assessor's Map/Parcel
In�sttaalyle�r''s Name,'Address,and Tel N Designer's Name Address,and Tel.No. l 111
/r Or/ /
tW X d CX 2-"- ✓ qkllk-
1 - �0 2,g U�✓ FM U�w ��. .� of IM✓a
Type of Building: '% .
Dwelling No.of Bedrooms Lot Size, ` `1 sq.ft. Garbage Grinder( )
Other Type.of-Building WO o d No:vr� -'�of Pe"rso'� �^ns Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) u�I f gpd Design flow provided ` gP
} �� d
Plan Date 7- 17 2i ° " (``Nunl`er of sheets Revision Date
Title +,s x l•� :F
Size of Septic Tank �a� � Type of S.A.S.
Description of Soil {U- � �1 1'G a `7 A +� �l 12 ' 5", L a—q Q ��71 1�C)" i
Nature of Repairs orAlteratrons(Answer'when applicable)
r
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed .�o— --�.r Date 6- 1- 1-7
Application Approved by �L✓� I f �` S Date ",��
Application Disapproved by .. Date
for the following reasons '@
Permit No. �� —I Date Issued ��� _ 1 7
----------------------------------------------------------------------------------------------------------------------------------="----
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the(,On-site Sewage Disposal system Constructed Repaired( ) Upgraded( )
Abandoned( )by E- - o
at (q f ( /,� .� � 1V 1(t- has been constructed4in accordance
with the provisions of Title 5 and-t e for Disposal System Construction Permit No. �Gl�- dated 1 f b
Installer 4�� ° it 7 Designer lW✓! 60,gyp _ q f Ire e 1-1
#bedrooms Approved design flow U�I1� gpd
The issuance of this permit shall not a construed as a guarantee that the system will function as designed.
' Date „ Inspector
-----•----------------------------------------------------------------------------------------------------------------------------------
No. go I I6 Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS i
Disposal &pstem Construction Permit
Permission is hereby ranted to onstruct( ) Repair( ) Upgrade( ) Abandon( )
System located at
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
2' Provided:Construction mustb espmpleted within three years of the date of this permit.
Date �� D Approved by
Town ®f Barnstable
Regulatory Serhees
Thomas F. Geiler,Director
IABNSTABLE,
MAW. Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,NU 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& DDesiMer Certification.]Forma
Date: Sewage Permit# 20 i-7-109 Assessor's MaplPar eel
Designer: DOWN C ft Installer:
Address: (v��(j�j 4U, (,8 Address: 2�� P -
� OPT �� d�75 n�ic,�+, M�rYh"
On 4- 18--1-7 M,�1 J .A �,S}oA-,was issued a permit to install a ti
(date) (installer)
septic system at aYez& 15&4 04-e-rvi If, based on a design drawn by
(address)
b,mw D" -Pt�. dated f-- 17
(d signer) -
,.,e,- - I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
• greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State&Local.Regulations. Plan revision or
certified as-built by designer to follow.
MEL A.
�o
0)-A A
(Installer's Signature)
t�2
--� ONM-
(Designers Signature) ( (Affix Designers Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF
COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE
RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU.
Q:Health/Septic/Designer Certification Form 3-26-04.doc
1
I3epaz-tAamnt of Regviatnlcy.SetrvAces
c Public HeaZih-Division DI$te /d
200 Main SUre,Hyannis MA 12601 I
a M1Ct •� E
�D(J dv
Date Scheduled Tuna /j- JN'ce k'd, �
1 W
t71
osal
Performed�y i��1iCt7 � �6�� t: Wi[nessedBy V-
LOC.tATIqON r�
Location AddreFs �o /� � U InUaIIY ,OWaet sNamc 6I 1
os_}r'�v,1l e ! Address
\\ GG((
Assossar'sMap/Pa[se1: `3/� Engincer'sNama CL�Lt�'� e .
NBW CONSTRIICP.[ON REPAIR
Land llse: It'—"SGC P1AG l 3ioprs(9b] SaaccSmnes. lV l
t
Dj5=G s$am: Open watet•Body5)2 j i- ti Ycssibly wet,Arra2 ArinkmgY atcY clI�f 'd�Fc
I •Dral'naga Way y l.Gn. tt Property Line J ft Ofbarfk
SEMI 'CH;(Stmet name,dimensions of lot,exact Ionflans of test hales&pem testa;Iacala v nd=ds tt pxo"dmity to holds)
ya
- S Z
Parent material(geelagic)V lQL t(� i Q Depth to Ae0acl£ m•i
pp rf
Depth•toGm¢ndwater.StattdingWaterinHale: //T!> Weeph1A*=PltFaaz
• Estimated Seasonal High-firowdwater(:-{ -t��G.r-- - - - - -- — ----- - _
l EA'1J[4)10TFOR ONALBaGR WATER TARL.H.
Method Used: r 6,^,1 ' 'to
Depth Observed standing in a6s.hole - la, Goptli,t059111ilflttla3: ltt,
D�¢'[ht�c,_t;cepingfivmsideq ate�o q�-•!tt, dYnundwatelr.Aid,�iWkt�at "� '� t
IndexWnII#11iWLY I2cadngDakc l L7/! IadexWe111eYal� T. � Adf,fttwZ,� ?�.._ptx?UAt1V1nMtlCYalrad �,z
FERCOLAT1,0N TESL'` ba>n Iy Th. 4 --f
Ohse.-vatian �f '
[J IF
DeptltafPerc. f�� V f Tlmsn[G' ��,•�,_,_.. •
S[artl'ra-soak'lime C� �� 77
End Pro-sank J9 10,L .
Ram&Aa.11ach 7�• ..
Situ Suitability Asamrar= 540kassed �J Sitp Fc:ilod: AddidcaaIybstmg Necdcd0!71'01 .. . '
ozgnnl Pdbla73eauhDlvlsian - - ObservationHoleDaLaToBeCamm leted=Back
**4`l f pe�colataou test is to be cuLducted-Wit jU 100'Hof WeA=d,you Must fsstnotes the
Barnstable Conservation Damson at least one(1)week pHor to beginning,
1�:}SP.P'I'ICIPERCFORM.DDC '
LOG ]gale#
Dcp0rfrom Soill-ladzon SoilTexft= ShclColor Soil•. Gthcr
Surface(in) (LiSDA) (NlinselI) Mottling cslmch¢c'5toucs,nculders.
ii6M&Ien y.9b'Cravall
�lq
{ OB- ST E�V•.A-11�].N[C1Y�`]GQ�,�
Dcpthirom Salllforizoa S'aTTMtam Soil Color Sail other
5mtzce(i¢.) (USDA) (Mm:aell) Mottling (StrncrCre,Smnca,Se¢idca.
• ansis cn 90 Grave
0, �t4DEEP OIBSMVATION ROLE LOG Role 4.
�1
Dcpthfmm SoURorizon SonTmonrc Soil Color Sail other'
Smface on.) ((ISDA} (Mm sdlJ Mottling (Stractuxo,Sinncs,Banldcrs.
Cormtmay,Ir,G e
4,16
]Dm OBSm'0.A'�' 0x1[OLnLba. Role#
Depthfrom SoilHnd=n SoilToxturc Soll(Jalor San Othor
Surface(n-) (USDA) (Mnnseli) Mattiing (5haeture,Stones;Bouidsrs.
-Cori em a v, ..
Y+lood7nsaranne-)[tafe'1V1at�a.
" Above5tltlyearfloadboundmy No� Yes,_-..,, '
'Within500yearbouadmy. No Yes - '
Wtdvn 100year flood boundary No..� ym
Y)e>ufhofl'�atmcaTlnd3ccarrin�7PerviouSMiitsrfa'(
Does at Lead fonr feet ofnaimaliyocomringpervions aie�cistinallarapsnbsesroedthrougitnutthe
area-proposed for the soil ahsorptian systam'1
If not,what is the depth of haturaily occmTIng p&4vious matariall
Cert"dication f -
I c=tffy that on j/a {data)I havepassed the sail evaluator ercmnination agrnoved by the '
Depalhtlant o3:EnvuonnienMI Proteetlon uld tharthe above analysis was performed by mo consistent with .
the rcgtmed training,expert3ee and experionca described in 10 CURI5.OI7.
�P a
Signature , Date
' Q:VS,nt''tTC11'L12Cn0ItMnOC '
TOWN OF BARNSTABLE
LOCATION ,t -4,4-C-t ! AJ (fib SEWAGE #Rom=
r VMLAGE 40 9'irl4A A LA-- ASSESSOR'S MAP& LOTS il,40'af
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY 1-5 0 14-ytt—
LEACHING FACILITY: (type) -- C.`"I-- (size) t,--
NO.OF BEDROOMS
BUILDER R OWNER oZfa t L�
PERMITDATE: I I k2 COMPLIANCE DATE:
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 of le ng facili ) Feet
Furnished by
A
r
F Q
Al X
I !S.? 371
D,b�F 3l�
laTo. V Fee
a,
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZIPPrication for ligpogal *pgtem Construction Permit
Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at:
L catio�or.j,ot Nov / D Owner's Name,Address and Tel.No.
Ott
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
r ')
Type of Building:
Dwelling No.of Bedrooms _ Garbage Grinder
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures C
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil
Nature of Repairs or Alterations(An swe hen plicable)
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 in operation until a Ce 'fi-
cate of Compliance has been issue b 's B MO . �
Signed A Date_
Application Approved by ® Date
Application Disapproved for the following reasons
Permit No. Date Issued
———————————————————————————————————————
3 Fee
o
THE COMMONWEALTH OF MASSACHUSETTS
_`""OUBLIC HEALTH DIVISION -;TOWN OF BARNSTABLE., MASSACHUSETTS
0ppYication for Migpoq;al *pgteut Cori0truction 3permcit
Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at:
Location or of N0Wi. Owner'ses 1.No.
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms _ Garbage Grinder
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow 4 -gallons. j
Plan Date Number of sheets Revision Date
Title
Description of Soil
*+ 411Y-
Nature of Repairs or Alterations(Answe hen a plicable)
y4 Date last inspected:
AgreemenW..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 Ce 1 1-
Cate of Compliance has been issue by s B OrMofailth
.
:
3 Signed ® Date f'
,t,
A rpplication Approved by a / Date
Application Disapproved for the following reasons
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
{
BAR NSTABLE;MASSACHUSETTS`------'-'- --'-- --
ctCertificate of Compliance.
THIS IS TO CERTIFY,that the On-site Sewage Disposal ystem insta led( or repaired/replaced( )on
by Installer he�� '✓ �����
at / AK O ram- ��'�U/ instructed in accordance
with the provisions of Title 5 and the for Disposal System Constructs Permit No. ti *3 0 -r
Date 1 �o" G �i Inspector
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEeTHAT THE SYS-
TEM WILL FUNCTION SATISFACTORY.
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
33i!6po2!; Y *pgteu�t con!6truction permit
Permission is hereby granted to
to construct( )repair( Wan On-site Sewage System located at No.# .�a k/f�-
r
Sheet
and as described in the above Application for Disposal System Construction Permit.
No. 01 Date
The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or specs conditions.
All construction mud be cdmp
ted within three years of the date below. �
Date: 74 Approved by
r ! Board of
i
l—
Town of Barnstable
�.. Department of Health, Safety, and Environmental Services
eAttxff ARIA
Mom. Health Division
367 Main Street,.Hyannis MA 02601
Office: 508-790-6265 Thomas A.McKean
FAX: 508-775-3344 Director of Public Health
I
July 5, 1995
Kay Daley
Lisa Gardner
61 Great Bay Road
Osterville, MA 02655
ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL
CODE, TITLE 5.
The septic sYtm e owned by you located at 61 Grat Bay Road, Osterville was inspected on
May 31, 1995 by J.P. Macomber 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:
• Main house cesspools in groundwater
You are directed to hire a licensed Town of Barnstable septic system installer to submit a
sketch diagram of a proposed system to the Town of Barnstable Health Division Office
(Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance
with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) days of
receipt of this notice.
You are also directed to bring the septic system into compliance within thirty (30) days
of receipt of this order letter.
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 HE BOARD OF HEALTH
T o as McKean, R.S., C.H.O.
Agent of the Board of Health
[Installer letter]
�Itl
TO: ;�, Z(e s����`` (Date) ''
ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL
CODE, TITLE 5. lo
The septic system owned by you located at l was
inspected on 9 P PIoan _�,P,—xMassachusetts 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 fpllowing:
You are directed to hire a licensed Town of Barnstable septic system installer to submit a
sketch-diagram of a proposed system to the Town of Barnstable Health Division Office
(Town Hall, 367 main Street, Hyannis) that will bring the septic system into compliance
with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of
receipt of this notice.
You are also directed to bring the septic system into compliance within thirty (30) days of
receipt of this order letter.
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 THE BOARD OF HEALTH
Thomas A. McKean, R.S., C.H.O.
Agent of the Board of Health
Town of Barnstable
ASSESSORSWR
093 G o PpftCELNO'
6/
�D AT E.•-----6/95------
PROPERTY ADDRESS: 61_Great Bay_goaa __-__-_-
Osterville Mass.
-- 02655------------------
{
4
On the above date, i Inspected the septic system at the above address.
This system consists of the following: i
A. 3-Block cesspools for the main house.
B. 1-Block-*cesspool for the cottage.
of the following conditions:
Based on my inspection, I certify 9
A. This is not a title five septic system-
B. The main house cesspools are in the groundwater.
C. The cottage cesspool is not in• the `ground water. I
I
SIGNATURE:
S � ---
Name: J-P.Macomber Jr
Company: J-P_Macomber_& Son Ind`
Address: Box 66
co
co �;
--Centerville,Mass_ 02632 � I19�s
P h o n e: 508-775-3338
\ i
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY.
RPM
Ca��S�Ce
MACOMBER Sc SON, INC.
sspools-LeachfIeIds
Pumped & Installed
Town Sewer Connectlons
66 Centerville, MA 02632-0066
775.3338 775-6412
i
l�
t M
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
Address of property (, iz .,,2��, \20A
Owner ' s name
Date of Inspection
�A uC �'��
PART A
CHECKLIST
Check if the following have been done:
I
Pumping information was requested of the owner, ant and
Health. occupant, Board of
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. N
available with N/A. Note 1f they are not
The facility .or dwelling was inspected for signs of sewage back-up.
The site was inspected for signs of breakout.
All system components, excluding the SAS, 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 SAS on the site has been determined based
on existing information or approximated by non-intrusive methods.
The facility owner (and occupants, if different from owner) were
provided with information on the proper maintenance of SSDS.
' r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION
FLOW CONDITIONS
If residential
DEN i
TL+.I number of bedrooms i
nuinber' of. current .resid nts
garbage grinder, yes or no C O_TTPC
laundry connected to system, yes or no
seasonal use, yes or no
If nonresidential , calculated flow:
Water meter readings, . if available
ep. 5y5�
Last date of occupancy - . 'U6 ��t�� � �
GENERAL INFORMATION
Pumping records and. source of i ormation:
'Coe.0 i5i L
System
Pumped as part of inspection,if yes, volume pumped yes or no
Reason for. pumping:
-----------
Type O"fskys�tem
Sept ' tank/distribution box soi
.i_ Single cesspool � _/ l absorption system
Overflow. cesspool Fsl,�i,TX .4. M^%N JO�L-
Privy
Shared system (yes or no) (if
records, if any) yes, attach previous inspection
Other (explain)
Approximate age of all components. Date installed if
.information: known.
� Source
I` Sewage odors detecte
d when arriving at the site r.
yes or no
. i-
M1
9
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
SEPTIC TANK: Lbw C
(locate on site plan)
depth below grade:
material of construction: concrete metal
FRP other(explain)
dimensions:
sludge depth
distance from top of sludge to bottom of outlet tee or baffle
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.
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, recommendations for repairs, etc. )
DISTRIBUTION BOX.. k-k E -
(locate on site .plan)
depth of liquid level above outlet invert
Comments :
(note if level and distribution is equal, evidence of solids carryover,
evidence of leakage into or out of box, recommendation for repairs, etc. )
PUMPCHAMBER: tAO U G
(locate on site plan)
pumps in working order, yes or no
Comments:
(note condition of pump chamber, condition Of pumps and appurtenances
recommendations for maintenance or repairs,etc. ) '
f
10 h
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECT,-.ON FORH
PART B =7
SYSTEM INFORMATION continued
SOIL ABSORPTION SYSTEM
✓Y S E M
(
SAS
(locate on site plan, if possible; excavation not required, but may be
approximated by non-intrusive methods
If not determined to be present, explain:
Type
leaching pits and number
leaching chambers and number
leaching galleries and number --
leaching trenches, number, length
leachingfields, number, dimensions �.-..
overflow cesspool , number
Comments:
(note condition of soil, signs of hydraulic failure, level of pondirig, .
condition of vegetation, recommendations for maintenance or repairs, etc. )
`: !;; 1 L-op—
CESSPOOLS (locate on site plan) : 44571EM 1 -Sv5r!ErK Z SV5�,►3
number and configuration 2-
depth-top of liquid to inlet invert
depth of solids layer .
depth of scum layer - Uc'"'e blow t
dimensions of cesspool
materials of construction S'DE"P
indication of groundwater g` - CO`LC- 6`0<4 CoruC_ C5 '
inflow 166-rmw( 3
( sspool must be pumped as " 5
part of l ins ection -�' �`"C'w
p ) S���o<� ir4CYjS-Q. 6�0 �-1i.C� G-»z-o !-�zU z•i
Comments: �k
pFSYs�
(note condition of soil, signs of hydraulic failure level 'of
condition of vegetation, recommendations for maintenance or repairsl,1etc. )
PRIVY:
(locate on site plan) � I y
I C)
materials of construction
dimensions
depth of solids
0
Comments:
condition of vegetation
(note condition -of soil , signs of hydraulic failure, ' level of.
, recommendations for maintenance or repairs,letc.
i
i
i
SUBSURFACE ,SEWAGE DISPOSAL SYSTEM INSPECTION .FORM
PART B
SYSTEM INFORMATION continued
SKETCH. OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmar s
locate all wells within 100 ' k
WA.=iE
(ft t T4)E C
Q H \
r v I
^7
0
• 'S Y 3�N-L `
DEPTH TO GROUNDWATER ' T eP fq
• depth to .-
P groundwater *15YsTErvl (�LrZpUNp WA
method of d termination or a �' Z r4e6vC- G'ep '
approximation:
k! t
_ A,
12
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
FAILURE CRITERIA }i
.•ii
Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of
determination in all instances. If "not determined" , explain why not)
A& Backup of sewage into facility?
�a Discharge or ponding of effluent to the surface of the ground or
surface waters?
Static liquid level in the distribution box above outlet invert?
Liquid depth in cesspool <6" below inve
flow? rt or available volume< 1/2 day
90 Required x
•�- Pumping P g 4 times or more in the last year? '�-
number of times pumped
R' Septic tank is metal? cracked? structurally unsound? substantial
infiltration? substantial exfiltration? tank failure imminent? 1
Is any portion of the SAS, cesspool or privy:YES '
below the high groundwater elevation?
ti�o " C07TgNC>e -Y&1-e_=VLA • kb C>
k[Q within 50 feet of a surface water?
!Va within . 100 feet of a surface water su
water supply? PplY or tributary to a surface
fro within ..a Zone I of a public well?
�Q..- within 50 feet of a bordering vegetated wetland or salt marsh
�,. y, not the SAS)
within 50 feet of a private water supply-
well?
40
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 co
py for coliform bacteria, volatile grganic compounds, ammonia welltnitrana
ogensis
and nitrate nitrogen.
05/-�1/1995 07:53 508-428-3508 C:. -.0.MrA. WATER DEPT PAGE 04
KEY NUMBER <1316 >
NAME <DALEY, KENNETH > B-C 1 B-C 2
B-C 3 B-C 4
STREET 61 GREAT BAY ROAD
CITY OSTERVILLE ST MA ZIP 02655-2312 REF 1 REF 2
PHONE ( ) - REF 3 RED' 4
METER NO. < 1277> DATE READING CONS
STREET <GREAT BAY RD NO. 61> ( 06
12 31 94 4 i 1(6
CITY OST S ST LOC 30 94 2083 13]7��
-7Z
PHONE ( 14 - 12 31/93 2 2 6
06 30 93 1928 32 fTS
ROUTE NUMBER 17 2 31/92 18 153
SERVICE DATE 12/12/50 06/30/92 1743 17
METER DATE 03/27/51 12/31/91 1726 130
CAPACITY 7 06/30/91 1596 25
STYLE T8
SIZE 1 RATE SCHEDULE
KEY PIT PLASTIC
NOTE RR FRONT LEFT ADDITIONAL CONS 0
ALTERNATE MIN 0
K
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
PART D
CERTIFICATION
Inspector : Peter Sullivan PE
Location : 61 Great Bay Road Osterville
Date : May 31,1995
Certification Statement
I certify that I have personally inspected the sewage disposal 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.
I have determined that the system fails to rotect public health and the environment
as defined in 310 CMR 15.303 . T e asis for this determination is provided in the
FAILURE CRITERIA section of this form.
tovpmy your
Peter Sullivan PE
Distribution:
Original to system owner
Buyer
Board of Heath
�IR OF
4.�
SULLIVAN �
No. 29i33 °1
w, N'n
`�'OAtAL E °
.r
Town of Barnstable
Department of Health, Safety, and Environmental Services
RAMWABM
M� � Health Division
FDA 367 Main Street, Hyannis MA 02601
Office: 508-790.6265 Thomas A.McKean
FAX: 508-775-3344 Director of Public Health
October 3, 1995
Kenneth D. Daley
401 E. Linton Blvd., Apt. 674
Delray Beach, FL 33483
SECOND ORDER TO COMPLY WITH 310 CMR 15.009 THE STATE
ENVIRONMENTAL CODE, TITLE 5.
The septic sytem owned by you located at 61 Great Bay Road, Osterville was inspected
on May 31, 1995 by J.P. Macomber 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:
• Bottom of the cesspools were sitting in the groundwater table.
Letters were mailed to Susan Gill and Kay Daley on July 5, 1995 and July 13, 1995.
However, the system has not been upgraded and the assessor's records indicate the
property's owned by you.
You are directed to hire a licensed Town of Barnstable septic system installer to submit a
sketch diagram of a proposed system to the Town of Barnstable Health Division Office
(Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance
with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) days of
receipt of this notice. You are also directed to bring the septic system into compliance
within thirty (30) days of receipt of this order letter. 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 THE BOARD OF HEALTH
�omis cKean, R.S., C.H.O.
Agent of the Board of Health
jF'rop-m-ty Irmt.Ary AR
Accou,.rit No." 4:*-:'7 77 F"a r,el n t
-i
I..-o(.-.at i on: 6-1 GRFAT RAY i'-U'l N F-,i g 11!:-,)c-)1- 0 d 2i'AA F- -e 1-Dis
LID? 1
e a-s
Ci-kri-pri'k- Own." DALEY, D a
I AF"T E".,''I d g s.,;40 1 1.1V I Ul I r.iL j
1: D e-1 t 'R un f
januar-%/ t,7,t; DAi-FY Nrll*.)D , 0 d -F,,i
t(--�s:, L n d 147""'00 1,.*-.ii..i.-:Ll(-i�i.11-ig,..L''.' F
-'r ,Ay j'-,C)PjT, F,1-
n
C ' att - TPC k
,an-trol ,f.n-Fc.. 1- S AU .C.) Ur.I cl k..l -k;.-
gc,
1-and d By,'l a 1.,�ce 13 By!
'T-Jtle. A c:L.o,..l n t. T e I--)
Prc-,.-st.; MAT -For, a
Ne:.---,-t screen A R Act if
C-A,jr-je, Namf
Farcel klumb,, I,,
r
a
TOWN OF BARNSTABLE
THE Taw
OFFICE OF
i Heaa9TABL i BOARD OF HEALTH
7 NAB& p
°o 039. gee 367 MAIN STREET
MAY k HYANN►S, MASS.02601
July 13, 1995
Susan E. Gill
Cotton Real Estate
Box 68
851 Main Street
Osterville, MA 02655
Dear Ms. Gill:
I am in receipt of your letter dated July 12, 1995.
The septic system at 61 Great Bay Road, Osterville shall be upgraded prior to re-
occupancy of the dwelling. Therefore, the new owner shall not occupy the dwelling until
after the septic system is upgraded. Please provide this office with the full name and
address of the buyer so that we may properly contact him/her.
Sincerely yours,
mas A. McKean
Director of Public Health
Town of Barnstable
TM/bcs
ASSESSORS MAP NO: �
PARCEL NO:
sueg
f
FROM: COTTON REHL E=TPTE FRX: 1 502 420 3161 .1uI-12-95 Wd 0 45 PRGE:Cofton
REAL ESTATE
July 12 , 1995
Town of Barnstable Board of Health
P.O. 534
Hyannis, MA 02601
To Whom it May Concern,
Mr. Kenneth Daley of 61 Great Bay Road in Osterville has
received a notice from you demanding compliance of his
septic system within 31 days .
The property is presently under agreement and is scheduled
to close on the 29th of September. The buy r, Mr. Craig of
Washington D.C. is going to do extene ve renovations
Including adding a second floor. it is a second home for
the Craig's and they will not reside in the house until
renovations are complete. Also they will possibly be doing
a larger system to accommodate additional bedrooms . The
construction work will begin immediately a or closing and
the new conforming septic will be part of the construction.
Y ask that you inform Mr. Daley as soon a possible that
you will require the new system of the buyer after the
closing.
Most Sincerely,
Susan L. Gill
Broker
SO/1g
0 851 Main Street Box 68 Osterville, Massachusetts 02655 (508)428 9115 FAX (508)A20-3161
D 6 School Street Cotuit,Massachusetts 02635 (50B) 428 9593 FAX (508) 428.6758
FINE
® � �6 KLINE
ARCHITECTURAL DESIGN
Ffi(WA2Tw
. � rvrv:.FneliHrtlGxhriCeSiv„i.mm
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.. SHE9.I.',FLI
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ARCHITE C.TURAL DESIGN:
NOTES',
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ARCHITECTURAL DESIGN .
P XRa211Tx.
. 3 /B - n,�vr.Frc{rBYJYceraCesyr,>°n
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NOTES:
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- ARCHITECTURAL DESIGN .
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NOTES:
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ARCHITECT DESIGN
A/IET MY R3AG
56"
- --- --
#
" ✓'_. ' w .:...- v a_.r 4rvQ- . • .��rvotoRrrs�c.000rsrPrtrr;i v rvlr.oawrur.n-o,..�l.L�rvr eBBB(rr eesllb�itIoaLr.cory r
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R WA
4OclIL p--.ern
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e-
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^----------- - --_-- ---- - fSE
-------------------
DATE
PLAN*EINELINI4
;N.
E
y J ter, -
..
�`rtii)
�i
_. , .. 11ryrIE�l�I 11 .. FFUJECTn I105
FOUNDATION PLAN TYPICAL WALL 5EGTION -
. SCALE:5/16"=1'-0" - SCALE:1/2"=1'-0" -
.. WE 3'2o", ..
H40VNT I 4 SC E WITH
NOTES
DE I N.
O E�
SYSTEM SG
ALL SYSTEM COMPONENTS SHALL CHARCOAL FILTER AS
i S L BE
SYSTEM PROFILE
LE O
K D-WIT OWN PLAN
MARE H.MAGNETIC TAPE R SHOWN LA VIEW
LEG
END
END
0
NAV D 88
t
- _ 1. DATUM_ COMPARABLE ARA
D M IS
_ 5
0 P BLE MEANS FOR FUTURE PITCH. BACK TO SAS LOCATION.
._ TI
» NOT,TO SCALE
G DISPOSER IS NOT ALLOWED _._.
GARBAGE D )
PROVIDE MIN. 20, DIAM. WATERTIGHT
NO LOW POINTS.
99 _
TIN CON
TOUR
EXISTING
_ `.EXISTING 'ACCESS COVERS TO WITHIN 6 OF FIN. 2 MUNICIPAL WATER IS TH GRADE 2 CAST IRON COVERS'ESTOGRAE
2 PEASTONE OR GEOTEXTILE »
D OR CONCR
ETE
V TO w COVERS (THIN 6 GRADE,
D COORDINATE ]��
ATE: W OWNER � NO
PROPOSED .4 BEDROOM DWELLING ,
E rth
- 9.1 »
9
X 14.1 .TOP FOUND EL FILTER FABRIC
EXIST. SPOT E LEV. OVER'STONE
3. MINIMUM PIPE PITCH TO BE 1 8 PER FO
OT.
00T.
DESIGN FLOW. 4 BEDROOMS ® 110 GPD 440 GPD
11.Z
Bay
_ 99 :PROPOSED CONTOUR 2MINIMUM .75 OF COVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM
4. DESIG
N N LOADING FOR ALL PROPOSED PRECAST UNITS
F
US
E 440 GPD DESIGN LOW - • »
NOTE. 2 MIN: WA _
WALL TO BE HTANK)
PRECAST H 10
H 10
Locus
3 BLOCKS OR
8
4 ._
SPOT EL<`PROPOSED S 0 THICKNESS REQUIRED:`.PRO OS ED
.. RISERS
Q
PRECAST RI
SERS 20 4 0SCH40 PVC 5. PIP I
TH1
MORTAR '.ALL
H 20
E JOINTS TO BE MADE WATERTIGHT.
_ .. •• . .. • ... . '. COMPONENTS
SEPTIC TAN
K: 440 GPD 2 880 s .MIN.-suMP
PI PES LEVEL 1ST 2
4
y
» 4
T HOLE
P
INV S EL 9. 0
_TES - .
12 MIN. INir DIM: (N ) l 6. CONSTR 1CTION DETAILS TO $E IN C
Y
END S
':.SIDES
10.2
ACCORDANCE WITH
. >... 10 CMR 1�.000
P TANK .. .. _. .. _. TITLE 5:
00 ..GAL.- SEPTIC � � <�US
E A 15 <.
1 D:5 ( )
to to o o o .. : . . ..
2
•
SLOPE OF.GROUND
CRAWLSPACE ABOV
E GRADE > o 0 0 0
0 0 0 0
SL . _ . . 1500.GAL H-70 .
10.1 TEE
TEE > o 0 0
TO CO'`ONE SIDE VENTED DE
9. 4
SEPTIC T ..
9
E TANK 0 0 0 0 7 THIS PLAN IS FO
R PROPOSED WORK ONLY AN N
EL 8.1
o 0 0 0 0
0 0 ®®®®®®
0
L D NOT TO
0 o O o 0 0 , e
.- T BOX . ... � 0000
LEACHI
NG: _. o 0 0 0 0 0 WATERTES D
d 4 LIO. LEVEL o 0 0 0
o 0 0 0 B r
i 9
o 0 o E USE FOR 0 0 o D LOT 'LINE STAKING ANY OTHER� 0000 OR ER B
®®�® ®®®®Gas- _o 0 0 0 0_ ®®® ®®
�Qo
UTILITY POLE
BAFFLE .
o o_
eLEVELNESSo 0 0 0
0 0 0 0
- _ ;
.. ACME OR E UAI.
FOR o 0 0 0
O
0 0 0 0 , PURPOSE.
P 4 137G0 0 0
SIDES:
2(33.5
.5 + 12.83 2 .7 0 0
> o 0 0 0
.. 0 0 0 0 T.2D 9. 0 9.33 -
RANT
5
FIRE HYDRANT , .••t
y,r _ .>. ,. . :. $. PIP -
_ . . E FOR SEPTIC SYSTEM TO SCH. 40 4 PVC.
1 .83 ' .74 318 . . . .
C
BOTTOM 33.5 x 2 BO 0
o
a
N
�.- J O O O O O O O O O O O 9 O O O O O O O O O �. '.
MAY APPEAR IN DRAWI G Wes eoLso 0 0 0 0 NOT ALL 000 0 00 0000000000 -
NOTE. 0
"I
0000000000000000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o00000000000000 - _ -
- .fnn noonnoon000nonn ooH 20 500 GAL LEACHING CHAMBER
_ _ _ _ .o oE BY ACME ' OR EQUAL.
_ _ _ _ PRECAST Q
9. COMP N: NT 0 _ SNOT TO BE BACKFILLED OR CONCEALED' �
:TOTAL
615 S.F. 455 GPD
3/4"-1-1/2* DOUBLE WASHE D STONE 4 MIN.
3 UNITS R_ EQUIREDINSPECTION
WITHOUT _. Ba
ALL AROUND PREC
AST STRUCTURES
BY BOARD OF:HEALTH .AND --
y
a,
PERMIS
SION OBTAIN F _
OBTAINED.FROM HEALTH.CRUSHED STONE OR MECH
ANICAL HE
6 RU
0 I �OVERALL DIMENSIONS T
t 0 OUTSIDE OF STON
E: 33 50 X 12.83
CHAMBERS (ACME OR EQUAL)
3 500 GAL. LEACHING C USEa.
ON 15:221 2 COMPACTI
(
o
cv
10. CONTRACTOR HA, < SHALL BE RESPONSIBLE FOR. CALLING
i
VERIFY THE
ER SHALL E 4 S ONE: ALL :AROUND THE INSTALL WITH T
D GSAFE 1 888 34 4 7233 :AND VERIFYING
N THE
I TES AND ALL F L UTILITIES LOC
ATIONS 0 AL
_ LOCATION C r ALL UNDERGROUND &:OVERHEAD UTILITIES
PRIOR TO AND COMMENCEMENT OF,WORK.
BUILDI
NG 'SEWER OUTLETS
LOCUS MAP
INSTALLING ANY
ELEVATIONS PRIOR
TO
2:5
1
1 . ANY UNSUITABLE
P 1 ABLE MATERIAL ENCOUNTERED SHALL BE " _SLOE 1% P_ SLO E
( ) _ . SCALE 1 2000 t
% SLOPE
PORTION 0 F SEPTIC SYSTEM
( ) ,
REMOVED 5 BENEATH AND AROUNDTHE P
ADJUSTED GROUNDWATER
E PRO OSE D
MA
H 2 0
D STED
FACILITY.
LEAGH ING
EL'.2.2
LEACHING
ASSESSOR MAP'
- `12 > S 93 P
F S
4 4PARCEL 8
0 SEPTIC
FOUNDATION- IC BOAR OF HEALTH N ON TANK V DATE D APPROVED D . BOX
15
FACILITY
,
ILI_ TY
12. EXISTING P SE TIC SYSTEM SHALLPUMPED
BE UM ED AND
LOCUS IS :WITHIN 'F EMA 'FLOOD. ZONE
E AE EL 12
REMOVED O� PUMP I PUMPED AND FILLED WITH CLEAN SAND.
AS SHOWN ON COMMUN
ITY PANEL
13. FLOOD RESISTANT FOUNDATION DESIGN BY D OTHERS.
25001 CO757J DATED 7
ALL UTILITIES SERVICING BUILDING
TED 16 2014
_ LD TO BE .ELEVATED
ABOVE BASE FLOODVA F ELEVATION 0 12.0
14. GUTTERS ANDOWNSPOUTS
6 .
D TO BE DIRECTED TO
c
DRYWELL.> OR ROOF DRIP
00 DR LINES`TO TON TRENCHES.STONE E CHES.
Z NIN O G .SUMMARY
ZONING DISTRICT:
C RF 1 DISTRICT
C
MIN. LOT SIZE 87,120 S.F.
AMIN: LOT FRONTA
GE 20B-0
,
A
Bl
�.
MIN. ,
LOT WIDTH 125
A
X
x
MIN. FR ONT SETBACK 30
- G
R
4 MIN. SID
E SETBACK 15
x <
3
a.
MIN: REAR SET_---- BACK
x
x
t
MAX.0� BUILDING HEIGH 30
0
0• tt
2 ,
f
h �' of SITE IS
L
� LOCATED `WITHIN THE R ESOU
1
PROTECTION V 0 OVERLAY DISTRICT
ff
C
BENCHMARK.
8 ` P
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