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0158 GREAT BAY ROAD - Health
158 GREAT BAY ROAD, OSTERVILL A= 072 � -- b p 1, 3 s a f a BAXTER & NYE, INC. Registered Land Surveyors and Civil Engineers 7 Parker Road/ Osterville, Massachusetts 02655 / Tel. (617) 428-9131 WILLIAM C.NYE,R.L.S.-President RICHARD A.BAXTER,R.L.S.-Vice President PETER SULLIVAN,P.E.-Vice President-Engineering April 6, 1988 Town of Barnstable Board of Health P.O. Box 534 Hyannis, , MA 02601 RE: Lot 1 - Great Bay Road Osterville Dear Board: Per the conditions of the Disposal Works Permit , I have provided construction inspection during the installation of the septic for Lot 1 . The system has been installed as per the approved plan. I trust that this meets your present needs.' Very truly yo, rs, Peter Sullivan, P.E. Baxter Nye, Inc . :'PS/fmj ;�yj OF a PI'T£R SULLIVAN No. 29733 0 34NNA L MEMBtWS OF. CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS/AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSErIS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS �SrI TOWN OF BARNSTABLE LOCATIONLO T G�Zti}%�/�% � SEWAGE #�L-4<- VILLAGE 0q. od �,�/'�/� Is/'�� ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. 2G �C©•�,si ��s / -2 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size),2 J7 X . NO. OF BEDROOMS S 'PRIVATE WELL OR PUBLIC WATER R,.�/c BUILDER OR OWNER ��( T� rti 2 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No y i I�Ll 13 r -------------- �P Id ^. SUBJECT TO Ace' , BARNST!+P ¢,SsL.. MA-P 12 (� Z N Lv"T .3 Z- 1.---- ----.. Fps ..........._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® O.F HEALTH (� ... .. ...............OF...... P ' Appliration for Dispoii al Workii Towitrur.tion Errant Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal ystem at: U77' GRe�- VTnEraj L >� w Loc ioc CAd�dr�s Address a Installer Address Type of Building Size Lot........`_OZ-A�'C-ST feet' V Dwelling—No. of Bedrooms............................................Expansion Attic (/4 Garbage Grinder ( P a`J Other—Type T e of Building No. of persons............................ Showers _ YP g ---------------•----•------- P ( ) — Cafeteria ( ) 04 Other fixtures -•----•-----------------------------•--•---------------•---------•--••----•••-•---•-••--••--••-••-••••••-----•----------••-••----•--.............•••- W Design Flow............................................gallons per person per day. Total daily flow............... 5 ..................gallons. WSeptic Tank—Liquid capacity.ISOO." ons kength................ Width.............. Diameter................ Depth................ x Disposal Trench—No.�-P« ?�.....?!........ Total Length:..-2`a_...._.-_ Total leaching area.._77.lQ....sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( � ) Dosing tank ( ) _ '-' Percolation Test Results, Performed by.....% _4`1Z-._.5.;!`' ._..��':................ Date......:5_.."'Z�'®Z Test Pit No. 1....L ._.minutes per inch Depth of Test Pit.................... Depth to ground water...._._' __-------. f=, Test Pit No. 2.......:........minutes per inch Depth of Test Pit......... ......�...__.._.. Depth to ground water...6 S. t� ......... ------- -•---------------------- O Description of Soil.....0-:`:�-�.......5.P- i' S�1'Rsca.1 L-------------Z............................... ....-.-• ---------- v ....................... --------------------------------------------------------------------------------------------------------------------------- ---•- SIGNING ENGINEER MUST SIIPEifvi5E W •-• •. . . ---_. ... '�F= ..............................WIN Nature of Repairs or Alterations—Answer when applicablVSTALLATION AND CERTIFY flil Iivt lli li�ila.................•---- . THE SYSTEM WAS INSTALLEL7'O'ST ------•---------•-••••••-•--•----•- b -- ...................................•-•---------------------------•-•-------- Agreement: ACCORDANCE TO PLAN. 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 ----------------------------- Application Approved By-- .•--•--- ....---•----------------•• Date Application Disapproved for the following reasons:--••----•--•---•••-•----•---•----••---------•-------------------------------------------•--•....------.....••--- ........................................................................................................................................................................................................ Date PermitNo.._ ..................................... Issued-....................................................... Date - N ..5. 2-- 1-e'.T �— l Fu$.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I.I.................OF...... App irFatiou for Bi_qvniiFal Worko To ustrurtiou Prrutit Application is hereby made for a Permit to Construct ('Ll� or Repair ( ) an Individual Sewage Disposal System at: t a i '�i t, 4r �`!' s......... .... ......... .. • -.... __......_ - - ................................................ •---_.. Location,Address or o. ......................[��' �CCv 1'rs?.v�:...l.1JC- , IZ'� ��.zt�r�T . - ...............•--•• ......• --......._._..••---...._._._.. _. Address l < ' S�1' G O t U 7 LZ . Installer Address Q Type of Building/ Size Lot____. '-Z__�kC'Sq-feet' Dwelling t—�No. of Bedrooms________________........................Expansion Attic (N),' Garbage Grinder (11��) Other—T e of Building No. of persons____________________________ Showers — Cafeteria a' Other fixtures -------__.............................................................................................................................................. W Design Flow................ ..........................gallons per person per day. Total daily flow...________:_=? --- ___..................gallons. W Septic Tank—Liquid capacity_'`?__ agons Length................ Width__._______.___. Diameter---------------- Depth............... Disposal Trench—No.�=':� V I_._.__Z_I_.._.___ Total Length..__ _` ___....... Total leaching area.____?LQ....sq. ft. Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (1 ) Dosing tank ( ) 04 Percolation Test Results Performed by.---- �_ .__ ..N'' (NC..................... Date.__._..___:"'4 '".�Z-__... 0-1.4a Test Pit No. L___ _---------minutes per inch Depth of Test Pit.______.:........... Depth to ground water_-_--'�--________-__. (i, Test Pit No. 2................minutes per inch Depth of Test Pit........5........... Depth to ground water_._ -_--_________._. a' •--------------------------------------------------------•--••-••-------•-•••-•--•-•- Description of Soil ---------------�?-� ------------•--._._._....----•-•-----------------------------------•••.....................................................t..1'�'� S(�lvD x U ---------•------•-------------------------•----••--....-----•--•-------------•----•------•----------••--------------•---•--•------------•--•-----------.....------------•-----------....-••--------••... W UNature of Repairs or Alterations—Answer when applicable..........................................................................................______ --------------------------------------------------•---.........----------------•-•--------------••-------------•-•---------------------•--•--••--•••-•••••••------......__. Agreement The undersigned reesto install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITA LE 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.....................-••-•----•----•-•-••------•-•--•--•-...-•----•--............... ................................ kaTe Application Approved By.......... - - ------------ --------------------------- 641 - Date Application Disapproved for the following reasons:_________________________________________________________________________________•-•------•-------•__.._..__._.. ..........................•--•-•-----•-•-•--••-------••••---•••••-•...:••-•-•----._.....::...---•--....._••----------•----•------------•-___.-•-...••--••••--•---••-•--••-••••••••--••-•--•---_._....--- •. Date Permit No.. w- � Issued Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... L !...N..............OF.......�„r 51 .Z�� :................................... • �rr�ifirtt� of f�u�t�rfi�aatrr THIS IS-TO CERTIFY That the Individual Sewage Disposal System constructed or Repaired by :.............•---���.. 4,. 4�+..................... !.'--g•._............`....--•-----------........................................................... LOT- l Installer R- at-------•...............................��14--.-------�' 44-------�.....------------•�S\• V•i l l_�` has been installed in accordance with the provisions of TI 5 of The State Sanitary Cod as des�ib d in the application for Disposal Works Construction Permit No� - z' ,-- dated-- '�:',r�------ ----------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM,WILL FUNCTION SATISFACTORY. DATE................................................................................. Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS .. BOARD OF HEALTH .. ? 4'-A..............OF.........�J �f���._.1��_I7?�-�'............................ No. FEE. ... Dioposal 1116p Qlongtrwfia pruttc�- Permission is hereby granted............. ••....... ...... ...................................... to Construct ( "S or Repair ( ) an Individual Sewage Disposal System atNo..............f.. i____-•---1 �� t rti ;'` ...... ;............ ---- ----;-- ...................................................... Street as shown on the application for Disposal Works Construction Permit K __ Dated_ ........... w ................................. - --------- ------••................................... DATE_ . D ._ II c) _________________________________________ Board of Health FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS TO I BAR S ABLEE CONSERVATION G3 C /:ONUVIISSION ;w ��. G• i al .4 --i �► ::. 1 ,O _. _. _ to 3' r ;- : 4 ci _ F tGt�6 : _._.... -----.._.... . _..._ . :,..- i f77 6 7 - 110 _ nv � { � .. - - E���= --�•�' .-q F'�_ -gyp �Lt��=�5..._ ._`���!P'/ / Y r_•- J ,Mo0 4�_;. ! L_��"x I - �{�FVSsvPS 117 i �4 4— —4"—$t , t � SFWil - 1 — � I NO sc. •; •3 Of Mq ! , r _. _ - _: _ .--�-+_>-1 . : ; ::. �o�,� 9°y NET C : ��p�-t{��►�� �.i: T PETER Gin �E( tiny` wok_ E`uP, SULLIVAN �-+� �- ����� ����:e� -: v�Pa�J=��►J No. 29733 - - - G r �• G/STET �� MATE�'-I�L IF ��\� 0 Fr, I ti-_ NLL- t•�t C-i1U�S ` _ Q�: .- �� -r r .• s,ON E�� Fi2o� u Ya�N{s'jt, .Ft{L--b ANO Rc?LALc r1 FT-A LUEA,J coapa Z9 e f IDES I Girl .� = 5 6ED�uOMS {N•lLE FftM1 rl NO 55a:6Px_x �so1�, U Sc, (�- -� X$ UJ�n(D I F t- r N T SF __. ' U'i i. � 4 �E � L. . t.t�ISiL tiles : TOTA ��31 V. . _:.F a r :: _ :; cl � T. DESIGNING ENGINEER MUST SUPERVISE INSTALLATION AND CERTIFY IN WRITING PEC.�I..PtTio� G T HE SYSTEM INSTALLED IN STRICT r.,:. "'DANCE TC) PLAN. 1 V s I COMMONWEALTH OF MASSACHUSETTS 1 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS �ry DEPARTMENT OF ENVIRONMENTAL PROTEC hflfi ONE WINTER STREET, BOSTON, MA 02108 617-292-5500 Mq r 61998 � W'ILLIAM F.WELD P7TKCrDY Governor Se . ARGEO PAUL CELLUCCI �'' Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM A, �i�i$ issiooes PART A CERTIFICATION Property Address: 158 Great Bay Road', Osterville, MA Address of Owner: Same Date of Inspection: 4/22/98 (If different) Name of Inspector: C.?r pl] E 0,111a37 I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: CARMEN F. SHAY — FNVTRONMFNTAT & CIVIL ENGINEERING Mailing Address: 14 That(-hprs T,anP, E. Falmrntth, MA 02536 Telephone Number: (508)-548-0796 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experienc " function and maintenance of on3ite sewage disposal systems. The system: ��(NOFMgs S X Passes o�'� CARMEN 9cyN ° _ Conditionally Passes E. , . Needs Further Evaluation By the Local Approving Authority 1 Fails - 9 IF Inspector's Signature: Date: 4/23/98. `GS PEA The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. 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 tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank. failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97.) Page 1 of 10 DEP on the World Wide Web: httpVwww.magnet.state.ma.usldep Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 158 Great Bay Road, Osterville, MA Owner: Mr. William Downey t Date of Inspection: 4/22/98 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 pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN.A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 56 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that _ the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued), Property Address: 158 Great Bay Road, Osterville, MA Owner: Mr. William Downey Date of Inspection: 4/22/98 D) SYSTEM FAILS: " You must indicate ei;!.er "Yes" or "No';as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage 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 surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. 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. E] LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following? The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply c 1 the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area- IWPA) or a mapped Zone II of a public water supply well) 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 04/25/97) . Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 158 Great Bay Road, Osterville, MA Owner: Mr. William Downey Date of Inspection: 4/22/98 Check if the following have been done: You must indicate either "Yes"or "No" as to each of the following: Yes No X _ Pumping information was provided by the owner, occupant,,or Board of Health. X _ 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 pan of this inspection. X _ As built plans have been obtained and examined. Note if they are not available with N/A. X _ The facility or dwelling was inspected for signs of sewage back-up. X _ The system does not receive non-sanitary or industrial waste flow. X _ The site was inspected for signs of breakout. X _ _ All system components, excluding the Soil Absorption System, have been located on the site. X _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: X _ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System.. X _ Existing information. Ex. Plan at B.O.H. X _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) 115.302(3)(b)J (revised 04/15./97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART C SYSTEM INFORMATION Property Address: 158 Great Bay Road, Osterville, MA Owner: 4/22/98 Date of Inspection: Mr, William Downey FLOW CONDITIONS RESIDENTIAL: Design flow: 550 p.d./bedrdbm for S.A.S. Number of bedrooms: _ Number of current residents: Garbage grinder (yes or no):_Yeg f Laundry connected to system (yes or no): Yes Seasonal use (yes or no):EQ_ Water meter readings, if available (last two (2)year usage (gpd): Sump Pump (yes or no):__Nn Last date of occupancy: urrently Occupied COMMERCIAUINDUSTRIAL: Type of establishment: Design flow:_&allons/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:_- 1997 - 250,000 gal. 1996 — 234,000 gal Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information.. No pumping records on file at the Barnstable Sewer D .Dt_ PogsihlP that system has System pumped as part of inspection: (yes or no)_ not been pumped since If yes, volume pumped: ¢allons Reason for pumping: installation. TYPE OF SYSTEM X 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) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known)and source,of information:-9 years old - ;)Pr own-Pr-and design plan obtained. Sewage odors detected when arriving at the site: (yes or no)_Ep . A (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _ PART C SYSTEM INFORMATION (continued) Property Address: 158 Great Bay Road, Ostervillerg MA Owner: Mr. William Downey Date of Inspection: 4/22/98 N/A TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _,metal _Fiberglass _Polyethylene —Other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Alarm in working order _ Yes; _ No Date of previous pumping: 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: 1 /16 to 1/8 inch Comments: (note if level and distribution is a ual, evidence of solids carryover, evidence of leakage into or out of box, etc.) D-box level and distribution level amongst the three outlet lines. Ferlormecl 5 gallon of water test to observe eQualE istri ution No sign of back-up or cnlidg rrarrv—near n—hnx in good Condition with no sign of sidpwall deterioration, PUMP CHAMBER: NJA (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 158 Great Bay Road, Osterville, MA Owner: Mr•, William Downey Date of Inspection: 4/22/98 SOIL ABSORPTION SYSTEM (SAS)-X (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) r If not determined to be present, explain: Type: leaching pits, number._ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: 1 field 24' X 28' w/a 1' .,effective depth overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) No sign of hydraulic failure or ponding, vpgPtntinn- Field consist of three rows of flow ' a lacent to leaCh'iateaand found no signs of hydraulic fai 1 t3ra CESSPOOLS: N/A (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer. Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: i (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) x PRIVY: --A/A ,. (locate on site plan) Materials of construction: . Dimensions: Depth of solids: ` Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page a of 10 y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address; 158 Great Bay Road, Osterville, MA Owner: Mr, William Downey Date of Inspection: 4/22/98 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent. references landmarks or benchmarks Swing Ties locate all wells within 100' (Locate where public water supply comes into house) AtoC - 20 toC - 19 AtoD = 22. toD - 21 A to E - 25.5 B to E - 42i � llUUi `LP . . . . . . . ,` 1. ( 1; Ko : : : CA 5TUDIo ) \ ... . ,\(��" V` /�-si' _ •h.�? ,Sow ram. `'. ,d. \ ti ( � q• I � .7•.f I . Iod% l; r :. .Cq1 tC�{ bEr F LU.I-I 1 `� �--- ----- _._---- . ••_ - .. •� 1 4d.6`7 ' - �--.ham / (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 158 Great Bay Road, Osterville MA Owner: Mr• William Downey Date of Inspection: 4/22/98 Depth to Groundwater 9 Feel Please indicate all the methods used to determine High Groundwater Elevation:, X Obtained from Design Plans on record _X Observation of Site (Abutting property, observation hole, basement sump etc.) _X Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers _X Use USGS Data Describe in your own words how you established the High Groundwater Elevation. Must be completed) Depth to groundwater was estimated by site observation of high tide at the abutting marsh/wetland area and cross-referencing with both the design plan (with test pit information) and USGS data. Based on these references, none of the system compnents are in groundwater. Additionally, there should be a four foot+ separation from the groundwater and the bottom of the SAS. (revised 04/75/9.7) Page 10 of 10 i I ENVIROTECH LABORATORIES,INC. MA CERT.NO.:M-MA 063 449 Rte. 130 Sandwich, MA 02563 508(888-6460) 1-800 339-6460 FAX(508)8884446 CLIENT: Janice Shields LOCATION: 158 Great Bay Rd. ADDRESS: 151 Cliff Rd. Osterville, MA Wellesley Hills, MA 02481-2712 COLLECTED BY. Meehan SAMPLE DATE. 5/2/2000 SAMPLE TIME. N/A WATER SAMPLE TYPE. New Well DATE RECEIVED: 5/2/2000 LAB I.D. #: 0005035 WELL SPECS.: N/A RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Coliform bacteria /100ml 0 0 9222 B 5/2/2000 pH pH units 6.5-8.5 6.12 4500 H+ 5/2/2000 Conductance umhos/cm 500 1067 120.1 5/2/2000 Nitrate-N mg/L 10.0 0.085 300.0 5/2/2000 Nitrite-N mg/L 1.00 < 0.003 300.0 5/2/2000 Sodium mg/L 28.0 191.1 200.7 5/3/2000 Iron mg/L 0.3 3.32 200.7 5/3/2000 Manganese mg/L 0.05 0.178 200.7 5/3/2000 COMMENTS: pH is below recommended limit and may have corrosive characteristics. Sodium indicates possible salt water intrusion or road salt run off. Iron and Manganese are not a health hazard, but can cause taste, staining and odor problems. Filtering system should be considered. <=less than Date S (V >=greater than R ald J. Saa " TNTC=too numerous to count Laboratory Di for No.-------------------- Fee----- ---------- BOARD OF HEALTH TOWN OF BARNSTABLE ZIpplication Ar Veil Con0ructionpermit Application is he eby made for apermiitt to Construct (-), Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel Owner Address Installer — Driller Address — Type of Duadin& Dwelling ---------------------------------------------- Other - Type of Building-------------------- No. of Persons-------------------------- Type of Well Purpose of Well----------------- ----- p Y--------------------------------- , Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Sign e,4 '— -- date Application Approved By �-- - - - -- -------- date Application Disapproved for the following reaso ---------------- --------- -------- — ---- ------------- -- --------------------- ----- • — date _!�✓ Permit No. - - -- Issued—= - - -�,1----- ---------- date -------------- -------------------------------- ----------------------------- ---- - - - -- - ----- -- --- - - ----- ----------- --- -- -- - - - - - -i BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERT�IIF��Y, That the Individual W ll Constructed K),/Altered ( ), or Repaired ( ) by— A4411111vol Installer has been installed in accordance with the provisions of the Town of Barnstable B ar-of Heea ZPrivate Well Protection Regulation as described in the application for Well Construction Permit No Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---- — Inspector-----------------_-- -----—-__ _ S •..JJ'i-r'.I� t�.n.A .t'F..,Cftrh-•'..{. .Y..� _•1-.• ... r -.• V e'-.�a ..«. .., r- .. .r.i._tY...+� _�Ce. •• .- .. -$2ti --- ---4�--------- No ---- --- Fee- �. BOARD OF HEALTH. :p- TOWN OF- BARNSTABLE, [ication rV pit,Conaruction ermit x ' Application isahe eby`made for a permit to Construct O Alter ( ) ,or Repair ( .)an individual.Well at: ' L'ocahon` .'Address- r Assessors•Map and Parcel * 1 Owner Address s ` Installer - Driller Address. ' 4. . I Type offiuilding . lilin Other - Type of Building --- =-------------- No. of Per -- - - - --—=-- - Type of.'Well`=-------------- . -- -- -`--- -�'" Capacity� - Purpose of Well------------- --------- A greement: The undersigned agrees-to install the afore'described individual well in accordance with t v' '. g gr he, ro > ;Ions of The P Town of Barnstable Board of, Health Private Well Protection' Regulation The undersigned further agrees not to place the well,in operation.until a Certitificatee of Compliance has been issued by'the Board of Health. Signe /!' JIG ; ,- ® - �' — �J / date ±, Application-Approved'By �--- �/� y a date. Application Disapproved for the following reasoru/' --- --date T 7 Permit No: -- Issued-- --- -� e date �Ssk+.fe-.7LaR.3*.3.t,i�ir+x4+-apt'drab:xit�s4Y�..aB�SaafiLa�.erex'.v.1Sat�.erYs�.`szelaa*.Fvaaaa�{al�r*��sd;fey.Z�RB,Taersi�a'.sta�isa�..�Mi�Yw^ft�i'sss4' G �s+ts+�,��•,,-'k+e�+A.^.tRCr+r�..#:ZsT.' t 4_ ,yy.:. "' —v' --Yk s' r '` w +s' r' -B. y. .,.� '„y+,;�•---" —• N ,'TOWN OF BARNSTABLE t ertif at �Com [iarice c h• t ;THIS IS TO CERTIFY That the'lndividual Well Construct id (✓) Altered (, )"or Repaired ( ) " -- -- o _ Installer.". iat has been'installe'd in accordance with the provisions of the Town of Barnstable B �rr/d of Heat Private Well Protection Regulation as described in the application'for Well Construction Permit No.t/v-vim Heal � `�'d6__ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY.. DATE— Inspector -=---- -- -- - — ---- f�..T_•`i+id-Ssf i+s^i"4Y2Y+�i�E3CS22i D44t+E.CJ+TH2hS'?+i?449! 48T EYREHi4i2b�a^iliiilGfr?i4i's-+r'9i'?i2i$99YPPSi44t•i�F2p4LTt9s4i�` ,4i{# .W_i.As.t;+li'�*'si!i2i£L,Ta'Y;a._c.+LS{�ifA�i:�!',.'Ti.+o 1 • ^. t + .. .. •.• n._ .. ,.fineJ:x.'wal,•S.xuF m.+1aL. _ �w .. f � ' #•. `f BOARD OF HEALTH f TOWN, , OF BARNSTABLE Well Congtructoni3ermit Fee Permission Is hereby granted to Construct (` ) Alter ( ); or Repair Individual Well"at i 4 ,r d =No. �s�.f� "IT Gii� /PII� .57� .p�!/�,�-1 street — ` - as shown`on the applca/ho `'for a`Well Construction Permit No.- Dated - _ Board o/Healthy"�� DATE t✓✓ po"° LOCATION -0 SEWAGE. PERMIT NO. X6 i / VILLAGE g ea4E,INSTALLER'S NAME i ADDRESS R U I L D E R OR OWNER 0 2�:LA C C & AVVA✓�—S DATE PERMIT ISSUED 74 2 DAT E COMPLIANCE ISSUED �� � J . � � ��� r .� �` �� / d"�, ® � s,� U �O`'a/ l. �� �J THE COMMONWEALTH OF MASSACHU$ETTS BOARD OF HEALTH OF.........................................................................................• -r` Appliration for Uiipn,ial Works Tontitrurtiun Urrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at• ' ---------------- d.�....._... .._.. -------•---.._____ ......... - ....... ...;qw .. ............... ........ ..................• ............... W UL1 �e21 N m 1`E'RV f l.Ldss "I ASS U --.�:.1 �.............. Installer Address d Type of Building Si N 2 l_E I:A"M)L / Size Lot._5,t_j __I.:_._Sq. feet l Dwelling—No. of Bedrooms____________________Fq_q�_y_ ._.Expansion Attic ( ) Garbage Grinder ( Other—Type of Building ............................. No. of persons____________________________ Showers — Cafeteria Other fixttye , W Design Flow...........................................gallons per person per day. Total daily flow.... _��_._______................gallons. WSeptic Tank—Liquid capacitvf�dbgallons 1 I,ength________________ Width....... ..� Diameter................ Dgp,t/h�___..__.._.. x L i2p=4- k—No. ._.___-1._._._.. Width____..._.._(._•_._._.. Total Length.....�_S.... Total leaching area________X-______..sq. ft. Seepage Pit No._________-,._______ Diameter.................... Depth below iiplet.................... Total leaching area..................sq. ft. Z Other Distribution box (kl' Dosing tank ( ) F Percolation Test Results Performed by...__ a -A.& - ..T'E.JK......1...... --•-------- Date.....,--o-•�-#•�...L83...... l Test Pit No. 1...... per inch Depth of Test Pit._...__ ....... Depth to ground water........ ............ Test Pit No. 2.___.._�.....minutes per inch Depth of Test Pit........ 1.... Depth to ground water--------- ........... R+ - •---•. .............. ------------------------------------------------------- --------------------- -----------•••---•---•---•----_---- 0 Description of Soil.............(.".Le .Sh .f�._...........: x W --- ---------------------------------------------- -----------------•-----•--...__._.__--------•----....________....._____....________.-----_____...--------------------------•-----------•...•--•---_-- UNature of Repairs or Alterations—Answer when applicable............................................................................................... ---••......................................................•--------------------_.._---••---•--•-...----•---•----------•--------__________._____....----••---__..___.__.-------•__._____.---•-•••-_----- Agreement The undersigned agrees to install the aforedes ribe ndi 'dual Sewne Dispo 1 Sy tem in accordance with the provisions of TITLE; 5 of the State Sanitary Co e T un ersigne f rther rees t to place the system in operation until a Certificate of Compliance has been ' the b r of lth. igig ---•-------•-•-.•• .. ..................... ....---......._.....__ ...._..._ ApplicationApproved B . ___ •-----•-•- --- ....................................................__..._ ...... 1 Y 1 _. 3_........ Date Application Disapprov f the following reasons:................................................................................................................. .._........••••--•-•••••........................•---__...-----••••--•----•.._.._..-•-•-•••.............•-----------------________---•-----••----...-------____•-------______---_._.___..____---•--...--- Date PermitNo......................................................... Issued-....................................................... Date f r FES. cS THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................O F........................... .................................. ri Apli iration for Diapuiitti Workii Tontrnrtion "fermi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .................................................••-•--••---.......----••---•--._.......••----_... --•-----------------------••--•----••------------------...-------------••------•--------------- Location-Address or Lot No. .................................................................................................. -----•--•-----------•-•.....____..._.._____.............................._......._..•......•...... Owner Address W Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.............................. .. .....Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of ersons...._....._.._.............. Showers — a yp g p ( ) Cafeteria ( ) a' Other fixtures ................................. . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter--------------•- Depth................ x 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 ( ) ~' Percolation Test Results Performed b ...._...... Date............................. 14 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... Test Pit No. 2................min>t_e per i7f�� Depth of Test Pit..............._.... Depth to ground water........................ ........... .. ........................................................................-............................................................... 0 Description of Soil.......................... ---------•-•--------•------------•--.....---•-----...---------------------------------...................................................... x U ••••----•--•-•••-•••-----•-••-•-••-•-•-•-•-••••--------•-•-----••------------------••----....._...--•.........------•---------------------------•-------------.......---........------•-•--------------- W ----••-•--------------------••---...............---••---••-•------------•---•-------•-•------------------------------------------------------------------•----------------------.........._......._..--- U Nature of Repairs or Alterations—Answer when applicable._.............................................................................................. ----------------••••-••-•...._...•----•------------•-•--...._._._.......•••--•••-•----------..............._...----•--••-•••-•-•••••----•----------•-•--•-------•-•-----•--•---------•-•--------••-----• Agreement: The undersigned agrees to install the aforedes ribe ndiv�dual Sew e Dispo 1 System in accordance with the provisions of TITLE: 5 of the State Sanitary Co e T undersigne fuh-ther rees of to place the system in operation until a Certificate of Compliance has been i the b of ellth. ;/gnd ` ' .............. .......................................•-•-_..._. ....---...�/.. ......._--•- Dat Application Approved B • ---------------•-•-•--_- _-____-.__-___-__--- . /y Date Application Disapprov f the following reasons:...................................0.........•--•----••------•------------••--•----------=-----............_._ ....................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS s.4 BOARD OF HEALTH ..........................................OF.......................................0............................................. , ' Tatif iratr of Tomplittnrie THIS,I-Xio C5RTIFY, That the Individual kwage Disosal System constructed ( or Repaired ( ) by--- . �,. /{11 c_ .......,,._...._... ..1L......--..................................................................•---..._---••-•-•--•--._....-•-- at.._._.e- '_�............� {-�L�--- le "--------�•-Installer -------•-....----••••--•••••-•..............••---•--•-----.... has been installed in accordance wi -the rovisions fof TI �r �T e State Sanitary Code d r' ed in the application for Disposal Works C struc on Permit No �.-,1-. 1.-�._......... dated_fa'�G....�,�................. THE ISSUANCE OF THIS IFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILV FU TION SATISFACTORY. DATE--__,.'. Z ................................................... Inspector....----- -.. ......---------••--------------•---•---------------••-•----••-_----- E COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEALTH ..........................................OF..................................---..........------... ................. 3 r� No........�l FEE........................ Raposal% - rkii Ton ndion famit Permission is hereb Ygranted__ ..... --.. to Cons�cV( or.-Rep )-a - diy1 Sewa e is p sal System atNo. •- f..... '=Gt......... .................. ......... ... ....--•---------------------•--------•---------------•----------....-----------••----..... Street as shown on the applicatio or Dispos Works nstruction Pe it~No. _� ._..----- Dated.......................................... r- .. ................_.......__..__.....___.............._...._......_ L.oard of Health DATE.............. .. .............................................................. f . FORM 1255 A. M. SULKIN, INC., BOSTON 1'� ,3 ,DaTA (.{AV& F.ow — 4 Ito+50%�f�a � . . . : t �� . : . . i i � • ; � - i i S t-tCc TAj Le..c ddo K2oc7o .. f : . . : . . . .. . • ; ' 1 , . ; s- �L j 1..k'�JlG1-1 j: l f✓LD:• US�.:' - �LW/ oI pFusi0e5: :. . ! !- 1 Y:�•�_t'l:sV�� :� i, r�A�L�. .'��� �_. _1. .._ .-.-'����T_e-.,�{�I^�N- �✓Y�-t `C+I:A"� rL'20 r 1 i 80TTOM 11R�b, d.4.$ S1� ! �2�4L• �C l',D `°ate G p : : ' : : : _ :_... ' t ;.. . P6er.0vAn0Q VATS- W •lm1u. o2t.w, . . 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