Loading...
HomeMy WebLinkAbout0770 MAIN STREET (OST.) - Health 1 U Tower Hill Roads, sterville 141 — 034 5, 0 I F///TSMEAD 01 No.2-153LGN UPC 12134 HASTINGS,MN �r /�O?c `P �C JA4 OF THE Toy, Town of Barnstable * Regulatory Services * * BARNSTABLE, y� 65S. `0$ Thomas F. Geiler, Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: January 10, 2007 To: Thomas Perry, Building Commissioner From: Donna Z. Miorandi, R.S., Health Inspector CC: Thomas A. McKean,R.S., Director of Public Health Thomas G. Geiler, Director of Regulatory Services Chief John Farrington, COMM Fire Department Robin Giangregorio, Zoning Enforcement Officer Re: Storage of Fuel Oil Delivery Trucks It has come to the Health Department' s attention via a complaint from the Osterville Village Association that there is storage of four (4) fuel oil delivery trucks parked daily behind the former Village Market located at 770 Main Street, Osterville. Upon inspection of the property on January 9, 2007 it is confirmed that four(4)-3000 gallon fuel oil trucks (totaling 12,000 gallons) owned by Point Oil are stored at the above location that is owned by Hostetter Realty Co., Inc. This property officially known as 10 Tower Hill Road, Osterville, and on Assessor's Map 141, Parcel 034 is located in the State Approved Zone II (Zone of Contribution to our public supply wells). I believe this is a prohibited use under the zoning bylaws. There may also be other violations with respect to the four large storage trailers that are also stored on this site. Q:\MEMO\III Main It,0,,erville\Point OillZoning Violation Please inform me of your decision and be advised that Councillor James Crocker wants to be copied on all correspondence regarding this matter. With respect to the latter, please notify me of the proper protocol for informing Councillor Crocker. Enclosure: Town of Barnstable GIS Map QA MEMO\770 Main St.,OstervilleToint Oil\Zoning Violation Map Page 1 of 1 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size ® Zoom Out In L ICU JPG Map: 141 $ Location: 1 a�117155 # 76 14111-7001 Owner: 1 % , CN.l # 71 # 64 " 117180002D 141033 r_. 117154 �# '6'. t� 141117002 fl Location In 141036001 # 6L # 0 Map & farce �, Location 17075004CND 14 10 38 # 675 Acreage 'x= 21`: �=-=117072CND � � t � � Current Ovd E 1410�~l Mailing Addi k 17079 1L� # 10 824 ��- 1 _.I Y 141036 Appraised � � r� 1170d1 E 117176 117084 # 7J8 q I �,� Extra Featur x t l # 8NI #,r ,d 141035 �l 1410 7CND 117080 aLs� t �sq # 75 s Out Building i 117ii5� # 81 P,, Land L "®"` # 776.r1171 6 1 t 1 a Buildings 117u90 #'80 Total Apprai `���%its 117088 MAIN STREET `' '1117091 17087 17y099 791r.11_ #'8,,, cam' ` y Assessed V 1 14101, . , � 117092 ' f 141014CPND Extra Featur f ,, �095 7: rf# 0 �, r141013CND 141012�y-y Tp .,� eF u Out Building A 117093' 141016• $ Land 4 #43 9# 3,t 1 ti # 15 `ter , , . Buildings Total Assess Set Scale 1" = 218 I Aerial Photos Copyright 2006 Town of Barnstable,MA All rights reserved.Send questions or comment: i I BarnstableMA v0.2.7 [Production] http://www.town.'bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=141034&map... 1/10/2007 • rr No. Fee $ 5 0 —0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Application for Mig ogaf * gtem Congtruction Permit � p Application for a Permit to Construct( )RepaAXY�Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ivia1n s t Tee t o S.t e r v 111 Powner's Name,Address and Tel.No. Mass.Assessor's Map/Parcel Great Atlantic & Pacific Tea Co. � A� 3 Installer's Name,Address,and Tel.No. 508 7 7 5—3 3 3 8 Designer's Name,Address and Tel.No 5 0 8—7 7 5—3 3 3 8 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville,Mass. 02632 Box 66 Centerville,Mass. 02632 Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building Store Food No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 623 gallons per day. Calculated daily flow gallons. Plan Date 7/1 6/9 8 Number of sheets Revision Date Title gize of Septic Tank 2000 existing Type of S.A.S. 10 500 gallon chambers. Description of Soil Class 1 Material Nature of Repairs or Alterations(Answer when applicable) adding 10 500 gallon chambers to the existing septic system Removing existinq pits. Relocating catch basins per order of the engineer. 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 an of to place the system in operation until a Certifi- cate of Compliance has been issue by this Bo d Signed r Date 8/1 9/9 8 Application Approved by Date Application Disapproved for the fo owin easons Permit No. Jr- Date Issued „ ,.. i 4.< ..,,j•': . ' '., No. �' - 1 �Y Fee $ - 5 0.0 0 ' THE COMMONWEALTH OF MASSACHUSETTS k >` Entered in computer: s IP,,,.. Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for,Mi-5po.5a1 *p5tem Construction Permit Application for a Permit to Construct( )RepaitX(XX)Upgrade( )'Abandon( ) El Complete System El Individual Components '+� A Location Address or o[No. main street OstervilEiwner's Name,Address and Tel.No. Massy Great Atlantic & Pacific Tea Co.' A Assessor's Map/Parcel�'• � a� , (� 5� Installer'ss Name,Address,and Tel.No. 5 0 7'�5—3 3 3 8 Designer's Name,Address and Tel.No. 0 8-7 7 5-3 3 3 8 ,,J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. --- Box 66 Centerville Mass. 02632 Box 66 Centerville,Mass. 02632 Type'of Building: Dwelling No.of Becr°roovs ,r'lo of Size sq.ft. Garbage Grinder( ) Other Type of Building "Ste. . ��ta�"persons Showers( ) Cafeteria( Other Fixtures Design Flow 623 :'. gallons per culated daily flow gallons. Plan Date, 7/1 6/9 8 Number of sheetft i Revision Date `°Title f” Size of Septic Tank 2000 existing Type of S.A.S. _10 500 gallon chambers", ' Description of Soil , ,r ! „d 4.•d, ._ Class.-1y�Mate.rial 9 �� , Nature,of Repairs or Alterations(Answer when applicable) adding 1.0 500 -gallon chambers tibothe existing sep is system. Removing existing its. Relocatin catch basins-kper order of Y the engineer. Date last inspected: ' 4 _' 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 an of to place the system in operation until a Certifi- cate of Compliance has been is by this Bo d e !' Signed x t. Date. 8/19/9 8 Ahpli ation Approved by # �" Date Application Disapproved for the fo .owin easons <i 0- • t Permit No. 9J`^ $' a Date IssuedX ` - THE COMMONWEALTHOF MASSACHUSETTS j. BARNSTABLE, MASSACHUSETTS Certif gate of A' nipliallce THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(f ) Repaired (XX)Upgraded.( ) Abartdo_n ed( )by J.P.Macomber & Sci6 I•nc. } atA&P Main Street Osteryille,MASS. ,' has been constructed irr'accordance ' with the provisions of Title 5 and the for Disposal System Construction Permit No. — 79 dated Installer-J•P-Macomber & Son,Inc. Designer Sullivan Engineering i The issuance of this permit shall not be construed as a'guarantee that the syste will function as designed. } Date-a O —2r- Inspector V... No. - .`7 Fee 5 0..0 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE MASSACHUSETTS Mwi5p0ar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair�- XX)Upgrade( )Abandon( ) System located at Main Street Osterville Mass. A&P and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this ermit. Date: T� Approved by i 0 t :Q ' Ste• a i VIO x Ad vv -r.6-t, All ve 1. IN 40 so, 4 — T • 1--•i a 1 Ito, ' —r- r�"' .. ,� O �. is �-1f„�� —- 6 e.G ,�- Q• � �• � ,,. Ae 73 iao Ccl .ate; � .' �� .•�, •P� r'=tom'.j' ... - 3...� �_ .. k 't ;'1611y; 15:0; 50 28 115 '33ULLLIVAN ENG eINC PAGE 04 ' 34 �FO. C�i�Y9bl�i, 'Z?U �x•'S,T sot, t 85�0 DEVELOPED PROFILE OF pi*npn; :D•SFP-r1Q SYSTtM ' Not to SO did Frith COid Fl Fabritl r J:;..._.._... s� •!i�}�'tls� i4a SIM" o a.eaahlnq I 1 g/4"-1 !! "Double .r� Chgmbtr iVaoh®d zo CROSS SECTION Or C1 A1044BER NOT TO SCALE NUES L Water Supply ForThis Lot i$MuniCipal WQtj&r. 2 Location of Utilities Shown on This Plan Are AWDX, At Least 72 Hours Prior to Any Excavation ForTi his Project The Cpnsrr,00rShall Make The Required Notification to 0:41 Safe(1-800-322-4 84 4) 3 The Contractor is Required to Secure Appropriate Permits From Town Agencies For ConstructdoiA Defined by This Plon. 4 Install Risers as Required tcrNithin 12.J`of Finished-Grads. 3.All Structures Buried Four Feat or More or Subject f to Vehicular Traffic to be M-20 Loading. ' 14, 1 6,Septic System to be lr-maliedin Accordance With 310 CMR 15.00 Latest Revision And The Town of SBLLNAN ENGINEERING INC. Barnstable Board of hcolth Regulations. P.O. BOX 6510 T Al l Piping to be Sch. 40 PVC 7 PARKER €;OAL 0STE iVILLE, MA 02655 ew TOWN OF BARNSTABLE LOCATION A SEWAGE # VILLAGE Q STeg VIZ2 e ASSESSOR'S MAP & LOT 1 Y I - 03-7 INSTALLER'S NAME&PHONE NO. _cJ •/ M d C D 1(4 G'X 't 5 O/W SEPTIC TANK CAPACITY o 7 LEACHING FACILITY: (type)1O-FL6 f,:JC11AA f (size) J6 .S',,c)S..1 NO. OF BEDROOMS BUILDER OR OWNER �. ( � .,, Ac��► Ll,� PERMITDATE: - I 9 COMPLIANCE DATE: g— C,! 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 leaching facility) Feet Furnished by 4 e FEB..... �............... Nol. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ��,f✓-. ......jl�.......OF......../�F ff-'Y....................._--.-.-._.----------;................. App iration for Biopwi ai Works Tonuarn.rtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ........ • t_ /......5 ® 1. _ ...._..Cd: -e �.. ........... %S / .........................-•---•--•------------- r Lo ni��'�Locat.on Addrss . ..........Z .r ......... ........ ....� ........--- Owner ddress Installer Address Type of Building Size Lot-----------------------------Sq. feet Dwelling—No. of Bedrooms....A10'..1!�%•_/.............Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P 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 by.......................................................................... Date........................................ 1 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ L� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+' •---••-•-••....................•••••••-•---•••--••-•-••-•--••--•----•-•••-••...................••............................................................ 0 Description of Soil........................................................................................................................................................................ "4 V ...... -•--------------------------------------------------------- -------- •......... •------- -------------------------------------------------------- --------------------- •------ ------------------------- W -----------------------------------------------------------------------•--------------...------....-----------------------------------•----------------------------------------------------------•-•... UNature of Repairs or Alterations—Answer when applicable......................................................_.._.___..-__._............_.............. •-------••-•-----------------------------------------------•---------------------------••-•----------------------------------------------------------------------------------------------.......•-•••--. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 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 ss d by boar of health. Application Approve B --........ ................. Date Application Disapprove or following reasons-------------•--------------...------•------------------------------------------•--------------------------...._. .................••-•-•••••••••••--.......-•-•-•.....---•---------••-••••-----•-•-----•--.....-----•••--•--••-•••--•--•-••-••••••-•-•-•-••••••-••-••••-•••••-••--•••-•••-•---•••----•••-•-•--••••--•.--- Date PermitNo......................................................... . Issued....................................................... Date f .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , 1 - ------4........OF.......,, °............. Appliratiou for Bispvii al Morks Tonstrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys at: ... ...........e�:�� .�!' ,/`. ''................................................ L.C.ion Adess • or Lo No , /.. ---- -- - , '" '!" ram! ................ Owner ddress Installer Address VType of Building / Size Lot............................Sq. feet a Dwelling—No. of Bedrooms.... tc?_: , ''_/_..............Expansion Attic ( ) Garbage Grinder ( ) pa Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — 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 (: ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................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.................... QI' ----•----------------------------------------- -------------------•-•---•--•-•-•- -• ....................................................................... 0 Description of Soil......................................................................................................................................................................... V -------•••------•--.......................................•........ W VNature of Repairs or Alterations—Answer when applicable.................................................................. -----•-••-------•----•••-•-----•-------•-------------•--•---------••-•--•---•-----------•-••-•--------•-••••-------------------------•'---•-----•••--------•---•-••-•-------------------....._...._..._. Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL% 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. fri- ---- eApplication Approv --• --- --_..._ --------------•-- e Application Disapproved or following reasons--------------------•=-------------------------------------•---------------••---------••--••-...............-- r .------•-••------..--_._...-•-----------------•--------------------------------------•-------_...-----••-•------•-•--- Date PermitNo.....................................................•--- Issued..................................................... Date a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF............................................................. Tntifiratr Of Tompliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (' Repaired ( ) by....•= ---------------------------------------------- --------------------------------------------- Installer has erf in galled in ac ordan'ce wltltie p osisi s of TITIF 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.... 2............ dated_....__________________________________________ THE ISSUANCE F THIS CERTIFICATE SHALL N®7 BE C�NSTRIIE® S A GUARANTEE THAT THE SYSTEM 1AlILL�U N SATISFACTORY. DATE....... -_�I...-- �-•-----•.............•-------••-----------. Inspector--•---- -•--•-- ----.._...-•--------....---------•---•-•--....-•----...........-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........O F.......................... No...1 ....L� .. FEE._.f v--- --- t1wil ork � at #rt irrat pruti Permissionis hereby granted-•• - - . --•-----•................---=---•------•-•-•-•----.._.......---------...----•---...._..----••----.........--••-•--- to Construct ) R I ividual Sewage Disposal System at No -Street as shown on the application for Disposal Works Construction Permit No......... �"___ e4obated.......................................... ............................ _..--- Board of Health ---....................•---------••----•--------.._..___--------- h - DATE-----•-•-- •----•--•--•-•--•••--••---••- - •• --- FORM 1255 A. M. SULKIN, INC., BOSTON 9/23/2019 ShowAsbuilt(1653x2338) AsBuill •Page:.l oft 't TOWN OF BARNSTAB 77� sfJ/iYt Cs. '[:OCATION �+P SEWAGE 8 VILLAGE f) s7eRV/LL ASSESSOR'S_MAP&LQT !.-0 . INSTALLER'S NAME: PHONE.NO, �� M� C n U1/�eX t �D/y sEmd TANK CA PACfI Y .�. l>Ac�mra i:Aeu:rnc:(type)/O-FL6 yW eNAi ►Z14e;P�11e)!D f.son NO OFBEDROOMS ax BUII DER OR OWNER. itt.� Q B'�`�_ _ re.,` PERMITDATE COMPLIANCE DATE; �.� 4- - `' •$eparafinn_I)15tanCe.BetWCen tbe: ! 4 .. - - z l, Maximum Adjusted Groiindwate(,Table and Bottom of,Iscachmg Facility r` - Triv*'W*i Supplyweu and Leaching Facility (If any:wells;ei6i t' on site or within 2tlg 7eet of leachta fecili Feet: x p g ty) within 300 feet of r f Edge of Wet)aad and Leaching Facility(If-,any'wedaads ei st leaching facility).tw=Ad by, Fee4, 'Rr # yn P � fn M i \ - y V t f http:/lissgl27intranet/propdata/prebuilt aspx�mappar=1170878 eq=2 9/12/201? https://itsqldb.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=141034&sq=1 1/1 Commonwealth of Massachusetts , Executive Office of Environmental Affairs Department of Environmental Protection William F.Weld Governor Trudy Coxe Secretary.EOEA David B. Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A RE �� '70 _ CERTIFICATION Property Address: 7ii0'.11 H ri t'-/ ST' G`,t t.:",fit c Address of Owner: F E B 2 8 199 5 Date of Inspection: Fes, Q jjkc% (If different) Name of Inspector:,C•,c, m. v j`-- HEALTH Dr: Company Name, Address and Telephone Number: 774VN OF BARNSTALIE Cice%V\(-t(r,-\t,^ink _ o21J W��i`����R(1J1 Hole�• 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 ofAhe time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Date: �/�K ?91t�Inspector's Signature: ' � i �f 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)Iappropriate 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. 1 _ re INSPECTIONS SUMMARY: Check A, B, C, or D: Al SYSTEM PASSES: I 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. B) 9YSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion 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 tank is metal, cracked, structurally unsound, shows substantial infiltration or exhItration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a contorming septic tank as approved by the Board of Health. •` 1 .revised 51'_5/95; One Winter Street • Boston, Massachusetts 02108 • FAX(617) 556-1049 • Telephone(617)292-5500 `• Printed on Recvcied Pacer SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date •.i Inspection: BI SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken o. obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with �.pproval of the Board of Health): 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 systen-, will pass inspect lor;1f.(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed Cl 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 50 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) DETERMII�45 THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tribwaiy to a surface water supply. _ The system has 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 system and is within 50 feet of a private water supply wefl. _ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private v,ater supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the weii;i free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or leis than, 5 ppm. DI SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The oasis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct 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 surface waters due to an overloaded or clogged SAS or cesspool. ,revised 8/15!551 2 t s 4 ; , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: DI SYSTEM FAILS (continued): Static liquid level in the distribution box above outlet invert dueto 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. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 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: 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 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. irevised 8/15/951 3 L _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST 1�u��eT1e2. Property Address: 7'70 7 A -� St• Us\.e `'c Owner: Date of Inspection: (--`� C1�� Check if the following have been done: I* Pumping 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 pan of this inspection. iy`a As built plans have been obtained and examined. Note if they are not available with N/A. Zhe facility or dwelling was inspected for signs of sewage back-up. JZThe system does not receive non-sanitary or industrial waste flow 4"The site was inspected for signs of breakout. All system components, exccludirtg the Soil Absorption System, have been located on the site. ,,, he 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. IL'T'he size and location of the Soil Absorption System 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 Sub- Surface Disposal System. revised 8i15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: '770 Owner: �tvi`l z'[Ce t 1Ze:�`���r.,, Date of Inspection: `e- C��CIC�b FLOW CONDITIONS RESIDENTIAL: Design flow: eallons Number of bedrooms: Number of current residents:_ Garbage grinder (yes or no):_ Laundry connected to system (yes or no):_ Seasonal use (yes or no):_ Water meter readings, if available: Last date of occupancy: COMMERCIAUINDUSTRIAL: _ Type of establishment: ��'•� "..-�r ►.'=,�,�-C Design flow: (0 allons/day Grease trap present: (yes or no)_eJ 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: C, OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: il/c;i c 141, System pumped as part of inspection: (yes or no)_.&/0 If yes, volume pumped: Qallons Reason for pumping: TYPE Of SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, ifany) Other (explain) •� /000 Cn S Stern ._1�J�ri�tl rD APPROXIMATE AGE of all components, date installed (if.known) and source of information: Sewage odors detected when arriving at the site: (yes or no)�(p revised 8/:5i55) 5 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: �ieZ(e�.7C't�IT�Te..T Date of Inspection: 6 1 eb:CIS l�ci II SEPTIC TANK:_ c)j UU C C,r}I l U r�.s (locate on site plan) Depth below grade: Material of construction: zc'oncrete _metal _FRP _other(explain) Dimensions: 6 6 X Sludge depth: ,ti/oA/C Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: b/IC 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, etc.) A/ conl0o�r•�/i o 7f}rr r-oe GREASE TRAP:_ ljaOG'.S�/ (locate on site plan) i Depth below grade: / Material of construction: concrete _metal _FRP —other(explain) Dimensions: G X J Scum thickness: iVoN6 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, etc.) o .revised 8/15/95) 6 _. r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: '7?v� ►�►a�� Si. C�ie� \�c. Owner: �oSYcT�rr �C•� lT7 TRuT Date of Inspection: • ii= c ccb� )j1 cib TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction: _Concrete _metal _FRP _other(explain) Dimensions: Capacity: Qallons 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: f� Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of b x, etc.) / Q _St— -o 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 B/.5/951 7 l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 77G N"k 'S" Os rti•��� Owner: lAo�'wme" - —Cis„( Date of Inspection: �eb Il l cf SOIL ABSORPTION SYSTEM (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: �{ _�' :5 i�/1 C leaching pits, number: — F'x� leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: _ Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetal on,etc.) -�n `icY>n (i) �,/•�;-� i CESSPOOLS: _ (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: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 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 8i15i95) f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 7 70 t-AAIA St• C �.e'..'�lc. Owner: lAo _QzftlTj Tee�T Date of Inspection: l—z�J.�f1�01q6 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' ()00 %PEAS YRA -414 k o o 96 67 �--� Io5 DEPTH TO GROUNDWATER , Depth to groundwater: feet method of determination or approximation: r go j� O l p rn C � C.A 4. fl' a V: • izevised 8/15/95) 9 OF BAKNSTAB LOCATION 4W SEWAGE# VMLAGE Cj S`��/� �lLL @ ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. rJ e J /VI C D m ISG'K-t S D/V SEPTIC TANK CAPACITY :aQ o Q LEACHING FACILITY: (type)/®-F46 W C11A A elf-f Fsize) / C s0©a NO. OF BEDROOMS BUILDER OR OWNER arc A1b 0,J,— Qng,.:./�- G PERMTTDATE: I = 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 leaching facility) Feet Furnished by ell. .ere �•ni�� �� �� s '. s 1 i J �y TOWN OF BARNSTABLE LOCATION�;.// ,[1�/�l � SEWAGE# 'VILLAGE ���I2-�)l I1 F ASSESSOR'S MAP &LOT 0 3 7 pIidrr C�NAME&PHONE NO. SEPTIC TANK CAPACITY C7 11� n LEACHING FACILITY: (type) L5"AC- S (size) NO.OF BEDROOMS /� BUILDER OR OWNER 4S /� �)�A PERMITDATE: - 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 leaching fff ility) Feet Furnished by o`L'9 ��6 j.+ -- �� 97 O S �- � �