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1039 MAIN STREET (OST.) - Health
1039 Main Street (Ostm) Osterville P A = 118 009002 ° , y o - y .: o 0 a Y � o t ` , r v : , e 1 , , " ^ r e - y Commonwealth of Massachusetts /! 00 1�_ vO� �? Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t 1039 Main Street u Property Address , Deborah Maniace Owner Owner's Name/ information is Ost required for every erville ✓ Ma 02655 10-2-19 �• ,, •' page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. . Important:When filling out forms A. Inspector Information 4/0 (O on the computer, use only the tab Brett Hickey key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key. ' 374 Route 130 + cs5 Company Address Sandwich Ma 02563 City/Town State Zip Code rxn, (508)477-0653 S113747 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this.inspection I have determined that the system: 1. ❑0 Passes 9 }' _ r 2. ❑ Conditionally Passes` , 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails ' R Brett Hickey 10-2-19 ' ;;E6t m.aen"id�°v.°.ou,em°a-oR®�panee°.mvation.rei.c=U3 �zle:2°t°.1°.1°13:3°:31-01W Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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 DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. , Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page;of 18 I Commonwealth of Massachusetts + �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1039 Main Street Property Address Deborah Maniace Owner Owner's Name information is Osterville Ma 02655 10-2-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: - , I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The system was in working order at the time of inspection. System is permitted for 3 bedrooms and designed to accommodate 330/GPD. However, property file shows a discrepancy with number of bedrooms allowed by zoning. Zoning should be contacted for more information. System meets Health Department requirements for 3 bedroom per conversation (10-10-19) 2) .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. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1039 Main Street Property Address Deborah Maniace Owner Owner's Name information is Osterville Ma 02655 10-2-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ' ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N' ❑ ND(Explain below): ❑ distribution box is leveled or replaced , ❑ Y ❑ N ❑ ND (Explain below): I ❑ The system required pumping more than 4 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 ❑ Y ❑ N ❑ ND(Explain below): ' ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): k 3) 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 public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: l5insp.doc-rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 cam, Commonwealth of Massachusetts �M ,ip Title 5 Official Inspection Form �^ Subsurface Sewage Disposal System Form -Not for Voluntary.Assessments u— 1039 Main Street Property Address Deborah Maniace Owner Owner's Name information is Osterville Ma 02655 10-2-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No El El clogged of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ O Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1039 Main Street Property Address Deborah Maniace Owner Owner's Name information is Osterville Ma 02655 10-2-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes . No ❑ El Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ a Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow ❑ 'Q Required pumping more than 4 times in the last,year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ a 'well'. portion of a cesspool or privy is within a Zone 1 of a public water supply well:. ❑ El Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 0 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ _ El The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ❑ The system fails. I have determined that one or more of the above failure F criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be j necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you'must indicate either"yes" or"no"to each of the following, in addition to the question's in Section CA. 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 ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection El Area—IWPA)or a mapped Zone II of a public water supply well l5insp.doc•rev.7/28 M18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts �m ,,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1039 Main Street Property Address Deborah Maniace Owner Owner's Name information is Osterville Ma 02655 10-2-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate yes rr or no for each of the following for all inspections: Yes No El ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ E Were any of the system components pumped out in the previous two weeks? El ❑ Has the system received normal flows in the previous two week period? ❑ El Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ E] Was the facility or dwelling inspected for signs of sewage back up? El ❑ Was the site inspected for signs of break out? El ❑ Were all system components, excluding the SAS, located on site? El ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ a Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: El ❑ Existing information. For example, a plan at the Board of Health. ❑ 0 Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1039 Main Street Property Address Deborah Maniace Owner Owner's Name information is Osterville Ma 02655 ' 10-2-19 required for every page. City/Town State ' Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 3 3 Number of bedrooms(design): Number of bedrooms(actual): 330/GPD DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Description: *See notes on page 2* ' Number of current residents: Does residence have a garbage grinder? ' , ❑ Yes E] No Does residence have a water treatment unit? ❑ Yes No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes 0 No information in this report.) Laundry system inspected? ❑ Yes 9 No Seasonal use? ❑ Yes [g No See below Water meter readings, if available(last 2 years usage (gpd)): Detail **2018- 61,000gallons 2017- 78,000gallons** Sump pump? "' ❑ Yes ❑■ No ' current 41 Last date of occupancy: Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 c Commonwealth of Massachusetts ' w Title 5 Official Inspection Form i� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1039 Main Street Property Address Deborah Maniace Owner Owner's Name information is Osterville Ma 02655 10-2-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA Type of Establishment: Design flow(based on 310 C M R 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ No ❑ Yes Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No , Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Owner- last pumped 4 years ago Was system pumped as part of the inspection? ❑ Yes ❑■ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection- Form ; Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments 1039 Main Street u Property Address Deborah Maniace Owner Owner's Name information is Osterville Ma 02655 10-2-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: 0 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) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): . f Approximate age of all components, date installed (if known)and source of information: 1995 . r Were sewage odors detected when arriving at the site?• -❑ Yes K No 5. Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron �❑_■ 40 PVC ❑other(explain): Town water Distance from private water supply well or suction line- feet Comments(on condition of joints, venting, evidence of leakage, etc.): M t5insp.doc-rev.7l26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ii Subsurface Sewage Disposal System Form -Not for Vol untary.Assessments 1039 Main Street u. Property Address Deborah Maniace Owner Owner's Name information is Osterville Ma 02655 10-2-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ❑■ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a•copy of certificate) ❑ Yes ❑ No 1000gallons Dimensions: 311 Sludge depth: 3311 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 NS NS Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is not in need of pumping at this time but should be pumped every two years for maintenance. I l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form . * . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 1039 Main Street Property Address Deborah Maniace Owner Owner's Name information is Osterville Ma 02655 10-2-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): ` NA Depth below grade: * . feet Material of construction: ❑ concrete ❑ metal ❑fiberglass El polyethylene El other(explain): Dimensions: s 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 Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): NA Depth below grade: Material of construction:, ❑ concrete ❑ metal ❑fiberglass El polyethylene ❑other(explain): Dimensions: Capacity: a gallons Design Flow: gallons per day t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 6 , Commonwealth of Massachusetts Title 5 Official Inspection Formii Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1039 Main Street Property Address Deborah Maniace Owner Owner's Name information is Osterville Ma 02655 10-2-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): orr Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The d-box was in workingorder at the time of inspection. p t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form l Subsurface Sewage Disposal System Form Not for Voluntary Assessments 9 p Y rY 1039 Main Street ' Property Address Deborah Maniace Owner Owner's Name information is required for every Osterville Ma 02655 10-2-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) ' 10. Pump Chamber(locate on site plan): - Pumps in working order: ❑ Yes ❑ No` Alarms in working order: ❑ Yes ❑ No` Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): NA " If pumps or'alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: k' • -Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ` 4 infiltrators Tx29' Fx 1 leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 a�-N Commonwealth of Massachusetts qm Title 5 Official Inspection Form I o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1039 Main Street Property Address Deborah Maniace Owner Owner's Name information is required for every Osterville Ma 02655 10-2-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The SAS was in working order at the time of inspection. Leaching was dry when viewed. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): NA 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 ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 i c Commonwealth of Massachusetts Title 5 Official Inspection Form T Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1039 Main Street V� Property Address Deborah Maniace Owner Owner's Name information is Osterville Ma 02655 10-2-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): NA Materials of construction: Dimensions . Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): u t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts �n ,p Title 5 Official Inspection Form ?= ie Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1039 Main Street v� Property Address Deborah Maniace Owner Owner's Name information is Osterville Ma 02655 10-2-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately TOWN OF B�A^RNSTABLE !/ LOCATION�61Y •�FJ►����,GiiJ�l7lY'c� SEWAGE VILLAG ASSESSOR'S MAP 6 LOT U INSTALLER'S NAME& PHONE NO- SEPTIC TANK CAPACITY/-'G�77O--0.^ .//� ,LEACHING FACILITY:(t9Pe�-.�17`z'2i2'.i __7�5_ (size).-�•,F'o��' - NO.OF BEDROOMS 3 PRIVATE WELL R PUBLIC_WAT�, BUILDER OWNER �f��.//U yy7TG � DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes C No c'3• �'7 r 3� �• 43 l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts ' w Title 5 Official Inspection Form T_ 11. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1039 Main Street Property Address , Deborah Maniace Owner Owners Name information is Osterville Ma 02655 10-2-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information(cont.) 15. Site Exam: . ❑■ Check Slope R . ❑■ Surface water ❑■ Check cellar ❑■ Shallow wells" k No GW 4' below SAS Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation:' ❑ , Obtained from system design plans on record If checked, date of design plan reviewed: Date Q Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: A transit was used to determine high groundwater. Bottom elevation of system was determined and transfered to low point where no water was present showing ground water is >4'below SAS. Before filing this Inspection Report, please see Report Completeness Checklist on next'page. t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts �e 1�3 Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1039 Main Street u= Property Address Deborah Maniace Owner Owner's Name information is Osterville Ma 02655 10-2-19 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ❑� A. Inspector Information: Complete all fields in this section. ❑■ B. Certification: Signed& Dated and 1, 2, 3, or 4 checked �■ C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed �■ D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14:.Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 s [ 44r ` -- wAl-e& 1,64 ^ �eN 4 t v !2 e _Ft r - - - ¢. rn • i let �V-!J7L IAA r a i � 5 e�F �L l= a • .� � r �1ij r " ' �4C4 i �� J COO rn ► c o WA f • _ r . r . - tee^-d 00 COMMONWEALTH OF MmsACHUSETTS EXEcuTIVE OFFICE OF ENVIRONMENTAL AFFAIRS -DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE s OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Prop'ertyAddress-. 1039 Main Street -� Osterville � Owner's Name: Carol Mead Owaees Address:_p0 Rnw 1 7 0 - North Bridgton.* ME 04057 Date of Inspection: 0 6-0! -0_7 Name of Inspector:(please print)j Sean Jones _ Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1 089 , _Centerville, MA Telephone Number: (508 i 77 S-8776. *� CERTIFICATION STATEMENT' I certify that 1 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 the inspection.The inspection was performed based on my training and experience in the proper functio and maintenance of on site sewage disposal systems.I a'a DEV� approved system inspector pursuant to ection 15.340 of Title 5(310 CMR 15.000). The system Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authoritjr ap OD Fails O to Inspector's Signature: Dote; PQ rV f" The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of eattltw rfl DEP)within 30 days of completing this inspection.If the system is a shared system or has a design now f 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies"sent to the buyer,if applicable,and the appro`ting authority. . Notes and Comments *`**This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 , OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued)Property Address: 1039 Main Street s ervi e Owner: Carol Mea Date of laspection.: 0 6—0 5—0 7 Inspection Summary; Check A,B,C,D or E/ALWAYS complete all orsection B A. Syst Passes: i have not found any information which indicates that any of the failure criteria described in 310 CMR i 5.303 or in 310 CMR I5.304 exist_Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: //4 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. Answer yes,no or not determined(Y,N,ND in the explain. ) for the following statements.!f`boi determined"please The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,ekhibits substantial infiltration or exfltration or tank failure is irmninent System wall pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. 'A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance ndicating that the tank is less than 20 years old is available. ND explain: Observation ofsewage backup or break out Or high static water level in the distribution box due ftbroken or obstructed pipes)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Hoard of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 tMes a ear due topass inspection if(with approval of the Board of Health): y �Or °mod pipe(s).The system will broken pipe(s)are replaced obstruction is M=Ovcd ND explain: Page 3 of l I OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1 039 Main Street Osterville ,' •� - Owner: Carol Me-ad Date of inspection:_ n F_n S_0 7 C. Further Evaluation is Required by the Board of,Hesith: J if s Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing Ito protect public health,safety or the environment. le System will pass unless Board of Health determines in accordance with 310*CMR I5J03(l)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet ofa 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 any)determines that the system is functioning in a manner that protects the-public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within Ioo feet of a surface water supply or tributary to a surface water supply, _ the system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more front a private water supply well** Method used to determine distance '`This system passes if the well water analysis,perforated at a D£P certified laboratory,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,provided that no other failure criteria are triggered:,A copy of the analysis must be attached to this form- ^ 3. Other: 3 age 4 of l I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1039 Main Street Osterville Owner: Carol Mead Date of Inspection: 0 6—0 5—0 7 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for ail inspections: Yes Xbackup of sewage into facility or system component due to 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 _Il,iquid depth in cesspool is less than 6"below invert or available volume is less than Y2 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 SAS,cesspool or privy is below high ground water elevation. Any portion of 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 veto supply well with no acceptable water quality analysis.(This system passes if the Weil water analysis, performed at a DEP certified laboratory,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 S ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.l _(Yes/No)The system fails.I have determined that one or more ottee above failure criteria exist as described in 310 CMR 15.303,therefore the system(ails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: � v To be considered a large system the system must serve a faci!ity with a design now of I0,000 gpd to 15,000 gpd- You must indicate either'yes"or"no"to each of the' following: (The foliotitiing criteria apply to large systems in addition to the criteria above) yes no Qte 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 It of a public water supply well If you have answered"yes"to any question is Section E the system is considered a significant threat,or answered "yes"in Section D above the large system bas failed.The o Amer yr operator of arty large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1039. Main Street Ostervi e Owner. rar A Mead Date of Inspection:_ 0 6—0 5—0 7 Check if the following have been done.You must indicate' es"or"nd'as to each of the following: Yes No : } Pumping information was provided by the owner,occupant,or Board of Health ' —�f%4/_ Were any of the system components pumped out in the previous two weeks? �L Has the system received normal flows in'the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? ✓/_ Were as built plans of the system obtained and examined?(If they were not available note as N/A). v/— Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break o T OU i% Were all system components,excluding the SAS,. _ glocated on site? Were the septic t - ,p tank-manholes uncovered opened, p ned.and the interior of the tank inspected for the condition of the baffles or tees.material of construction,dimensions,depth of liquid,depth of sludge and depth of scum _�Z_ Was the facility owner(and occupants if different from owner)provided with informatio maintenance of subsurface sewage disposal systems? non the proper The size and location of the Soil Absorption System(SAS)on the site has been determined based on:, Yes 'no Existing information.For example.a plan at the Board of Health. V/____ Determined in the field(if any of the failure criteria related to Part C is at issue approximati is unacceptable)(3I0 ClAR i 5.302(3)(b)) on of distance 5 - i Page 6 of I I , OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1039 Main Street Osterville Owner: Carol Mead Date of Inspection: 0 6—0 5—0 7 FLOW CONDITIONS RESIDENTIAL. Number of bedrooms(design):.-3 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 6 f� Number of current residents: c-9- Does residence have a garbage grinder(yes or no): My Is laundry on a separate sewage system(yes or no):Ao [if yes separate inspection required) Laundry system inspected(yes or no): vj h Seasonal use:(yes or no):/VO 2006 - 34,000 Water meter readings,if available(last 2 years usage(gpd)): 'Sump pump(yes or no):.A,'O 2005 — 42, 00 Last date of occupancy: C-,�-Pe—t COMMERCIALIINDUSTRIAL ' 1 Type of establishment: 1 Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.). Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):— Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): !tO If yes,volume pumped:_ gallons—Now was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM optic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool Privy —Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: III r - rerdrds -f- `7,Z,3 a o ,-f Were sewage odors detected when arriving at the site(yes or no): AIP 6 I'agc 7 of I I OFFICIAL INSPECTION FOR AI—NOT FOit VOLUNTAILY ASSLSSM NTS SUBSURFACE SEWAG E DISPOSAL SYSTEM INS PECTION LCT10N I Ottlbl PART C ' SYSTEM INFORALATION(continued) Property Address: 1039 Main Street Osterville Owner: Carol Mead ; Date of Inspcetlon: 06-05-07 ` BUILDING SEWER(locate on site plan) Dcpdi below grade: ;7- S % , Materials of construction:_cast von V140 PVC, od' mr(exhlairt).. Distance from private Hater supply weilor suction line. Comments(on condition of juu,ts,ventingg,evidence of leakage,etc.); J©�R�I E.iG•t: 2:K - f�Ty ti'�t,�G4 .` - 9 r - SEPTIC TANK: +!(locate on site plan) Dcpth below grade: 1y � Material of construction:_concrete_metal fiberglass_Solyetiiylene _odrer(explain) If tank is metal list age:_ Is agc conFimicd-by a Ccnif-rcate of Compliance oyes or no):—{attach a copy of certificate) Dimensions: f(��G �cs�w•�s -Sludge:depth: �z>" Distance from top of sludge to bottom of outlet Ice or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: _ Distance frorn bottom of scum to bottorn of outlet tec or bathe: I low ticcrc dimensions detcnnincd: Comments(on pumping recommendations,inlet and outict ice or baflic condition,structural intcbrity,liquid IcvcIs as related to outict invert,evidence of icakagc/, �nK. woJ sy�L,"'f d�41� 5t1J/�C� i"l�a•Lt' f.�J✓� as t'•T- �7+Yfl+ 4�P� .. 'eJ✓i'IliJ� f.-tv�..�. ... 7 i GREASE TRAI' - (locate on site plan) Dcpdi below grade:_ Material of construction:_concrete_nicial fiberglass_}tolyethylcne otlicr (explain): _ Dimensions: Scum thickness: - Distance froth top of scutit to top of outlet Ice or baffle: Distance front bottorn of scum to bottunt of outlet tee or baffle: Datc of last pumping: Conuiients(on pumping reconuucndatiuns,WcI and outict ice or balnle condtttva,structural inicbrity, liquid Ict•cls as related to outlet invert, evidence of leakage,etc.): 7 page 8 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORKIATION(continued) Property Address: 1039 Main Street nste_E ille Owner: r_;3 ;Il moan Dtrteotlnspeetlou: 06_05-07 TIGHT or HOLDING TANK: )V r (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete rectal fiberglass__polyethylene other(explaul): Uintcnsions: Capacity:_ gallons Dcsign Flow; gallons/Jay Alainn present(yes or no): Alain level: Alarm in workingorder Date of last pumping: (yes or no):, Comments(condition of alanu and float switclics,ctc.): DISTItIDUTION BOX: {dpresent must be opencd)(loule on site plan) Depth,of liquid level above outlet invert:Q" Comrnenu(note if box is level and distribution to outlets equal,any evidence of;ofiJs carryover,any evidence of leakage into or out of box,ct ): f a......p )b " PUNIz CRAM DER: /V c on siteplan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,cunditiorr of pumps and appurtenances,e(c.): f Page 9 of 1 I OFFICIAL INSPECTION FORM—NOT'FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1039 Main Street Ostervil e Owner. Carol Mead Date of Inspection:06-05-07 SUIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation-not required) If SAS not located explain why: Type leaching pits,number__ leaching chambers,number: eaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: over cesspool,number umovativelaltemative system Type/name of technology: Comments(note condition of soil,signs ofhydraulic failure,level of pondin„damp soil,condition of vegetation, etc 1-41.4 '✓o S aY�"fii: v 1U✓ S r G S y c �y��Y�.L/a C 'Y t.�i.c/t t CESSPOOLS: r (cesspool must be pumped as part of inspection)(iocate on site pla n) n) 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(yes or no): Continents(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.).- PRIVY:NI (lorate 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.): 9 Page IU of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1039 Main Street s ervi e Owner: Carol Mead Date of Inspection: 0 6-0 5-0 7 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within I GO feet.Locate where public water supply enters the building. 3 -TA,.; A-► 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBS URFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1039 Main Street Osterville Owner. Carol Mead Date of Inspection: 0 K—0 5—0 7 SITE EXAM / Slope t/ Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within I50 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: — lars�.•�' ^-ct� �'� +/a�u tne5 �,�},c la/.S 7..e � b� �ef�sS .nj � ,� o� l r�crcu�r btu `�n++iiJt w_i�Y enw a"D1I tiv4�* r ISa s $ Shv� It r /r- ,� dJ .�. / n� COcc r�irt.6G,. �N fC ld 1� � afysn„l. r 11 .,, ,BIA . 0 .4 1659. D�A1d To n of Barnstable Zoning Board of Appeals Decision and Notice Appeal No. 1997-21 John M. &Karen E. Butler Variance to Section 3-1.3 5) Bulk Regulations Summary Granted with Conditions Applicant: John M. &Karen E. Butler Property Address: 1045 Main St., Osterville Assessor's Map/Parcel Map 118, Parcel 9-1, 9-2 Area .18 ac., .72 ac. Zoning: RC Residential C Zoning District Groundwater Overlay: AP Aquifer Protection District, Background: The property that is the subject of this appeal is located at 1045 Main St., Osterville. The property contains two buildings, a single family house and a second building, previously a yarn shop. It is located in the RC Residential C Zoning District, where there is a minimum area requirement of one acre and a minimum width of 100'. The property was shown as one parcel on Assessor's Maps from 1983 through 1996. The applicants are seeking a variance from Section 3-1.3 (5) Bulk Regulations minimum lot area and minimum lot widths for the two proposed lots. According to an affidavit from a previous owner, both buildings have been in existence since 1941, prior to zoning. Massachusetts General Laws Chapter 41, Section 81-L requires Planning Board to endorse plans dividing properties containing two buildings where both buildings precede the town's adoption of the subdivision control law. This section of the General Laws does not address zoning compliance and that is the reasoning behind the zoning requests. An Approval Not Required Plan (ANR)was signed by the Planning Board in 1987, which showed the division of this property into two lots. This plan was not recorded, but a second plan signed in 1995 was recorded. The lots are shown on the applicant's plan as 0.18 and 0.72 acres, with lot widths scaling to 49' and 100', respectively. Procedural Summary: This appeal was filed at the Town Clerk's Office and at the Office of the Zoning Board of Appeals on January 13, 1997. A public hearing before the Zoning Board of Appeals was duly advertised and notices sent to all abutters in accordance with MGL Chapter 40A. The hearing was opened February 19, 1997, at , which time the Board found to grant the Variance with conditions. Board Members hearing this appeal were Emmett Glynn, Gene Burman, Elizabeth Nilsson, Robert Thorne, and Chairman Gail Nightingale. Attorney John Alger represented the applicants, John and Karen Butler, who were present. Hearing Summary: Attorney Alger submitted a memorandum in support of this appeal.: Attorney Alger gave a detailed history of the buildings, the site and its previous owners. There was one structure shown on the plan in 1987, Zoning Board of Appeals-Decision and Notice Appeal No. 1997-21 John M.&Karen E.Butler Variance to Section 3-1.3 5) Bulk Regulations when an Approval Not Required Plan was approved but never recorded. In 1988, a permit was granted to relocate an historic structure to this site on a newly constructed foundation. That was never completed but later, permission was granted to allow a residential structure to be built on that foundation. During construction, there was a financial problem and the only work completed was the building"shell". Mr. and Mrs. Butler purchased the property for$140,00 in 1993. Because the land was subdivided on an approved APR plan, Mr. and Mrs. Butler were issued a Building Permit to complete the"shell"to construct a structure. There was a misunderstanding as no one was aware at that time that the plan had not been recorded. In 1995 by permit, a septic system was installed. Later Mr. and Mrs. Butler were informed by the Building Department that their building permit had expired and that the ANR plan was never recorded. All work stopped. Attorney Alger indicated the relief requested is for a variance to allow the two lots to exist as independent lots each to support their own single family residential house. The exterior of the house on Lot 2 is almost complete with a Title V septic system. The house on Lot 1 has been upgraded. Permission is needed to complete the work on the house on Lot 2 and when done, the applicants plan to sell it. The size of Lot 2 is rather small and the petitioner wishes to change the lot lines to make Lot 2 a little bigger and therefore, Lot 1 a little smaller. The resulting lots will be more rectangular in shape. Mr. and Mrs. Butler want to live in the house on Lot 1. Attorney Alger understands mistakes have been made but there has been a business on this site since 1941 and has continued through 1988. He reviewed the area surrounding locus and explained what relief is needed. The lots are similar to other lots in the area and granting the relief sought would not be detrimental to the area nor would it derogate from the spirit and intent of the Zoning Ordinance. Each lot has a separate septic system on their own lot. Public Comment: Four letters in support of the appeal were submitted to the file by Attorney Alger. They were read by Chairman Gail Nightingale. No one spoke in favor or in opposition. Attorney Alger explained in detail the sketch submitted by CapeSury showing a Lot 9-1, 9-2, and 9-3. Lot 9-1 will be reconfigured so that a portion of it will become Lot 9-3 and be combined with Lot 9-2. Findings of Fact: Based upon the testimony given during the public hearing on this appeal, the Board unanimously found the following findings of fact: 1. The applicants are John M. and Karen E. Butler with property located at 1045 Main St., Osterville, MA. There are two parcels of land identified as Parcel 9-1 and 9-1 on Assessor's Map 118, in an RC Residential C Zoning District. 2. The applicants are seeking a variance from Section 3-1.3 (5) Bulk Regulations for a minimum lot area and minimum lot widths for the two proposed lots. 3. An Approval Not Required Plan (ANR)was signed by the Planning Board in 1987, which showed the division of this property into two lots. That plan was not recorded, but a second plan signed in 1995 was recorded. The lots are shown on the applicant's plan as 0.18 and 0.72 acres, with lot widths scaling to 49 feet and 100 feet, respectively. 4. The relief sought is to enable the petitioners to maintain Lot 9-1 (the larger lot)as their principal location of their home. The relief is sought for Lot 9-2 (the lot with a house shell located on it)to make it a sellable residential property. 5. This property was formally a place of business and is now intended to be a residence which would be in keeping with the area and not in derogation of the spirit and intent of the Zoning Ordinance nor would it more detrimental to the neighborhood affected. 6. Both properties have Title V septic systems (approved by the Board of Health), each on their own lot. 7. Both properties pre-date zoning. 2 Zoning Board of Appeals-Decision and Notice Appeal No. 1997-21 John M.&Karen E. Butler C7 Variance to Section 3-1.3 5) Bulk Regulations Decision: Based upon the findings a motion was duly made and seconded to grant the relief being sought in Appeal Number 1997-21 with the following terms and conditions: 1. Lot 9-2 may be extended to include an additional 5,109 sq.ft. to the west of Lot 9-2. Lot 9-3 is not to be considered a buildable lot and is to be deeded to and become part of Lot 9-2. That then enables Lot 9-1 to be defined as an area of approximately 26,426 sq.ft. with a two story residential dwelling fronting on Main Street, Osterville. This is shown on a sketch prepared by CapeSury dated 10/Feb./97 bearing the Professional Seal of Richard R. Lheureux, Professional Land Surveyor. 2. Both buildings shall be used for residential use in conformance with the uses allowed in the RC Residential C Zoning District. 1 Both properties shall meet all requirements of the Building, Health and Conservation Divisions and the Fire Department. 4. On site septic systems shall meet the requirements of Title V without variances from the Board of Health. 5. There.will be no further expansion of the Building on Lot 9-2. -It is to have no more than two bedrooms. f 1� 1�/o�y -oo� The Vote was as follows: AYE: Gene Burman, Emmett Glynn, Elizabeth Nilsson, Robert Thorne and Chairman Gail Nightingale NAY: None Order: Variance 1997-018 has been granted with conditions. This decision must be recorded at the Registry of Deeds for it to be in effect. The relief authorized by this decision must be exercised in one year. Appeals of this decision, if any, shall be made to the Barnstable Superior Court pursuant to MGL Chapter 40A, Section 17, within twenty (20) days after the date of the filing of this decision in the office of'the Town Clerk. 5' 1997 Gatda htingale hairm Date Signed I Lutchen Ider, Clerk of the Town of Barnstable, Barnstable County, Massachusetts, hereby certify that twenty (20) days have elapsed since the Zoning Board of Appeals filed this decision and that no appeal of the decision has been filed in the office of the Town Clerk. Signed and sealed this „ day of !/'(I19 7 under the pains and penalties of perjury. Linda Hutchenrider, Town Clerk 3 r 07-1 1-2007 a e_e 1 m 21P NOTICE: The Town of Bamstable Deco mmenA1 hat th --an n1i rant seek legal advice to prepare a properly worded deed restriction document. DEED RESTRICTION WHEREAS, I�I /1C M !4r 2 O (ownefs nam of � s d (a dress) is the owner of dGlif �- ( (address) located at v,�Li Ic MA (hereinafter referred to as and being shown on a plan entitled "Subdivision of Land in MA, Property of et al, duly recorded in Barnstable County Registry of Deeds in Plan Book� q q — , Page Or on Land Court Plan Number WHEREAS,) a as the (owner's name) owner Of said lot has agreed with the Town of Barnstable Board of Health to a restriction as to the number.of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for the.Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance-of a building permit for the construction of a single.family home on this property, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the .Barnstable County Registry of Deeds by recording this document, deedr v 'i Bk 22179 Pg 136 #41026 NOW, THEREFORE tQ hAt does hereby place the (owners name) following res�t�;riilc�tion. crn.�h�iis above-referenced and' in accordance with his agreement with t 1p..-a�+]�L1.1. arzisa:,... run with the land and be binding.upon all.successors in title: • y� �� yyi�� may have constructed (address) ""' on the lot a house containing no more than -T')%edrooms. OA grees that this shall be-permanent deed (owhees name) restriction affecting .,__located on MA, and . being shown on the plan recorded in Plan Book , Paged Or on Land Court Plan For title of see the following deed: Book J`;Page . Or Land Court Certificate of Title Number Executed a seated instrument day ofOQ Owners signature a Owner's signature Owner's signature COMMONWEALTH OF MASSACHUSETTS ss 20_ Then personally appear the above• med known to me to be the perso ho execute acknowled foregoing instrument and ' e the same to be free act and deed, before me, Public R Notary commisslon expires: ELIZABETH W.WAOAM NOTARY PUBLIC coa ao&maith of Manadmseb (date) My commission Expires deedr June 7. 2013 AN IMSM OF DM COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION �ECHIVED APR 1 4 2005 Tt.......F'BAKNSTABLE TITLES r+c"ALTy DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: '1039 Main Street Osterville, Owner's Name: Carol Mead Owner's Address: Date of Inspection: Name of Inspector:(please print) Wi 1 1 i am _ • Robinson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 Centerville, MA Telephone Number: ( 5081 775-8776 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 the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Sec 'on 15340 of Title 5(310 CMR 15.000). The system: asses Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: �� k�,�,, , Date: �•—/ -�0 S The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heatth or DEP)within 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 DEP.The original should be sent to the system owner and copies sent to the.buyer,if applicable,and the approymg authority. Notes and Comments ""This report only describes conditions at the time of inspection and under tite conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 1 I ' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1039 Main Street Osterville Owner: Date of Inspection: —O s Inspection Summary: Check A,B,C,D or El ALWAYS complete all of Section D A. Syst Passes: 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: A ne or more system components as described in the"Conditional Pass"section need to be replaced or The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. es,no or not determined(Y,N,ND)in the for the following statements.if"not determined"please e septic tank is metal and over 20 years old•or the septic tank(whether metal or not)is structurally exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the - existing tank is replaced with a complying septic tank as approved by the Board of Health. 'A me 1 septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicatii ig that the tank is less than 20 years old is available. ND exp ain: bservation of sewage backup or break out or high static water level in the distribution box due to-broken or _ obstru pipes)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approv of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced N),inspection lain: The system required pumping more than 4 taus a year due to broken or obsvixicd pipe(s).The system will pa if(with approval of the Board of Health): broken pipe(s)are replaced obstrucdw is rcmovcd ND exp in: P'age3ofII OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1039 .Main Street Osterviile Owner: Carol Mead Date of Inspection: 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 fail' g to protect public health,safety or the environment. 1. yytem will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the s stem is not functioning in a manner which will protect public health,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. ystem will fail unless the Board of Health(and Public Water Supplier,if any)determines that the syste is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within.100 feet of a surface water supply or tributary to a surface water supply. — The system has a septic tank and SAS and the SAS is within a Zone For a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more front a private water supply well•• Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform acteria and volatile organic compounds indicates that the well is free from pollution from that facility and - e presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other ilure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of I 1 OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSALS YSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1039 Main Street Osterville Owner: Carol Mead Date of inspection: D. Sq stem Failure Criteria applicable to all systems: You ust indicate"yes"or"no"to each of the following for all inspections: Yes o Backup of sewage into facility or system component due to 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 AS 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 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 SAS,cesspool or privy is below high ground water elevation. Any portion of 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 wattr supply well with no acceptable water quality analysis.(This system passes if the well water analysis, performed at a DEP certified laboratory,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, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails.1 have determined that one or more of.the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems:To considered a large system the system must serve a facility with a design now of 10,000 gpd to 15,000 gpd• You ust indicate either"yes"or"no"to each of the following: (the f lowing criteria apply to large systems in addition to die criteria above) yes no the system is within 400 feet of a surface drinking water supply e system is within 200 feet of a tributary to a surface drinking water supply _ _ t,a system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-1WPA)or a mapped ne 11 of a public water supply well if you have swered"yes"to any question in Sccdan E the system is crosidered a significant threat,or answered "yes"in Sec ion D above the large system bass fabled.The u%mcr or operator of"large:system considered a significant dreat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The )-stem owner should contact the appropriate regional office of the Department. 4 Page S of]] OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1039 Main Street Osterville Owner: Carc)l Mead— Date of Inspection: — d Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? _ Has the system received normal flows in the previous two week period? _2t/Have large volumes of water been introduced to the•system recently or as part of this inspection y Were as built plans of the system obtained and examined?(If they were not available note as N/A) _ Was the facility or dwelling inspected for signs of sewage back up Was the site inspected for signs of break out? r Were all system'components,excluding the SAS,located on site? a Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition_ of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? !/`— Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes ..10 _�/ Existing information.For example,a plan at the Board of Health. t 7U '_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance. is unacceptable)13 10 CMR 15.302(3)(b)] 5 Page 6 of i.l , OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1039 Main Street Osterville. Owner: Carol Mead Date of Inspection: —O 3 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):.. Number of bedrooms(actual): DESIGN flow based on 310 CMRR115.203(for example: 110 gpd x#of bedrooms): wo Number of current residents:e/ Does residence have a garbag grinder(yes or no):,�-,f Is laundry on a separate sewage system(yes or no)4zd [if yes separate inspection required] Laundry system inspected(yes or no):�v Seasonal use:(yes or no):/6/0 Water meter readings,if available(last 2 years usage(gpd)): 2004 — 35, 000 Sump pump(yes or no): 2003 — , 0 0 0 . Last date of occupancy: COMMERCIA USTRIAL Type of establishm nt: Design flow(base on 310 CMR 15.203): gpd Basis of design w(seats/persons/sgft,etc.): Grease trap pre nt(yes or no):_ Industrial was holding tank present(yes or no):_ Non-sanitary aste discharged to the Title S system(yes or no): Water meter eadings,if available: Last date o occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part ofthe inspection(yes or no): 4=_0 If yes,volume pumped:__gallons--How was quantity pumped determined? Reason for pumping: - TYP OF SYSTEM _Septic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval 1 _Other(describe): Approximate age of all components,at in lied(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): /L 6 1'agc 7 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F.OhM PART C SYSTEM INFORII'IATION(continued) Property Address: 1 039 Main Street a s ervi . Owner: Carol ea Dale or]nspection: — O BUILDING SE1YE locale on site plan) Depth below grad . Materials of con ruction:_cast iron _40 PVC_other(explain): Distance Gont ivalc water supple well or suction lulc: Commcnts(o condition of joints,venting,evidence of leakage,etc.): r J • SEPTIC TANK: /(Iocate-onoc site plan) Depth below grade: Material of construction:_c✓oncrcic metal fiber lass of etln Ienc _other(explain) _ — g � y If tank is metal list age:— Is age confinned•by a Certificate of Compliance(yes or no):—(attach a copy of certificate) r Dimensions: Sludge depth: 3.. Distance Gom top of kludge to bottom of outlet Ice or bafllc: Scum thickness: 9 r Distance from top of scum to top of outlet Ice or baffle: Distance(join bottom of scum to boltonn of outlet tee or baffle: ' flow were dimensions determined: O 0 ,,- G y Comments(on pumping recommendations, inlet and outlet Ice or baffle condition,structwal integrity,liquid lcvcls as related to outlet invert,evidence of leakage,etc.): GREASE TRAP: - locate on site plan) - Depth belLkn : Material o ion:_concrcle_racial fiberglass___polycthplcnc,._othcr (explain): — Dimensio Scum Ihic Distance of scum to top of outlet tee or baffle: Distance om of scum to bottom of outlet►ee orbaffle: Dale of laing:Conunentmping recommendatiuns,inlet and outlet Ice or bank condilio:t,structural integrity,liquid levels as relatedt invert,evidence of leakage,etc.): --------------- ,age 8 of 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SENVAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORNIATION(continued) Property Address: 1039 Main Street Osterville Owner: Carol Mead Dote of Inspection: TIGHT or 110 ING TANK: (tank must be pumped at time of in slit ction)(locate on site plan) Depth below gr de: Material of cot truction: concrete_metal_fiberglass_polyethylene other(explaut): Dimensions: Capacity: —gallons Design Flow gallons/day Alarm presc t(yes or no): Alarm leve . Alarm in working order(yes or no):— Date of las pumping: Comment (condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opencd)(locatc on site plan) Depth of liquid level above outlet invert: Conunents(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of - leakage into or out of box,ctc.): h t< " E PUAIP CHAMBER: (locate on site plan) Pumps in working or er(yes or no): Alarms in working der(yes or no):— Comments(note a ndition of pump chamber,cundition of pumps and appurtenances,etc.): f - Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1039 Main Street Osterville Owner: Carol Mead Date of Inspection: / O SOIL ABSORPTION SYSTEM(SAS): /(locate on site plan,excavation"not required) If SAS not located explain why: Type ._ I eaching pits,number:— leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology- Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): i h'6 CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and co �guration: _ Depth—top of iquid to inlet invert: Depth of soli layer: Depth of sc layer. Dimension of cesspool: Materials f construction: Indicatio of groundwater inflow(yes or no): Comme is(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: ocate on site plan) Materials o onstruction: Dimensio Depth of olids: Comm is(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1039 Main Street Osterville Owner: Carol Mead Date of Inspection: '—/ SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet..Locate where public water supply enters the building. 13 " d a � 1 10 f Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C < SYSTEM INFORMATION(continued) Property Address: 1.039 Main Street Osterville Owner.Carol Mead Date.of Inspection: SITE EXAM Slope Surface water Check cellar. Shallow wells - Estimated depth to ground water y feet Please indicate(check)all methods used to determine the high ground water elevation: tamed from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting propertylobservation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must descc *be ho✓you es bl'shed the high ground water elevation: 11 TOWN OF BARNSTABLE LOCATION/ n �� �1�l✓✓���1`��� SEWAGE VILLAGBf OU,��e ASSESSOR'S MAP & LOT /e-oo � U -INSTALLER'S NAME & PHONE NO. p/"ldl SEPTIC TANK CAPACITY LEACHING FACILITY:(type >�,/�' 6rs z,�.) (size) NO. OF BEDROOMS PRIVATE WELL R PUBLIC WATER BUILDER OWNER 1° DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED• `�'�t°� VARIANCE GRANTED: Yes No ����� ���� f � a r ��, No... FnR. THE COMMONWEALTH OF MASSACHUSETTS T / BOARD OF HEALTH - C TOWN OF BARNSTABLE �i Appliration for Divi-poml Works Towitrnrtion Prrmit application is hereby made for a Permit to Construct ( ) or Repair 04,) an Individual Sewage Disposal System at: .....--•-•.............••-•-•.........---••..-._....---•-••••------•- --•-••-•-••••--•--•-•• ------•-----------------------•------ Location•:\ddress or Lot No- �h� ?---.............................:-----._.__/�` ------ >. -- s-3- ................ !E t--°�'uA....................-..-----•--- owner Address t-------•-------------------- Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling— No. of Bedrooms-_-_-------- �------------ ----___Expansion Attic ( ) Garbage Grinder aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures --------------------------------------------------------------------------------------- ------------------------------------------------------------- W Design Flow.................... __________-gallons per person per day. Total daily flow_---___________s�.__-��................gallons. W Septic Tank—Liquid capacity/llpa...gallons Length................ Width_-______-__-__- Diameter................ Depth................ x Disposal Trench—No. -------/......... Width_______ _ ______ Total Length__.._______ Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter-------------------- Depth below inlet____._ �__ Total leaching area..................sq. ft. Z Other Distribution box (tom) Dosing tank ( ) aPercolation Test Results Performed by........................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit--_-_-_____________ Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to ground water------------------------ P4 --------------------------------------------------------•-----------------------------•-•--•--•-----......................................................... 0 Description of Soil....................................................................................................................................................................... W U ------------------------------------=--•-------- --------------------------•-------------•----------------------------------------------•----------------------------._...---------••-•-------•--------- W ---------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------- U Nature of Repairs or Alterations—Answer when applicable._.. 1 0 4.4----� Y Agreement: The undersigned agrees to install the aforedescribed-Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance s'b n issued t board of health. Signed ------------ ----------------------------- -- --- ----............... ------------------------- �y�� Dare . ApplicationApproved By ---------------- ... ..... ..................................................................... ....... Application Disapproved for the following reasons- ------------------------------ --------------------------------------------- -------- ----------------------- ------------ ................ . ... ... ........... ......................-.............-..... .......-.......-..-------------- Dare PermitNo. ............ ram... Issued ........................................................ ............ Dace k � e t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE P� 'l ppliratiott for Tivi ial Works C�onotrnrfinn remit ppn is hereby made for a Permit to Construct ( ) or Repair i><) an Individual Sewage Disposal System at: �N 'i .................... .......................................... + Locat(ion//-Address �/ or Lot�N.o,. _ ......................_.......................................... -•----...-----------......-•-•--------....------.!`.'.".......___.....___._...................__. Owner �Y �� Address / W — -ICI TT`/ cL.-6,4�S T/+-JU%U IJ R � W.7{"-TL. y ,ems � !J a --••--•....------••--•••---•-----•-•---•-...---•••-•-------------••--------•---••--•----------•-- ,FAD - Installer Address d Type of Building Size Lot............................Sq. feet lk Dwelling— No. of Bedrooms...............�_-_._______-_-.-___Expansion Attic ( ) Garbage Grinder aOther—,Type of Building ____________________________ No. of persons______._-_-__------___.___ Showers ( ) — Cafeteria ( ) d Other fixtures . W Design Flow-------------------_5 ...........gallons per person per day. Total daily flow..._-__-----.__2 7d_.._......._.___gallons. WSeptic Tank—Liquid capacitv/UQO...gallons Length________________ Width__.-_.--�_____. Diameter................ Depth................ xDisposal Trench—No. .......�-------- Width_..._..7_.__._... Total Length..... .... Total leaching area....................sq. ft. Seepage Pit No--------_----------- Diameter____.-__-__..___.__ Deptll,belMv inlet....... Total leaching area..................sq. ft. Z Other Distribution box O Dosing tank//',( �) ~' Percolation Test Results Performed by.......... ----.......................................................... Date........................................ a Test Pit No. I....._..____Minutes per inch Depth of Test Pit___________________,Depth to ground water........................ fZ4 Test Pit No. 2................minutes Per inch Depth of Test Pit.................... Depth to ground water........................ a ' --------------------------------------------------------------------------•-------•.......................................................... 0 Description of Soil------.... =. - v --------•-•-•----•••---••--�� .. x..---•-----------------------------------------------------------------------------------••----------- •-•---------•---------........ W I+ u4. Nature of Repairs or Alte afions - Answer when applicable.___/nl.-5i s �-.__ _....../¢�_4 .... -. � r .. ._ ............ _.?_ .. ......_._ •/_...__•S-/-LJiV E. Agreement The ui dersigATLE d agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued �Vinh board of health. Signed ............u...._------------------- .--------------- �_ S__�5�� h' ... Dare s Application Approved BY ( V -----------.`i-------------'-`--..---..----------------------------- -------`�.-�- -----9 a application Disapproved for the following' : ................... j Dare r PermitNo- ------------/ 1 !--- --------- Issued ..................................-- .-- .......... Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ' Gelr#ifi ate of Compliance 117- THIS IS TO CERTIFY, That t.e Individual Sewage Disposal System constructed ( ) or Repaired r U v t c�_T� y s'r7L—U-,c.�-rv�..1 w by ....--------------------------------------------------------- - ............... G � .: '�..c�.. I'Y1/�-i�---. at --_--------------------- - ... -......... - - - has been installed in accordance with the provisions of TI'I'I,E 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ----- -.----. .d-.--..... dated ._......._...._-_-------._...- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE i SYSTEM WILL FUNCTION SATISFACTORY. �.� -�DATE........ .. . Inspect r ....-------------------------------- ---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH V TOWN OF BARNSTABLE No..........:.. � FEs.. . � 11ioVnottl Workii �nnl r r#inn rrini Permission is hereby granted......................... ... ".'_T.'_`-U. ..........__ :`.sTiNc�►`�r�;+�l to Construct ( ) or Repair an Individual Sewage Disposal System Street _4 ^ - ` _ as shown on the application for Disposal Works Construction Permit No.�__..._-___�-_.__. Dated______________________ _�......__._..... ................. -=._�-------------------- ................................. .� _ 5 Board of Health DATE....................... �( : __._.....----------- FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS Ac PC r � a s -- - j` 6 �t ' ,�-+re n k E Y l g 0 ; PERCENTAGE OF LOT COVERAGE S APUI N/F KENNEY LOT AREA 13113t S.F. ,Cr EXISTING STRUCTURES 7.8% y GRAVEL DRIVEWAY 13.4% o TOTAL COVERAGE 21.3% 9y Q . • F� • `�CuS LOT LOCUS MAP - 9-1 PLAN REF: 531-93 DEED REF: 25744-325 ASSESSOR'S MAP: 118/009/002 ZONING: RC SETBACKS: 20'-10'-10' i FLOOD ZONE: C 2 N 83'07' PANEL NUMBER: 250001 0.016 D 00" W 241.63' � 3 10.4ft 10.1ft I� � DATED: ,7/2/1992 a _ �; — _� o co LOT —2 Cv `� I 131113.1 S Q. FT. PROPOSED r _ _ �' :.:r.. . •.. . B I ' I ' a 0.3 ACRES DECK�.L -_ -_ •.----':.- - : 97.6ft -PLOT PLAN 0 LAND I o 11¢.3ft I Q - LOCATED AT: — SETBACK LINE I _- -_-_ _- PEeOtNi IL�j _10 39 MAIN STREET PEA Tf3ti RECORD�3Rt3 o. N 84'46'03" GRAVEL E�•. w - -_ OSTER VI LL' M A 121.58' N _ y is ���Y, M ' O V N 84.38'20" W ~x 135.34' PREPARED FOR: DEBORAH IRELAND Z NOVEMBER - 27, 2013 REV: REV: N/F CAZEAULT o► ��N�r F.11 S. S� �Q ERF� REV: STEP"E" N YANKEE LAND SURVEY CO, INC. GRAPHIC SCALE oo\(LF 119 ROUTE 149 30 0 15 30 so ®� ;J _,c Joey® MARSTONS MILLS, , MA � '►�� s F`� Z�. I'� TEL: .(508)428-0055 FAX:' (508)420-5553 1 inch = 30 ft. i� yankeesurvey@comcast.net, www.yankeesurvey.net SHEET. 1 OF 1 JOB#: 54979 JM