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Home My WebLink About0027 NORTH BAY ROAD - Health 101 CARRIAGE ROAD, OSTERVILLE A=072-022 f 0 Commonwealth of Massachusetts Title 5 Official Inspection Form CS�� I p � Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 Carriage Rd. Property Address GUARENTE, MARY L Owner Owner's Name information is required for every Osterville MA 02655 7/15/14 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 farms A. General Information on the computer, use only the tab 1. Inspector: I key to move your cursor-do not Robert Paolini use the return key. Name of Inspector Robert Paolini Septic Service "ICI Company Name 17 Playground Lane Company Address - gyp Yarmouthport MA 02675 City/Town State Zip Code 508 362-3555 S14454 Telephone Number License Number B. Certification , I certify that I have personally inspected the sewage disposal system at this a less and ft it the information reported below is true, accurate and complete as of the time of ttie inspectio&—The it ,--�ection was performed based on my training and experience in the proper function and pnaintenalVe of ors site sewage disposal systems. I am a DEP approved system inspector pursuantto Section 15.340 of Title 5(310 CMR 15.000).The system: ¢ 0 Passes ❑ Conditionally Passes ❑ �ails . ❑ Needs Further Evaluation by the Local Approving Authority 7/1.5/14 Insp or's Signa ure 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 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 approving authority. ****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. t5ins•3/13 Title 5 Official Inspection Form: b ce Sewage Disposal System•Pa e 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments "F 101 Carriage Rd. Property Address GUARENTE, MARY L Owner Owner's Name information is required for every Osterville MA 02655 7/15/14 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A System Passes: ❑x 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: 13) 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): t5ins•3/13 TiUe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form lu Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 Carriage Rd. Property Address GUARENTE MARYL Owner Owner's Name information is required for every Osterville MA 02655 7/15/14 page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cunt.): ❑ 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): ❑ 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): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. 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: ❑ 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 Carriage Rd. Property Address GUARENTE, MARY L Owner Owner's Name information is required for every Osterville MA 02655 7/15/14 page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) 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 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. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Z Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ E9 Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow L', •3/73 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 Carriage Rd. Property Address GUARENTE, MARY L Owner owner's Name information is required for every Osterville MA 02655 7/15/14 page. City/Town State Zip Code Date of Inspection B. Certifi.cation (cost.) Yes No ❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ❑x Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ 0 Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ a 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.] ❑ 0 The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ 0 The system fails. I 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 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 questions in Section D. 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 Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes" to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 Carriage Rd. Property Address GUARENTE, MARY L Owner Owner's Name information is required for every Osterville MA 02655 7/15/14 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No 0 ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ 0 Were any of the system components pumped out in the previous two weeks? ❑ 0 Has the system received normal flows in the previous two week period? ❑ 0 Have large volumes of water been introduced to the system recently or as part of this inspection? 0 ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) 0 ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑x ❑ Was the site inspected for signs of break out? 0 ❑ Were all system components, excluding the SAS, located on site? ❑x ❑ 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? 0 ❑ 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: ❑ ❑x 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 550 15ins•3113 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of W f Commonwealth of Massachusetts Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °r 101 Carriage Rd. Property Address GUARENTE MARYL Owner Owner's Name information is required for every Osterville MA 02655 7/15/14 _ page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes 0 No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes 0 No information in this report.) Laundry system inspected? ❑X Yes ❑ No Seasonal use? ❑ Yes ❑X No Water meter readings, if available last 2 ears usage d na 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes 0 No Last date of occupancy: 7/15/14 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Lt5ins-3113Water meter readings, if available: •3l13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 Carriage Rd. Property Address GUARENTE, MARY L Owner Owner's Name information is required for every Osterville MA 02655 7/15114 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes Z No If yes, volume pumped: gallons How was quantity pumped determined? 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, 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): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 Carriage Rd. Property Address GUARENTE, MARY L Owner Owner's Name information is required for every Osterville MA 02655 7/15/14 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components, date installed(if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes Z No Building Sewer(locate on site plan): Depth below grade: 2' feet Material of construction: ❑ cast iron 0 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of leakage.System vented through the building vents. Septic Tank(locate on site plan): Depth below grade: 3' 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 Dimensions: 1500 gl H2O Sludge depth: 1" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 Carriage Rd. Property Address GUARENTE, MARY L Owner Owner's Name information is required for every Osterville MA 02655 7/15/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 35" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 811 Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every 2 years.Inlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Carriage Rd. Property Address GUARENTE, MARY L Owner Owner's Name information is required for every Osterville MA 02655 7/15/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Carriage Rd. Property Address GUARENTE, MARY L Owner Owner's Name information is required for every Osterville MA 02655 7115/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No 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.): Box is Ievel.Box has three outlet Iateral.No evidence of solids carryover.No evidence of leakage. 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.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Carriage Rd. Property Address GUARENTE, MARY L Owner owner's Name information is required for every Osterville MA 02655 7/15/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑x leaching fields number, dimensions: 16'x47'x6" ❑ 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.): Sandy soil . No signs of hydraulic failure Cesspools(cesspool must be pumped as part of inspection)(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 ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 Carriage Rd. Property Address GUARENTE MARYL Owner owner's Name information is required for every Osterville MA 02655 7/15/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ." 101 Carriage Rd. Property Address GUARENTE, MARY L Owner Owner's Name information is required for every Osterville MA 02655 7/15/14 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 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 X� x' 0o 3 S' ),y 44 7 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Carriage Rd. ,p - Property Address GUARENTE, MARY L Owner Owner's Name requir atF.on is Osterville MA 02655 7/15/14 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: 0 Check Slope 0 Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of leaching 8' 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 ❑ Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: As-Built ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS observation well data.USED:Technical bulletin 92-0001 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .'r 101 Carriage Rd. Property Address GUARENTE, MARY L Owner Owner's Name information is required for every Cisterville MA 02655 7/15/14 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist 0 Inspection Summary: A, B, C, D, or E checked 0 Inspection Summary D (System Failure Criteria Applicable to All Systems) completed 0 System Information—Estimated depth to high groundwater 0 Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file Lt5 ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 THE FOLLOWING IS/ARE THE BEST , IMAGES FROM POOR QUALITY ORIGINAL (S) m A- Allr=DATA to I 19.7' 6.8 Stone RetainingWall - 1 .5 Prop an A C Units ❑❑ PROPOSED " � GO �07° L K PER ++ri jj „fir r!�n; ,I • p�D X t r-';I J 10 7- y M n r\ p160, \.. Sin_17.2, O 1�p Q s _ r R'1 ••� r� R=15. #101 h ® ' 1 112 Sty w f 17x' p Dwelling r" < t x� `PG Tank \ �� rR6PGSED VA�� ❑ . I D am: P C) \ \, r y� TE�RAC \ t�g�oo!ai EXISTING rVOI & PA \ \ TO,BE REMOVED ` ss \ a' DRf a'T Bit driveway With Stone0. MetaINA v s / t � N86*07'30"E � x -- t ' e z¢ DANADA`KRIS Trust " � Priscilla M Hostetter7Rfr •', ASSESSORS MAP NO', No. `-= � � PARCEL NO- l%/ 1 , 'I Fee �---`--�BOARD OF OF HEALTT— TOWN OF BARNSTABLE ApplicationArVell Con!gtruct ion Permit Application is hereby made for a permit to Construct (✓j, Alter ( ), or Repair ( )an individual Well at: iva _ -�-------�-------- �--2--=----------------- -- ----------- ---------------- p Location — Address Assessors Map and Parcel -- ((�� 1 —2 •_ t5J7�e�a�L`�p —`�-- — Owner Address D A_Soc,�_.tirt l - /b,3 0� 9Go ^t41111 . - --_----------------------- ----- ---------- ---- -------- Installer Driller Address Type of Building Dwelling------------------------------------------------------- Other - Type of Building -------- No. of Persons-------------------- Type of Well Purpose of Well---'-rLG '- ----------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until aific a .of Compliance has been issued by the Board of Health. Signed - - --- --- - adoa---- date Application Approved By ---- — -Z '-- date Application Disapproved for the following reasons:----------=----------------------------------------- ----- —--- - -- -------------------------------- —_-_-------- ,/� date Permit No. Issued---2 r-��- ` t_t?,�Y1-- -------- -- — date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed Altered ( ), or Repaired ( ) Installer at - 1. Ccelfta 2J DS1�ei�. l/ NSA E has been installed in accordance with the provisions of the Town of Barns/table Board of Health Private Well Protection IV Regulation as described in the application for Well Construction PAT DW '- -Dated '-- `-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---- - Inspector------------_— - __ No.-.- J` I BOARD OF. HEALTH TOWN OF BARNST,ABL,E iirat�iohArIVrItCongtrur.tion ff it k p Application is hereby made for 'permit 'to Construct (✓f Alter ( ), or.Repair ( )an individual Well at: rLyoec As2ses�sor_s'Mvap,�a`nada A dre ,'Parcel Owner — Address -- I --- - A- c nx- -��Q---- M`'� — "=---------- 'J Installer — D'Iler — Address Type of Building e ; Dwelling _-- Other Type of Buildt ------ No.':of Persons---- ------- ------------ Y YP 8---- -- ' t. -type of Well �i c/°�.0^—- — '--- -- Capacit — Y---- - - --- �"� 8 Purpose of Well Agreement: I , -The undersigned agrees,to install the aforedescribed individual well in.accordance;with. the provisions'of The Town'of Bamstable Board of.",ealth Private Well Protection Regulation The undersigned further agrees not to place the..well'in operation until a Cer ific a .of Compliance has been issued by the Board of Health. Signed - — ------ --- o 7 --= date Application,Approved By �% - date Application Disapproved".for the following reasons: =----- -------- ------------ .i date , Permit No. Issued--- r-�'�- --'" - - f date - _ 1 PA LPJ v� BOARD OF HEALTH. - TOWN . OF . B.ARNSTABLE C ertif irate Of Compliance THIS IS TO CERTIFY; That the Individual Well Constructed:(i*OT,'Altered.(::' ), or.Repaired ( )' by - --- - =- -- —- - -- - -- — - - ,, Installer at— Cal/t�sJ has been installed in accordance with'the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Pe f-iiflrgC-- � ��-Dated THE ISSUANCE OF THIS-CERTIFICATE SHALL:NOT BE CONSTRUED AS A.GUARANTEE THAT THE WELL- {l SYSTEM WILL FUNCTION SATISFACTORY. 11 DATE----- _ Inspector----------- -_- - .:Sari?i!oS2EC'GyIiFL��'i'Riir�iM1iV60.1giRi90<5fB�9mQ�siWYPiBaaa�+eEYFm'�.bTtPeQS9L2:bEYH18��0.9Y4ilL9i¢e4iOHf40i4Gvil3@i fEii44m�!bPin6?iE 9.i'�a@i �?b'.mtvA�8.s4iTc4if -_GsrtA�4Ses.: BOARD OF:HEALTH - TOWN : OF BARNSTABLE Well ongtructionermit 1 NO. ?� - � Fee- l Permission is hereby granted /4 to Construct ( -1, Alter ( ), .or Repair ( ) an Individual Well at: OS�ci �L /�tQ { Street as shown on the application for a Well Construction Permit �U �No.- ---- - Dated- -�f- '- � - - Board of Health DATE c Eind9MapxP�ei- 071011012 nd z carte' a , f e! 071011012 / all � 0 el L LOT#265 7 , Grey 'z L t n 1 Ctt1T OW� GUARENTE,WILLIAM&MARY L to "S�S� 130 214D ALLANDALE RD dear tide r CHESTNUT HILL MA 02167 r� s wead�i< 00 0000-000 Deed Date-N ��, �� eference C150725 � , // x %C'ondo�Complex„ Bu�ldtn a f)ni ��'" ' lan a 1st y GUARENTE WILLIAM&MARY L ne11� p D,ee 9NllVIY � ee. R $3a. J Values ran 000820900 Bui d nga 000000000 xtra Features ` ` cat►on� 101 CARRIAGE ROAD g6re Dist", CO U S .��,� � WEST BAY TERRACE z � de�C. 1883 0064 ,0�w, f� 3 t � ,E TOWN OF BARNSTABLE rf LOCATION /�1 . ��r�f'ea�� o e4 SEWAGE # ✓ VILLAGE ,� e P pa;��e! ASSESSOR'S MAP 6z LOTO 7/- 1-6 �! a INSTALLER'S NAME & PHONE NO. dAiW 74VAors -' f 9+ lt SEPTIC TANK CAPACITY i LEACHING FACILITY:(type) i (size) �NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER ® BUILDER OR OWNER DATE PERMIT ISSUED: 41 Ay DATE COMPLIANCE ISSUED: /4 VARIANCE GRANTED: Yes No 9 . � r Celt' ' 9 No. 9 U ' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppitcation for Migogal *p5tem ttCow5tructfon Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) K Complete System ❑Individual Components Location Address or Lot No. 10 1 CA R 2 I A&6 R D Owner's Name,Address and Tel.No. LO?' ZFaS, OS��'rv .e� rI�A• LyOIA G• .S/Ni*M Assessor's Map/Parcel C/D S Ll L L I VpN E�1iG/it/EErJwfi //!JG M 7/ — P 11-1 I i Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. -7 P,4r14 ETt R.D• os-t A. Type of Building: Dwelling No.of Bedrooms S Lot Size 76,5_9 Z- sq. ft. Garbage Grinder( ) NO Other Type of Building RES'_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow S,SO gallons per day. Calculated daily flow S.S"O GPD gallons. Plan Date O C't. Z 1 jqq,7 Number of sheets 1 Revision Date N/A Title S I tE L13A/ QT' 1,01 CAM146-F RvAD Size of Septic Tank 150 O Type of S.A.S. Lr r:AC N' FIELD - 1.t''X y 7 ' Description of Soil G- 2 I L-04M _2-t- 10 CL ERN /VIED I c/M S yNP Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by ;!his Bo lth. Signed Date Application Approved by r Date f-2 3- Application Disapproved for the following reasons Fq Permit No. - Date Issued Z 3 -- —------------------------------.-- -- ♦ - lip �. Fee COMMONWEALTH OF MAS$ACHUSETTS Entered in computer: Yes PUBLIC HEALTH-DIVISION -TOWN OF BARNSTABLEs MASSACHUSETTS rication for igpogar *pgtem �Congtruction Permit � Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) K Complete System ❑Individual Components Location Address or Lot No. 1 O 1 C A R 2 I LN G C R D Owner's Name,Address and Tel.No. LOt Z(,S, CJ�t�rvi��-c Myth' 1y0► A C_ S/I/i7N Assessor's Map/Parcel <1 "~ M 7/ — P 1I—I I ; Installers Name,Address,and Tel.No. Designer's Name,Address and Tel.No. f Pa-re r s4144.�v4" PA.),04,c ' P—D• 05-tA-r!/i c c.4=- /1/I A. y z 0 - 3 3 q'/ rw." Type of Building: t Dwelling No.of Bedrooms 6- Lot Size 76 ,5,g t' st.ftg Garbage Grinder( ) N o Other Type of Building R E-5 . No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow SS-O G F'D gallons. -"Plan Date O C?. Z 1/ 19 97 Number of sheets I Revision Date VQ /A Title S 1 -t g F i-A/✓ a T I G I C/••1 rl-IA G'E= R c./4 D Size of Septic Tank 1 50 O GAL , Type of S.A.S. !,6 AC H F I F L D - I (,' X q 7 Description:,of Soil G- -I L041" Z +- 10 C L CAN /46 D►uw1 6/9/iII y� ,t - iti ,,. Nature of Repairs or Alterations(Answer when applicable) Date last inspected: s; ,,. Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued Ahis Boarof alth. Signed ( Date Application Approved by Date "`2 3" 9� t Application Disapproved for the following reasons y ' Permit No. '3�' Date Issued --------------------------------------- > ` THE COMMONWEALTH OF MASSACHUSETTS, qr BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( Repaired ( )Upgraded( ) Abandoned( )by at 10 1 Cl4rrl A6-e Zo,4 D , OY S>t/- i/prne,rl, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9�S Z dated �'Z 3 q Installer Designer The issuance of this permit shall not be construed as a guarantee that the syste%,will function as designed. Date ' . v Ui / Inspector _`_ ^s _ _ __ _ No. / O- ,�Z— ----------- --------------Fee /0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLEs MASSACHUSETTS lwigogal Opgtem Congtruction Permit a^Permission is hereby granted to Construct( k-jRepair( )Upgrade( )Abandon( ) System located at 10 1 C tj rr/P C-e fZoA n — La-7, a G S O Y S7-E r NA R Bar5 . �9 StFl-v/ L L tF , 1Y1 y <f 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 t. Date: - Approved .y r TOWN OF BARNSTABLE LOCATION 96t r �. , Va g-.� SEWAGE # i VILLAGE , jf ASSESSOR'S MAP & LOTO 2%-a/ INSTALLER'S NAME 6i PHONE NO. 4A f?U 74;r : '°' `a -o Y SEPTIC TANK CAPACITY LEACHING FACILITYA ype) %i 1 ? . (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: =a r r VARIANCE GRANTED: Yes No :r i 1 , R , I I l J) 'o, •j;� ` ,'Isabella ' k «' JU' DESIGN DATA, `Public �4' �_' a " PROPOSED 5-BEDROOM SINGLE FAMILY DWELLING 11 4 �.•�� "" NO GARBAGE GRINDER L i -t s,yti` DESIGN rL.OW: 5 x 110 GPD = 550 GPD Vo �me , + S 4�, '• SEPTIC TANK: 550 GPD x 200% = 1100 GPD FINISH GRADE i ,ove1. �' c' o �' LOG '-'S G,., USE 1500-GALLON SEP11C TANK I n ci�t<'�'�pster °L PER TITLE 5: 7 ' Ha A rbors ' ` i' -BO 11 ' ' \ '� �; 550 GPD/0.74/ G/SF/D = 743 SF EFFLUENT LOADING RATE ADD 1/8" - 1/2" STONE AS REQUIRED � USE 1°6' x 47' LEACHING FIELD WITH (3) 4" DISTRIBUTION LIVES -. yap INSIIU MATERIAL 4" PERF SCHED 40 PVC JILLE GRAND ISLAND MAY BE REPLACED WITH � TO MEET 3-FOOT MAXIMUM - % ,o ALL PIPE TO LEACH FIELD TO BE SCHEDULE 40 PVC SOLID USE 16' x 47' LEACHING FIELD IF ENCOUNTERED REMOVE (4) 4" Dig.+AETER DISTRIBUTION LINES UNSUITABLE MATERIAL TO INSURE THE " REMOVE UNSUITABLE MATERIAL ALL PIPE IN LEACH FIELD TO BE SCHEDULE 40 PVC PERFORATED REMOVE UNSUITABLE MATERIAL FROM BENEATH SYSTEM IF ENCOUNTERED SIDEWALL AREA. OF SYSTEM IS IN - 2 OF 3/4 - 1 1/2 •--- CLEAN MEDIUM SAND OR FILL PER STONE FOR 5-FEET (SEE NOTES) f ENDS TO BE CAPPED OVERDIG 1' INTO MEDIUM SAND LAYER 310 CMR 15.201 15.293 NO ALLOWANCE FOR SIDEWALL AREA BACKFILL WITH CLEAT- MEDIUM SAND PER 310 CMR 15.002 - 4 4 , 4 4 LOCATION UAP _ COTUIT QUADRANGLE TOTAL DESIGN: 752 SF PCC RISER WITH TEST HOLE 02014-1991 SCALE: 1:25,000 REQUIRED: 743 SF TOP FND EL 18.0' P - 7702 5' 16' S' METAL FRAME & COVER DEPTH ELEVATION 26' ASSESSORS PERCOLATION RATE: LESS THAN 2 MINUTES PER INCH (ASS.:MED) F. G. = 17.5' t F. G. = 18' f » MAP 71 PARCEL 11-11 1, _ — 0' 11' DETAIL.LEACH FACILITY ZONES:: TEST HOLE BY,BAXTER & NYE, INC. 2"-1/8"-1/2" STONE LOAM . TEST DATE: FEBRUARY 14, 1991 '""-- 4" SC. 40 AQUIFER PROTECTION OVERLAY DISTRICT SOIL TEST NUMBER: P - 7702 16:25' _ SUBSOIL END SECTION . 16.0' 1500-GAL INVERT EL m 9.32' � � N. T. S. ZONING DISTRICT: RF - 1 SEPTIC TANK 15.75' 15.5 15.0' 3/4"-1 1/2" DOUBLE WASHED STONE 2 9 MINIMUMS 15.25' END PIPE EL 14.75' • AREA a 43,560 S. F. �• ,`, . ,.�..4.. BEDDING AS FRONTAGE Q 20' v PER TITLE 5 16' BOTTOM EL = 13.0' WIDTH 125' ;•� CLEAN FRONT SETBACK = 30' NOTES: MEDIUM SIDE SETBACK 15' 10 10.5 11 2.5 3 SAND REAR SETBACK = 15' (1) WATER SUPPLY FOR THIS LOT IS MUNICIPAL WATER • (2) LOCATION OF UTILITIES SHOWN ON THIS PLAN ARE APPROXIMATE. FLOOD ZONES: V17 & A14 AT LEAST 72 HOURS PRIOR TO ANY EXCAVATION FOR THIS OBSERVED WATER FIRM COMMUNITY PANEL PROJECT THE CONTRACTOR SHALL MAKE THE REQUIRED EL = 1.7' No. 250001 0018 D NOTIFICATION TO DIG SAFE (1-800-322-4844) AND 10' 1' REVISED: JULY 2, 1992 APPROPRIATE WATER DISTRICT FOR LOCATION DATA. AS SHOWN ON THIS PLAN (3) THE CONTRACTOR IS REQUIRED TO SECURE APPROPRIATE LINES TO PERMITS FROM TOWN AGENCIES FOR CONSTRUCTION D-D:IN=D DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM DISTRIBUTION Box BY THIS PLAN. INSTALL RISERS AS REQUIRED TO WITHIN 12" OF FINISH GRADE. NOT TO SCALE (4) (5) ALL STRUCTURES BURIED FOUR FEET OR MORE OR SUBJECT TO VEHICULAR TRAFFIC TO BE H-20 LOADING (6) FOR ALL ASPECTS OF THE SEPTIC SYSTEM THE CONTRACTOR SHALL COMPLY WITH ALL GOVERNING CODES AND REGULATIONS; eN• IN PARTICULAR 310 CMR 15.000 THE STATE ENVIRONMENTAL CODE TITLE 5, TOWN OF BARNSTABLE BOARD OF HEALTH REGULATIONS DETAIL LEACH FACILITY PART VIII: ON-SITE SEWAGE DISPOSAL REGULATIONS AND THE BOARD OF HEALTH RECOMMENDATIONS FOR ACCEPTED PRACTICE. PLAN VIEW (7) REMOVE UNSUITABLE SOILS BENEATH PROPOSED SYSTEM IF REQUIRED. � N. T. S. BACKFILL WITH CLEAN GRANULAR MATERIAL FILL TO BE GF'ADED AS FOLLOWS: NOT MORE THAN 159 RETAINED ON No. 4 SIEVES.. NOT MORE THAN 90% RETAINED ON No. 50 SIEVE, OF FRACTION PASSIOG No. 4, 10% OR LESS TO PASS No. 100 SIEVE AND 5% OR LESS TO PASS No. 200 SIEVE, SOIL TQ BE APPROVED BY ENGINEER FOR COW"LIANCE 4' 4' 4' 4' r" PRIOR TO PLRCING ON SITE. �. LOT 218 'r ,d► 4" SCHED 40 PERFORATED PVC PIPE (TYPICAL) � (8) ELEVATIONS REFER TO NATIONAL GEODETIC VERTICAL DATL M "� PLACE CAPS AT ENDS �,0 L.C.C. 15354-131 — -_ , — t JAMES I. BLACK III El. .y tr / ` Q Mll i n ��!'n '� I 16' I Bib a! �� ni+t 1 i ju 12 ( m S E E CB FND FR p CT eq � RFF Y V ,` 4 I ,� SE3 3064 _ / e J LOT 220 0 I ' /� - 2 I B6 _ WETLAND DELINEA11ON 1 L.C.C. 15354-131 + I F B7 — BY FRUGO EAST, INC. �\ DONALD R. OSBORN / N 80•42'34 07-10-1996 I 447.00 A9 1 0 %A1T B5 ISOLATED I 1 _ / ` CB FND `. i VEGETATED 265 52,789 sq.ft. upland 23,803 sq.ft. wetland ` WETLAND I 76,592 s .ft. total 1.76 acres • 89 q WETLAND e`b shape factor a 21.16 6 81 2 �� .�p'� TP / WETLAND DELINEA11ON / NCO \ BY FRUGO EAST, INC. 5 S I T E P L A N 07-10-1996 1 ' o �9� AT \ o pNE J B3 �` 101 CARRIAGE ROAD N LOT 265 OYSTER HARBORS, •OSTERVILLE, MASS. LOT 66 `. 0R,� FOR L.C.C. 15354-74 w a �� SF / I o PAUL M. & JOAN C. HEFFERNAN �, \ , 0. N \ , . Al LYDIA G. SMITH yy CIV f S �, — ° q SCALE: 1" � 30' OCTOBER 21 1997 \ \ , o, BAXTER & NYE, INC. CATCH BASIN & LEACHING PIT \Y �1 ` h `v .-_-.._..____ / ----- / 812 MAIN STREET . �:. 0. fig' TO CONTAIN DRIVEWAY RUNOFF(,- `--------------.-._._ �� bSTERVILLE, MASS., 02655 (508)-428-9131 - ,. Ltd•- o - S-86'07'03" W FND04• CB FND 235:36'. . ELCB 12 23' N �) e i GRAPHIC SCALE EL • 1 Z — 93 LIMIT OF IP FND 32 ZONE A14 • d t drive 11' wide ��is8 22, / 12 IN FEET ) _`�— _..-c-�, '�•�., 1 inch 30 it. OF LOT 221 \ ^ I R 16 I �. �� t�OF j4 �N I � \ • � PETEPI �. o c�HdRn SULLIVAN33 L.C.C. 15354-131 " \ n JAMES I. BLACK !II XTER � \ o 24M w CIVIL co LOT 229 l 14 \ E� 2 erSTE�° I L.C.C. 15354-131 � �, RICILLA M. HOSTETTER TRS. I I O .DWG)