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HomeMy WebLinkAbout0296 PARKER ROAD - Health 296 PARKER ROSTERVILLE y; o o v 0 0 a Commonwealth of Massachusetts J /f . Ae C 1 W Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 296 Parker Rd Property Address Ism Christine Frisbee Owner Owner's Name : ; q information is required for every Osterville. ', MA 02655 7-16-15 2- page. City/Town _ State Zip Code Date of Inspection e — 2I 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. A. General Information / 1: Inspector: 6l � Ol0,5 a a. Shawn Mcelroy , Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification 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. 1 am a DEP approved,system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The'system: ` r • J. ® Passes .f.f ;}., 0 Conditionally Passes ,_ ❑ Fails ' - ❑ Needs Further EvaWatio by the Local Approving Authority 7-16-15" Inspector's Signature` Date The system inspector shall submit4 copy oft 1s'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:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' M 296 Parker Rd Property Address Christine Frisbee Owner Owner's Name information is required for every Osterville MA 02655 7-16-15 page. City/Town 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: ® 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: - System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. 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•W 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form hi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 296 Parker Rd Property Address Christine Frisbee - •' , Owner Owner's Name information is required for every Osterville MA 02655 7-16-15 page. City/Town State Zip Code Date of Inspection. B. Certification (cont.) : ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarm's are repaired. B) System Conditionally Passes (cont.): " 5 ❑ Observation of sewage backup,o' r break out or high'static water level in the distribution box due to broken or obstructed pipe(s) o(due to'a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): (•r j r El broken pipe(s) are replaced` ❑ Y ❑RN''❑ ND,(Explain below): ❑ obstruction is removed , ❑ Y, ❑ N ❑ ND (Explain below): El 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.v 'I.'Sysi6h 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:_ `, A ' ❑ 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•3113- Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 296 Parker Rd Property Address Christine Frisbee Owner Owner's Name information is required for every Osterville MA 02655 7-16-15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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 " El ® 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 SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than /z day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 4 Commonwealth of Massachusetts :� _ a• s;{ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form 'Not for Voluntary Assessments. . '. 296 Parker Rd r Property Address Christine Frisbee Owner Owner's Name information is required for every Osterville MA 02655 7-16-15'. W. " page. City/Town State Zip Code Date of Inspection B. Certification (cont.) '. r Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ` ' ❑ ® Any portion•ofthe SAS, cesspool or privy is below high ground water elevation. El ® 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 1 of a public well. ` ❑ '® Any portion of a cesspool or privy is within 50 feet of a'private water supply well. 1 t ❑ * ® Any portion ofra 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.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. q' The system(fails. l 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 iri 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 r r Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 296 Parker Rd Property Address Christine Frisbee Owner Owner's Name information is required for every Osterville MA 02655 7-16=15 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 r cw ❑ ® 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? Have large volumes of water been introduced to the system recently or as part of El ® this inspection? ® ❑ 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? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ 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: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 ' Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G °M 296 Parker Rd y Property Address Christine Frisbee Owner Owner's Name ; information is required for every Osterville MA 02655 7-16-15 page. City/Town State Zip Code Date of inspection D. System Information Description: Number of current residents: - 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (include laundry system inspection ,§ El Yes ® No information in this report.) Laundry system inspected? f k=} c; ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): - Detail: r .. Sump pump?: ; , rs, 1 •.,. t ❑ Yes ® No 7-2015 Last date of occupancy: e Date Date Commercial/Industrial Flow Conditions: Type of Establishment: r 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?r-• , , F .. ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-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 M 296 Parker Rd Property Address Christine Frisbee Owner Owner's Name information is required for every Osterville MA 02655 7-16-15 page. Cityfrown State Zip Code Date of Inspection D. System Information (coot.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: s ' Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: , I - gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box, soil absorption system . ❑ Single cesspool ❑ Overflow cesspool a ❑ 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) 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-W3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts is _ W Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments ..a 296 Parker Rd Property Address Christine Frisbee t x. Owner Owner's Name information is �, required for every OSterville MA 02655 7-16-15 page. City/Town , _ State Zip Code Date of Inspection D. System Information (cont.) , ►. Approximate age of all components, date installed (if known) and-source of information: 2007 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: ' , ¢., .. .' . . 26" feet Material of construction: ; • ❑ cast4 iron' ® 40'PVC " ❑ other(explain): Nf►. a # ,+• Distance from private water supply well'or suction Iline: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: J 18"feet ' Material of construction: 'A ® 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 gal Sludge depth: 12" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M y 296 Parker Rd Property Address Christine Frisbee Owner Owner's Name information is required for every Osterville MA 02655 7-16-15 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 20" Scum thickness 1 Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal.System'Form -Not for Voluntary Assessments Fi ,M 296 Parker Rd Property Address ; Christine Frisbee Owner Owner's Name information is Cisterville MA 02655 7-16-15 required for every • - I page. City/Town State Zip Code Date of Inspection D. System Information (cont.) .i, X _�• Y Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,"evidence of leakage, etc.): ' a' 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 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 Forth: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 296 Parker Rd - Property Address Christine Frisbee Owner Owner's Name information is required for every Osterville MA 02655 7-16-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 0. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 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.): Good condition with water at working level and no sign of back-up from chambers. 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-W 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts t �1ri.. _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments:.+,c 296 Parker Rd _ Property Address Christine Frisbee Owner Owner's Name information is - required for every Osterville MA 02655 7-16-15 + page. City/Town State Zip Code Date of Inspection a; D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 5-500's ❑ leaching galleries number: ❑ leach ing,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.): Leach chambers in good condition and empty at inspection with no visible stain lines. 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 296 Parker Rd Property Address Christine Frisbee Owner Owner's Name information is required for every Osterville MA 02655 7-16-15 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.): f 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 ` :y• -.•' 296 Parker Rd `' Property Address Christine Frisbee = Owner Owner's Name information is rt required for every Osterville. MA 02655 7-16-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) a ►` ; d t . .�. 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 axi I/ 40B 13 -0-0 ' r 1�. rf �� 133 ,E t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 296 Parker Rd Property Address Christine Frisbee Owner Owner's Name information is required for every Osterville MA 02655 7-16-15 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ` ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells - Estimated depth to high ground water: 12'+ 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/observatiori 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: Original design plans show no groundwater at 12'. 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 W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments LAM 296 Parker Rd Property Address Christine Frisbee Owner Owner's Name information is required for every Osterville MA 02655 7-16-15 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 10�• 16,y. Y•P x s'•�' 4d 9 , r Yo' R f � p'•IIN' Q . BFyRpOM'I ... U IOM' DRUNK _ T - T u V Q LNG • � 5'�4Yy4C•dc N'-1' _ Ya vw r -�17- V.9y'x � INC. ol_afc 5uil_fl FALMOU7F1 FtD••MAWON6 M'LL6•MA 381 OLO tlPN 0 P,F.G. %.� 1/6•1 .,,.�.,� GApFt10 b,� un � �F MA 2 \ ��• S %6 PI?101GER RP M AT sob1 � i;Nnn�.O IIU•aM plan I�iXT$t.�ng '� � pcIBTiNG Ft. N A'8 5�Aoof 56'6 2' 12'2— 9'3"6 7'6"2 —8'� —1 7'6 2'6 7'3 2'5 4'10 T 4'5"6 4'0"2 T 3'6 5'6-7 2'6 . 0� OO Closet M O o CO Closet M tD Area ILU � Master bedroom a M N Bedroom N Chimmney M N M Stairs UP M SO Open To Below Office Area-- 20 31 2'9 L67 4'3 8'1 J- 811 T6 Ii 7'10 52—5'10 32 10110 JIVING AREA 16'2 I, 15'4 1505 sq ft 56'6 9(J 200-7— 6114 Yl-)I- -�7 L 2ov7—ja4 5_6dPOOAIIs o1e�S���. ''four 2Ad rV_j I'•Ila' !'$5'Aa' t'a' !'tea' I!'$' Ifi' T-0' 10-Da' !'-1•X!'O' 6'-VW'm't41{'.1' Y+'X 4'-I' Y+•X 4'-1' - Y+ } `ALL♦ � V Y+' 4 + BEDROOM'! `f KRCHIN i BEDROOM 9 cl Y+' a x 4 �a NULL ,, f , GARAGE d [I" oV , DNING ROOM 9 LFD BEDROOM-1 I LNNO ROOM 3 f y i e' s'-�a7�eaf-tlt s•-P I - 9 Qr covEREo PORa4 „ � Ya v16• r 9'•346'X 4'41• OLDE CAPE BUILDERS, INC. MI OLD FALMOUT14 RD. •MARSTONS MILLS•MA —r�� �. 1/8.I . •.• , .. P.F.C. UL CAPRIO plan (9Xisting 1� ADDITION AT MISIBW RESIDENCE 2%6 PARKER RD •OB ILLE• MA. ,4 8 EkISTINCa FL N g(c� Dlfo�- �pf� � � j F;. w _ S4 5/4.'X 4'-%' 2'-s4'X sb' &'-4%'X 4'q' it i .'Lyyp4jj77t'� n �{i M BATH BEDROOM'] z y nue � k X BEDROOM�! O •y`eimr+�ARE/. !'-] LWa YQ 6/4'X 4'•I'h' D-]5!4'X 4'W' 1� 1 )N ce - F J OLDE CAPE BUILDERS, INC. 381 OLD FALMOUT14 RD. •MARSTONS MILLS•MA « Y., I/S•I-0 ....,.� �,.,., P.F.C. Il. .. PAUL GAPRIO i, ADDITION AT FRISMEE RESIDENCE 2S& PARKER RD •OSTERVILLE•MA 'Y'"y�{ Ot'M•C WyW SECOND FLOOR PLAN Q-Z w tr-;q YNC,7 Y+•X 3•i' Y.'X 3•i• 2-f-TI•' I Ys'X 3W ♦•-II Vil"X•Ob' Y•6 V � LQlEN IDro BlbD 'r ts CLosqoucER Roo -.� Y-a' KRC4EN y` I 6 � -� y MID ROOM Mete b.U, { 9 F1 4 Y+' a 4 _ I nAETER SUITE Q R x LIBRARYip _ cLOBET ` or� - J o ion I 0 rG! LW�d ROOM Cam+ R n I x 9 �'3'O• !••Y X b•-0' I !•-Y X 6•-0' I I , OLDS CAPE BUILDERS, INC. Yfi n uN FLooR PLAN 381 OLD FALMOUT14 RD. •MARSTONS MILLS• MA P.F.G. PAt�GAPRIO ADDITION AT FRISBEE RESIDENCE 296 PARKER RD•OSTERVILLE • MA { MAIN FLOOR PLAN t•, tFl�: 41 TI Wi dl" STABLE qq L4CA�'a'iQI�, f VIt.IAGE / t, - ASSSSt�IZ'S. 1Alr$s R.OT S 7 . 7I`TSTA3A-WS ROM&I' it1AIE TvF} 'SE M. C,,:TANK-',C-APAC£I'Y CHING;FACII C e� � � J� SOv 5 NO:F Bl 13 OO1�hS PE�M&TDA'Ti6: CO]�FLIANC� I?1�'1�. so 11p-. on lhstance'$etwee' tbe 'Maximuea Adlustecl>Grountiwater.able a the Bottom of l eaehtng Ra tity eeY' PsYvate Stater Supply Well and Lung Factltry (€f styrells exist qn site or:vnthuif3D feet of Iesug facny) t' Edge of�tetlar+d and I.eacling£�aaltty( 'anY welds exist viitiun 3Q feet cif Ieachirtg factlty� of:.' I+utnshed by , g � O � D 17� s-er /33 � TOWN OF BARNSTABLE i6C ATION `Z9le �c.r z�.� rt'. SEWAGE# 2,8Q7-1'tG VILLAGE ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. !Ob•'77l—'R3J CJ SEPTIC TANK CAPACITY LEACHING FACILITY.(type) je)n k C"or5 (size) (0,1�X So-AZ NO.OF BEDROOMS OWNER . PERMIT DATE: il-Z-d 7 COMPLIANCE DATE: �! Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY �� `� �i v 4 � Ai- Z34 et 3 D z- lub 4 3- 6-4 wip133 4. W lit 134- I LG � Y / No. �GD� 2 i f Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF-BARNSTABLE, MASSACHUSETTS Zipplication for Oigool 6pgtem Cow9trUCtton Permit Application for a Permit to Construct( ) Repair( ) Upgrade(; Abandon( ) (�Complete System ❑Individual Components Location Address'or,Lot Nio.�� Wk*ete ?ea-> Owner's Name,Ad ess,and Tel.No. �J Assessor's Map/Parcel1,4 O 7 -2 % ae F p Installer's Name,Address,and Tel.No. Designer'se,Address��,nd Ao. TI pe of Building: Dwelling No.of Bedrooms � Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Z- Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 15—IS-6 gpd Design flow provided �(p 7, .S� gpd Plan Date Number of sheets / Revision Date Title t1''n F G tr?e� Size of Septic Tank .gyp L Type of S.A.S. (4#441y" �f Description of Soil — � G ! �p `/ 7 e Natur of Repairs or AltetiOns(Answer when pplicable) 64 I 4 ` 1� 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 n t to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date P O Application Disapproved by: w. 49'eu Date 3rr a for the following reasons — Te- 1-1 r ' rp - Pl e -S,I ue f e Permit No. ZGJ"7— 12 Date Issued r .,3 No. GU 7 - 1 '"� J txl _ 4%� (/ �fJ - Fee J" THE COMMONWEALTH Of MASSACHUSETTS Entered in computer: PUBLIC HEALT14 DIVISSION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippYication- for �Digpogal *pgtem Cow5tructiott permit Application for a Permit to Construct O Repair O Upgrade(0 Abandon O Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel L . Installer's Name,Address,and Tel.No. Designer's Name,Address and el_ o. Type of Building: .� Dwelling No.of Bedrooms r�.� S %�/� Lot Size .2</ K7141 sq. ft. Garbage Grinder (.46) 1 � N Other Type of Building es r �L'nJi, C No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) SS6 gpd Design flow provided s�r �, S gpd /�'�Qc�l7z ,�©n 2 / Plan Date Number of sheet jj Revision Date ' Title �l,7F � .,/--�yG R e � C i rkJ, /F r A 7 J-?c Size of Septic Tank /-SDU ``(,%�IGl L Type of S,.A.S.S 1,//V7Un/c Description of Soil - 7, Natu of Repairs or Alt e ations(Answer when applicable) �j 6", � f (_ C y Date last inspected: Agreement: } The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of ,�. Compliance has been issued by this Board of Health. f f J Signed O' C np /�-,� t Date ( (_ Application Approved by, a 11, Date MVU-7 x Application Disapproved by: Date 3u u 7 :I ' ( n for the following reasons- NQe TPf> u�Pt +ur ;n[�H r n Y/11 �- �n ,e r { �P1� /r � S-� S- err .ws J,n �, urn re p,l o2Gu SP T.. v t �S, 9.2 S.T. 1n a/o. s2 , �14.2s,2�� t! Permit No. a Dry-7- I Date Issued L Z � • ————————— — —--- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS ;` (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewag Disposal System Constructed ( ) Repaired ( ) Upgraded (k) Abandoned( )by bb �( ; c!D 10 ' { at L. , has been constructed in accordance f with the provisions of Title 5 and the for Disposal System Construction Permit No. 7 w �� dated c/11�(G7 Installer `. Designer i #bedrooms ' Approved,desi.gn`.-�flow gpd The issuance of this perm it shall not,be construed as a guarantee that the syst m will funcS' gas designed. Date i6o J l 5 Inspector No. 21P 7- 1 2; Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-'BARNSTABLE, MASSACHUSETTS '=igpogar *pgtem Cougtruction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade (y, Abandon ( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the'date Or e it Date N�� G Approved by Fee. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippYication for �Digos;ar PA tem Construction Permit Application for a Permit to Construct(,) Repair( 1400, Jpgradebandon O Z1 Complete System ❑Individual Components Location Address or Lot No.a,?6O Owner's Name,Address,and Tel.No.C vl�s�``� ��/Sh�'e- Assessor's Map/Parcel Installer's Name,Address,and Tel.No.�pr>A�� �� Designer's Name,Address and Tel.No. SSd"! / Type of Building: {� Dwelling No.of Bedrooms J Lot Size 97 y sq.ft. Garbage Grinder (� Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(pm.required) fSb gpd Design flow provided f_&7 �i gpd Plan Date Akr4 :P 7 JOO 77 Xa--"4, er of sheets l Revision Date -�2 -�`7 Title 51 �e it►� hip�� Size of Septic Tank /,!`ld ce Type of S.A.S. ' fZI�0 Cie.Z Description of Soil Nature of Repairs or Alterations(Answer when applicable) L Ar �kf S �� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Signed _ Date < Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE IFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( Upgraded Abandoned( )b / d �� 7r1V-1 y'iv� at ���p 9-- 6& 451allle has been constructed in accordance with the provisions/of Title 5 and the for Disposal System Construction Permit No. dated Installer ��p'/td ® ,< J �< Designer S ,low R A-S. #bedrooms J� Approved design flow S-&7 7-Y gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. Fee (/lJ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Dizponl *ps;tem Co truction Permit Permission is hereby granted to Co struct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at J-76 1-elar`le and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date Approved by ,._.. _..,, -.........,,. ,.i ._. -... . ... .. ,pry q,� .- ....�.. .x ...,.<.,�„",.,.h �:�':.. mir .. t�;,;�r-',r':�,i ... -5; .•t^; . .-:,.r;,,>,_. r"—."; .' :k No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippYf cation for Mfs;pooal *p tens Cowaruction Permit Application for a Permit to Construct O Repair Kgrade Abandon O 2--complete System ❑Individual Components �r.4�.- FFisb e Location Address or Lot No.a�& Owner's Name,Address,and Tel.No. Ch.-/S I/t e 'Assessor's Map/Parcel q &e/v-&7t-7777 Installer's Name,Address,and Tel.No.13arAJOL/4, (mow}� Designer's Name,Address and Tel.No.pST�Sd o ! 5a y?S•` 3G, 'f t I'� / sr>ti IV9- y?g-&Yl, 05 ."//, rh,� Type of Building: Y Dwelling No.of Bedrooms J Lot Size .97 y sq. R. Garbage Grinder ( )� Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures y Design Flow�(min.required) S'SO gpd Design flow provided gpd Plan Date ��/ClrG © Nu�bof sheets Revision Date -� - `? Title 5i li � p c )3,1.y:f/ Size of Septic Tank St-1- ^ ives l fi"__1 Type of S.A.S. �j- S� Ce C 1 , Description of Soil -1- 6X6!I ' pp Nature�of Repairs or Alterations(Answer when applicable) /��f , Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o I�ealth. Signed ./t ,� Date J l( 12 '7 Application Approved by Date Application Disapproved by: Date `t for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS R Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( Kupgraded Abandoned( )by at Po,- t!::;. ��/p has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. / dated Installer //�! �o J Designer � ,lp�1Q /� R.• S', #bedrooms J� Approved design flow 5-&7 T gpd The issuance of this permit shall not be construed as a guarantee that the system will function-as designed. Date l;r f ,/t:- Inspector No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS xissoogat *p!5tem Co�Otruction Permit Permission is hereby granted to Construct ( ) Repair ( v) Upgrade ( ) Abandon ( ) System located at 1"l-al!/10 ft is 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 permit. t. Date Approved by VENLAFAXINE HCI EFFEXOKXRRamm Town of Barnstable. Regulatory Services Thomas F.Geiter,Director Public Health Division- ►�'` Thomas McKean,Director 200 Main Street,Hyannis,NIA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Fortn Date: Designer: % Installer: C Address: _ ii'1 ,2 ©Ash' s Address: ' On was issued a permit to install a (date) (installer) a septic system at � based on a design drawn by (address P+• dated 3,&1496�> ? v+v (designer) c certify that-the septic system referenced above was installed substantial' accor g to the design, which may include minor approved changes such as lateral ke ocatio f t o s distribution box and/or septic tank. , I certify that the septic system referenced above was installed with ma' r chap�es ( . greater than 10' lateral relocation of the SAS or any vertical relocation o any cGMmRDIWFt of the septic system)but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. s jN Of l yes STETSON (Installer's Signature) HALL R. No.527 'goeai6ze) (Affiix Design Here) _ PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH D ION. CERTIFICATE OF COMPL. CE WELL NOT BE ISSUED UNTIL BOTHTHIS FORM-AND AS- BUILT.CARD ARE RECEIVED BY THE BARN--,— P T*LIC HEALTH DIVISION. THANK'YOU. Q:Health/Septic/Dewpw C"tific ation Form Town of Barnstable . )Department of Regulatory Services 3 (r7L103 awaT�B Public Health DivisYou Pate Musa, et' MA 02601 b, .bJa�. 200 Main Street,$yaanis TfD µp`l CO Fee Pd. Date Scheduled N1cw L�` '« 2 p03. Time . ent o,� Sewage Disposal Soil Suitability Assessor f ��f J �i9lLaS� Witnessed By: Performed By: r owner's Name Location Address Zq a-r k Address L 9& /V' S S Engin ',eer" ,Ia�ine Assessor's Map/Parcel: Lam'. �Cj FTfo J �S� Telephone# SD NEW CON5TRUCTTON _____ REPAIR Surface Stones r-Lvl � slopes(%) Land Use iA SDO it Drinking Water Well? _tt en Water Body --ft Possible Wet Area $ Distances from: Op g Olher Drainage -- e Way Z a( + .. 8. Property Line -� . ds In proximity to boles) 5I<ETCS:(Street name.d+ mansions of lot,exact locations of lest holes&port tests,locate wetlan I • F, Ems' �D� • Q0 �s �lA%�✓ Depth to Bedrock — Parent material(geologic) �--- Wuping from Pit Face dDepth to Groundwater: Standing Water is Hole: Op Estimated Seasonal I•Iigh Groundwater in Method Used: in. Depth to soli mottles ient R Depth Observed standing in obs.hole: iq. Groundgratcr AdjusAoundwater Level_ Depth to weeping from side of ohs hole: — Adj.facwr� 4�OC7J"Index Well# Reading Date: Index Well level mammon Observatio / Timaat 9" n Hole# �L-- — — a r � Time at 6 • Depth of Pere Time(9"-6� — Start Pre-soak Time O:oO -5 rr�"l nE End Pic=soak . Rate b inAnch Additional Testing Needed(Y/N) Site Failed:�— ' ' Soil Depth frbm Soil Horizon Soil Texture Soi Co or OWec Mottling 5truotore,Stones,Boulders. Surface(in.) (USDA) (Mansell) tenc ` . won O- 7 _ C to Q . Depth from Soil Horizon Soil Texture Soil Color Mottling Structure,Stases,Boulders Surface(in.) (USDA) (MunsciQ rl4isten •iL Grave Soil Other Depth from Soil Horizon Soil Texture Soil Color Mottling Structure,Stones,Boulders. Surface(in.) (USDA) (Munsell) Consiste • Grave r !Depthfrom So' Horizon MSoil Texture. !4� ones Boulders.e(in.) (USDA) Y. el ' Flood Insurance Rate Mau: /. Above 500 year flood boundary No_ Yes Within S00 year boundary No Y Yes Within 100 year flood boundary No_ Yes Depth of Naturally►Occurring Pervious Material. Does at least foot feet of naturally occutrutg pervio material exist in all areas observed throughout the -area proposed for the soil absorption system? 15 . If not,what is the depth of naturally occurring pe 'ous material? cer-firicition I certify oaf n (date)Y Have passed the so' evaluator exemi11at1on approved by the Department of Environmental Protection grid that the above analysis was performed by me consistent with _.. .�r..... ,�:.,,,t a,5 �10 r.MR 15.®17. f DATE: 8/19/99 PROPERTY ADDRESS: 296_Parker Road __0stervilleZMass_________ 02655 ------------------------ On the above date, I inspected the septic system at the above address. This system consists of the following: 1 . 1-1000 gallon septic tank. 2 . 1-Distribution box . 3 . 1-1000 gallon precast leaching pit packed in stone . Based on my inspection, I certify the following conditions: 4 . This is a title five septic system. ( 78 Code ) 5 .. 'The septic system is in proper working order at the present time . 6 . `Liquid depth in the leaching pit is 22 " below the invert . 7 . Pumped septic tank at time of inspection . - -----� SIGNATURE: 1 Name:_,., P ,— Macomber_,Jr ______ Company: Joseeh_P. Macomber_& Son , Inc . <, AUG 66 �. 3 Address:— Box------------------- N 0 raw o F 99� Centerville , Ma__02632-0066 HoPTAa� Phone• 5 0 8-7 7 5-3 3 3 8 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachflelds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 • a COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292.5500 TRUDY C( $acre ARGEO PAUL CELLUCCI DAVID B. STR( Governor CoT:ss: SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTiON FORM PART A CERTIFICATION PTopeMAddrws.s: 296 Parker Road Ostervillw(ri&t%bvr1efJames P. Kelly Osterville ,MM3/gJ655 Address of Owns: Date of Inspection: Harrw of Inspector:(Please Print) Joseph P.Macomber J r . I am a DEP oved system irupectot worst to Section 16.340 of TM@ 6(310 CMR 15.000) Company Name: J. .Macomber & S o n Inc . MaaWAdcirau: Rox 66 CPnrPrVl 1 1 P ,MAIRC _ n2632 Teleplwrse Nurrsbers)Cg � ' g g CERTIFICATION STATEMENT I certify that I have personally Inspected the sewage disposal system at this address and that the Information reported below is true, accurate and complete as of the time of Inspection. The Inspection was performed based on my training and experience in the proper function and maintenance of on•site sewage disposal systems. The system: /Passes _-Condiuonally Passes Needs Further Evalua ion By the Local Approving Authority _ Fails -y/'y� inspector's Sigrwwre: r ` Date: �" The System Inspect hall submit a copy of this Inspection report to the Approving Authority (Board of Health or DEP)wlthin thirty (30) days c 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 own shall submit the report to the appropriate regional office of the Department oKnvkonmental Protection. The original should be sent to ttsa system owner and copies sent to the buyer. If applicable, and the approving authority. NOTES AND COMMENTS e revised 9/2/98 PascIof11 fro Pnnied on Recycled Pepe - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r PART A - CF3iTiFiCAT10N (corttirwed) P*opeMAd&au: 296 Parker Road Osterville ,Mass . DW11ef James Kelly Dart.of 4tsp.ction: 8/2 3/9 9 ' INSPECTION SUMMARY: Check A, A C, o/ D: A. SYSTEM PASSES: I have not found any Information which Indicates that any of the failure conditions described in 310 CMR 1.6.303 exist. Any failure criteria not evaluated are Indicated below. COMMENTS: Mow w a _invert B. SYSTEM CONDITIONALLY PASSES: One or more system components as described In the 'Conditional Pass' section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass. Indicate yes,no, or not determined(Y, N, or ND). Describe basis of determination In all Instances. If 'not determined-, explain why not. The septic tank Is metal, unless the owner or operator has provided the system Inspector with a copy of a Certificate of Compliance (attached)Indicating that the tank was Installed within twenty(20)years prior to the date of the Inspection; or the septic tank, whether or not metal,Is cracked, structurally unsound, shows substantial Infiltration or exfiltration, or tank failure Is Imminsnt. The system will pass Inspection If the existing septic tank Is replaced with a complying septic tank as approved by the Board of Health., Sewage backup or breakout or high static water level observed In the distribution box Is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass Inspection if (with approval of the Board of Health). broken pips(s)are replaced obstruction is removed distribution box Is levelled or replaced - The system required pumpMg-hors than'four dmos a•yeardue to broken or obstructed pipe(s). The vystam wi hmrr— Inspection If(with approval of the Board of Health): broken pips(s)are'repiaced obstruction Is removed revised 9/2/98 Page 2ofII f IS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 296 Parker Road 0s•t'erville ,Mass . Owner: James Kelly Data of Inspection: 8/2 3/9 9 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: No Conditions exist which require further evaluation by the Board of Health In order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES W ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH.YM1.PROTECT THE PUBLIC HE LLTH.AND SAFETY AND THE DiWONMENT- 410 Cesspool or privy is within 50 feet-of 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 AND SAFETY AND THE ENVIRONMENT: lud 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 60 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well Is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance .UJ�_(approximation not valid). 3) �OTHER j IN �1d:J revised 9/2/98 Page 3orn r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) PropertyAddreas: 296 Parker Road Osterville ,Mass . Owner: James Kelly Date of Inspection:8/2 3/9 9 D. SYSTEM FAILS: t You must Indicate either "Yes" or "No" to each of the following: _L&J_ I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is Identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ y Backup of-sewage iRlofeci{ityror••erstem component due lo an overloaded orcbggedSi0.S•or-cesspool . - -�-- •�-' X1 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 bop b_ove outlet invert due to an overloaded or clogged SAS or cesspool. the leachin Xis �22" Liquid depth in -below-invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped j__. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is-within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for -coliform bacteria,volatile organic.compounds, ammonia nitrogen-and nitrate nitrogen. - E. LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems In addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No i the system is within 400 feet of a surface drinking water supply the system-is-witWn 200 Not -surfeoa,drinking�water-supply - • -- _ the system is located In a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further inforrnatiph. revised 9/2/98 Page 4of11 f 1 l ^� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 296 Parker Road Osterville ,Mass . Owner: James Kelly Date of inspection:8/2 3/9 9 Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. _ / -None of the system-compoaants ba►w:baan puatiped4or-aUsast twoweaka audthe-system hasbaeaa*ceimiagwsasai.flow rates during that period. Large volumes of water have not been introduced Into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was Inspected for signs of breakout. _ All system components,44ciuding the Soil Absorption System; have been located on the site. _ The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge, depth of scum. The size and location of the Soil Absorption System orrthe site has been determined based on: _ Existing information. For example, Plan at B.O.H. Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) (15.302(3)(b)) _ The facility owner.(and.occupants,Jf diffaraW frool.ownw).wara pr�oYlded with Infnrmntiomon tha propg(�nintnnn.v e f SubSurface Disposal Systems. 1 , I revised 9/2/98 Page 5ofII f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Addlress: 296 Parker Road Osterville ,Mass . ownw: James Kelly Date of 4rspec8on: 8/2 3/9 9 FLOW CONDITIONS RESIDENTIAL: Design flow: &A g.p.d./bedro m. Number of bedrooms(desi n) Number of bedrooms(actuaqLI Total DESIGN flow Number of current residents Garbage grinder(yes or no): Laundry(separate system) Ly_es or tQg If yes, sepamte.1nspection.required Laundry system inspected (die)or no) Seasonal use(yes ory Water meter readings,If available(last two year's usage(gpd): Yy7 l�C� did - Sump Pump(yes or no) Lest date of occupancy: COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: A4 qpd ( Based on 15.203) Basis of design flow Vh Grease trap present: (yes or no) Industrial Waste Holding Tank present: (yes or no)& Non sanitary waste discharged to the Title 5 system: ( as or no)A Water meter readings,If available: Last date of occupancy: Ad OTHER:(Describe) Last date of occupancy: Nn GENERAL INFORMATION PUMPING RE CARDS and so ce of'nformation: System p mped as part of inspection:(yes or no) If yes, volume pumps allo�ns�j � .�,� Reason for pumping:+��dr L � ��� I TYPE OF SYSTEM y _Septic tank/distribution box/soil absorption system AO Single cesspool WIT Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) 414 I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Otherjw" OXIMATE AGE of all yo�onents, date installediif known)-and sou of,information: • Sewage odors detected when arriving at the site:(yes or no) i revised 9/2/98 Page 6of11 l r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 296 Parker Road Osterville ,Mass . Owner James Kelly Data of huPwdw:8/2 3/9 9 BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction:_cast iron j/40 PVC—other(explain) Distance fr orri�private water supply well or suction line Diameter Comments: (condition of joints,venting,evidence of faakage,-etc.) —- Joints appear tight . No evidence. of leakages _ SEPTIC TANK:1=9f (locate on site plan) rt Depth below grade J Material of construction: concrete_metal_Fiberglass _Polyethylene_other(explain) If tank Is(petal,list age Zy Js.ag�e�.c�onfumed by Certificate of Compliance (Yes/No) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee orbaffle_o_ Scum thickness:_ Distance from top of scum to top of outlet tee or baffle: Q Distance from bottom of scum to bo of o tle tee or baffler How dimensions were determined: Comments: (recommendation for pumping,�condition of inlet and outlet tees or.baffles,.depth of liquid level In relation to outlet invert, structurel-integrity, evidence of leakage,etc.) Pump tank every 2-3 years , Tnlet R outlet tees are in :1ara _ Thp tank is etr11CtiirP11y soli 1d 2pd r-hows no ayd,depr.@ GREASE TRAP: e, (locate on site plan) Depth below grader Material of construction.dAconcreteN/4metalj!lFiberglassNAPolyethyleneileother(explain) .4 Dimensions: ill Scum thickness: 04 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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level In relation to outlet invert, structural integrity, evidence of leakage,etc.) Grease trap is not present , I _ revised 9/2/98 Page 7of11 I_ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 296 Parker Road OsteTville ,Mass. Owner: James Kelly Date of Inspection:8/2 3/9 9 TIGHT OR HOLDING TANK(Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:AJh Material of con3truction:A]Aconcrete4l4metal Fiberglass PolyethyleneAJ�/ other(explain) Dimensions _ Capacity: gallons Design flow: gallons/day Alarm present Alarm level: V4 Alarm in working order:Yes. No40 Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) iQ t or holding- tanks are not present - DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Comments: (note•if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) — — Distribution box has one lateral .No evidence of solids carry over . No evidence of leakage intn nr wit of the hnY , PUMP CHAMBER:_&,�Vq- (locate on site plan) Pumps in working order:(Yes or No) A Alarms in working order(Yes or No)�� Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) ump .chamber is not present . revised 9/2/98 Page 8ofII I 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / SYSTEM INFORMATION(continued) PropertyAddra": 296 Parker Road Osterville ,Mass . Owner: James Kelly Data of kupection:8/2 3/9 9 SOIL ABSORPTION SYSTEM(SAS):,1-1-� (locate on site plan,If possible;excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: Isaching fields, number, dime slons: overflow cesspool,number:Alternative system: L�Pv Name of Technology: zz Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) Loamy Sand to meth"m fine sand - Ne sisal of hydr-aulie below a invert i e . CESSPOOLS:Azqt (locate on site plan) Number and configuration: Depth-top of liquid to Inlet Invert: Depth of solids layer: Depth of scum layer: AM Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of Inspection) esspoo s are not present Comments: (note condition of soil, signs of hydraulic failure,.level of.ponding,condition of.vegetation, etc.) Cesspools are not present PRIVY:A ►IV4 (locate on site plan) Materjals of construction: ��/ Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation;etc.) rlyy is not present , e revised 9/2/98 . Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORM.AT10N(con*Kkad) Prop.MAd&—:296 Par4er Road Osterville ,Mass . Own-w: James Kelly Da`°of * 8/2 3/9 9 SKETCH OF SEWAGE DISPOSAL SYSTEM: include Iles to at Isast two permanent rafaranca landmarks of benchmarks locats all wells within 100'(locate where public water supply comes Into house) I' 8 a� as �y � / a w i revised 9/2/98 Pact 10of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ,1 PART C SYSTEM INFORMATION(continued) NW.nyAd& .,: 296 Parker Road Ostervi.11e ,Mass . Own«: James Kelly Dena of kupecti0n:8/2 3/9 9 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date websita visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Collar Shallow wells r Estimated Depth to Groundwater Feet Plesse Indicate all the methods used to determine High Groundwater Elevation: _LZObtained from Design Plans on record �/ Observed.Sits (AbuWng propertyyy bservatlon hole, basameot sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps _k/Checked pumping records �Chscked local excavators, Installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Used water contours map. Gahrety & Miller Model 12/16/94 r revised 9/2/98 Page it or it �N f•TRftT..--RIT�r Tr•TfI�RR`RTfRIlTR1R..lR1frTRTtff►ITRnA..T1TIRA'Y TIY'*IfC11RT/ T•R•RT�TTRR••-...t..I-••t SO TOWN OF Barnstable WARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION •••T}•1�T••. ::t-T.111t�.�TTJIt TT11•R.TTT+IIl1QT1fSN'�IT1:T.t'tT:1YT1'7riT1R�•'1"�RR�IT Rr101TR�TA7R7 RmIR •.TI`T'R^•1.•-.•� -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRES$ 296 Parker Road Osterville ,Mass . ASSESSORS MAP, BLOCK AND PARCEL # JCS OWNER' s NAME James Kelry PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr . COMPANY NAME J•P•Macomber & SwA 'Inc . COMPANY ADDRESS Box . 66 Centerville ,Mass . 02'632. Street Town, or CSty State LIP COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 1 790 - 1578 m CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and omplete as of the time of +inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one: ysteui PASSED' _zS The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have con acted has found that the system fails to Protect the i-iublic health and the environment in accordance with Title 6 , 310 CMR 15 . 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date e copy of this certification must be provided to the OWNER, the BUYER 3rn where applicable ) and the BOARD OF HEAL1'II. ..n * If the inspection FAILED, the owner or.1 h operator shall upgrade ' the eystem. within one year of the date of the inspection, unless allowed or required otherwise as provided in 3.10 CMR 15 , 306 . partd .doc No. _ _ j v Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Di-4pool *potem Comaruction Vermtt Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System El Individual Components Location Address� or Lot No. ,�r tom- A 9,�Ce rL Q 0 Owner's Name,Address and Tel.No. Assessor'sMa /Paz/el q ! 2), kc l/eY Installer's Name Address,and Tel.No. Designer's Name,Address and Tel.No. e v4 J `l7 7—o/7 7 /Zh MA CaGYoi Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ' ci ­o 0 4 •P �t!L 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 issue Board of Health. Signed Date Application Approved t" Date - 34 Application Disapproved for the following reasons IZ9 CA ` Permit No. Date Issued '' L - - - - - - - - - ., ,. No. �J % 1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 2pplicatton for Mtzpooal *potem Con5tructton Vermtt Application for a Permit to Construct( )Repair( )Upgrade( )Abandon(. ) ❑Complete System ❑Individual Components Location Address or Lot No.a p iz l"e Pt Na b Owner's Name,Address and Tel.No. z �ray a Epp ii�-d0, kc /ley Assessor's Map/Parcel � 61 Installer's Name Address,and Tel.No o� Designer's Name,Address and Tel.No. Zola � Aw S eh. l D/77 a ith h11A oa6y51 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other - Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank / Type of S.A.S. Description of Soil f ' Nature of Repairs or Alterations(Answer when applicable) ,1 44 � w ci G U G 4 Date last inspected: Agreement: 41 �' + Afl� / f C ��l•�Z w (— , �-. 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 6$ace�the system in operation until a Certifi- cate of Compliance has been issue p4m,Board of Health. ;1 Signed Date Application Approved b - Date —,7 7 t Application Disapproved for the following reasons f Permit No. 1 Date Issued " --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certtftrate of Comphance !� THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( Repaired( )Upgraded( ) Abandoned )by 9 k�lS 1�­ x C A,,.,4 1 w C at 3 6 A h •Pk R P U ti l has been constructed in accordance with the provisio s f Title d the for Disposal System Construction Permit No. dated Installer /— Designer The issuance of this permit shall not b construed as a�guarantee that the system will function as designed. Date -7— t fi - Inspector- ------------------------------------�+-------------------------- No. /� Fee 7 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwt5po5a[ *p!tem Congtructton Vermtt Permission is herebygranted to Construct L/, Repair( )Upgrade( )Abandon( ) System located at 3 t/ U k, 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 thi it. Date: ' � Approved b 6 TOWN OF BARNSTABLE LOCATION SEWAGE # �j YILLACE ASSESSOR'S MAP & LOT1 �/-- INSTALLER'S NAME & PHONE NO. he SEPTIC TANK CAPACITY tOOO LEACHING FACILITY:(type) (size) k_oQo NO. OF BEDROOMS� PRIVATE WELL OR PUBLIC WATER BUILTIRR OR OWNED DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: { Q �, \Au THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN! OF BARNSTABL.E Appliratiutt for DiuVniittl 3Uur1w Tunutrur#iun Permit Application is hereby made for a Permit to Construct ( ) or Repair JX� an Individual Sewage Disposal System at: 29.6...Parker...Raad..DO tsruille........................... .................................................................................................. Location-Address or Lot No. James...Kai-l- ------------------------------------------------•------_---_------ .................................................................................................. Owner Address J.r........................................................... .................................................................................................. Installer Address Type of Building Size Lot............................Sq. feet ., DwellingX---No. of Bedrooms...........3------------------------------Expansion Attic ( ) Garbage Grinder (NO) a Other—Type of Building ............................ No. of persons-------.--.--------.-------- Showers ( ) — Cafeteria ( ) Other fixtures --------------------- --------------- ---- -----------------------------------------------•---....------ W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length--------- ----- Width.........------- Diameter---------------- Depth................ x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.............------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by...--------_-----......a ------------------------------------------------- Date...------------------------------------ Test Pit No. 1 ............minutes per inch Depth of Test Pit-------------------- Depth to ground water.................. Gz, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water......................... ---------------------------------------------------•------------- ........................................................................................... 0 DescriptiAZWOO&....Gravel............... V -------------------------------------------•--------•----------•---------------------------------------------...------------------------------------------------•--- W ----------•- ------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable.--Omit C e s s poo 1 s. Install 1 —1 0 0 0 ------------------------------------------ .................gallon....tank...:l-di s tr.ib.0 tio.a--b-ax...Im l-Q 0 0---gall am...lea c h-.-P-it............................ 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 Complia ce has b en,i�sue by th bo rd of health. Signed --- --- -- - /.`./.......... 1 5 Date Application.Approved By ---------------- ` ....... ..... s, ,-`^" ......... ...- /".�.........- ApplicationDisapproved for the fo lowing re ons- ---------------------------------------------------------------------------------- ---------------------------------------------- ------------ ------------------------- -------------------------- --- -------------------------- -------------- --------------------------------------------------------- ------------- ........................................ Permit No. ..----- -.--?.............. E�* 4�-------------- Issued -------------------------------- Da[e t � r No.... �= 7y� VFICR_!.�.......C?.n.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Di_viipuuttl Nurku Towitrnrtiun rrmit Application is hereby made for a Permit to Construct ( ) or Repair �X) an Individual Sewage Disposal System at ) 29.6...Parker...Rctad..BSI~Pruil_l e............................ --••------------•---••••••--------•-•••------•----•••-..............------•-----.........----•••-- Location-Address or Lot No. Owner Address a J..-R.k..'lac_Q_ rnbjar...rn----------------------------------------------•--•------ ------ = l' Installer ' t Address UType of Building s Size Lot............................Sq. feet Dwelling— No. of Bedrooms.........._3.__•--_•__________________-----Expansion,Attic ( ' 1)t l Garbage Grinder (r1D) aOther—Type of Building ____________________________ No. of persons-___:__.-__--`-__--_..._-_ Showers ( ) — Cafeteria ( ) d Other fixtures - _'...:.; ' W Design Flow--------------------------------------------gallons per tperson per day:- Total daily flow-...........................................gallons. WSeptic Tank—Liquid capacity__.__--____gallons Length_____________'_ Width---------------- Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No________________-__. Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................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........................ a ----•---•-------------------------------•--••--------------•---••-•-----••----......•--•••----••••-•........................................................p c Descrlptionao @orix ...Gravel-•-----------------------------------------------------------------------------------.............................................................. x W U Nature of Repairs or Alterations—Answer when applicable._.�mit ces pool Insta11 1 -- --00 - -- - 1 gallon--•tank•-.1_-df tribution-•box__-1_-1000---gallon•--leach ni-t. 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 Complia ce has b en (slued by th Kbord of health. Signed - /,. ............. Lf.. ----------------------- --3.,/..1../_9.5........_:...... Dates Application,Approved By --------------- ------- ---------- Application Disapproved for the following re sons- ------------------ -------- --------------------------------------------------------------------------------------------------- Date Permit No. ........ ............. . .ye-------------- Issued ......... Dare R THE COMMONWEALTH OF MASSACHUSETTS 'N BOARD OF HEALTH TOWN OF BARNSTABLE CITertifi ate of (1amplian>ce THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX) by ............. Ar--.Jr---_ ---- -------- ------._--------------------- ------------------------....----..---- ---- ._............................................... I rnndler at - ----------29.F.--.Parker.._Po.a.d...--®at.er.v.il.le------- . .........._.._.._............. ... .............. has been installed in accordance with the provisions of TITLE 5�f The State Environmental Code as described in the application for Disposal Works Construction Permit No. ....... ..^ .�1/��.__... dated ........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------............... ............ . - ....... - - ---_-_--- -- Inspector ----- \ --------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE t No....- �o 00 .•--.�........�d FEE..--•--•---....�....... Disposal Workii Tonotrurtiurt rrrntit Permission is hereby granted___).-P.Macomber Jr. ----------------------•-•-------•-----•-----------•---•--•--•--•--....---------••----•-•----_...•--•-............. to Construct ( ) or RepairX(XX) an Individual Sewage Disposal System at No....... 96...??arkor-_R_�rl...�stnryiII..... ._... ----- ----- ---------------------------------------- --------------------------- Street as shown on the application for Disposal Works Construction Permit No.?3__7 Dated______�� 6------------ �J J -- - -- ----... �- Board of Hcalth DATE............. FORM 36508 HOBBS&WARREN.INC..PUBLISHERS CENTERVILLE-OSTERVOLLE-MARSTONS MOLLS FIRE DEPARTMENT INCIDENT REPORT Type of Call:____ - �WCAlarm No:_ 6g _ Brief Narrative Required on all Calls Location:---,3/ kAU P— ,R � Os7- Date: �� ��-9S ON LOCATION AT THIS ADDRESS FOR THE REMOVAL OF --- Q. - ----------------- ---------- Called by: Z3_$ _Tel.#: Time rec'd A 275 GALLON FUEL OIL TANK BY SHORELINE TANK Dispatcher: Comments: SERVICE. _ WHILE TANK WAS SUSPENDED OVER EXCAVATION HOLE, Apparatus response: Total anpower:�— BOTTOM OF TANK DEVELOPED LEAK THAT STARTED AS On the )6S-4--On location: I Ret. <<t� In Service ! A DRIPPING, THEN DEVELOPED INTO A SMALL STREAM Weather:A r: Temp:_Lg Wind: � 1© OF PRODUCT. TANK WAS QUICKLY BROUGHT OVER AND THEN LAID ON IT'S SIDE ON A PIECE OF PLYWOOD Other Agencies Notified BACKHOE OPERATOR THEN OUIMY REMOVED A FULL Name/Agency Te/e No. By BUCKET OF SOIL IN THE HOLE WHERE PRODUCT HAD LEAKED. II TECTABLE SIGN OF PRODUCT- PRODUCT LEAKED APPEARED TO BE AFTROXIKATRLY 1 PINT OR LESS: Buildings - Type of Occupancy: Tele No: IPRODUCT ON PLYWOOD, APPROXIMATELY 1/2 CUP.WAS Owner: _ Address: CLEANED UP WITH ABSORANT PADS. Tenant__ REMOVAL COMPANY STATED CONTAMINATED SOIL AND ========== PADS WILL BE PLACED IN APPROVED CONTAINER FOR Equipment/Type:_— ---Location: — _ PROPER D�PO,SAI.. Year: Make: Model:_ IN MY OPINION, NO OTHER ACTION NEED BE TAKEN Serial No. AT THIS TIME. Motor Vehicle - Year: Make/Model: .Color:— —VIN: Reg.#: Owner: _Address: Operator:— Address: — — Brush Fire - Class: Area/size: Automatic Alarms - Classification/Code: List Items needing Follow Up: NONE- REPORT SENT TO TOWN HEALTH AND DEP. Form #62 left at: "Y Report by: ' C-O-MM Form #19A Chief Rec'd: Date: t CENTERYILLE-OSTERVILLE-MARSTOQS MILLS FIRE DISTRICT 1875 ROUTE 28 CERTERVILLE, MA 02632 (508) 790-2380/FAXO(508) 790-2385 OIL/HAZARDOUS MATERIAL RELEASE FORM F,A,# F-0847 LOCATION: ADDRESS OF RELEASE: 11 PARKER IWAD OSTERVTT.T-F._ AA_ 07632 DATE OF RELEASE:. 11/171M' PRODUCT RELEASED. 19 Trm, OTT• ESTIMATED QUANTITY- 1 PINT CORRECTPIE ACTION TAKEN BY RESPONSIBLE PARTY: ERCAVATO CONTAMINATED SOTT. WRT.T, REf.ON SPTT.T._ AND CONTATNIERT7.ED FOR PROER DTSm POgAT._ NOTIFICATIONS: . FIRE DEPARTMENT: YES6[y) NO( ) DATE: 11 /17/QS TINE• 1ns7 NATIONAL RESPONSE CENTER YES( ) NOS DATE: TIME: • DEPT.OF ENV IRONMEENTAL PROTECTION YES( ) NO(Xj DATE: TIME OIL SPILL COORDINATOR: YES( ) NO(Xj DATE: TIME: Q TOWN BOARD T HEALTH: YES( ) NO(Xh DATE TIME: TOWN H ARBORM ASTER: YES( ) NO(Xj D ATE: T IME OTHER AGENCIES: COMMENTS- SEE REPORT ENCLOSED I REPORTED BY• 9114 IVL LPO DATE: ; MITE COPY-FIRE DEPARTMENT YELLOW COPY-D.E.P. 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