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HomeMy WebLinkAbout0376 PARKER ROAD - Health 376 PARKER PF OSTERVILLE + , A = ,115 031 1 I 1 I I _° , m o ---- In OFF � CIAL USE 0' Certified Mail Fee Ir t Extra Services&Fees(check box,add fee as appropriate)', r-3 ❑Return Receipt(hardcopy) $ 3 []Return Receipt(electronic) $ Postmark O ❑Certified Mail Restricted Delivery $ '• N Here «- C3 ❑Adult Signature Required $ k r []Adult Signature Restricted Delivery$ t ) e LJ Postage m $ � Total Postal $ ANGELI,ALESSANDRtA PRZIREMBEL u) Sent To � . 376 PARKER ROAD StreetandA OSTERVILLE, MA 02655 Ciry,-State, :•r r rr rr•••. Certified Mail service provides the following benefits: o A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(including the recipients retail associate. .7 signature)that is retained by the Postal Service- Restricted delivery service,which provides - for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent.. Important Reminders. Adult signature service,which requires the ■Yoti may purchase Certified Mail service with signee to be at least 21 years of age(not r. First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which e Certified Mail service is not available for requires the signee to be at least 21 years of age International mail. and provides delivery,to the addressee specified ■Insurance coverage is not available for purchase by name,or to the addressee's authorized agent- with Certified Mail service.However,the purchase (not available at retail). —3 of Certified Mail service does not change the a To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. USPS postmark If you would like a postmark on f r, ■For an additional fee,and with a proper this Certified Mail receipt,please present your -n endorsement on the mailpiece,you may request Certified Mail item at a Post Office-far the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion . of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply F, You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, 1 complete PS Form 3811,Domestic Return Receipt attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records. Ps Forth 3800,April 2015(Reverse)PSN 7530-02-000.9047 TOWN OF BARNSTABLE � 2000-740 LOC. TION376 PARKER ROAD SEWAGE # VILLAGE 0 S T E RML L E ASSESSOR'S MAP &LOT l.r'03 1 INSTALLER'S NAME&PHONE NO. E L L I S BROTHERS C O N S T . SEPTIC TANK CAPACITY L6(Z® 10M AI-M f' LEACHING FACILITY: (type) N P- C n2 Z n 4 j ly tk4- (size)Z2 ,�;X 4 0 NO.OF BEDROOMS ; BUILDER O OWNER SkELLA i G� PERMTTDATE: / 1 /0 0 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility IVA Feet Private Water Supply Well and Leaching Facility (If any wells exist JA on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist �r within 300 feet of leaching facility) /Y Feet Furnished by i3 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY' A. Signature ■ Complete items 1,2,and 3. ■ Print your name and address on the reverse X 0 Agent so that we can return the card to you. ❑Addressee ■ Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Qelivery or on the front if space permits. 1__nrr;�;<_n+�;re��e,i_+,,• is delivery address different from item 1?113 Yes i If YEs,enter delivery address below: ❑No ANGELI,ALESSANDRA PRZIREMBEL 376 PARKER ROAD OSTERVILLE,MA 02655 a ., Service Type ❑.Priority Mail Express& v�ll'�III�I I��I I'I I II II I II I I I�I'I I I I II II IITII I All ❑Adult Signature ❑Registered Migim ❑�dduult Signature Restricted Delivery ❑Registered Mall Restricted 9590 9402 1934 6123 0978 52 f ceriifled MaiIfied l Restricted Delivery .t eat.Receipt for ❑Collect on Delivery Merchandise 2_..,Articla_Numhcr Lrrmnefgr Fm..; -O_Colleninn-Delivery Restricted Delivery 0 Signature ConfiitnationTm 7 015 1730 0001 4990 4056 J1 Restricted Delivery ❑Re tricted Delivnature ery won PS Form 3811,July 2015-PSN 7530-02-000-9053 Domestic Return Receipt LISPS TRACKING# First-Gass Mail Postage&Fees Paid' i USPS Permit No.G-10 i 9590 9402 Ift' 16123 0978 52 United States •Sender:Please print your name,address,and ZIP+411 in this box* *ostal Service a�„� ToNvii of Barnstable om Health Division ` :r 200 Main Street , { Hyannis,MA 02601 -.ii',d-.�•..� l��-I�1l11��111l�tll�il�'��'Sli��'�1"l�11�111lIt��.y����41111i1I4Rl� R&G PUNT SERVICE 223 TREMONT STREET TAUNTON,MA 02780 (508)989-9977 RGPump@yahoo.com SALES RECEIPT BILL TO SALES# 5229 Vincent D'Olimpio DATE 11/10/2017 Robert Paul Properties DATE ACTIVITY" A M 0 N1' 11/09/2017 376 Parker Road Osterville MA 11/09/2017 R&G Pump Service has replaced the alarm box 3,000.00 and float and tested the pump 11/09/2017 The System works 100% Thank you, TOTAL. 3,000.00 Rick AMOUNT RECEIVED 3,000.00 BALANCE DUE $0.00 I� i Invoice Invoice#: 117022 Date: 11/10/2017 STELLA WHITCOMB STELLA WHITCOMB t 376 PARKER ROAD 376 PARKER RD OSTERVILLE, MA 02655 MAIN HOUSE OSTERVILLE, MA 02655 WH1122 59798 Due upon Receipt. 11/1/17: CAPPED OFF LAUNDRY CONNECTION,SLOP SINK DRAIN,AND WATER LINES.TESTED OPERATIONS. 1.00 PERMIT-PERMIT(PLUMBING AND OR EA $52.00 $52.00 GAS) 2.00 12CXF-1/2"COPPER X1/2"FEMALE EA $3.10 $6.20 ADAPTER 4.00 12CPRESCAP-1/2"COPPER PRESSURE EA $1.03 $4.12 CAP 1.00 4JIMCAP-4"JIM CAP EA $13.08 $13.08 1.00 PLUMBING-PLUMBING SERVICE CALL HRS $149.00 $149.00 1.00 PLUMBING-PLUMBING SERVICE CALL HRS- $0.00 $0.00 Subtotal $224.40 Sales Tax $1.47 Payment $0.00 !elb AT tal i � f`,N ,r s Asa , + $2{2 x�87 E r 1i, F Thank you for your business! t �. :� !,L. Invoices not paid in 30 days will be subject to finance charges. Carl F.Riedell&Son Inc. 778 Main St.Osterville,MA 02655 Phone: 508-428-6365 I c,9s f Town of Barnstable Barnstable oft"r<r� ' Regulatory Services Department MAmMeaC j + lARNSrABIE I 1639. ,.� Public Health Division gFDµ 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#1015 1730 0001 4990 4056 October 17, 2017 ANGELI, ALESSANDRA PRZIREMBEL 376 PARKER ROAD OSTERVILLE,.MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 376 Parker Road, Osterville, MA was inspected on 10/05/2017 by Frank Nunes III, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Must tie in laundry to septic system. High water alarm switch must be repaired in pump chamber. You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., -O Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\376 Parker Road Osterville.doc Town 'of Barnstable • rs�axsrAacE. MAM Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA'02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A McKean,CHO Feb 6, 2007 Rev. 5111/16 DEADLINES TO REPAY FAILED.SYSTEMS (Town Code §360-4-4 and Title V: 310 CMR 15.000) An`Z"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑Discharge or ponding of effluent to the surface of the ground . o Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE(1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑Any portion of the cesspool within a Zone 1 to a public well ❑Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO 2 YEAR DEADLINE CRITERIA Single Cesspool t Ifl L a r� cQ ❑Any conditionally passed systems (broken cover,relocation of a pipe,relocation of a driveway due to,H-10 components, etc) o Leaching pit or cesspool with high liquid level, <12"below inlet (per Town Code §360-9.1) ❑Leaching facility with standing liquid level at or`above the invert pipe (per Town Code §360-20 h)" OTHER Hi A k A W- Ste. Repair deadline: a\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments t M 376 Parker Rd Property Address r a Angeli i Owner information Owner's Name is required for Osterville ✓ MA 02655 10/5/17 -4 every page. R City/Town State Zip Code Date of Inspection Q 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: Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Citylrown State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that 1,have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 16.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 10/5/17 Inspector's ' nature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original 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.doc-rev.6116 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 , 376 Parker Rd Property Address , Angeli Owner information Owner's Name is required for every page. Osterville MA 02655 10/5/17 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: ❑ 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: Single cesspool that serves laundry and a sink was not rerouted per engineered plan on file Pump chamber high water alarm not functioning. 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 376 Parker Rd Property Address Angeli Owner information Owner's Name is required for Osterville MA 02655 10/5/17 every page. Cityfrown 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/alarms are repaired. B) System Conditionally Passes(cont.): ❑ 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.doc•rev.6/16 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 376 Parker Rd Property Address Angeli Owner information Owners Name is required for every page. Osterville MA 02655 10/5/17 City/Town 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 ❑ ® 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 %day flow t5ins.doc•rev.6/16 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 r 376 Parker Rd Property Address Angeli Owner information Owner's Name is required for every page. Osterville MA 02655 10/5/17 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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 of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 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. [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. ❑ ® 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 16,000 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.doc•rev.6/16 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 376 Parker Rd Property Address Angeli Owner information Owner's Name is required for every page. Osterville MA 02655 10/5/17 Cityrrown 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 ❑ ® 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 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): 6 Number of bedrooms(actual): 6 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 376 Parker Rd Property Address Angeli Owner information Owner's Name is required for every page. Osterville MA 02655 10/5/17 City/Town State Zip Code Date of Inspection D. System Information Description: The cottage and the house each have a 1500g poly septic tank. The flow from the cottage goes to a 1000g poly pump chamber and then up to the d-box and shared SAS. The main house is a gravity feed to the d-box and shared SAS Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ® Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): Detail Laundry system is a single cesspool per engineered plan which the piping was to be rerouted in 2001 per the plan. It"Fails" per Barnstable regulation Sump pump? ❑ Yes ❑ No Last date of occupancy: 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 Water meter readings, if available: t5ins.doc•rev.6/16 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 , 376 Parker Rd Property Address Angeli Owner information Owner's Name is required for every page. Osterville MA 02655 10/5/17 Cityrrown 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: No recent pumping Was system pumped as part of the inspection? ❑ Yes ® 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): pump chamber t5ins.doc-rev.6M6 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 M , ' 376 Parker Rd Property Address Angeli Owner information Owner's Name is required for every page. Osterville MA 02655 10/5/17 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 2001 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 12"feet Material of construction: ❑cast iron E 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.): Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ® polyethylene ❑ other(explain) All covers are to 6"of grade If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500g. Sludge depth: trace t5ins.doc•rev.6/16 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 376 Parker Rd Property Address Angeli Owner information Owner's Name is required for Osterville MA 02655 10/5/17 every page. Cityrrown 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 >12 Scum thickness trace >211 Distance from top of scum to top of outlet tee or baffle >2 Distance from bottom of scum to bottom of outlet tee or baffle' 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.): Pumping suggested evry 3 years to prolong the life of the system r T i plan):.-Grease rapI locate on site n p a ): Depth below grade: feet Material of construction:, ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: r 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.doc•rev.6/16 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 376 Parker Rd Property Address Angeli Owner information Owner's Name is required for every page. Osterville MA 02655 10/5/17 Cityrrown 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.doc•rev.6/16, 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 376 Parker Rd Property Address Angeli Owner information Owner's Name is required for every page. Osteryille MA 02655 10/5/17 Cityrrown 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 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.): D-box is 3' below grade and in very good condition. Cover raised to 6" 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.): 1000g poly tank as pump chamber. It is 4' below grade and has a 18"access riser that is inadequate to acces and service the pump.The pump is functioning at this time and effluent levels are appropiate. The high water alarm sytem is not functioning at this time * 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.doc-rev-6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I Commonwealth of Massachusetts \ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 376 Parker Rd Property Address Angeli Owner information Owner's Name is required for every page. Osteryille MA 02655 10/5/17 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 24 infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Infiltrators were video inspected and are dry at this time.Top of chambers is approximately 3' below grade. No indication of past fail conditions. 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.doc-rev.6/16 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 M 376 Parker Rd Property Address Angeli Owner information Owner's Name is required for every page. Osterville MA 02655 10/5/17 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.doc-rev.6/16 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 376 Parker Rd Property Address Angeli Owner information Owner's Name is required for every page. Osterville MA 02655 10/5/17 City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 C.C_SS Pout_ eol-Ag E 3 � r� 9 1Q � -3 c 3 t t5ins.doc•rev.6116 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 v ye` 376 Parker Rd Property Address Angeli - Owner information Owner's Name is required for every page. Osterville MA 02655 10/5/17 Cityrrown 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: >132" 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 NGW 132" Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with,local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6/16 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 376 Parker Rd Property Address Angeli Owner information Owner's Name is required for every page. Osterville MA 02655 10/5/17 Cityrrown 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.doc•rev.6116 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 17 of 17 � L TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION I Date Time: In Out � Owner &C'53AftJVf-A AqN Gr,,c.r Tenant Suu�•ram. f-- ' 2? Address In UN"G uJ� �Q_ 4'q,L,` Address J--7(o Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use _ 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing 18. Driveway Width 19. Number of Tenants Observed WA- PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed max) Number of Persons Allowed (max) Person(s) Interviewed 0LJr-)1QR-- ip Inspector If Public Building such as Store or Hotel/Motel specify here in N � c Q LO 4cry,,& AP 6,10 70 5 4- ��� C � 7� A.M. FOR ATE TIME P.M. M � PHONEQ '' OF ' j RETlJRNECI PHONE ( YOUR CALL;:; AREA COOE UpobER EXTENSION MESSAGE t PLEASE CALI QUILL CALL,r 4 A. / ✓ CAMw~Tip S)"�YOU W:QEVTS TQ SEE YOU 'IGNED (V rSal'48ao NOTES_ i' 'ti k ME Ft ''� Town of Barnstable g Board of Health E1 .iA P.O. Box 534, Hyannis MA 02601 1 A Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Ralph A.Murphy,M.D. k Sumner Kaufman,M.S.P.H. t To: WHITCOMB, STELLA PRZIREMBEL;P Date Monday,Marc O5,2001 %WHITCOMB,STELLA PRZIREMBEL E 131 CLIFF RD WELLESLEY M 02181 RE:Underground Storage Tank at 376 PARKER ROAD Map Parcel: 115031 Tank NO: 01 Tag NO: 0 Our records indicate that your underground fuel(or chemical)storage tank is over 30 years old,and has not been removed as required by section 03: subsection 2 of the Town of Barnstable Health Regulation regarding fuel and chemical storage systems. You are directed to remove this tank sixty(60)days from the date of this notice. After your tank is removed, please furnish this office evidence in the form of a permit from your local Fire Department within ninety(90)days of the receipt of this notice. You may request a hearing provided a written petition requesting same is received by the Board of Health within ten(10) days after this order is served. Per Order of the Board of Health Thomas A.McKean,RS,CHO \ Health Agent " Iv Jv ai SENDER: I also wish to receive the v ■Complete items 1•:�ndtnr 2 for additional services. :Complete items'3,4a,and 4b. , following services(for an 4) ■Print d your name o ame and address on the reverse of this form so that we can return this extra fee): Y ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address permt. y ■Wn e�'Retum Receipt Requested'on the mailpisoe below the article number. 2. ❑ Restricted Delivery N c ■The Return Receipt will show to whom the article was delivered and the date delivered. Consult postmaster for fee. 3.Article Addressed to: 4a.Article Number E S y�lii-- 4b.Service Type 0 0 i� / l / � ❑ Registered Certified ¢ G p Express I ❑ Insured c� `� ❑ Retu ee ise ❑ CODEM 7.Dat r D �r z r^ m 5.Received By:(Pfint Name) 8.Add ee's Ad ( if requested W and is pa1)7, d) ^ r cci1 yr S 6.Signature:(Addre see or Agent) q X-S �� ( I L(i cV6 PS Form 3811, D oember 1994 102595-97-e-0179 Domestic Return Receipt UNITED STATES POSTAL SERVICE First-Class MailPostage&Fees Paid uses Permit No.G-10 ® Print your name, address, and ZIP Code in this box l Board of Health { Town of Barnstable P.O. Box 534 !Hyannis,Massachusetts 02601 i :tttltlllttttt�t�tttiitt�at�ttfltrtttl��ttt� J v i l Z 203 499 141. i' US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sent to 9L 7 tW et N}+@��r� . Lic//Y. 1 a 021 Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee Ln Return Receipt Showing to Whom&Date Delivered n Return Receipt Showing to Whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees is Z Postmark or Date L / Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). m 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the Q) return address of the article,date,detach,and retain the receipt,and mail the article. LO 3. If you want a return receipt,write the certified mail number and your name and address rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the 0 addressee,endorse RESTRICTED DELIVERY on the front of the article. M 5. Enter fees for the services requested in the appropriate spaces on the front of this S receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. ti 6. Save this receipt and present it if you make an inquiry. t o2595-s7-B-oi 45 a Town of Barnstable Department of Health, Safety, and Environmental Services `'b BAPMMAM"ZA : QJ V J Public Health Division ; .&W 639' A�� ��• �: 4� � 2 � 367 Main Street,Hyannis MA 02601 ��;( � CC y7 �\ P Office: 508-862-4644 /�Ji Thomas A McKean �h FAX 508-790-6304 Director of Public Health TO: STELLA P.WHITCOMB 131 CLIFF ROAD DATE: JAN. 20, 2000 WELLESLEY, MA. 02181 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 376 PARKER ROAD. was inspected on 09/04/97 by JOSEPH P. MACOMBER JR. a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: MAIN CESSPOOL FOR THE HOUSE IS WITHIN 23 FEET OF PONDS EDGE. THE FACILITY LEACHING TRENCH IS IN THE WATER TABLE AND WITHIN 15 FEET OF WETLANDS.' The above noted system has been in a failed state for more than two years according to our records. You are directed to hire a licensed professional engineer (PE) to design a system that will bring the septic system in compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within fourteen (14) days of your receipt of this letter. You are also directed to hire a licensed septic system installer to install the system components within thirty (30) days of your receipt of this order. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. P RD 0 THE BOARD OF HEALTH / s omas A. McKean, , C.H.O. Agent of the Board of Health Town of Barnstable N .. ....... TOWN OF BARNSTABLE. A R", 200,0-: 40, PARKER ROAD 376 LOCATION- SEWAGE # OSTERVI�LLEL VILLAGE ASSESSOR'S MAP &LOT- 1 IS'03 EL!ISBROTHERS CONST . INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 140o 1a;o 'YOU T LEACHING FACILITY: (tYpe) 1q NO.OF BEDROOMS- 4. BUILDER OW'OWNEiq S!- Ll VJ Vni 1 PERMITDATE: 4/00 COMPLIANCE DATE- Separation Distance Between the: AJAMaximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any,wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility.). Furnishe d by,--- -------------- A,q V -UV -Z R- D -4:7 V C Crocker, Sharon From: Crocker, Sharon Sent: Friday, July 24, 2009 3:36 PM To: Martin, Cynthia Subject: UST- 376 PARKER RD, OST Mrs. Stella Whitcomb, 376 Parker Rd, Ost 58-428-9654 stopped in to try to resolve underground storage tank record. She said she has worked with us three times over the years and hired someone to go over the property to verify there were no tanks in the ground. She also spoke with Tom in past. Please call and see if you can make the necessary adjustments in the records and database. I also left a letter from her plumber, Riedell, on your desk. Thanks, Sharon 1 . V 1 4 - s0 t PLUMBING•HEATING•AIR CONDITIONING 778 MAIN STREET OSTERVILLE,MA 02655 - PH:(508)428-6365 FAX:(508)420-0180 Mrs. Whitcomb After inspecting your property for any signs of an old underground or inside oil tank, I located the old oil line and it dead ends at the foundation, Mrs. Whitcomb explained to me that there is now a septic system where the oil tank may have been at one time. I could see nothing that would lead me to believe that there is still an oil tank on this property. Carl F. Riedell & Son Inc. accepts no responsibility for any oil tanks that may be located on the property in the future. _ Richard Summersall P�yER ECL��o PLUMBING•HEATING•AIR CONDITIONING - 778 MAIN STREET OSTERVILLE,MA 02655 - PH:(508)428-6365 FAX:(508)420-0180 376 6cq 62 . Mrs. Whitcomb After inspecting your property for any signs of an old underground or inside oil tank, I located the old oil line and it dead ends at the foundation. Mrs. Whitcomb explained to me that there is now a septic system where the oil tank may have been at one time. I could see nothing that would lead me to believe that there is still an oil tank on this property. Carl F, Riedell &Son Inc. accepts no responsibility for any oil tanks that may be located on the property in the future. Richard Summersall K+ n Y� L i f� Town of. Barnstable , tvernatE, Department of Health, Safety, and Environmental Services MAM Public Health Division 367 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean FAX: 508-790.6304 Director of Public Health TO: STELLA P. WHITCOMB 131 CLIFF ROAD DATE: JAN. 20, 2000 WELLESLEY, MA. 02181 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. _._.._ _..._..,_.. ._ .,a...,... The septic system owned by you located at 376 PARKER ROAD. was inspected on 09/04/97 by JOSEPH P. MACOMBER JR. a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: MAIN CESSPOOL FOR THE HOUSE IS WITHIN '23 FEET OF PONDS EDGE. THE FACILITY LEACHING TRENCH IS IN THE WATER TABLE AND WITHIN 15 FEET OF WETLANDS. The above noted system has been in a failed state for more than two years according to our records. You are directed to hire a licensed professional engineer(PE)to design a system that will bring the septic system in compliance with 310 CMR 15.00, The State Environmental Code,-Title 5 within fourteen (14) days of your receipt of this letter. You are also directed to hire a licensed septic system installer to install the system components within thirty (30) days of your receipt of this order. 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G...: .x. .\;v...........nt:...t...: ..... ....: t 77 .4::; ..:l.:? n:. _. ,`Kctv�F. . . ,..,.�..n. G..r. ........ .».. .... .:.. ..... ..« %' .. rwa.. l.?f• J .,:.x.. ..,.,.r...�..>'.r...:....:.f. r,. �,...�3.nn,.r:�. .::.............:. .... ..r.. .. �i`%✓�; .r..ii?D.:,.. : .c, ...... ... . t+t.....a...,.. . ... ... .., ,....t .....: ...: :... ..... a....,... ..:.,...: ,.:3 .» �.. ..a.: :.r):: r ... .�.. . ,. �»aa•-»k!.,r... .. n.. ,.. zw,".»rna, r nr `"���' .xc. ��- st > A �"n�''�:/ixu�w.:v�3•vk.:L':Y;k�•a!4y�.k.. ,h ihl t a1!: : '..n•�1r1'+,�'"��..ra.�:�2t:a»ay.."a:t43}'? t...�»f:£:##::�'EY. '�2:' :':::........:::��'.'� e 2 d P F MI6 O O 3.76 TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet` Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by r 5 O Ate__ DATE: 8/ PROPERTY ADDRESS: !376 -Parker Road RECEIVED Osterville,Mass . S EP 5 1997 HEALTF,r-PT. 02655 TOWN C�I' ,.` . On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . Cottage system. 1 -1000 gallon septic tank. 1 -Leach trench 4x20 2 . Main House System. 2-61x6 ' block cesspools . 1 rear 1 front. Based On my Intkoaction, I certify the following conditions: 1 . Cottage has a•• title five septic system 78 Code. Cottage system is in failure because the leach trench is in !. the water- table and 1 2 ' off wet lands'. .2 Main house is not a title five septic system. This is split sewage system that consists of two 6 ' x6 ' bloc cesspools . Rear cesspool is .in failure. To close to pond. 23 ' .Front cesspool is wraped with roots..., The two systems must be upgraded to the 9 5` "Coca . - SIGNATURE: Name: J . P , Macomber Jr., i ------ --------------- Company: J . P_MacoMber &- Son-_Inc , Address _�_ - 031 _-Cente�rvilleLMass__024632 ` Phone: _50S_77_5-3338------- •r 'I THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY J JOSEPH P. MACOMBER. & SON, INC. TankrCeupoolrLeschtlelds l Pumptd L Instilled Town Sewer Connections P.O, Box 66' Centerville, MA 02632.0066 775-3338 775-6412 l kp-- COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617.292.5500 %AILLL4N1 F WELD TRH D1"CO Goscmor Sc:rc: ARGEO PALL CELLUCCI DAB ID B STR(_ Lt Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Comr as c PART A CERTIFICATION 376 Parker Road Osterville MA William Pr Property Address: r Address of Owner: 444 CENTTRALRAL Park Date of Inspection: 8/2 6/9 7 (If different) West#jD Name of Inspector: Joseph P. Macomber Jr . rk 10025 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 C 1fs .0�� Company Name: Joseph P. Macomber & c Mailing Address: Box bb, Centerville , Ma . 02632-0066 Telephone Number: CERTIFICATION STATEMENT I cenify that I have personally inspected the sewage disposal system at this address and that the information reported below is vue, accuratt and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function ano maintenance of on-site se age disposal systems. The system: /Passes / Conditionally Passes ­4 L„nhor Gvahiahnn Rv tha I nral Annrovine Authority Inspector's Signature , The System Inspectorellbmit a copy of this inspection report to the Approving Authority within thirty (30) days of completing th,s 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 suomn the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system own, and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A) SYSTEM PASSES: A16 have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15 303 ,\ny failure criteria not evaluated are indicated below. COMMENTS: 81 SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired The system upe 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 ,4)6 t The septic tank is metal, unless the owner or operator has provided the system inspecor with a copy of a Cenificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection, c the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltraiion, or tan, failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tanK as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web. http 1twww.rrapnet state ma usioep Printed on Recycied Paper • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 376 Parker Road Ostervi l le Ma Owner: William E Major Date of Inspection: g/5/9 7 BI SYSTEM CONDITIONALLY PASSES (continued) ,LI�44AC Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced AW The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: [t=g Cesspool or privy is within 50 feet of a surface water '*WJ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: y The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. NL` The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance AW (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 376 Parker Road Osterville Ma Owner: William E Major Date of Inspection: 9/5/9 7 D) SYSTEM FAILS: You must indicate ei; .er "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CN1R 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 N Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. 1 �V141f�- Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipets). Number of times pumped _. Any portion of the Soil Absorption Systemscesspool 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. 41- Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: A0 The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No /&/? the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information, (revii*d 04/25/97) P&go 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 376 Parker Road Ostervi1le Ma Owner: William E Major Date of Inspection: 9/5/9 7 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes N Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. K;!! 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, uding 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 on the site has been determined based on: The facility owner (and occupants, if cUfferent from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing information. Ex. 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)J (revised 04/25/97) Pegs 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 376 Parker Road Osterville Ma Owner: William E Major Date of Inspection: 9/5/9 7 FLOW CONDITIONS RESIDENTIAL: Design flow:Q g.p.�./bedroom for S.A.S. Number of bedrooms: i:? Number of current residents: Garbage grinder (yes or no):A/0 Laundry connected to system (yes or no):Ay Seasonal use (yes or no):ky= n Water meter readings, if vailable (last two (2) year usage (gpd): — �'/ Sump Pump (yes or no): ` o— I� t 7 Last date of occupancy: COMMERCIAUINDUSTRIAL: Type of establishment: Design flow:^)A gallons/day Grease trap present: (yes or no)AIL9 industrial Waste Holding Tank present: (yes or no)�/Q Non-sanitary waste discharged to the Title 5 system: (yes or no)&ff Water meter readings, if available: AU4 Last date of occupancy: lq OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source f information: AmI System pumped as pan of inspection: (yes or no)Aep If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM _Septic tank/di��soil absorption system Single cesspooLS Overflow cesspool ,yfZ Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) _0a4 I/A Technology etc. Copy of up to date contract? Other ZJ1+ APPROXIMATE AGE of all c mponents, date installe (if kno n) and source of inf rmation: �s� - li �c ji / �v T t er .Gr> �.v Sewage odors detected when arriving at the site: (yes or no) (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 376 Parker Road Osterville Ma Owner: William E Major Date of Inspection: 9/5/9 7 BUILDING SEWER: (Locate on site plan) 1� Depth below grade: Material of construction: cast it n .. 40 PVC _ other (expl n) ��Z JMT P V Ti ' Distance from rjv ate water supply we I or suction line _A Diameter Coen (conditio of joints, venting, evidence of leakage, tc.) S �y SEPTIC TANK:J�IQ''MM� 'WS (locate on site plan) Depth below grade: material of construction: concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list aged,/4 Is age confirmed by Certificate of Compliance4A(Yes/No) Dimensions: Sludge depth: L G.P . Distance from tiff sludge,, to bottom of outlet tee or baffle:�iOff_ Scum thickness:1 . lu�� Distance from top of scum to top of outlet tee or baffle: e- Distance from bottom of scum to bottom of outlet tee r baffle:ai -e, How dimensions were determined: r Comments: (recommendation for pumping, condit n of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc. B O GREASE TRAP:dk4y-a (locate on site plan) Depth below grade:, material of construction:(AconcretelometalW, FiberglassA�APolyethylenWilother(explain) .ui4 Dimensions: A/1* Scum thickness: Distance from top of scum to top of outlet tee or baffle: &-d Distance from bottom of scum to bottom of outlet tee or baffler Date of last pumping: 4 Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural ote ty, evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 376 Parker Road Osterville Ma Owner: William E Major Date of Inspection: 9/5/9 7 TIGHT OR HOLDING TANK:A62&1&(Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade:v Material of construction:&Aconcrete, metal&OFiberglass4�APolyethylene,�Aother(explain) All$ mA Dimensions: iJA Capacity:_ h),A gallons Design flow: AA gallons/day Alarm level: JJA Alarm in working order Yes;&-ld-No Date of previous pumping: A24 Comments: (condition of inlet tee, condition of alarm and float switches, etc.) T Are Ayr /ze-c2 T. DISTRIBUTION BOX:A&q/-0 (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.) PUMP CHAMBER: (locate on site plan) Pumps in working order: (Yes or No) 4-4 Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) � is Ivor �/�S�vT (revised 04/25/97) Page 7 of 10 ` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:376 Parker Road Osterville Ma Owner: William E Major _ Date of Inspection: 9/5/9 7 SOIL ABSORPTION SYSTEM (SAS):z (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number: leaching galleries, number: leaching trenches, number,length: .. A leaching fields, number, dimensions: overflow cesspool, number: 0 Alternative system: A.)6 Name of Technology: AJ� Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of veget tion, etc.) CESSPOOLS: (locate on site plan) Number and configuration: — Cz - 'J / Depth-top of liquid to inle invert: Fj/I 7— �Aw Depth of solids layer: Depth of scum layer: Dimensions of cesspool: _ Materials of construction: r Indication of inflow groundwater: beump r inflow (cesspool t be umpe as pan of inspection) .0 �1./�/J. e�Gc p c /` A 9y Comments: (note cond Lion f soil, signs of hydraulic failure, ley I of pon ing, conditionx of vegetation, etc.) _ i rrr"7 ►4,04 14 s PRIVY: (locate on site plan) Materials of construction: NiO Dimensions: Depth of solids:,V/9 Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) AlryLl 1,5 Am-7— 4P - (rovi..d 04/25/97) P.g. 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 376 Parker Road Osterville Ma Owner: William E Major Date of Inspection: 9/5/9 7 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) e2 r � 1 I � Y 9 x' � o o yr �376 .oACkeT (revised 04/25/97) Page 9 of 10 Vu SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 376 Parker Road Osterville Ma Owner: William E Major Date of Inspection: 9/5/9 7 Depth to Groundwater /�1 Feet Please indicate all the methods used to determine High Groundwater Elevation: I Obtained from Design Plans on record observation o Site (Abutting property, observation hole, basement sump etc.) �etermine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records _Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be complete �¢ ;�.'✓i� ,9 � �cT- P,�r4 v9 3ow 'W'v `re./T y � (revised 04/25/97) Page 10 of 10 ( r+•„+ n..•"t�-r.�.rn�/fr'n mrs—+..'T+r.T n:•.T•.+•rTr:�nTT1L*��InT a i--r.--r-:—+.T—� _ ._ ' TOWN OF Barnstable WARU OF 11EALT11mTr••--a'+ra- SUBSURFACR 1111A01 11I1I'OSA1 ,SYSTF,M INSPECTION FORM - PART U - C111'11111ATIO � -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 376 Parker Road Osterville,Mass. ASSESSORS MAP , BLOCK AND PARCEL OWNER ' s NAME William E: Major PART D - CERTIFICATION NAME OF INSPECTOR Joseph P. Macomber Jr . COMPANY NAHE Joseph P . Macomber & 'S`on , Inc . COMPANY ADDRESS Box 66 Centerville , Ma . 02632-0066 Street Town or Clty St.tI t;P COMPANY TELEPHONE (508 775 -3338 FAX ( 508 ) 790 -1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system n : this nddress and that the information reported is true , accurate , and complete as of the time of .-inspection . The inspection was performed and an,,, recommendations vegarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance o : on- site sewage disposal systems . Check one ; Sys tevi PASSED The inspection (4hich I have conducted has not found any information which indicates that the system fails to adequately protect public health or Lhe environment as defined in 310 CMR 15 , 303 , Any fail(, re criteria not evaluated are as stated in the FAILURE CRITERIA sectic,; o " this form , XXXX.XXXXX>;i,'.System FAILED* ` The inspection which I have con\__�ucted has found that the system fn : ls _o Protect the }public health and the environment in accordance with 5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , Inspector Signature Date �7 One copy of this c t.ification must be provided to the OWNER , the BUYER ( where a pl icable ) and the DOARD OF HEAL7'!I , • If L h e Inspection FAILED , the owner or•"oporator ehall upgrade the eyote ^. - ir.hin one year or the date of the inspection , unless allowed or requires' otherwise as provided in 310 CFIR 16 , 305 , parts! , dc �G W Ul :C7 7 I'7 y _ Sb'yV �71 THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIERONMENTAL PROTECTION DE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE S SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws_ Issued by The Department of Environmental Protection_ Junc 8, 1995 Acting Dircctor of the ion of Wvcr�PoLlu�tionontrol . No.� G�� THE COMMONWEALTH OF MASSACHUSETTS FEE 56' BOARD OF HEALTH T� 0 F APPLICATION FOR DISPOSAL SYS EM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) - ❑Complete System ❑Individual Components Soc�tion% Owner's Name k�lp/Parcel# Address Lot# TelepF�one# K � IJ'sNarye- _ S�� si er'sName Address�a.'CJN` —I:elelf # phone# r Type of Building: Lot Size Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min. equ'red) iO�,49 gpd Calculated design flow ��d gpd Design flow provided W gpd Plan: Date Jt' Number of sheets Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation l�1� DESCRIPTION OF REPAIRS OR ALTERATIONS a49 v't! -C The undersigned agrees install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees�t placeett'he system in o ration until a Certificate of Compliance has been issued by the Board of Health. Signed �-'S Date Z2 — </�`--0 FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 _ 'No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTHOf 1 OF it xi / Jr / APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) - []Complete System ❑Individual Components Location Owner's Name p/Parcel# Address j 1, Lot# Telephone# Installer's Namme q AA Desi er's Name 511 Address 'g X Address Tele�hon�# T✓el phone# i { Type of Building: Pirc_1. Lot Size Sq.feet j Dwelling—No.of Bedrooms D Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures i Desi n Flow min. a u'red .0 D d Calculated design flow �I d d Design flow provided d g ( q ) gP g gp g P gp j Plan: Date_' S ZO I'1� Number of sheets Revision Date .� Title I i Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation vl/ DESCRIPTION OF REPAIRS OR ALTERATIONS ` c�if1 riiJ C The undersigned agrees install the above described Individual Sewage Disposal System in accordance with the provisions of /t° TITLE and further a rees of to°f lace the system in o era6on urifil a Certificate of Compliance has been issued b the Board of Health.5 P' 9 P Y Y � Signed~` Date �7'�--- Ipspe�ttens i FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 ! a-.-----:--- a-------�--1--r_.--a.-.---sue-- ® -----.---mom------- -------a-'--—ST�r^'.�..vLt•d' No. sW�J 7 THE COMMONWEALTH OFMASSACHUSETTS FEE ` + OARD OF- HEALTH � CERTIFICAT OF COMPLIANCE vs . Description of Work: ❑ Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ),Upgraded( ),Abandoned( ) by: at ,4 7-C�4 lC r�.�- / ETr�✓s � has been installed in accordance-with the provisions of 310 CMR 15.06 (Title 5) and the approved design plans/as-built plans relating to application No. dated/ 7 :�u Approved Design Flow 66 (gpd) Installer J Designer: Inspector 4-C&, t alDate /ZO/zcv The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 _ .---= � -—--— _———— —---- ---——-----—— -----.--•—'— — -- -- — No. THE COMMONWEALTH OF MASSACHUSETTS FEE II BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ), Abandon ( ) an individual sewage disposal system at -3176 J�X> ` as described in the application for Disposal System Construction Permit No. dated Provided: Construction shall be completed within three years of the date of this pe t.All local conditions must be met. Date " 1 Board of Heal FORM 2 - DSCP DEP APPROVED FORM 5/96 c FORM 1255 (REV 5/96) H&W HOBBS&WARREN TM PUBLISHERS- BOSTON ' Barnstable BIKE Town of Barnstable � r 9s w , Re ulator Services Department ,6,9. Q Public Health Division 2007 200 Main Street, Hyannis MA 02601 Office:508-862-4644 _ Thomas F.Geiler,Director Fax:508-790-6304 Thomas A.McKean,CHO. To: Date: April 1, 2009 Stella Przirembel Whitcomb 131 Cliff Road Wellesley, MA 02181-2712 RE: Underground Storage Tank at: 376 Parker Road Osterville, MA Map Parcel: 115031 Tank NO: 1 Our records indicate that your underground fuel (or chemical) storage tank is over 30 years old, and has not been removed as required by section 326-3: subsection 2 of the Town of Barnstable Code regarding fuel and chemical storage systems. You are directed to remove this tank within sixty(60) days from the date of this notice. After your tank is removed, please furnish this office evidence in the form of a permit from your local Fire Department within ninety(90) days of the receipt of this notice. You may request a hearing provided a written petition requesting same is received by the Board of Health within ten(10) days after this order is served. Per Order of the Board of Health Thomas A. McKean, RS, CHO Health Agent Town of Barnstable Regulatory Services f RAR.STAUM g Y t M&.� Thomas F. Geiler, Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 To: WHITCOMB, STELLA PRZIREMBEL;P Date Tuesday,February 20,2007 %WHITCOMB, STELLA PRZIREMBEL E 131 CLIFF RD WELLESLEY MA 02181 RE: Underground Storage Tank at: 376 PARKER ROAD ` Map Parcel: 115031 Tank NO: 01 Tag NO: 0 Our records indicate that your underground fuel(or chemical)storage tank is over 30 years old,and has not been removed as required by section 326-3: subsection 2 of the Town of Barnstable Code regarding fuel and chemical storage systems. You are directed to remove this tank within sixty(60)days from.the date of this notice. After your tank is removed, please furnish this office evidence in the form of a permit from your local Fire Department within ninety(90)days of the receipt of this notice. You may request a hearing provided a written petition requesting same is received by the Board of Health within ten(10) days after this order is served. Per Order of the Board of Health Thomas A.McKean,RS,CHO Health Agent SMEAD No. 1011A 2-1531_ MADE IN i-% GET np!;ANIZED AT SME4n-f�^►1 ! T.O.F. AT EL. 18.1' SYSTEM PROFILE _ TEST HOLE LOGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) :! AH OJALA, PE— ACCESS COVE? (WATERTIGHT) To ENGINEER: mewls uuE FEL. 16.0' WITHIN s" OF FIN. GR,aDE r- DONNA MIGRAN(�l, RS 2% SLOPE REOUIRED OVER SYSTEM ` 17.0 — 1 6.0'" WITNESS: SEPTIC TANK #1 DATE 5/9/00 1 RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE : FOR FIRST 2' \ r> ! / EXIST. C.I. PROPOSED 1500 r ERC. RATE _ < 2 Mlty,/INCH o ' INVERT r:EG+ POND GALLON SEPTIC 13.77' �, I 9744 wlnCLUUSNO coLE Locus w H-20 HIGH CAPACITY INr ILTRAT. CLASS SOILS P# 14.02' TANK (H- 10 } GAS BAFFLE 13.28 13.11 00o TI- coo MIN o 13.03' _ - =_ CD VARIES ( 2 % SLOPE) �__6" CRUSHED STONE OR MECHANICAL DEPTH OF FLOW = �_ COMPACTION. (15.221 [2]) MIN ooc�Qo 10 Q 12.19' Q ELEV..4' 2` jµPwA� R° TEE SIZES: MIN { 1 % SLOPE) 0 17.4 0' INLET DEPTH = 107 ( 1 % SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED ,TONE 0 & A EL. 12.0' OUTLET DEPTH = 14" SL 5 8' 3" 1 OYR 4/2 LOCATION MAP NO SCALE SEPTIC TANK #2 PROPOSED 1500 LS ASSESSORS MAP 115 PARCEL 31 GALLON SEPTIC 6 95' 1OYR 5/6 7.2 TANK (H- 10 ) GAS m``m 24" 15.4' PLAN REF. - LCP 7686 WATERPROOF BAFFLE �m�`� �P FLOOD ZONE: C 3 @ m 2% SLOPE N C � EL. 6.46" CRUSHED STONE OR MECHANICAL QJ� y�� ' COMPACTION. (15.221 (21) PROVIDE MIN. 2' COVER OVER PIPE CIR PERC MS USE INSULATING BLANKET 2.5Y 7/6 ALARM AND CONTROL PANEL TO BE INSTALLED INSIDE }� ���, �,� ;1 ,,z;, BUILDING. ALARM TO BE ON INV. IN 6,60' ' SEPARATE CIRCUIT FROM PUMP 2" PRESSURE PIPE TO D'BOx 1000 GAL. H-10 �/ PROVIDE TEE AT D'BOx 800 GAL.+ PITCH TO DRAIN BACK TO PC ALARM ON WEEP HOLE � FLOAT SWITCH RESERVE ( SETTINGS: PUMP ON -CHECK ' ! 4' WORKING RANGE B. VALVE , ZOELLER 'WASTEMATE' C 4' SUBMERSIBLE MODEL M282 1/2 HP PUMP 132„ 6.4 _ ! PUMP OFF 4' SYSTEM (OR EQUAL) ! ! NO WATER ENCOUNTERED NO I ES: ! ! ' PUMP CHAMBER -'COMPACTION.6" CRUSHED STONE.OR MECHANICAL r. ._, -R NOT ALLOWED � APPR:i i'vA `,TED FROM QUAD MAP I (15.221 2 ) ScP - DLS!GI�. (G r �t DISPOSER IS. ) DATUM IS - _- ._ . EXISTING #7 (NOT TO SC LQ 6 E =I)Rr OMS GPD) 2. MUNICIPAL 'yATER IS ------ - ! (WATERPROOF) _ NOTE: CONTRACTOR TO MACE USE 6r0. GPu DESIGN FL O'/%' 3. IM 1; : sui'A F_Ir { M i I (� i r^ 1�I r- n ! o EVERY EFFORT .TO AVOID SEPTTANK: 6r0 G D ( 2 ) 1320 CJ 10 r 4. DESIGN �OA�II� , FOR ALL PRECAST Ulr!TS TO 8� A„5H0 H- i `•.� (#5 CUTTING OF TREES. — - -- 5. PIPE JOINTS TO BE MADE WATERTIGHT. ! p COORDINATE WITH OWNER. USE J•2) 1500 GALLON SEPTIC TANKS ! I v 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. ! I! cgs 1 as ENVIRONMENTAL CODE TITLE V. LEAC r ;ING: &Vw T- v N/A 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE --�4 SID S: -- --.—____ -- USED FOR LOT LINE STAKING. �' t ��<oJ,• oh BOTIJM: 40 x 22.5 (.74) i = 666 GPU 8. PIPE FOR SEPTIC SYSTEM! TO SCH. 40-4" PVC. ! `1 900 666 9, COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT TO S.F. GPD � 3 U�r LEACH FIELD OF H-20 HIGH CAPACITY INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTF,INED _ FROM BOARD OF HEALTH, G INV _ IN[-ILTRATORS AND STONE (SEE DETAIL) 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) EXISTING CESSPOOLS, 1 I r) ------ -- - — �' EXIST. EXIST I , LEGEND WORK LIMIT LINE OF (2. 1 BR DECK = 1 I I STAKED SILT FENCE COTTAGE < I CESSPOOL {U `� QC� PROP sT a 1 GO 0 PROPOSED SPOT ELEVATION '� j ( n n, w j L _ to �.� �°.� AAAA , 1 Lr ; I I D �- ___�� , BtNCHM:.RK: STAKE W''TH TaOK 1 0Oy0 EXISTINGSPOT ELEVATION OF Ld I ---- x 2�?9,QD' SST o ! ( AT ELEVATION 12.3' j� /� �? 7 /� 4 r 6 [ ' I .v _ i ? I -- --- StU COIN I UUit Q TN ,... - - IN THE TOWN O Q j HOLL.YS + I T -- Inn - r ^bpi r1 !�? T � � 'jam/7• [�� s_ T 1' �-� L_1 T f T I \ \d j ',�j { n r; , 1�1(1 P X li ly,I _/., 1 TER 1 l.� r'r � _j .�: . � I I 1 ,( I NEC P O a n } � r L s� � l I I I ( T` i_.7-`I'?� �\ rtvE�,T BLLo� ;s PINE_ rtE - _. --._. ----— 1 _ Al P PARED FOR: STELLAJ a ss3 #1� d - j \ l ! o -_ - � I pLu ;r, ry i}_ nL-RO�IcD To tires PI I UH PINE O / CONNECT TO NEW SEPTIC fAClLiiii 1 I o \ WATERL;NF re i NV = 14.4' 30 0 30 60 90 EXIST 5 `- 1� �F' LEACH FACILITY (NITS) I \ PROP. ST 1 B�r�I?M. J BOARD OF HEALTH DWELLING DE I AIL I �\ TF = 18.1' MA SCALE: 3G 1 - DATE: rar.v 20, 2000 SASE MENT SLAB I� AI tv v i � Dti ' ' — -- ------------------ U�El _T I I 2' i I L.�. ( i � 22.5 k off SC3-362_ 0 . � fax �08 32-S88680 I I UTIL POLE -- 2 1 1 3 down cape engineering, ine. s , CIVIL N; - I I CIVIL ENGINEERS �� N � 1 F� �� " No 3,0`2 - - - _ ._ I I � l'� _ �.d,� ♦ irk �,:.`-iC 1+1a, 3_'+.GA-+rCe:ri ✓ r.,ti m n r n �-'- I �. ) / s9 _:,�s_ l✓� t 4ti� ' I ✓U� I I - 9 39 main st. yarmouth, ma 02615 00-082 I _