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0015 PINE LANE - Health
15 PINE LANE, OSTERVILLE A=118 - 90 I TOWN OF BARNSTABLE wtOFTHErO OFFICE OF i EAINSTAIM i BOARD OF HEALTH b,6s. op i639 . 367 MAIN STREET a Mph a� HYANNIS, MASS.02601 May 23, 2000 Peter Sullivan, P.E. Sullivan Engineering P. O. Box 659 Osterville, MA 02655 RE: 15 Pine Lane, Osterville Dear Mr. Sullivan: You are granted a variance on behalf of your clients, Edward and Sally Marney, to replace the septic system at 15 Pine Lane, Osterville. The variance granted is as follows; 310 CMR 15.22(1): To install a soil absorption system only five (5) feet away from a property line, in lieu of the minimum ten (10) feet setback requirement. The variance is granted with the following conditions: (1) The property shall not contain more than three (3) bedrooms. Dens, study rooms, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed restriction at the Barnstable Registry of Deeds which restricts the property to a maximum of three (3) bedrooms. A copy of the recorded deed restriction shall be submitted to the Health Division prior to obtaining a disposal works construction permit. marney tr This variance is granted because this proposal is to replace an existing septic system which is located approximately fifty (50) feet closer to the wetlands (Sam's Pond) than the new proposed soil absorption system. Also, the engineered plan meets all of the maximum feasible compliance standards contained in Title V, the State Environmental Code. Sincerely yours, Susan G. R�Ak R.S. Chairperson Board of Health Town of Barnstable SGR/bcs marney TOWN OF BARNSTABLE LOCATION �� h�' �A/1 E SEWAGE # VILLAGE 1,1514 1O;,E/e ASSESSOR'S MAP & LOT t� INSTALLER'S NAME&PHONE NO. 1C�`�y �dilS SEPTIC TANK CAPACITY /SD + LEACHING FACII.ITY: (type). (size) NO.OF BEDROOMS BUILDER OR OWNER y PERMIT DATE: 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 J , i SZj pQ �. 0 tj No. 340.& Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppitration for Mt5pogar *pztem Conotrurtton Verna Application for a Permit to Construct( )Repair( )Upgrade(X)Abandon( ) Complete System ❑Individual Components Location Address or Lot No. 15 P he / Owner's Name,Address and Tel.No. Sid- '/a8" eo/96 P a L d)Born e /77it rnz;Y v- sal/y /9• Assessor's Map/Parcel /!) /le ��rG�/ a B /q r/ Pri r,ce- !9 ve . a fv m'-Is /r rn 4 0 a 4-ye Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Peter Sv//i'vf,7 pE 2? Type of Building: Dwelling No.of Bedrooms ih-A10-ot Size 0-33 Acre. Garbage Grinder(�✓� Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow '"L) gallons per day. Calculated daily flow -3iO gallons. Plan Date 127&,r /a dOOO Number of sheets / Revision Date h o Title 5i'fc Plan160^U�Q ode pin' �us�eJW U�41_tf... �i SU-11,'ra 7 t/7y zhr . Size of Septic Tank /500 !/Za_1/04 Type of S.A.S. Lc2chi� ChctmLY-JtnA Description of Soil 0--3 ,1 (r ao e /'yJQ�e r, 3- 7/' brn e0ars—, os a ti L /D r 61 'Id e-„ �f tee ',,A brh i%cr.4 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by1ktjs Board of Healt Signed Date_ (1� Application Approved by Date S"-2-2-do Application Disapproved for the fo owing reasons Permit No. -logs., e 7 Date Issued y� s t -- .41 No. : t� — t „� Fee ! THE C'OMMONWE'AL W-GiF MASSACHUSETTS Entered in computer: -.....oI Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pprication for Digpogar *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(K)Abandon( ) Complete System O Individual Components Location Address or Lot No. /5 10 i2e I a.. /k. Owner's Name,Address and Tel.No. tJ 0e- V_?e - e,/,/J`^• Dst erV0 r, /n q L djs0i1 e /71arnel w Sally /)vtr'.J Assessor's Map/Parcel h� //? ,()r��/ �Q 11 � tj jV IS iq�� %, /yr,q •J Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. j 0 `'/•;? .3 S/t� Peier Sv111'14q iaC �7l •��I \ � /•�a r/Le r ��.., d,;;fcrV�%!r, J•77N 0��5:� Type of Building: + Dwelling No.of Bedrooms !n•i/6p�of Size Os321944W Garbage Grinder(AV Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 3 Desi n Flow '•� ��gallons per day. daily flow .3 gallons. g g P Y Y Plan Date MIr /09 a000 Nuymber of sheets / Revision Date n D Title Sr% P/ar7 itOegtut -feig7 /,/ st Sc.r/l)'tal Lr I. SizeV Septic Tank ,500 a// Type of S.A.S. Lca ch C'han� Description of Soil; .3 " 7 bra BOarG-, gS&rW- /dqr 6 3 0 'Ir ,:�a r7d,- /d G/G 4"4 e04,-[0. st,lk O�Srr. 6/4 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by s Board of Health c Signed mw..Y \ Date Z k '0 Application Approved by Date - Z2_ &o Application Disapproved for the fo owing reasons Permit No. anod - " ,7 Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance <Rep THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed(✓ ed( )Upgraded( ) Abandoned( by c Ure V & at J /'ice 72e O fc r✓i // has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 34,.yi- G d 7 dated i Installer A Designer The issuance of this e s 11 b cjstrued as a guarantee that the s ill function as desi led. Date / Inspector � '�t/ ——————————————————————————————————————— No. 3 o7 Fee (r7 iv THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migozar,�ut Con.Mructiort Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at /.,S /�i h G k a rt.e s 6 ,7(c r Y i'//e- 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. Date: /�.- -��' Approved by�� ~ LAW OFFICER OF JOHN R. ALGER, P.G. { ATTORNEY AT LAW 8845 MAIN STREET P. O. BOX 449 OSTERVILLE, MA 02655-0449 TELEPHONE(508)428-8594 FAX (508) 420-3162 May 31, 2000 Ms. Susan G. Rask, R.S. Chairperson Board of Health Town of Barnstable 367 Main Street Hyannis, MA 02601 Re: 15 Pine Lane Osterville Dear Ms. Rask:. I enclose herewith a copy of a deed restriction in connection with the above property which has been recorded in the Barnstable Registry of Deeds in Book 13038 Page 144. Very t ly yours, JRA/bt Enclosure c.c. Sullivan Engineering, Inc. Y;• DEED RESTRICTION WHEREAS, Edison C. Marney and Sally A. Marney of 199 Prince Avenue, Barnstable (Marstons Mills), Barnstable County, Massachusetts are the owners of a certain parcel of land together with the buildings thereon at 15 Pine Lane, Barnstable (Osterville), Barnstable County, Massachusetts by deed from Lawrence Wray et ux recorded in Barnstable County Registry of Deeds in Book 12637 Page 58. WHEREAS, Edison C. Marney and Sally A. Marney as the owners of said lot have agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre- condition to obtaining a variance from the State Environmental Code, 310 CMR 15.21.A and to obtaining a.building permit for this lot; WHEREAS, the Town of Barnstable Board of Health, requires that said restrictions be put on record in the Barnstable County Registry of Deeds; NOW, THEREFORE, Edison C. Marney and Sally A. Marney do hereby place the following restriction on their above-referenced land in accordance with their agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: Until such time as technology changes and the Barnstable Board of Health changes its regulations or otherwise grants permission, said premises at 15 Pine Lane, Osterville may have constructed upon the lot a house containing no more than three (3) bedrooms and agree that this shall be a permanent deed restriction affecting said premises. For title of Edison C. Marney and Sally A. Marney see the following deed: Book 1263 7 Page 5 8. Executed as a sealed instrument this day of , - 2000. EDISO C. M Y ,r /-SALLY A.,MARNEY C J COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. 2000 Then personally appeared the above- named Edison C. Marney and Sally A. Marney and acknowledged the foregoing instrument to be their free act and deed before me Notary P;blic' v My commission expires: //- o c7/ I _ t Name: Address: Villa e:` OU_ INDO .HI SPE Sauna:_Bathing Ld Lifeguard Swimm PINEBROOK CONDOMINIUM TOWNHOUSE TERRACE HYANNIS, 1 0 0 19 NO YES RESORT AND CONFERENCE CENTER OF HY 35 SCUDDER AVE. HYANNIS, 1 ' 1• 1 1 ++ YES No 9 YES SANDY TERRACES ASSOCIATION 570 WAKEBY ROAD PO BOX 24 MARSTONS MILL 1 11 0 1 H D. YES F THE HOLIDAY INN HYANNIS 1127 IYANNOUGH ROAD HYANNIS, 0 1 1 0 0 19 YES TRADE WINDS 780 CRAIGEVILLE BEACH ROAD CENTERVILLE 1 0 0 WEEKES CROSSING COMMUNITY ASSOCIAT PO BOX 834,257 PERCIVAL DRIVE WEST BARNSTA 1 0 0 19 YES Y.M.C.A. 2245 IYANNOUGH WEST BARNSTA 0 2 0 YES,CE YACHTSMAN CONDOMINIUM ASSOCIATION 500 OCEAN ST.#19 HYANNIS, 1 10 0 20 YES NO w Ci�doo�, o �-f��orF60k 15 wiv fools f No.... ®:_ 3 Fi$ ............ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ,Q TOWN OF BARNSTABLE Appliration for Uiipnsal Mirkii Tonstr7aIndividual n rrmi# Application is hereby made for a Permit to Construct ( ) or Repair ( Sewage Disposal System at: .........s...---_..__........................................................................ --••-•--- -•-•--_.. ....------_..._ ._......._....-.-..........--•- Location-A d r t No. V`l 1) d es Installer A ress dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.................... ' ..........Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons____________________________ Showers — Cafeteria Q, Other fixtures ----------------------------------- --- d W Design Flow..........................................._gallons per person per day. Total daily flow............._..............................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth.......... x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area_...................sq. ft. Seepage Pit No---------_---------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank .( ) ~' Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ 1� Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water........................ a •-------••-•-•----•-••------•--••••---••--•••---••---•---•-•••-•----•-•--•-•--------------.................................................................. 0 Description of Soil......................................................=........................x W ------------------------------------------------------------------------------------------------------------------ ---------- -------•----------------------------------- UNature of Repairs or Alteration A swer w applicable___ -------- . -----------•----••--•-----------=------------------------------------------------------------------------------ Agreeme4►t: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Envir me 1 Code—The undersigned further agrees not to lace he system in operation until a Certificate of Corn ante be t e and of health. Sign ---- ... -� ...---...I��------- - ------------------- ........ �C1 g ---- --- -------------- Date Application Approved By ------------ ......... .... ........ ..... Date Application Disapproved for the following reasons- --------------------.............................................................................------ --------------------------- --------------- -- ---------------------------------------------------------- ---- ------------------------------------------------------------------------------------------------- -------------------------------------- C� Date PermitNo. ............/..o.....�Q../--------------------- Issued ------------------------------------------------------------------- Date rJ u No..---�---��--- �rs_I - _ Fps..---..•.�...-�............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF -HEALTH TOWN OF BARNSTABLE 66fAj O Applira#iun fur Dispu.ittl Warks Tuntrnrttun ramit t Application is hereby made"for a Permit to Construct ( ) or Repair ( �, an Individual Sewage Disposal System.at: ................_............-....... ....---- .. .--..----- •---------- �� -- --- ......................." _ � --• - .: Location-A r t No ; or o ner dd ss w � a --C_�_...................................... �...................... !!� Installer Adflress d Type of Building I Size Lot----------------------------Sq. feet U Dwelling No. of Bedrooms...... Attic ( ) Garbage Grinder ( ) p., Other—Type of Building ____________________________ No. of persons............................ Showers ( R') — Cafeteria ( ) PaOther fixtures ------------------------------------------------------------••-•------------------------•---------------•--••-----•-•••-••--------•-•••....:._..___. W _ Design Flow............................................gallons per person per day. Total daily flow................................:...........gallons. W — :Septic Tank—Liquid capacity............gallons Length------_-------- Width................ Diameter----------_ _Depth__!!:�______-. x rDisposal'`I reach—No.____•__•____________ Width.................... Total Length____________-------- Total leaching area.........:..........sq. ft. Seepage Pit No-_------------------ Diameter---------------..... Depth below inlet.................... Total leaching area_.______.__.._____sq. ft. Z �� Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date......................................... Test Pit No. 1................minutes per inch Depth of Test Pit____________________ Depth to ground water------------------------ r3;4 Test yit No. 2................minutes per inch Depth of Test Pit__-_________________ Depth to ground water___________________-___. " 9 --------------------------••----------------------------...------------•---•-------•-•-•--•--------------•-•---•----------------•-••-••-----._...--•--....-- Descriptionof Soil...............................................................................-----------------------•--------------------------------------•-•--•••-------------••--- U ---------------------------------------------------------------•--------------------------------------------------------------------------------•----------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------W V 'Nature of Repairs or Alterations h Answer w applicable -------�M ------------------ C ---------------------------------------------------------------------------------------------------------------- Agreement: ' The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Envir en 1 Code—The undersigned further agrees not to lace e system in operation until a Certificate of Com ancen bee s d"byte and of health. Signe ... '7 g U --- --- ---------------- - Da[e Application Approved BY -�-t .: --'.. date Application Disapproved for the ollowing reasons: -----------------------------------------------------------------------------------------------------------\K.-------------------- ----------------------------------- ---------------------------------------- • � Da[e PermitNo. ............ ....... -_------------------_- Issued ................--------------------------------------------------- Daze THE COMMONWEALTH OF MASSACHUSETTS c' BOARD OF HEALTH \_ TOWN OF BARNSTABLE Tertificttte of C antpliance T O CER That the Individual Sewage Disposal System constructed ( ) or Repaired ( �� by---- a ..................................................------------------------ at ---- -�...---- -... -----d -------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ---------9 ---- ----01......... dated --------------- ------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE,CONST .UED'AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIONSATISFACTORY. 1 DATE.. _-1 .+. .!,� - - - Inspector / /(... V THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �� _ �� TOWN OF BARNSTABLE No. .................... FEE... Permission is hereby granted- --- t........... ............................................ to Construct (c----) br Repair ( an ndiuiriva Sewag Disposal System Street as shown on the application for Disposal Works Construction Permit No..�_t�'_�� Dated.......................................... ------------P ----------------------------------------------------- DATE...............-................................................................ Board of Health FORM 36508 HOBBS h WARREN,INC..PUBLISHERS i Apr-26-00 09:03 BARNSTABLE HEALTH DEPT 5087906304 P.02 Y + DATE: U� FEE: �`� eARWSTeetB MASS. 059. tee$ REC. BY 19 ` Town of Barnstable � , 9MED. DATE: Board of Health 367 Main Street, Hyannis MA 02601 - Office: 508-862-4644 Susan G.Rask R.S. FAX. 508-790-6304 Sumner Kaufman,M.S.P.H. Ralph A.. urphy,M�9'. VARIANCE REQUEST FORM rp LOCATION 1 /' '�` y 0 Property Address: J �I N E L4�1 C �T�e-V I LL-C e99ymr ?o� - T� O Assessor's Map and Parcel Number_ 1 S f � Size of Lot: d 3'J R c- , Wetlands Within 300 Ft. Yes Business Name: No Subdivision Name: APPLICANT'S NAME: ED M A P--�E� Phone Did the owner of the property authorize you to represent him or her? Yes X No.— PROPERTY OWNER'S NAME CONTACT PERSON Name: E O A JA LLA M Ae lUt C— Name:—PC-i37 2- U L L k 034t-A �t Address: s t't WI C LA►y'E-I ro 1 l(U 6 Address: F0601C 6 Se) On, I t_(_C, Phone: '� - / Jf Phone: VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) 3to CWlIZ 15 a 2%4. CIL v1A:yU SETPJAUCS t=2o66j YI&A-A, Fe=o,,&t9,L6 Cor.-,et-tAVVC4 PapPe�i-f L t+y a �o Fee V-GiSwk RG 0 MEG F-1- ILEQUt�CCt7 Check lisl(to be completed by oofce staff person receiving variance request application) Four(4)copies of engineered plan submitted(e.g.septic system plans) V Four(4)copies of floor plan submitted(e.g.house plans or restaurant kitchen plans) 16--- Signed letter stating that the property owner authorized you to represent him/her for this request v Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee co llected(no fee for aRgaard mods ieation renewah.greau trap (same o"ttliexuee eny),ours de dining variance«ncwals 133me ownedleaeee only],end Variances to repair railed sewage dhposal systems lunly irtuo expansion to the building proposedl) _ Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Ralph A. Murphy,M.D. Q:/WP/VARIREQ f P. F2 tee Wo - ram♦ Sullivan Engineering, Inc. 4 7 Parker Road Box 659 Osterville MA 02655 Peter Sullivan P.E . Mass. Registration No. 29733 Phone 508-428-3344 fax 508-428-3115 mail,PSullPE@aol.com ABUTTER NOTIFICATION LETTER RE: Board of Health Variance Request As a direct abutter of a proposed project, please be advised that a Variance Request has been filed with the Barnstable Board of Health. The project information is as , follows: Applicant Edison Marney Project Location 15 Fine Lane, Osterville (Map 118 Parcel 90) ' Project Description Install septic system to maximum feasible, compliance (requested variance to property line. setback-10 feet required/5 feet provided) Applicant's Agent Peter Sullivan PE Sullivan Engineering Inc. P O Box 65917 Parker Road Osterville, MA 02655. Public Hearing - School: Administration Building - Conference_ Room Date: , 2000 Time: 'Meeting starts at 9:30 AM , Plans and the application describing the proposed activity are on file•at the Board of ' Health office at Town Hall in Hyannis 508-862-4644 and at Peter Sullivan's office_ Please call if you have any questions. j .. Sullivan Engineering Inc. f Box 659 Osterville MA 02655 Abutter Notification i List of Direct Abutters 15 Pine Lane, Osterville Map 118 Parcel 90 Map Parcel Owner . LL 118 89 Andrew E. & Jane Flacks 25 Pine Lane Osterville; MA 02655 118 91 Donald B. & Sanna Williams 295 Coombs Street Napa, CA 94559 , 142 11` Leroy C. & Claire B. Hopkins 215 Tower Hill Road Osterville, MA 02655' f 35 wr 118 blPAP e O Q 4#31e,� \ write Pilo 33 1 OWE ' T #137 AW142 27' `� / 39 (� N6P 118 / #290 fly \�< UIP 118 97il 8 96 wile 4o wv 42 wile Wile #313 954� p 397 #32 281 O t 100 W1 #142 110 2 #266 43 O 1011 , 2643 #258 MAP 142 #136 47 OIii ve 5" 0 9 le 2 *m Awl 12D r66P 142 4 LOCUS= 4 2 #24 wP a 9 " . : 243-. J61118 MAP 142 9pp 1 44-1 AUP 118 #•t5 #120 89 - #� 161 wrtte 33 0 - - 878 O #45 O W 142 wr' a wW l42 wr 142 1 36 ,l" #129 Will a53' #21s 0 # 12 ✓ 142 831a 'Wile24 86 f O wW142 • wr 142 1� p.. 0 W 142 4+1494 ?�5 $ wWIC wr142- # 0a 0 7 �• O. .••... 142 9 a wr I W 142 26 , O 15 #188 Wr4611 118 AW 142 IW 142 18 9 # # 87 " � 1 11 o 0 6W I O ; r6ru 1 N SCALE: 1 - 50 MAP 118 PARCEL 9,0 . s *NOTE- Planimetriq to 'raphy,and **NOTE:'The parcel lines are only graphic tepresentations DATA SOURCES: Planimohics(man-made features)were interpreted from 1995 aerial photographs byThe James ►*gelation were ma Io meet National of property boundaries. They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1984 aerial photographs by OD Map Accuracy Stan,Flo a scale of do not represent actual relationships to physical objects Cotporalion. Planimetriq topography,and vegetation were mopped to meet National Map Acarary Standards 1"=100'. on the map.. at a smle of V=100'. Parcel lines were digilind from 2000 Town of Bamstable Assessor's tax maps. :..\gisxtllbam\.dgn1ml18p90.dgn Mar.24.2000 13:08:19 I I f1 ' ~ � I 1. o .L .s I IT —T NSENDER: COMPLETE THIS SECTION COMPLETE THIS S ECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Received.by(Please Print Clearly) B. Date f Delivery item 4 if Restricted Delivery is desired. w Print your name and address on the reverse so that we can return the card to you. C. SignaJ ■ Attach-this card to the back of the mailpiece, X t or on the front if space permits. ❑Addressee D. Is delivery address different fro item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No 3. rvice Type lrtA/,'Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes I 2. Article Number(Copy from service label) ;t itttttis i! ft tt{ i ixx , V PS Form 3811,July 1999 Domestic Return Receipt 102595-99-M-1789 T UNITED STATES POSTAL SERVICE Firs.6aass Mail I •. r�i ,Y.. . USPS u• r!vI Permit`Ni�' • Sender: Please prinf youK Qame,:address, and ZIP+4 in this box • SULLIVAN ENGINEERING INC. P.O. BOX 659 7 PARKER ROAD t. OSTERVILLE, MA 02655 ri SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Received by(Ple Print Clearly) �. Date of Delivery item 4 if Restricted Delivery is desired. �� ,9 L p � ■ Print your name and address on the reverse f C.---Si nature so that we can return the card to you. t ■ Attach this card to the back of the mailpiece, ❑Agent or on the front if space permits. m e D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No �95 &vm 41 -55 5 3. Service Type Certified Mail ❑ Express Mail / ❑ Registered ❑ Return Receipt for Merchandise 1 ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes i 2. Article Number(Copy from service label) 41 1;7-2/r/ {it - r 4li9: PS Form 381''T,July 1999 Domestic Return Receipt 102595-99-M-1789 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No. G-10 • Sender: Please print your name, address, and ZIP+4 in this box • I ' SULLIVAN ENGINEERING INC. P.O. BOX 659 +. 7 PARKER ROAD ®STERVILLE, ILIA 026W I J, i I SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Received by(Please Print Clearly) 1 51. Date of D ive_ry item 4 if Restricted Delivery is desired. �� � � C ■ Print your name and address on the reverse C. i nature so that we can return the card to you. �%■ Attach this card to the back of the mailpiece, X �' Agent❑Addressee or on the front if space permits. D. ,delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No CZALJA co S 3. Service Type Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number(Copy from service label) PS Form 3811,July 1999 Domestic Return Receipt 102595-99-M-1789 a UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No. G-10 • Sender: Please print your name, address, and ZIP+4 in this box • � I SULLIVAN ENGINEERING INC. P.O. BOX 659 7 PARKER ROAD OSTERVILLE, MA 026,% r/ 40 DATE:-8/31/99 ---------- PROPERTY ADDRESS:_11•_Pine_Lar2__________ Osterville ,Mass . 02655 0 %D On the above date, I Inspected the septic system at the above s. This system consists of the following: "g n `p 1 . 1-1000 .gallon septic tank. 2 . 1-Distribution box . 3. 2-4 x4 gallies €- Based on my inspection, I certify the following conditions': ® 1999 4. This .is a title five septic system. ( 78 . Code ) 5. The septic system is in proper working orders" t at the present time . SIGNATURE: -14ZIA_ Name:_,L,L, Macomber Jr1______ Company: Jose_2h_P. Macomber_& Son , Inc . ---- ---------Address:- Box- 66 ________ Centerville , Ma . 02632-0066 Phone:___508_775_3338—____ THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY C P. MACOMBER & SON, INC.Tanks-Cesspools-LeachfleldsPumped & InstalledTown Sewer Connectlonsx 66 Centerville, MA 02632-0066 775-3338 775-6412 Mai& ,t COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292.5500 TRLDY CO' Secret; ARCED PAUL CELLUCCI DAVID B. STRU: Governor Co:n,:.sstor SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTiON FORM PART A CERTIFICATION PropeMAddress: 15 Pine Lane Nartw of Owrser Lawrence Wray Osterville ,M ss . 02655 Address of Owner: Dau of lrtspection: 8/3 0/9 9 Name of kupector:(Please Pnno Joseph P.Macomber J r . I am a DEP approved system inspector pursuarrt to Section 16.340 of This 6(310 CMR 15.000) CompanyNanw: J. P Macomber & Son Tnr _ lvt*1ng Address: BA 66 Telephone Number: 568-775-5558 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 kupection. 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 Condidonally Passes _ Needs Further Evaluation By the Local Approving Authority Fails L V kupectoe's Sigrtaoua; Date: The System Inspect shall submit a copy of this Inspection report to the Approving Authority (Board of Health or DEP)within thirty (301 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 owns ' shall submit the report to the appropriate regional office of the Depanment oKnvkonmental Protection. The original should be sent to iris system owner and copies sent to the buyer,If applicable, and the approving authority. NOTES AND COMMENTS e r revised 9/2/98 Page Iof11 `� Pm1ed on R.cyelad Vapor V SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) I PropenyAddrass: 15 Pine Lane Osterville ,Mass . own«: Lawrence Wray Data of Inspection:8/31/9 9 INSPECTION SUMMARY: Check A, B, C, of D: A. SYSTEM PASSES: I have not found any information which Indicates that any of the failure conditions described In 310 CMR 16.303 exist. Any failure criteria not evalustsd are Indicated below. COMMENTS: I B. SYSTEM CONDITIONALLY PASSES: A)-L 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 t 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 Imminent. 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 pips(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 pipe(:) are replaced obstruction Is removed distribution box Is levelled or replaced - The system requlrsd pumphig-mon than-four-times a•Yeardue to broken or obstructed plpe(s). The ryrtam wi tvvr-- Inspection If(with approval of the Board of Health): - broken pipe(s) are*replaced obstruction Is removed s revised 9/2/98 Page 2of11 f 1. f YJ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 15 P i n e Lane O s t e r v i l l e ,Mass . Owner: Lawrence Wray Date of Inspection: 8/31/9 9 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: iyV 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 IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH.WILL.PRQTECT THE PUBLIC HEALTILAND SAFETY AND THE EN)aBONMENT: Cesspool or privy is within 50 feet of surface water 40 Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. I 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 HEALTai AND SAFETY AND THE ENVIRONMENT: AID 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 la 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 disiance .4J,4—(approximation not valid). 3) OTHER revised 9/2/98 Page 3of11 � y f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 15 Pine Lane 0 s t e r v i 11 e ,Mass . Owner: Lawrence Wray Date of Inspection:8/31/9 9 D. SYSTEM FAILS: You LnU3t indicate either "Yes" or "No" to each of the following: 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 • Backup of•towage intofecili"r-eyetem component-due%to an overloaded or-clogged-SiAS-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 01 i�the oiktribution,box above outlet Invert due to an overloaded or clogged SAS or cesspool. Liquid depth in oesspoM Is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more th n 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped T 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. V 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, the system is within 400 feet of a surface drinking water supply the system-is-witWn 200 feet*U*44butery4oa eurfoo"4nk4wg watw--4upPly 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 infor nation. revised 9/2/98 Page 4orii r f k, OF j SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Addres3:15 Pine Lane Oster•v i 1 l e ,Mass . owner: Lawrence Wray Data of Inspection:.8/31/9 9 I �I 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. _ Nona of the systemsompoaants.haw:bsen pawgwd4*rstJeast two�weWw andtha-system hasbeeaasceiaingnsasssal Aow 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, G.Vcluding 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: _ 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)1 The facility owner.(and.OGCilpa625.Jf differaui frnm.oner).+ncataprnyided.with Infntmatioann thA *ansM&4f SubSurface Disposal Systems. I i h 1 I revised 9/2/98 - Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAddress: 15 Pine Lane Osterville ,Mass . Owner; Lawrence Wray Date of Inapectl0 s t e r v i l l e ,Mass . FLOW CONDITIONS RESIDENTIAL: Design flow: 1lb g.p.d./bedro Number of bedrooms d sig ) Number of bedrooms(actual): Total DESIGN flow , Number of current residents: Garbage grinder(yes or no): Laundry(separate system) (yes or _;. If yea,separate Inspection,required --. Laundry system inspected a or no) D Seasonal use(yes or no). Water meter readings,if available(last two year's usage(gpd): 7'�r P �f, Sump Pump(yes or no):A-W , 4 � �J Last date of occupancy: COMMERCIAL/INDUSTRIAL: �� Type of establishment: Design flow: gad ( Based on .,203) Basis of design flow Grease trap present: (yes or no) Industrial Waste Holding Tank present: (yes or no),44 Non-sanitary waste discharged to the Title 6 system: (yes or no)d/ Water meter readings,if available: Last date of occupancy:. OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING R CORDS and source f inJprma SysteFK pumped as part of inspection:1yes or no) If yes, volume pumped: gallons 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) 1/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installediif known)-and Bourse of.information: �. �� f- - Sewage odors detected when arriving at the site:(yes or no) revised 9/2/98 Page 6orII �s (f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 Pine Lane O s t e r v i l l e ,Mass . Owner: Lawrence Wray Date of Inspection:$/31/9 9 BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: cast iron Z0 PVC—other(explain) Distance from�private water supply well or suction line Diameter V_ Comments: (condition of joints,venting,evidence of leakage,-etc.) Joits appear tight , No evidence of leakage . SEPTIC TANK: (locate on site plan) Depth below grade: Material of construction:Zoncrete_metal_Fiberglass _Polyethylene_other(explain) V If tank Is Enetal,list age Js.age.confwmed by Certificate of Compliance (Yes/No) Dimensions 016IIL4 V r11>!!�> Sludge depth: Distance from top of ludge to bottom of outlet tee orbaffie:� - Scum thickness: Distance from top of scum to top of outlet tee or baffle:.Y Distance from bottom of scum to bottom of outlet t or baffle: / 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, structureHntegrity, evidence of leakage,etc.lPump tank every 2-3 years . Inlet & outlet tees are in place . The tank iG gtrnrtnrg11y ennnd and chnwc nn evidenrp of 2lra-ge GREASE TRAP: (locate on site plan) Depth below grader Material of construction:)oncreteA/4metaIV4FiberglassV4Polyethylenec'other(explain) Dimensions Scum thickness: Distance from top of scum to top of outlet tee or baffle:—ALI Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping:A�4 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 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 Pine Lane Osterville ,Mass . Owner: Lawrence Wray Dow atlinspectio+5/31/99 TIGHT OR HOLDING TANKA"(Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade: Material of construction:l/Aconcreta,�/Qmetalt✓AFiberglassA4lPolyethylene4✓,4other(explain) Dimensions: Af Capacity: AM gallons Design flow: AJA gallons/day Alarm present Alarm level: Alarm in working order:Yes44 NoA Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) Tight or holding tanks are not present . DISTRIBUTION BOX.- (locate on site plan) Depth of liquid level above outlet Invert: dJ0 Comments: (note-if level and distribution is equal, evidenoe of solids carryover, evidence of leakage Into or out of box, etc.) -— Distribution box has one lateral . No evidence of solids carry over , No Pyidpnrp of leakage intn or not of the hnx _ PUMP CHAMBER: (we. (locate on site plan) Pumps in working order:(Yes or No) 4)/0 Alarms in working order(Yes or NO-A&I Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) Pump chamber is not present . revised 9/2/98 Page 8of11 1< SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropenyAddres3:15 Pine Lane Osterville ,Mass . O` rw: Lawrence Wray Date of Inspection: 8/31/9 9 SOIL ABSORPTION SYSTEM(SAS):Y (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:_v f� leaching chambers,number:v / leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimens: cesspool,numb Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc.) Loamy sand to honpy f; np Qa.n.rl No sl gas of hydr-aulie CESSPOOLS:XWE (locate on site plan) Number and configuration: Oapth-top of liquid to Inlet invert: Depth of solids layer: Depth of scum layer: DimensioN of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) esspoo s are not Drpspnt Comments: (note condition of soil, signs of hydraulic fallur•,.Isvel of.ponding,condition of.vegetation,, etc.) PRIVY:/,�f. (locate on site plan) Materjels of construe n: N/7 Dimensions: /l Depth of solids: Comments: (not•condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) revised 9/2/98 Page 9of11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFOR) AT10N(c"rdn)od) PrW-vyAd&—: 15 Pine; Lane Osterville ,Mass . Owrw: Lawrence Wray Date of6-Poc :8/31/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include t)ss to at Fast two psrmsnont reference landmarks or benchmarks locate all walls wlWn 100' (Locate whore publlc water supply comas Into house) )uv 9 t revised 9/2/96 Peet 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddreas: 15 .Pine Lane Osterville ,Mass . Owrw: Lawrence Wray Date of kupection: 8/31/9 9 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Walls checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater�'O'Feet Please Indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record bserved.Site (Abutting propert bservatlon hole, basement sump etc.) _ZDatermined from local conditions Checked with local Board of health Chocked FEMA Maps 4 Checked pumping records Checked 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 l revised 9/2/98 Page tlofil a•.TnTw.-n t'R.�TT•rnranrrmnr.r-t.n renrrrlrr.7e•'errrrtrRtrnA9 ftR+t7Fi .TT.'.TT.4��:..z-.r••}. 'TOWN OF Barnstable BOARD OF HEALTH SUBSURFACE SEWAGE (DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION •••rn ter•••::t-Te.a-.-rnmr.+n-+t.+r.rsaesrrtn�rrr.�n•t*-m.r�w+Fisrr�rnew.► MITI" I •.+.-e-r•r.--r—..� -TYPO OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRES$ 1_5 Pine Lane Osterville ,Mass . ASSESSORS MAP, BLOCK AND PARCEL # i I70-in_ OWNER' s NAME Lawrence Wray PART D - CERTIFICATION NAME OF INSPECTOR _Joseph P.Macomber Jr . COMPANY NAME J.P.Macomber & SO -Inc . COMPANY ADDRESS ' Box .66 Centerville ,Mass . 02632. Street Town or City State LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX (508 1 790 - 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposaj 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 . Chec one: Systeui PASSED _ 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 16 . 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 tcted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . 1 �'� Inspector Signature Date D76 copy of this certification must be provided to the OWNER, the BUYER where applicable) and the BOARD OF HEAL11II. * If the inspection FAILED, the owner or"" ` orator shall u P pgrade ' the system. within o•ne year of the date of the inspection, unless allowed or required otherwise as provided in 3.10 CMR 16 , 305 . partd.doc =� TOWN OF BARNSTABLE LOCATION Al"Ve 2,4,y e SEWAGE # 0MO 16 VILLAGE 1-751411.4'1v ASSESSOR'S MAP & LOT_ INSTALLER'S NAME&PHONE NO. 44,614�,t e,&-C SEPTIC TANK CAPACITY 1So 0 LEACHING FACILrrY: (type) (size) /D e Y36 NO.OF BEDROOMS BUILDER OR OWNER l' PERMITDATE: 4�"cff7-d2) COMPLIANCE DATE: — A90 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 o - g CS a Y ij - i TOWN OF 3ARNSTABLE LOCATION 5 L�1-A = SEWAGE # `& 30 VIL-LACE 0 ASSESSOR'S MAP & LOT r INSTALLER'S NAME &PHONE NO.( R\ �C>MVNO '1r11 60 SEPTIC TANK CAPACITY' I � ��• LEACHING FACILITYAtype) C-�cwt- . (size) NO. OF BEDROOMS_ PRIVATE WELL OR UBLIC WATER BUILDER OR OWNER LRU3\ �U�� ,i. go DATE PERMIT ISSUED: lr� .DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No � �� ' jl ��`lJ (Sty 9 a �- -r j y TOWN:.OFI;ARNSTABLE .. . LOC: TION z�— e SEWAGE # �t VILLtf GE ` f ASSESSOR'S'MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /DPI® LEACHING FACILITY: (type) VKIP r 6��'rC/� (size) NO.OF BEDROOMS BUILDER OR OWNER Jglgl�� PERMIT.DATE: COMPLIANCE DATE: Separation Distance Between the: • t Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility I'L'' Feet Private Water Supply Well and Leaching Facility (If any wells exist on.ste or within 200 feet of leaching facility) Feet t,Edge of Wetland and Leaching Facility(If an wet ds exist w h n 300 feet f le fa •lity) Feet Furnished b x 7 'N. i At r rr i r1o.............$ Fxs........ ./...... THE COMMONWEALTH OF MASSACHUSETTS �- BOARD OF HEALTH Appliratiuu for Biuvu.'ial Workg Tamitrurtiun tirratit Application is hereby made for a Permit to Construct ( ) or Repair (,,,.-) an Individual Sewage Disposal System at: �- �_ .... C�.�.........................................................���.�/_,�' ............. 4-''.e.f..........a..... ... Location-Address r Lot No. wa Owner � .......... `.0—� . s Installer Address d Type of Building Size Lot........5701 ...Sq. feet U Dwelling—No. of Bedrooms.....___...,,1...........................Expansion Attic ( Garge Grinder (dt3-� Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures -----.....--••---•--•------••••. ... w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. G4 Septic Tank—Liquid capacit 4jL;cA.gallons Length................ Width................ Diameter................ Depth................ 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 (t.�` Dosing tank ( ) / 1-4 Percolation Test Results Performed by.......................... .. . ... ..... Date.......7f-. t X... �...�� Test Pit No. 1........ ...Sminutes per Inch Depth of Test Pit...... ... Depth to ground water.___.. ... _ fz, Test Pit No. 2....4" minutes per inch Depth of Test Pit...../------------ Depth to ground water-..." ................. .r. a Description of Soil ..-......•..--- x �- x ----------•--- ----------------------•-----------------------.....-----------------•--•-•--•--••-••...-----•----•--••...••----•-----•-•-----•-•------------•--------•-----•------------._.....---....-- V Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'l U 5 of the State Sanitary Code—The undersigned further agrees n to place the system in operation until a Certificate of Compliance has been issued by the board of li th. Signed............... ! /....... ----•• l _----- - - -•- ' Date Application Approved By................. ....... -�---••--•------.........--•-•------- Date Application Disapproved for the following reasons---------------------------------------------------------------•-------------.....--------.......------....------ ....................................................---•----•--•--•---•.........-••-•••••••--•-----•--•---.................-•-•--------•-•----•--•------•-•-•------•--••----••-----------•-••--------- Date PermitNo......................................................... Issued......................................................... Date ....... THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA Nam.,...-------- FEs....... t��. ...... -__�- THE COMMONWEALTH OF MASSACHUSETTS r� BOARD OF HEALTH � - ..Ot4/,00U.........OF.......... ,7 .. ./_.. '. ....... Appliratiou for Disposal Work, Cfonstrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at* .. ! - :.p.1........................... -�--......--_... � /, ..55:: .. c{.�.. ..... _.. . .... Location-Address r Lot No. 47 Owner ess .................................•� ..y.------. l�! " sl/------------................---------- ••- .......-::........--------....... Installer Address Type of Building Size Lot..._.1,-1.42-14....Sq. feet U Dwelling— No. of Bedrooms... fit..:........................Expansion Attic ' Gart/ge Grinder (A'V Other—T e of Building No. of persons............................ Showers QI YP -g ---------------------------• P ( ) Cafeteria ( ) al Other fixtures ................................. . Design Flow............................................gallons per person'per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacit�fjO&..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. _.__.......0...._.. 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.......................... -�.4�!L �,V......��.... Date......_�����'�-- ..... Test Pit No. I......__._..5 minutes per inch Depth of Test Pit...... .. Depth to ground water...... . .b-cuo,. 44 Test Pit No. 2.._.....,,�, ^niinutes per inch Depth of Test Pit----- _.__.__..... Depth to ground water... ............ 0 -_-------•--•---------------- - �....., yF'^% Description of Soil.--------•--------•----------•---......- r ------. V ------------------------------------•--....._........._._...-•-•----• -............ .�''✓" f u�......-------����.-----...----•---......._ W ------ --------------------•----••-•••••-----•-•-•---••-•--------------•-----------•••----•••••--•----••---••---•----------•-•------••--•-•---•--------•---------------•---........-------•------•----- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... --------•-------------------------------------------------------------------------------------------•-•-.......---•----•-•--•---•--•----•--.....••••-----•-•-•--•--•---••-••...............-----•------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIL- 5 of the State Sanitary Code—The undersigned further agrees no o place the system in operation until a Certificate of Compliance has been issued by the board ofrh1th, Signed ........_... . .•• --•-•--- ------ ... ...P- Date Application Approved By................... •.........................•-•--_.... Date Application Disapproved for the following reasons:.............................................................................................................. ----------•-------------•-----•-•-............__...-•---••----------•-•---....••------..............•----•------•..................-•--••--••-•.....•-•-••••-•---•---•--....----•-•----•-•--------.----- Date PermitNo......................................................... Issued_....................................................... Daze THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........� .......OF............... ................................`C.................... Trrtif iratr of Tootpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( /or Repaired ( ) by............................................ r .....PInstdller �� �{?�f.-•-----•-••-=--•...................••----•-•----.......----••----.......... j - �' •f„1" has been installed in accordance with }Iieiro4isions of rIL . of The Sta e Sanitary Code as described in the application for Disposal Works Construction Permit No.. _....... . dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORX,,�_ u _ DATE.=...... ............... �inspector.................................................................................... THE COMMONWEALTH OF MASSAtHUSETTS BOARD OF HEALTH' . f�..4..............OF.....----.. .../,..t�!v`3'.I' �-�`c .................. g.r Ide /.... .... ... Disposal luorks Tonotrttrxion rr Permission is ereby granted......................... ,�++ '__.__.___.-- W......r to Construct or Repair ( ) an Individual Sewage Di Oral System .-- at No..._.. . C - . - .6'Y-X- . • �s,r._>c....... ...... � Street J as shown on the application for Disposal Works Construction Permit No.................. Bo DATE-----------•---- - / /.. ..... FORA 1255`,A. M. SULKIN, INC., BOSTON rV •',., ;; , ♦ '_' t .� �"fr,�,w�''P li w.. fy�s.y rt i i iY.Y r R v�. 3rr r :a- ,, , i { i t4 w f � a y 4-.it) /i'm/,., �p � S!�� �!w^�-• (mot`t 1 3f ., ' f'L'1 � ��GA9b Ilk"r b0 R oo. pati C 10, NJ Qj `� tF ;L.DT { /0792:. ���tN°FM� s y% .Al �S'' 3 3 o 4RSE n No.10951 O �. ��� IF STATE- /-/�✓y4 v�/i � `� o PF /}vices. .-r ' G/5 T E �� w �FSSIONAI-�a� LEGEND EXISTING SPOT ELEVATION 04 jwA.QF CERTIFIED PLOT PLAN � 'ass EXISTING CONTOUR ——— L.o ?- 4 y. FINISHED SPOT ELEVATION RoeERT 1✓/ �- FINISHED CONTOUR " eRuc "' ��ST� . ELDRED w IN APPROVED BOARD OF HEALTHr .< "� ,$`7 E��r�� � � r ` �~ a � w 1 � � 4a® � .�1 i3 1 ..� A .3 -.. ..., �►e1,�� OATS AGENT >: 4 DATE SCALE' L O RED GE ENG/NEER/NG CO. IN CLIENTS i :CERTIFY THAT THE PROPOSED EGISTERE _ REGISTERED t, J08',NO.'` °b..._. BUILDING SHOWN ON THIS PLAN CIVIL LAND _`` CONFORMS TO THE ZONING -LAWS ENGINEni ER Y :` DRBY� L. . OF PARNSTABLE �. MAS . 712 MAIN STREET CH,'8Y J H YA N N I S, MA,9,S.. BHEET'.L OF Z -DATE REG. _LAND SURVEYOR eye nti �j 44 lit t' D- M U m D r N o � o b Ia b i •T � ' p� 4 vJ F: 0 � y R - -R o ri y . o lb 4 2, AC tv t% IvaI . . _ ,.. • Ilk •�• 44 m` m 0 o o ti : . . . . .n . . . � c IP ra t v a. C)yM �' � � L rl � hln �► ht Z 11 rl ?.14. KL. 44.o py„d O oac.ANic. MArmRiAL. r0 O 6 BRN A • COAtSM SAND °o'CJ••�. Jo`eh 1 O Y R 5/3 4• OGJg STRONG t3RN COARSE BRN'154 VILLLQ W C04RSE R + 82 •SAND IOY 6/b 40 40 L.'T.YEQISt-t 6 IN COARSE - is • "D SAND 10 YR G�4 t,� o NO GROUNo WA'rr-k fly SULLIVAN ENG-%N%.UX%tAfr INC •. •• •'r MARCH 2'3�2000 _ ° , •� +� LOCUS PLAN Scale:I"= 2000' Assessors Map I1 g C—a� A. M ' S �� Parcel 90 4 or.�' Zoning RC 2 �. Z2 .• nlwyxyxSetbacks a » Farr,, a.e«"e hn Front- 20 ``. 62 V M Mir Side 81 Rear-15' to Site isinaWelI Protection \ ti. �/q Overlay District(WP) `•••-,,,� g�iv1 � (�M' '� cn.�e.. �-I to .10 0�—� we ANps �'Lr+G�GD CROSS SECTION OFCHAMBER t say t N SR '-:NOT 1a ewtc �d 0 _..__ __... F.G.44.3 FG.44.0 nn 40.8 -�''�-►""'" " � 416 1500 Gallon _ Top El.41.8 ••-M- --� Septic Tank 41'4 41.2 41.0 _.,.. Bedding as 5.3 LOT ARC IG Per Title 5 0°3�Act WORK -tSTAKeo K y 0ALM-5 Sams ams of Test Hole E1.33.5 S Pond El.9.2 - �d �Nc� DELVELOPED PROFILE OF PROPCISE^ SEPTIC S`!ST&r-M Not to Scale g• V6 L-Y Re?MOvti tX15T• SePTIC SnIST'iffM I L st pl • ` �► I WQTES DESIGN DATA `14- L WoterSupply ForThis Lot is Municipal Watt' Single Family-3 Bedroom(Minimum Design) w Pao -.,. Q' 2 Location of Utilities Shown on This Plan Are A ro)L With n l Garbage Grinder AMOITIONg PP Daily Flows 110 z 3=330-GPD At Least 72 Hours Prior to Any Excavation ForThis Septic Tank t330 GPD x 200%=660 GPD Project The ConfroctorSholl Make The Required Use 1500 Gallon Septic Tank cxtST• w/F DWSLLINIC, p Notif ication to Dig Safe(1-800-322-4844). F.F. 46,S I LEACHING AREA ° The Contractor is Required to Secure Approppriate 3 0 G / - - Permits From Town Agencies For Construetioa 6 Required t-- 3 PD 074 44 SF :r Defined byThis Plan. Sidewall =2(10+30')2=160 S.F. N ° le'of Area=Id x30'= 300 S.F^ q 460 S.F.Total Provided o J 4 Install Risen as Re uired to Within 12 of 10 fd -= . Finished Grade. LEACHING CHAMBER DESIGN 64 tw' i� 5.AllStructuresBuried FoIrFeetorMoreorSub Subject'l All Pipet to be Schedule 40. Use d 07 to Vehicular Traffic Lobe H-20 Loading. 2-500 Gal.Leaching Chambers Ina I+ F1 I to6 Septic System to be Insiolledin Accordance Wlih 10't130' washed Stone Field as Shown SRPT%C O k 310 CMR 15.00 Latest Revision And Ttle Town of TQ.NK LT*j I ; \ �I Barnstable Board of Health Regulations p Q {•�I N �� W� T. All Piping to be Sch 40 PVC.- 0, t fi ' _D •.C>'t .1�1 tot 1� � J -----1-----•- •��, to fF tN•1 k Si il.L4vol � 0 �A [�12-� t ,� PAIL I �k1 FEIV G �! 44.'/2 -.�9 �.l' e•-.dr `s`� IAI t UGLU"Tap L ja Directions to Site from Hyannis: Take Route 28 towards Ostervilie; Left onto R�1.OLAT! <xXIST. 6A� p Five Corners Road and stay straight on Five Corners which runs into Bumps River AIL R IN ARtitA oft /)_ Road and stay straight on Bumps River which runs into Pond Street; Take a left onto NRW SY t's•TRM, F`(/ Tower Hill Road; Take a right onto Pine Lane and house is#15. — — — — - — � SITE PLAN - - --- --- — � PROPOSED SEPTIC SYSTEM g>z � �2a xo� UPGRADE PLAN VIEW PER AT of SULI_IVAff Scale: 1 20, NO.29733 15 PINE LANE s c`s/IL o OSTERVILLE, MASS. FOR s`Uf'• �i�' ED MARNEY 0 ALE: AS SHOWN DATE: MAR.10,2000 SULLIVAN ENGINEERING INC. OSTERVILLE , MASS. &TTA("WKAr'n1T A �nn1� I T.H. EL, 44.0 •,• ••a ®, Pb d p ORGANIC MATERIAL O �.J Toad B BRN R. COARSE SAND .:©• �Gvg 10 Y R 5/'S ° 7„ STRONG (3R N COARSE i s n 2b� BI SAND -7;5-.YR T/& ' BRN'ISH YELLOW COARSE \ f „ g2 SAND IOYR 6/6 40 LT.YE12ISV4 BRN COARSE •o• o• •� ,1 C• SAND id YR L/H • • • ' 1 2(i 1 r o•�• � c NO CGROuNb WATER ' ray SULLIVAN ENG-%V4ft8 %NG• INC o••• �. s P��j LOCUS PLAN Scale:I"= 2000' Assessors Map 118 Parcel 90 �f � Z� 1Mi1i eridi Zoning RC ul"� \ 'e..,� Setbacks 1 ie ftbrk aml.aaw fnl Front- 20 ��. V 4 ' Side 8�Rear-15 ~ 6uM �V IF"S101N Site isinaWeiI Protection OverlayDistrict(WP) 13iv1 Cbambw� Doubts Dmbl 1 W "1LANp5i CROSS SECTION OF CHAMBER =LAGbED �'� __.. BY �NSR •.:Nor To sw►I.c An w_ w .: o �_. FG.aa.3 ................. ..... n 11 41.8 _.. 40.8 1500 Gallon Top El.41.8 Septic lank 8 41.4 Bat.El.38, ° ,•,.....«•.''+` ,,.e'er..,.... � ..,. ` 41.2 41.0 _i L `' Bedding as 5.3 .- oT Ar�R E) Per Title 5 Bottom of Test Hole EI.33.5 L.o.33Act p�GE r S.rAVMD 11Yx�! ClALeS Sams Pond El.9.2 0 0 DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM �r © Not to Scale • J 0 $• !ko uY FtEmovaExist. r SPTIC►c sysrEM y i0 ` II.1 NOTES DESIGN DATA W. V �. Single Family-3 Bedroom(Minimum Design) I.Water Supply ForThis Lot is Municipal Water - With no Garbage Grinder pROi�• °id - -�' 2 Location of Utilities Shown on This Plan Are Approx. Daily Flow=110 x 3=330 GPD AaC1'S tcyNS' At Least 72 Hours Prior to Any Excavation ForThis Septic Tank:330 GPD x 200%=660 GPD -- Project The Contractor Shall Make The Required Use 1500 Gallon Septic Tank ° �xIST w/� �7WELI_IIVi i I Notification to Dig Safe(1-800-322-4844). LEACHING AREA IF.F. y 5,S 0 3 The Contractor is Required to Secure Appropriates 330 GPD/0.74=446'SF Required ° Permits From Town Agencies For Construction _ Sidewall =2(10'+30')2=160 S.F. T _ ° Defined by This Plan. Bottom Area=10'x30' = 300 S.F N I 4 Install Risers as Requiredio Within W'of 460 S.F.Total Provided °=1 Finished Grade. LEACHING CHAMBER DESIGN V 5.All Structures Buried Four Feet or More or Subject r All Pipes to be Schedule 40. Use 07 to Vehicular Traffic to be H-20 Loading. 2-500 Gal.Leaching Chambers ina li II r� 6. Septic System tobe Installed in Accordance With 10'x30' Washed Stone Field as Shown 51ipTIC O °[� 310 CMR 15.00 Latest Revision And The Townof 'I`ANK 1 �T�. 0 � \� � tY/�, Barnstable 7. All Piping lobe Sch. 40 PVC. Board of Health Regulations I 000 I •�{ N �tG ���J°�' �° Maximum Feasible Compliance `tJ11N•1 I i q�.,g J'64 Variances Required I z 1 O 14 !, 1. 310CMR15.211(1):Minimum Setback Distances from property line - - - —' A 10(ten)feet required 5(five)feet provided. 6V-� � ,- 1?Ai4 { i aert o� aw-ra' I,Y 1•i' Directions to Site from Hyannis: Take Route 28 towards Osterville; Left onto RIP-t-OCAM111 sy'IST• Gt',s Five Corners Road and stay straight on Five Corners which runs into Bumps River 5ER%4FC6 IN ARC-A OF , Road and stay straight on Bumps River which runs into Pond Street; Take a left onto Nsew sy s�eM, Tower Hill Road; Take a right onto Pine Lane and house is#15. L_ A � -- SITE PLAN -f______ PROPOSED SEPTIC SYSTEM UPGRADE AT �R PLAN VIEW ICI 15 PINE LANE Scale: 1 = 20 l' 0STERVILLE, MASS. <�t FOR i ED MARNEY SCALE: AS SHOWN DATE MAR.10,2000 Revision Add Notation For Board of Health Variance Date:April 26,2000 /0 SULLIVAN ENGINEERING INC. Request /\ OSTERVILLE , MASS. 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