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Home My WebLink About0077 ROBBINS STREET - Health 77 Robbins Street Osterville P A =":141 069 „ . a . , .a 4 ° ° av ° ° n o ° Commonwealth of Massachusetts ,Y/ f 009 y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Robbins Street Property Address A7 James and Kimberly Bletzer Owner Owner's Name ,Q} information is required for every Osterville MA 02655 2/23/2016 page.. City/Town State Zip Code Date of Inspection co cn Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. - Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not David B. Mason use the return Name of Inspector key. David B. Mason Company Name 4 Glacier Path Company Address East Sandwich MA 02537 City/Town State Zip Code 508-367-1617 S1287 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system` ® Passes ❑- Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving.Authority i 2/25/2016 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 } Commonwealth of Massachusetts u r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ,M 77 Robbins Street _ Property Address James and Kimberly Bletzer Owner Owner's Name information ievery s required for Osterville MA 02655 2/23/2016 page. Cityrfown 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: The observations noted in this report represent the condition of the system only on this date of inspection and the information contained herein does not guarantee the continued operation of the system 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts ' R y Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;N 77 Robbins Street Property Address James and Kimberly Bletzer Owner Owner's Name information is required for every Osterville MA 02655 2/23/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational.-System will pass with Board of Health approval if pumps/alarms`are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or breakout 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 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form '. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 77 Robbins Street Property Address James and Kimberly Bletzer Owner Owner's Name information is required for every Osterville MA 02655 2/23/2016 , page. 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 '/z day flow t5ins•3/13 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 77 Robbins Street Property Address James and Kimberly Bletzer Owner Owner's Name information is required for every Osterville _ MA 02655 2/23/2016 page. City/Town 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. ❑ z 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 15,000 gpd. For large systems, you must indicate either"yes"-or"no" to each of the following, in addition to the questions in,Section D. . Yes No ❑ ❑ ' the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant'threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Robbins Street Property Address James and Kimberly Bletzer Owner Owner's Name information is required for every Osteryille MA 02655 2/23/2016 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ 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): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Robbins Street Property Address James and Kimberly Bletzer Owner Owners Name required for is every Osteryille required for eve MA 02655 2/23/2016 ' page. City/Town ' State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection El Yes ® No information in this report.) .Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): yes Detail: 2015; 132,000 gallons and 2014.104 000 gallons Sump pump? ❑ Yes ® No Last date of occupancy: Current 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 I Industrial waste holding tank present?, D Yes Z No Non-sanitary waste'discharged to the Title 5 system? ❑ Yes ® No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Robbins Street Property Address James and Kimberly Bletzer Owner Owner's Name information is required for every Osterville MA 02655 2/23/2016 page. Cityfrown 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: Board of Health Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? gauges on truck Reason for pumping: Required maintenance pumping Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 77 Robbins Street Property Address James and Kimberly Bletzer Owner Owner's Name information is required for every Osterville MA 02655 2/23/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 12 Years Were sewage odors detected when arriving at the site? ❑ Yes Z No Building Sewer(locate on site plan): 3 Depth below grade: feet Material of construction: ❑ cast iron ®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:rade: 13 inches feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Typical 4" Sludge depth: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments N 77 Robbins Street Property Address James and Kimberly Bletzer Owner Owner's Name information is Osterville MA 02655 2/23/2016 required for every page. CitylTown 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 47" Scum thickness 5" Distance from top of scum to top of outlet tee or baffle 3" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Scour Stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Effluent level with outlet invert. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w. 77 Robbins Street Property Address James and Kimberly Bletzer Owner Owner's Name information is required for every Cisterville MA 02655 2/23/2016 page. 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: r 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,.w 77 Robbins Street Property Address James and Kimberly Bletzer Owner Owner's Name information is required for every Osteryille MA 02655 2/23/2016 page. 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 effluent level with outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No evidence of solids carryover. Utilized camera to inspect distribution box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a'conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Leaching field without inspection port. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for.Voluntary Assessments ,^M 77 Robbins Street Property Address James and Kimberly Bletzer Owner Owner's Name information is required for every Osterville MA 02655 2/23/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4 Cultecs - ❑ 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.): Unable to access due to lack of inspection port. probed area around the leaching without an idication of effluent. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13'of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Robbins Street Property Address James and Kimberly Bletzer Owner Owner's Name information is required for every Osterville MA 02655 2/23/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): h Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 9 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Robbins Street Property Address James and Kimberly Bletzer Owner Owner's Name .information is required for every Osterville MA 02655 2/23/2016 page. Cityrrown 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 77 Robbins Street Property Address James and Kimberly Bletzer Owner Owner's Name information is required for every Osterville MA 02655 2/23/2016 page. 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: 14'feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: ,Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Groundwater Contour Map ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Groundwater Contour Map Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form �m Subsurface Sewage Disposal System Form - Not f&Voluntary Assessments 77 Robbins Street_ Property Address James and Kimberly Bletzer Owner Owner's Name information is Osterville MA 02655 2/23/2016. required for every page. 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•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 t-1sJwJ111� t-16-IIUIIL \.Q1 uJ 1 arc 1 vl 1 f� Lt TOWN OF BARNSTABLE LOCATION RObgin 5T SEWAGE M VII.LAGE��STC�h ASSESSOR'S MAP&LOT 191 A INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACnT LEACHING FACL=:(ripe) y- CU (size) 4/ Sri NO.OF BEDROOMS BUILDER OR OWNER 1 G. 0 rC PERMITDATE: COMPLLJCE 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 leachia facility), Feet Furnished by -�n s�ort7�1 Al- as (31- 31 A a- A3- 3I M- ra 13y. C9 „ 3 Zo t� 10 ,��C-D http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=141069&seq=1 2/24/2016 • D Print this page . Owner Information - MapBlocWLot: 141 /069/-Use Code: 1010 Owner Map/Block/Lot GIs,MAPS BLETZER,JAMES M& 141 /069/ Owner Name as of KIMBERLY A Property Address 1/1/15 77 ROBBINS STREET 77 ROBBINS STREET OSTERVILLE, MA. 02655 Co-Owner Name Village: Osterville Town Sewer At Address: No GIS Zoning,Value: RC . Assessed Values 2016- Map/Block/Lot: 141 /069/-Use Code: 1010 2016 Appraised Value 2016 Assessed Value Past Comparisons Building $ 182,400 $ 182,400 Year Total Assessed Value: Value Extra $ 37,000 $ 37,000 2015 - $ 471,400 Features: 2014'- $ 457,600 2013 -$457,700 . Outbuildings: $ 3,400 $ 3,400 2012 - $458,700 $ 251,300 $251,300' 2011 - $455,100 Land Value: 2010 - $ 459,700 ' 2009 -.$ 529,300 2068 - $ 539,100 2016 Totals $474,100 $474,100 2007 - $ 559,000 . Tax Information 2016 - Map/Block/Lot: 141 /069/-Use Code: 1010 Taxes C.O.M.M.FD Tax $ 753.82 (Residential) Community Preservation Act $ 132.42 Tax Town Tax(Residential) $ 4,413.87 Fiscal Year 2016 TAX RATES HERE 5,300.11 . Sales History-Map/Block/Lot: 141 /069/-Use Code: 1010 History: Owner: Sale Date Book/Page: Sale Price: http://www.townofbamstable.us/Assessing/printl6.asp?ap=0&searchparce1=141069 2/24/2016 R iiuiaus�. ub�. �• va .� • o BLETZER, JAMES M & KIMBERLY A 2003-01-21 C 167983 $490000 CURLEY, RICHARD L & MARTHA H TRS 1996-084 5 C 141836 $1 CURLEY, RICHARD L & MARTHA H 1965-02-25 C34543 $0 . Photos 141 /069/- Use Code: 1010 P . Sketches- Map/Block/Lot: 141 /069/- Use Code: 1010 rb ¢S i As Built Cards:Click card#to view: Card#1 . Constructions Details- Map/Block/Lot: 141 /069/-Use Code: 1010 Building Details Land Building value $ 182,400 Bedrooms 4 Bedrooms USE CODE 1010 Replacement Cost $233,786 Bathrooms 2 Full-1 Half Lot Size (Acres) 0.37 Model Residential Total Rooms 8 Rooms Appraised Value $ 251 Style Cape Cod Heat Fuel Gas Assessed Value $ 251 Grade Average Heat Type Hot Water Year Built 1966 AC Type Central Effective depreciation 22 Interior Floors HardwoodCarpet Stories 1 1/2 Stories Interior Walls Drywall Living Area sq/ft 2,326 Exterior Walls Wood Shingle Gross Area sq/ft 4,116 Roof Structure Gable/Hip Roof Cover Asph/F GIs/Cmp http://www.townofbamstable.us/Assessing/printl6.asp?ap=0&searchparcel=141069 2/24/2016 1 1111E 1 ug�. tQ�G J VL J . Outbuildings & Extra Features-Map/Block/Lot: 141 /069/-Use Code: 1010 Code Description Units/SQ ft Appraised Value Assessed Value WDCK Wood Decking 288 $ 3,400 $ 3,400 w/railings BFA Bsmt Fin-Avg 650 $ 8,700 $ 8,700 FPL2 Fireplace 1.5 stories 1 $4,300 $4,300 BMT Basement- 1156 $ 24,000 $ 24,000 Unfinished . Sketch Legend Property Sketch Legend B2N Barn-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only BAS First Floor, Living Area FTS Third Story Living Area(Finished) SOL Solarium BMT Basement Area(Unfinished) FUS Second Story Living Area(Finished) SPE Pool Enclosure BRN Barn GAR Garage TQS Three Quarters Story(Finish( CAN Canopy GAZ Gazebo UAT Attic Area(Unfinished) CLP Loading Platform GRN Greenhouse UHS Half Story(Unfinished) FAT Attic Area(Finished) GXT Garage Extension Front UST Utility Area(Unfinished) FCP Carport KEN Kennel UTQ Three Quarters Story(Unfini: FEP Enclosed Porch MZ1 Mezzanine, Unfinished UUA Unfinished Utility Attic FHS Half Story(Finished) PRG Pergola UUS Full Upper 2nd Story(Unfinis FOP Open or Screened in Porch PRT Portico WDK Wood Deck PTO Patio Microsoft VBScript runtime error'800a01a8' Object required: " /Assessing/print16.asp, line 151 http://www.townofbamstable.us/Assessing/printl6.asp?ap=0&searchparcel=141069 2/24/2016 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROT RECEIVED SEP 3 2002 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS' SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION lv Property Address: 77 Robin Street Osterville, MA 02655 Owner's Name: Dick Curley Owner's Address: Same Date of Inspection: August 15 2002 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Map: 141, Osterville,MA 02655-0049 Parcel. 069 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The'inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems: I am a DEP approved system inspector pursuant to Section 15,340 of Title 5(310 CMR 15.000). The system: ✓ Passes Cond'tionally Passes Nee s urther Evaluation by the Local Approving Authority ' Fail Inspector's Signature: Date: August 19, 2002 The system inspector shall su t copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of,10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 77 Robin Street Osterville, MA Owner: Dick Curley Date of Inspection: August 15, 2002 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: 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. Answer yes,no or not determined(Y,N,ND) in the 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. ND explain: 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 obstruction is removed .distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 77 Robin Street Osterville, MA Owner: Dick Curley Date of Inspection: August 15, 2002 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. s . 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 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 wat&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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: I 3 Page 4 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 77 Robin Street Osterville, M4 Owner: Dick Curley Date of Inspection: August 15, 2002 D. System Failure Criteria applicable to all systems: You must indicate either`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 '/2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped— ✓ 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)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 System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• 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) 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. 4 Page 5 of l l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 77 Robin Street y Osterville, M4 Owner: Dick Curley Date of Inspection: August 15,2002 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: Yes No ✓ — 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(3)(b)]. 5 Page 6 of 11 ` OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 77 Robin Street Osterville, AM Owner: Dick Curley Date of Inspection: August 15, 2002 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 Number of current residents: 2 Does residence have a garbage grinder(yes or no): Yes Is laundry on a separate sewage system (yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): 2001 - 123,000 gals.; 2000-91,000 gals. Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Never pumped-per owner Was system pumped as part of the inspection(yes or no): Yes If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: Pumped for maintenance after the inspection 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) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Sep. 30197-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION'(continued) Property Address: 77 Robin Street _ Osterville, AM Owner: Dick Curley Date of Inspection: August 15, 2002 BUILDING SEWER(locate on site plan) ` Depth below grade: Approx. 28" Materials of construction: _cast iron ✓ 40 PVC ._other(explain): Distance from private water supply well or suction line: Comments(on condition of joints, venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: Approx. 16" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: -30" Scum thickness: 6" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle: 8" _ How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): " Tees were present. The liquid level was even with the outlet irrvert. There were no signs of leakage. The owner had the tank Pumped after the inspection. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness:- Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 77 Robin Street Osterville, MA Owner: Dick Curley Date of Inspection: August 15, 2002 TIGHT or HOLDING TANK: None (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box,etc.): The D-box was level No solids were present There were no signs of backup or failure from the leach field. PUMP CHAMBER: None. (locate on site plan) Pumps in working order(yes or no): ` Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 I Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 77 Robin Street Osterville, M4 Owner: Dick Curley Date of Inspection: August 15, 2002 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: ✓ leaching chambers,number: 4 cultecs with 4'stone-per as built card 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.): The leach field was located, but not dug up. There were no signs of backup or failure in the D-box. The bottom to grade was approximately 6. CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 77 Robin Street Osterville, MA Owner: Dick Curley Date of Inspection: Augmt 15, 2002 Map: 141 Parcel: 069 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. AI- a3 (3 i 3"1 � /D- tq3- 31 " ALI- 3 y 10 Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 77 Robin Street Osterville, MA Owner: Dick Curley Date of Inspection: August 15, 2002 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 22' +/- feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: The bottom of the leach field to grade was approximately 6. Using the Barnstable topographic map and the Cape Cod Commission water contours map the maps were showing approximately 22'+/-to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 °FtT°wti Town of Barnstable Regulatory Services • sn�uvsrnsc.E, v Mnss Thomas F. Geiler, Director 1639. DMAC A�0 Public Health Division Thomas McKean,Director 367 Main Street, Hyannis,MA 02601 Office: 5087862-4644 Fax: 508-790-6304 July 9, 2001 Richard L. Curley Attorney at Law . 77 Robbins Street Osterville, MA. 02655 Dear Mr. Curley, Thank you for your letter dated July 2, 2001. Attached is a copy of the septic system repair sketch regarding 92 Cranberry Ridge, which you requested. If you should have any questions regarding the system, please telephone Health Inspector Glen Harrington, R.S.-at (508) 862-4644. Sincerely.yours - T omas McKean ` RECE4 vEC RICHARD L! CURLEY ATTORNEY AT LAW JUL,O 6 2001 ozea� ems -z�� TOWN OF HEALTH DEPT.BLEB 77 Robbins Street Osterville, MA 02655 (508) 428-8485 (508) 428-8486 FAX July 2, 2001 Board of Health Town of Barnstable Hyannis, MA 02601 Dear Gentlemen/Ladies: re: Question concerning Septic System abutting property A client, (and longtime friend) of .this office, Barbara Pina, 106 Cranberry Ridge, Marstons Mills, MA, has consulted with me concerning a problem she has with the septic system om an abutting parcel - 92 Cranberry Ridge. Although the vent pipe has been re-located, Mrs. Pina still has a question(s) about the location of the system. She would like to have a copy of the installation plan --- She has requested this info/material but has not had any luck. Ve ruly yours, Richard L. Curley RLC/mhc File 19505 `I gPFt t..: a r,�. 3 ¢ k..._ .' - s P z, .c...'r ` a. _ 1.1 ;1', AV k. .r?. a %.a Ktx, ..s.. �. _ 4 a rE, as. ..;s .r '3 :, j(t ja 1 T ! a _ G r ,. 3 a.! tt-s x ,yLl.. F [i 5 !{. ,Z L ft TT . .3, YZ ! ,.d -1 ..,.uu rt f 5 .;� A F :! l !� .t .i 3�3'. !) 1 r IJ Is+'E'y6' I 1! .t t t :` * t/�s r ..i, !tb F -7 YC'y'j y '_� i H .-1, . T'' .f C`: ! 'i f i Y - a Y� 1. S F, I .. . 4iuF' ties 1. r e_ 9' - l. jA xys ,5 .. +�(.f'f jyry I t, > ! 2 x ti'il� ; s y3 J,,: ! Y L r LL" S )1�j S9 afl S ea a u __, e...! .... - _ —__— _ wswxarr a _y TOWN OF BARNSTABLE t-2'g,I r F F '�.ra4Yt rf rS - .a, 4,, 1 tl 5 D f # Y� '< LOCATION f� C_ls¢e�J�ry /<r N' �r� SEWAGE # .`I�l `�'2l - KP y 7>f� t..a ', E r aI. t :.._:.I*'�:-;-,��.�-:�.�'I.i;....._..:_--.-.I,�.-,.-,.1�'.:----�:.--.;�.i,�...��',''._-..,.�.,.z Z_`-.,-..��._:..�-::-.;iI�.:.,.�--i-*.;.,-�!:...�1-_,- ink e r T 2: 11 - - f .,,,-� ° 3 VILLAGE fll�arsrah5 !??��1�. ASSESSOR'S MAP & LOTo30 os'G 4� ti ° y /os :d� d, �.4r,nos N;,5 , I INSTALLER'S NAME&PHONE NO. -177- 0 3 _Q ' ?,y@R+ji�f 1. '�et ;, I { SEPTIC TANK CAPACITY /da0 - qI ''2,r� ? LEACHING FACILITY: (type) 2��ov�i�/, �r y Guifl (size) ?�X /3 4 � 1 NO. OF BEDROOMS ? _ _ . .: ,<� . 5j i f _ r . ,T rFi` BUII.DER OR OWNER 41/r �is�i°laro/ �, .. hYt;K K ' PERMIT DATE: /9, 9 9 COMPLIANCE DATE: 7 --2 D 9Q Ft F F" { '` if=A 4 Separation Distance Between the: rA Feet 's Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ,Q_ {C t - l,�f, a r. Private Water Supply Well ad�Leaching Facility (If any wells exist _ - .,-C yr a + . on site or within 200 feet of leaching facility) __Feet €fin Edge of Wetland and Leaching Facility(If any wetlands exist ,. Feet I , within 300 fee of leac 'ng ility _ .. .. fit" Furnished by " €.Vz, r . .. ..} r7 Fl -: .. Yf A i L 4 zf..3liir?, I„ _3iyif 2 _ t 3 ' .. - _ ..' _. r� atl`t s r 'k. } _ - e� k le 2:l 3 ' -tI - 3U !Tr}it f �qq ._ E V t ^S j - 'n " - 1 }T� rf 1 A I P l8 �P zF _ ti r yy } r,. ` t IA - .. .. PP'L .�- - r r - .- ffry G t:at j- - r j " 4 k Et r r - . ... 'i,..� zC t ;' " ;. , .iy { l Allow of i:. WON, a,> t di RON OWN ARE tog f a• a MY J j is t5 h f MY,! + { S 2 li 'To o^ :FEES ARM bow t s ,c..--+•wr�'^��. �".r.'"c �:.�'�'r. � a::.,�"•�.^.,a�., '��;'� .`„' ,f..a 1' - - �.a..n..;c `'�` �� -y+ pal?khi r�w3"�'+.` �.,�.,•�..r�r�`-a.� ^�"� ,� � ° "F�. -.. -�u.,.,�„a s,•,k'n t e. r -n Kv "Y, ✓ wc].s �. .ncr„y--"�^� ��.,;.,."` ,'��r-^ .Fr�c -.�"'' �'1.,��d� a-�r„r��.: -' w �.''�P"- :c �H�" ��r>°ter'.. 4 .,., _ ��•� `'�'->C'� �-,i,'�"'C.C,...�r_ ,.yY:w'Yd_'r'w ..uS. 3. �r y '�' f: '} 7 iF . � a � _ �� ,a,..3 �,,... - 'S�+ +SY-� - ,a-P w..5,x �.v*y _.�.-�`""+�""SWj e�a.•�.�, _ n,�'a"�.;a,_ 'git Y Ys f p TOWN OF BARNSTABLE LO-CATI0V RO�t 5T SEWAGE # VILLAGE— ST�Cl/� ASSESSOR'S MAP & LOT INST.�LLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) y� CV (size) y SYoe-k- NO. OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIAPICE 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 leachin�facility) Feet Furnished by `.:.��/�SpcCl� O-A Al- a3 ' 31 A 10 �3a• Na q a, P-- (33- Aq- 3 TOWN OF BARNSTABLE LOCATION � � 906b�-h S SEWAGE # VILLAGE 61 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.a: r 4C2 4L =962:1 SEPTIC TANK CAPACITY �-- LEACHING FACILrrY: (tyc,>e C U f//•E' (size) NO.OF BEDROOMS BUILDER OR OWNER PERMUDATE: Y COMPLIANCE DATE: S 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 �� .. 6�1 ,� �\ c <� �� r ' �+ �, , r�. ,. � _' . . No �� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for 33igaal *pztem Con5truction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) O Complete System O Individual Components Location Address or Lot No. -7"? i`/j$� S'fO�r's NC'amg,Address and Te�..jVo. ` Assessor's Map/Parcel !/[J yyy l� CrJc , -I T Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms t Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs pr Alterations(Answer when applicable T4�1) 5-o C� P C o 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 e 1 ` Signed Da Application Approved by Date Application Disapproved for the following reasons Permit No, Date Issued �� `T No. Fee �O O THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Zippfication for Oie;pool bp!5tem Construction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. —2 D i/) S Ow 's Name AAdddress d Tel. o. Assessor's Map/ParcelQ 5 rp` Pr �v 1 r Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil r Nature of Re ay Alterations Alterations(Answer when applicable 5-0 0 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 i of eal , r Signed Date Application Approved by Date _ . Application Disapproved for the following reasons Permit No i Date Issued r t ——————————— ———— —t—— ——— —————— ——THE COMMONWEALTH OF MASSACHUSETTS K. BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,t t the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded Abandoned( )by .-� �sr' at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. E dated,5-4.4, -,-)Y 9 Installer Designer OF The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date - 'i r"7 - CT % Inspector ----- _ r e a No. �— -------------------------Fee 5 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwigozal *pztem Construction Permit Permission is hereby granted to Construct( )Repair(AS p.rade( )Abandon( ) System located at ,� rS .`i'13' r 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 com leted within three years of the date of this � it. (� Date:_ �' Approved b ,,- �'`i .d-a /�'' �%`` �? ' �+ NOTICE: This Forin is to I)e used for the Repair of Failed • '' '~ Septic Systems Only CEIt,rjr,ICA'FION Or SKETCII AND'APPLICATION FOR A DISPOSAL 1VOIZKS WNS'I-ItUCHON 1'EIttl9l'I' (jVI'1'II0U'1' 1)ES1LNED I'LANS) hereby certify that the application for disposal works construction permit signed by me dated_ '�� , concerning the f n located at O �� " mks all of the property following criteria: There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system The observed groundwater table is 14 feel or greater below the bottom of the leaching facility • There is no increase in now and/or change in use proposed • There are no variances requested or needed. DATE: SIGNED: �� 7 LICENSED SEPTIC SYSTEM INSTALLER IN TFIE TOWN OF BARNSTABLE NUMBER (Allach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submiltcd). TOWN OF BARNSTABLE LOCATION lt1 ��1, S SEWAGE/ Y ELL AGE �A oidlyGDe. ASSESSOR'S MAP& LOTZZ G� :,INSTALLER'S NAME&PHONE NO.� SEPTIC TANK CAPACITY O LEACHING FACILITY: (ty (size)or NO-:OF BEDROOMS BUILDER OR OWNER PERMTTDATE:J�`I� COMPLIANCE DATE:S f f� 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 Furbished by 1 c� t J S � � . I r 1 --_, _. .. . - -._ I._.- r I l "x . . - _ .. , , . ---- _ - __. I I __ , I I I I i i I 1 ! i I I � '~I _..__ -T1. I I 1 i — 1 I_ _i,_..... 1 L. ' ! 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