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0086 SAND POINT - Health
A=073 - 015-002 r ■y � r' a a 4 E i �.i -_:- O�0,1&�—N I , , � � I , , . - ..- , ,--�,j. , i, � I . ' ' - - - , . .. , -. I " ' �_-",� � � -� ,�� ��. . ,.,� - I- - ,. ,,., .- I. , - ---. �,,�� "'.", " ". I, �. -.-, � - � . , I � -� � _� '��'.-�t�") . - �11__'.� � � 4, , � , - , ,1 _ _ - - . , ,� �.�,,. . , . �, . 00AN1 I , -`��__.1�11_` � L., � ., , , ��,;.. , - ," " - - �. I:. V_� - 11 ?' - :, 7['own of Barnstable P# ��: 7 04'►�- � ,� �- �, , I ' '' ; Departd►ent of Regulatory Services F r .- 6 6 / .. # W. l. r . ,,,�,,�,�,� : r P'ublic Health Division Date G t , 0 rn treei H annis MA 02601` �6 e� 20 Ma S a¢A° y r ' L. ; I# / o® -,. , � 4 y Date:Scheduled t !' Ttme_"i.�-, -"; 41- - , Fee Pd '•� M1 04 i , , 1 t' a , i ;. i i' �, : 1 i H e t 1 ; r {{I 1 t�ly, Soil�'�' '11� tabil �Assessynent or S' e` is :os f a' �.. vqj,Qk iiiiiiiiiiiii 'i i 1' " ` t 2 P, $7 �P 0, "erformed t^< J 'i:�, xa"G� 1yy IVUG ) Witnessed B By :; . C,-, y I s t.hy; £ , �O AT10'k I&�GENEiu, INFORMATIONi. �t 2� S,6 GZ ,� C Location Address /y��(��C/� Owner s Name r J B 5 4 , { ' ,4 �i�s t i(Z : �1QiS. Address W S�MQ i �/S 1�@ f30 Q ". e .:,-} r 7ht { zl 'i r +•'I 1# { s , I I :. rv.,; t., rt Assessor sMap/Parcel' O;. A. I j: i j J Engmeer s Name .5 e_1„i V H�' 41}G`i�+C; ' i , ' NEW C,ONSTRiJCTION.r 1; 1. :REPAIR ix 1 t :Telephone# 1 q2� a�; .; : +' Land Use QCS1 il., 9r �f�LI I:� �t Slopes(%) 1 fj tub urface Stones �� ,° ZIi �4 •'Gj � 71�#,e^{Ir t1ya la �i;l tI ��or.�♦ .� i� oTheysyt� s�: JIL � � i� Distances from ;l Open Water ody ft. ;Possible Wet Area Aj0 ft Drinking Watei Well{i' !'1 x 8_. ?. ' ; f ' St p Jy i r txl ra�,t. fl�. � kA , Ib i I zi r ° fI i 1� i 13ramage W ay it x ft . Property Line ft Other AcQft I " '� J x �,, 1,# 'rt? { f' [ r C 1 - :'r .la _ L t I I tic kI I' I v :" I ��f, r = ` t?'EJ +§ '�'d n s�' I!L:. { t - SKETCny (Street name dimensions of to exact locations o_test holes&pert tests locate wetlands in proxututy to holes) # a s t! # Ir; i , q,ihll r 1 f' + I ti r ¢ t r i % k,`- r5 L t Y tj I t 'at�t �. 1 I[ 3 7 1 L i:' z t ;: f , ;t C z.'i} , a fir z 1� . 7- "t }} 'rl_� }..° I �j.:Ut� Ir?r.'i. �� Fk.k,# # h { r t _ At to ffi i }I � t a 7 s I. a 4i 3 - ,ai' I, I.t_ it is li{ r, r. _ t "-'� ft 11 .� a '�..I - {._I ;�II , Jr'I k2 {4 f ".:Ii ::t�. a . r.; s 66 ° l� ;�. . Sf l.. 7 I { t ¢{ it V..l.y' { 7,' p: r."¥{ i 1 ..a } ,. # ISl ,, S �� # i r rr; f I �r j1. I, l tie it s l W .I I r � pt z 1 % t i �� ',r 1 l . I 1 ` , ��. I r -- .E t x ( !6 !J ' ' 1 IIr t ' i. ; 11� # 1 1 r . .� -, �6 �,. .!:;,rr ,"�.,�d r -'�lj�r'K vt I, </ i f {t��/ 1 t F r, F �il. p S.7 I II la. .�, r ' , - f �b Z } e% I{ � :L { �ix ! i iJ•, ! ,i lli l al rr tf'i :i ', 1 s I I " # ai c $ Y .rxi �� ��I a�tl;if I I h,{S! 6i I I-{:fir a �t '3 " _> h _Jr�', .7 a�' i r , ki �� { I 1 I I IIL: J (, TjjI I 1 .', s 4' r . { f t�l S \t 5 1+' 1 ;:1' 1 k I �'+ - j f # I} 2���, i!' 1, ,, 39 � ;t �; it ; , ; ,rr t w '� �t I' ,tpl # I. I, k r# � Ifr ' i ' v i �6666 , Tt 4 �, t r; t 'ItE { gy a �? r ongf 1.j ' '.�ppi3} F' I I }-s�11 to jr,. i f !it {V ak`f al , {d�+� a n r # ^ �! 1 1 _s -13 � }T,# I jj � Ii�l!i I, t ll.. II �t' I ! a - i .' f � z 1 �,t:.z t... to -_ -.` { ,! , I o-1 �I #i 7n'.;`. 1 i er:: .'i r` -"+ „ , - _ k. Al ! 1 f ' � Parent matenaQ eolo d rc)��} >`\ iJa;1` # 'y; (Depth to�Bedr ck�.'�+ 2 � �, . 'I#1�` a + iirtl#{ #a) 1 ' +.•;rI li IY-r.,. i" •� # { ek # r'« a ti.r:.{ O€;�,:'� t :! r:, St � , { '. trlt� I� . I!.11 ' ��J .,rJtl, #x { k 3: 1, t "' Depth toy- !1 water ,Start g Water in Hol� �®�� Iz r+ s�,Weeping from�Pii Face �YV I ��f � � '� .+,# ,'Pt ".I t 1 II , 1 11 it + i I� # r p' y ! 10t - G1 � , lal �I l"sa=#I { #, t �I ��, 11 , ,,,&` f ,Estimated Seasonal FLgh j nd dater I I i s ,l , 04 . l 4' E �`� � '5 nr 4 Cn j9�¢*�; ��': + �C 7 '• t^ t, S4I�# i I IIl'` �,I{:ll { E I1'Xli { it ; F �;2}fit:! }�. d,.'.,, ri_��:... s �� { a`; :y in t,s�s I I i.: ', r l tl e,}I! Ei ;'r J!{ I !' I t R q 6 D E A�IO FOR SEASONAL'HIG. ATE TAB "E - MethodUsedl;l. l# 1I �11 �t:I;, I 13��1'�.: rr lt '' 3 `:"a « 4 _ ' I!F. % j —�' all? .. ,1 of l J , e t De iti Observed' ding in obs h I ,�.�I{ ! r:.w t m }Depth to soil mottles t .j�I r(1, "ai ,i(i 1'J!'ti t•t r l,; 4 ! I,.; I;t+-_ !1 -.r m_�" 4.---•...r.a4. .. P Iz P g ° flti I # # m GroundwaterAdlustinent I: ft De do wee n ms�de o obs!: le , r. ? Ind@x Well#`� l#! N{;Rfla'' g Daiel!'�#I {,;I: Iridez Weill level f # ! AdI!'factor i'' z' ` Adj.Groundwater Level- t `t k ,I t 5 C.. f l t', t .a1 t S" 1 I.- 06, 't, : I II II 11'�11 'lIt# aJ i:, ; °���! G Ir ' r !f f z,I f I x I { !'}I� 1 f{��_j I{i rf °� {'; ,6-"# I:ATIONjTEST j Hate Z+ Tlme 3 Observation , 1 ' a ( I" # # l {�I� i . 2}} y H11 ole# I'It . 1 t" #i° ,,I' "{� P`I �� 1 �i 1 Tltite at9 {F„'.. I i a r:� $�a r1. {. r Depth of Percl i`#i E F i'1! Ir .�"Ii fa .` #t t �, I # Tune at 6 b Y::- WI t,« '� r ( #'7 +rr r`, Jr. I:b. I _ I Hit (. i , t �: Start Pre soak Tune,@} j: J{i :Z, ,' 1 I ,n l # Tmie(9 6 )r �� r h>x -+II , Us I Ift ..I,fi '�. 'I r e i r { S d' J ! � �� End Pre soak �'� bit ' fl r{Y1�l , I °! " # f j{ f�� i + 1 RateMmJlnch.`J1 I i ?'�,11�' .i',l x ei ±1 I l►'(11f ,'1 ;, t', ! t ` i1: k�, I�. t. =r : „x [ I� {,t #1 II I:t'1!I!�f? '_'i et I I � i rj 't -y}I t t, .: t♦ j!.`'•y z i 5, 'VM s �f Site Suitability Assessment i�Srte Pas M 1i, 1�f r- Site Failed , Additional Testing Needed(Y/N) 1I { { , Ori final Publid'Health Dvisronv t ;� I-6� fit;t l'rObservatton Hole Data,To Be Completed on Back --- , 1.I'I , 6'I I rlI # 1}I is r a !µ. - ' x ***If percolation I . iIt to be cone; uct A within"1004 of wetland,you must first notify the �! 1 : '. I I �'- Barnstable:,COnservation Division'at least one Q)week prior to beginning. 1 � , I I , Q:ISEPTICIPERCFORM bOC ;r ! 7 . `' # ? r ! , _ 1 i j ; I Ei � ,;a ' " tI a k { -11:. _ 1 - . . { DEEP OBSERVXROloT HOLE LOG Hole# Depth from Soil Horizon p n Soil Texture Soil Color' Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. cv.%Gravel)' Consistency, s: 34-1�Z - I I { I DEEP'S BSERVATI1 HOLE LOG I3ble# ;' Depth from . Soil Hor n Soil Texture Soil Color Soil Other i Surface in. SDA Mansell Moulin (Structure,Stones,Boulders. Ik Consistencv.'"/o Graven". A\ © 54 I S f II , 1 DEEP I BSERVAITIOI�IHOLE LOG Hole# I Depth from Soil 1zon': Soil Texture: Soil Color: Soil Other', Surface.(m) i I (iISDA); (Mansell) Mottling (Structure,Stones,Boulders l. I ; : Consistencvi%Gravel) ' r r F: J 4. { DEEP OBSERV TION HOLE LOG Hole Depth from I I Soil,Ho�tion; So' Texture Soil Color Soil Other Surface in. SDA `' Mansell Mottlin Structure Stones Boulders. ^4 r .� Consistenc ,%Gravel 0'(� I I l4{��rr� t i JO-40 ° V cc l- I f P 53- z® �i •I �; k I {! 14 { if � Flood Insurance Rate a ' I Above SOO�ye I'odaioundaryj I ,i i Yes ✓ f l I , I�i 'I Within 500 ye�r boundary No I Yes i I � ii I I�rl l l l r:. � k,•I:��� ''� �' � , :-- . �:'. �'� 11 . Within 100 year od borindary, N yI Yes Il De th..of Nit!urall Qurrin 'Peron .us iMaterial ; Does at least fourifee'tio'frlaturallyioc 'ntng pervious material exist in all areas observed throughout the i II I�' 6�. I Ili area proposed forlthe,so�l absorptton s stems I I I I I t:!' If not what is the depth of naturally o cumng pervious material? i v.. : Certification- I certify that iont 0 + (dat )I have passed,the soil evaluator examination approved by the Department,of Env onmental Protection and that,the`'above analysis was performed by me consistent with II III{y the required,trammgl'expertise and experience described in.310 CMR 15.017. Sign ature C Date . � I 1 QASEPTIC\PERCFORM..DOC. i a I t TOVfJ OF BA STABLE LOCATION Din , SEWAGE# Q-00 -2/7 . VILLAGE ASSESSOR'S MAP&PAR EL�f_��'�� 1 alp SEPTICsNKCACITY ONESC)oNO. _ LEACHING FACILITY:,(type((j) 0fi C5 (size) 16 NO. OF BED OOMS. OWNER PERMIT DATE: COMPLIANCE DATE: 7b f 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 c -46 102 .� �-46' No. �� 7 06 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0(ppYication for Oiopotar *p5tem Construction i3ermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System Individual Components Location Add s or Lot No. r Owner's N e,Add ss d el.No. 7gG �F vo Pom T` col F;0 Assessor' p cep./ Installer's N Address. el.No Desi er' Name ddress and Tel.No. , CC C�J 66MO it! 51arIl /NC. 'j E . /6`l 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 Flo gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank jfXAcA1 Type of S.A.S. Description of Soil Nature of Repairs or Iterations Answer he a ca le) /Y 02; 1-To Date last inspected: Agreement: The undersigned agrees to ens a aoft ction and maintenance of ore described on-site sewage disposal system in accordance with the provision f Title 5Environmental Code n o place the system in operation until a Certifi- cate of Complian a as been is - Signed Date *3 je.icy Application Appr ve by Date 7 —27 Application Disapproved for the follo g reas s Permit No. 6 6, Date Issued No. ! J _ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION- TOWN OF BARNSTABLES MASSACHUSETTS 2pplication for )Di9;po!5a1 6p5tem Conotruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System Individual Components Location Addre s or Lot No. Owner's Name,Address and Tel.No. y1 � �D/sv T oHjv F1 15:Assessor s Ma /P"�l J p S 2D/ly'` 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. j Plan Date Venil 07 umber of sheets E Revision Date ' . Title ICE Size d Septic Tank A Type of S.A.S. Description of Soil (yNature of Repairs or Alterations Answer when applicable) //v � 6 MWA i Date last inspected: _ Agreement: The undersigned agrees to ensur a construction and maintenance of the fore described on-site sewage disposal system----' in accordance with the.provisio"this Environmental Code a no place the system in operation until a Certifi- cate of Compliance as been is o Signed _ Date Application Approve by `` Date —?;Z Application Disapproved for the follow g.reas' s y s Permit Na.9 Date Issued. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS' Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( . ')Repaired (,v-)Upgraded( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector ---------------------------------------- No: Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS liooal *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( ,Upgrade( )Abandon( ) System located at and as described in the above Application for Disposal System Construction,Permit. The applicant recognizes his/her duty to comply with Title 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 TOWN OF BARNSTABLE LOCATION .'` SEWAGE # 8 lgq VILLAGE 0S7swj u-LA . ASSESSOR'S MAP 6z LOT MA/ `1 I'd I INSTALLER'S NAME & PHONE N0.6g -66 M IRE92!a ' 5' SEPTIC TANK CAPACITY LEACHING FACILITY:(type) NO. OF BEDROOMS 4 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER t 1*d c lr DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No t./ m � i 3 ` (SID e � c y AsBuilt Page 1 of 1 TOWN OF BARNSTABLE a LOCATION64 r5*0 P©IN SEWAGE #q7-1a VILLAGEoqSlL Hw✓y ASSESSOR'S MAP & LOT�3• ��S"•DO; INSTALLER'S NAME & PHONE NO, 0/ /A SEPTIC TANK CAPACITY 1 R 0 LEACHING FACILITY:(type) Alf size) NO. OF BEDROOMS PRIVATE WELL 01 E:BLIC W TE BUILDER OR OWNER C� S GU sue' DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED; •2�' VARIANCE GRANTED: Yes No L-T http://issgl2/Intranet/propdata/prebuilt.aspx?mappar=073015002&seq=1 12/10/2013 l _ , Commonwealth of Massachusetts Executive Office of Environmental Affairs 9G Department of , Environmental Protectio William F.Weld r rud Coxe Governor �' Aro•o Paul Celluccl David S.Struhs tt.Governor ,r , _.. ,.. C.omml01bMr SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A - Dan Hostetter CERTIFICATION Property Adder Sand Point , O s t e r v i l l a Address of owner. Date of Inspection: 3-2 7—9 6 (If different) Name of Inspector. W.E. Robinson SR Company Name,Address and Telephone Number. ( 5 0 8) 7 7 5-8 7 7 6 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on'my training and experience in the proper function and maintenance of on-site cew disposal systems. The system: i _ Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails , d � Inspector's Signature: �-/, y Date: 3 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A,B, C,or D: A) SYS ASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B YSTEM CONDITIONALLY PASSES: . One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. to yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal,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 ponforming septic tank as approved by the Board of Health. (revis 11/03/95) 1 One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 QV Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) Property Address: 86 Sand Point 0 s t ery i l l e , Owner. Dan Hostetter Date of Inspection: 3—2 7—9 6 B] - CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(*) 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(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C) THER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1 SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: 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. Z) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is teas than 100 feet but 50 feet or more from a private water supply well,uiniees a well water analysis for conform 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 6 ppm. 3) THER (revised 11/03/95) 2 i i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:. 86 Sand Point ' O s t e ry i 11 e Owner. Dan Hostetter Date of Inspection: j 3—21—9 6 DI FAILS: t have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the i Backup of sewage into facility or system component due to an overloaded or dogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or dogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or dogged SAS or cesspool, Liq(uid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. f _ 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. rtion of a cesspool privy rivy is within 100 feet of a surface water supply or tributary to a surface water supply. Any�po Any,portion of a cesspool or privy is within a Zone I of a public well. Aay portion of a cesspool or privy is within 50 feet of a private water supply well. i 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 ooliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. i El LARGE STEM FAILS: following criteria apply to large systems in addition to the criteria above: system rvea a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public and safety and the environment because one or more of the following conditions exist: 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 they 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 o operators`of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements 314 CidR 5.00 and 6.00. Please consult the local regional office of the Department for further information.. i (revised 11/03/95) 3 � t i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM f PART B • CHECKLIST PmP*F y AddyOw 86 Sand Po int Os rv ' Owner t e ill e Dan Hostetter Date of Inspection: 3 i-2 7-9 6 ` Check if the following have been done: -4umping information was requested of the owner,occupant,and Board of Health. -Lekone of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. 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. v All system components,excluding 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 bales or tees, material of construction,dimensions,depth of liquid,depth of sludge, depth of scum. 41---�Iile and location of the Soil Absorption System on the site has been determined based on existing information or app ted by non-intrusive method". The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. I . (revised 11/03/95) 4 i i i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM f PART C {r SYSTEM INFORMATION Property Address: ! 86 Sand Point Osterville Owner Dan Hostetter Date of Inspection: ( 3—2 7—9 6 FLOW CONDITIONS RESIDENTIAL: Design Clow:,�l ons Number of bedrooms: L•_ Number of current residents: Garbage grinder(yes orEno):—y— _ Laundry connected to system(yes or no):� Seasonal use(yes or no) A-� f Water meter readings,if available: 119 �2 q! OU O Iq q s/i"3 d®y 5. f f Last date of occupancy:13";--7 5 � COMMERCIAL/INDUSTRIAL:- Type of establishment: } Design flow:_gallona/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yea or no)_ Non-sanitary wades dis4arged to the Title 5 system: (yea or no)_ Water meter readings,if available: t Last date of occupancy! OTHER:(Describe) Last date of occupancy., GENERAL INFORMATION PUMPING RECORDS and source of information: # w IA System pumped as part of inspection: (yes or no)_/—o If yea,volume pumped: aallond Reason for pumping: TYPE OF SYSTEM "ptic tank/distribution box/soil absorption system Single cesspool Overflow oe pool Privy Shared system(yes or no) (if yea,attach previous inspection records, if any) Other(explain) i c APPROXIMATE AGE of all components,date installed(if known)and source of information: O y i3 Q a Sewage odors detected when arriving at the site: (yes or no) (revised 11/03/95)' 5 L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address: 86 Sand Point 0sterville Owner. Dan Hostetter Date of Inspeotion: 3-2 7-9 6 SEPTIC TANK- ( locate on site plan) Depth below grade: Material of o_-struction•—concrete_metal_FRP_other(explain) i Dimensions: 'f' t' /b 14 Sludge depth. N , Distance from top of sludge to bottom of outlet tee or bale: 39 Scum thickness: I "� - Distance from top of scum to top of outlet tee or baffle: k Distance from bottom of scum to bottom of outlet tee or baffle: 5 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.) C — N G E TRAP:_ Oom&on site plan) Depth below grade: Mate of construction:_concrete_metal_FRP—other(explain) i. ions: thickness: from top of scum to top of outlet tee or baffle: from bottom of scum to bottom of outlet tee or baffle: Comm to: (repo endation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, of leakage,etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 86. Sand Point Osterville owner. ; Dan Hostetter Date of Inspection: 3—2 7—9 6 r , i TIG OR HOLDING TANK (locate site plan) r Depth grade: Material construction:_oonc:ete_metal_FRP_other(explam) r I Dimensio f Capacity: one Design fl w: I aallons/day Alarm 1 1: Co ts: (co of inlet tee,'condition of alarm and float switches,etc.) i DISTRIBUTION BOX:_ (locate on site plan) C Depth of liquid level above outlet invert: i Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) A PUM CHAMBER! (loca on site plan) 1 Punkin working order:(yes or no) ts: (note edition of pump chamber, condition of pumps and appurtenances,etc.) 4 i 1 1 t (revised 11/03/90 7 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 86 Sand Point O s t ery i l l e Owner. Dan Hostetter Date of Inspection: 3—2 7—9 6 SOIL ABSORPTION SYSTEM(SAS): (locate an site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits,number:_2— , leaching chambers,number:_ leaching galleries,number: leaching trenches, number,length: leaching fields,number,dimensions: overflow cesspool, number: Comments: (note condition of soil signs of hydraulic failure, level onding, condition of vegetation,etcJ �i a G.o CESS LS-_ (locate site Number d configuration: Depth-top f liquid to inlet invert: Depth of lids layer. i pth of layer: mensie of cesspool: of construction: ica ' of g:vuadwater: inflow(oesapool must be pumped as part of inspection) Comma :(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) PRIVY: (locate site plan) Ma of construction: Dimensions: Depth lids: Common (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, (revised 11/03/95) 8 v SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 86 Sand Point Osterville Owner Dan Hostetter Date of Inspection: 3-2 7-9 6 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' r r � I `��'}i \ � 1 } i DEPTH.TD GROUNDWATER Depthetound .1-4P method of determination or approximation: (revised 11/03/95) 9 3.iL.±r..rr..3.. ..,...._ �.1,::.e.:i ... ,_ _. ..csyn :.w .._ � �..�_r...:��..v.t .. arm...w..avr.uu.. u........�....+w,.._w.s................_..—,.._d..... ..+..w.._ .....g.w.......,..-........ems. ... Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection s . ' Southeast Regional Office William F.Weld (, j /� ((yy Governor U N 4 1J9b Trudy Coxe Secretary,EOEA <; David B. Struhs " I+ }il Commissioner URGENT LEGAL MATTER: PROMPT ACTION NECESSARY CERTIFIED MAIL: RETURN RECEIPT RE4 UESTED May 22, 1996 B Daniel & Priscilla Hostetter RE: q- RTN!: TABLE--BWSC a �� 770A Main Street tOsterville, Massachusetts 02655 4-12172 NOTICE OF RESPONSIBILITY M.G.L. c . 21E, 310 CMR 40 . 0000 On May 1, 1996, at 10 : 00 a.m. , the Department of. Environmental Protection (the "Department." ) received oral notification of a release and/or threat of release of oil and/or hazardous material at the above referenced property which requires one or more response actions. The lines of an underground storage tank system failed a tightness test necessitating the initiation of immediate- response actions . The Massachusetts Oil and Hazardous Material Release Prevention and Response Act, M.G.L. c.21E, and the Massachusetts Contingency Plan (the "MCP" ) , 310 CMR 40 . 0000, require the performance of response actions to prevent harm to health, safety, public welfare and the environment which may result. from this release and/or threat of release and govern the conduct of such actions . The purpose of this notice is to inform you of your legal responsibilities under State law for assessing and/or remediating the release at this property. For .purposes of this Notice of Responsibility, the terms and phrases used herein shall have the meaning ascribed to such terms and phrases by the MCP unless the context clearly indicates otherwise. - The Department has reason to believe that the release and/or threat of release .which has been reported is or may be a disposal site as defined by the M. C. P. The Department also has reason to believe that .you (as used in this letter, "you" and "your" 'refers to Daniel '.& 'Priscilla Hostetter) are a Potentially Responsible Party (a "PRP" ) with liability under M.G.L. c . 21E §5, for response action costs. This liability is "strict" , meaning that it is not based on fault, but solely on your status as owner, operator, 20 Riverside.Drive • Lakeville,Massachusetts 02347 • FAX(508)947-6557 • Telephone (508) 946-2700 - 1 y, -2- generator, transporter, disposer or other person specified in M.G.L. c . 21E §5 . This liability is also "joint and several" , meaning that you may be liable for all response action costs incurred at a disposal site regardless of the existence of any , other liable parties . The Department encourages parties with liabilities under M.G.L. c . 21E to take prompt and appropriate actions in response to releases and threats of release of oil and/or hazardous materials . By taking prompt action, you may significantly lower your assessment and cleanup costs and/or avoid liability for costs incurred by the Department in taking 'such actions . You may also avoid the imposition- of, the amount of or reduce certain permit and/or annual compliance assurance fees payable under 310 CMR 4 . 00 . Please refer to M.G.L, c. 21E for . a . complete description of potential liability. . For your convenience, a summary of liability under M.G.L. c. 21E is attached to this notice . You should be .aware that you may have claims� against third parties for damages, including claims for contribution or reimbursement for the costs of cleanup. Such claims do not exist indefinitely but are governed by laws which establish the time allowed for bringing litigation. The Department encourages you to take any action necessary to protect any such claims you may have against third parties . At the time of verbal notification to the Department, the following response actions were approved as an Immediate Response Action (IRA) • Removal of 100 cubic yards of Contaminated Soils. ACTIONS REQUIRED Additional submittals are necessary with regard to this notification including, but not limited to., the filing of a written IRA Plan, IRA Completion Statement- and/or an RAO statement . The MCP requires that a fee of $750 .00 be submitted to the Department when an RAO statement is filed greater than 120 days from the*date of initial notification. Specific approval is required from the .Department for the implementation- of all IRAs and Release Abatement Measures: (RAMs) . Assessment activities, . the construction of a fence and/or the posting of signs are actions that are exempt from this approval requirement . In addition to oral notification, : 310 CMR 40 . 0333 requires that a .completed Release Notification Form (BWSC-103 , attached) be submitted to the Department within.sixty (60) calendar days of May 1, 1996 . -3- You must employ or engage a Licensed Site Professional (LSP) to manage, supervise or actually perform, the necessary response actions at this site. You may obtain a list of the names and addresses of these licensed professionals from the Board of Registration of Hazardous Waste Site Cleanup Professionals at (617) 556-1145 . Unless otherwise provided by the Department, potentially responsible parties ( "PRP' s" ) 'have one year from the initial date of notification to the Department of a release or threat of. a - release, pursuant to 310 CMR 40 . 0300, or from the date the Department issues a , Ndtice of Responsibility, whichever occurs earlier, to file with the Department one. of . the following submittals : (1) a completed .Tier Classification Submittal; (2) a Response Action Outcome Statement or, if applicable, (3) a' . Downgradient Property Status . The deadline for either of the first two submittals for this disposal site is May 1, 1997 . If required by the _MCP, a completed Tier I Permit Application must also accompany a Tier Classification Submittal . This site shall not be deemed to have had all the necessary and required response actions taken unless and until all substantial hazards ;presented by the release and/or threat of release have been eliminated- and a level of No Significant Risk exists or has been achieved in compliance with M.G..L. c . 21E and the MCP. If you have any , questions relative to this notice, please contact Julie Hutcheson .at the letterhead address or at' (508) 94.6- 2852 . All future communications regarding this release mush reference the following Release Tracking Number: 4-12172 . -Mary truly. yours; Richard F. Packard, Chief Emergency Response / Release Notification Section- ' P/JH/jt CERTIFIED MAIL #P606 845 361. RETURN PECEIPT REQUESTED Attachments : Release Notification Form; BWSC-103 and Instructions Summary of 'Liability under M.G.L. c.21E . CC : Town of` Barnstable Town Hall 367 Main Street Hyannis, MA .02601 ATTN: Warren J. - Rutherford, Town Manager -4- cc: Board of Health Town Hall 367 Main Street Hyannis, MA 02601 ATTN: Brian R. Grady, R.S. ; Chairman Fire Department 1875 Route 28 Osterville, MA 02655 ATTN: Chief John M. Farrington DEP - SERO ATTN: Andrea Papadopoulos, Deputy Regional Director Z q3 Lr8l 59 756 Receipt for Certified Mail o No Insurance Coverage Provided ,�osr..ES Do not use for International Mail (See Reverse) Street nd No. l0 P .,Stat and ZIP Cpje f^ C UlI�7 Q Postage M � E Certified Fee C LL• Special Delivery Fee CO ft'c�siifCtetlf D ery 0 IReNrh� -� ,o - - - - to Who 'f 'ate De ed r Return ' esiei't Showin o l`Vho , Date,a essee's - s TOTAL P tage &Fees Postmark or Da STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). m 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address 12 leaving the receipt attached and present the article at a post office service window or hand it to i your rural carrier(no extra charge). % I 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return address of the article,date,detach and retain the receipt,and mail'the article. 0) r 3. If you want a return receipt,write the certified mail number and your name and address on a 2 return receipt card,Form 3811,and attach it to the front of the article by means of the gummed � ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. C 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, OD endorse RESTRICTED DELIVERY on the front of the article. 0 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If tL return receipt is requested,check the applicable blocks in item 1 of Form 3811. W a 6. Save this receipt and present it if you make inquiry. 105603-93-B-0218 °' SENDER: ■Complete items 1 and/or 2 for additional services. I also wish to receive the rn ■Complete items 3,4a,and 4b. following services(for an H ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. ai ■Attach this form to the front of the mail piece,or on the back if ace does not ti e p p 1• ❑ Addressee's Address permit. •� d ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N ■The Return Receipt will show to whom the article was delivered and the date a delis-.red. Consult postmaster for fee. 0 a 3.Article Ad essed to: 4a.Article Number CL 0 -/ � �Q 4b.Service7p e � W 51^d, 1 0 t o ElRegistered Ur Certified W 11 1 e- p y ❑ Express Mail ❑ Insured 5 ❑ Return Receipt for Merchandise ❑ COD c 7.Date of Delivery o a z 0, el d By: Pri e) 8.Addressee's Address(Only if requested c g 1 and fee is paid) L t— g 6.Signature:(Addressee or Agent) o X y PS Form 3811, December 1994 Domestic Return Receipt r First-Class Mail UNITED STATES POSTAL SERVICE Postage&Fees Paid uSPS Permit No.G-10 • Print your name, address, and ZIP Code in this box • Board of Health Town of Barnstable P.O.Box 534 Hyannis,Massachusetts 02601 IKE Town of Barnstable 070 snttxaTnsLe, Department of Health, Safety, and Environmental Services �.1639. Public Health Division �� �Fc a 367 Main Street,Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean FAX: 508-775-3344 Director of Public Health May 9, 1996 Mrs. Priscilla Hostetter 86 Sand Point Osterville, MA 02655 RE: 86 Sand Point Dear Ms. Hostetter: The County Department of Health and the Environment has notified this office that a recent soil vapor analysis test performed at 86 Sand Point Osterville, showed signs of soil contamination. You are directed to have your tank precision tested upon receipt of this order letter. If your tank fails the precision test you are required to remove the tank immediately. You are directed to submit a copy of your precision test results to the Public Health Division within 5 days of receipt of this letter. Sincerely, Thomas A. McKean Director of Public Health of B'jR BARNSTABLE COUNTY DEPARTMENT OF HEALTH AND THE ENVIRONMENT SUPERIOR COURT HOUSE POST OFFICE BOX 427 C�• h. ra. BARNSTABLE, MASSACHUSETTS 02630 Phone: (508)362-2511 Ext.330 Public Health Administration 333 Environmental=Health 383 l Water�0u'al ty Analysis 337 TDD 362-5885685 t�l May 6, 1996 �,- MAY 8 199,E Mr. Daniel Hostetter 770 A Main Street fool Osterville, MA 02655 C r '#A Dear Mr. Hostetter The purpose of this letter is to relay the results of an underground storage tank test , performed 4/29/96 by this department on the tank located at 86 Sand Point, Osterville. A soil vapor analysis test performed on one of the monitoring wells adjacent to the tank did show signs of soil contamination. Given the unmistakable presence of this contamination indicated by the test, it is my strong recommendation that you either have a precision test conducted to ensure the integrity of the tank, or have the tank removed. I have enclosed information regarding precision testing, which generally runs $300-400 per tank. You should note, however, that your tank is required to be removed at age 30 years regardless of the test results. I have also enclosed a list of tank removal companies in the area. These companies or the Centerville Osterville Marstons Mills Fire Department can advise you of the proper procedures for tank removal. There is a $40 fee for testing the monitoring wells. A check made payable to Barnstable County can be sent to: Barnstable County Health & Environmental Dept. , P.O. Box 427 ; - Barnstable, MA 02630_ a Attn: Jane Crowley If I can be of further assistance, please call me at (508) 362-2511 extension 371. Si erely, Jane Crowley Project Assistant Underground Storage Tanks cc: Barnstable Board of Health ✓ ' COMM Fire Department Health Complaints 10-May-96 Time: 3:00:00 PM Date: 5/8/96 Complaint Number: 176 Referred To: DONNA MIORANDI Taken By: JEROME DUNNING Complaint Type: ARTICLE XXXIX HAZARDOUS WASTE Article X Detail: Business Name: Number: 86 Street: SAND POINT Village: OSTERVILLE Assessors Map_Parcel: Complainant's Name: LT. GLEN WILCOX Address: C-O-MM FIRE DEPT. Telephone Number: 790-2375 Complaint Description: LT. WILCOX CALLED TO RESPOND TO A LEAKING UNDERGROUND FUEL TANK. WANTS HEALTH DEPT. TO UTILIZE HNU FOR SOME READINGS. Actions Taken/Results: DZM responded and realtors along with new potential buyer, John Fish, along with some construction workers (Suffolk Construction) and Mike's Petroleum Service were on site. Mike's was performing a vacuum test on the tank. Two monitoring wells were around the tank. According to the County Health Dept. (Jane Crowley) it was the upgradient m.w. that had failed. Utilizing the HNU DZM did not detect anything. However, soil around the upgradient m.w. had readings of 40 ppm. Soil around the side of the tank was saturated but only had readings of 30 ppm. Soil around the downgradient well exhibited no contamination. Initial vacuum test had failed but test on 5/8/96 passed. During the interim of the two tests by Mike's Petroleum , Reidell had replaced the copper feed lines and tightened some fittings. Lt. Wilcox was going to investigate why it was done without a permit. Potential new buyer is hiring an environmental firm to come out on 5/9/96 and i Health Complaints 10-May-96 perform further analyses. At that time the tank may have to come out and perhaps may install a propane tank. DEP will have to be notified- attorneys are aware of it but, DZM will follow up on the notification.DZM left the site at 4:45 pm. Due to a note from a message of Priscilla Hostetter I called DEP on 5/10/96 at 10:45 am and made a report of this release. Spoke to Julie Etchinson at DEP. She will report back to me. Investigation Date: 5/8/96 Investigation Time: 3:30:00 PM 2 mot , Town of Barnstable Department of Health, Safety, and Environmental Services �� Public Health Division '0ri�o wla� 367 Main Street,Hyannis MA 02601 Office: 509-790-6265 Thomas A.McKean FAX: 508-775-3344 Director of Public Health May 9, 1996 x Mrs. Priscilla Hostetter N` 86 Sand Point Osterville, MA 02655 RE: 86 Sand Point Dear Ms. Hostetter: The County Department of Health and the Environment has notified this office that a recent soil vapor analysis test performed at 86 Sand Point Osterville, showed signs of soil contamination. You are directed to have your tank precision tested upon receipt of this order letter. { If your tank fails the precision test you are required to remove the tank immediately. You are directed to submit a copy of your precision test results to the Public Health' Division within 5 days of receipt of this letter. r s Sincerely, .fi IV 14, Thomas A. McKean a Director of Public Health , a i. o� aA�M BARNSTABLE COUNTY DEPARTMENT OF HEALTH AND THE ENVIRONMENT SUPERIOR COURT HOUSE V 4 POST OFFICE BOX 427 BARNSTABLE,MASSACHUSETTS 02630 • A. a Phone:(508)362-2511 Ext.330 Public Health Administration 333 Envlronm tat Health, 383 Wate a�r Ahilysis 337 TDD 362-5885 May 6, 1996" MAY 8 1996 .., Mr. Daniel Hostetter - .;• ... µ z, 770 A Main Street1°° Osterville, MA 02655 Dear Mr. Hostetter The purpose of this letter is to relay the results of an underground storage tank test performed 4/29/96 by this department on the tank located at 86 Sand Point, Osterville. A soil vapor analysis test performed on one of the monitoring wells adjacent to the tank did show signs of soil contamination. Given the unmistakable presence of this contamination indicated by the test, it is my strong recommendation that you either have a precision test conducted to ensure the integrity of the tank, or have the tank removed. I have enclosed information regarding precision testing, which generally runs $300-400 per tank. You should note, however, that your tank is required to be removed at age 30 years regardless of the test results. I have also enclosed a list of tank removal companies in the area. These companies or the Centerville Osterville Marstons Mills Fire Department can advise you of the-proper procedures for tank removal. •,t`' e. . There is a $40 fee for testing the monitoring wells. A*check made payable to x= Barnstable County can be sent to Barnstable County Health & Environmental Dept. P.O., Box 427 Barnstable, MA 02630 Attn: Jane Crowley , if I can.be of further: assistance, please call me at (508) 362-2511 extension 371. _ •. �g � �`«v `fro �F Si erely, u y rK r Jane Crowley Project Assistant Underground Storage Tanks cc: Barnstable Board.of Health ✓: ; COMM Fire Department - y ] TANKS] ] 7] FUEL STORAGE TANK RECORDS ] HELP [ ] FOR PARCEL NBR: ] 073] ] 015] ] 002] ] ] MAIN ACTION ICI Action Tank Nbr Tag Nbr Installed Location ----Notification Dates----- [ ] [ 11 [ 6671 [0201861 [B ] Test ] ] Rem ] ] ---- Test --- --Abandoned-- -- Removed -- -- Variance - Fuel Reason Capacity Constr Status Leak-Det Cath-Det [D ] [H ] [ 2 0 0 0] [SS] [N ] [N] [N] Additional Details [TAG#667 REPLACED WITH TAG #8441 -------------------------------------------------------------------------------- Action Tank Nbr Tag Nbr Installed Location ----Notification Dates----- [ l [ ] [ ] [ ] [ ] Test ] ] Rem ] ] ---- Test --- --Abandoned-- -- Removed -- -- Variance = Fuel Reason Capacity Constr Status Leak-Det Cath-Det [ ] [ ] [ ] [ ] [ ] [ ] [ ] Additional Details [ ] -------------------------------------------------------------------------------- Cancel [ ] END OF DATA NEXT SCREEN [HMENU] ACTION [ ] PARCEL NBR [ ] [ ] [ ] ] ] TANK NBR [ ] ] PAR ] Real Estate System - General Property Inquiry] Help [ ] Parcel Id: 073 015-002- Account No: 32706 Parent : 38373 Location: 86 SAND POINT OY H Neighborhood: 23WA Fire Dist : CO Devel Lot : 146 & 1 Lot Size : 2 .49 Acres Current Own: HOSTETTER, PRISCILLA M State Class : 101 SAND POINT No. Bldgs : 2 Area: 4788 Year Added: 85 OSTERVILLE MA 2655 Deed Date : 030190 Reference : C120079 January 1st : HOSTETTER, PRISCILLA M Deed MMDD: 0390 Deed Ref : C120079 Comments : Values : Land: 1598900 Buildings : 485800 Extra Features : Road System: 86 Index: 1682 (SAND POINT ) .Frntg: Index: ( ) Frntg: Control Info: Last Auto Upd: 050695 Status : C Last TACS Update : 121190 Land Reviewed By: Date : 0000 Bldgs Reviewed By: Date : 0000 Tax Title : Account : 5725 Taken: 082495 Account Status : Hold Status : Cancel [ ] Press XMT for more data Next screen [PAR ] Action [ ] Owners Name [ ] Road Index [ ] Road Name [ ] Parcel Number [073] [016) [ ] [ ] [ ] ............ THE ; 0 MQNWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........OF.. 1 ?74.. ................................... Appliratiou for llhipaaal Works, Tomitriir#'inn ramit Application is hereby made for a Permit to Construct ( ) or Repair (K) an Individual Sewage Disposal System at: i ...-- L cation-Address or Lo ................................................... Owner 11' ! Address W Installer Address Type of Building Size Lot..'zZl_ ..: C U Dwelling—No. of Bedrooms.._` -Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type of Building /.... No. of persons............................ Showers a yP g ------.--------•------ P ( ) — Cafeteria ( ) dOther fixtures ......_. . _--- ...................................................--------•--........................................................... W Design Flow........t - .._.. _____._gallons per person per day. Total daily flow____......�nn O_____________________gallons� WSeptic Tank—Liquid capacity) allons Length._�0--�•- Width._-6.-. Diameter. ..- Depth.15L.. ' x Disposal Trench—No. .................... Width.............._..... Total Length.................... Total leaching area.....................sq. ft. Seepage Pit No....... Diameter.... ........ Depth below inlet....6P.......... Total leaching area...e�? '}..sq. ft. Z Other Distribution box (*5 Dosing-lank ($W _ 1 ~' Percolation Test Results Performed by._+--'-...A& .. _.__-L c........._... Date...�Q-VQ`.'. ......... ,tea Test Pit No. I...4.3?- _.minutes per inch Depth of Test Pit....XZ.......... Depth to ground water... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ __. ............ .... ....... 0 Description of Soil.....-E)_—k 7..... ��:�? � 4 ___ ` ----- 2'............... _ - .ate---- x ;... r .._.. —�acQs�a r- ----------------------------------------------------------------------------------- W ------------------------------------------------------•------------------•----------------------------------------------•----------------------------------------------•-----•--:......_. VNature 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 TL ITLE: 5 of the State Sanitary Code—.The undersigned further agmes-riot place the system in operation until a Certificate of Compliance has been e/d/ he of h Signed--....... � ............. .................. .5....a...... � Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons-------------•-------------------•-••--------•----------•--------------------•--•------------------.......-•---- ........--•----•-•--•................•--•--••••-•--...........----•-•--•--...........---•---•••........--I................................................-.............................................. p' Date PermitNo...... -9.--.-L-'7--------------------------_ Issued-....................................................... Date No... �5 .��.�1 � t i--f Fas_��� THEICOMMONWEALTH OF MASSACHUSETTS BOARD O F HEALTH {....................OF.-................... .. >._.....,. Appliration for Disposal Works Tonotrnrtiott ramit Application is hereby made for a Permit to Construct ( ) or Repair (1{ ) an Individual Sewage Disposal System at: , l ...... W --if-...-_•,---t; ................ .... _�....\....u........�C-.t..i�.....�\...... Lot (......t.Z..=.,.".t.[I....• ...�....;..>..J..LatiAress C . `. ••• .............. Owner ..................Address .._. ..... ,� ----------------------------------------- -•------------------------------------........... . ......---------,-------.............._.._....---dres...........................�.c�t.............. � Installer Address ,� U Type of Building 4 Size Lot-._._..:.�:............... '9q. Feet �., Dwelling—No. of Bedrooms........... ................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building ....... No. of persons............................ Showers a, yP g •-----•--••----•-•--• P ( ) — Cafeteria ( ) a' Other fixtures -------------------.------•---------------------------------------- ................................... --.. Design Flow.....__. �...._.. �.....-•---..ons �^;� = W g gallons per person per day. Total_daily,flow........... ... ,gallons. W Septic Tank—Liquid capacity:`1 agallons Length.�CL_L. Width_��L.` : .... Diameter.`":::-::::_... Depth.:.?..':�'... x Disposal Trench—No..................... Width ................ Total Length................... Total leaching area..•.........•.--...sq. ft. �a z " 3 Seepage Pit No...._�.-.:---_..._ Diameter..-lC.�......... Depth below inlet.....::............. Total leaching area........ .�...sq. ft. Z Other Distribution box ��j Dosipg;tank ( C ` _ '"'14 Percolation Test Results Performed by._ .. ....`:�_2:!.... L S'� �.............. Date......................................... 64 Test Pit No. 1__'_._'....minutes per inch Depth of Test Pit...j. .. ........ Depth to ground water..�::�_'_` `_.- tz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a �........................... .. ........ .".......... _ .--- D Description of Soil......-'_ ��� 1 ". `� ' �c i \ �.%' U r.� •.t �� t.5� .................................................................................................. W UNature 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 TITI.i 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................................................... --•......- ------....- Date ApplicationApproved By................................................................................................_ Date Application Disapproved for the following reasons:........................................................................................................... .L..K..---...... ...................... .. ... .....................------------........------....................-----...------..............Dau............_ PermitNo. . ............ .... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... 0ortif iratr of Tontplianr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) at.............LC�J.____.f.......5. ...— U Installer.............. - .. ^..... ... ...-.... has been installed in accordance with the provisions of TIT F 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......_ .5.: f.�y....... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......................^..��?. A.. .............................. Inspector..............--- . �... a 5 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .:..�. � ............ TQ�,c::�::c........OF............. �� ................._............ .......... No. Fay. Disposal Works Tonstrurtion Errant Permissionis hereby granted.............•-•---------••--•--...................................................:....----...................---........................_.. to Construct ( ) or Repair ( K) an ndividual. wage Disposal System at No..............�:.�?..7... ......... •c �ti •--....._._...._.. Street �p / as shown on the application for Disposal Works Construction Permit No.Q.Q..:el... Dated.......................................... V r �.... 7 Board of Health DATE................... _... .................................. FORM 1255 A. M. SULKIN, INC.. BOSTON t 70- p._ - ... ram.. - rl el Lol Or A0, r ,ram f-. ,� -2 .• sP : 5''�P .! �: <. l3"�" -.4t • , y"�- ,�,` ; -�;,, . � �-_ , y cry X } ' L^�. 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