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0211 STARBOARD LANE - Health
Osterville64 .f:Rl= � &Q. f A` 166"044-"001-�� 4F t \v ' I I i TOWN OF BARNSTABLE LOC:',�4:�I'I01- :;2 f Il fin.�l�. at.� �,�- SEWAGE # VU fAGE S'Te ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO,:1�/15T�.9.>= f SEPTIC TANK CAPACITY / 7 dO $ C. 1 _ LEACHING FACILITY: (type) �-" Li�� �' ��619�° (size) ,2 X✓3 90OF BEDROOMS BI.1(LDER OR OWNER C 4 PERMTTDATE: COMPLIANCE DATE:_ Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by -` p.-1 T ' ' y 3 { Noll 031 FEE COMMONWEALTH OF MASSACHUSETTS w Board of Health, I�in. ��-1i .�2�i'� ,MA. 't � rl APPLICATION FOR DISPOSAL SYSTEM C®NSTRUC I ION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade(/Abandon( ) - ❑Complete System O Individual Components Location N Owner's Name 0,��•�L1� Map/Parcel# _co, Address Lot# .�Z Telephone# Installer's Name /2�'- �xGA,V,476�J Designer's Name Address ; �,� ��crx ,� Address 42 CANTERBURY LANE Telephone# Telephone# 508/540-2534 Type of Building Lot Size sq.ft. welling No.of Bedrooms rt#Lx5-,*' 93s!$,e- lsmgr� 3_�Vp S TSj l n Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) AA E) gpd Calculated design flow%Ak?, to 33e) Design flow provided gpd Plan: Date I L-\D-oA Number of sheets ,� Revision Date d%- -V Title !25-1—trj [-1 %!L1JCM- U- S l��f'l lie. `YtJ r�fQ '�); e�:-A XE*4 2A'c!1 Description of Soil(s) ���_ rj� PLAIL"k Lem Soil Evaluator Form No. 1 o Name of Soil Evaluator Jr• n Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS T7►�tier)�,4_ 1'"MULL" t§1 15, A 91pa> The undersigned agr s to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE td further agr o t t pl e e system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date a /I ec ons ' No. P _ .< T r FEE 5� 031 f Q ) # �M f V . AMONWEALTH OF MASSACII�1S''�TS fy i -*'""Board of Health i+Nvu t,4;r�.:cSs� ,WA � APPLICATION FOP, DISPOSA SYSTEM ONSWU-CTI~�D�N PERMIT K.. JIV Application for a Permit to Construct( Repair( Upgrade(1 /Abandon( - ❑Complete System 'Q Individual Components Location p��, �,�p,�, Owner's Name Map/Parcel# W, AA --got, Address Lot# ,�Z- ` Telephone# Installer's Name ��j�- �ATI7571/ Designer's$41FeHEN J.DONTE AND ASSOCUTES Address Z t Address EAST FALMOUTH;MASSACHUSETTS 02536 6984402634 Telephone# !�/Z _ .Z �y Telephone# Type of Building Lot Size sq.ft. welling)No.of Bedrooms t'9.,.ott5f* t31%$— la,,,Mc-r''"D S!i;p S44r 1 v % �AOJ Garbage grinder( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures %I^ _ Design Flow (min.required) A*6 gpd Calculated design flowU;tti 3:;e2 Design flow provided &")93 gpd Plan: Date 1�_—t D—04 Number of sheets 1 Revision Date 'o1 ^ 2>-D Title �=P_e'1 C.. ��.t�'pts-+t J G11RA.►'7C't ` Uil) �R tl.tli�l.r �.'c�s Description of Soils) t��f"� �it'Y-" �j,N►� �tt� t..17s� Soil Evaluator Form No. 1 0 qzz C' Name of Soil Evaluator 3c' • � �lIV Date of Evaluation at t3—ytS DESCRIPTION OF REPAIRS OR ALTERATIONS fi''x`S.: T�''-.•7u,u �V�ii�t-1.t GA S a L.an7 .I�s s,-b•,� �n '33a 1, �I� , l� Nrr�( ) 3'JD C t� 15 7=ba Ulm1J k s F The undersigned agr es to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agr o not to place a system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed C Date /InspecTions-� No.c3wo 5 -6 30� J* FEE COMMONWEALTH OF MASSACHUSETTS Board of Health, MA. CI RTIEICATE ®E COMPLIANCE Description of Work: ❑Individual Component(s) §kComplete System The unde signed hereby certify that the Sewage Disposal System; Constructed (P,Repaired ( ),Upgraded ( ),Abandoned ( ) by: 4n, .1 at Lam) 0,:�h.---a 1 C AQ has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-b rilt�plans relati g,to,- application No. ')00 5 `bJS date _ J J 05 Approved Design Flow 8 (gpd) Installer Designer: L1 Q Inspecto Date 3 /Vo 5. The issuance of this permit shall not be.construed is a guarantee that the system will"fiinction as-designed: No. ./ FEE COMMONWEALTII , MASSACHU'SE11, Board of Health, _ J/ � �7►1A. ' DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is h reb_ ranted to` Construct Re air r yg /j ( ) p ( ) Upgr/a'de( ) Aban o/n( ) an individual sewage disposal system at I �M� (}l/-�0_� /I/ r ( �I 'as described in the application for - nn, , Disposal System Construction Permit No. tl 1,, dated Provided: Construction shall be completed withi ' three years of the date of thilk-permi't AM local conditions must be met. ' Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date 14AN, Board of Health Town of BArnstable ' P NE °'�; Regulatory Services Thomas F. Geiler,Director i6M Public Health Division rEo '� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Forw Date: 0 3 - o - 5 y Designer: Installer: ST'EPHEN J.DOYLE AND ASSOC! ,,. Address: 42 CANTERS URy LANE Address: V, EAST FALMOUTH,MASSACHUSETTS 025H 508/540-2534 On o 1 --r-A was issued a permit to install.a (date) (installer) septic system at -C.\` 1,4jN, e,,based on a design drawn by (address) 43�.o� dated (designer) I ertify that the septic'system referenced above was installed substantially according to e design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic systemreferenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical.relocation of any component of the septic system)but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. a OF A4ASS� c STER(Ins y`^ ta11e s Sign )ature K1F A- 3 (Designer's Si ature) (Affix Designer Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC H1ALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOT8 THIS FORM' AND AS- BUILT CARD ARE RECEIVED By THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form TOWN OF BARNSTABLE LOCATION I ff An.�O lea .z- SEWAGE # 04 VILLAGE ASSESSOR'S MAP & LOT " 3d- INSTALLER'S NAME&PHONE NO, -h.�.� SEPTIC TANK CAPACITY LEACHING FACILITY:.(type) q��" yi�'� �' *A*'6-'z"o (size) .2 5 X/3 NO.OF BEDROOMS BUILDER OR OWNER C 4 <1- PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 33 4 .3'i 3 4, 3 ' r g Health Complaints 05-Apr-06 Time: 1:05:00 PM Date: 4/2/2006 Complaint Number: 18730 Referred To: DAVID STANTON Taken By: DAVID STANTON Complaint Type: ARTICLE XXXIX HAZARDOUS WASTE Article X Detail: Business Name: Number: 211 Street: STARBOARD LANE Village: OSTERVILLE. Assessors Map_Parcel: 166-044-001 Complaint Description: A LEAKING FUEL OIL TANK IN BASEMENT AT SAID RESIDENCE. Actions Taken/Results: DS WENT TO SAID LOCATION AND MET WITH COMM FIRE, AND THE PROPERTY OWNER. THE OWNER CALLED COMM FIRE AFTER HE NOTICED A LEAK UNDER HIS FUEL OIL TANK. LESS THAN 2 GALLONS OF FUEL OIL WERE RELEASED. THE BASEMENT WAS IN VERY GOOD CONDITION, WITHOUT ANY CRACKS. THE SPILL WAS CONTAINED WITH SPEEDY DRY AND, AND PADS. COMM FIRE INSTALLED A MAGNETIC PATCH. REIDELL WAS GOING TO PUMP IT OUT INTO A TEMPORARY TANK. OWNER DEBATING INSTALLING A GAS FURNACE, OR REPLACE THE OIL TANK. DS RECOMMENDED A DOUBLE WALLED OIL TANK IF IT IS FINANCIALLY FEASIBLE TO PREVENT THIS IN THE FUTURE. DEP NOT NOTIFIED AS THIS APPEARED TO ALL HAVE BEEN CONTAINED AND CLEANED UP, AND DID NOT GET RELEASED INTO THE ENVIRONMENT. OWNER VERY i Health Complaints 05-Apr-06 FORTUNATE HE WAS HOME AND NOTICED IT BEFORE IT GOT ANY WORSE. Investigation Date: 4/2/2006 Investigation Time: 1:25:00 PM 2 n g y 01 }t° k' kx'� n w Logged In As: Parcel I Tuesday, April 4 2006 Parcel Lookup Parcellnfo _.� _.....� _............ .�....... ..... _..... . Parcel ID 166 044 001 Developer Lot LOT 32 Location 211 STARBOARD LANE Pri Frontage 1472 Sec Road Sec Frontage Village jOSTERVILLE Fire District,C-O-MM Sewer Acct Road Index 1527 Owner Info p ...._.._. ...._.. _ __._ ...___. __.._...., Owner=CALLEN, ANDREW B Co-owner �. _ _.... ........ .._ .. ....,,...._�_ ......... ...mm Streetl 1205 FAIRHAVEN HILL RD Street2 City'CONCORD State MA Zip 01742 Country USA Land Info _.. _ _. _...... _,,.... .. ...... _. ... .�._ ...... ...... ....., . Acres,1.32 use Single Fam MD Zoning RF1 Nghbd 0113 ......... ..............._ ......... _. Topography Level Road `Paved utilities Public Water,Gas,Septic Location 3 ....._...._ Construction Info ..... ....... .................. ......... ......... ......... ................ ........ _ ............. ......... Building Year f Roof AC 1952 Gable/HI Central _.._. Built. Struct p. Type, BtATI1921 Effect.—.. _. Roof Bed 4454 Wood Shingle 14 Bedrooms / Area Cover Rooms f .. ..._.__. . ...__„ ✓ style:Cape Cod Int Drywall Bath ___.. ...—_..._ ......�... t� � Wall ry Rooms Model Residential Total 9 Rooms ' Rooms ........................................ Grade Custom I.nt? Bath ... ST. Floor' Style i Kitchen Stories '1 1/2 Stories Vdernized Style Ext ... Heat 1 Bath Wall Wood Shingle Fuel Split= w TypeHot Air _ _. Found ation 011 Permit History ...........................__. ........................... _.................. Issue Date Purpose Permit# Amount Insp Date Comments 2/7/2005 Addition 82073 $250,000 GAR 9/26/2000 Remodel &Addn 48885 $320,000 1/17/2001 12:00:00 AM 1/13/1997 New Addition 20492 $8,000 6/25/1998 12:00:00 AM DECK f I1 5/1/1995 I I B37715 I$850,000 1 I OS 2 STOR II - Visit History . ..... ... ........._ ......... ........._ ............ Date Who Purpose 11/6/2001 12:00:00 AM Martin Flynn Meas/Listed 1/17/2001 12:00:00 AM Martin Flynn Measur/New UC Under Construction 9/29/1999 12:00:00 AM Donna Dacey Meas/Listed 16/25/1998 12:00:00 AM Lloyd Kurtz - Sales History Line Sale Date Owner Book/Page Sale Price 1 11/8/1996 CALLEN, ANDREW B C142629 $325,000 2 9/15/1992 SMITH, SCOTT C & MARIA C C127808 $450;000 L3 10/15/1985 BAMBERA, JOHN D C103668 $380,000 4 _ 11/15/1978 HAVLIN, JANET LORD C76236 $0 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parcel Value 1 2006 $492,300 $5,400 $0 $570,400 $1,068,100 2 2005 $434,700 $5,300 $0 $427,700 $867,700 3 2004 $324,800 $5,300 $0 $427,700 $757,800 4 2003 $337,200 $5,300 $0 $216,000 $558,500 5 2002 $293,600 $5,400 $0 $216,000 $515,000 6 2001 $252,700 $2,500 $0 $216,000 $471,200 7 2000 $221,300 $2,500 $0 $130,200 $354,000 8 1999 $221,300 $2,500 $0 $130,200 $354,000 9 1998 $211,000 $2,500 $0 $130,200 $343,700 10 1997 $213,500 $0 $0 $251,300 $464,800 11 1996 $197,500 $0 $0 $251,300 $448,800 12 1995 $197,500 $0 $0 $251,300 $448,800 13 1994 $172,500 $0 $0 $226,100 $398,600 14 1993 $172,500 $0 $0 $228,300 $400,800 15 1992 $196,300 $0 $0 $251,300 $447,600 16 1991 $224,300 $0 $0 $327,700 $552,000 17 1990 $224,300 $0 $0 $327,700 $552,000 18 1989 $224,300 $0 $0 $327,700 $552,000 19 1988 $183,600 $0 $0 $152,700 $336,300 20 1987 $183,600 $0 $0 $152,700 $336,300 L21 1986 $183,600 $0 $0 $152,700 $336,300 Photos 211 Starboard Lane, Osterville. Pinhole leak at bottom of fuel oil tank in basement. K: i by COMM fire, bucket underneath, Reidell i„ uttank. .:�ess then 2 gallon, not into the ground, all contained. IDS r t �a �• •.Z 2� TV I�1 1�<.. i. CM cu THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A m / �C(�`J IL DATA CENTERVILLE-OSTERI/ILLE-MARSTONS MILLS FIRE DISTRICT 1875 ROUTE 28 CENTERVILLE, MA 02632 (508)790-2380/FAX#(508)790-2385 01UHAZARDOUS MATERIAL RELEASE FORM X-11 2n F.A. cc LOCATION: ADDRESS OF RELEASE' i-H-17 J C-rl DATE OF RELEASE:- PRODUCT RELEASED:- ESTIMATED QUANTI,ry, CORRECTIVE ACTION i-AFER-B-Nq5�i9S—P06BLE PARTY: W I I AA 'n,-777-I A K F NOTIFICATIONS: FIRE DEPARTMENT: YES( ),-NO( DATE: TIME,--- NATIONAL RESPONSE CENTER YES( ) NO( ATEz jI wt=—.T 7 T ME:T7 DEPT. OF ENVIRONMENTAL PROTECTION YE*( NO(,�ZATE:, TIME:__ OIL SPILL COORDINATOR: YES( ) NO(d, DATE- TIME: TOWN BOARD OF HEALTH: YES( ),NO( DATE, TIME- TOWN HARBORMASTER, YES("') NO( DATE:- T IME77 OTHER AGENCIES. COMMENTS. 'e-l".77F77-/.-rr-- L 4 N�l 77177 7 7-7 all -777- ?7-7 q4n,o W U7 REPORTED BY: DATE, I I —W I V WHITE COPY-FIRE DEPARTMENT YELLOW COPY-D.E.P. PINK COPY-BOARD OF HEALTH C-0-MM FORM#59 Find Map/Parcel 166044001 Town of Barnstable ' a Health Department Health System MOM NOW `MaplP�arCel 166044001NM Tarik Nbr 01 Ta F. 0000 �Instalied �— "LocatiIRM on B Mknl Test Notifies#ion Date ( 5ta#u Date K, WN Rpmoval Notifieation�Uate Test a r I 3 . Abandon F , "F2ert val L� 04/02/2006 < 40W ,A, Fuei St ro end=: FO ` uei 5torageReason C1apa Cot1s#rucrion L�ak Detection °,cathodic�etecne tian Starage Tank Info rqp Additional Details Leaked approx 2 gallons "r r r Adtl �¢ � C ange f ' COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ,AAP PARC5I. LOT - - TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 211 Starboard Lane Osterville MA 02655 Owner's Name: Drew Callen Owner's Address: LR Date of Inspection: October 20, 2004 Name of Inspector: (Please Print) James M. Ford u4 Company Name: James M. Ford Mailin Address: P.O.Box 49 g _ Osterville.MA 02655-0049 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 Conditionally.Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: IMVA4 Date: October 21. 2004, The system inspector shall sub ' 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. j 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 f Page 2 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 211 Starboard Lane Osterville, AM Owner: Drew Callen Date of Inspection: October 20, 2004 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 riot)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 f Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 211 Starboard Lane Osterville, AM Owner: Drew Callen Date of Inspection: October 20, 2004 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 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 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: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 211 Starboard Lane Osterville, AM Owner: Drew Callen Date of Inspection: October 20, 2004 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 %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 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 211 Starboard Lane Osterville MA Owner: Drew Callen Date of Inspection: October 20, 2004 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 CUR 15.302(3)(b)]. 5 r Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C .SYSTEM INFORMATION Property Address: 211 Starboard Lane Osterville,MA Owner: Drew Callen Date of Inspection: October 20, 2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3. Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): n/a [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)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): epd 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: Unavailable Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed 10128196-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 I Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 211 Starboard Lane Osterville, AM Owner: -Drew Callen Date of Inspection: October 20, 2004 BUILDING SEWER(locate on site plan) Depth below grade: 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: 14" 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: 3" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 12" 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 invert. There did not appear to be any signs of leakage. 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 r Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOL UNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 211 Starboard Lane Osterville,MA Owner: Drew Callen Date of Inspection: October 20, 2004 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 and clean. No solids were present. PUMP CHAMBER: None (locate on site plan) Pumps iri 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 ► L Page 9 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 211 Starboard Lane Osterville, MA Owner: Drew Callen Date of Inspection: October 20, 2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: ✓ leaching chambers,number: Maximizer infiltrators 36'6"x 9'x 2' 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 chambers were dry and clean. There did not appear to be any signs offailure. 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: 211 Starboard Lane L Osterville,AM Owner: Drew Callen Date of Inspection: October 20, 2004 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. (3ack WAIk ov� q boor a a 3o S a ak 1,;0 y SS 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: 211 Starboard Lane Osterville,1M Owner: Drew Callen Date of Inspection: ' October 20, 2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 30+/- 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: Using Barnstable topographic maps and water contours maps, the maps were showing approximately 30'+/-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 TOWN OF BARNSTABLE 'ION `( k)zzm a4I�� ��� SEWAGE# c;?3 VILLAGE 1-)3-��ISC 1/'/ IAE, ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. �� �e�I�'I�I� 171t95^c;? 0�D SEPTIC TANK CAPACITY (9 4110--1S LEACHING FACILITY: (type) (size) �A' ®Z Q NO.OF BEDROOMS [l e'BUILDER OR OWNER��<fA, / J Ale- Z PERMITDATE:� ,—I.7-�n 93" COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility)- Feet Edge of Wetland and Leaching Facility(zany wetlands exist within 300 feet of leaching facility) ' Feet Furnished by =�. JAMIK pv¢ J �iF,SGMC Y7� . JooiZ A l/ 17�vnof t .4 y TOWN OF BARNSTABLE LOCAf,,)N SrA&Ar� /A/,L SEWAGE # VILLAGE 0 STtfv,I� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Sw aLEACHING FACILITY: (type) 101 i'��t�.A V4 �Zt 1 (size) Yo.(o X 0`x ;L� •NO:OF BEDROOMS Is ,BUILDER OR OWNER �ffl�J II PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leacnng facility) —I Feet Furnished by 'r^S IDCIJ t►u n �b(C f3Atk wglk ou A Door � 130 lS a WE' ao y SS ' yo ;~ No. �✓ �� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Miopooar *pztem Congtruction Permit Application is hereby made for a Permit to Construct( )or Repair( &,Kan On-site Sewage Disposal System at: Location Address or Lot No.a l( S f mtbo-" (A) Owner's Name,Address and Tel.No. Assessor's Map/Parcel 0 5+_e L)i 1 1p— ®qdl Installer's Name,AddreA6,apd "dANCO Designer's Name,Address and Tel.No. i350 Main-Street W. Yarmouth. MA 09673 Type of Building: „ Dwelling No.of Bedrooms 3 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 v Description of Soil Nature of ReI /rs or Alterations(Answer when applicable) �- /SOD J'_n f,'L �L a,JL � LI- Ir» fr o f s rn A,4;M i z e Y-51 ZJ cS�ex� ro,n�A 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 this Board of H alth. Signed Date f 0 - ! *) j Application Approved by Date A,) r12 "�� Application Disapproved for the following reasons Permit No. P G " sue_ Date Issued No. 7 A Fee E)' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -.TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYtcatton for Oigaal *pgtem Construction 3permit Application is hereby made for a Permit to Construct( )or Repair.( t,)ian On-site Sewage Disposal System at: Location Address or Lot Wail Sfa r boats& //U. Owner's Name,Address and Tel.No. Assessor's Map/Parcel `.. 66— O�/Y. 001 S'co# Sl";dh all Sacbo.,4 /A). !J� Installer's Name,Address,&&$NCANCO Designer's Name,Address and Tel.No. 350 Main Street W. Yarmouth, MA 02673 Type of Building: ,- Dwelling No.of Bedrooms �J Garbage Grindef( ) ( l Other Type of Building No.of Persons Showers( ) Cafeteria( ) 1 Other Fixtures Design Flow gallons per day. Calculated daily flow 1 gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when a plicable)' C- /S'o0 �Q� 1-0 a x fo U- n� I+i ,i+ors /niogiA �2er� GJl 3� J��te aivu�d� E i Date last inspected: 1 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system F 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 this Board ofj eal7 Signed Date 10 / '_9 C Application Approved by V( a� Date AU Application Disapproved for the following reasons Permit No. Date Issued `0 ———————— ————————————————— ————————— j THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced( "(on r by CU Installer elgl co ` at // /M 5 1 if,f V� has been constructed in accordance with the provisions of Title 5 and the for Disposal System ConstructioiDermit No dated 0 7%;;1 ',96 1 Date Inspector a THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THA THE SYS- TEM WILL FUNCTION SATISFACTORY. jNo. /G �s��--------------------------Fee � 1 l THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS ]Dtopooal bpotem Conotructton Permit a Permission is hereby granted to C'AlUCO to construct( )repair( ✓f an On-site Sewage System located at No.# Or t` Street and as described in the above Application for Disposal System Construction Permit. 24, r --'3 !6— 7—9 No. Date The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within three years of the date below. Date: �� l 7'. I�'� Approved by_f ` ZL�L- Board of Health CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I, J ; Cayj hereby certify that the application for disposal works construction permit signed by me dated I o . (l 4 C' , concerning the property located at all �� n Q' r r� �J f "� meets all of the 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 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED : �� C j2 -- - - DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. 41bAr lire CZA (4- too e Ark AP 4A - 0'0/~ dW SM 6OIL olp lot --a4. No.. .. F�a.. .. THE COMMONWEALTH OF MASSACHUSETTS 6*/00 BOARD ® HEALTH OF......... :---- ApplirFafivaa -fur 43iupuuttl Works Cnuaa,i#rurtivaa Vrruift Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: �� � o tion•Addres ` or Lot No ------• • -- •----• -- Ow er, Address a •-`•` .......... _-`............. ..• ........ Installer Addre Q Type of Buildin Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) PP., Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures -------------------------------------------------------------------------•------- -------••-••----•---------------------------------------- w Design Flow............................................gallons per person per day. Total daily flow.-..........................................gallons. 1:4 Septic Tank—Liquid capacity------------gallons Length---------------- Width----------i..... Diameter----.----------- Depth----------- , x Disposal Trench—No-____________________ Width----------------- Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ` aPercolation Test Results Performed bY.......................................................................... Date------------------------------------.-.. a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ 9 Test Pit No. 2________________minutes per inch pth of Test Y' ..__.__._.._.__.____ Depth to ground water----------------.-------- a' •-----------•------- ---- - --- ....... ......................................................... 0 Description of Soil-------------------------------------- _- -----------------------------.——-------------------------- x w VNature of Repairs or Alterations—Answer when applicable..........--------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------.----------------------------------------.----------_---------------- r Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI.of the State Sanitary Code— The undersigned further a rees not to place the system in operation until a Certificate of Compliance has b issued by e and o health. igne I Date Application Approved B PP PP rove Y......-� `•�-- - - - ------- ---- -------- ----- -- - -- �� �to---- --- Application Disapproved for the following reasons_______________________________________________________ .........................................._______________ 1--------•---•••--•--------•-------------------•------------------------•---............................................................. �--------.-.-.-.-.-.-.-.-.Permit Date r No.--••----•••---•-- Issued.__.. ..73 �--- i Date a J 0 0 D p 0 f D p _ _ p D , p 0 p p p b - b o I D p �D b p I'r D � YV e D b o She D4 p + b Y - v b No..--• _ .. Fsa..�2..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD Z HEALTH OF ....................... ? ..... Appliratinn -for lliipuottl Works Tongtrnrtinn Prrulit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: Addres * r or Lot No -------- - O ,ner 9" Address Installer Addres Type of Buildi Size Lot----------------------------Sq, feet Dwelling— o. of Bedrooms---------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ---------------------------- No. of persons---------------------Mr_::: Showers (_ ) — Cafeteria ( ) W Other fixtures --------------------------------------- - w Design Flow_________________________________ _____'gallons per person per day. Total daily flow---------------------------------------------gallons. W Septic:Tank Liquid capacity------------gallons Length------------------Width.--------------. Diameter_------.------- Depth---------- __.-.- x Disposal Trench—No- --------- ---------_'Vl/idth-------------------- Total Length.................... Total leaching area.-..-.---- -- -----sq. ft. Seepage Pit No--------------------- Diameter-_--------------------- Depth below inlet.................... Total leaching area--_.--.-.----_---sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------- --------------•---•-•----_._---.....__-_._.------------•-------- Date-------------------------------------- Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water..:---:_-.--.--.--.-__. f14 Test Pit No. 2................minutes per inch th of Test P ---------_---------- Depth to ground water-._-.-.---.---.---_.... ---------------------- -------------- ------------------------- .......................................................................................... 0 Description of Soil----------------_. ....._•• ..........................................----------------------------------------------------- �., ---------------- --------------------w U Nature of Repairs or Alterations—Answer when applicable._..-------------------------------------------------------------------------------------------. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further a rees not to place the system in operation until a Certificate of Compliance has b issued by e ar o health i igne --- -= A............ •..._. .. ------- Application Approved By - `. r to Application Disapproved for the following reasons:---_-------•-->........................................ ........................................................ .._.--••••-••.....................•••-------••------•---...-•------------•••••• •---•---•-----•----=-•--------------------------•------------------------------•--•-------------------------------_----- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH . ... ........O F..... ► „ ''. - Trrtifiratr gf _1 pliany T S TO IFY hat the ` divid 1 Sewage is sal S- e s cted ( ) or Re tred ( ) b -- ... ........ - 4--- ---- ��' Installe has been installed in accordance with the provisions of Article XI e State Sanitary ode dde cri e application for Disposal Works Construction Permit No. _ dated : .:...-. ----------- •- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE© AS'A GU RANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector................--------------------=------•---'------------------._..............:_. THE COMMONWEALTH OF MASSACHUSETTS BOARD 'OF EALTH ...O F No. FEE•- �i��n l alan��rnr�inn Permission is hereby granted—, tip`----`----- tom`"1, ----- to;Con r ( ) or R air ( Individual Sewage Dispo 1 af No as shown on the application for Disposal Works Construction 3kit No. ----- ed---f _- ---:- '".. 4.2. - --- --------- ------ Boar o "" ' d f aIth � DATE..... .._ :------ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - ' � �G z Ivalye 9 _fj I _Z\7 Finish Grade El 51 t 1/8" to 1/2' washed Stone ® 3" ,Thick Finish Grade EL 51 t 6" 6" 1l11/I1/ llllllllfl / 6" Ifll / o,„ FNV EL 0"via. RNER 0 Dia ER `` ;D RISER 50.70' 8.5' Ris t El. 49.27' 5r :- : : . o0o r�o� i-•♦- 12.83 --►i e INV EL °�° aee o o e°e e E1 46.44' F 34" .to"Jam 14".{fin. INV EL S'�'p Nvy V EL ��\ w^ �:;� 48.44' 1 1/2" washed stone Qa� o o •b' 24" INV EL INV EL , 49.40 \ :::.. 4 4 4 4 \Below Row Line�- , 49.60 B",Storie �':.;< �, 58" 49. 75 50 00 ytq'nd Le nei �" 4 HOLE DISTRIBUTION BOX "�� ��':: `' 25' i� Number of Trenches - 1 ttj N Number of Chambers - 2 ``- PROPOSED LEACH TRENCH 01) 52 ` ... �. PROPOSED LEACH TRENCH - END VIEW N.T.S. 1500 GALLON SEPTIC TANK �� �. ;;. '''� • Install Two 500 Gallon Units :: Bottom of Deep Observation Hole El. 41.1 1500 GALLON REINFORCED CONCRETE SEPTIC TANK �;::<:: with Four Feet of Stone at Sides and Ends. Minimum Construction. Materials Per 310CHR 15.226(2) Tees shall be constructed of Schedule 40 PVC and shall extend a � t� :. .. \ Adj. High Ground Water AEI. 10.0' (Bumps River) minimum of 6" above the flow line of the septic tank and be on a ce y�• :..� ``: , ter � p� the centerline of the septic tank located directly under the s°'eYh , 3k c9 Note: ' 9 1 ��� �� `� �-� Remove all unsuitable material 5' around SAS a y a `� `` o�`'`''`"" : , down to the "C" layer El 48.1' and replace with clean clean-out manhole. 1 a4 �yl ca: -... � ( ) p � The inlet pipe elevation shall be no less than 2" nor more than 3" tet1�11 yy f' --. .:: granular sand per 310 CMR 15.,255 (3), (4), (5). above the invert elevation of the outlet pipe. fi 1 l ' -` : ` ;; O ' and (s). '. f Septic tank shall be installed level and true to grade on a level, ta'�les i �� �� :; ': : ASSESSORS DATA: stable base that has been mechanicallycompacted and on which s�, �5;:;:: `� n ` � '` =- 6 of crushed stone has been placed o ensue stability and AV ''a 4 / "' � I � 'C� 166 044-001 d 6r / F; '`' LOCUS to*. `� tna� / ,�'�' ea; r'' t Util/Pole/ �...... $^ to prevent settling �o �o o s41 =:-:;. :: : Septic tank shall have a minimum cover of 9': ge ,� t at 52 � ' 1 . \ REFERENCE PLAN Q a' / ao t�'�6� / _..,:. •;::;;•::;.::::- ;>< V / '' 19680J Two 20 manholes with readily removable impermeable covers to of durable material shall be roTlded w.t th access ports. a F i y t. ;;;:;. �. P P / l 4e FEMA DATA: ZONE "C" The outlet tee shall be equipped with gas baffle. ;:'s ZONING DISTRICT RF-1 Design Data: i :. .:::;;, y►;' 1 '`.>:. '�� :; OVERLAP DISTRICT ¢ }• 1 �:;:;. co AP & RPOD g / S Four ExistingBedrooms L �, � _�P BUILDING SETBACKS Existing System (To Remain) Has Only Three Bedroom Capacity FRONT 30` 'r0 osed System �_ ( �;:;:` :.:::< 1 52 1 �'� �.� SIDE AND REAR 15 One Bedroom = 1 X 110 d = 110 d Required Flow '`' ► 1`'``: :.• :=:;: , �P gP 4 53' ... ;_:<; 1 ► 100.4 aro °Garbage Disposal '• Tw l_ ::.. '' - '� I `r »: Use: Chamber Trench 251 x 12.83 W x 2 Eff De th oa 1 .: .;:: P t V _ [25' -f- 25' f 12.83 -f- 12.831 x 2.0 = 151 0 ...._"�, ......,:.: 25' x 12.83 = 320 / 2 Basement StiI2g VP 471 x 0. 74 = 348 GPD Total Design Flow for New System f yrel - / ;.;;_;.;_F. :• eB. / l •: >... PRECAST REINFORCED CONCRETE DISTRIBUTION BOX ' Install on a level base Minimum wall thickness = 2" AS TrIsed � � , � i B� Top c8 FNn SAS Trench � \ ' �.. .-� ••' D�TU)l.• NGyDt �• :;::. \ / •::::: Minimum inside dimension = 12 proposed Outlet inverts shall be equal to each other and at 1500 Gal ` 2 minimum below inlet invert. 50 '- ' r 1 a Relocate - - ,� : ' > '; GRAPHIC SCALE The distribution lines from the distribution box shall all have Planter 88.2 equal inverts as determined by flooding the distribution ,box to ; �, ,' so o ,s 30 so ,zo the height of the distribution line invert after all lines have Existing Septic— ��- been sealed in place. '�, - --__ Per As-built Card ro Invert adjustments shall be made by filling with durable and w -�-'� ( IN FEET ) nondeformable material permanently fastened to the line or �," 2$ i inch = 30 ft. reconstructing the lines until all inverts are of equal elevation. o 4s �a2 Qt -48_-- -- Septic System Upgrade Plan b Prepared For- LOT LOT 32 �. �:.� (S HE CALLEN RESIDENCE 57,674fsq.ft. ,�' ��P>rcrl c;: sry`s GENERAL CONSTRUCTION NOTES In 1. All the workmanship and materials shall conform to D.E.P Title 5 TH El. 51.1' :�� WILLIAM y�; Ds t er vzll e Massa Ch use t tS a o LIEBERMAN 2. and the Town of Barnstable rules and regulations for the subsurface -~�--'4s`` �' „A„ 0 ;� NO.23,971 0► disposal of sewage. , / 5 p4 SL IOyr 3/2 .r' ,� Scale: 1 = 30' Date: December 10, 2004 ,2. At least one access port over tank tees shall be accessible � (f� within 6" of finish grade, with any remaining access ports bro ugh t �5 6 � r{I_:_ . Prepared By. to within 6" of finish grade. '�" Y ® .o Stephen J. Doyle and Associates Jam" ` ,�� 42 Canterbury Lane, E. Falmouth, MA 02536 3. All components of the sanitary system shall be capable of l0yr 5/8 l -� Soil Log Telephone: 508/540-2534 withstanding H-10 loading unless they are under or within 10 ft Performed B : S. Do 1e 36" (El. 4B.1) �►►• �� of drives or parking. H-20 loading shall be used under or within Date. J�Iduary 13, 2005 "Cr, �►► OF` A$6, �� R e vi m a Ca ra B1 10 ft of drives or parking unless noted. Plastic equals may be Perc Rate: c2 Min/Inch , �sTeq�a '���• used in lieu of all recast units -,- BOK Dave Stanton FINE 2.5y 7/3 pe " Q ' ,SAND rc 54 ;� sTE<jHEN 4. The exca va for contractor shall verify the loca tion of all site `'-44 DOYLE ► utilities prior to any exca va tion, and shall be responsible for 96 ; #3755��� t all matters relating to electric easements Cz � tA° ES oQ 5. Sewer pipes shall be 4 Schedule 40 PVC laid a t a min. 0.02 slope. Sol P P p FINE Syr 5/6 6. Any masonry units used to bring covers to grade shall be SAND „ o A-i w -� mortared in place. 12, 7._ .Finish__era de shall have a minimum sloe of 0.02 ft per foot. El. 41.1' --- P P NO. DATE DESCRIP71ON BY