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HomeMy WebLinkAbout0371 STARBOARD LANE - Health 3 "I Starboard Lane Osterville A= 166-047-001 t I r i �I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 371 Starboard Lane Property Address William Dole Owner Owner's Name information is required for every Osterville Ma. 02655 11/14/2013 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael T Bisienere urJ use the return Name of Inspector key. Cape Septic Inspections - VIC] Company Name 624 Old Barnstable Road Company Address Mashpee Ma. 02649 Cityrrown State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority ___�-.!i�2=✓h �2 11/15/2013 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection orm.Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w ,.• 371 Starboard Lane Property Address William Dole Owner Owner's Name information is required for every Osterville Ma. 02655 11/14/2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .'° 371 Starboard Lane Property Address William Dole Owner Owner's Name information is required for every Osterville Ma. 02655 11/14/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due -to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ -distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass'unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: M ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet.of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts, Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 371 Starboard Lane Property Address William Dole Owner Owner's Name information is required for every Osterville Ma. 02655 11/14/2013 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow 4 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 . I Commonwealth of Massachusetts Title 5 Official Inspection Form x Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,. 371 Starboard Lane Property Address William Dole Owner Owner's Name information is required for every Osterville Ma. 02655 11/14/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped` ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ I the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-- IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •'' 371 Starboard Lane Property Address William Dole Owner Owner's Name information is required for every Osterville Ma. 02655 11/14/2013 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑. ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® a Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): >550 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,•°° 371 Starboard Lane Property Address William Dole Owner Owner's Name information is required for every Osterville Ma. 02655 11/14/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The main house has three bedrooms with atleast a.three bedroom leaching and the addition has two bedrooms with a three bedroom leaching Number of current residents: - 2 . Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ® Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): Detail: 2012 241,000 gallons used 2011 127,000 gallons used Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 371 Starboard Lane GM Property Address William Dole Owner Owner's Name information is Osterville Ma. 02655 11/14/2013 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 371 Starboard Lane Property Address William Dole Owner Owner's Name information is required for every Osterville Ma. 02655 11/14/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: tank a back yard year unknown tank b driveway 1997 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: (A) 12" ( B ) 16" feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: (A) 12" ( B ) 16" feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Tank(A) 1000 gallon septicTank (13)1500 gallon septic tank a Sludge depth: < 1 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 371 Starboard Lane Property Address William Dole Owner Owner's Name information is required for every Osterville Ma. 02655 11/14/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 39" Scum thickness Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? field instruments Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,• 371 Starboard Lane Property Address William Dole Owner Owner's Name information is required for every Osterville Ma. 02655 11/14/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 371 Starboard Lane Property Address William Dole Owner Owner's Name information is required for every Osterville Ma. 02655 11/14/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" both of them. 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 r Commonwealth of Massachusetts u - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Y 371 Starboard Lane Property Address William Dole Owner Owner's Name information is required for every Osterville Ma. 02655 11/14/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: one system (A) stem (B)® leaching chambers number: Two sy, ❑ 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.): Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,•'' 371 Starboard Lane Property Address William Dole Owner Owner's Name information is required for every Osterville Ma. 02655 11/14/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 t Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 371 Starboard Lane Property Address William Dole ' Owner Owner's Name information is required for every Osterville Ma. 02655 11/14/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 1J (n ' F] �3d-1cK oc HoJse I a l sys-r � �) G QD ^ � = 2 2 _ 3V t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 17 Assessing As-built Cards Page 1 of 2 TOWN OF BARNSTABLE LOCATION SEWAGE M VILLAGE Q✓�7�'��//Ili' ASSESSOR'S MAP dt LOTALdyT.Oc INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACnY /f b0 a C rCHING FACILITY:(type) 4.ce'1 L/xa6.s (size)1A et a r NO.-GEARDROOMS 3 DELDER OWNER CC,4110 "PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility sf Fat Private Water Supply Well end 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 y S pd l t� • 1q• 1b wk^y���y 41 O "° {1 • I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments • 371 Starboard Lane Property Address William Dole Owner Owner's Name information is required for every Osterville Ma. 02655 11/14/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 15 plus feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I augared a hole at a lower elevation and shot it with a transit Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 i r K Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 371 Starboard Lane Property Address William Dole Owner Owner's Name information isequired for every Cisterville Ma. 02655 11/14/2013 page. Cityr'rown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file z _ t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 17 of 17 �. -row j 6 To•.0 w o� MO.29713 CIVIL B CD 1 �t *X Q+rsLM�T 1Jo. 92-1� 2:i�G•I J2 r t-no a � fi GVD: FPS_ L /EG.Z- _ D,J O ---- ScALC / f o VIE e— i�a9E �w.AG S _ � ,AA c' _.TOWN OF BARNSTABLE LOC)�►i'ION 3 L/ s /�>�OQr Imo• SEWAGE # f -12 VILLAGE ASSESSOR'S MAP & INSTALLER'S NAME&PHONE NO. �0�����/ �l� � 7��—�✓��J SEPTIC TANK CAPACITY /,ro 0 LEACHING FACILITY: (type) S�oD Cx( Levc4 G)xwd� (size) /,A A,21 ,AA � NO.OF BEDROOMS 3 UII.DER OWNER PERMTTDATE 3/I COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Sf 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 qd No. 1 Fee AA THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppricatiou for Oigooal *p6tem Construction Permit Application for a Permit to Construct( .4e-p-4 pgrade( )Abandon( ) ❑Complete System E)Individual Components Location Address or Lot No. Z 7� s��'�OQ�^ Owner's Nanie,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder I Other Type of Building Xe5l e 4e No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 311) gallons per day. Calculated daily flow 30 gallons. Plan Date Number of sheets Z_ Revision Date Title Size of Septic Tank ��i 0� Type of S.A.S. Z—S®a9P����i l G�ombc Description of Soil Nature of Repairs or Alteration/ (Ans er when applicable) .17n5l'L4ll 153W:AW Z—,SOD 9Ql IGy/ G WW 'he"'S 41, 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 this B d of ealth. Signe Date Application Approved by Date Application Disapproved for the following reasons Permit No. 7 r t2Y Date Issued r` r:�, t f� No. ! l ' " ►f,/ V Fee ._ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:, Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS .1pprication for Di!5pogaf-*pgtem Conttrudion Permit Application for a Permit to Construct pair grade( )Abandon( ) 1 Complete System ❑Individual Components Location Address or Lot No. 3 7l S 7�j��./�Q�,� Owner's Name,Address and Tel.No. Assessor's Map/Parcel /" v /#. //n L'B� . 15A'rriiIle �,� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinderki!5- Other Type of Building/PSe.Af No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 334 gallons per day. Calculated daily flow 3 30 gallons. Plan Date 12 -2- 9 Number of sheets Z Revision Date Title SP_0)`//, "'leif lal' 3 7l Size of Septic Tank 15 Type of S.A.S. 7 Description of Soil Oi f e Nature of Repairs orAlteratio s(Answer when applicable) Date last inspected: `$ Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued y this Bo d ofj1ealth. Signed Date 3,4Z, `l Application Approved by Date 11 Application Disapproved for the following reasons - r Permit No. 97 = !2 !� Date Issued 1 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed(6,- Repaired4;Z�Upgraded( ) Abandoned( )by AeX C_,nY,5Z-. at , 7/ 5 7C r//1 e. has 1¢en constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer 424&42z31-1 6_eeon 7 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 Digoaf *p5tent Congtruction Permit Permission is hereby granted to Construct yai( r(, pgrade( )Abandon( ) System located at 3-7/ ODY 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 - �.SI� DATA :, rl►.1�LE F/ +t�`t' g>�acrwt rE pt_a tit otil Back uErz KIO ,-A V 3ALr- Grz QV SW-- Z 5' LOT 17atLy PWW = x IIG = 4,, we PGrz;oe� �Pi SiRri1G TANL s `%30 X TOO%= (o� USF_ 1SDO GA. Ar-rucAMON 6tZ1=A '�• USE 2 - 5'0o Giau.o" 9q.,cc.,gs7 3 GpD �9 /SF= q4(10 5 P dPP ucaTor-1 AM v�516 N 5ItswaL AAA= 0 z.t2_s)2,\2= ►AS s F -At L of �1kl ���.rn3��, �.rOM AJZVA = 300 3 F a+• -row AMA_ -44 6 s t= s 3 MA1C• ,, (7F�LoI.ATlv�1 �dTE L 5 M ti/I WA z" la4i sty o d r • L IE-117c Q w Lp�/ Sj.YQ�f IO A O-���� �2"a�1 C M -.e-All Il E A. omet yes Toot-Mpo �S �ocAr�fl UNDEe �¢�vE F& • si va SLH�1D e IM/. 5�.t) Fa's Ee:s I q"q W G 1A_Zc I Nv { jw I►u SG 6 s l Grl C NElM36p_ ' BoJ< 9L4 S44 (=,W • 0 M �'VELOP'F3� PROF«-�' NO EObl LnC�.T►o�l 3� l S A%vo LAtN►E OF PETER SULLIVAN FLAW IZ�Eti1C� N0.29733 Lo-C- 2 v CIVIL AfAF ►6�,(o FAPl�I V J- l :. BA : Hym I Wa LAUD SUevl=`lt>z5 • �IG1�� 12����94� oSTeev11� MASS. OrFsers MOM $V 1ilt)%W"S 4POOLt�' No'r' 51z A(P(,16AHT: (UJIUAM USED Tb S67 A'5c.a-SN PWOPEr Tr LINes. _ Tarc.+�V of �,�ruSTR3c.t� \ OF Ck 1S PETER �AOUSE L=^nON F,.O*,11 SULLIVAN 61 • q S �cE i�ua n� ray �oN►.�to ow.►E NO.29733 y CIVIL TONAL t2(o3�9� Z-b7 • �1 QE2.MiT A1o. 92-1� L�4 2 !92 ACV I-no G/ • / J� GuD. Fief_ JrWr-i-L l a. \ �c o POSE D SEP'R C �� i 'P7AkT�e.� IJY6 ��.1G �sc�2v��.1.t i�lasS f y ��' � ' ���;� f A NO F BARNST BLE LOCATION�;�,('QlE ti y� �� SEWAGE VILLAGE ©��� �V�L-L�" ASSESSOR'S MAP G LOT INSTALLER'S NAME 6a PHONE NO. SEPTIC TANK CAPACITY /OZJO LEACHING FACILITY:(type) �oaa G.�� p� (sue) ty NO. OF BEDROOMS PRIVATE WELL ORIPUBLIC WATER BUILDER OR OWNER ki DATE PERMIT ISSUED: �- DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No G, p� V DEC-0.31-199 14 42 fUIJPJ OF -- . s TOWN OF BAMSTABLE LOCATION 371 Starboard ''' Lane � VILLAGE Oster v i l l e,Mass . SEWAGE ASSESSOR'S MAP& LOT— INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHIIVG FACILITY: (type) —� (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COIvlPI,lgNCE BATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet _�— on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist -'Feet within 30U feet leaching facility) Furnished by Feet a- *+ TOTAL. P.02 / TOWN OF BARNSTABLE D `/ LOCATION 3?l S /�JL'Qr�z�//J SEWAGE # f �Z7 VILLAGE �s '�y�/!� ASSESSOR'S MAP&LOT e M) INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /S'0 O G� LEACHING FACILITY: (type) S`oU 4 C/xwiA (size) NO.OF BEDROOMS 3 UILDER` "OWNER C(cwr�O PERMITDATE: ?J COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Sf Feet Private Water Supply Well and Leaching Facility (If any wells exist / on site or within 200 feet of leaching facility) g .V Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by o � q DATE:_ _84=j.95 PROPERTY ADDRESS: 37-1--St-a-rboard Lane RECEIVED Osterville , - - AUG 7 1995 `Mass 02 6 5 5 HEALTH CPT. _-- _-. ._:_._. ...- .•-__-- TOWN OF BARNSTABLE --- On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . This is a. title five septic syste . ( 78 Code ) 2 . 1=1000 gallon tank 3. 1-distribution box. — ' . - 4. 1-1000 gallon leaching pit . Based on my Ins wctlOn, I certify the following conditions: , 1.. T�is is, a title five- septic system,: (, CV&6e 2. Tk-e:',gr�!ptic .system is'" in proper working` order" at the present 'time . ) . i i SIGNATUR!F: Name:_J^P_Macomber Jr.., i Company:_)•P_Macomber & Son-_Inc Address: - c-g�--___-4------- --Cente?rvill,e LMass__0.2632 Phone:---5Q87�a3338_-=--- , 1 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. ran ks-Cesspools-Leachflelds - Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 - v 9 o Fh• U" nit i - . 7 LWp.Cb' DIS:'06TL SYSTEM JROI�#'CTION Andress Of ProPer.tY 371 Starboard Lane Osterville ,Mass Owner ' s name William Sharron Date of Inspection 8/4/95 PART A Cf+U CRLIST Check if the following have been done: Pumping information was requested of the owner, occupant, and Board .of Health. V/ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The site was inspected for signs of breakout. All system components , excluding the SAS , have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, - depth of liquid, depth of ludge , depth of scum. The size and location of the SAS on the site has been determined based n existing information or approximated by non-intrusive methods. The facility owner (and occupants, 'if different from owner) were- provided with information on the proper maintenance *.of SSDS.' M i SUBS t. RFA' E SEWAGE DIS!'0rAL SYSTEM IVSPECTIO „ ' PART B N �„RM SYSTEM INFORMATION; FLOW CONDITIONS: ' If residential number of bedrooms number of current residents garbage grinder, yes or no laundry connected to system, yes or no seasonal use,, yes or no If nonresidential , calculated flow: Water meter readings, if available: 1993=324, 00.6' GLS=887. 67 GPD High water useage do to raising: of 1994=230, OOO GLS=630. 14 GPD plants and a sprinkler system for a very large yard . Last date of occupancy Presently GENERAL INFORMATION Pumping records and source of information: Never pumped per owner. Tank should e pumpe . No System pumped. as part of inspection, yes or no if yes, volume pumped o Reason for pumping: rrnTTT7 i . Type of system YES Septic tank/distribution box/soil -absorption system NO Single cesspool NO Overflow cesspool NO Privy NO Shared system (yes or no) (if yes, attach previous inspection No records, if any) NoNR Other (explain) ' Approximate age of ;all components. Date installed, if known. Source of information:_..._ - 3 yea NO Sewage odors detected when arriving at ,the' site, yes or no Recommendations 1 . _ Pump the septic tank, 2 . Replace broken cover on the distribution box. . 3 . No other repairs are needed . l 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: 1000 gallon tank. (locate on site plan) depth below grade: 191, material of construction: XXXXconcrete metal FRP other(explain) dimensions: 8 ' 6" W=4110" H=517" 27" sludge depth 24" distance from top of sludge to bottom of outlet tee or baffle 3" scum thickness 4" distance from top of scum to top of outlet tee or baffle 19" distance from bottom of scum to bottom of outlet tee or baffle 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, recommendations for repairs, etc. ) Pump septic tank once every three years , Inlet & outlet tees and depth of liquid level are fine . Tank is structurally sound . No evidence o leakage from the septic tank. No repairs needed at this time-. Septic tank should be pumped . DISTRIBUTION BOX: XXXX (locate on site plan) NO depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc. ) Distribution x is level with no solids carry over ,. No si�ns of leakage in or out -of the distribution box . . No rpilairs, needed at this time , PUMP CHAMBER: NONE (locate on site plan) NONE pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs, etc. ) NONE r SUBSURFACE SEWAGE DISPOSAL SYSTEK INSPECTION TORN . PART D SYSTEK IN 0RKATION continued SOIL ABSORPTION SYSTEM (SAS) :XXxX (locate on site plan, if possible; excavation not required, but �may •be ' approximated by non-intrusive'. methods) If not determined to be present, explain: Type leaching pits and .number 1-6'' xV- Precast• leach p leaching chambers and number leaching galleries and number leaching trenches, ' number, length leaching fields, number, dimensions 0 overflow cesspool ,:. number 0 Comments: (note condition of soil, signs of hydraulic failure, level of pondirig, condition of vegetation, recommendations for maintenance or repairs etc. Sand & gravel -, o : signs o y ra No repairs needed at this time . CESSPOOLS (locate on site plan) : _ number and configuration NONE depth-top of liquid to inlet invert _NONE depth of solids layer _NONE depth of scum layer NONE dimensions of cesspool _NONE materials of construction NO I NE indication of groundwater inflow (cesspool must be pumped as part of inspection) -NnNF Comments: 1 (note condition of soil, signs of hydraulic failure, level 'of ponding, i condition of vegetation, recommendations for maintenance or repairs,etc.) NONE PRIVY: (locate -on site pl an)..._.... . ------- - '.-.._._._ ...... - ..._.: _ ....... materials of construction NONE , dimensions NUNE depth of solids NONE Comments:m ents: (note condition of soil, signs of hydraulic failure, - level of.ponding, condition of vegetation, recommendations for maintenance or repairs,v" . 11 i SUB6URFACE SEWAGE DISPOSAL SYSTEM INSPECTION •FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE L_SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' Town Water . � �£ L' s � 7l S` -A OC b o L+� DEPTH TO GROUNDWATER . . 40 '+ depth to groundwater r method of determination or approximation,: Test hole dug for insta ation years 13 ', ` no''' water . PlAn -an filo at the Barnstable Boar ea t yannis , ass .• . ri 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM f PART C 1 FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. ' If "not determined", explain why not) Backup of sewage into facility? ® Discharge or ponding of effluent to the surface- of the ground or surface waters? NO Static liquid levelin the distribution box above outlet invert? �S ��T ee Li uid depth in q p �sspo.e- <6" below invert or available volume< 1/2 day flow? Required pumping 4 times or more in he last year? number of times pumped d Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS, cesspool or privy: U4 below the high groundwater elevation? lU0 within 50 feet of a surface water? 1100 within 100 feet of a surface water supply or tributary to a surface water supply? A/0 within a Zone I of a public well? NQ within 50 feet of a-` bordering vegetated wetland or salt marsh- (cesspools and .privies only, not the SAS) ? �1 within 50 feet of a Kprivate water supply well? 10 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 anal, .for coliform bacteria, volatile organic compounds, ammonia nitrogen-% and nitrate nitrogen. - _ , _ •. .. TOWN OF Barnstable BOARD OF HEALTH i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D - CERTIFICATION �s.:-__�-_-.:-=^.:r.—i�_�=:'���r�--ss�.__r.�-ter:=-����.ycr-.��:_-._-..__-..-.,_. ..•—._..-- _ —TYPE OR PRINT CLEARLY— PROPERTY INSPECTED STREET ADDRfZS 3`P1. Starboard Lane Osterville ,Mass . ASSESSORS MAP, BLOCK AND PARCEL # 146- V f OWNER' s NAME William Sharron PART D - CERTIFICATION NAME OF INSPECTOR J.P Macomber Jr COMPANY NAME J.P.Macomber & Son Inc. COMPANY ADDRESS Box 66 Centerville Mass . 02632-0066 Street Town or City State ZIP COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 ) 790 - 1578 CERTIFICATION STATEMENT s I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate , and complete as of the time of inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : XXXX System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection which I have conducted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form. a Inspector Signaturet �6 Date 5 One copy of this ce tification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, the owner or operator shall upgrade the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 310 CMR 15 . 305 . partd.doo Cc,;mcnweam cr Masscc:,:tiers Execue Otfice cr Envrcnmenic iiG;S lN Department of Environmental Protection ' Water Pollution Control Tecnnicel Asswcnce and Training Sections VAUL&m F.Wald Trudy Coxe Socr o y.COEA Thomas B. Powws .fang C MM=KW.r 06/12/95 ATTN: Joseph P. Macomber, Jr. Joseph Macomber and Son PO Box 66 Centerville, MA 02632- Dear Joseph P. Macomber, Jr. , I am pleased to inform you that you have attended training, met the experience qualifications, and have passed the Title 5 System' Inspector exam, pursuant to 31.0 CMR. 15 .340 . The passing grade for the exam was 39/52 or 75. This is an official notification that you are a Certified Department of Environmental Protection System Inspector pursuant to 310 CMR 15 . 340 . You will receive a System Inspector certificate at a later date. If you have any futher questions, please write to me at the following address : Kimball Simpson D. E. P. Training Center 50 Route 20 Millbury, MA 01527 Thank you very much for your time and consideration in this matter: Sincerely, Kimball Simpson, DEP Training C- rater Director [2405� Route 20 9 Millbury, MA 015.77 • FAX 5II8-755.9253 • Telionon• 508-756-7791 r Water .,.�.. .,.�� Conservation SAVE Tips ME. , . CHECK FOR LEAKS Water Loss in Gallons Due to Leaks Leak this Loss Per Day . Loss Per Month Size 120 3,600 • 360 10,800 • 693 20,790 1,200 36,000 • 1,920 57,600 3,096 92,880 ,0 4,296 .128,980 ® 6,640 199,200. 6,9.84 200,520 81424 252,720 9,888 296,640 ® 11,324 339,720 12,720 381,600 14,952 448,560 �d OWiV OF BARNSTABLEr LOCATION ,(��� y�l� SEWAGE # VILLAGE �Cj����I� ASSESSOR'S MAP & LOTi IJIp�D7'4L�,�� INSTALLER'S NAME & PHONE NO. j l4,'/ fx SEPTIC TANK CAPACITY /OZXO 4�/J �D'� Gd'r/ /1 LEACHING FACILITY:(type) /,!�'�' � (size) ,/ ,K(5, NO. OF BEDROOMS PRIVATE WELL ORIPUHLIC WATER BUILDER OR OWNER .* cs�avvr DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: kho zy g— VARIANCE GRANTED: Yes No W/ 1 (J. � r '� � s-�_a�' ' � �r'% _ � . M /6` , � �� �- �,'F i�4,;/' No.__ 12'..A....... Fss... ...0......' THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE , ppfiratiuu for Diiipom1 Works Tomitrurttutt ranfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewag41is1pD'os System at: Address or Lot No. f ' / �r / .........11z.L�...! rn^• ljft/LO.............................................If �1. C/�&. •... ....... ..._.._........- ... -..._..... Owner ddress ) J / Installer Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms..... ....................................Ex ansion Attic�--� g— p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------ ----------------------------------•------------------•••-----------------------------------------.......------------------. W Design Flow............................................gallons per person per day. Total daily flow.......Ss2.Gy........................gallons. W Septic Tank—Liquid capacity.��..gallons Length................ Width................ Diameter---------------- Depth......... .... ._.. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No-----/------------- Diameter.... /C_ -___ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date......................................... Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ W ---•----•---------=----------------•---......_...--------------.....------------•--...........------........................................................ 0 Description of Soil........................................................................................................................................................................ W x -------------------• -------•------------------------------------ ---•----------------------•--•--•-------------------------------------------------•-----••----------------------------................ 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has een i e y the board of health. Signed .- --- ... -' ..... 3 �� ............ Application Approved By ..................CJ' V. ....... ... ........ Application Disapproved for the following reasons- -------- ---- -------------------------------------------------------------------- ----- ----------------fe-------------- -- . .............................. .. ........................................ Dace tNo. ...... -.....1.1q---------------_-------------- Issued -----------.......-------- ---------.....----............------ Date No....IQ?:-..19...... Fxs........ ..n.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ,Apure#inn for Uhiposal Marks Tnnitrurtion Prruti# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................. . - tocatio 'Alfws� or Lot No. •� /• j-•..... ./_/_... V...................................... �_f. Own r Y�v� Address "✓ / nsta er. / r ✓� 7y/ ddresSr �r QType of Building Clue Lot............................Sq. feet U Dwelling—No. of Bedrooms..._&----------••-------- -----Expansion Attic ( ) Garbage Grinder ( ) 1 aOther—Type of Building' ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -------------------------------------------•----------'-------•---------------------------------.........--•--------------•••--• Design Flow............................................gallons per person per day. Total daily flow--- a.. gallons. W Septic Tank—Liquid capacity._--- lions Length................ Width.. Disposal Trench—No. .................. ......___..... Diameter................ Depth................ x .. Width.................... Total Length.................... Total leaching area............,.......sq. ft. Seepage Pit No....../.-.--------- Diameter...... .. .... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) 4 Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes'per inch Depth of.Test Pit.................... Depth to ground water........................ P� ---•-----------------------------••-••••----•-•---••---.....-•--•-•.......--•---....--•••---•--•-----....--•-••--------•--•---- ...__....__.._...........__ 0 Description of Soil........................................................................................................................................... W U -••--------•-•-•--•-•--••-•----•••---•----•-••-•._...---•-••-•-----•-•--------••••--•-----------••----•-.....---•-•--•--------•••••-----•----•-•-...••••-•---•-•-••••-•--•.............................. 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 TITLE 5 of the State Environmental 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 /y/ f ........................................ \ Application Approved By .................. ------------....--------.............. ---- ------.Application Disapproved for the f reasons- ----------------------------- ---------------------------------------------------------------------------------------------------- - - ------------- ---------------------.- . ------------..................-------- ............................ / q Date PermitNo. ...... a'-------..1. { --------_-_-_----------- Issued -------------------=-----------------.................... _ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE VX r#tft.cate of Compliance THIS IS TO CERTIFY, the Individual Sewage Disposal System constructed ( ) or Repaired by.. � ; - ................. --------------....------------------....-...-------------------------......----------:----------------------- Installer a n .�.t�C t has been installed in accordance with the provisions of TITLE 5qof The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..... . . .................. dated ................----------------------..---.---- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. f G DATE.. .....C�-� .------------------------------------- Inspector .... ................ ................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE �...[..... FEE. .......... Permission is hereby granted------- /�---------,.�-3._-<0 � ., ... to Construct ( ) or Repair (�) anJI`n is ividual Sewage Disposal System at No........... ,✓ ..7/... ---•- Street qq as shown on the application for Disposal Works Construction Permit No.J-__/g._._ Dated.......................................... _ .......................v...: ..................................................._ 9� ...•. Board of Health DATE-------%--------/--,--- �-/-•---•................................ FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS No. Fee--- R BOA D OF HEALTH TOWN OF BARNSTABLE 0Ipplication-*rVell Con0ructioupermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: -� - S` �_ - - = - - - -1 --& ° ---------------------------------- Location — Address Assessors Map and Parcel _ --�-�' ----------�Q-L-Z------------------------------------- — -3�1-------S � ���4= --i-A-MeE�-------� t 6 5 Owner Address ( w- r _M-------a -------d �3 Installer — Driller Address Type of Building Dwelling------------------------------------------------------------------- Other - Type of Building-------------------------------- No. of Persons-------PIA--------------------------------- P �- S1 S SLR Capacity Type of Well- r: -- -- -- - --- - - -- 0� -------------------------------- Purpose of Well----- - �1_� � ----Bf--_ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation u Certificate .of Compliance has been issued by the Board of Health. Signed -.--- - ��� l�------ 5following ------ -------- ----- ---- ---- -- e ate Application Approved By �- ----— --------------- date Application Disapproved for!theason :------------------------=-------------------------------------------------------------------- - —-- ------ ------- - ----- - - - - ----------- ------ -- ---------------------------------------- date Permit No. -l/l✓ ---- --- Issued---- - __0 --------------------- -- date --- ------------------- - --s -------- __ _ — �,:�---r— _--- — -- --- BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by--------------------------------------------------------------------------------------------------------------------------------------------- Installer - --------------------------- at- -- -- --- —---- ------------------------------------------------------------------------------------------------ has been installed in accordance with the provisions of the Town of Barnstable Board of Healt rivate Well Protection i Regulation as described in the application for Well Construction Permit No. =�Q--__ __ ated----------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- ---- — — - --- -- Inspector---------------------------------------------------------------------------- No.wu� ---- - Fee---3 BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rVell CootructionAermit r Application is hereby made for a permit to Construct ( ), Alter ( ) or Repair ( )an individual Well at ------sZ''_ __ ex)--- - - -------- --7__ � ---------------------- - Location Address Assessors Map and Parcel Owner Address j 14 �r --l - -----��Q---- %`-------------� �3 Installer — Driller Address Type of Building Dwelling---------------------------------------------------------------- Other - Type of Building --------------- No. of Persons---- fQ / ; P u L s!s oTYPe of Well----- Capacity-L - -- ---------------------- Purpose of Well-----7 ---------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private.Well Protection Regulation The undersigned further agrees not to place the well in operation u Certificate .of Compliance has been issued by the Board of Health. Signed - ._-_ date 1/ __ Application Approved By - ------ - ------------ ------------------------- date Application Disapproved for!theollowing reaso. :-- ------ -------------------------------------------------------------------------------------- ----------------------------------------------- ----------- -date , it Permit No. --�g Issued— - --------------------------------------kk t- ---- —— ----------- - 1„ .. % ----date i is '�'as rr�orsora um a+momodraser¢sa: e►e�atmesza—emraoe 1 BOARD OF HEALTH d TOWN OF BARNSTABLE Certificate ®f (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) bY----------=------------ ----------------------------------------------------------------------------------------------------- - - - - -- --- —- S� Installer at- - -- — ------- --- ----- <. has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application'for Well Construction Permit No. � _- - ated------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--------- - --—-- — - -- -- Inspector---------------------------------------------------------------------------- BOARD OF HEALTH �. TOWN OF BARNSTABLE We uc 'on r� Well ion tr t i �erm�t � No. - -- ---- Fee--o------------- Permission 's het ranted- y !-� — f— to Con t ), lte ( ) R/e'pair ) In�'vidual W 1 at: Ja N o. -- u - - / -- 'd �# --- � + --:.-'-----=--------------- Street\ as sho on t applicati f a Well Construction Permit No. 4_7 - - Da- -— - -- - - - ------------------------- - - O tq Board f He th DATE-- T - -- ----— ICI f 1 C.. LINCOLN LAND 276. 14 LOT 20q) ai 1 9 co ` M - S?f J N pa. o w p0' 1gwcl- f.4 e.e 2p3•g� . a _ MORTGAGE LOAN INSPECTION -SAGAMORE SURVEYASSOCIATES A OCIATES SCALE I IN.= 60 FT. t 995 i�+.oF�e P.O. BOX 28 DATE: AUGUST 22, � ��� ���, SAG MORI E BEACH, MA. 02552 ;� � rw MAS c¢�„ + 88 �3667 C PO/JYBRIANR CERTIFY TO CAPB COD BANY, AND TRUST COMPANY Vt q 14Y " THAT THE LOCATION OF THE BUILDING SHOWN HEREON CONFORMS �o Nb.3A3 e TO THE ZONING OF THE TOWN OF BARNSTABLE (OSTERVILLE) Nr�E s,o I CERTIFY THAT LOCUS 'DOES NOT LIE WITHIN THE FLOOD HAZARD 20NE AS DELINIATED ON MAP 00 6C COMMUNITY NO. 5®_ p N Rl E: BARNSTA6 E —REGISTRY DEEDS EG R N BOOK PAGE, L.C. PLAN NO., 28475—G ' LOT NO.: 20 BUYER: PLAN BY, BAXTER AND 'NYE, INC.' DAL. pk JANUARY 4 19,84 F I S .. N A. ., -. ..' a"q°A b��. 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