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HomeMy WebLinkAbout0044 SUNSET LANE - Health 44 SUNSET LANE OSTERVILLE A = 117 114 0 ems:; fl i i i I t Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 44 Sunset Lane Property Address Mark& Christine Burns Owner Owner's Name information is Osteryille MA 02655 May 10, 2013 required for Y every 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: A. General Information When filling out t. forms on the computer,use 1. Inspector:only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name r� 189 Cammett Road Company Address Marstons Mills MA 02648 CitylTown State Zip Code 508.428.1779 S1 12855 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this addrgas and that4be --eg information reported below is true, accurate and complete as of the time of the In ction. ThMnsp ion was performed based on my sp training and experience in the proper function ant .6i tenance-off on site sewage disposal systems. I am a DEP approved system inspector pursuant t89S,ection 15-340 o: Title 5 (310 CMR 15.000). The system: Win_ ® Passes ❑ Conditionally Passes ❑ Fail, �R s ❑ Needs Further Evaluation by the Local Appro g Authority N u- 0- May 10, 2013 Job# 13-38 In or's Signa ure 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 systel 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 InspectilForm. Vaceage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 44 Sunset Lane Property Address Mark & Christine Burns Owner Owner's Name information is Osterville MA 02655 May 10, 2013 required for y every page. City/Town . 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: Tank was not in need of pumping at time of inspection, leaching system showed no signs of surcharge or saturation. 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 I Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 44 Sunset Lane Property Address Mark & Christine Burns Owner Owner's Name information is Osteryille MA 02655 May 10, 2013 required for y every 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 Ibox. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurfoce Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 44 Sunset Lane Property Address Mark& Christine Burns Owner Owner's Name information is Osterville MA 02655 May 10, 2013 required for y every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface watt;,-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 asses if the well wa ter analysis, performed at a DEP Y P y , p 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 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,••'• 44 Sunset Lane Property Address Mark & Christine Burns Owner Owner's Name information is Osterville required for MA 02655 May 10, 2013 every 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 ❑ ❑ 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 cor..tact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 44 Sunset Lane Property Address Mark&Christine Burns Owner Owner's Name information is required for Osterville MA 02655 May 10, 2013 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® ❑ information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board if 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): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 44 Sunset Lane Property Address Mark & Christine Burns Owner Owner's Name information is Osterville MA 02655 May, 10, 2013 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 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 Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 107,000 gal = 9 ( Y 9 (gpd)): 146 gpd. Detail: Consumption includes irrigation system. Sump pump? ❑ Yes ® No Last date of occupancy: UnknownDate 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: l5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 44 Sunset Lane Property Address Mark &Christine Burns Owner Owner's Name information is Osterville MA 02655 May 10, 2013 required for y 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: None Was system pumped as part of the inspection? ❑ Yes ® No i If yes, volume pumped: gallons I 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): l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 44 Suns et Lane Property Addre ss P Y Mark & Christine Burns Owner Owner's Name information is Osterville MA 02655 May 10, 2013 required for y every 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: System installed: 9/7/00 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1feet Material of construction: cast iron El ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: i feet Comments (on condition of joints,venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 8 Depth below grade: 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: 10.5' long x 5.8'wide- 1500 gal. 0„ Sludge depth: l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 44 Sunset Lane Property Address Mark&Christine Burns Owner Owner's Name information is required for Osterville MA 02655 Ni.;y 10, 2013 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 0.. Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank had liquid only, no solids. Liquid level was found at bottom of outlet invert and tees were intact. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete 1. ❑ 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 l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 44 Sunset Lane Property Address Mark& Christine Burns Owner Owner's Name information is required for Osterville MA 02655 May 10, 2013 every 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.): 4 *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 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 44 Sunset Lane Property Address Mark &Christine Burns Owner Owner's Name information is required for Osterville MA 02655 May 10, 2013 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No solids or high stains present. 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:Subsurft-c Sewage Disposal System Page 12 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 44 Sunset Lane Property Address Mark & Christine Burns Owner Owner's Name information is Osterville MA 02655 May 10, 2013 required for y every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4 Infiltrators ❑ 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 pondinr, damp soil, condition of vegetation, etc.): Stone and soils surrounding SAS were probed with no evidence of saturation found. 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 U. Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 13 of 17 _ 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 44 Sunset Lane Property Address Mark &Christine Burns Owner Owner's Name information is Osterville required for MA 02655 May 10, 2013 every 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 44 Sunset Lane Property Address Mark & Christine Burns — ---- ._.._. Owner ...__._.._.._ _...__._ ._.._._... _... Owner's Name - --- ----------- information is Osterville MA 02655 Ma 10 2013 _required for --- - -----.._. _ -..._....._.. —..—Y 10, 2 every page. City/Town 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 we!!-,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 3 + F•. 15 20 Back 20 .r Yard f :.? 30 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 44 Sunset Lane Property Address Mark &Christine Burns Owner Owner's Name information is required for Osterville MA 02655 May 10, 2013 every page. Cit /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: More than 10 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: Low areas of adjacent properties are considerably lower than SAS. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 44 Sunset Lane Property Address Mark&Christine Burns Owner Owner's Name information is required for Osterville MA 02655 May 10, 2013 every page. Cityffown 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 Y t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 •a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System sessments �. P, ;M 44 Sunset Lane D l ' 11 Property Address SEP 2 3 REC'D u Allan Klick Owner Owner's Name information is required for Osterville By Ma. 026555— 9/16/2010 every 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: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name t� P.O.Box 763 Company Address Centerville Ma. 02632 �OA City/Town State Zip Code (508)428-4028 S14454 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 9/16/2010 In ector' SI n 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. /fir l/ t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal stem•Page o 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �nM 44 Sunset Lane Property.Address Allan Klick Owner Owner's Name information is required for Osterville Ma. 02655 9/16/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present. B) System Conditionally Passes: I ❑ 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): II t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage D;sposal System•Page 2 of 17 L Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 44 Sunset Lane Property Address Allan Klick Owner Owner's Name information is required for Osterville Ma. 02655 9/16/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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): i ❑ 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 obstructedpipe(s). The ❑ Y q P P 9 Y system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 44 Sunset Lane Property Address Allan Klick Owner Owner's Name information is required for Osterville Ma. 02655 9/16/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for 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: i 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 Y2 day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts L W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 44 Sunset Lane Property Address Allan Klick Owner Owner's Name information is required for Osterville Ma. 02655 9/16/2010 every 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 El ® 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 ❑ ❑ 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 44 Sunset Lane Property Address Allan Klick Owner Owner's Name information is_required for Osterville Ma. 02655 9/16/2010 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ - Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? 0 ❑ 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): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 44 Sunset Lane Property Address Allan Klick Owner Owner's Name information is Ostery required for ille Ma. 02655 9/16/2010 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® .No Water meter readings, if available last 2 ears usage d 2009:4,000 g ( y g (gp ))' 2010:51,000 Detail: Sump pump? ❑ Yes ® No Last date of occupancy: unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): ` Grease trap present? ❑ Yes ❑ No I Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 44 Sunset Lane Property Address Allan Klick Owner Owner's Name information is required for Osterville Ma. 02655 9/16/2010 every page. City/Town 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 44 Sunset Lane Property Address Allan Klick Owner Owner's Name information is required for Osterville Ma. 02655 9/16/2010 every 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: 2000 Were sewage odors detected when arriving at the site? ❑ Yes ® No 4 Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line. 10, feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of leakage.System vented through the house vents. I Septic Tank(locate on site plan): Depth below grade: 16"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years I` Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No ` Dimensions: 1500 gallon Sludge depth: 3" t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 44 Sunset Lane Property Address Allan Klick Owner Owner's Name information is required for Osterville Ma. 02655 9/16/2010 every 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 29" Scum thickness 0 8-1 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 44 Sunset Lane Property Address Allan Klick Owner Owner's Name information is required for Osterville Ma. 02655 9/16/2010 every 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 i f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 44 Sunset Lane Property Address Allan Klick Owner Owner's Name information is required for Osterville Ma. 02655 9/16/2010 every 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 No 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.): Box is Ievel.Box has two outlet laterals.No evidence of solids carryover.No evidence of leakage. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 44 Sunset Lane Property Address Allan Klick Owner Owner's Name information is required for Osterville Ma. 02655 9/16/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 31'x10'x2' ❑ 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.): Sandy soil.No signs of hydraulic failure.Leaching field was dry at time of inspection. 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 44 Sunset Lane Property Address Allan Klick Owner Owner's Name information is required for Osteryille Ma. 02655 9/16/2010 every 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.): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System form -Not for Voluntary Assessments . 44 Sunset Lane Property Address Allan Klick Owner Owner's Name information is required for Osterville Ma. 02655 9/16/2010 every page. City/Town 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 tw 1Cre.QR 1'� I . e_ .� 40 g,c_. A- -F' =�o c - e - 2� A- t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 44 Sunset Lane Property Address Allan Klick Owner Owner's Name information is required for Osterville Ma. 02655 9/16/2010 every page. City/Town State Zip Code Date of fnspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of SAS 25' 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: As-Built ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 44 Sunset Lane Property Address Allan Klick Owner Owner's Name information is required for Osterville Ma. 02655 9/16/2010 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater { ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 z-ro- J� 0 6 COMMONWEALTH OF MASSACHUSETTS ExECUTIVE-OFFICE OF ENVIRONMENTAL AFFAIRS . d DEPARTMENT OF ENVIRONMENTAL PROTECTION a '1 q0 • TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION ' Property Address: 44 Sunset Lane Osterville,MA Owner's Name: Ralph Hansen Owner's Address: 44 Sunset Lane OSterville,MA Date of Inspection: 6/10/2006 Name of Inspector: Jason Mauro (please print) Company Name: Mailing Address: 96 King Street#2 Dorchester,MA 02122 Telephone Number: (617)840-8796 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:,I c;, X Passes ,,, Conditionally Passes ' Needs Further Evaluation by the Local Approving Authority ,� Fails " Inspector's Signature: _ _ Date: 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. Notes and Comments \ i ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 '—page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 44 Sunset Lane Osterville,MA Owner: Ralph Hansen Date of Inspection: 6/10/2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due.to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with . approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 44 Sunset Lane Osterville,MA Owner: Ralph Hansen Date of Inspection: 6/10/2006 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 15303(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: i Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 44 Sunset Lane Osterville,MA Owner: Ralph Hansen Date of Inspection: 6/10/2006 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 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of tunes 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.] (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 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. 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 H 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. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 44 Sunset Lane Osterville,MA Owner: Ralph Hansen Date of Inspection: 6/10/2006 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X Was the site inspected for signs of break out? X Were all system components,excluding the SAS,located on site? X 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? X _ 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 X _ Existing information.For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS" SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 44 Sunset Lane Osterville,MA Owner: Ralph Hansen Date of Inspection: 6/10/2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 gpd Number of current residents: 2 Does residence have a garbage grinder(yes or no): N Is laundry on a separate sewage system(yes or no): N [if yes separate inspection required] Laundry system inspected(yes or no): N/A Seasonal use:(yes or no): Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): No Last date of occupancy: Current COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqf,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: Owner 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 X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool —ivy _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 9/200 i Were sewage odors detected when arriving at the site(yes or no): No Title 5 Inspection Form 6/15/2000 6 Page 7 of 11 " OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued)' Property Address: 44 Sunset Lane Osterville,MA Owner: Ralph Hansen Date of Inspection: 6/10/2006 BUILDING SEWER(locate on site plan) Depth below grade: 2' Materials of construction:_cast iron 40 PVC_X_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): All components appeared to be in"like new"condition and to functioning properly. SEPTIC TANK: (locate on site plan) Depth below grade: 2.5' Material of construction: X 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: 10'x6'x5' Sludge depth: Sludge thickness less than'/2" Distance from top of sludge to bottom of outlet tee or baffle: 4.5' Scum thickness: Less than'h" 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: Scum thickness less than'/2" How were dimensions determined: Measured in Field using `flan method" Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): All components appeared to be functioning properly and in good working condition.No signs of leakage were observed at the time of inspection GREASE TRAP: N/A (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 4 as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Sunset Lane Osterville,MA Owner: Ralph Hansen Date of Inspection: 6/10/2006 TIGHT or HOLDING TANK: N/A _(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: 0" 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.):Distribution Box appears to be level. Water introduced into box flowed evenly through all outlet pipes. No evidence of solids carryover in D-Box No signs of cracks or leaks observed The Distribution Box appears to be functioning properly. PUMP CHAMBER: N/A (locate on site plan) J Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): I Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Sunset Lane Osterville,MA Owner: Ralph Hansen Date of Inspection: 6/10/2006 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ X leaching chambers,number: 3 . 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.): Soil conditions in the leaching field area appeared to be normal with no signs of failure No signs of I hydraulic failure or ponding were observed. Vegetation in this area was not overgrown No signs of leaching field failure were observed during themspection process.Leaching Area Dimensions 31'x'10' CESSPOOLS: N/A (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: N/A (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.): j I Title 5 Inspection Form 6/15/2000 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: 44 Sunset Lane Osterville,MA Owner: Ralph Hansen Date of Inspection: 6/10/2006 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. SEE ATTACHED l Title 5 Inspection Form 6/15/2000 10 05/09/06 13:08 FAX 508 559 6432 W ALLESSANDRO CORP. Cj003 � •' 508 420 3161 P.07 JLN- -2001 12*10 CC(TTON REAL- ESTATE -- rma►c oa 21 t-D1 ARGA � Lr.AC{i1N10 O,ll ALs. - t Udl►MBQR �'�',� too 4 I 1 f►�1 h W.nI*-" �~I SEPTIC \ _1 T>iNi� t!i'at{ST,1A/ATRR Lu"N t T ttiT� MM'!a R P{T b �\-110 o , PLAN VIEW Scale t I %2 Assessors Map 11T Parcel 114 Maximum Feabwe GtapWtaae vwi..o F.Mind Qu Use TINST MPI-S ILL- 40.0 1. 910L7�LS.Z11(1): 8a16dtDI�tYiO$OtgOropeylti 10(tea{)hm rq*w 4(b4 fad 0 L OA►M "dithd cl aditiw+ lot liars F*101mnIW)o�o4eplamm. L Lmd9uryoroa to a taaaalr �l 3. Dad reeui:ciaa Bor 4(�hedtmm aearA be reooadd R tlie> oFAoods tr (BjppELESA1ROyfi am S/BQ•'JOME B' SMti6SrKO�7.a7Ytk SCA`AQSB {T�I t3y shho t 10.4k E4/tiS6 3q, t'e.YGLt�N BAN Co+►R16 BANo 10YR 6/`f L4 i,T,YE'%S"t3RM FINE Cy swap {oYR bop/ {2d a TEi6T IiOLL� BH SW6,.%vP.N tiNfr.{NC- oCr. 7.s alt99 U0 GR0�41D WA1ttaR �►Qrxauo�vAStt:e �rr.r,w�eD Q 6L5 . FearlTew.a oa'•F3/e�sMmi.� Gw���n.. • C.o�.t ron�e. MAP x SITE PLAN PROPOSED SEPTIC UPGRADE AT 44 SUNSET LANE OSTERVILL.E • MASS. FOR CENTERVILLE VILLAGE g APARTMENT REALTY TR. SCALE;AS SHOWN DATE OCT. 26,1999 { vwtcM or 7 ao ADPW V&PU 4"S SULLIVAN ENGINEERING INC. SHEET 1 of 2 OSTERVILLE MA 9907Z . TOTAL P.07 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM • PART C SYSTEM INFORMATION(continued) Property Address: 44 Sunset Lane Osterville,MA Owner: Ralph Hansen Date of Inspection: 6/10/2006 SITE EXAM Slope Surface water Check cellar Shallow wells t Estimated depth to ground water >25' feet Please indicate(check)all methods used to determine the high ground water elevation: X Obtained from system design plans on record-If checked,date of design plan reviewed: 1/27/2000 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) X Accessed USGS database-explain: You must describe how you established the high ground water elevation: Obtained information from design plans which depicted goundwater at elevations GREATER THAN 25' below grade. This concurs with observations made on USGS Topographic Maps for this area Also the inspection was performed during the springtime when groundwater levels are typically at their peak R Title 5 Inspection Form 6/15/2000 11 '!OWN Or BARNSTABLE LOC UON F �✓ SEWAGE #k4�" VILLAGE D st —ASSESSOR;S MAP &c.OT �.G,4 INS'T:"LLER'S,-NAMEE&PRONE NO. t'TIC TANK CAPACITY LBACHING FACILITY: (type) AC�piV (size)5,5 r b V2 _ NO.OF BEDROOMS BUILDER OR OWNER �( PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: z Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facilty-(If--any wells'efist � 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 F r 13 -(2' - c - No. �C.W" — tLJ/ V /`=Ci� c�7ct'4' r Fee 4/o d`N THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION a TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Migpoml 6potem Construction Permit Application for a Permit t onstruct( epair( )Upgrade( )Abandon( ) 1XComplete System ❑Individual Components Location Address or Lot No. Lf q SU rtse�f 4ane- Owner's Name,Address and Tel.No. :� oOr Osterr)'Pe Cenfervj/Jr V1,11 q6 rfrna°�/S �eai Tr t Assessor'sMap/Parcel / /7 Q�� /J �170 4 1"A/t7 .S f, 4stCrVi/JC�, Installer's Name,Address,and Tel.No. (V Designer's Name,Address and Tel.No. jam— �/a��3 3 q 7 "In1 loe�rS,,,lll.vd� 1 PE/S vI/�'va.7 X t P-D •404 1k5Z DSferv�%/e Type of Building: Dwelling No.of Bedrooms �Mot ize Go// qe- sq.ft. Garbage Grinder(M) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow y 1/0 6-f A gallons per day. Calculated daily flow gallons. Plan Date Q- a G 4 Number of sheets Revision Date Title Si`-e jela4l 0 A1Sfd. dLOh C /�f- (4�t q t-/ . LU y)st l- Lrc h e, 0slcrv4JC /o fdG191 Size of Septic Tank / �i OD Pd/0 n Type of S.A.S. L a6h/'Ita 0-Jut"d2z. ?_ „ , O Description of Soil t� —J� L64e r 1 ! .3" -- 7„ C &6wn C n oaru sa n�L i Sorn� e6l0ps /byr 5-1 7" — 17' fj hd 7 5" � s/G /7" — 39" 6,a broto�I A el/nO r 10//6 vri„ _G6° LI ellvw,� drn r6arse /d r Natup° —/ao ' Ca T L. elln-. �,brier,. '�vant- /o r re of Repairs or Alterations(Answer when applicable) IV JT r er_t�l t ST S ERVISE Date last inspected: 114STAL ON D CE - WRITNG THE SYSTE S INST IN STI3OCT Agreement: ACCORDANC T The undersigned agrees to ensure the construction and in ' tenance of t afore described on-site sewage disposal system in accordance with the provisions of Title 5 of t Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this oard o H alth. Signed Date Application Approved b Date Application Disapproved for le following reasons Permit No. Date Issued 2- - W TOWN OF BARNSTABLE ,. LOCATION S' SEWAGE #IT j VILLAGE- ASSESSORS MAP &LOT INSTALLER!&NAME&PHONE NO. Q-F 2L OPTIC TANK CAPACITY I J b® LEACHING+FACILITY: (type) rr--Z (size) NO.OF BEDROOMS BUILDER OR OWNERS ' i PERMITDATE: COMPLIANCE DATE: _ ISeparation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet IPrivate 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 306.feet of leaching facility) / Feet Furnished-by w. • � aces ► • . —'(/`C7 l '< �� hence J Fee �- �'/G G•BtJ ' NQ� / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: i` 'es 'PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprtcatton for Mtgpogal *pgtem, Congtructton Permit '. Application for a Permit too onstruct( pair( )Upgrade( )Abandon( ) [Complete System ❑Individual Components Location Address or Lot No. I/q ,54,/r,ce-t 4anc Owner's Name,Address and Tel.No. C�fl)JCrVI/J:: V,i/A r/717&,4 /91°a/k OstCrr,Il l� /3 Assessor's Map/Parcel n r /or // �p /I),i i'11 S f Q S f c°ry3%1 G Installer's Name,Address,and Tel.No. 02 / Designer's Name"Address and Tel:No. S0Z'f- Vel -3.3 v y )!' PEE vd,/� /aUlI/'va/2 Jj 'r d rP r.a . /c1r re to " a 1 iXe� �eG PO ,v°v�' LoSy OSfcr✓:ii�. . Type of Building: w`� 1 t Dwelling No.of Bedrooms k of size d• /a,t sift. Garbage Grinder(N�j t Other Type of Building No.of Persons Showers Cafeteria( ) Other Fixtures ry.. Design Flow gallons per day. Calculated daily flow `J pb gallons. Plan Date e Number of sheets Revision Date ' Title S,`�e (Plain r6,Zs Pd- 1kQf7'C I.C.VJG r t d-L iLt 41 tl Su hse4- Lahr , os�-c r v,))C /°/aG j9 9 -- Size of Septic Tank �i'00 9R 11 D n Type of S.A.S. L n!1 L�'i 0/0 I Y��2 _ O Description of Soil O 3 Lac rn _3" 7" GCawr, C'adrscs /dyr V — ) 7' 6, r-?4 7-S!V 5/4 17 , a 39„ 6 b r o 8 Farce sa)� r GJk 3el , -�d' �� k lip/1,� ,�k' (,rn Co�fr¢ Sang /U'' r y —YRo 1 Ca i, rll—al 6r44, A )L"-jQnAL. /U tyr Nature of Repairs or Alterations(Answer when app)icable) , N D� Date lasf•inspected: _ - a \ Agreement: The undersigned agrees to ensure the construction and m ' tenance of the described on-site sewage disposal system in accordance with the provisions of Title 5 of thee-Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued��by this oard o H alth. • ' Signed Date Application Approved b} f Date 12001 r Application Disapproved for a following reasons n j t --Permit No. Date Issued 2 THE COMMONWEALTH OF MASSACHUSETT BARNSTABLE, MASSACHUSETTS Certificate of dot tpriance - y THIS IS TO CERT that theOn-sit S wa a isposai Syste eons�tructed( Repaired( )Upgraded( ) Abandoned( )b PA at y U h.e,r rl I-)C l GS f r ✓I7/+✓Y' has been constrnmd dance with the provisions of Title 5 and the for Disposal System Construction Permit No."(6_1 dated Installer / Designer .-: - n( n 11 o The issuance of this/ t ha�not be-construed as a guarantee that t je st�m.will f ngtigri as designedr! yf lj ;r ,V� Date C� �� Inspector / I ji/ l/I Q ------jj--------------------------------- �.. No. 200()—Q• � 1 Fee 4/�o1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS Mtgpogar„*pgtem Congtructton 30ermtt Permission is hereby granted to Cons t` Repair( )Upgrade( )Abandon( ) Systemlocatedat , 'Yq UhSef LQhG GsJ'erY,iVf, 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-c-ommpleted within three years of the date of this pe t. Date: ,�, , Approved b,, .e � Sullivan Engineering Inc. 7 Parker Road Box 659 Osterville MA 02655 Peter Sullivan PE Mass Registration No. 29733 508-428-3344 fax 508-428-3115 e-mail PSullPE@aol.com MEMO TRANSMITTAL SHEET . January 27, 2000 i To: Dan Hostetter/Richard Callahan -Fr: Sullivan Engineering Inc. . . i RE: Septic System for 44 Sunset Lane:O'sterville Message: - Enclosed please find 4 copies of the septic plan for the property referenced and the application for the Board of Health Permit. I will send you a copy of the letter from,the Board of Health granting the variances approved as soon as I receive it. Also please remember Board of Health will not issue the permit.until,the deed,restriction has been recorded. . As soon as you have the letter from the Board of Health grantingf the variances and the deed restriction recording information, you will be able to pull the permit. Any questions, please call'. 47, ' yo\ YARIANCL' F , \ -- N21•33E. 99.3' _ LOT ARS A LEACHING O,11 AC-2 Z CHAMBER t �•' X � to Jly >, O 4� :g V ul Existing 4 Bedroom .. - Q W/F[belling SEPTIC \ \I J TANK BXIST,WATOR° ; �d REMOVE ExIST. MF.TMR PIT 1 p LMAC14 PIT 1 _ \38 r - ' -e •. a .._ � r a, .., PLAN VIEW ..4 . Scale 1 =20 Assessors Map 117 Parcel 114 Maximum Feasible Compliance Variance Required TL S T HOLE E L, H O,C 1. 310CMR15.211(1):Minimum Setback Distances from property line 0 10(ten)feet required 4(four)feet provided. O LOAM Additional Conditions 2. Registered Land Surveyor to stake easterly lot line prior to installation of system. B R_W. CbAR6C SAIv A, S o lrlt 3. Deed restriction for 4(four)bedrooms must be recorded at the Registry of Deeds. t? COBBLES 10Y R 5/3 ' 7' BI STRONG BRN C,4ARSE SAPID 7•JYR S/!o . - 17 t gRNtISH `JEL,coARSE _ - - 6i SAND 10 YR f./6 39 OF LT.YELISH BRN COARSE C 1 SAND 1OYR 4/`I r R 'LT, YEL:15" BRN FINE S(JLUVAN ' C2 SAND IoyR �/y , N W.M33 Y CIVIL TBST F10LG BY SULLIVAN EN&Awc. t A{60 OCT, 2.5 1999 N O GROGND WATS-R i-eoM ow�.1 or=�i41¢NS PvC.ir 61ZWA Wt..' Co/u roue. hlk�' ;• s SITE"PLAN f _ PROPOSED SEPTIC UPGRADE AT `4.4 SUNSET LANE -.0STERVILLE , MASS. p FOR CENTERVILLE VILLAGE APARTMENT REALTY . TR. - REVISION OI/27�00 ADDED VARIANCES SCALE: AS SHOWN DATE: OCT 26,.1999 SULLIVAN ENGINEERING INC. SHEET I Of 2 OSTERVILLE MA 99077 ,1 FDESIGN DATA pplyForThis Lot is Municipal Water. Single Family-4 Bedroom of Utilities Shown on This Plan Are Approx. With no Garbage Grinder T2 Hours Prior to Any Excavation ForThisDaily Flow=110 x4=440 GPD The ContractorShall Make The Required Septic Tank:440 GPD x 200/o= 880 GPD tion to Dig Safe(I-800-322-4844r Use 1500 Gallon Septic Tank ntractor is Required to Secure Appropriate LEACHING AREA Permits From Town Agencies For Construction ' . 440 GPD/0.74=595'SF Required Defined by This Plan. Sidewall =2(12't35')2= 188 S.F 4 Install Risers as Requiredto Within 12!'of Bottom Area= 12'x 35' = 420 S.F., Finished Grade. 608 SF Total Provided 'LEACHING CHAMBER DESIGN` 5.All Structures Buried Four Feet or More or Subject 4 All Pipes to be Schedule 40.Use ` to Vehicular Traffic lobe H-20 Loading. a 4-509 Gal.Leaching Chambers ina pti 6, Sec System to be Installed in Accordance With 12 x 35 Washed Stone Field as Shown 310 CMR 15.00 Latest Revision And The Town of Barnstable Board of Health Regulations 7. Al I Piping to be Sch: 40 PVC. y 4 t _ FG.40.0 F G.40.0 ca U cn 38.0 37.0 3 7.8Z 1500 Gallon 376 Top E1.38.0 Septic Tank 37.4 :=• 37.2 Sot.E1.35.0 Bedding as Per Title 5 5.0 id 10.5' 10 10' 12' r Bottom of Test Hole El.30.0 No Ground Water. DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Not to Scale Flnieh Grader Filter Wmpachd FIII io Fabric Pea Stone e• Leeching a - Chamber Double Washed Stono . I 1 4-10 r .12'-0" OF CROSS SECTION OF CHAMBER NOT To SCALE: 4 LA no, 29M 6'VIL OCTOBER 26,1999 O CENTERVILLE VILLAGE APPARTMENT REALTY TR. 44 SUNSET LANE OSTERVILLE,MASS. - S H EET 2 of 9 B 128 1�e P O'L'S t 082 20888.res 2—0-3--2 O_O 0=01,�0 O" 10 m IS RESTRICTION WHEREAS, RICHARD P. CALLAHAN, Trustee of the Centerville Village Apartments Realty Trust, under declaration of trust, dated July 8, 1993, recorded in Book 8688, Page 228, of 770A Main Street, Barnstable (Osterville), -Barnstable County, Massachusetts, is the owner of the real estate located at 44 Sunset Lane, Barnstable (Osterville), Barnstable County, Massachusetts (hereinafter referred to as "Premises"), and more particularly bounded and described on Exhibit "A" attached hereto; and WHEREAS, Richard P. Callahan, Trustee, as the owner of the premises has agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on the said premises as.a precondition to obtaining a variance from the Town of Barnstable Board of Health and to obtaining a building permit for this lot; and WHEREAS, the Town of Barnstable Board of Health, as a precondition to granting the variance from side line setbacks and authorizing the issuance of a building permit for the construction of a single family home on the premises requires that the agreement for the restriction on the number of bedrooms in any house constructed on the premises be put on record with the Barnstable County Registry of Deeds by recording this document. NOW, THEREFORE, Richard P. Callahan, Trustee, does hereby place the following restriction on the premises above-referred to in accordance with his agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: 1. The dwelling constructed on the premises may have no more than four (4) bedrooms. 20888.res This restriction shall continue in full force and effect until such time that the premises is connected to Town sewer or the construction of a residence with greater than four (4) bedrooms is allowed as of right, at which time this restriction will become null and void. For title Richard P. Callahan, Tru stee, see deed from Stuart H. Cammett, Jr., Administrator, dated September 27, 1999, recorded in Book 12572, Page 228. Executed as a sealed instrument this 5� day of February, 2000. r/"7 Ric and P. Callahan, Trustee COMMONWEALTH OF MASSACHUSETTS Barnstable, ss: February �, 2000 The personally appeared the above named Richard P. Callahan, Trustee, and acknowledged the foregoing to be his free act and deed, before me Albert J. Schu , Notary Public My commission expires: August 27, 2004 20888.exa EXHIBIT "A" The land, together with the buildings thereon, located at 44 Sunset Lane, Barnstable (Osterville), Barnstable County, Massachusetts, more particularly bounded and described as follows: Beginning at the southeast corner of the herein conveyed premises at the corner of a certain roadway and land granted to Fannie A. Robbins; thence running north 21 degrees 35' east by land of said Fannie A. Robbins, 98.3 feet to a.corner and land now or formerly of Edith Marion Crosby; thence north 81 degrees 30' west by land now or formerly of said Edith Marion Crosby, 50 feet to a corner; thence south 21 degrees 35' west still by land now or formerly of said Crosby, 98.3 feet to a thirty-foot right of way now or formerly of said Crosby; thence south 81 degrees.30' east by said right of way, 50 feet to the first mentioned.corner and place of beginning Together with a right of way to pass and repass over the above-mentioned roadway lying along the south side of the herein conveyed premises and extending westerly to Parker Road. So YARIANCL' Y N21.33'E -- LOT AP-SA \, LEACHING O.11 AC..=, I CHAMBLR +„ �--F D-dox ESQ oi 0. lot ' I M I O da V tn Existing 4 Bedroom ,—— 0 W/F Owslling T 1 jl SEPTIC \ TAN K \1 - -� EXIST, WATL'R It `o R6MOvE EX1sT. M6TMR PIT 1 LMAGH PIT 0 S8I.33'W \38 O PLAN VIEW Scale: I =20 Assessors Map 117 Maximum Feasible Compliance Parcel 114 Variance Required T L 5 T Hot_E M L, y O,0 1. 310CMR15.211(1):Minimum Setback Distances from property line 10(ten)feet required 4(four)feet provided. O LOAM Additional Conditions 3 2. Registered Land Surveyor to stake easterly lot line prior to installation of system. BRN• Co ARG E S AN q,S o M E 3. Deed restriction for 4(four)bedrooms must be recorded at the Registry of Deeds. E COBBLES lo`/R 513 Bt STRONG BRN C.OAR5E 17" GAND 7..7`lR. 5'/4, . 61 BRN�ISH YEL.COARSE SAND t p Y R G/6 eQ O i 39+ LT.%EI:ISH BRN COARSE CI SAND IoyR 6/y ��A ` LOB LT, YEL 15F1 BRN FINE NO.29M CZ SAND IOYtZ �/y CIVIL 120 f � 4 TLST HOLE gy SULLIVAN ENv.1NG• � O CT. 25 19 9 9 NO GROGND WATC-R. C� C eouupwACE2 �r�thht�© d� EL57 C-OA4 MDoe. mot P SITE PLAN PROPOSED SEPTIC UPGRADE AT 44 SUNSET LANE CISTERVILLE , MASS. FOR CENTERVILLE VILLAGE APARTMENT REALTY TR. REv+sont 01/27/00 ADDED VARIANCES SCALE: AS SHOWN DATE: 0CT. 26, 1999 SULLIVAN ENGINEERING INC. SHEET I Of 2 OSTERVILLE MA 99077 r }3 � NOTES DESIGN DATA I.Water Supply ForThis Lot is Municipal Water. Single Family-4 Bedroom 2 Location of Utilities Shown on This Plan Are Approx. With no Garbage Grinder At Leosf 72 Hours Prior to Any Excavation For This Daily Flow=110 x4=440 GPD Project The ContractorSholl Make The Required Septic Tank:440 GPD x 200%= 88 0 G PD Notification to Dig Safe(1-800-322-4844) Use 1500 Gallon Septic Tank I The Contractor is Required to Secure Appropriate LEACHING AREA Permits From Town Agencies For Construction ' 440 GPD/0.74=595 SF Required Defined by This Plan. 4 Install Risers as Required to Within 12 of BottomaArea=(112'x35'= 42 S.F. Finished Grade. 608 SY Total Provided 5.All StructuresBu'ried Fomr FeetorMore orSubject' LEACHING CHAMBER DESIGN to Vehicular Traffic lobe H-20 Loading. All Pipes to be Schedule 40. Use 6 Septic System to be Installed in Accordance With 4 7 509 Gal.Leaching Chambers ina 310 CMR 15.00 Latest Revision And The Townof 12x 35 Washed Stone Field as Shown Barnstable Board of Health Regulations Z Al I Piping to be Sch.40 PVC. _ m FG.40.0 3 u F.G.40.0 0 0 n 38.0 37.0 37.8 1500 Gallon 376 Top E1.38.0 ' Septic Tank - 37.4 Sot.E1.35.0 37.2 Bedding as Per Title 5 5'0 10 10.5' 10 10 12' Bottom of Test Hole E1.30.0 No Ground Water. DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Not to Scale Finish Grade Filter q Fabric �"—Compacted FIII— pea Stone Leaching Al Chamber 3/4"-1 1/2" Double WashW Stone 4-10OF I 12-0• , CROSS PMRIR�. SECTION OF CHAMBER � NOT TO SCALE. SULUVANIm. f OCTOBER 26,1999 CENTERVILLE VILLAGE APPARTMENT REALTY TR. 44 SUNSET LANE OSTERVILLE,MASS. SHEET 202 1 s Aid I \\ �, N'.W) 1 i - -�.. -- LW i b to Flo _, f . s i g • L r Btb elOA 1 I I i ! 1 i s, Tbmcvi i i \ j i I 1 4YSISTING FIRSr FLCO2 N8LJ TfiSILK ON ' /•1�a9 w IN Dou+S • Nf W S H ELT RACK \ I� m SENDER: I also wish to receive the o ■Complete items 1 and/or 2 for additional services. � following services(for an rn ■Complete items 3,4a,and 4b. �yy w ■Print your name and address on the reverse of ttfis form so that we can return this extra fee): card to you. d ■Attach this form to the front of the mailpiece,or on the back if space does not 1.❑ Addressee's Address 2 ■W permit.Write"Return Receipt Requested"on the mailpiece below the article number. 2.❑ Restricted Delivery 4) ■The Return Receipt will show to whom the article was delivered and the date delivered. Consult postmaster for fee. a 0 3.Article Addressed to: 4a.Article Number ZIA Cr fl, 4b.Service Type 3 c ` � ❑ Registered k Certified Cr y ❑ Express Mail ❑ Insured U [IReturn Receipt for Merchandise El COD w C7. Date of el v ry o Z I ®Q 0 o � pc 5.Received By:.(Print Name) 8.Addresse 's Address(Only if requested Y and fee is paid) W L � cc, 6.Sign ure: (Addressee orAgent) F' T i 1 `�•: ( i;F . %Ifii� Ii ii 1 if i 2 PS Form 3811,December 1994 102595-9e-13-0229 Domestic Return Receipt UNITED STATES POSTAL SERVICE Poi ^. First-Class Mail O �`" �-�-V Po ige&Fees Paid SPS w PM Permit No.G-10 O Print your A d,`ad&ess, and ZIP bode in this box O "30,0C` SULLIVAN ENGINEERING INC. P.O. BOX 659 7 PARKER ROAD ®STERVILLE, VIA 02655 i��tlsilil�til44}�}litll�tillill Sullivan Engineering Inc. .7 Parker Road Box 659 Osterville MA 02655 Peter Sullivan P.E . Mass. Registration No. 29733 Phone 508-428-3344 fax 508-428-3115 mail:PSull PE@aol.com ABUTTER NOTIFICATION LETTER RE: Board of Health Variance Request. . As a direct abutter of a proposed project, please be advised that a variance request has been filed with the Town of Barnstable Board of Health. The specific project information is as follows: Applicant Centerville Village Apartments Realty Trust Project Location 44 Sunset Lane, Osterville, MA Map 117 Parcel 1.14 Project Description The client is requesting a variance to the sideline. setback for repair/upgrade of a Septic System Applicant's Agent Peter Sullivan PE' Sullivan Engineering Inca P O Box 659/7 Parker Road Osterville, MA 02655 Public Hearing Barnstable Town Hall, Hyannis Please call for location of hearing Date: January 18, 2000 Time: . Meeting starts at 7:00 PM Plans and the application describing the proposed activity are on file at the Board of Health office (508) 862-4644, and at Peter Sullivan's office (508) 428-3344. Please call if you have any questions. If you wish to know the location and`a more definite• ' time for the hearing, please,call the.day ofwthe hearing. Thank.you. t.. • .arts`. . . -� ;�'-,,� TOWN OF BARNSTABLE CE?NE T� OFFICE OF m � i B�9T� i BOARD OF HEALTH eASIL op,e�1639. `� 367 MAIN STREET 'ea MAX�" HYANNIS, MASS.02601 February 1, 2000 Peter Sullivan, P.E. Sullivan Engineering P. O. Box 659 7 Parker Road Osterville, MA 02655 RE: 44 Sunset Lane, Osterville Dear Mr. Sullivan: You are granted a variance, on behalf of your client Centerville Village Apartments Realty Trust, from 310 CMR, 15.211 to place a soil absorption system only four feet from the property line. You are granted permission to construct an onsite sewage disposal system at 44 Sunset Lane, Osterville with the following conditions: (1) No more than four (4) bedrooms are authorized. Dens, study rooms, finished attics, sleeping lofts and similar-type rooms are considered "bedrooms" according to the Massachusetts Department of Environmental Protection. (2) A registered land surveyor shall place stakes at the property lines prior to construction of the septic system. (3) The designing engineer shall supervise the construction of the septic system and shall certify in writing to the Board that the system was installed in strict accordance with the submitted plans. The variance is granted because the existing failed septic system consisting of a deep leaching pit will be replaced with a system which meets all of the Board of Health Regulations and State Environmental Code provisions. Sincerely yours, fuan G. R a�ld, R.S. Chairperson Board of Health Town of Barnstable SGR/bcs sunset Z-203 499 027 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sent to Sire Number i Pidstg9ce,State,&ZIP C Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee LO Return Receipt Showing to Whom&Date Delivered a Return Receipt Showing to Whom, a Date,&Addressee's Address TOTAL Postage&Fees $ 0 Postmark or Date - � /)� y '99 Stick postage stamps to article to cover First-Class postage,certified mall fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service a window or hand it to your rural carrier(no extra charge). In 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the Q) return address of the article,date,detach,and retain the receipt,and mail the article. LO 3. If you want a return receipt,write the certified mail number and your name and address rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the O O addressee,endorse RESTRICTED DELIVERY on the front of the article. 5. Enter fees for the services requested in the appropriate spaces on the front of this E- receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. ri 6. Save this receipt and present it if you make an inquiry. t o25s5-s7-e-ot 45 a OpIME?, Town of Barnstable BARxST,AB Department of Health, Safety, and Environmental Services t""� 1639• Public Health Division 9� `m�' A'FD1A°�A P.O. Box 534,Hyannis MA 02601 Office: 508-8624644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health April 1, 1999 Stuart Cammett, Jr. 852 Bishop Road Gross Pt. Park, MI 48230 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410 00 STATE SANITARY CODE II MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE BOARD OF HEALTH NUISANCE CONTROL REGULATION NUMBER ONE The property owned by you located at 44 Sunset Lane, Osterville was inspected on March 30, 1999, by Jerry Dunning, Health Inspector for the Town of Barnstable, because of a complaint. The following violations of the Nuisance Control Regulation Number One Regulation and the Sanitary Code II were observed: 410.602: A large brush pile at rear of property, which has become a refuse for rodents, and observed by local people. Pile must be removed and bait area. You are directed to correct violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven(7) days after the date order is received. However, this violation must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. PER ORDER OF THE BOARD OF HEALTH Th as A. McKean Director of Public Health ca m mettAvp/q/Is PAR ] Real Estate System - General Property Inquiry] Help [ ] Parcel Id: 117 114- - Account No: 58626 Parent : Location: 44 SUNSET LANE OST Neighborhood: 27BC Fire Dist : CO Devel Lot : Lot Size : . 11 Acres Current Own: JONES, RUTH M State Class : 101 %CAMMETT, STUART H JR No. Bldgs : 1 Area: 962 852 BISHOP RD Year Added: GROSSE PT PARK MI 48230 Deed Date : Reference : January 1st : JONES, RUTH M Deed MMDD: 0000 Deed Ref : Comments : Values : Land: 51700 Buildings : 15700 Extra Features : Road System: 44 Index: 1565 (SUNSET LANE ) Frntg: 50 Index: ( ) Frntg: Control Info: Last Auto Upd: 082397 Status : C Last TACS Update : 081997 Land Reviewed By: Date : 0000 Bldgs Reviewed By: Date : 0000 Tax Title : Account : Taken: Account Status : Hold Status : Cancel [ ] Press XMT for more data Next screen [PAR ] Action [ ] Owners Name [ ] Road Index [ ] Road Name [ ] Parcel Number [117] [115] [ ] [ ] [ ] 0 /M :r NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE BOARD OF HEALTH NUISANCE CONTROL REGULATION NUMBER ONE The property owned by you located at W V ',5 L,-4qqA 1 ,u 0 /.111,iJG /Y1&,, was inspected on 3 -►3y- Cf?199Q, by N Health Inspector for the Town of Barnsta le, b cause of a complaint.. The following violations of the Nuisance Control Regulation Number One Regulation and the Sanitary Code H were observed: 16 !ao (w Alo CL You are directed to correct violations within �] of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven(7) days after the date order is received. However, this violation must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more o than $500. Each separate day's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health Health Complaints 30-Mar-99 Time: 11:24:36 AM Date: 3/30/99 Complaint Number: 1783 Referred To: JEROME DUNNING Taken By: LS Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: Business Name: Number: 44 Street: SUNSET LANE Village: OSTERVILLE Assessors Map-Parcel: Complaint Description: PILES OF BRUSH UP AGAINST THE HOUSE. THERE ARE RATS AND RACCOONS IN THE AREA. Actions Taken/Results: Investigation Date: 3-3o- IT Investigation Time: 1 7-7 `UNITERSTATES POSTAL SERVICE r- C-T Ifst-CPostac aius,'� Perm'Tit Nam.. o Print your name, dj�ess, a IP Code II Public Health Division Town of Barnstable P.O.Box 534 Hyannis,Massachusetts 02601 0SENDER: ■Complete items 1 and/or 2 for additional services. I also wish to receive the w -Complete items 3,4a,and 4b. following services(for an ` 4) ■cPrint a d too ou.ame and address on the reverse of this form so that we can return this extra fee): ■Atttacc this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address Z permit. ■Write'Retum Receipt Re uested'on the mail piece below the article number. d d a 4 p' 2. ❑ Restricted Delivery � « ■The Return Receipt will show to whom the article was delivered and the date .. delivered. Consult postmaster for fee. ° 3.Article Addressed to: 4a.Article Number d a► 7Z o?aj 4b.Service Type m � ❑ Registered Certified W um)W Y� ❑ Express Mail ❑ Insured A ❑ Return Receipt for Merchandise ❑ COD c 7.Date of Delivery z �j J " 0 5.Received By: (Print Name) 8.Addressee's Address(Only if requested '9 and fee is paid) t g 6.Signatu A dress nt) ~ PS FoA 3811, December 1994 102595-97-B-0179 Domestic Return Receipt r16 ROOM / DATE: /d?'G/'9�'J dp tHE� A ... . . DEC 3 1999 FEE:� • • TOWN U BARNSTW of BARNBTABIE, � HEAL EPT" '� f Barnstable REc. BY � 9� - Board of Health 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORM, ' LOCATION Property Address: ? �u hz�, l✓f ko-n 05fzri" V j Assessor's Map and Parcel Number: 1/ 7 1//y Size of Lot: • �� G C re Wetlands Within 300 Ft. Yes Subdivision Name: IV 0- No Business Name: APPLICANT CONTACTE ' Name: 0er)krv111e V,-I Q e- /TQd,/h/ Trusf Name: fifer' SU/ va r, P-0. 60A 6Sg 7 /Irzer- Address: 77019 /'na4n Sf 6Sfcrv)'/lc Address: GSfcrv�'/lam m,4- 0---)Z1s.5 Phone: �"O�- /�� �0 (0 Phone: .56F - 41.2,0- 33 yy FAX: 6-aj, - �i /9 7 FAX: VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) m FC : No a/-her v r2 h%m s 9-rea Va-4426/e 5etbAG/1s A 10ea-tc W. e 6ejo7C .5 Y5?-m Checklist(to be completed by office staff-person receiving variance request application) Four(4)copies of plan submitted(including septic system plans and/or restaurant floor plans) -,-"Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variances only) ` Variance request application fee collected[no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee only],outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Ralph A.Murphy,M.D. Qt/WP/VARIREQ # Sullivan Engineering Inc. 7 Parker Road Box 659 Osterville MA 02655 Peter Sullivan P.E . Mass. Registration No. 29733 Phone 508-428-3344 fax 508-428-3115 mail:PSUIPE@aol.com ABUTTER NOTIFICATION LETTER RE: Board of Health Variance Request As a direct abutter of a proposed project, please be advised that a variance request has been filed with the Town of Barnstable Board of Health. The specific project information is as follows: Applicant Centerville Village Apartments Realty Trust Project Location 44'Sunset Lane, Osterville, MA Map 117 Parcel 114 Project Description The client is requesting a variance to the sideline setback for repair/upgrade of a Septic System Applicant's Agent Peter Sullivan PE Sullivan Engineering Inc. P O Box 659f7 Parker Road Osterville, MA 02655 Public Hearing Barnstable Town Hall, Hyannis Please call for location of hearing Date: J an Ls a.r-y I F,a0QQ ! Time: Meeting starts at 7:00 PM Plans and the application describing the proposed activity are on file at the Board of Health office (508) 862-4644, and at Peter Sullivan's office (508) 428-3344. Please call if you have any questions. If you wish to know the location and a more definite time for the hearing, please call the day of the hearing. Thank you. Sullivan Engineering Inc. Box 659 Osterville MA 02655 Abutter Notification List of Direct Abutters of 44 Sunset Lane, Osterville, MA Map 117 Parcel 114 Map Parcel Owner 117 113 Cecil Hammond 48 Sunset Lane Osterville, MA 02655 117 115 Malcolm& Kathleen Horton 38 Sunset Lane Osterville, MA 02655 117 123 Mary J. Butler 33 Sunset Lane Osterville, MA 02655 117 179 Town of Barnstable (Municipal) 367 Main Street Hyannis, MA 02601 r Property Location: 44 SUNSET LN OST MAP ID: 117/114/// Vision ID:6890 Other ID: Bldg#: 1 Card 1 of 1 Print Date:11/03/1999 NS7WUCTI DE12111 __.-- emeni escnptton --Commercial Data ements Style ypeRanch Element Cd. i Description- Model Residential eat Grade D D Frame Type Baths/Plumbing Stories I Story Occupancy 0 eiling/Wall 10 1 ooms/Prtns Exterior Wall 1 4 Wood Shingle /o Common Wall 2 Wall Height Roof Structure 3 Gablefflip Roof Cover'` 3 sph/F Gls/Cmp Interior Wall 1 8 Typical 2 Element Gode Uescr7plion ractor Interior Floor 1 0 Typical Uomplex 2 Floor Adj 22 2 Unit Location Heating Fuel None Heating Type None umber of Units AC Type None. Number of Levels /o Ownership 1 10 a.. Bedrooms 4 Bedrooms Bathrooms I Bathroom ;_ 0 Full , na I.Base to 48.1111 Total Rooms RoomsSize Adj.Factor 1.31877 Bath Type Grade(Q)Index . .70 19. Adj.Base Rate 4.31UP b Kitchen Style Idg.Value New 2,848 i - Year Built 927 6. 6 ff.Year Built 1950 rml Physcl Dep 7 uncnl Obslnc on Obslnc peel.Cond.Code ? Coae escn t:on M Percentage pecl Cond% t juiu Single ram iuu Overall%Cond. 53 eprec.Bldg Value 22,700 "I",umvulzw Code n honnrts unitPrice" .... esc p r. DpMI %Cnd Apr. Value i h Lode escnptton LivingArea UrossAreal LJI.Area Unit Cost Undeprec. Value ` HAS First Floor , FOP Porch,Open,Finished 24 5 9.23 22 t ross Ztvlzease Area 961.6 Idg Val: , r Sry YARIAp1cE LOT A'R6 A \. I LEACHING O,11 AC 2, a Z I I CHAMBER S �--} D-oox ~ . g o 4 to \ i 1 I O V Eating 4 Bedroom \ —— G WF Dwelling T1j SEPTIC \ \, 4--tismova TANK199%ST,WATHR`o Exls'r. .. M6TMR PIT LMACH F%T 1 0 -- -- s Oil 3s'W 98.3' — 419 1 s ' o . PLAN VIEW Scale: 1 =20 Assessors Map 117 Parcel 114 TLST HOLE: r-L. 40,0 OT O LOAM E 6RN, COARSS SANQ,50M6 Co86LEs 10yR 5/3 P, BI STRONG BRN COARSE o'er •y 1 17" SAND 7,a`IR 5/4, : G i •G" F1 BRN�ISH YEL.COARSE Eain�'W .,z'r`" Bi SAND 1014R (6/6 c LT,y EL16H BRN COARSE . '' 4' CI SAND 10YR 6/y LO C LT, YE1:.151i BRN FINE 2 SAND IOYR(o/y 120 TB5T V40LE BY SULLIVAN EN4•ING OCT. 25 19 9 9 N4 GROLND WATErZ• �'e-��-►oWAS"Ert �►'C�MAR© Q,. ELS 7 � . eDM a>ww.l oi-�A��sS�F�vC-� 6&VJA,tCA— CDtiA f SITE PLAN PROPOSED SEPTIC UPGRADE AT 4.4 SUNSET LANE OSTERVILLE , MASS. FOR CENTERVILLE VILLAGE APARTMENT REALTY TR. SCALE: AS SHOWN r DATE:OCT. 26, 1999 SULLIVAN ENGINEERING INC. SHEET I Of 2- , OSTERVI LLE MA 99077 NOTES DESIGN DATA L Water Supply ForThis Lot is Municipal Water. Single Family-4 Bedroom 2 Location of Utilities Shown on This Plan Are Approx. With no Garbage Grinder At Least 72 Hours Prior to Any Excavation For This Daily Flow=110 x4=440 GPD Pro ect The ContractorShall Make The Required Septic Tank:440 GPD x 200/a 880 GPD Notification to Dig Safe(1-800-322-4844) Use 1500 Gallon Septic Tank 3 The Contractor is Required to Secure Appropriate LEACHING AREA Permits From Town Agencies For Construction ' 440 GPD/0.74=595 SF Required Defined byThis Plan. Sidewall =2(12'+35)2= 188 S.F. Install Risers as Required to Within 12 of Bottom Area= 12'x 35'= 420 S.F. 608 SF.Total Provided Finished Grade. LEACHING CHAMBER DESIGN 5.All Structures Bdried Four Feet or More or Subject Al I Pipes to be Schedule 40. Use to Vehicular Traffic lobe H-20 Loading. 4-509 Gal.Leaching Chambers ina 6 Septic System to be Installed in Accordance With 12'x 35 Washed Stone Field as Shown 310 CMR 15.00 Latest Revision And The Town of Barnstable Board of Health Regulations 7. Al I Piping to be Sch.40 PVC. a, 40.0F.G.40.0 U nU v' 'FG. 38.0 37.0 37.8 1500 Gallon 376 Top E1.38.0 Septic Tank r 37.4 ;:.. Sot.E1.35.0 37.2 . ., - Bedding as Per Tltle s 5.0 10� 10.5� 10` 10`. 12' Bottom of Test Hole E1.30.0_ No Ground Water. DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Not to Scale Finish OracleFilter , is Fabric �— Compacted Fill t"O �r '' Pea Stone $$ • �' ��� r � cTv1R Cl "• Leaching, 3/4"-1 I/2"' v Chamber a Double Washed r ° ` •s' v< 1 ftris 4—to: ) Li r 12'-0�� CROSS SECTION OF CHAMBER NOT TO SCALE. 4 i • OCTOBER 26,1999 CENTERVILLE VILLAGE APPARTMENT REALTY TR. 44 SUNSET LANE OSTERVILLE,MASS. SHEET 2 of 2 EXISTING FLOOR PLAN AT 44 SUNSET LANE, OSTERVILLE. < Y l l'X 15� KITC416N t BEDROOM G %5ATH BATH Io'x Zo' a 7 X 7' -7—7 meo Room LIVING ROOM BEDROOM► q'X301 ENCLOSE-0 PORCH Wx so, SECOND FLOOR t SCALE• V - '• F I RST FLOOR SCALE' ve I�1'ON ai SENDER: -Hsu-��Q� I also wish to receive the ■Complete items 1 and/ord for additional services. / 7'""'� following services(for an y ■Complete items 3,4a,and 4b. m ■Print your name and address on the reverse of t is form so that we can return this extra fee): card to you. N ■Attach this form to the front of the mailpiece,or on the back if space does not 1.❑ Addressees Address perm■Writ e"Return Receipt Requested"on the mailpiece below the article number. 2.❑ Restricted Delivery � t ■The Return Receipt will show to whom the article was delivered and the date U. delivered. Consult postmaster for fee. ° 0 3.Article Addressed to: 4a.Article Number ,'// y c 4b.Service Type uO ❑ Registered 21 Certified fn 3� ❑ Express Mail ❑ Insured uNi ❑ Return Receipt for Merchandise ❑ COD 0 7.Date of lie o �0 ° ° �5.Received By: (Print Name) 8.Address e's Address(Only if requested Y and fee is paid) 6.Sign ss a or &nt) i j a X iiii c j HH„, D i fi H PS Form 811,December 1994 102595-98-13-0229 Domestic Return Receipt Ml=p First-Class Mail UNITED STATES POSTAL SERVIC(c��,"' �� R______­-'P6s_1age&� 111 Fees Paid USP PM i. Pemit No.G-10 II 0 Print your h4A', 96bress, and ZIP Code in this box 0 r. ISULLIVAN ENGINEERING INC. I P.O. BOX 659 7 PARKER ROAD OSTERVILLE, MA 02655 I `t.�L'�.r� `�.7'�t'f�s.'�..)AYQ �{liti}lli�i.11l?lli�ii}2�tif1i111i1k911iiillilifli}�flit}�i.f11 a SENDER: 97L�iL I also wish to receive the ■Complete items 1 and/or 2 for additi al services. y y E� following services(for an y ■Complete items 3,4a,and 4b. (D ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. d ■Attach this form to the front of the mailpiece,or on the back if space does not 1.❑ Addressee's Address .•2 ipermit. 2.El Restricted Delivery m � ■Write"Return Receipt Requested"on the mailpiece below the article number. ry N r ■The Return Receipt will show to whom the article was delivered and the date delivered. Or1SU postmaster ostmaster for fee. a 0 3.Article Addressed to: 4a.Article Number 7 � �S�a -mot ,7 ,� / 9 c �}? �• 4b.Service Type G v ❑ Registered Certified cc ran ❑3� Express Cn cI ress Mail El W U�LoS l ❑ Return Receipt for Merchandise ElCOD 3 0 7. Date of eliv ry o ®d ofZ .5.Receive B : (Print Name 8.Addr ss 's Address(Only if requested Y f— and fee is paid) w t M 6.Signature: (Ad essee or Agent) ~ � kill i 1sift tt iil ;fjfyff if i it ( ►cl i flint( �t ; i ii f I� " PS Form 3811,becember 1994 102595-98-B-0229 Domestic Return Receipt 1 t-Clla-ss Mail UNITED STATES POSTAL SERVICr,,,,,P"41 to et�Tees�M rmit No. 10.. .. O Print your n e,adWe§' , and ZIP Code in this box-* fi SULLIVAN ENGINEERING INC. P.O. BOX 659 # 7 PARKER ROAD OSTERVILLE, MA 02655 ai SENDER: I also wish to receive the a ■Complete items 1 and/or 2 for additional servicet. ,J rn ■Complete items 3,4a,and 4b. 7 yi��tiu'n�� f0110W1n9 services(for an d ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. ■Attach this form to the front of the mailpiece,or on the back if space does not 1.❑ Addressee's Address •2 m permit. 2.❑ Restricted Delivery w � ■Write"Return Receipt Requested"on the mailpiece below the article number. ry N r ■The Return Receipt will show to whom the article was delivered and the date COnSUIt ostmaster for fee. delivered. p Q o 3.Article Addressed to: 4a.Article Number —/ 7 0 i 7 6 cc a 4b.Service Type + E ❑ Registered Certified V ❑ Express Mail ❑ Insured r W , oaf d J ❑ Return Receipt for Merchandise ❑ COD 3 o / 7. Date of Delive o Q / 7 0 m 5. Received By: (Print Name) S.Addressee's Address(Only if requested Y and fee is paid) w s 6.Signature: (Addressee or Agent) is oi,, Ij l 2 PS Form-"`3811,December 1994 - 102595-98-13-0229 Domestic Return Receipt UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid i USPS Permit No.G-10 • Print your name, address, and ZIP Code in this box • SULLIVAN ENGINEERING INC. P.O. BOX 659 7 PARKER ROAD OSTERVILLE, MA 02655 �J. ��I!!!!!Il1fliftlitltL�11!!!�!!I{itlF�ifl!isfils�fllt�Fslitfi�